CDCs Diffusion of Effective Behavioral Intervention DEBI Program and National Research Translation E

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CDCs Diffusion of Effective Behavioral
Intervention (DEBI) Program and National Research
Translation Efforts

• Alice Gandelman, MPH
• California STD/HIV Prevention Training Center (CA
  PTC)

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Evolution of DEBI as a National Diffusion Effort,
Pre-AHP

• Studies conducted by researchers, published in
  peer-review journals
• some received additional funds through
• CDC REP project
• CDC DEBI project
• little national momentum for formal adoption and
  implementation

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Evolution of DEBI as a National Diffusion Effort,
Post-AHP

• Increased formal/national emphasis
• Viewed by CDC as moving HIV prevention field
  forward
• Viable way to continue HIV prevention funding to
  CBOs
• Endorsed science, or evidence-based approaches
  to implementing HIV prevention programs

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DEBI Evolution, cont.

• 2003/04, directly-funded CBOs required to
  implement one or more DEBIs (150 agencies)
• Required to attend formal training on funded DEBI
  intervention(s) (via PTCs)
• Technical assistance available through federally
  funded resources
• CBAs
• BSSVs
• Not required for state/local health departments,
  but evidence-based approach encouraged

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www.stdhivpreventiontraining.org
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Prevention Training Centers and DEBI Training
Charge

• Behavioral Intervention Training Centers part of
  the National Network of Prevention Training
  Centers (NNPTC) -
• California (Oakland)
• Colorado (Denver)
• Texas (Dallas)
• New York (Rochester)

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DEBI Trainings Offered by PTCs

• Individual-Level (ILI)
• RESPECT (fall 2005)
• CLEAR PCM (fall 2006)
• Group-Level (GLI)
• Healthy Relationships
• VOICES/VOCES
• Many Men Many Voices

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DEBI Trainings Offered by PTCs, cont.

• Community-Level (CLI)
• Community PROMISE
• Mpowerment (via S. Kegeles CAPS)
• DEBI courses offered by CBAs
• SISTA
• Safety Counts
• VOICES/VOCES

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DEBI Implementation Challenges

• Based on rigorously evaluated research
• Known efficacy in research setting
• First major effort to implement evidence-based
  approach in HIV prevention nationally
• Research studies difficult to replicate in
  community settings
• New challenges in real-world settings

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Friend or Foe? DEBI Terminology and Impact on
Implementation

• Effective implementation of DEBI requires
  adherence to the intention and integrity of the
  intervention related to
• Core Elements
• Key Characteristics
• Fidelity
• Adaptation
• Reinvention

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Core Elements

• Required elements that represent the intent,
  theory, and internal logic of the intervention
  and most likely produce the interventions main
  effects.
• Identified by researchers through study
  implementation
• Must be implemented with integrity and fidelity
  to increase the likelihood that prevention
  providers will have program outcomes that are
  similar to those in the original research.

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Key Characteristics

• The interventions recommended activities and
  delivery methods.
• May be modified to fit the risk behaviors and
  influencing factors of the target population and
  the unique circumstances of the agency and other
  stakeholders.
• Modification should not compete with or
  contradict the intent, theory, and internal logic
  of the intervention.

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Adaptation

• Process of modifying key characteristics of an
  intervention without competing with or
  contradicting the core elements.
• Key characteristics are adapted to fit the risk
  behaviors and influencing factors of the target
  population and the unique circumstances of the
  agency and other stakeholders.

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Fidelity and Reinvention

• Fidelity conducting an intervention by
  following exactly the core elements, procedures,
  and content that determined its effectiveness.
• Reinvention - Reinvention is a modification that
  competes with or contradicts the core elements of
  an intervention. Therefore, the findings of the
  original intervention do not apply, and the new
  intervention should be renamed and re-evaluated.

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Challenges at the Practice LevelEfficacy vs.
Effectiveness

• (Research) Efficacy
• Effective outcomes in research
• (Program) Effectiveness
• Successful implementation and outcomes at program
  level
• Evidence-based approaches based on successes in
  controlled research settings, not every day
  realities of CBOs and local health departments

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Challenges at the Practice LevelEfficacy vs.
Effectiveness, Cont.

• Diffusion process opening up Pandoras Box of
  issues
• Basic skills
• Resources
• Allowable adaptations
• Evaluation of adapted intervention

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The New Science of Research Translation Many
questions, Fewer Answers

• Very Exciting (equally chaotic!)
• What happens when agencies do not adhere to core
  elements?
• Do agencies know how to effectively make
  allowable changes?
• How will they know if their adaptations are
  successful (evaluation)?

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DEBI Adaptations at Agency Level Both Science
and Art

• New PTC course Adapting EvidenceBased
  Interventions
• Objectives
• Understand DEBI terminology
• Conduct/utilize information from community
  assessment process
• Specifically defined target population
• Risk behaviors
• Factors influencing risk behaviors

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Addressing DEBI Adaptations at Agency Level, cont.

• Course objectives, cont.
• Develop plan for allowable adaptations, based on
  agency capacity
• Understand difference in pre-testing and piloting
  and relevance in adaptation process
• Become familiar with basic evaluation terminology
• Learn about technical assistance resources

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Available Trainings

• DEBI trainings
• AED
• PTCS
• Skills-based courses at CA PTC
• Risk Reduction/Client-Centered Counseling
• Small-Group Facilitation
• Bridging Theory and Practice
• Program Planning and Evaluation
• Assessment Methods

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How to Request Trainings

• DEBI trainings
• www.effectiveinterventions.org
• CA PTC trainings (DEBI and others)
• www.stdhivtraining.org
• California STD/HIV Prevention Training Center (CA
  PTC)
• 300 Frank H. Ogawa Plaza, Suite 520
• Oakland CA, 94612
• [phone]