integrating hiv/aids and substance abuse prevention in minority communities: a u.s. national...
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Integrating HIV/AIDS and Substance Integrating HIV/AIDS and Substance Abuse Prevention in Minority Abuse Prevention in Minority
Communities: A U.S. National Communities: A U.S. National InitiativeInitiative
Funded by the Substance Abuse and Funded by the Substance Abuse and Mental Health Services Mental Health Services
Administration,Administration,Center for Substance Abuse Center for Substance Abuse
PreventionPrevention
Lucille Norville Perez, MDLucille Norville Perez, MD Fabian Eluma, MD Fabian Eluma, MD
JSI Research & Training InstituteJSI Research & Training InstituteProject Coordinating CenterProject Coordinating Center
Understanding Client Needs:Baseline Risk Factors
Thomas W. Mangione, Ph.D.Rodolfo Vega, Ph.D.
Anita Raj, Ph.D.Hortensia Amaro, Ph.D.
Kim WatsonLucille Perez, M.D.
Goals of Initiative
To increase capacity in minority communities to prevent HIV and/or substance abuse
To deliver prevention services to African-American women and Hispanic Women
To deliver prevention services to minority youth
To identify effective mechanisms to deliver prevention services to these communities.
Research Design
Baseline, 3 month follow-up, 9 month follow-up
Constructed comparison groups
Scannable, Self-Administered surveys Adult, Youth (13+) & Children’s versions Translated into Spanish Program staff available to help complete
survey if needed
Centralized Processing for Scanning, Cleaning Data
Additional Types of Data Being Collected
Process Data on # persons serviced and types of services
Yearly site visits
Client focus groups in some sites
Cost Data for delivery of service units
Access Capacity for Providing Services both Directly and through Other Community Agency Linkages
Baseline Data Status 3 Different Baseline Groups of participants
Adults Youth (13+) Children
Before Study is finished we expect between 1000-1500 baseline surveys for participants and similar n’s for comparison groups
Today’s presentation based on 1000 youth & 1000 women combining participants & comparison group members
Additional baseline and follow-up data is being collected
Additional completed surveys are being cleaned Today’s data should be considered preliminary
Racial/Ethnic CompositionAdult Women
African
American
58%
Hispanic
32%
Other
10%
Have Children Under 18 Adult Women
Yes
68%
No
32%
Racial/Ethnic CompositionYouth
African
American
67%
Hispanic
26%
Other
7%
Gender CompositionYouth
Boys
51%
Girls
49%
Age Distributionfor Girls & Boys
57
18 18
13
9
6
11
18
12
1716
13
22
5
10
0
5
10
15
20
25
<13 13 14 15 16 17 18 19+
Girls
Boys
Women’s Drug Use In Past 30 Days
25
4
5
5
2
73
0 20 40 60 80
Drink at all
Drink 5+
Marijuana*
Crack/Cocaine
Needle Sharing (Among Users)
IDUs
Rates calculated to include entire sample in denominator.
* This number was changed after APHA 2001 presentation.
Women’s Sexual Risk Taking Behaviors - Past 30 Days (of sexually active)
19
14
49
8
47
90
24
48
51
0 20 40 60 80 100
Sex Under Influence
Unprotected Commerical Sex
LT Used Condom Anal Sex
Had Anal Sex
LT Used Condom Vaginal Sex
Had Vaginal Sex
LT Used Condom Oral Sex
Had Oral Sex
Sexually Active*
* Calculated to include entire sample in denominator.
Women’s Perceptions of “Great Risk” When Having Sex with Other Partners or Sharing Needles
92
88
87
84
80 85 90 95
Share Needles
Unprotected Anal Sex
Unprotected Vaginal Sex
Unprotected Oral Sex
Youth Alcohol & Drug UseIn Past 30 Days
11
10
3
17
15
41
0 10 20 30 40 50
Crack/Cocaine Use
Marijuana*
Drink 5+
Drink at all
Smoke Cigarettes
Ever Smoke
Rates calculated to include entire sample in denominator.
