Evidence-based Programming for Seniors
description
Transcript of Evidence-based Programming for Seniors
Evidence-based Programming for SeniorsTips for Selecting, Implementing, and Evaluating EBPs
Marcia Ory, PhD, MPHAshley Wilson, MPHProgram on Healthy AgingTexas A&M Health Science Center
South Padre, TXMay 2012
Topic for Discussion
EBP rationale, definitions, and program elements
Steps in choosing an EBP for your organization
Local, State, and National Examples
Challenges and Successes
Questions & Answers
Audience Query
How many are currently delivering
evidence-based programs (EBPs)?
What types of programs are you currently delivering?
What are Evidence-based Programs?
• Evidence-Based Programs are interventions based on evidence that is generated by scientific studies published in peer-reviewed journals.
• Model Programs are a type of evidence-based program
What are evidence-based programs?
• Previously implemented• Found to make positive differences in the lives of
participants
Evidence-based Program have been:
Adapted from Brownson et al, 2003
Type 1:
Evidence that a health issue
exists
Type 2:
Evidence about design, context, and attractiveness of program
Type 3:
Evidence that a
program is effective
Three Types of Evidence
Why the Recent Interest in EBP’s?
Magnitude and seriousness of health and social problems in our communities
Awareness of preventability of many problems
Emergence of evidence-based practices and programs
Spend limited resources more efficiently
Question
What are some advantages and disadvantages of evidence-based programs versus “home grown” ones?
Perceived Disadvantages of EBPs
Requires knowing where to find and how to understand/judge the evidence
Feels like standardization of program rather than site-specific tailoring
Tools and processes are unfamiliar
Difficult to build community support—many prefer “home grown” to “off the shelf”
Can be expensive
Online Training Modules: Evidence-based Health Promotion Programs for Older Adults
Increase in the likelihood of positive outcomesLead to efficient use of resourcesFacilitate the spread of programsFacilitate the use of common performance measuresSupport continuous quality improvementHelp to establish partnershipsMake it easier to justify funding
Online Training Modules: Evidence-based Health Promotion Programs for Older Adults
Perceived Advantages to EBPs
Tiered Set of Criteria for Defining EBPs Implemented Through OAA
FY2012 Congressional appropriations
require Title IIID funding to be
Evidence-Based
http://www.aoa.gov/AoARoot/AoA_Programs/HPW/Title_IIID/index.aspx
Minimal Criteria
Demonstrated through evaluation to be effective
for improving the health and wellbeing or reducing
disease, disability and/or injury among older adults
Ready for translation, implementation and/or broad dissemination by
community-based organizations using
appropriately credentialed practitioners.
Intermediate Criteria
Published in a peer-review journal.
Proven effective with older adult population, using some form of a control condition (e.g. pre-post study, case control design, etc.).
Some basis in translation for implementation by community level organization.
Highest-level Criteria
Undergone Experimental
or Quasi-Experimental
Design
Level at which full translation has occurred
in a community
site.
Level at which dissemination products have
been developed and are available to the public.
How Does One Chose a EBP?
Choosing an EBP
Step 7: Sustain the program
Step 6: Evaluate the program
Step 5: Translate the intervention into a program
Step 4: Select an intervention
Step 3: Establish broad-based partnerships
Step 2: Identify effective interventions
Step 1: Identify an important health issue among the Seniors you serve
The tasks do not always follow a sequential progression. The list provides a guide, not a strict set of steps.
Step 1: Identify an important health issue among the Seniors you serve
Review health statistics and other data to identify relevant health conditions and risk factors• Information sources include the Texas Department of State
Health Services and county Community Needs Assessment documents
Ask questions of seniors in your constituency
Determine if the identified health issue affects all of the Seniors you serve or only a subset
Step 2: Identify effective interventionsAging Texas Well• http://www.agingtexaswell.org/ebased/index.cfm
National Council on Aging• http://www.healthyagingprograms.org/content.asp?sectionid=32
National Cancer Institute• http://rtips.cancer.gov/rtips/index.do
Substance Abuse and Mental Health Services Administration • http://nrepp.samhsa.gov/Search.aspx
Partnering for SuccessIdentify organizations with a common mission• Align goals• Tap into the
organizational cultures and core values of partners
Communicate • Encourage
honesty• Clarify
expectations• Make sure
everyone is given the same information
Work together• Share praise,
glory, and recognition
• Realize that no partner is perfect
• Think creatively
Share Resources• Enhance participant
recruitment• Maximize program-
to-program referrals and dissemination
• Share facilities and materials
• Cross train staff and volunteers
• Increase data collection and
• data analysis capacity
Step 3: Establish broad-based partnerships
Step 4: Select an intervention
Program Match
• Does the program fit your mission?
• Is leadership supportive of the program?
• Are clients interested in the program?
• Can you implement the program as designed?
Costs and Resources
• Is there a licensing fee?
• What type of facilitator is needed?
• Is facilitator training required?
• What equipment and supplies are needed?
• Is the program ongoing or periodic?
Cultural and Contextual Relevance
• Is the program culturally appropriate?
• Are materials written at the correct literacy level and in the correct language?
• Does the program have regional appeal?
Looking for Evidence-Based ProgramsBased on Best Practices and PrinciplesSubjected to rigorous research designProgram is efficacious on outcomes of interestProgram is manualized for replicabilityTested in multiple settings and populationsPublished in peer review literatureEndorsed by professional bodyFeasible to move to scale
Is Your Community Ready to Implement Evidence-Based Health Promotion Programs?
