1. Home Visiting in Tribal Communities: Using the OPRE Review One Sky Center R. Dale Walker, MD Douglas A. Bigelow, PhD 19 February 2011

2. Outline Frameworks for use in planning Logic model details Cultural appropriateness criteria Intervention details Creating, operating a planning coalition 10/24/20152Using the OPRE Review

3. Developing a Community-Driven Best Practice Goal: An evidence-informed, community-driven program 1.Community Assessment & Planning Process: 2.Cultural 2.Cultural Validity 3.Evidence-informed program design  Coalition  Criteria  Logic Model 10/24/2015Using the OPRE Review3

4. Best Practice includes Culture Best Practice PracticeCultureScience 10/24/2015Using the OPRE Review4

5. Practice (Service) Culture  Philosophies  Belief about causes of problems and solutions  Local innovation, trial and error  Medicinal use of wild plants and minerals  Healing procedures  Oral transmission of knowledge  Community evaluation and acceptance Best Practice Science & Scholarship 10/24/20155Using the OPRE Review

6. Parent Knowledge Skills Motivation Performance Home Visiting Education Training/Demonstration Support/Encouragement Linking Child Safe Healthy School ready Culture Vision/Aspiration Morale Values Principles Stories Images Local Context Employment Housing Recreation Community Activities/Events Social Structure Politics Services/Resources Income support LE/Justice Physical MD Mental Health Sobriety Education Food Emergency Shelter 10/24/20156Using the OPRE Review

7. Parent Knowledge Skills Motivation Performance Home Visiting Education Training/Demonstration Support/Encouragement Linking Child Safe Healthy School ready Culture Vision/Aspiration Morale Values Principles Stories Images Local Context Employment Housing Recreation Community Activities/Events Social Structure Politics Services/Resources Income support LE/Justice Physical MD Mental Health Sobriety Education Food Emergency Shelter 10/24/20157Using the OPRE Review

8. Parent Knowledge Skills Motivation Performance Home Visiting Education Training/Demonstration Support/Encouragement Linking Child Safe Healthy School ready Culture Vision/Aspiration Morale Values Principles Stories Images Local Context Employment Housing Recreation Community Activities/Events Social Structure Politics Services/Resources Income support LE/Justice Physical MD Mental Health Sobriety Education Food Emergency Shelter 10/24/20158Using the OPRE Review

9. Parent Knowledge Skills Motivation Performance Home Visiting Education Training/Demonstration Support/Encouragement Linking Child Safe Healthy School ready Culture Vision/Aspiration Morale Values Principles Stories Images Local Context Employment Housing Recreation Community Activities/Events Social Structure Politics Services/Resources Income support LE/Justice Physical MD Mental Health Sobriety Education Food Emergency Shelter 10/24/20159Using the OPRE Review

10. Parent Knowledge Skills Motivation Performance Home Visiting Education Training/Demonstration Support/Encouragement Linking Child Safe Healthy School ready Culture Vision/Aspiration Morale Values Principles Stories Images Local Context Employment Housing Recreation Community Activities/Events Social Structure Politics Services/Resources Income support LE/Justice Physical MD Mental Health Sobriety Education Food Emergency Shelter 10/24/201510Using the OPRE Review

11. Parent Knowledge Skills Motivation Performance Home Visiting Education Training/Demonstration Support/Encouragement Linking Child Safe Healthy School ready Culture Vision/Aspiration Morale Values Principles Stories Images Local Context Employment Housing Recreation Community Activities/Events Social Structure Politics Services/Resources Income support LE/Justice Physical MD Mental Health Sobriety Education Food Emergency Shelter 10/24/201511Using the OPRE Review

12. Logic Model 1. Causes Goals 2. Target Population Intervention Outcomes 10/24/2015Using the OPRE Review12 4. Theory of Change 5. Operations Manual 3. Strategy 8. Long term (Impact) 7. Medium term 6. Short term

13. 1. Causes Problem Injury Lack of development Not ready for school Causes Parenting role performance Family strength/dysfunction External factors 10/24/201513Using the OPRE Review

