1. Minority SA/HIV Initiative
SPF Step 2 - Capacity Building
Pam Tindall, CSAP’s Western CAPT
Haner Hernandez
Marcus Bouligny
Kris welcome

2. Learning Objectives Explore sustainability as it relates to capacity
Review Strategic Prevention Framework
Overview capacity
Define types and levels of capacity
Explore capacity in context of MAI grant
Discuss the role of cultural competency in capacity building
Explore sustainability as it relates to capacity

3. Activity (Tables) - Elevator speech: “What is the SPF
Activity (Tables) - Elevator speech: “What is the SPF?” (one or two sentences)

4. SPF – Step 1: Assessment Review
Outcome-based prevention focus
SPF process
Step 1: Profile population needs, resources, and readiness to address needs and gaps
Documenting findings in the online Management Reporting Tool (MRT)
Outcome-based px focuses on 1) identifying substance abuse and HIV/AIDS related problems, 2) what we call intervening variables (R&PFs and other factors contributing to the incidence of SA and transmission of HIV/AIDS (permissive norms, availability of drugs, risky sexual behaviors, ) and 3) strategies that the literature on SA and HIV/AIDS Px have found to be effective in addressing these particular contributing factors and problems.
SPF – data-driven strategic planning process which guides our comprehensive approach to SA and transmission of HIV/AIDS
Step 1: explores the extent of ATOD use and consequences, incidence of transmission of HIV/AIDS, related risky behaviors and contributing factors such as risk and protective factors. This is done by compiling and analyzing lots of qualitative and qualitative data into an epi profile of your community/focus pop (peeling the onion), selecting some priority problems/ contributing factors/ target population to address with your initiative, then looking at what already exists in your community that addresses these problems and contributing factors, what is needed (where the gaps are), and how ready the community is to accept, support and participate in prevention initiatives.

5. Strategic Prevention Framework
Step 1: Assessment
Profile population needs, resources, and readiness to address needs and gaps
Step 2: Capacity
Mobilize and build capacity to address needs
Step 3: Planning
Develop a comprehensive strategic plan
Step 4: Implementation
Implement evidence-based programs, policies, practices
Step 5: Evaluation
Monitor, evaluate, sustain, and improve
Step 2 involves building our capacity to do each step of the SPF, to assess, to plan, to implement, and to evaluate. It involves building our capacity to organize in ways that will help us do these things. It means bringing together the people in our communities who have a stake in our issue, bringing together our resources, and improving our ability to organize and work together to address needs ID’d in Step 1.
Step 1 – We’ll need to build our capacity to assess our population’s needs, resources, and readiness to address these needs and fill the gaps in resources we identify.
Step 3 – We’ll need to build our capacity to bring together a group of stakeholders to create a comprehensive plan for how our cmty will address the needs we’ve identified, and the factors contributing to those needs, using strategies and programs shown to be effective.
Step 4 – We’ll need to build our capacity to implement p/p/p to carry out strategies, and to begin gathering certain kinds of information about these p/p/p’s which will help us evaluate how effective our p/p/p’s are.
Step 5 – We’ll need to build our capacity to monitor and evaluate our efforts, improve our strategies, and sustain the organizations, programs, policies, and practices we’re implementing.

6. Goals of the Minority SA/HIV Initiative
Build foundation for delivering and sustaining quality, accessible, state-of-the-science SA and HIV prevention services
Engage community groups to prevent and reduce the onset of SA and transmission of HIV/AIDS
Focus on high risk sub-populations
The purpose of this initiative is to support an array of activities to assist grantees in building a solid foundation for delivering and sustaining quality and accessible state of the science substance abuse and HIV prevention services. Specifically, the program is intended to engage community-level domestic public and private non-profit entities to prevent and reduce the onset of SA and transmission of HIV/AIDS among the following at-risk racial/ethnic minority subpopulations:
reentry populations (i.e., racial/ethnic minorities who have been released from prisons and jails within the past 2 years);
men having sex with men (MSM);
Black, Latina, or Hispanic women;
adolescents (age 12-17);
young adults (age 18-24); and
older adults, age 50 and over in communities of color disproportionately affected by SA and HIV/AIDS.
In step 2, we assess and build our capacity to do this.

