Monitoring Healthy Relationships: A Small Group-level Intervention for People Living with HIV/AIDS Miriam E. Phields, PhD Science Application Team, Capacity Building Branch Division of HIV/AIDS Prevention National Center for HIV, STDs, TB Prevention Centers for Disease Control and Prevention Presentation slides available at Select Health Relationships, Select HR Resources and Tools Web Conference: February 23, 2006

2 Objectives To provide a brief overview of Healthy Relationships (HR) intervention and CDC training on HR To discuss the resources and training needed to implement the intervention To discuss strategies and methods for conducting contract monitoring and quality control for CBOs implementing the HR To introduce an optional tool for monitoring HR implementation

3 Goals of the Healthy Relationships Intervention To reduce sexual risk behaviors of men and women living with HIV/AIDS To reduce HIV-related stress

4 Overview of the Healthy Relationships Intervention Evidence-based People living with HIV/AIDS Small groups Five sessions Develop coping skills to manage stress and to improve decision-making skills

5 Healthy Relationships Training Four-day training Facilitators are strongly encouraged to attend. Program managers/coordinators may also attend. Sign up at CDC will provide the trainers and the intervention packages HDs provide the training space and A/V equipment

6 Healthy Relationships Trainings Sponsored by CDC From Jan. 1, 2005 to Dec. 31, 2005: – 29 trainings – 470 participants – 193 agencies 129 CBOs (340 staff) 32 HDs (63 staff) 32 Other (CBAs, PTCs, Univ) (67 staff)

7 Healthy Relationships Intervention Materials Distributed to training participants only Bag contains – Implementation Manual – Technical Assistance Guide – Marketing and Educational Videos – Session Envelopes – Risk Continuum Banner – Information sheet – Electronic version of forms Does NOT include any of the movie-quality clips

8 Costs of HR Use the Cost Worksheet to develop a budget (see HR Starter Kit pp. 7-9) – Figures are based on one implementation of the complete intervention to one target population. Costs will depend on: – Costs in a particular area – Staff turnover – Number of cycles of the intervention (one cycle = 5 sessions) – The number of peer facilitators who will be needed for each cycle delivered to a different target population.

9 Monitoring Effective Behavioral Interventions To systematically check the progress, content, and quality of the planning, implementation, and evaluation of an effective behavioral intervention To assess progress and completion of contractual agreements and deliverables (e.g., performance indicators, services, etc.) To assess technical assistance (TA) needs To provide TA and other support to implementers

10 10 Domains for Monitoring the HR 1.Pre-implementation Activities 2.Facilitators 3.Administrative Items 4.Location and Materials 5.Policies and Procedures 6.Adaptations 7.Participants 8.Session Format 9.Implementation Activities 10.Quality Assurance and Evaluation

11 Pre-implementation Activities Is HR an appropriate intervention for the CBO? – Agency capacity (e.g., adequate resources including staff, space, money, access to target population) – Target population (e.g., risk behaviors, behavioral determinants)? Has an assessment been conducted with target population?

12 Pre-implementation Activities (con’t) Implementation plan developed – sample on Logic model developed – sample on Recruitment plan developed – including how to sort people into groups and administer Initial Assessment Survey (IAS)

13 Pre-implementation Activities (con’t) Retention plan developed Stakeholders identified and contacted Advisory group established and meetings held as planned (e.g., monthly, quarterly, etc.) Intervention materials reviewed and approved by the Program Review Panel

14 Pre-implementation Activities (con’t) Facilitation and coordination sessions planned by co-facilitators Facilitators practiced sessions before conducting HR with consumers/participants Debriefings planned Referral plan created and tested

15 Facilitators Two facilitators per group – One facilitator, who is a mental health professional or experienced counselor, has been hired or volunteered – One facilitator, who is a peer for the targeted audience and living with HIV/AIDS, has been hired or volunteered Both facilitators have group facilitation experience/training.

16 Facilitators (con’t) At least one facilitator is living with HIV/AIDS At least one facilitator matches target population All facilitators completed the CDC’s HR course

17 Facilitators (con’t) Total number of facilitators will depend on the number of groups delivered to different target populations For example: – Women’s group – MSM group – Heterosexual men’s group MH Fac. Peer Fac. Peer Fac. Peer Fac. Women’s Group Heterosexual Men’s Group MSM Group

18 Administrative Items Job descriptions prepared Organizational chart prepared Regular staff meetings held and topics/discussion documented New staff orientation developed and documented Licenses/certifications verified Personnel folders complete

19 Location and Materials Easily accessible location for sessions Private room large enough for sufficient number of chairs to be arranged in circle with TV/VCR/DVD TV/VCR/DVD with remote control Easel Chart Guides created Easels, easel pads and markers obtained Movie clips selected that are appropriate for group members Movie clip intervention tape created

20 Location and Materials (con’t) Initial Assessment Survey (IAS) completed for all participants Personal Feedback Reports (PFRs) made from IAS for each participant PFR posters created Resource Packets prepared Condoms and anatomical models obtained Refreshments planned and obtained Incentives determined and obtained

21 Policies and Procedures Confidentiality policy HIV in the Workplace policy Staff and participant illness policy Data security procedures Attendance policy (especially for Session Two) and closed group Visitor/observer policy Legal policies (state disclosure laws and duty to warn) Mandatory Reporting policy (e.g., abuse, intent to harm, etc.)

22 Policies and Procedures (con’t) Participant consent or release of HIV-related information form and signing process Volunteer policy for peer facilitator Incentive monitoring policy Adverse event and crisis management procedure Mental health professional/experienced counselor facilitator’s responsibilities policy Peer facilitator’s responsibilities policy Participant eligibility policy Client grievance policy prepared and displayed Recruitment policy and screening procedure

23 Adaptations Documentation of all changes to key characteristics and other adaptations Formative evaluation and assessment to validate need for adaptation has been conducted. Advisory Group consulted Revisions made to HR logic model to describe adapted intervention Revisions made to HR implementation plan to match adapted intervention Marketing materials adapted

24 Adaptations (con’t) Number, length, or frequency of sessions adapted, if necessary Refreshments adapted, if necessary Incentives adapted, if necessary Risk Continuum Cards revised IAS revised PFRs (including posters) revised Easel Chart Guides revised and prepared with set-the-scenes that match clips chosen Appropriate clips chosen for target population and each “type” of group (e.g., women’s group, MSM group, heterosexual men’s group)

25 Participants Living with HIV/AIDS only Narrowly defined target population Groups divided by gender and sexual orientation Small groups of 5-12 people No couples in group Policy about sexual contact with other group members during group Age 18 and over Sufficient recruitment has been conducted to fill the groups (5-12 people)

26 Session Format 5-6 sessions maximum All sessions follow the Facilitators’ Session Outlines Sessions are 120 minutes long or adapted for population 2 facilitators (1 mental health professional/ experienced counselor and 1 peer) conducted sessions

27 Implementation Activities Facilitation and coordination sessions conducted by co-facilitators Debriefings held Participant-specific session notes are documented Attendance documentation (date, session #, names of participants) is available Client records kept locked and with limited access

28 Implementation Activities (con’t) Core elements implemented with fidelity: 1.Defining stress and reinforcing coping skills across three life areas—disclosing to family and friends, disclosing to sexual partners, and building healthier and safer relationships. 2.Using modeling, role-play, and feedback to teach and practice skills related to coping with stress. 3.Teaching decision-making skills about disclosure of HIV status. 4.Providing personal feedback reports to motivate change of risky behaviors and continuance of protective behaviors. 5.Using movie clips to set up scenarios about disclosure and risk reduction to stimulate discussions and role-plays.

29 Quality Assurance and Evaluation A quality assurance plan has been developed that includes session observations and record reviews and dates for implementation The quality assurance plan is implemented and results reviewed by program manager in timely manner A participant satisfaction survey is administered annually and results reviewed by program manager An evaluation plan has been created The evaluation plan has been implemented

30 Quality Assurance and Evaluation (con’t) Evaluation forms have been developed A database has been created and data entered Data are analyzed periodically and reports generated Reports are reviewed periodically by program manager Evaluation data used to improve program Quality assurance, evaluation, and participant satisfaction results are used to make adjustments to the implementation of HR

31 Monitoring Tool for Healthy Relationships Implementation OPTIONAL Downloadable Word document May be revised, added to, changed in any way for your use Monitoring tool available at – Select Healthy Relationships – Select Resources/Tools

32 Snapshot of Monitoring Tool for Healthy Relationships STANDARDMET (circle) SOURCES (circle or write in) NOTES I. Administrative Items Job descriptions preparedYes Partially No Job descriptions Organization chart preparedYes Partially No Organizational chart Regular staff meetings held and topics/discussion documented Yes Partially No Staff meeting schedule and minutes New staff orientation developed and documented Yes Partially No New staff orientation plan and personnel files Licenses/certifications verifiedYes Partially No NA Personnel files Personnel folders completeYes Partially No Personnel files

33 Questions and Answers Presentation slides available at: Select Health Relationships Select HR Resources and Tools