Recruiting and Engaging Participants: Culturally Appropriate Strategies

1. Recruiting and Engaging Participants: Culturally Appropriate Strategies Facilitated by: Rocco Cheng, Ph.D, Martha Madrid, and Kerrilyn Scott Prepared for: The SDFSC Grantees Ventura County February 25th, 2005 Prepared for the California Department of Alcohol and Drug Programs by the Center for Applied Research Solutions (CARS)

2. Overview I. Recruiting Participants • General Strategies Based on Research Findings • Proactive vs Reactive • Social Marketing Framework • Cultural Competence • Concrete Tips and Case Examples • Parents • Youth • Reflection Activity and Discussion (Lunch Break) II. Engaging and Retaining Participants • General Strategies Based on Research Findings • Concrete Tips and Case Examples • Parents • Youth • Reflection Activity and Discussion III. Next Steps/TA Areas

3. Workshop Goals • Provide overview of effective strategies for recruiting and retaining participants. • Identify current successes and challenges to recruitment and retention. • Facilitate group discussion and brainstorming of potential solutions. • Identify next steps

4. Getting to know you… • Each project introduces itself, naming individual participants and agencies they represent •Identify greatest program strength and greatest program challenge related to recruitment and retention 5

5. BARNGA… • Rocco introduces rules for playing BARNGA card game. •Group plays card game and briefly discussions interactions and learnings. 5

6. I. Recruitment—what does the research say? 3

7. Recruitment Frameworks Recruitment Frameworks • Proactive Versus Reactive Strategies • Social Marketing Approach

8. Recruitment Frameworks Proactive Vs. Reactive • Proactive Strategies • Actively seeking out potential participants • Presentations • Personal Contacts • Reactive Strategies • Passive program information dissemination • Radio announcements, flyers, newsletters • Call-in lines

9. Research Findings • Successful Recruitment of Minorities into Clinical Trials: The Kick It at Swope Project • Study Issue: ethnic minorities are often underrepresented in clinical trials and recruitment is challenging • A combination of proactive (in person appeals by study staff and health care professionals) and reactive (disseminating information that asked participants to contact a hotline) recruitment strategies were employed over 16 months

10. Research Findings • Kick It at Swope Findings: • Reactive recruitment strategies added to multiple proactive strategies were more effective, more efficient, and less costly than proactive recruitment alone. • Close monitoring combined with the use of multiple recruitment methods and flexible recruitment plans can lead to successful, efficient, and low-cost recruitment.

11. Research Findings • In general, the literature supports proactive approaches over reactive approaches when used alone. • However, a combination of approaches is generally recommended.

12. Social Marketing Approach Three Major Ways to Build Participation • Diversify Recruitment Approaches • For those disinclined to participate • Broaden Recruitment Approaches • For participants that are inclined to participate but don’t have the information • Deepen Recruitment Approaches • Utilization of current/previous participants for outreach

13. Building Participation • What’s the Message? • Diversifying Recruitment • Focus on What’s in it for Me? • Perceptual • Broadening Recruitment • What does the program have to offer? • Practical • Deepening Recruitment • Now What? • Experience

14. Alignment Among Goals, Target Populations, and Relevant Factors Building Participation

15. Personal beliefs about participation • Socio-demographic factors • Personality factors • Past experience • Socio-cultural factors Attitudes towards participation Intention/ decision to participate Reaction to experience Participation Perceptions of social norms toward participation Building Participation Participation Model Background Perceptual Practical Experience Diversify Broaden Deepen McCarthy, Jinnet

16. Importance of Recruitment and Retention Studies • Ease of recruitment is indicative of the feasibility of the program service design and the appeal of the intervention for potential participants. • High retention can be indicative of the utility of the design and desirability of the services. • Low participation can be evaluated to identify the degree of fit for the target community.

17. Importance of Cultural Competence • What is Culture? • “The body of learned beliefs, traditions, principles and guides for behavior that are commonly shared among members of a particular group. Culture serves as a road map for both perceiving and interacting with the world”.

18. Four Step Model Towards Cultural Competence • Learning about culture and important cultural components; • Learning about your own culture through a process of self-assessment that includes examining your culture’s assumptions and values and your perspectives on them; • Learning about the individual participants in your program; 4) Learning as much as possible about important aspects of their cultural backgrounds with a focus on ATOD-related issues.