7. Best Processes1 for Implementing the Strategic Prevention Framework
1. Analyzing Information About the Problem,
Goals, and Factors Affecting Them
Collecting & Analyzing Data About the
Problem and Contributing Factors
A. Assessment
B. Capacity
10. Documenting Progress and
Using Feedback
Documenting Progress and
3. Defining Organizational Structure
and Operating Mechanisms
Defining Organizational Structure
and Identify Resources
E. Evaluation
9. Assuring
Assuring Technical Assistance
12. Sustaining the Work
Sustaining the Work
8. Implementing Effective
Interventions
Implementing Effective
7. Developing Leadership
Developing Leadership
Different points of view (next 2 slides)
In thinking about the capacities we will need in order to do this, one conceptual framework that is very helpful is this one used by public health.
This model shows what kinds of processes other public health initiatives have found to be effective, processes that build capacity to effectively implement the SPF and to effectively address whatever the public health issue is which we are addressing, in our case SA and the transmission of HIV/AIDS - review
Our projects will want to build our capacity to use these same processes.
What kinds of capacities/abilities would we need to collect and analyze data…
C. Planning
D. Implementation
4. Developing a framework or
model of change
Developing a
Model of Change
1Best processes identified through a literature review conducted by Dr. Renee Boothroyd, University of Kansas – used with permission.
5. Developing and Using
Strategic and Action Plans
Developing and Using
Strategic Action Plans

8. Develop Comprehensive
Skills Required to Implement SPF
(Core Competencies)
1. Analyzing Information About the Problem,
Goals, and Factors Affecting Them
Assess Community Needs and Resources
A. Assessment
10. Documenting Progress and
Using Feedback
Sustain Projects and
Initiatives
B. Capacity
3. Defining Organizational Structure
and Operating Mechanisms
Create and Maintain Coalitions & Partnerships
11. Making Outcomes Matter
Evaluate Initiatives
9. Assuring
Build Leadership
E. Evaluation
12. Sustaining the Work
Secure Ongoing Funding
7. Developing Leadership
Enhance Cultural Competence
8. Implementing Effective
Interventions
Influence Policy Development
6. Arranging Resources for
Community Mobilization
Improve Organizational
Management & Development
It’s also helpful to look at building capacity to implement the SPF process to address SA and HIV/AIDS from the angle of skills we will need.
In our projects, we will want to build our capacity/ability to…
What kinds of capacities/abilities would we need to assess community needs and resources…
These public health conceptual frameworks may help us focus our capacity-building on specific processes and skills.
So now let’s look at HOW we might assess our capacity for implementing the SPF and effectively addressing SA and HIV/AIDS in our communities.
8. Implementing Effective
Interventions
Develop Interventions
C. Planning
D. Implementation
4. Developing a framework or
model of change
Develop Comprehensive
Strategic Plans .
5. Developing and Using
Strategic and Action Plans
Develop Action Plans

9. Building Capacity- Is it Possible?
A shoe factory sends two marketing scouts to the field to study the prospects for expanding business.
One sends back a telegram saying,
SITUATION HOPELESS STOP NO ONE WEARS SHOES
The other writes back triumphantly,
GLORIOUS OPPORTUNITY STOP THEY HAVE NO SHOES!
(The Art of Possibility, Rosamund Stone Zander & Benjamin Zander)
In order to do all this and implement programs, policies, and other changes designed to reduce the likelihood of SA and the transmission of HIV/AIDS, we’ll need to have a positive outlook and a creative approach to collaborating with our community, involving our focus populations in every step, and mobilize our resources in ways that benefit all our stakeholders.