* This number was changed after APHA 2001 presentation.
Youth Sexual Risk Taking Behaviors In Past 30 Days (among sexually active)
13
63
15
67
90
26
49
26
50
0 20 40 60 80 100
Sex Under Influence
LT Used Condom Anal Sex
Had Anal Sex
LT Used Condom Vaginal Sex
Had Vaginal Sex
LT Used Condom Oral Sex
Had Oral Sex
Sexually Active*
Ever Had Sex
* Calculated to include entire sample in denominator.
Youth Perceptions of “Great Risk” for Sexual & Drug Use Behaviors
30
57
25
82
60
59
50
0 20 40 60 80 100
Use Marijuana Weekly
Smoke Cigarettes- 1+ pack daily
Weekly Alcohol Use
Share Needles
Unprotected Anal Sex
Unprotected Vaginal Sex
Unprotected Oral Sex
SAMHSA/CSAP Initiative is Providing HIV & Substance Abuse Preventionin Minority Communities at Risk
Integrating HIV and Substance Abuse Prevention
Programs: How Racial/Ethnic Minority
Communities are Meeting the Need
Anita Raj, Ph.D.Rodolfo Vega, Ph.D.
Thomas W. Mangione, Ph.D.Jacqueline J Nolan, MPH
Maya Y Mauch, MPHLucille Perez, M.D.
Process EvaluationProcess Evaluation
Goals were to determine:Goals were to determine: What strategies, supports, and What strategies, supports, and
resources are necessary for agencies resources are necessary for agencies to implement HIV and Substance to implement HIV and Substance Abuse Prevention programs for women Abuse Prevention programs for women and youthand youth
What strategies, supports, and What strategies, supports, and resources are necessary for resources are necessary for community-based agencies to community-based agencies to participate in a cross-site program participate in a cross-site program evaluationevaluation
Process EvaluationProcess Evaluation
Research Questions:Research Questions: What do programs look like? What do programs look like? What recruitment and retention What recruitment and retention
strategies work for different populations?strategies work for different populations? How are participants responding to the How are participants responding to the
program?program? What has facilitated or hindered agencies What has facilitated or hindered agencies
when engaging in program evaluation?when engaging in program evaluation?
Research MethodsResearch Methods
Quantitative and Qualitative data Quantitative and Qualitative data collection methods collection methods
Intervention data from quarterly Intervention data from quarterly reportreport
Site visitsSite visits Monthly technical assistance callsMonthly technical assistance calls
Presentation ObjectivesPresentation Objectives
Describe intervention strategies used by Describe intervention strategies used by different population-based programs different population-based programs
Describe recruitment and retention Describe recruitment and retention strategies and how special populations are strategies and how special populations are reachedreached
Describe challenges for program Describe challenges for program development, implementation, and development, implementation, and evaluationevaluation
Describe characteristics that facilitate Describe characteristics that facilitate successful program implementationsuccessful program implementation
Populations ServedPopulations Served
25 Youth-Focused Sites25 Youth-Focused Sites 11 Women-Focused Sites11 Women-Focused Sites 7 Family-Focused Sites7 Family-Focused Sites 4 Other Sites4 Other Sites
indicative of multiple populations indicative of multiple populations servedserved
3 of these sites include men3 of these sites include men
Intervention StrategiesIntervention Strategies
6%6%11%11%10%10%Street OutreachStreet Outreach
4%4%7%7%8%8%Individual Risk Individual Risk Reduction CounselingReduction Counseling
6%6%9%9%16%16%Single Session Single Session GroupsGroups
17%17%15%15%17%17%Multi-session Multi-session GroupsGroups
6%6%15%15%13%13%Education and Education and Skills TrainingSkills Training
Family Family ProgramsPrograms
Women Women ProgramsPrograms
Youth Youth ProgramsPrograms
Intervention Strategies
25%25%21%21%9%9%OtherOther
3%3%9%9%15%15%Community Community BuildingBuilding
25%25%9%9%8%8%Mental Health/Mental Health/
Support GroupsSupport Groups
8%8%4%4%4%4%Case Case ManagementManagement
Family Family ProgramsPrograms
Women Women ProgramsPrograms
Youth Youth ProgramsPrograms
Successful Recruitment Successful Recruitment StrategiesStrategies Make services accessible to communities where Make services accessible to communities where
they are:they are: Community CentersCommunity Centers Home visitsHome visits Street OutreachStreet Outreach Mobile ApproachesMobile Approaches
