Welcome to the Acci ó n Mutua web-seminar: Adaptation of Evidence-Based Interventions: An Overview

1. Welcome to the Acción Mutua web-seminar: Adaptation of Evidence-Based Interventions: An Overview Before we begin, a little about our format… • Presentation by seminar speakers (approx. 45 min.) • Followed by question and answer session (approx. 15 min.) **************************************************** • Please press *6 on your telephone keypad to mute your line (to un-mute your line, press *6 again) • If you are experiencing difficulty with your phone connection, dial *0 for the conferencing service operator • Questions submitted prior to the web seminar will be addressed first during the Q&A • For questions that arise duringthe presentation, click on the “hand” button and type your question or wait to be called on to ask your question over the phone

2. Acción Mutua is a capacity building assistance (CBA) program of AIDS Project Los Angeles in collaboration with the César E. Chávez Institute of San Francisco State University Funded by the Centers for Disease Control and Prevention

3. Adaptation of Evidence-Based Interventions: An Overview Rosemary Veniegas, Ph.D. Associate Director – Intervention Core, Center for HIV Identification, Prevention and Treatment Services & Behavioral Social Science Volunteer, American Psychological Association Contact information veniegas@ucla.edu (310) 794-0619 ext. 224.

4. Overview • National context • Key Concepts and Terms • The Adaptation Process • Guidance & Lessons Learned • Resources for Capacity Building Assistance (CBA) and Technical Assistance (TA)

5. National Context • Infectious Diseases • CDC – DEBIs (Diffusion of Effective Behavioral Interventions) • Substance Abuse, Mental Health • NIDA – ATTN (Addiction Technology Transfer Network) • SAMHSA – NREPP (National Registry of Evidence-based Programs and Practices) • Health Care/Services • AHRQ – PPIP (Put Prevention Into Practice) • NCI – RTIPS (Research Tested Intervention Programs)

6. CDC DEBI Websitewww.effectiveinterventions.org • SAMHSA NREPP website • www.modelprograms.samhsa.gov

7. Key Concepts and Terms • Evidence-based intervention • Adaptation & reinvention • Core elements and key characteristics • Fidelity • Technology transfer and exchange

8. What is Evidence-Based? (CDC 2003, 2006, 2007) • Evidence-based interventions (EBIs) have undergone scientific evaluation and been proven to be efficacious or effective. • Other characteristics can include: • Theoretically based • Specified core elements • Developed by and for target population • Addresses community needs • Effective in changing behaviors • Sustainable over time • Homegrown interventions can be EBIs too! • Popular Opinion Leader, an EBI

9. Popular Opinion Leader(Kelly et al., 1991, 2004) • Core elements • Directed to identifiable target population, well-defined community venues, population size • Use of ethnographic techniques to identify popular, well-liked, trusted individuals • 15% of target population trained as POLs • Teaching POL skills for effective behavior change communication • Weekly POL meetings to refine skills monitor conversational outcomes • Goal setting for conversations • Review, discuss, reinforce conversation outcomes • Use of logos/symbols as conversation starters

10. Popular Opinion Leader(Kelly et al., 1991, 2004) • Key characteristics • Elicit involvement of gatekeepers • Identify social networks in target population • Use key informants to identify opinion leaders from social networks • Train opinion leaders • Seek agreements to have conversations • Place posters at venues, give POLs logo items to wear • Recruit successive POLs, train • Hold reunion meetings for POLs

11. What is Adaptation? (McKleroy et al., 2006) • Modifying key characteristics, activities, delivery methods without competing or contradicting core elements, theory or internal logic of the intervention • Necessary to ensure relevance in local settings, with new populations, or comply with funder • Check with your funder about what they consider appropriate adaptation

12. Reinvention (CDC, 2006) • Form of adaptation • Necessary for new populations/settings • Core elements have been modified (i.e., adding or dropping) • CDC recommends • Renaming intervention • Formally evaluating prevention outcomes • Ensuring behavioral outcomes were achieved

