Download presentation
Presentation is loading. Please wait.
Published byJob Gray Modified over 9 years ago
1
Implementing and Evaluating Evidence-based Strategies
*This session includes deeper evaluation measurement content continued from the Planning Evaluation session. Talking Points: We covered Planning for Evaluation early in this training before the Finding, Selecting, and Adapting sessions. This helps you keep evaluation in mind throughout the planning process. Now we will delve deeper into implementation and evaluation plans as they apply to existing evidence-based approaches.
2
Implementing & Evaluating
Where do We Stand? Establishing Goals & Objectives; Planning for Evaluation Assessing your Community Finding Evidence Selecting Best Fitting EBAs Adapting Talking Points: At this point in the process, you have selected an evidence-based approach that is compatible with your community and context. You have also considered how to adapt it to increase fit. Now strategic implementation plans are needed to ensure implementation fidelity and quality. Alongside the implementation plans, a detailed evaluation plan should include both process and outcome measures of success. Implementing & Evaluating
3
Session Objectives Describe successful program implementation
Discuss the importance of community engagement, partnerships, and collaborations to implement programs Describe key tasks in planning, implementation, evaluation and maintenance Develop an implementation and evaluation work plan integrating RE-AIM measures that match program objectives and activities Talking Points: In this session, we will: Describe what successful (or quality) program implementation means in the context of your stakeholders and community. Discuss the importance of community engagement, partnerships, and collaborations to implement programs. Describe key tasks in planning, implementation, evaluation, and maintenance of an evidence-based approach. Develop implementation and evaluation work plans integrating RE-AIM measures that match program objectives and activities.
4
Intervention Planning Model
Community Assessment Develop Goals & Objectives Plan the Intervention Finding, Selecting and Adapting an Evidence-based Approach Assess Readiness Share your successes *** Apply lessons learned to Maintain and Sustain the intervention Evaluate Processes Talking Points: This flow diagram summarizes the Intervention Planning steps we’ve covered in this training. Here we focus on the implementation and evaluation measurement steps. We also should remember plans to disseminate results and apply what we have learned for long-term sustainability. Evaluate Outcomes Implement
5
Planning Steps Enlist community/stakeholder input
Use existing committees Understand current context, policy or environment Best communication/outreach strategies Understand context, fit, and your readiness Incorporate previous needs assessment data Know your organizational culture related to health Draft work plan for program, policy, strategies Research any previous interventions for useful content/language Receive feedback from expert panel Talking Points: Before implementation, there are key planning steps to strategically work on prior to initiating activities. Community stakeholder engagement is crucial in multiple ways. You may find pre-existing infrastructure and committees (e.g., health ministry) to involve in planning which would also promote sustainability later. This group could provide insight into the context and successful communication methods that you may not have otherwise predicted. Understand context, fit, and your readiness Using existing assessment data and knowledge of the culture can help you predict barriers and address them early. This understanding can also help you start at the appropriate readiness level so the community may be more accepting of the messages. Throughout planning and implementation, keep in mind the goal to maintain fit/compatibility between your context and the EBA. Draft work plan for program, policy, strategies As we mentioned early in the training, one benefit of using EBAs is that there may already be existing materials, language, content, work plans, checklists, and evaluation tools that you could use. Then you don’t have to start from scratch or reinvent the wheel. Remember to ask experts for input into work plans to catch areas for improved reach, retention, implementation feasibility, etc.
6
Planning your implementation and evaluation: Review Materials
Talking Points: Refer to the intervention materials you gathered while you were selecting an evidence-based option. You may want to gather more detailed or updated materials as you begin to plan implementation and evaluation. The intervention developers may also be able to share evaluation instruments and updated materials.
7
Policy Process Guides Talking Points: Evidence-based policies and environmental changes may have different support materials such as guides for process steps, example model policy language, or case study examples from successful initiatives. Read carefully through the steps to implement, timeline, and resources to implement. It helps to review existing materials when developing the implementation and evaluation plans.
8
Assess Readiness Do you have: Supportive leaders? Engaged partners?