There is buy-in from leadership
There is access both to personnel with the expertise to do these programs and to the population that needs these programs
There is funding for the program
Agency/partner-ship is willing to do evidence-based health programs and stay true to the model being implemented
National Council on Aging Organizational Readiness Checklist
Step 5: Translate the intervention into a program
• The process of taking a program originally implemented in a controlled “laboratory-like” setting and making it suitable for implementation in the community
Translation
• The faithful and accurate adherence to the core elements of an intervention, must be maintained
• Preserves the evidence-base
Fidelity
Step 5: Translate the intervention into a program (cont.)
• Program components that generated the positive outcomes
• Goal setting, identifying barriers, monitoring behavior change, etc.
Core elements
• Attributes that make the program “fit” the population
• Size of fonts and reading level of materials, marketing techniques, etc.
• Key characteristics can be adapted, but core elements cannot be adapted (jeopardizes fidelity)
Key characteristics
Step 6: Evaluate the program
Plan goals for process and
outcome evaluation before program implementation
Create or find the instruments and
protocols needed for data collection
Monitor program operations and
make adjustments to evaluation plan
(if needed)
Evaluate program delivery and
outcomes to assess program success
Use findings in future program
planning
Step 7: Sustain the programElements of a sustainable infrastructure and delivery
system
1 •Effective leadership
2 •Adequate delivery infrastructure
3 •Partnerships
4 •Centralized and coordinated logistical processes
5 •Business planning and financial sustainability
6 •Quality assurance and fidelity to interventions
CDSMP Example
Local Level
East Texas Coalition (Brazos Valley) – 750 participants with 544 completers
State Level
Texas – enroll 4,098 participants with a 72.5% completion rate (3,975 completers)
National Level
By March 31, 2012, 50,000 older adults will participate in CDSMP type programs nationwide
Texas Healthy Lifestyles
Bexar AAA-San Antonio Area
Central Texas AAA-Temple, Belton, Killeen
East Texas AAA-45 counties
Rio Grande AAA-El Paso Area
Tarrant Count AAA-Fort Worth
Region Target Enrollees Target Completers
Tarrant County 960 697
Central Texas 900 653
Rio Grande 888 645
East Texas Coalition 750 544
Bexar 608 436
Texas Targets by Region
Reach
Are we reaching our intended population?
How do we attract underserved populations?
How do we minimize dropout?
Recruiting: What Works?
Quality Leaders & Classes
Go to where seniors WORK, PLAY, PRAY, LIVE & EAT
Perseverance
Incentives
Food
Recruiting Program Participants
Networking• Get out in your community• Presentations • Word of mouth
Senior Luncheons
Senior Expos, Health Fairs
City Senior Department
How to Recruit New Partners
Identify common organizational mission
Make clear what expectations are—MOU!
• Go beyond usual set of partners• Identify various contributions
Think creatively
Keep a log of partner contacts
Recruiting Community Partners
Approaching Potential Partners• Networking• Program can be mutually beneficial to existing organizations
What to expect from a partner• Space• Participants• Leaders
What to provide partner• Program• Leaders• Materials
Quality Assurance & Program Fidelity
Quality Assurance refers to the entire scope of a state’s/organization’s program implementation.• National Level• Texas• East Texas Coalition
Fidelity refers very specifically to the degree to which a particular program is delivered as intended.• Stanford Patient Education Center (CDSMP)
Both include: planning, monitoring, evaluating and making corrective actions• Have a plan
Steps to Program Fidelity4. Create a communications mechanism for feedback
3. Provide copies of plan and set training schedule
2. Prepare state-specific fidelity plan
1. Read Implementation Manual for each program
For reference, view NCOA Module 4: “Assuring Program Quality” at www.ncoa.org/chamodules
Example Fidelity Plan
Balancing Treatment Fidelity and Adaptation
• How to maintain fidelity to essential elements?
• What is needed to tailor programs to populations?
• Employ cultural, age or gender appropriate examples
• Keep the principles---Contextual the examples!
Considerations in Fidelity Monitoring and Enhancement Identify and operationalize
essential components of original program
Know if adaptations are consistent with original study
Simplify data collection
Maximize fidelity with “teach-back” where instructors have the opportunity to practice teaching during the trainings
With appreciation from Minnesota AAA
Challenges
Participant Attrition
Leader Attrition
Program Fidelity
Data Collection
Solutions • Recruit & provide quality classes in community• Provide transportation• Know community trends• Rural communities = fewer participants
Participant Attrition
• Provide leaders classes to teach immediately after training
• Involve leaders in scheduling classes• Stipends if available
Leader Attrition
• Dedicated Program Coordinator• Protocol for fidelity checksProgram Fidelity
• Academic partnersData Collection
Program Evaluation•What do we want to know?
•Create instruments•Data collection process?•Who collects & manages the
data?•Database creation
•How to provide feedback to community & stakeholders?
Why is this
important?
Program Evaluation TipsDo you have other data collection requirements?• AAA Client intake forms
Know target population’s abilities • Age• Reading Level• Eye sight
Don’t let it take too much time away from your program
KISS (Keep It Short & Sweet)
Texas Size Successes
Exceeded our goal of 4,000 enrolleesDeveloped training infrastructureSustainability mechanisms• Diabetes accreditation• Partnering with health care organizationsClustering of EBPs
Conclusions
EBPs have many benefits for improving population health
There are inventories of EBPs—no need to start from scratch
Partnerships are critical for recruitment, adoption, maintenance
For maximum impact—consider the context!
For more information:
Program on Healthy Aging 1266 TAMU
College Station, TX 77843-1266
Phone: 979-458-4202Fax: 979-458-4264
www.programonhealthyaging.org