Deliver educational messages using peer approachDeliver educational messages using peer approach Referral from family, friends, and other service Referral from family, friends, and other service
agenciesagencies Provide services in other organizations that have Provide services in other organizations that have
access to clientsaccess to clients Provide intervention in a safe space without Provide intervention in a safe space without
judgement and expectationsjudgement and expectations Develop a trusting relationship with the communityDevelop a trusting relationship with the community
Characteristics of Programs with Characteristics of Programs with Strong RetentionStrong Retention
AllAll Peer drivenPeer driven Recognition of Recognition of
ParticipantsParticipants High Program High Program
stabilitystability Culture, Culture,
Gender, Gender, Developmental Developmental CompetenceCompetence
YouthYouth Parent supportedParent supported
WomenWomen Childcare and Childcare and
TransportationTransportation FamilyFamily
provide family provide family activitiesactivities
Challenges to Program Challenges to Program Development: Development: Curriculum DevelopmentCurriculum Development
Developing HIV and Substance Abuse Developing HIV and Substance Abuse prevention integrated curricula was prevention integrated curricula was challengechallenge Programs brought varying levels of Programs brought varying levels of
expertise in curriculum developmentexpertise in curriculum development Culturally tailoring programs was a Culturally tailoring programs was a
necessary and time-consuming processnecessary and time-consuming process Developing mechanism for documenting Developing mechanism for documenting
curriculum changes remains a challengecurriculum changes remains a challenge
Challenges to Program Challenges to Program Implementation: Staff TurnoverImplementation: Staff Turnover
Staff TStaff Turnover was often highurnover was often higho Often funded for part-time jobs, resulting in Often funded for part-time jobs, resulting in
overworking of employee or inability to fill overworking of employee or inability to fill positionposition
o Training and continuing education not included, Training and continuing education not included, minimizing opportunity for advancementminimizing opportunity for advancement
o Salaries and benefits not strongSalaries and benefits not strongo Work itself is mentally draining, and some Work itself is mentally draining, and some
programs have no built in support systems for programs have no built in support systems for their stafftheir staff
Challenges to Program: Challenges to Program: Inadequate InfrastructureInadequate Infrastructure
Infrastructure of agency was often not prepared for Infrastructure of agency was often not prepared for increased fundingincreased funding SAMHSA funding provided a huge increase in SAMHSA funding provided a huge increase in
agency budget, and many agencies did not have agency budget, and many agencies did not have structure to manage budget of this size.structure to manage budget of this size.
Inadequate MIS systems were commonInadequate MIS systems were common difficult for sites to manage new budget difficult for sites to manage new budget communication difficulties with PCC and other communication difficulties with PCC and other
sites (within program and outside program) sites (within program and outside program) were commonwere common
staff were often not available and/or sufficiently staff were often not available and/or sufficiently trained to manage current MIS systemstrained to manage current MIS systems
Challenges to EvaluationChallenges to Evaluation
The GFA did not make explicit the The GFA did not make explicit the requirement of a cross-site evaluationrequirement of a cross-site evaluation
Many grantees were unfamiliar with the Many grantees were unfamiliar with the IRB/FWA/COC processesIRB/FWA/COC processes
FWA rules changed during processingFWA rules changed during processing Many grantees were unfamiliar with Many grantees were unfamiliar with
evaluation methodology and evaluation methodology and requirementsrequirements
Evaluation-related challenges resulted in Evaluation-related challenges resulted in delays in program implementationdelays in program implementation
ConclusionsConclusions
Despite significant challenges, programs have been Despite significant challenges, programs have been able to develop and implement integrated HIV and able to develop and implement integrated HIV and substance abuse prevention programs focused on substance abuse prevention programs focused on women, youth, and families.women, youth, and families.