Resources (money, staff, supplies)? Staff with knowledge, skills, and enthusiasm? Accounting and administrative structures? System for monitoring progress/evaluation? Refer to implementation guides and protocols for resources needed Talking Points: In planning for implementation, you will need to get your organization prepared. Ask the Audience: What are other ways you might assess your organization’s readiness for implementation? Share examples from experience about readiness or lack of readiness, if appropriate. Examples to Share: Hiring staff or recruiting volunteers Engaging stakeholders in evaluation planning Program staff orientation Program/Policy/Strategy overview (e.g., core elements/components or key steps for implementation, outcomes) Materials Logistics Strategize to engage leaders, purchase supplies, train staff, work with champion to engage staff, and plan for engaging partners.
9
Readiness Checklist for Body and Soul
Assess Organizational Readiness Readiness Checklist for Body and Soul *Refer to Organizational Readiness Checklist as a reference (not as an activity). This tool can be shared as early as the Community Assessment or Selecting an Option modules. Talking Points: This is an example of a tool that could be used to asses organizational readiness to implement an EBA. It can also help you improve your readiness by thinking about how to build your capacity to implement a program, policy, or strategy. The 1st column considers your capacity and resources such as staffing and training. You check the 2nd column for “Yes” if your organization already has this capacity. Check the 3rd column if you do not presently have this capacity, but could easily build capacity. For example you may easily be able to build capacity through a training, webinars, recruiting experts for the committee, or partnering more closely with a person or group in the immediate community, etc. The next column is “No” for “We do not have this capacity.” and it would be hard to obtain. The Comments field should capture reasons for the responses and brainstorm ideas how to build capacity. If your organization lacks capacity in many areas on the checklist, you could also reconsider if this EBA may not be the most compatible fit at this time.
10
What leads to implementation quality?
Community level engagement (funding, policy, politics) Provider/implementer characteristics Need for innovation Benefits of innovation Self-efficacy Skill proficiency for implementation Talking Points: As you plan an implementation work plan, keep in mind there are certain characteristics that lead to implementation quality and higher levels of fidelity, as discussed in the previous session. Community level engagement (funding, policy, politics) – A supportive community environment is important. This may include funding support from leaders, supportive pre-existing policies, or a political dynamic that facilitates your work. Provider/implementer characteristics – The key individuals involved can affect implementation quality. The champions, main stakeholders, and especially the implementers need to see the: Need for the innovation or EBA Benefits of innovation/EBA Self-efficacy – They should think they are capable of delivering the EBA. Skill proficiency for implementation – They should actually possess the skills or training needed to implement the EBA. Durlak, J.A., & DuPre, E.P. (2008) Implementation matters: A review of research on the influence of implementation of program outcomes and the factors affecting implementation. Am J Com Psych. 41:
11
What leads to implementation quality?
Implementers’ organizational capacity General organizational factors (vision, norms, climate) Specific processes (decision-making, partnerships, communication) Staff considerations (leadership, champion) Prevention support Training Technical assistance Talking Points: Implementers’ organizational capacity General organizational factors (shared vision, organizational norms, positive work climate) Specific processes (shared decision-making, engaged partnerships, efficient communication, clear delineation of tasks) Staff considerations (enthusiastic leadership, consistent champion, sufficient management support) Prevention support is critical, especially for the implementers to understand the EBA deeply and implement it well. Training - especially important at the beginning to understand the EBA core elements, key process steps, and logistics. Training builds skill and capacity needed before and during implementation. Technical assistance – ongoing consultation help may be needed to answer questions as they arise, address barriers, and adapt according to situations. Durlak, J.A., & DuPre, E.P. (2008) Implementation matters: A review of research on the influence of implementation of program outcomes and the factors affecting implementation. Am J Com Psych. 41:
12
Create a Work Plan Ideas from your Organizational Readiness Assessment
Your Work Plan for Implementing and Evaluating Body and Soul Talking Points: A work plan can be developed by considering the original program materials, readiness assessment, selection, and adaptation tools. Ideas about adaptation should be incorporated in the work plan.
13
Components of a Work Plan for Implementation
SMART Objectives List of tasks or activities for each Objective Person responsible Resources needed Target completion dates Indicator(s)/Measures of completion or progress Talking Points: In creating a work plan, you may want to create a table with the columns appropriate for your programs or policies. These are some examples: SMART Objective Activity Person responsible Resources Needed Due Date or Date Range Indicator(s) of completion or progress
14
Example: Work Plan for Body and Soul
* Provide this as a handout so participants can see it. Presenter can modify using other examples. Talking Points: Here is an example of a work plan for the Body & Soul program. A more legible hard copy should also be included in the materials. *Walk through one row of this example if time permits: Let’s look at Row #2
15
Example Work Plan Talking Points:
The SMART Objective is to “Host 4 of more church-wide activities to promote healthy food.” The Activities column includes a Lunch with the Pastor, annual picnic, Fall Festival and Spring Health Fair. The health ministry director and pastor are responsible parties.