13. What are Core Elements?(CDC, 2003, 2006) • Critical elements believed to be responsible for EBIs effectiveness • Required elements that represent the theory and internal logic of the intervention and most likely produce the intervention’s main effects • Must be implemented with fidelity to increase the likelihood that prevention providers will have program outcomes that are similar to those in the original research • Cannot be ignored, added to, or changed

14. What are Key Characteristics? (CDC 2003, 2006) • Crucial activities and delivery methods for conducting an intervention • CAN be adapted to meet the needs of target population and ensure cultural appropriateness

15. What is Fidelity? (CDC, 2005) • Part of quality assurance • Implementing or adapting an intervention that adheres to the core elements and internal logic of the intervention • Maintaining the core elements, protocols, procedures, and content that made the original intervention effective • Keeping the “signature” of the intervention (Miller, 2007)

16. Why does fidelity matter?(Dusenbury et al., 2003) • Adherence • Was intervention delivered as planned? • Dose • What sessions of the intervention were dropped? Shortened? Added? • Quality of delivery • How skilled were facilitators in conducting intervention activities? • Participant responsiveness • How did consumers respond to the intervention?

17. Why Adapt & Implement EBIs? • EBIs not yet developed for target population (e.g., transgenders) • Content may be outdated (e.g., “HIV virus”, videos need to be updated) • New risk factors or behaviors are identified (e.g., crystal/methamphetamine) • New intervention policies apply (e.g., Advancing HIV Prevention, Prevention with HIV positive people)

18. Adaptation and Reinvention • Adaptation • POL for Latino young migrant men (Somerville et al. 2006) • Expanded POL training on HIV and STDs • Communication style module changed to be more culturally appropriate, non-linear • Inclusion of referral making in conversations • Reinvention • May be necessary because of new target population or setting • POL delivered without additional POL training or monitoring of conversations (Kelly, 2004)

19. Technology Transfer & Exchange • Transfer (CDC to CBOs) • Translation, dissemination, acquisition of information about interventions (Kraft et al., 2000) • Exchange (CBOs to CDC, researchers, community planning groups) • Communication of barriers/facilitators experienced in practice, to improve intervention effectiveness (Gandelman et al., 2005) • Transfer and exchange are necessary to adaptation

20. Target population • Interventions • Goodness of fit • Stakeholders • Organizational capacity Assess • Decide to adopt, adapt, or select another intervention • Make necessary changes to EBI Select Prepare • Prepare agency • Pre-test materials • Implementation plan • Successful pilot of adapted intervention Pilot Implement • Implement adapted EBI Overview (Adapted from McKleroy et al., 2006)

21. Step 1: Assess • Target population • Identify target population • Understand risk factors, behavioral determinants, risk behaviors, epidemiological trends, social norms • Choose risk factors to target • Identify where, when, how to reach target population

22. Step 1: Assess (cont’d) • Interventions • Identify and review possible EBIs • Review content of EBIs • Identify risk factors, behavioral determinants and risk behaviors • Identify core elements and key characteristics • Access cost and resources needed • Talk with other agencies

23. Step 1: Assess (cont’d) • Goodness of fit • Match between risk factors, behavioral determinants, and risk behaviors in EBI and those of target population • Short list of EBIs • Identify areas needed for EBI adaptation • Identify areas for agency capacity building

24. Step 1: Assess (cont’d) • Stakeholders • Identify stakeholders • Seek input • Assess referral and collaboration possibilities • Define accountability • Identify competing programs

25. Phase 1: Assessment (cont’d) • Organizational capacity • Resources or experience • Physical • Financial • Access • Values/mission • Staff/human resources • Cultural competence • EBI • Evaluation • Accountability

26. Step 2: Select • Decide to adopt, adapt, or select another intervention • Build capacity on EBI and for implementation • Consult with stakeholders • Consult with staff