Program strategies are tailored to the unique needs Program strategies are tailored to the unique needs of target populationsof target populations Youth and Women Programs focus more on HIV Youth and Women Programs focus more on HIV
and Substance Abuse intervention solelyand Substance Abuse intervention solely Family Programs focus on more holistic related Family Programs focus on more holistic related
issues, including mental health and group supportissues, including mental health and group support Culture-tailoring is an integral part of program Culture-tailoring is an integral part of program
development.development.
ConclusionsConclusions Recruitment strategies are similar across Recruitment strategies are similar across
groups, relying on captive groups, referral, groups, relying on captive groups, referral, and outreach.and outreach.
Retention strategies are also similar across Retention strategies are also similar across groups and primarily relate to increasing groups and primarily relate to increasing strength of program (e.g., program stability, strength of program (e.g., program stability, recognition and involvement of participants).recognition and involvement of participants).
Needs of Special Populations (gay youth, Needs of Special Populations (gay youth, street youth, homeless, substance abusers) street youth, homeless, substance abusers) are primarily reached by providing a safe, are primarily reached by providing a safe, nonjudgmental place in which education and nonjudgmental place in which education and skills can be gained.skills can be gained.
ConclusionsConclusions Major support is needed for programs to be Major support is needed for programs to be
able to accomplish this work.able to accomplish this work. This support must includeThis support must include
Assistance with Curriculum Development Assistance with Curriculum Development and Documentation of Curriculum Changesand Documentation of Curriculum Changes
Adequate Staff Resources to minimize Staff Adequate Staff Resources to minimize Staff TurnoverTurnover
Adequate Support for Agency Infrastructure Adequate Support for Agency Infrastructure changes required by initiatives such as the changes required by initiatives such as the MAIMAI
Training and Support for EvaluationTraining and Support for Evaluation
Getting Ready to Implement and Evaluate:
Lessons Learned
Jacqueline J Nolan, MPH Maya Y Mauch, MPH
Dianne Perlmutter, MSW, MPH Patria Rojas, MSW, MPH
Leslie Roberts, MPH Lucille Perez, M.D.
OverviewOverview
One component of the SAMHSA Integrated One component of the SAMHSA Integrated HIV/AIDS and Substance Abuse Targeted HIV/AIDS and Substance Abuse Targeted Community Capacity Initiative is to provide Community Capacity Initiative is to provide technical assistance (TA) to the 47 funded technical assistance (TA) to the 47 funded programsprograms
TA needs ranged from program TA needs ranged from program implementation to program evaluation. implementation to program evaluation.
Most TA provided was in the area of Most TA provided was in the area of evaluation. evaluation.
Technical Assistance Technical Assistance
The TA section of today’s panel discussion will profile: The programs: settings, target population, and The programs: settings, target population, and
curriculacurricula
The TA frameworkThe TA framework
The TA needs of the programs The TA needs of the programs
The TA strategies used to address the needs of The TA strategies used to address the needs of the programsthe programs
Programs’ Settings
CBOCBO ASOASO Community CentersCommunity Centers Street OutreachStreet Outreach SchoolsSchools Head StartHead Start Churches/Faith Churches/Faith
BasedBased PrisonsPrisons
Health Centers/HospitalsHealth Centers/Hospitals Community WideCommunity Wide HomesHomes Housing DevelopmentsHousing Developments SheltersShelters
Target Population
26
17 159 6
0
10
20
30
40
50
IDU Homeless HIV+ GLBTQ CSW
Examples of Science-Based Curricula Used by the Programs
ASK US Be A Responsible Teen (BART) Be Proud Be Responsible Education Now And Babies Later (ENABL) Family Strengthening Programs Focus on Families Life Skills and HIV Prochaska Trans Theoretical Model Safety Net
The Technical Assistance Framework
Building and maintaining a trusting relationship
Maintaining and delivering TA through regular communication and contact with the programs
Developing an in-depth understanding of the proposed intervention, the program, the affiliated agency/organization, and the evaluation plan
Developing a technical assistance plan
Building and maintaining a Building and maintaining a trusting relationshiptrusting relationship
Acknowledge the program’s expertise, experience and commitment to the work
Assess the program’s knowledge and perception of research and evaluation
Frequent check-in calls
Clarify and reinforce the goals and purpose of the technical assistance
Developing an in-depth understanding of all aspects of program
What is the intervention model or design? What science-based curriculum is being used? How has the intervention design changed from the
original proposed plan? How has the intervention or curriculum been modified
to be culturally relevant/appropriate? What is the evaluation plan and design? Staffing structure What partnerships or collaboration have been
developed as a result of this program? Location of program within the organization How has agency capacity increased as a result of this
program?