16
Example Work Plan Talking Points:
They will need resources such as pastor support, facilities for events, and volunteers to run events. There is a due date noted (and work plans should be modified as timelines change) The indicator of completion or progress will be captured in activity reports and participant sign-in logs.
17
Definitions of Workplan Steps: Policy & Environmental Change
Review evidence/data on the problem and potential solutions Gain stakeholder agreement on priority problems and preferred approaches, Draft policies in the form of rules/laws Formulation Identify decision makers who will sponsor or promote the policy Formally pass the policy in the form of a law, regulation, or budget Put environmental change in place (ex: inaugurate walking trail) Communicate the new policy/environmental change Enactment Monitor and document the use of the policy Continue promotion, operationalization, and use of the policy Conduct activities that support compliance to the policy Establish a plan for enforcement Implementation Maintain policy implementation Ensure sustained effect through monitoring and enforcement Possibly make further policy modification Maintenance Talking Points: Policy and environmental change is slightly different than program implementation. The four phases are: Formulation, Enactment, Implementation, Maintenance. There are nuances in planning policies that are different from programs: The Formulation or planning stage could take longer. For organizational policy, boards or leadership may need to formally approve policy change. Legislative policy needs to go through advocacy and voting. The Enactment phase is the launch, inauguration, or kick off set for a policy to take effect or an environmental change is made available. Planners need to communicate, promote, advocate and/or enforce (e.g., memo/briefs, media kits, media channels, events, meetings). Preparation should be made for how to maintain changes over time (e.g. upkeep of trails) or how to continue enforcing policies. Share Examples with the Audience: (from your experiences and work) For example, if using a Walking Trail intervention, how do you create walking trail and promote use over time? Examples of policy enactment and communication: Signed/dated policy document to start paid time off for cancer screening Policy posted and announced by to employees Examples of Environmental change enactment and access: Walking trail completed and opened for use Healthy options made available in cafeteria Longest Jr. BB. (2009) Health Policymaking in the United States, 5th Ed.
18
Activity: Create an Implementation Work Plan
Talking Points: Please pull out several handouts for this activity including: Example Implementation and Evaluation Work Plan – Body and Soul Program (from the previous slide examples) The information sheet pictured here: Evaluation Work Plan Activity: Tobacco Use Prevention Policy – Process Steps
19
Activity: Create an Implementation Work Plan
Talking Points: And please pull out this blank handout: Implementation Work Plan: Tobacco Use Prevention Policy
20
Activity: Create an Implementation Work Plan
Review the handout on the Tobacco Use Prevention Policy Strategy Choose at least 1-2 of the objectives already provided or write your own (for a worksite or faith setting) For the objective(s) you chose, add: One or more activities Who would be responsible for each activity? What resources are needed? What is the completion date or due date? What are your measures/indicators of completion or progress? *Allow 15 minutes for small group discussion and 5 min to share example activities on the work plan. *Review and explain the handout on the Tobacco Use Prevention Policy Strategy with worksite and faith setting examples. *Ask them to discuss in small groups of 4-6 people. They can choose whether they prefer a worksite or faith setting. Activity Instructions: Choose at least 1-2 of the objectives already provided on the blank work plan handout. For the objective(s) you chose, write: One or more activities Who would be responsible for each activity? What resources are needed? What is the completion date or due date? What are your measures/indicators of completion or progress?
21
Implementation Work Plan Discussion
4. Share different examples from the groups. Specify if you chose a work site or faith setting. Explain which objective you chose. Discuss: activities, responsible persons, resources, dates, and measures of completion or progress *Spend about 5 minutes discussing in a larger group. Activity Instructions: Share different examples from the groups. Specify if you chose a work site or faith setting. Explain which objective you chose. Discuss: activities, responsible persons, resources, dates, and measures of completion or progress
22
EVALUATION Work plans have many of the same elements
SMART Objectives Activities for each Objective Indicators/Measures (of completion or progress) Person responsible Resources needed Target completion dates Processes for monitoring, reporting, modifying implementation and evaluation plans for evaluation activities Data sources Actual completion dates Talking Points: Evaluation work plans may be similar to implementation plans, but focus on ways to measure the process and outcomes through data sources and data collection methods that match objectives and activities.
