1. Slides for Module 4 Topic: Implementing Needs Assessment

2. Implementing Needs Assessment
Designing and Managing Needs Assessment
Analyzing and Presenting Needs Assessment Findings

3. Training Objectives
Following the training, participants will be able to:
Identify at least 4 different data gathering methods for use in needs assessment
Describe 4 steps in designing and implementing needs assessment
Describe 3 strategies for doing needs assessment with limited resources
Outline a multi-year needs assessment plan appropriate for their EMA or TGA
Describe 3 strategies for maximizing consumer and other PLWH involvement in needs assessment
Identify 5 factors to consider in making needs assessment findings understandable and useful for decision making

4. Designing and Managing Needs Assessment
Data-Gathering Methods
Using a Multi-Year Plan
Needs Assessment Steps and Staffing
Controlling Needs Assessment Costs
Maximizing Consumer Input
Prevention-Care Needs Assessment

5. Choosing Needs Assessment Methods
Many data-gathering methods available:
Some quick, others requiring extensive preparation
Some inexpensive, others requiring extensive resources (people and/or funds)
Some that call for extensive research and data skills, others manageable without extensive training

6. Data-Gathering Methods: Necessary Aspects
Approaches to implement each needs assessment component requiring new data collection
A combination of:
Quantitative data: information that can be expressed in numbers and counted – like epi or client characteristics data – that allow for numerical analysis and comparisons
Qualitative data: non-numerical information usually in narrative format – like findings from a focus group – that provide depth and context
Large-sample data from PLWH that provide findings “representative” of the population sampled

7. Useful Methods: Surveys
Often used to:
Assess PLWH or consumer service needs, experiences, barriers, and gaps
Obtain data from service providers
Reach large numbers of people, with sampling to obtain findings that represent the entire population sampled
Design and implementation:
Mostly “forced-choice” questions so responses can be tabulated
Often provided on a tablet or via Internet for easy tabulation – though paper surveys can be used

8. Useful Methods: Focus Groups
Often used to:
Obtain information about service experiences, needs, gaps, and barriers for a set of particular groups of PLWH
Gain in-depth understanding of needs of key populations
Obtain information relatively quickly and at moderate cost
Design and implementation:
Open-ended questions for discussion, often as part of a “script” for the facilitator, often with a quick survey on participant characteristics
Usually involves a small group of individuals (6-12) from the same target population
Requires careful notetaking

9. Useful Methods: Town Halls or Community Forums
Often used to:
Meet legislative requirements for community – especially PLWH – input to decisions about funding and services
Provide an open forum in several locations within the EMA or TGA to invite input and report back to the community
Design and implementation
Sometimes open-ended, with individuals signing up to make a brief (3-5 minute) presentation to PC/PB leadership
Sometimes structured around specific questions for discussion
May ask participants to vote on their top service priorities

10. Other Needs Assessment Methods
Provider forums: similar to a town hall or community forum but designed to obtain input from service providers, RWHAP- funded and non-funded
Key informant sessions: similar to a focus group in size, but designed to generate discussion with experts (providers, consumers, researchers) about a particular service category or model, or the needs of a specific population
Key informant interviews: individual interviews with purposes similar to key informant sessions
Special studies: focusing on a service category, population, barrier to care, or other issue and often using a combination of existing and new data

11. Using a Multi-Year Needs Assessment Cycle and Plan
Sound practice: multi-year needs assessment cycle
Epi Profile must be updated each year – and included in the annual RWHAP Part A application
Resource Inventory should be reviewed annually to identify new resources or service gaps
Other components, such as the PLWH survey or Profile of Provider Capacity and Capability, often updated on a 3-year cycle – so no data are more than 3 years old

12. Value of a Multi-Year Plan
Helps the responsible committee plan its work and determine when a contractor may be needed
Allows for multi-year PC/PB budget planning – more funds may be needed in years of major needs assessment activity such as a PLWH survey
Helps the PC/PB negotiate a realistic budget amount with the recipient to include in the annual application
Helps ensure that needs assessment is well planned and implemented, with reasonable deadlines

13. Developing a Multi-Year Plan
Plan for one major needs assessment activity each year, plus some smaller efforts, for example:
PLWH survey Year 1, special study on unmet need Year 2, profile of provider capacity and capability Year 3
Focus groups with key populations and/or key informant groups or interviews Year 2 or 3
Town hall or community forum every year
Be sure the cycle addresses annual deadlines, with findings available for:
Data presentation at beginning of the PSRA process
Use in preparing the annual application

14. Developing a Multi-Year Plan (cont.)
Try to leave a little unassigned needs assessment time/resources – flexibility to add a special study or explore an emerging issue
Identify resource requirements for planned tasks
Estimate required time and effort by PC/PB support staff
Identify assistance needed from recipient staff – to ensure subrecipient cooperation in data gathering, help in obtaining access to secondary data, help with data analysis
Consider any requests for surveillance staff beyond the normal epi profile
Determine whether a consultant, contractor, or university partnership is needed