19. I.B Concrete Tips and Case Examples 3

20. BEFORE Participants Enter the Program • The first impression and perception of the program and its staff may make or break the program • Where to find your target audience • How to represent your program • Who is it for and who else is there • Culturally and linguistically appropriate materials • What is your creditability: endorsement • What is it in for me/my children

21. First Impressions Can Make a Difference: Case Example • FNLM Findings: • Initial Connotation was almost always negative if proteges were informed about the program by the school counselor or principal • Initial connotation was typically positive if recruited by a favorite teacher or sent an invitational letter • Maintaining “voluntary” perception is important

22. BEFORE Participants Enter the Program • It is important to create a sense of comfort for participants to be associated w/ the program • Am I just another number to you? • Focus on personal needs and provide individualized care • Help participants understand the importance of associating w/ the program may get them what they need/want for themselves/children

23. Reaching Out to Families • Tip 1: Clearly communicate to parents in a language that they understand that the program values their participation and input. • This should be a clear and consistent message during all recruitment contacts. • Tip 2: Involve (and train) all program staff in creating an environment that makes parents feel welcome and respected.

24. Reaching Out to Families • Tip 3: Taking Care of Shame: Saving Face • Normalize the struggle participants go through • Address acculturation stress and losses • Identify examples of how others have gone through similar situations: use testimony • Help to provide a sense of hope • Stress the importance of and assurance of confidentiality • Reframe their struggles and efforts

25. Overcoming Negative Social Stigma • APCTC Mental Health Program Findings: • Paired with health booths at fairs • Extreme sensitivity in language utilized for brochures and flyers • Use of community (particularly faith-based) leaders • Use of community specific press-releases, news and radio advertisements, and newsletters—with an emphasis on alumni reports • Indirect recruitment through other family members

26. Reaching Out to Families • Tip 4: Location of Intervention • Staff should be familiar with community and target population “anchor” sites. (Local hang-outs, businesses or service providers frequently used by target population.) • When recruiting in the field staff should be able to identify well-known locale in relation to intervention site. (Across from Wal-Mart, in back of Casa Garcia Restaurant, corner of 3rd & Broadway) • All flyers or invitations should include user-friendly maps or explicit directions.

27. Reaching Out to Families • Tip 5: Program and Agency History • Agency/program history in the community and previous work with the target population is important. Know your agency’s history. Know what the community thinks and be prepared with “talking points”. • Poor experience, inconsistency or negative publicity can ruin a programs reputation. • Know who the gatekeepers are and establish working relationships with them, when possible incorporate them into your program, guest speakers, resources, field trips.

28. Reaching Out to Families • Tip 6: Personal contacts are extremely effective! (When the right tone and message is provided) • Flyers are probably the easiest, but not necessarily the most effective way to engage parents • Develop positive relationships and connections with parents.

29. Reaching Out to Families • Tip 7: If parents don’t come to you, go to them. • Identify community-based organizations, faith-based organizations, and/or other social service providers who have already developed positive relationships and trust with those in the target community. • Tip 8: Use a strengths-based, positive approach when working with parents.

30. Reaching Out to Families • Tip 9: Don’t be afraid to share power and solicit input from parents. • Tip 10: Have high expectations for participants!!! • They can be a valuable resource for the program and the community.

31. Reaching Out to Families • Tip 11: One recruitment method is not enough • Utilize multiple referral sources • Utilize multiple mediums (i.e. flyers, personal contacts, newsletters, public advertisements) • Utilize a combination of pro-active and reactive strategies

32. Reaching Out to Families • Tip 12: Utilize people who are enthusiastic, believe in the program, and can “sell” the program. • In many cases these may be other participants • Tip 13: Use of appropriate language(s) • Invest and allocate appropriate resources for translation of all recruitment materials and of hiring appropriate bi-lingual (in some cases tri-lingual staff). • Tip 14: Utilization of appropriate screening instruments

33. Reaching Out to Families • Tip 15: (Prinz et al): • Provide some elements of familiarity by linking the contact to institutions or individuals known to the potential participants. • Any subsequent contacts should reference the initial contact to make it easier for the participant. • The initial contact should be flexible, casual, and positive.