23
If you are adopting an existing evidence-based program, policy or other strategy...
Conduct formative evaluation on adapted materials Feedback from expert panel Focus groups/discussion with target populations Pilot testing If it was evaluated before, you can use prior process and outcome indicators, methods, and tools What outcomes were measured? How rigorous was the original evaluation? Do you have resources to do a similar evaluation? Monitor fidelity of implementing core elements and key process steps (process evaluation) Talking Points: If any materials or processes have been adapted from the original program, policy or strategy; formative evaluation should be conducted. This was mentioned earlier in the Adapting session that feedback from experts, pre-testing, and pilot testing should be done as part of the evaluation process. If the program, policy or strategy is research-tested, you can focus on implementing a good process and short-term outcome evaluation. If it is practice-based evidence, then there may be pre-existing tools available. The health outcomes are still the objectives to aim for, but it may be best to focus energy on process and short term outcomes. If the process evaluation shows that the strategies were implemented with high quality and fidelity, research suggests that health outcomes are likely to follow. It is also important to monitor the fidelity of implementation using process evaluation. You can track implementation of core elements and key process steps used in the original intervention.
24
Evaluation – Using RE-AIM
REACH your intended target population EFFECTIVENESS or efficacy ADOPTION by target staff, settings, or institutions IMPLEMENTATION consistency, costs and adaptations made during delivery MAINTENANCE of intervention effects in individuals and settings over time Talking Points: RE-AIM is a useful tool for selecting, implementing and evaluating interventions. As a refresher from other sessions, the acronym stands for: REACH your intended target population EFFECTIVENESS or efficacy ADOPTION by target staff, settings, or institutions IMPLEMENTATION consistency, costs and adaptations made during delivery MAINTENANCE of intervention effects in individuals and settings over time Re-aim.org has useful tools to use the framework. Here we will use it to think of how we will measure process and outcomes.
25
How many organizations adopt an EBA?
OPTIONAL SLIDE Talking Points: Some of the useful tools are highlighted here: Calculators for Reach, Adoption and Impact.
26
Adoption Calculator OPTIONAL SLIDE Talking Points:
This is an example from the adoption calculator tool.
27
Evaluation Phases Planning
Consult with the program stakeholders or resources Develop the questions Identify sources of data Make a timeline Data Collection Pilot test How will the questions be asked? Who will ask them? Data Analysis Who will analyze the data and how? Reporting Who will report and how? Who will receive the data and when? How will it affect the program? Talking Points: There are different phases to evaluation that overlap with implementation phases. This table shows some questions to think about in each phase. Also remember: Planning for implementation should also include planning for evaluation. Data collection and some data analysis (for process evaluation) should occur during and towards the end of implementation. Reporting may also occur mid-way through implementation and after implementation.
28
Gather Credible Evidence
Methods and Measures Evaluation questions Indicators Talking Points: Evaluation questions should drive what is measured. It can be tempting to measure what we know would be easy information to gather. But the main objectives and evaluation questions should determine the indicators of success and methods. The existing data and data collection tools should not be what drives the evaluation. (not the other way around)
29
Gather Credible Evidence
4/20/2017 6:37:48 AM Gather Credible Evidence Link each indicator to a data source Look for existing data If there are no data available – collect your own Look for existing data collection tools If there are no existing tools – create your own Data collection plan Who will collect? How will it be collected? When and How often will it be collected? Talking Points: Each indicator of success should match to a source from which to pull or gather data. That may be an existing data source or records. But if that does not exist, the data may be collected through other instruments that you develop. This may include activity logs, observation, surveys, or focus group guides.