10. Capacity - Definition The ability to mobilize stakeholders resources
…in order to implement programs, policies, and other changes designed to reduce the likelihood of substance abuse and transmission of HIV/AIDS
In the context of the SPF and this initiative, capacity means…

11. Mobilizing Stakeholders
State SA, HIV/AIDS prevention authorities (CDC, SSA)
Service recipients (substance users, injection drug users, GLBTQ populations, recovering community)
SA and HIV treatment providers, counseling services
Community-based organizations (coalitions, minority, Planned Parenthood, GLBTQ organizations, etc.)
Public health
Media
Business community (bar owners, GLBTQ-serving)
Law enforcement and justice agencies
Religious and fraternal organizations
Healthcare providers
State, local, tribal, Veteran’s governmental agencies
Others with a stake in reducing SA & HIV/AIDS
If we are to successfully use the SPF to address the unique problems, risk factors and needs of our focus population and sub-groups within that focus population in the context of our community, we will need to bring all our stakeholders to the effort, and keep them involved. We’ll need to really integrate our initiatives into the fabric of our community. And we’ll need to make sure that what we do in our project benefits all our stakeholders.
What are stakeholders? Who are our stakeholders?
We want to really involve these stakeholders in every step of developing our plan, implementing p/p/p’s, and evaluating whether our programs and services are reaching our focus population, are being implemented as planned, are having their intended effects.
Involve these folks in step 1 (how would you?), step 3 (how?) , step 4 (how?), and step 5 (how?).

12. Mobilizing Resources
Resources: the types and levels of assets that exist in a community prevention system that can help meet SA & HIV/AIDS prevention planning and implementation demands
When we think of mobilizing “resources,” we mean…
In the context of the MAI grant and the SPF, our “community prevention system” is the organizations, people, knowledge, skills, and money we can bring together into an organized way to reduce the occurrence, consequences, and risk factors for SA and the transmission of HIV/AIDS, and to increase protective factors.
How do we know what resources we have to bring to addressing the needs and gaps ID’d in Step 1 and what our community’s current capacity/ability is to reduce the consequences of SA and transmission of HIV/AIDS, change substance use and sexual behaviors, and reduce risk factors and increase protective factors in our focus populations?
Assess capacity, then develop a plan to build capacity in areas we need to, as identified by our assessment.

13. What Capacities Do We Assess?
Human capacities
Personnel
Knowledge
Skills
Fiscal
Technical
Data management
Organizational
Coalitions
What do we assess? When consider “resources,” often look at 4 types… and we assess these types of capacities.
Human-
Personnel
What staff does our project need to build our community’s capacity/ability to mobilize and organize stakeholders (ask for examples)
What staff are needed to run programs, implement policies, and make other changes to prevent and reduce the onset of SA and transmission of HIV/AIDS (ask for examples)
What staff are needed to work effectively with our identified subpopulation (ask for examples)
What kinds of knowledge are needed (ask participants for examples, e.g., knowledge of SA and HIV/AIDS transmission, knowledge of EBIs, knowledge of gate-openers, knowledge of culture and sup-population…)
What skills do they need (ask participants for examples, e.g., networking, communication, researching, writing, organizing, collaborating, evaluation…)
Fiscal
What funds, grants, other resources (media, print shops, health services, government services, business owners) exist in the community that we could collaborate with?
Technical
What resources/skills exist in our community for data collection, analysis, storage and presentation; for media production; for technical writing; for policy formation; for program delivery and management; for evaluation…
Organizational
What coalitions, community organizations, clubs, or other groups are working on these same or similar issues? What knowledge and skills do they bring?
We assess these resources/capacities and then we make a plan to build these capacities so that we can more effectively organize our communities to prevent and reduce the onset of SA and transmission of HIV/AIDS among our selected subpopulations.
So how do we know what capacities/abilities/resources we have and what ones we need to build?