Frequent communication and contact with the program
Using the “dental” approach (frequency of contacts/proactive vs.. reactive)
Using a diverse array of modes of communication including, the listserv, telephone, website, fax, and face-to-face site visits
Cluster meetings within states or regions
Grantee meetings/steering committee meetings
Development of a technical assistance plan
Developed jointly between program and Developed jointly between program and technical assistance coordinatortechnical assistance coordinator
Framed within the context of the goals of Framed within the context of the goals of the overall projectthe overall project
Incorporating local and national Incorporating local and national resources to support the technical resources to support the technical assistance planassistance plan
Technical Assistance Needs of the Programs:
Development, adaptation, and documentation of curriculums integrating HIV/AIDS and Substance Abuse prevention
Recruitment and retention of program staff Service delivery issues Outreach and recruitment of clients Development of adequate job descriptions Building and maintaining collaborative relationships Development of capacity and infrastructure in the
areas of MIS and fiscal monitoring Development of increased understanding of the
federal funding and reporting procedures
Evaluation TA Needs of the Programs
Developed an increased understanding of the need for and purpose of an internal review board (IRB), federal-wide assurance (FWA), and a certificate of confidentiality (COC).
Developed an understanding of comparison group issues
Supported data collection via survey administration
The TA strategies used to address the needs of the programs Assisted programs in identifying culturally appropriate
curriculums and offered strategies in curriculum adaptation and documentation
Offered staff recruitment and retention strategies Offered client outreach and recruitment strategies Suggested the importance of regular communications with
collaborators/partners Identified resources for MIS and infrastructure capacity
building Researched and provided information on federal reporting
requirements and grant management Identified and provided list of local and national IRBs Facilitated the process for several programs to acquire IRB
approval through a national IRB Offered strategies in survey administration Offered strategies in identifying comparison groups
Building a Cross-Site Evaluation Tool 48 Cooks with 47 Recipes
Maya Y Mauch, MPHRodolfo Vega, Ph.D.
Thomas W. Mangione, Ph.D.Hortensia Amaro, Ph.D.
Anita Raj, Ph.D.Lucille Perez, M.D.
The Challenge
To develop a cross-site tool able to meet the diverse needs of 47 unique programs. Programs serve many age groups of women,
families, youth and children. Programs target many different communities
including, African American, Latino, Native American and LGBTQ.
Programs use a variety of programmatic approaches including street outreach, case management, single and multi-session educational interventions, peer leaders and multimedia campaigns.
Programs brought a wide range of evaluation expertise and experience to the table.
JSI’s Approach
Use a highly participatory process
Make decisions through a consensus building approach
Acknowledge and utilize the expertise of the programs
Facilitate client feedback
The Process
Develop an evaluation design
Seek programmatic input through targeted workgroups and feedback from all 47 grantees
Garner client feedback through pilot tests
Use local and national experts to fine tune the instrument to be culturally competent, language appropriate, age appropriate and sensitive to LGBTQ issues.
Evaluation Design A steering committee of all grantees was held January
18, 2000.
