Transcript Adaptation of Evidence

Welcome to the Acción Mutua web-seminar:
Adaptation of Evidence-Based Interventions:
An Overview
Before we begin, a little about our format…
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Presentation by seminar speakers (approx. 45 min.)
 Followed by question and answer session
(approx. 15 min.)
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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 [email protected]
(310) 794-0619 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
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Infectious Diseases
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Substance Abuse, Mental Health
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CDC – DEBIs (Diffusion of Effective Behavioral
Interventions)
NIDA – ATTN (Addiction Technology Transfer
Network)
SAMHSA – NREPP (National Registry of
Evidence-based Programs and Practices)
Health Care/Services
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AHRQ – PPIP (Put Prevention Into Practice)
NCI – RTIPS (Research Tested Intervention
Programs)
CDC DEBI Website
www.effectiveinterventions.org
SAMHSA NREPP website
www.modelprograms.samhsa.gov
Key Concepts and Terms
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Evidence-based intervention
Adaptation & reinvention
Core elements and key characteristics
Fidelity
Technology transfer and exchange
What is Evidence-Based?
(CDC 2003, 2006, 2007)
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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)
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Core elements
 Directed to identifiable target population, welldefined 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)
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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
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Renaming intervention
Formally evaluating prevention outcomes
Ensuring behavioral outcomes were achieved
What are Core Elements?
(CDC, 2003, 2006)
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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)
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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)
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Adherence
 Was intervention delivered as planned?
 Dose
 What sessions of the intervention were
dropped? Shortened? Added?
 Quality of delivery
 How skilled were facilitators in
conducting intervention activities?
 Participant responsiveness
 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)
• Expanded POL training on HIV and STDs
• Communication style module changed to be more
culturally appropriate, non-linear
• Inclusion of referral making in conversations
 Reinvention
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May be necessary because of new target
population or setting
POL delivered without additional POL training
or monitoring of conversations (Kelly, 2004)
Technology Transfer & Exchange
 Transfer
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(CDC to CBOs)
Translation, dissemination, acquisition of
information about interventions
(Kraft et al., 2000)
 Exchange
(CBOs to CDC, researchers,
community planning groups)
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Communication of barriers/facilitators
experienced in practice, to improve
intervention effectiveness (Gandelman et al., 2005)
 Transfer
and exchange are necessary to
adaptation
Overview
Assess
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Target population
Interventions
Goodness of fit
Stakeholders
Organizational capacity
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Decide to adopt, adapt, or
select another intervention
Make necessary changes to
EBI
Select
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Prepare
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Prepare agency
Pre-test materials
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Implementation plan
Successful pilot of adapted
intervention
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Implement adapted EBI
Pilot
Implement
(Adapted from McKleroy et al., 2006)
Step 1: Assess
 Target
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population
Identify target population
Understand risk factors, behavioral
determinants, risk behaviors,
epidemiological trends, social norms
Choose risk factors to target
Identify where, when, how to reach target
population
Step 1: Assess (cont’d)
 Interventions
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Identify and review possible EBIs
Review content of EBIs
Identify risk factors, behavioral
determinants and risk behaviors
Identify core elements and key
characteristics
Access cost and resources needed
Talk with other agencies
Step 1: Assess (cont’d)
 Goodness
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of fit
Match between risk factors, behavioral
determinants, and risk behaviors in EBI
and those of target population
Short list of EBIs
Identify areas needed for EBI adaptation
Identify areas for agency capacity building
Step 1: Assess (cont’d)
 Stakeholders
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Identify stakeholders
Seek input
Assess referral and collaboration
possibilities
Define accountability
Identify competing programs
Phase 1: Assessment (cont’d)
 Organizational
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capacity
Resources or experience
Physical
Financial
Access
Values/mission
Staff/human resources
Cultural competence
EBI
Evaluation
Accountability
Step 2: Select
 Decide
to adopt, adapt, or select another
intervention
 Build capacity on EBI and for
implementation
 Consult with stakeholders
 Consult with staff
Step 2: Select
 Make
necessary changes to EBI
(adaptation)
 Decide what changes are needed
 Seek guidance or technical assistance
 Develop timeline and logic model
• A logic model describes the relationships
among risk factors/determinants, intervention
activities and desired outcomes

Track changes made
POL Logic Model
Risk determinants
Intervention Activities
Outcomes
Knowledge of
effective
communication
Teach POLs the
intervention
rationale
 perception of
behavior norms
Attitudes/norms
for engaging in
conversations
Teach POLs
conversation
elements
 confidence to be
able to engage in
behavior
Self-efficacy to
engage in
conversations
POLs practice and
engage in
conversations
risk behavior in
target community
Adapted from CDC POL Logic Model
Step 3: Prepare
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Prepare organization
 Recruit/train staff and volunteers
 Assign responsibilities
 Handle logistics
 Confirm referrals and collaborations
 Pre-test adapted EBI
 With stakeholders
 With members of target population
Step 4 : Pilot
Plan for implementing EBI
 Agency policies for adapted EBI
 Referral networks
 Roles and responsibilities
 Timeline
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Step 4 : Pilot
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Gauge success of pilot
Success: move to next step
Failure: review, revise, re-pilot
Fidelity
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Adherence
Dose
Quality
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
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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
http://rtips.cancer.gov/rtips/index.do
 Substance Abuse and Mental Health Services Administration
(SAMHSA) National Registry of Evidence-based Programs
and Practices (NREPP) available at
http://modelprograms.samhsa.gov/template.cfm?page=nrep
pover
 Cochrane Health Promotion and Public Health Field review
and protocols available at
http://www.cochrane.org/reviews/en/
 The Guide to Clinical Preventive Services available at
http://www.ahrq.gov/clinic/uspstfix.htm
 National Guideline Clearinghouse available at
www.guideline.gov/
 Center for Information Dissemination and Education
Resources (CIDER) available at
http://www.cider.research.va.gov/products.cfm
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
CDC
http://0-www.cdc.gov.mill1.sjlibrary.org/hiv/topics/cba/cba.htm
Community Planning Groups
CDC guidance www.cdc.gov/hiv/pubs/hiv-cp.htm
Community Planning Groups
List of CPGs
http://hivinsite.ucsf.edu/InSite?page=li-07-12
Health Departments/UCHAPS
http://www.aidsaction.org/uchaps/
BSSV Website
http://www.apa.org/pi/aids/bssv.html
STD/HIV Prevention Training
Centers
http://depts.washington.edu/nnptc/
HIV Prevention Research Centers
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Columbia University HIV Center for Clinical and Behavioral
Studies
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www.hivcenternyc.org
Yale University Center for Interdisciplinary Research on AIDS
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http://cira.med.yale.edu
Medical College of Wisconsin Center for AIDS Intervention
Research
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www.mcw.edu
UCLA Center for HIV Identification, Prevention and Treatment
Services
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http://chipts.ucla.edu/
UCSD HIV Neurobehavioral Research Center
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http://www.hnrc.ucsd.edu/
UCSF Center for AIDS Prevention Studies
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http://www.caps.ucsf.edu/
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: 213.201.1312
[email protected]