14. Assessing Capacity at the Community Level
Determine what resources you have (human, technical, fiscal, and organizational) to…
collect and analyze data
assess and increase community readiness
select strategies to address needs
implement policies, programs, & practices
evaluate effectiveness
sustain efforts
We’ll identify what resources (people, money, technical- tools, organizational- coalitions/skills) we have in our cmty to…

15. Examples of Capacities
State level
Workforce knowledge, skills and competencies
Infrastructure, such as coalitions
Data systems (CDC, SSA)
Knowledge of cultural protocols in sub- populations
Sub-populations’ capacity for prevention (people, skills, funds…)
Community level
Community orgs addressing SA and HIV/AIDS issues
Leadership within the coalition and the community
Prevention knowledge at the community level
Resources allocated and available to address SA & HIV/AID
Although the MAI initiative is focused on community-level efforts, we also want to take advantage of state-level resources available to communities, that will help us mobilize and organize our community.
These are the kinds of resources and capacities states and communities might access and/or work to develop

16. How Do We Assess Capacity?
Use capacity assessment tools to:
Identify our strengths
Identify gaps in knowledge and skills, and resources
Focus capacity building where it will be most effective in meeting our goals
Cap Asst Tools can help us…

17. Capacity Assessment Form (Community Level)
Communities assess their capacity to carry out effective prevention
Assess 5 areas of capacity
Rate themselves currently
Rate how important they believe each indicator is to the success of their prevention effort
Large gap scores indicate focus areas for building capacity
Refer to Handout, “Capacity Assessment Form (Cmty)” – one example from Nebraska (others exist) – REVIEW FORM
The form can be used by both SA and HIV/AIDS prevention practitioners to assess a number of areas pertaining to their cmty’s capacity to carry out effective prevention
The form lists, in the left hand column, five areas of capacity to assess. The first four areas pertain to capacity building; the fifth pertains to sustaining capacity
Each area has a number of indicators which are presented in the form of statements.
These statements reflect ideal conditions within a cmty that will support effective prevention efforts.
Preventionists can rate their cmty against these statements.
They can then rate how important they believe that indicator, or statement, is to the success of cmty prevention efforts.
When comparing the importance of that area to how a cmty assesses itself, a gap score is determined.
Larger gap scores indicate a condition that is important to the success of prevention efforts, but on which you ranked your cmty as weak. These would be areas on which to focus when planning to build capacity at the cmty level.
Review the form/define terms- who might be the “ prevention agencies,” “ prevention system members,” “the prevention system” in a cmty? What are some examples from your own communities?
Participants: take a moment to review the “Knowledge, Skills and Abilities” section, reflecting on your own community; this reflection will prime your thinking for the Capacity Building action plan development session that follows this overview.

18. Outcome-Based Prevention
Step : Focus Capacity Building Here
Substance Abuse
& HIV/AIDS Patterns & Consequences
Contributing
Factors
Evidence-Based Programs,
Policies &
Practices
In step 2, where do we want to focus our capacity building? (C/C/IVs)
Process: Strategic Prevention Framework

19. SPF Logic Model for Reducing High Risk Drinking 18-25 y/o
Step 2: Focus Capacity Building Here
Contributing
Factors
Consumption
Pattern
Strategies
Social Norms Accepting and/or Encouraging Binge Drinking
Media Advocacy to Increase Community Concern About Binge Drinking
Young Adult Binge Drinking
This is a logic model Tracy Johnson drafted, which he’ll use in his Step 3 presentation tomorrow.
It’s a logic model for reducing high risk drinking (binge drinking) among young adults, ages
In step 2, where do we want to focus our capacity building?
In step 3, we’ll identify EVI’s (media advocacy) to address the contributing factors. At that point, where will we want to focus our capacity building (on strategies).