15. Needs Assessment Step 1 Plan for the needs assessment
Determine the scope of the needs assessment – ideally, based on an existing multi-year plan & cycle
Determine the timetable
Develop the budget and ensure needed funds are available in the PC/PB budget
Agree on responsibilities for conducting and overseeing the needs assessment, including whether a consultant or contractor is needed – and begin the contracting process
Include a process for community input each year

16. “Staffing” the Needs Assessment
Options include:
PC/PB support staff
Recipient staff with strong data skills
A research expert who serves on the PC/PB or committee
A university partner – e.g., involvement of graduate students, interns
PC/PB members and committee members
Consumers and other PLWH who are not members
A contractor or individual consultant

17. Issues in Needs Assessment “Staffing”
PC/PB staff typically coordinate and oversee needs assessment
In smaller jurisdictions, staff may not have needed time or specific planning skills
PC/PB members and committee members can help, but often have limited time
Many EMAs and TGAs hire consultants to help, if funds can be made available
Good planning and supervision can help control needs assessment consultant or contractor costs
PC/PB support staff usually provide day-to-day supervision

18. Needs Assessment Step 2 Design the needs assessment methodology
Determine what information is available and what new data must be collected
Select the methods to be used
Involve a research expert to ensure sound process
Develop data collection tools – with input from the consumer committee or caucus
Translate tools into additional languages as needed
Develop a plan for aggregating and analyzing the data
Decide how to present and use results
Involve all partners in developing and/or reviewing the process

19. Needs Assessment Step 3
Gather the information required for the needs assessment
Arrange to receive epi data from surveillance staff (state or local) in needed formats
Obtain and review other existing information – from surveillance, recent needs assessments, the recipient, providers involved in research
Arrange for recipient help in ensuring subrecipient cooperation for accessing consumers or staff
Train data collection personnel
Collect new data
Provide assistance to individuals with special needs

20. Needs Assessment Step 4 Analyze findings and present results
Clarify key questions to be answered
Review how data from each source will be used
Decide how and by whom data from each method will be tabulated (if quantitative) and analyzed
Agree on how data will be summarized (Report? PowerPoint presentation?) and presented (A PC/PB meeting? A combined data presentation?)
Identify or develop user-friendly formats for presenting findings

21. Maximizing Consumer Involvement in Needs Assessment
Recruit consumers to serve on the committee responsible for needs assessment – include both PC/PB members and non-members
Involve the consumer committee or caucus in tool development
Ask the committee to review questions and response categories, to see if anything is missing or unclear
Have committee members pre-test the tools designed for PLWH

22. Maximizing Consumer Involvement in Needs Assessment (cont.)
Train consumers to help gather data
Facilitate focus groups or key informant sessions
Chair or facilitate town halls or consumer forums
Administer online or paper surveys
Identify and recruit consumers from targeted PLWH populations to complete a survey or attend a town hall
Ask consumers to help interpret findings
Encourage consumers serving on the PC/PB and committees to provide needs assessment input
Attend town halls or consumer forums
Complete PLWH surveys
[Note: Focus groups should target people who would not otherwise have input]

23. Controlling Needs Assessment Costs
Partner with other RWHAP Parts in planning and implementing needs assessment – e.g. use a shared PLWH or provider survey (add some local questions if needed)
Obtain tested needs assessment tools from similar EMAs or TGAs – most are happy to share
Train consumers to help gather data
Cooperate with non-RWHAP providers – e.g., ask HOPWA to arrange for residents of its housing to complete a survey

24. Prevention/Care Needs Assessment
Unified planning bodies may want to include all aspects of HIV prevention and care in needs assessment
Some prevention needs assessment involves separate efforts targeting individuals who are not HIV-positive
Costs can be an issue where no funds are available for prevention-focused needs assessment or to help with PC/PB support
Many aspects of HIV prevention can become a part of integrated needs assessment efforts

25. Integrated Prevention/Care Needs Assessment Strategies
Include prevention providers in the Resource Inventory and Profile of Provider Capacity and Capability
Include questions in PLWH surveys on topics such as:
Prevention for positives – prevention service needs, experiences, barriers, and gaps
Stigma and its impact on testing and linkage to care
Knowledge about HIV transmission, viral suppression, PrEP, and nPEP
Other topics that are a priority for state or local Health Department prevention staff

26. Integrated Prevention/Care Needs Assessment Strategies (cont.)
Ask recently diagnosed individuals responding to PLWH surveys about:
Level of HIV knowledge prior to diagnosis
Prior participation in HIV prevention interventions
HIV education provided following diagnosis
Testing experiences
Post-testing and linkage to care experiences, including counseling and partner contacts
Add focus groups for individuals from target populations who are not HIV-positive

27. Analyzing and Presenting Needs Assessment Findings
Analyzing Needs Assessment Findings
Integrating Data from Multiple Sources
Presenting Findings

28. Analyzing Needs Assessment Findings: Qualitative Data
Review and summarize qualitative data from focus groups, town hall meetings, key informant sessions or interviews:
Focus on identified key questions
Describe areas of agreement and disagreement
Highlight unexpected findings, new trends
Keep reports concise
Organize by topic
Use plain language
Protect anonymity of participants