27. Step 2: Select • Make necessary changes to EBI (adaptation) • Decide what changes are needed • Seek guidance or technical assistance • Develop timeline and logic model • A logic model describes the relationships among risk factors/determinants, intervention activities and desired outcomes • Track changes made

28. Teach POLs conversation elements  confidence to be able to engage in behavior risk behavior in target community POL Logic Model Risk determinants Intervention Activities Outcomes Teach POLs the intervention rationale Knowledge of effective communication  perception of behavior norms Attitudes/norms for engaging in conversations Self-efficacy to engage in conversations POLs practice and engage in conversations Adapted from CDC POL Logic Model

29. Step 3: Prepare • Prepare organization • Recruit/train staff and volunteers • Assign responsibilities • Handle logistics • Confirm referrals and collaborations • Pre-test adapted EBI • With stakeholders • With members of target population

30. Step 4 : Pilot • Plan for implementing EBI • Agency policies for adapted EBI • Referral networks • Roles and responsibilities • Timeline

31. Step 4 : Pilot • Gauge success of pilot • Success: move to next step • Failure: review, revise, re-pilot • Fidelity • Adherence • Dose • Quality • Participant response

32. Step 5 : Implement • Implement adapted EBI • Collect process data • Conduct process monitoring and evaluation • Collect intervention outcome data • Make small changes based on process evaluation • Use available technical assistance

33. Guidance & Guidelines CDC-specific information on EBIs • Provisional Procedural Guidance for Community-Based Organizations – Revised April 2006 • CDC Letter to CBOs June 2006 • AIDS Education and Prevention Supplement August 2006 (journal)

34. Guidance & Guidelines Other EBIs-related information • Research Tested Intervention Programs (RTIPS) available at http://rtips.cancer.gov/rtips/index.do • Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP) available at http://modelprograms.samhsa.gov/template.cfm?page=nreppover • Cochrane Health Promotion and Public Health Field review and protocols available at http://www.cochrane.org/reviews/en/ • The Guide to Clinical Preventive Services available at http://www.ahrq.gov/clinic/uspstfix.htm • National Guideline Clearinghouse available at www.guideline.gov/ • Center for Information Dissemination and Education Resources (CIDER) available at http://www.cider.research.va.gov/products.cfm

35. Resources for CBA & TA • Centers for Disease Control and Prevention • Community Planning Groups • Health Departments • Behavioral & Social Science Volunteer Program • STD/HIV Prevention Training Centers • HIV Prevention Research Centers

36. CDC http://0-www.cdc.gov.mill1.sjlibrary.org/hiv/topics/cba/cba.htm

37. Community Planning Groups CDC guidance www.cdc.gov/hiv/pubs/hiv-cp.htm

38. Community Planning Groups List of CPGs http://hivinsite.ucsf.edu/InSite?page=li-07-12

39. Health Departments/UCHAPS http://www.aidsaction.org/uchaps/

40. BSSV Website http://www.apa.org/pi/aids/bssv.html

41. STD/HIV Prevention Training Centers http://depts.washington.edu/nnptc/

42. HIV Prevention Research Centers • Columbia University HIV Center for Clinical and Behavioral Studies • www.hivcenternyc.org • Yale University Center for Interdisciplinary Research on AIDS • http://cira.med.yale.edu • Medical College of Wisconsin Center for AIDS Intervention Research • www.mcw.edu • UCLA Center for HIV Identification, Prevention and Treatment Services • http://chipts.ucla.edu/ • UCSD HIV Neurobehavioral Research Center • http://www.hnrc.ucsd.edu/ • UCSF Center for AIDS Prevention Studies • http://www.caps.ucsf.edu/

43. Thanks go to • Acción Mutua • George Ayala, Psy.D. APLA, GMHC • BSSV/APA • Uyen Kao, MPH • AJ King, MPH, CA STD/HIV Prevention Training Center For more information or to learn how to receive CBA services, contact us at: 213.201.1312 crodriguez@apla.org