An Evaluation Model to promote linkages between community-based public health practice and academia

Joseph Telfair, DrPH, MSW/MPH and Beverly Mulvihill, PhD Department of Maternal and Child Health School of Public Health University of Alabama at Birmingham

Outline Description of Integrated Model of Community- Based Evaluation model (IMCBE) Description of Integrated Model of Community- Based Evaluation model (IMCBE) Case Example: An overview of the community- based perinatal initiative (CPI) - primary purposes, focus and components and use of the IMCBE, including rationale, purpose and approach used in applying the IMCBE to the evaluation of the CPIs Case Example: An overview of the community- based perinatal initiative (CPI) - primary purposes, focus and components and use of the IMCBE, including rationale, purpose and approach used in applying the IMCBE to the evaluation of the CPIs Lessons learned and future strategies Lessons learned and future strategies

The Integrated Model of Community-based Evaluation IMCBE developed and utilized successfully in evaluating community- based health services programs IMCBE developed and utilized successfully in evaluating community- based health services programs Emphasis on collaboration and participation Emphasis on collaboration and participation Participants define the problem indicators to be assessed and have a part in the design of the assessment process Participants define the problem indicators to be assessed and have a part in the design of the assessment process

The Integrated Model of Community-Based Evaluation BASIC CHARACTERISTICS Flexibility Flexibility Adaptability Adaptability Longitudinality Longitudinality Comprehensiveness Comprehensiveness

FOUNDATIONAL PRINCIPLES Services are evaluated at the level of administration Services are evaluated at the level of administration Orientation of the service guides the evaluation Orientation of the service guides the evaluation Participants and providers are full partners in the evaluation process Participants and providers are full partners in the evaluation process The Integrated Model of Community-Based Evaluation

Assessment of Pre-Existing Conditions Planning & Decision making Implementation and Action Data Review, Analysis and Interpretation Report Development and Utilization EVALUATOR SKILLS TEMPERAMENT STAKEHOLDER FUNDING BUY-IN FLEXIBLE ADAPTABLE LONGITUDINAL COMPREHENSIVE IMPLEMENTATION PREREQUISITES CHARACTERISTICS PHASES OUTCOMES INTEGRATED MODEL OF COMMUNITY-BASED EVALUATION (IMCBE) Evaluate service at the level(s) it is administered/provided. Underlying orientation of service delivery guides the evaluation process Participants and providers are partners in the evaluation process FOUNDATIONAL PRINCIPLES INDIVIDUAL PROGRAM/AGENCY LOCAL COMMUNITY STATE OR NATIONAL ©Source: J. Telfair, Graphical Representation of the Integrated Model of Community-based Evaluation

CASE EXAMPLE Alabama Perinatal Program’s Community-Based Initiative Projects and the IMCBE

BACKGROUND Alabama’s infant mortality rate is the lowest in state record -9.5 (579) infant deaths per 1,000 live births, but still ranks among the highest rates in the nation (>20 % higher than the U. S. rate of 7.1 deaths per 1,000 live births in 1997) Alabama’s infant mortality rate is the lowest in state record -9.5 (579) infant deaths per 1,000 live births, but still ranks among the highest rates in the nation (>20 % higher than the U. S. rate of 7.1 deaths per 1,000 live births in 1997) The community-based Perinatal Grant initiatives represent efforts by Alabama to decrease perinatal and maternal mortality/ morbidity and child handicapping conditions through community initiatives The community-based Perinatal Grant initiatives represent efforts by Alabama to decrease perinatal and maternal mortality/ morbidity and child handicapping conditions through community initiatives

DESCRIPTION OF THE ALABAMA PERINATAL PROGRAM In 1980 legislature approved the Alabama Perinatal Act which established the Alabama Perinatal Prog (APP) under the direction of the State Board of Health and the State Perinatal Advisory Com (SPAC) which represents 5 Perinatal Regional Committees (RPACs) In 1980 legislature approved the Alabama Perinatal Act which established the Alabama Perinatal Prog (APP) under the direction of the State Board of Health and the State Perinatal Advisory Com (SPAC) which represents 5 Perinatal Regional Committees (RPACs) The purpose of the APP is to identify, recommend and support strategies to effectively decrease infant mortality and morbidity in Alabama The purpose of the APP is to identify, recommend and support strategies to effectively decrease infant mortality and morbidity in Alabama Between 1980 and 1995 the focus, structure and funding for the APP’s initiatives varied Between 1980 and 1995 the focus, structure and funding for the APP’s initiatives varied