20. Building Capacity Identify gaps from community capacity assessment
Create an action plan to address gaps
With our state’s readiness level in mind, we want to address gaps we IDd in capacity assessment.
Refer to handout, “Capacity Building- Organizational/Infrastructure Development Logic Model” (K. Johnson)
“Organizational/Infrastructure Development” is another way of saying “Capacity Building”
This capacity building plan is equally applicable at all levels (state/cmty/org)
The model presents goals, objectives, action steps and desired outcomes for planning to build capacity (at any level.) Read the goal of capacity building in the model- what does that mean? (common language)
This is accomplished by building capacity in five areas (factors): structures and formal linkages, champion and leadership roles, resources, administrative policies and procedures, and expertise.
Address these factors through actions (assess, plan, implement, eval, reassess) to build capacity.
The center column is the Action Plan

21. MRT – Sample Entry: Advisory Group
Our Project Advisory Board includes:
State CDC and SSA representatives
Service recipients
Sub-population representatives
SA & HIV/AIDS specialists
State public health representatives
State, Tribal, Veteran’s government representatives
Now let’s take a look at what a series of MRT entries might look like for capacity.
Advisory Board – expert resources to oversee the SPF process for this initiative
You’ll have an opportunity to talk about how to build capacity around your Advisory Group and Governing Board in the action plan development session following this presentation.

22. MRT – Sample Entry: Governing Board
Our Project Governing Board includes:
Project Manager
Substance abuse experts
HIV/AIDS experts
Focus population experts
Evidence-based interventions, planning & implementation experts
Epidemiologist
Evaluator
Governing Board – oversees and facilitates the actual work involved in the SPF steps
Project Manager – knowledge of data-driven process & diverse funding resources, stakeholder connections, leadership skills
Epi – knowledge and skills in needs assessment
You’ll have an opportunity to talk about how to build capacity around your Advisory Group and Governing Board in the action plan development session following this presentation.

23. MRT – Sample Entry: Collaborators
Our Project Collaborators include:
Service recipients
Sub-population representatives
SA & HIV/AIDS specialists
GLBTQ specialists
Local public health representatives
Business representatives
Law enforcement and justice reps
Health care/service providers
Local, tribal, government representatives
Collaborators – participate in certain SPF steps (assessment, capacity, EBI selection/planning/implementation, evaluation) and assure cultural and focus population responsiveness of processes, materials, communications, programs. Assure initiative is imbedded into fabric of community, other health promotion efforts. Run everything by these collaborators.
You’ll have an opportunity to talk about how to build capacity around your Collaborators in the action plan development session following this presentation. You’ll also be addressing capacity building in relation to project staff this afternoon, although there is no “staff” MRT entry required.

24. MRT – Sample Entry: Guiding Principles
Cultural Competence
Sustainability
Continuous Quality Improvement
Participatory Involvement
Our project is fully imbedded in the community. Our collaborators provide input into each SPF step, and sub-population focus groups review all project reports, recommendations and materials.
Must show how initiative incorporating 4 guiding principles.

25. MRT – Sample Entry: Accomplishment & Barrier
An active coalition of community stakeholders with the knowledge, skills and resources to accomplish a comprehensive needs assessment has been established.
This accomplishment enhanced our project’s capacity to collect and analyze data, involve our focus population in our needs assessment processes, and identify resources and service gaps.
Document both initiative’s accomplishments and barriers.

26. MRT – Sample Entry: Accomplishment & Barrier
No centralized state or local data management system exists.
This barrier impacted our project’s capacity to easily access data across silos, centrally archive data, and compare data documented using differing protocols.

27. MRT – Sample Entry: T/TA Report
Data management TA was delivered by the Project Epidemiologist to address data recording, storage and access across silos. Topics included:
Online data reporting system
Cross-silo collaboration for data sharing
Data access protocols
Document T/TA delivered to the initiative, in this case based on capacity needs.