30
Evaluation for Programs
Track program promotion and/or recruitment (# flyers, frequency of announcements) Document implementation of program core elements or key process steps (e.g., checklists, length & # of sessions, meetings) Collect process measures (e.g., attendance, timeline/work plan updates, etc.) Monitor program activities and performance (# of new screenings, timeliness of diagnosis) Talking Points: * Use personal examples from your work. Evaluations help to: Track program promotion and/or recruitment (# flyers distributed, frequency of announcements/listserv s sent, count other communication methods). Document implementation of program core elements or key process steps (e.g., check list for each component, length & # of sessions, notes for advisory committee meetings). Collect process measures (e.g., attendance logs, adherence to timeline and work plan, update the work plan to capture summaries). Monitor program activities and performance (# of new screenings, timeliness of diagnosis, note barriers and lessons learned). Ask the Audience: What other methods have you used to evaluate programs?
31
Evaluation for Policies
Document and publicize policy Track implementation of key process steps of the policy Documentation of policy Procedures for policy Communication Enforcement Collect process measures on benchmarks Track participants in policy planning (partners) Revisions of policies Advocacy efforts (e.g., media outlets, events) Adoption and enforcement Talking Points: *Use and tailor personal examples from your work. Document and publicize policy – The policy language should be clearly written, posted officially, and shared publicly. Track implementation of key process steps of the policy Documentation of policy - Policy language can be compared to existing model policy language used elsewhere from credible sources. Procedures for policy – Document when and how the policy was officially enacted. Was proper protocol used to carry out the policy? Communication – List ongoing ways, places, and frequency the policy was communicated (e.g. website, , meetings, human resources). Enforcement - Document how, where, and how frequently non-compliance is addressed with what groups of people. Collect process measures on benchmarks Track participants in policy planning (#partners, # reached by policy) Revisions of policies (note how frequently policy is enhanced or edited) List advocacy efforts (e.g., # media outlets, events, policy briefs, meetings with decision-makers, action alerts, letters to the editor) Adoption and enforcement (check if the policy is still in place over time and if/how it is enforced– interviews, observation, surveys) Ask the Audience: What other ways can you evaluate policies?
32
Example Evaluation Plan: Body and Soul
* Can refer to handout to read more legibly. Talking Points: Here are example evaluation questions, data sources, and data collection methods from Body & Soul. Start with your objective to create a matching evaluation question. Data sources may include notes, activity logs, surveys, official policy language, and interviews. Data collection methods could include reviewing those program documents, and conducting surveys and interviews.
33
Example Evaluation Plan: Body and Soul
Talking points: In our earlier example from Objective #2, these data sources and data collection methods will help answer the evaluation questions: Ask the audience: Were all 4 events completed? (Use document review to pull information from activity report summary.) To what extent did church members participate? (Use document review of the logs that capture the number of participants. The logs could be used to determine reach: participants/church members.)
34
Discussion: Develop an Evaluation Plan
* The presenter or groups can use this blank worksheet in their binders as reference or use it to write down their ideas (as individuals or as a group). This may depend on how much time the presenter has. Talking points: You can refer to this blank worksheet as we discuss the next example. Feel free to jot down some ideas or just use it to think about the discussion questions.
35
Develop an Evaluation Plan
Discussion: Develop an Evaluation Plan Refer to the SMART objective you chose in the work plan activity. Discuss evaluation question(s) that measure success of that objective. What are potential data sources to find this information? What are some methods you can use to measure these processes or outcomes? (e.g. logs, surveys, etc.) *20 min version: Allow 15 minutes for small group discussion and 5 min to share potential data sources and methods. *5-10 min version: The presenter can choose 1 SMART objective from the work plan activity to do together as a large group. The presenter may already recall some of the more interesting or relevant issues that arose in the work plan activity. The participants can discuss evaluation questions, data sources and methods to measure that objective. Activity Instructions: Refer to the SMART objective you chose in the work plan activity. (from earlier in this session) Discuss evaluation question(s) that measure success of that objective. Think about how you would know if you reached your objective. What are potential data sources to find this information? Keep feasibility, resources, and capacity in mind. What are some methods you can use to measure these processes or outcomes? (e.g. logs, surveys, pre-tests, post-tests, etc.) * Discuss the feasibility, capacity, and logistics of how they might collect and analyze that data from both existing sources and primary data collection they gather themselves. Also remember who the audiences and stakeholders are for the evaluation outcomes. *You may refer to the Evaluation Designs handout that is provided as reference as well.
