Before we begin, a little about our format…Presentation by seminar speakers (approx. 40 min.)

Followed by question and answer session (approx. 20 min.)

****************************************************Please press *6 on your telephone keypad to mute your line (to un-mute your line, press *6 again)If you are experiencing difficulty with your phone connection, dial *0 for the conferencing service operatorQuestions submitted prior to the web seminar will be addressed first during the Q&A For questions that arise during the presentation, click on the “hand” button and type your question or wait to be called on to ask your question over the phone

Welcome to the Acción Mutua web-seminar

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

Retaining Clients in HIV Retaining Clients in HIV Prevention ProgramsPrevention Programs

Ted DuncanTed Duncan

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

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Focus of the Focus of the PresentationPresentation

Addresses issues related to client Addresses issues related to client retention not the retention of retention not the retention of volunteers, staff or board membersvolunteers, staff or board members

Based primarily on lessons learned Based primarily on lessons learned from CBO facing challenges with from CBO facing challenges with client retention, not peer review client retention, not peer review literature searchesliterature searches

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Presentation ObjectivesPresentation Objectives

Describe what client retention is Describe what client retention is and why it is importantand why it is important

Describe the guiding principles for Describe the guiding principles for retentionretention

Identify retention strategiesIdentify retention strategies Describe how to plan for retentionDescribe how to plan for retention

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What is Retention?What is Retention?

Maintaining client participation for Maintaining client participation for the duration of the intervention the duration of the intervention cyclecycle– Multi-session group level or individual Multi-session group level or individual

level interventions: Completion of all level interventions: Completion of all sessions required for the delivery of sessions required for the delivery of the interventionthe intervention

– Completion of all sessions required to Completion of all sessions required to complete prevention plancomplete prevention plan

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Why is Retention Why is Retention Important?Important?

To realize full effect of an intervention, To realize full effect of an intervention, clients must receive full dosage.clients must receive full dosage.– The “effectiveness” of an effective The “effectiveness” of an effective

intervention was demonstrated among intervention was demonstrated among those who completed it and not those who those who completed it and not those who dropped outdropped out

– No intervention is effective if people do No intervention is effective if people do not stay in it.not stay in it.

A client who does not complete the A client who does not complete the intervention or service cycle is taking intervention or service cycle is taking the place of a client who may have.the place of a client who may have.

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Retention RateRetention Rate Proportion of people starting an Proportion of people starting an

intervention who complete itintervention who complete it What is an acceptable rate? What is an acceptable rate? It depends on:It depends on:

– The populationThe population– The interventionThe intervention– Requirements of the funderRequirements of the funder– Standards of the agencyStandards of the agency– External factorsExternal factors

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Guiding Principles of Guiding Principles of RetentionRetention

Provide high quality customer serviceProvide high quality customer service Understand the characteristics of the Understand the characteristics of the

target populationtarget population Implement and deliver services that Implement and deliver services that

are appropriate for the target are appropriate for the target population and settingpopulation and setting

Provide services and interventions that Provide services and interventions that are meaningful to target populationare meaningful to target population

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Guiding Principles of Guiding Principles of RetentionRetention (continued)(continued)

Communicate with clientsCommunicate with clients Be responsive to their needs and Be responsive to their needs and

their need for agency servicestheir need for agency services Set objectives for retention rates and Set objectives for retention rates and

then monitor themthen monitor them Revise retention strategies as Revise retention strategies as

neededneeded Anticipate barriers to retention and Anticipate barriers to retention and

plan around themplan around them

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Major Facilitators/Barriers Major Facilitators/Barriers to Retentionto Retention Location: Is it safe, convenient, easy to Location: Is it safe, convenient, easy to

get to, and in a “zone of comfort”?get to, and in a “zone of comfort”? Environment: Is it comfortable and Environment: Is it comfortable and

confidential?confidential? Quality of interaction: Is it inclusive, non-Quality of interaction: Is it inclusive, non-

judgmental, non-coercive, and speaks to judgmental, non-coercive, and speaks to the person and their issues?the person and their issues?

Expectations: Are participants clear on Expectations: Are participants clear on the intervention, process, and the intervention, process, and commitment?commitment?