DESCRIPTION OF APP COMMUNITY-BASED INITIATIVES (CPI) The purpose of CPI grant funds are to encourage innovative community-based projects designed to improve the health status of Alabama’s pregnant women and infants up to one year of age The purpose of CPI grant funds are to encourage innovative community-based projects designed to improve the health status of Alabama’s pregnant women and infants up to one year of age The 2000 CPI projects were in the following areas: The 2000 CPI projects were in the following areas: Family Support and Resource (FSP) Projects Family Support and Resource (FSP) Projects Transportation and Medication Support (TMS) Projects Transportation and Medication Support (TMS) Projects

METHODS Recognizing the importance of gathering and assessing valid and reliable data on perinatal programs, where possible, questions based on previously tested and standardized instruments were used Recognizing the importance of gathering and assessing valid and reliable data on perinatal programs, where possible, questions based on previously tested and standardized instruments were used CPI Staff had input into and helped revise data collection instruments to capture salient information on high-risk pregnant women and other health disparities CPI Staff had input into and helped revise data collection instruments to capture salient information on high-risk pregnant women and other health disparities All client and program level instruments were pilot tested and instruments designed specifically for this project were peer reviewed using a three round Delphi methodology prior to implementation All client and program level instruments were pilot tested and instruments designed specifically for this project were peer reviewed using a three round Delphi methodology prior to implementation

METHODS Data Collection Instruments Program Questionnaire Program Questionnaire Semi-Annual Client Satisfaction Report Form Semi-Annual Client Satisfaction Report Form Psycho-Social Risk Factor Assessment Sheet Psycho-Social Risk Factor Assessment Sheet Semi-Annual Support and Resource Service/Home Visit Report Semi-Annual Support and Resource Service/Home Visit Report Medication Data Information Sheet Medication Data Information Sheet Transportation Data Information Sheet Transportation Data Information Sheet Quantitative & qualitative analyses were used to provide meaningful interpretation of the collected data Quantitative & qualitative analyses were used to provide meaningful interpretation of the collected data

IMCBE and APP COMMUNITY- BASED INITIATIVE Interaction between the community-based programs (at statewide sites) and UAB (academic collaborator) was redefined from an expert-client relationship to a true partnership Interaction between the community-based programs (at statewide sites) and UAB (academic collaborator) was redefined from an expert-client relationship to a true partnership Work milieu was refocused to create mutual respect for the knowledge and experience of all participants (health practitioners, intake personnel, and perinatal care recipients, and researchers) and to build trust among them Work milieu was refocused to create mutual respect for the knowledge and experience of all participants (health practitioners, intake personnel, and perinatal care recipients, and researchers) and to build trust among them

IMCBE AND APP COMMUNITY- BASED INITIATIVE Scope and objectives for the work were defined by those involved and key components of community and university agendas were acknowledged and incorporated into the process and the product of the evaluation partnership Scope and objectives for the work were defined by those involved and key components of community and university agendas were acknowledged and incorporated into the process and the product of the evaluation partnership

PRACTICAL ADVANTAGES OF IMCBE TO PROMOTE LINKAGES Characteristics of IMCBE and principles that included full participation reduce barriers between public health practice community, the underserved community, and academia Characteristics of IMCBE and principles that included full participation reduce barriers between public health practice community, the underserved community, and academia Improved interaction and trust will develop from the application of the IMCBE in promoting linkages between the community and academia Improved interaction and trust will develop from the application of the IMCBE in promoting linkages between the community and academia

Creates a true community-oriented, culturally competent approach to partnerships and evaluation Creates a true community-oriented, culturally competent approach to partnerships and evaluation PRACTICAL ADVANTAGES OF IMCBE TO PROMOTE LINKAGES

Lessons Learned and Future Strategies Use of the IMCBE approach in promoting linkages between community and academia may provide policy-makers important information about the efficacy of programs in many areas: Use of the IMCBE approach in promoting linkages between community and academia may provide policy-makers important information about the efficacy of programs in many areas: Improving access and satisfaction Improving access and satisfaction Promoting cultural competency Promoting cultural competency Improving perinatal health outcomes Improving perinatal health outcomes Guiding and promoting capacity building Guiding and promoting capacity building Creating opportunities for collaboration by diverse entities on diverse projects Creating opportunities for collaboration by diverse entities on diverse projects

Use of the IMCBE approach in promoting linkages between community and academia helps to guide decision- makers and practitioners in the planning, implementation and future evaluations of state-wide perinatal and similar programs Use of the IMCBE approach in promoting linkages between community and academia helps to guide decision- makers and practitioners in the planning, implementation and future evaluations of state-wide perinatal and similar programs Lessons Learned and Future Strategies

Acknowledgements JoAna Dodson PERINATAL INITIATIVES PROGRAMS AND AGENCY STAFF COMMUNITY PARTICIPANTS BFHS STAFF, VOLUNTEERS AND OTHER STAKEHOLDERS PROJECT EVALUATION AND OFFICE ASSISTANTS