34. Reaching Out to Families • “Program administrators, teachers, and other program staff can effectively recruit participants by understanding the goals and objectives of the program and communicating with them in simple and direct ways so that participants understand what they will gain through their participation”.

35. Other Cultural Considerations • Sometimes cultural differences can lead to discomfort in participation. • For example, it takes time for immigrant parents to understand their rights and responsibilities in a system that is new to them. • May view program staff (particularly if associated with the school) as authority figures • Invitations to the program (school) can be seen as a sign of respect

36. Other Cultural Considerations • Some parents may be hesitant to participate due to their undocumented status or perception of anti-immigrant sentiments in the community. • In other cultures, parents may bring their younger children with them when they volunteer at school, when they come to parent meetings, and/or during other school events. • The provision of child care should be considered from the beginning of the recruitment process

37. Other Cultural Considerations • Food can be seen as an integral part of celebration/group activities and expected to be shared with everyone participating. • Gender roles can be more clearly defined. • Traditionally with mothers having more involvement in issues concerning education/programs for children.

38. Other Cultural Considerations • Extended family members may be integrated in the decision process for joining the program. • Be open to other family members (e.g. Grandparents, Aunts) being a part of the recruitment process and be sensitive to their role in the family.

39. Questions To Consider • What expressions, gestures and body language commonly accompany communication? Is eye contact considered polite or rude? Is usual tone of voice soft or loud? How close do people stand next to each other when speaking? Is touching acceptable? • Do all members of the family have the same right to speak? Do some members have fewer rights? Are there gender differences? Do children speak freely or are they reserved?

40. Questions to Consider • Is the family structure nuclear or extended? If extended, who is considered a member of the family? Do family members have to be living in the household? • Who has authority in the home? • Who has decision making roles? • Are family members expected to be involved in other family members’ decisions?

41. Using Community Connections • La Frontera Center: • Use of community members from each of target populations (Russian, Serbo-Croatian, Central American) • Arizona Mexico Border Health Foundation: • Promotora Model • Asian Pacific Counseling and Treatment Center: • Use of community leaders

42. In Summary • Building participation can involve different tactics for different populations • Understand target audience motivations and barriers • Understand where target audience is in the decision-making process to participate • Two way street re: information process • Get to know community – strengths and weaknesses • Explore collaborative relationships and establishment of formal referral partnerships

43. Reflection Activity

44. ASK THE WIZARDS • Discuss with your group a particularly challenging circumstance that you’ve experienced. • As a group, select one of these challenging situations (choose one that is rich in information) & have a messenger (the person whose “case” was selected) present the case to another table. • The messenger explains the challenging situation. • Using what we’ve learned today, discuss possible solutions to this challenging situation. • The messenger then returns to his/her Home Group & presents the Case Wizards’ solutions.

45. II. Engaging and Retaining participants—what does the research say? 3

46. Research Identified Family Support Principles 1. Staff and families work together in relationships based on equality and respect. 2. Staff enhance families’ capacity to support the growth and development of all family members: adults, youth and children 3. Families are resources to their own members, to other families, to programs, and to communities. 4. Programs affirm and strengthen families, cultural, racial, and linguistic identities and enhance their ability to function in a multicultural society.

47. Research Identified Family Support Principles 5. Programs are embedded in their communities and contribute to the community-building process. 6. Program advocates with families for services and systems that are fair, responsive, and accountable to the families served. 7. Practitioners work with families to mobilize formal and informal resources to support family development. 8. Programs are flexible and continually responsive to emerging family and community issues. 9. Principles of family support are modeled in all program activities, including planning, governance, and administration.

48. II.B Concrete Tips and Case Examples 3

49. Involve Parents and Family Members • Participants may show up w/ their parents/children and/or friends • Find out the key decision makers in the family and engage him/her • Respect family hierarchy • Address to the parents directly even when translation is needed • Get the buy-ins from parents/family members so they can be your ally

50. Help Participants Develop a Strong Sense of Program Identity • Get a good name for the program • Make the space comfortable and culturally relevant • Create program banners, logos, uniform/t-shirts, buttons