Convenient: Are there opportunities to Convenient: Are there opportunities to access other services?access other services?

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Major Major Facilitators/Barriers to Facilitators/Barriers to Retention Retention (continued)(continued) Schedule: Is it on the “right” day and at Schedule: Is it on the “right” day and at

the “right” time?the “right” time? Amenities: Are refreshments and food Amenities: Are refreshments and food

available?available? Competing priorities: Is there anything Competing priorities: Is there anything

else in a person’s life that may interfere, else in a person’s life that may interfere, but can be planned around? (For but can be planned around? (For instance, childcare needs for women)instance, childcare needs for women)

Social opportunities: Do people have Social opportunities: Do people have the opportunity to socialize casually?the opportunity to socialize casually?

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Retention StrategiesRetention Strategies

Organized, effective implementation of Organized, effective implementation of intervention or serviceintervention or service

Communication Communication – Telephone callsTelephone calls– Post cardsPost cards– Reminders at scheduled visits for other Reminders at scheduled visits for other

servicesservices– NewslettersNewsletters– Email messagesEmail messages– Reminders at the end of each sessionReminders at the end of each session

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Retention StrategiesRetention Strategies (continued)(continued) Set an objective for retention rate.Set an objective for retention rate.

– Example: 80% of all clients who enroll in Example: 80% of all clients who enroll in each cycle of Safety Counts will complete all each cycle of Safety Counts will complete all sessionssessions

Monitor retention rate to determine Monitor retention rate to determine whether objectives are being met.whether objectives are being met.

Try to understand why the objective was Try to understand why the objective was not met.not met.

Revise retention strategy or objective as Revise retention strategy or objective as appropriate.appropriate.

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Retention StrategiesRetention Strategies (continued)(continued)

Tailor strategies to fit the type of Tailor strategies to fit the type of InterventionIntervention

Interventions delivered to individualsInterventions delivered to individuals– Engage and get to know the individualEngage and get to know the individual– Communicate interest in the client as a personCommunicate interest in the client as a person– Utilize good communicationUtilize good communication– Provide support – someone to listen to themProvide support – someone to listen to them– Involve significant othersInvolve significant others

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Retention StrategiesRetention Strategies (continued)(continued)

Ask why those who enrolled in the Ask why those who enrolled in the intervention dropped outintervention dropped out– Clients who dropped out, clients who Clients who dropped out, clients who

didn’t drop out, key informantsdidn’t drop out, key informants Is there a pattern to the reasons Is there a pattern to the reasons

for dropping out?for dropping out? Can you plan around the reasons?Can you plan around the reasons?

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Retention StrategiesRetention Strategies (continued)(continued)

For interventions delivered to groupsFor interventions delivered to groups Think about retention strategies from Think about retention strategies from

the perspective of gender, the perspective of gender, race/ethnicity, behavior, etc.race/ethnicity, behavior, etc.

Communicate concern of the welfare of Communicate concern of the welfare of absent participantsabsent participants

Convey to absent participants that Convey to absent participants that he/she was missed by the group he/she was missed by the group (handwritten note, telephone call, etc.)(handwritten note, telephone call, etc.)

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Retention StrategiesRetention Strategies (continued)(continued) Use incentivesUse incentives Identify what appeals to target populationIdentify what appeals to target population Offer choices and combinationsOffer choices and combinations Make sure incentives are culturally appropriateMake sure incentives are culturally appropriate Check with funder before offering cashCheck with funder before offering cash ConsiderConsider

– Food and refreshmentsFood and refreshments– Gift certificatesGift certificates– Raffles Raffles – CardsCards– Small gifts (Calendars, pens, toiletries, etc.)Small gifts (Calendars, pens, toiletries, etc.)– Recognition: Certificate of Completion or Graduation Recognition: Certificate of Completion or Graduation

CeremonyCeremony

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Retention StrategiesRetention Strategies (continued)(continued)

Try to identify the characteristics of Try to identify the characteristics of those who complete the intervention those who complete the intervention as opposed to those who drop out.as opposed to those who drop out.

Is there a pattern?Is there a pattern? Once risk and eligibility is Once risk and eligibility is

established, screen for established, screen for characteristics that are associated characteristics that are associated with likelihood of completion.with likelihood of completion.

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Retention StrategiesRetention Strategies (continued)(continued)

Pay attention to the point in an Pay attention to the point in an intervention cycle clients drop out.intervention cycle clients drop out.

Is there a pattern?Is there a pattern? If so, what happened in the session If so, what happened in the session

immediately before that may have immediately before that may have contributed to clients not coming contributed to clients not coming back?back?

Can you fix it?Can you fix it?

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Retention PlanningRetention Planning

Before the intervention or Before the intervention or servicesservices

During the delivery of the During the delivery of the intervention or servicesintervention or services

Follow up to the delivery of the Follow up to the delivery of the intervention or serviceintervention or service

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Retention PlanRetention Planning ning (continued)(continued)

Specific strategies to maintain Specific strategies to maintain participation depend on:participation depend on:– The nature of the intervention or The nature of the intervention or

serviceservice– The characteristics of the target The characteristics of the target

populationpopulation– Organizational needs, resources, Organizational needs, resources,

and capacityand capacity

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Retention PlanningRetention Planning (continued)(continued)

What environment would be most What environment would be most comfortablecomfortable

Take culture into considerationTake culture into consideration Ensure physical comfortEnsure physical comfort Provide a sense of safetyProvide a sense of safety Be sure there is comfort with staff Be sure there is comfort with staff

providing service or implementing providing service or implementing interventionintervention

Ensure confidentiality of settingEnsure confidentiality of setting

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Retention PlanningRetention Planning (continued)(continued)

Plan retention during recruitmentPlan retention during recruitment Develop screening toolsDevelop screening tools In screening, try to identify potential In screening, try to identify potential

barriers and plan for addressing them barriers and plan for addressing them Ensure client is appropriate for the Ensure client is appropriate for the

interventionintervention Assess client’s ability to complete Assess client’s ability to complete

interventionintervention

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Retention PlanningRetention Planning (continued)(continued)

Secure client contact Secure client contact information at enrollmentinformation at enrollment

Get contact information of two Get contact information of two people who do not live with the people who do not live with the client but would know client but would know whereaboutswhereabouts

Obtain permission to make Obtain permission to make contactcontact

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Retention PlanningRetention Planning (continued)(continued)

Build a sense of ownership during Build a sense of ownership during intervention or service deliveryintervention or service delivery

– Involve them in the retention processInvolve them in the retention process– Solicit their input on why some people Solicit their input on why some people

drop outdrop out– Encourage a mutually supportive Encourage a mutually supportive

atmosphere to complete interventionatmosphere to complete intervention Use process monitoring to see if Use process monitoring to see if

retention strategies are effectiveretention strategies are effective

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Retention PlanningRetention Planning (continued)(continued)

Utilize intake processUtilize intake process– Explain purpose of interventionExplain purpose of intervention– Be honest about requirements and Be honest about requirements and

expectationsexpectations– Don’t use coercionDon’t use coercion– Secure client buy-inSecure client buy-in– Build client confidence to complete Build client confidence to complete

the interventionthe intervention

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The Bottom LineThe Bottom Line Use evidence to make decisions about Use evidence to make decisions about

retentionretention Plan for retention before starting the Plan for retention before starting the

interventionintervention Screen clients for risk, eligibility, and Screen clients for risk, eligibility, and

appropriatenessappropriateness for the intervention for the intervention Set retention objectives and retention Set retention objectives and retention

ratesrates Attempt to understand why people drop Attempt to understand why people drop

out of an intervention find ways of out of an intervention find ways of addressing the causesaddressing the causes

Keep trying! Keep trying!

Questions & Answers

iGracias ~ Thank You!

For more information on For more information on this presentation, contact:this presentation, contact:

Ted DuncanTed Duncan

CDCCDC

1600 Clifton Road, MS-E401600 Clifton Road, MS-E40

Atlanta, GA 30333Atlanta, GA 30333

tfd2@cdc.govtfd2@cdc.gov

Future Acción Mutua web seminars:

Latino Gay Men and Crystal Meth:

A Conversation with Rafael Diaz, PhDSeptember 14, 2007 11am PT

Social Marketing with Patrick “Pato” HebertSeptember 27, 2007 11am PT

Please register at accionmutua@apla.org