36
Intervention Planning Model
Community Assessment Develop Goals & Objectives Plan the Intervention Finding, Selecting and Adapting an Evidence-based Approach Assess Readiness Share your successes *** Apply lessons learned to Maintain and Sustain the intervention Evaluate Processes Talking Points: Once we’ve strategically planned implementation and evaluation, we should remember to disseminate results by sharing successes and lessons learned with stakeholders. We should also brainstorm practical ways to apply what we have learned for long-term sustainability. Evaluate Outcomes Implement
37
Share Evaluation Results
Use your evaluation findings to modify your program describe program benefits and challenges Reach all stakeholders inside and outside your organization In language and formats that everyone understands In time to make decisions Talking Points: Process evaluation findings can be utilized mid-implementation to change course and improve the direction of the program reach, retention, and implementation quality. Dissemination of findings can also be done in the midst of implementation to receive stakeholder feedback. Consider how each audience may want to receive the information, in what format and length (e.g. webinar, newsletter, detailed report, meeting presentation, etc.).
38
Maintenance…Plan for Sustainability
Sustainability is… … the existence of structures and processes which allow a program to leverage resources to most effectively implement evidence-based policies and activities. Talking Points: Maintenance plans should also be considered part of the work plan from the beginning program planning and in the midst of implementation. Stakeholders should consider the realities and feasibility of what can be maintained long term with or without funding. Example to Share: Policies may not cost financial funds to continue, but may require staff time investment to remind, communicate, and enforce on an ongoing basis. Luke D, Calhoun A, Herbers S. (Feb 2012). Building & Managing Sustainability in Public Health Programs. CDC Roundtable Presentation.
39
Maintenance Activities
Leverage resources to sustain interventions over time: Provide referrals for further service, when needed Seek additional funding Maintain or secure a program champion Make program a part of organizational services/policies Surveillance of the impact over time (e.g., tracking of smoking rates, BMI of children, screening) Demonstrate return on investment/cost savings to justify investment of other stakeholders Continue partnerships or build new ones to share costs and implementation delivery Talking Points: Leverage resources to sustain interventions over time. Maintenance activities may include: Provide referrals for further service to other appropriate organizations or networks that already do similar work (e.g. referral to tobacco quitlines, community health centers). Seek additional funding (and collaborators that will strengthen funding proposals). Maintain or secure a program champion - preferably find multiple champions or those that can train protégés. Make program a part of organizational services/policies – integrate the EBA into existing annual infrastructure or annual plans. Surveillance of the impact over time (e.g., tracking of smoking rates, BMI of children, screening). Demonstrate return on investment/cost savings to justify investment of other stakeholders (e.g. patient reminders reduce no-show rates and lost revenue). Continue partnerships or build new ones to share costs and implementation delivery (e.g. one group may do outreach and partner with a clinic to do screenings). Ask the Audience: What are other ways you might seek to maintain activities long-term?
40
Sustainability Planning Resources
Talking Points: This is one resource for planning for sustainability from Washington University. The online Program Sustainability Assessment Tool allows you to rate your program across 8 sustainability domains. It includes a framework, definitions, and an assessment tools. You can use these results to engage in sustainability planning. Schell, S.F., Luke, D.A., Schooley, M.W., Elliott, M.B., Herbers, S.H., Mueller, N.B., & Bunger, A.C. (2013). Public health program capacity for sustainability: A new framework. Implementation Science, 8(15).
41
Take-home Points: Importance of Implementation and Evaluation
Successful implementation and evaluation requires detailed, advanced planning Involve partners from the beginning to implement with high quality Assess organizational readiness and build capacity Use and adapt pre-existing guidance and tools RE-AIM can be helpful to measure success in meeting objectives Use evaluation findings and lessons learned to plan for long-term sustainability Talking Points: Successful program implementation and evaluation requires detailed, advanced planning (i.e., workplans). Partners and stakeholders should be involved from the beginning to implement with quality and higher levels of fidelity. Planning for implementation should include assessing your organizational readiness and building capacity for readiness. Implementation and evaluation of EBAs can utilize and adapt pre-existing plans, guidance and measurement tools from the original intervention. The RE-AIM framework can be useful in the planning process to measure success in meeting objectives. We should use our evaluation findings and lessons learned to plan for long-term sustainability.
42
Questions? What questions do you have about evaluation?
Similar presentations
© 2024 SlidePlayer.com. Inc.
All rights reserved.