28. MRT – Sample Entry: Conclusions & Recommendations
A strong coalition has the knowledge, skills and resources to perform a comprehensive needs assessment.
The effectiveness of this coalition enhances our project’s capacity to understand the impact of SA and HIV/AIDS within our target population and our community, & to utilize focus groups to understand what is required in order to address these needs.
Conclusion statements can focus on strengths of the initiative or can be more holistic in nature.

29. MRT – Sample Entry: Conclusions & Recommendations
A coordinated data management system is needed to enhance the utility and application of needs assessment data.
A coordinated data management system would enhance our project’s capacity to ensure a comprehensive, accurate needs assessment, easy access to data recorded using common protocols, and effective data comparisons.
Statements of recommended improvements or enhancements to the prevention system which would increase the effectiveness of the initiative and/or recommended improvements of the initiative itself.

30. Ensuring Cultural Competence in Capacity Building
“A set of behaviors, attitudes and policies
that come together in a system, agency, or
program or among individuals, enabling
them to function effectively in diverse
cultural interactions and similarities within,
among, and between groups.”
Source: U.S. Department of Health and Human Services
Haner
The purpose of integrating Cultural Competency in the SPF process is to ensure that Substance Abuse and HIV/AIDS Prevention services are assessed, developed, delivered, and evaluated based on a comprehensive understanding of the specific cultural characteristics and needs of the priority populations selected by the community-based organizations providing integrated services to at-risk minority populations.

31. Integrating Cultural Competence into Capacity Building
Key Questions:
How do we examine community resources and readiness?
► Key Stakeholders
► Gate Keepers and Gate Openers
► Collaborating Partners
► Existing Services and Resources
► Non-traditional Networks and Support Systems
Haner

32. Integrating Cultural Competence into Capacity Building
Key Questions (continued):
What policies are in place or need to be developed to improve cultural competence?
► Recruitment
► Retention
► Training
► Communications
► Community Input
Haner

33. Ensuring Cultural Competence in Capacity Building
How do we identify and mobilize mutually acceptable goals and objectives?
► Collaborative Process
► Dynamic and Fluid
► Sometimes feels “messy”
► Negotiating Differences
► Representation
Haner

34. Ensuring Cultural Competence in Capacity Building
How do we check cultural representation?
► Language
► Gender
► Age
► Ability
► Education
How do we ensure tools and technology are culturally competent?
How do we ensure a safe and supportive environment for all participants?
Haner

35. Elements of Sustainability in SPF Step 2: Capacity Building
What elements of sustainability are present in Step 2?
How do we know if those elements are present (what are possible indicators, and how can we began to measure them)?
>>>Guiding questions
Marcus

36. Action Areas For SPF Step 2: Capacity Building
1. Structures and Formal Linkages
2. Policies and Procedures
3. Resources (step 2)
4. Expertise
5. Quality and Accountability
6. Effectiveness
7. Reach and Alignment
8. Relationships (step 2)
9. Champions
10.Ownership
Marcus

37. Guiding Questions for Step 2: Capacity Building
Are key community stakeholders supportive of the goals and efforts of the SPF process?
Are any of these relationships creating a barrier to achieving, demonstrating, or sustaining the strategy’s positive outcomes of our SPF process?
Which current resources are needed to carry out a plan to address the issues identified in Step 1?
Of these resources, which is insufficient or is vulnerable?
How have you communicated your evaluation needs and expectations to your evaluator?
Marcus

38. Capacity Building IS Sustainability Building capacity of:
Staff (knowledge and skills related to data, sub-populations, SA & HIV/AIDS issue expertise)
Funding (diversify, resource-sharing, non-traditional, private, public)
Technical capacity (data management, access to training needed to implement p/p/p’s)
Organizations (coalitions, sub-population representation, community groups, issue experts)
CREATES sustainability. If these capacities are high, your project is sustainable. This takes an alert project manager keeping an eye on the big picture and creating buy-in and multiple champions in various sectors of the community.