Welcome to the Acci ó n 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 linePlease press *6 on your telephone keypad to mute your line (to un-mute your line, press *6 again) (to un-mute your line, press *6 again) If you are experiencing difficulty with your phone connection, dial *0 for the conferencing service operatorIf 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 Q&AQuestions submitted prior to the web seminar will be addressed first during the Q&A 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 phoneFor 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

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

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 (310) ext. 224.

Overview  National context  Key Concepts and Terms  The Adaptation Process  Guidance & Lessons Learned  Resources for Capacity Building Assistance (CBA) and Technical Assistance (TA)

National Context  Infectious Diseases CDC – DEBIs (Diffusion of Effective Behavioral Interventions) CDC – DEBIs (Diffusion of Effective Behavioral Interventions)  Substance Abuse, Mental Health NIDA – ATTN (Addiction Technology Transfer Network) NIDA – ATTN (Addiction Technology Transfer Network) SAMHSA – NREPP (National Registry of Evidence-based Programs and Practices) SAMHSA – NREPP (National Registry of Evidence-based Programs and Practices)  Health Care/Services AHRQ – PPIP (Put Prevention Into Practice) AHRQ – PPIP (Put Prevention Into Practice) NCI – RTIPS (Research Tested Intervention Programs) NCI – RTIPS (Research Tested Intervention Programs)

CDC DEBI Website SAMHSA NREPP website

Key Concepts and Terms   Evidence-based intervention   Adaptation & reinvention   Core elements and key characteristics   Fidelity   Technology transfer and exchange

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

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

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

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

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 Renaming intervention Formally evaluating prevention outcomes Formally evaluating prevention outcomes Ensuring behavioral outcomes were achieved Ensuring behavioral outcomes were achieved

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 intervention’s 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

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

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)

Why does fidelity matter? (Dusenbury et al., 2003)  Adherence Was intervention delivered as planned? Was intervention delivered as planned?  Dose What sessions of the intervention were dropped? Shortened? Added? What sessions of the intervention were dropped? Shortened? Added?  Quality of delivery How skilled were facilitators in conducting intervention activities? How skilled were facilitators in conducting intervention activities?  Participant responsiveness How did consumers respond to How did consumers respond to the intervention?

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)

Adaptation and Reinvention  Adaptation POL for Latino young migrant men (Somerville et al. 2006) POL for Latino young migrant men (Somerville et al. 2006) Expanded POL training on HIV and STDsExpanded POL training on HIV and STDs Communication style module changed to be more culturally appropriate, non-linearCommunication style module changed to be more culturally appropriate, non-linear Inclusion of referral making in conversationsInclusion of referral making in conversations  Reinvention May be necessary because of new target population or setting May be necessary because of new target population or setting POL delivered without additional POL training or monitoring of conversations (Kelly, 2004) POL delivered without additional POL training or monitoring of conversations (Kelly, 2004)

Technology Transfer & Exchange  Transfer (CDC to CBOs) Translation, dissemination, acquisition of information about interventions 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) Communication of barriers/facilitators experienced in practice, to improve intervention effectiveness (Gandelman et al., 2005)  Transfer and exchange are necessary to adaptation

Overview (Adapted from McKleroy et al., 2006) Implementation plan Successful pilot of adapted intervention Prepare agency Pre-test materials Target population Interventions Goodness of fit Stakeholders Organizational capacity A A ssess P P repare P P ilot I I mplement Implement adapted EBI Decide to adopt, adapt, or select another intervention Make necessary changes to EBI S S elect

Step 1: Assess  Target population Identify target population Identify target population Understand risk factors, behavioral determinants, risk behaviors, epidemiological trends, social norms Understand risk factors, behavioral determinants, risk behaviors, epidemiological trends, social norms Choose risk factors to target Choose risk factors to target Identify where, when, how to reach target population Identify where, when, how to reach target population