14. 1. Causes Goals Parent Delivery (birth) Parenting knowledge – (of child development) Parenting skills Non-abuse Non-neglect Child Cognitive & emotional development Health School readiness (ameliorated developmental delays, if any) 10/24/201514Using the OPRE Review

15. 2. Target Population Kids are the TP Abused kids Neglected kids Developmental deficiency (re school) – Physical – Cognitive – Emotional 10/24/201515Using the OPRE Review

16. 3. Intervention Strategy In home (“place- based”) Trained Peer-parents Professional staff – (RNs; MSWs) Links to resources – Navigate and access Parent needs – Counseling – Problem-solving – Access to resources Income; education; employment; treatment Context-specific needs – Culture – Family dynamics – Employment – Neighborhood 10/24/201516Using the OPRE Review

17. 3. Strategy: Visits Content (visit) Frequency/intensity – One per week Duration – 3 months to 2 years 10/24/201517Using the OPRE Review

18. 4. Theory of Change Place-based Staff characteristics Local context and culture 10/24/201518Using the OPRE Review

19. Cultural Intervention: Criteria for Cultural Validity Longevity Teachings (based on) Values (based on; incorporated) Principles (based on; incorporated) Elder’s approval Community feedback/evaluation/acceptance Contribution to advancement of the people Using the OPRE Review1910/24/2015

20. Activities Intervention: Activities Experience, observation, listening, participating Traditions, ceremonies, daily observances Stories, songs, artwork Oral, modeling, practice, animation Language, worldview, teachings, experience Using the OPRE Review2010/24/2015

21. Materials Intervention: Materials Settings Dress; Regalia Symbols; Graphics; Pictures Sensory Substances Food Food Fun Fun 10/24/2015Using the OPRE Review21

22. Personnel Intervention: Personnel Enthusiasm Confidence Caring, compassion Vision, knowledge Charisma Credibility Community status Community status Peer group status Peer group status 10/24/2015Using the OPRE Review22

23. 5. Program Manual Intervention activities Materials Personnel characteristics Training and supervision Detailed procedures Process milestones Short-term outcomes Long-term outcomes 10/24/2015Using the OPRE Review23

24. 6. Short-term Outcomes Parents’ knowledge Parents’ attitudes (incl. bonding) Parents’ skills/performance Child health 10/24/201524Using the OPRE Review

25. 7. Medium-term Outcomes Child development Child school readiness Child school performance Child health and thriving Family strength and function 10/24/201525Using the OPRE Review

26. 8. Long-term Outcomes Parental health and thriving School enrollment, retention, achievement, and graduation rates Non-delinquency Child-as-adult Employment 10/24/201526Using the OPRE Review

27. Create a Coalition Agreed-upon goals Vision & mission statements Action plan Structure for the coalition Identify need for specialists Resources (coalition ideas from the University of Kansas Community Tool Box http://ctb.ku.edu) http://ctb.ku.edu 10/24/2015Using the OPRE Review27

28. Coalition Rules  Open communication  Inclusive & participatory  Constant networking  Achievable goals  Creative meetings  Keep promises  Acknowledge and use the diversity of the group 10/24/2015Using the OPRE Review28

29. Coalition  Train leaders in all sectors that have the vision, commitment, and respect necessary to lead a collaborative.  Identify a facilitator to bring the different groups together.  Find the information necessary to understand issues and possible solutions.  Promote community empowerment.  Identify the stakeholders.  Make a commitment to collaborate.  Establish procedural ground rules.  Teach potential participants process skills.  Build trust, learned process skills, and explored beliefs.  Identify problems.  Clarify a vision and develop a mission statement.  Keep the process open and get input from community members.  Create options for solving problems.  Formulate goals, objectives, and an action plan.  Implement the action plan.  Evaluate the results.  Celebrate every success, large and small 10/24/2015Using the OPRE Review29

30. Action Plan (Coalition) Who, what, when action plan Resource plan Communication plan – (who should know what?) Ensure follow through on plan Keep track of progress Keep everyone informed Celebrate 10/24/2015Using the OPRE Review30

31. 31 Contact us at 503-494-3703 E-mail Dale Walker, MD onesky@ohsu.edu Or visit Contact us at 503-494-3703 10/24/2015