Welcome to the Accin Mutua webseminar: Adaptation of EvidenceBased 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 QA
• For questions that arise during the 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_at_ucla.edu
• [phone] 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 interventions 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
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 (contd)

• 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 (contd)

• 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 (contd)

• Stakeholders
• Identify stakeholders
• Seek input
• Assess referral and collaboration possibilities
• Define accountability
• Identify competing programs

25
Phase 1 Assessment (contd)

• 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
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
POLs practice and engage in conversations
Self-efficacy to 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.d
  o
• Substance Abuse and Mental Health Services
  Administration (SAMHSA) National Registry of
  Evidence-based Programs and Practices (NREPP)
  available at http//modelprograms.samhsa.gov/templ
  ate.cfm?pagenreppover
• 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.h
  tm
• 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?pageli-07-1
2
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.w
ashington.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_at_apla.org