Step 1: Assess (cont’d)  Interventions Identify and review possible EBIs Identify and review possible EBIs Review content of EBIs Review content of EBIs Identify risk factors, behavioral determinants and risk behaviors Identify risk factors, behavioral determinants and risk behaviors Identify core elements and key characteristics Identify core elements and key characteristics Access cost and resources needed Access cost and resources needed Talk with other agencies Talk with other agencies

Step 1: Assess (cont’d)  Goodness of fit Match between risk factors, behavioral determinants, and risk behaviors in EBI and those of target population Match between risk factors, behavioral determinants, and risk behaviors in EBI and those of target population Short list of EBIs Short list of EBIs Identify areas needed for EBI adaptation Identify areas needed for EBI adaptation Identify areas for agency capacity building Identify areas for agency capacity building

Step 1: Assess (cont’d)  Stakeholders Identify stakeholders Identify stakeholders Seek input Seek input Assess referral and collaboration possibilities Assess referral and collaboration possibilities Define accountability Define accountability Identify competing programs Identify competing programs

Phase 1: Assessment (cont’d)  Organizational capacity Resources or experience Resources or experience Physical Physical Financial Financial Access Access Values/mission Values/mission Staff/human resources Staff/human resources Cultural competence Cultural competence EBI EBI Evaluation Evaluation Accountability Accountability

Step 2: Select  Decide to adopt, adapt, or select another intervention Build capacity on EBI and for implementation Build capacity on EBI and for implementation Consult with stakeholders Consult with stakeholders Consult with staff Consult with staff

Step 2: Select  Make necessary changes to EBI (adaptation) Decide what changes are needed Decide what changes are needed Seek guidance or technical assistance Seek guidance or technical assistance Develop timeline and logic model Develop timeline and logic model A logic model describes the relationships among risk factors/determinants, intervention activities and desired outcomesA logic model describes the relationships among risk factors/determinants, intervention activities and desired outcomes Track changes made Track changes made

POL Logic Model Risk determinants Intervention Activities Outcomes Risk determinants Intervention Activities Outcomes Teach POLs the intervention rationale POLs practice and engage in conversations Knowledge of effective communication Attitudes/norms for engaging in conversations Self-efficacy to engage in conversations  perception of behavior norms Adapted from CDC POL Logic Model Teach POLs conversation elements  confidence to be able to engage in behavior  risk behavior in target community

Step 3: Prepare  Prepare organization Recruit/train staff and volunteers Recruit/train staff and volunteers Assign responsibilities Assign responsibilities Handle logistics Handle logistics Confirm referrals and collaborations Confirm referrals and collaborations  Pre-test adapted EBI With stakeholders With stakeholders With members of target population With members of target population

Step 4 : Pilot  Plan for implementing EBI  Agency policies for adapted EBI  Referral networks  Roles and responsibilities  Timeline

Step 4 : Pilot  Gauge success of pilot  Success: move to next step  Failure: review, revise, re-pilot  Fidelity Adherence Adherence Dose Dose Quality Quality Participant response Participant response

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

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)

Guidance & Guidelines Other EBIs-related information  Research Tested Intervention Programs (RTIPS) available at  Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP) available at pover  Cochrane Health Promotion and Public Health Field review and protocols available at  The Guide to Clinical Preventive Services available at  National Guideline Clearinghouse available at  Center for Information Dissemination and Education Resources (CIDER) available at

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

CDChttp://0-

Community Planning Groups CDC guidance Community Planning Groups CDC guidance

Community Planning Groups List of CPGs Community Planning Groups List of CPGs

Health Departments/UCHAPS

BSSV Website

STD/HIV Prevention Training Centers

HIV Prevention Research Centers  Columbia University HIV Center for Clinical and Behavioral Studies  Yale University Center for Interdisciplinary Research on AIDS  Medical College of Wisconsin Center for AIDS Intervention Research  UCLA Center for HIV Identification, Prevention and Treatment Services  UCSD HIV Neurobehavioral Research Center  UCSF Center for AIDS Prevention Studies

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: