CDC’s Diffusion of Effective Behavioral Intervention (DEBI) Program and National Research Translation Efforts Alice Gandelman, MPH California STD/HIV Prevention Training Center (CA PTC)

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

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

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

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)

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*

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

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

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

Core Elements ► Required elements that represent the intent, theory, and internal logic of the intervention and most likely produce the intervention’s 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.

► 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. Key Characteristics

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.

“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.

Challenges at the Practice Level Efficacy 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

Challenges at the Practice Level Efficacy vs. Effectiveness, Cont. ► Diffusion process opening up Pandora’s Box of issues  Basic skills  Resources  Allowable adaptations  Evaluation of adapted intervention

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)?

DEBI Adaptations at Agency Level – Both Science and Art New PTC course: Adapting Evidence=Based Interventions ► Objectives:  Understand DEBI terminology  Conduct/utilize information from community assessment process ► Specifically defined target population ► Risk behaviors ► Factors influencing risk behaviors

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

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

How to Request Trainings ► DEBI trainings: ► CA PTC trainings (DEBI and others) California STD/HIV Prevention Training Center (CA PTC) 300 Frank H. Ogawa Plaza, Suite 520 Oakland CA, (510)