29. Analyzing Needs Assessment Findings: Quantitative Data
For quantitative data from surveys or other sources:
Enter data into SPSS (data analysis software) or Excel, or use online survey analysis tools
Review data for completeness and “clean” the data as needed
Do initial tabulations by question and review responses
Separately tabulate, analyze, and compare data based on factors such as race/ethnicity, age, gender/gender identity, risk factor, place of residence, and co-occurring conditions
Conduct additional analyses based on key questions
Discuss and interpret findings in committee

30. Use to Address Key Questions
What core medical & support services are needed and by whom?
What services are being provided?
What service gaps remain—overall? for particular groups of PLWH?
What barriers are discouraging PLWH from entering and remaining in care, adhering to medications, and reaching viral suppression?
What disparities are there in availability, accessibility, and/or appropriateness of HIV services for particular populations and/or geographic areas?
What was suggested to fill gaps and better meet needs, overall and for specific populations?

31. Making the Most of Your Survey Data
Do not limit the value of your survey data through limited analysis
Be sure to separate and compare quantitative findings by key factors such as race/ethnicity, gender/gender identity, age, geographic residence
Often there are large differences in services, needs, barriers, and gaps based on such factors
Use multiple filters to look at several factors at once – for example, look at data for young MSM of color
Sophisticated computer programs and analytic skills are not required: even inexpensive online survey tools will let you “filter” responses in this way

32. Making the Most of Your Survey Data (cont.)
If 25 or more individuals from an important target population responded to your survey, separately review those data and compare findings on key questions
If you asked about characteristics and conditions like homelessness or unstable housing, country of birth, recent incarceration, substance use, mental health issues, or other health conditions like diabetes, separately analyze data for people reporting each characteristic
Findings cannot be assumed to represent the entire subpopulation, but are valuable – it is like having several focus groups but with more specific data

33. Integrating Data from Several Needs Assessment Sources
Compare findings from different components of the needs assessment – for example:
Compare PLWH and provider views about the most serious service gaps and barriers to care
Compare focus group findings on a specific population with survey data on the same population
See if trends reflected in your epi profile are mentioned in focus groups, town halls, or special studies

34. Integrating Data from Other Sources
Compare consumer data from the needs assessment with consumer data from the recipient, such as:
Client characteristics and service utilization data – usually available by race/ethnicity, gender/gender identity, age, and risk factor
Cost data by service category
For example, if some populations in your PLWH survey or focus groups say they find it hard to obtain particular services:
Do utilization data indicate that these populations are under- represented as users of these services?
Were all funds for these service categories expended?

35. User-Friendly Data Formats
Summarize findings in brief report(s) or presentation slides
Include understandable graphics
Present data in terms of both numbers and percent
Include a concise text explanation for each chart
Use creative formats to summarize and compare data from different sources
Always provide information needed to assess the quality of findings – e.g., number of responses, sampling approach, limitations in data gathering, problem questions
Test formats on new members including consumers

36. Year-Round Presentation of Findings
Present findings from individual components of your needs assessment as soon as data are ready – don’t wait for the annual data presentation
Present first to the responsible committee
Then to the PC/PB as a whole
Make a special presentation for the consumer committee
Frequent presentations, with mini-trainings on understanding and using data:
Provide information that can be used during the year
Add interest to meetings
Help PC/PB and committee members become comfortable reviewing data

37. Annual Data Presentation
Occurs in late spring, just before priority setting and resource allocation begins
Includes presentations on epi data, needs assessment findings, and other data from the recipient
May also include individual input from consumers and/or service providers
Sometimes agenda allows individuals to sign up to make 3-5 minute presentations
As an alternative, individual input can be obtained earlier through town hall meetings or community forums, with a summary provided at the data presentation

38. Annual Data Presentation (cont.)
Most successful where much of the information has already been discussed at a prior PC/PB meeting, and focus can be on comparing findings from different sources
Presentations should be reviewed by the responsible committee – including consumers – to ensure clarity, conciseness, understandable charts, and highlight new or unexpected issues or findings
Presentations should be sent out before the meeting to allow time for prior review

39. Sum-Up Needs assessment should involve:
An ongoing cycle and a multi-year plan
Use of several methods and multiple data sources
Analysis that goes beyond tabulation of data for all PLWH to include findings and comparisons by subpopulation
Needs assessment costs can be controlled with good planning and collaboration
Annual needs assessment activities need to be completed in time for use in PSRA and inclusion in the annual RWHAP Part A application
But findings should be presented throughout the year

40. Optional Slides for Activity

41. Instructions for Activity: Outlining a Needs Assessment Work Plan
Work in a small group and choose a facilitator, a recorder, and a reporter
Individually review the Situation and Work Sheet, then work as a group
Use the information from the training and your own experience to prepare a preliminary work plan for this PC/PB’s Needs Assessment Committee
Use the situation provided, making any other needed assumptions
You have 30 minutes – then your reporter will discuss your work with the full group