Consensus was achieved regarding the evaluation design and the topics for the cross-site instrument.
It was decided to develop a cross-site tool using the following parameters: Non-experimental design Non-equivalent comparison group Pre-test surveys administered pre-intervention Post-test surveys administered post-intervention Follow-up surveys administered six-months
following the intervention.
Process Flow Chart
W o m en's P r o gr am sP r o gr am R epr esentatives
C o nvened W o r kgr o upsM ar ch 22 , 2001
Y o uth P r o gr am sP r o gr am and Y o uth R epr esentatives
Issues G r o upsG L B T , Y o uth
H ispan icA fr ican A m er ican
P ilo t T estingB o sto n , C leveland
N ew O r leans, O ak landN Y C , Ind ianapo lis
F inal V er sio nD ata
V er sio n F ive
V er sio n Fo ur D evelo pedSent to all gr antees fo r feedback
V er sio n T hr ee D evelo pedSent to W o r kgr o ups fo r Feedback
V er sio n T w o D evelo ped
V er sio n O neFebr uar y 18 , 2001
L o gic M o delJanuar y 18 , 2001
Development of the Cross-Site Tool
Draft one of the cross-site tool (Version 1.0) was developed based on the concepts and measures identified at the Steering Committee meeting.
Domains were identified that should be included in the evaluation instrument. Questions in these domains were included from: The Center for Disease Control The National Institute of Drug Abuse The Center for Substance Abuse Prevention The Prevention Minimum Data Sets The Handbook of Tests and Measurement for Black
Americans.
Feedback on the Tool
Version 1.0 was sent to all grantees on February 18th requesting feedback
Feedback on Version 1.0 was compiled and incorporated into a second version, Version
2.0.
Workgroups
Two workgroups, a women’s group and a youth’s group, were convened in Boston the week of March 22, 2000.
The groups consisted of the PCC TA Coordinators and evaluators, representatives from programs serving women and youth, as well as four adolescent program participants
Each group discussed Version 2.0 of the survey and provided feedback.
The TA Coordinators conveyed feedback from their respective programs.
Feedback on the Tool II
A third version (Version 3.0) of both surveys was developed based on the discussions held in the two workgroups.
This version was forwarded to all members of the workgroups for additional feedback.
Version 3.0 was revised to incorporate the final
round of feedback and a fourth version of both the women’s and youth survey was developed (Version 4.0).
This version was distributed among all 47 grantees and written feedback was obtained.
Pilot Tests
Pilot tests of the survey were conducted at eight sites; four each for the women’s and the youth surveys.
Pilot tests reached over a hundred people of color in the following areas: Boston New York City New Orleans Oakland Cleveland Indianapolis.
Pilot TestsPilot Tests
Information from the pilot tests was helpful in Information from the pilot tests was helpful in resolving questions about the following issues:resolving questions about the following issues: Survey lengthSurvey length FormattingFormatting SequencingSequencing Language LevelLanguage Level Sensitivity. Sensitivity.
Respondents found the survey encompassingRespondents found the survey encompassing
The pilot tests found that the content of the The pilot tests found that the content of the surveys stimulated discussionsurveys stimulated discussion
Issue Groups
Four issues groups were held which brought together representatives of the Technical Experts Group, grantees, national and local experts, and PCC staff.
The four issues groups were charged with the task of making the instrument Culturally competent for all African-American
communities (including Caribbean-American and recent African immigrants),
Language appropriate for Spanish-speaking individuals,
Age appropriate
Sensitive to GLBT issues.
Final Content of SurveysFinal Content of Surveys Drug/Alcohol Use Behavior last 30 daysDrug/Alcohol Use Behavior last 30 days Sexual Behaviors last 30 daysSexual Behaviors last 30 days Perceptions of Risk for Drug/Alcohol UsePerceptions of Risk for Drug/Alcohol Use Perceptions of Risk for Sexual BehaviorsPerceptions of Risk for Sexual Behaviors Intentions for Alcohol, Drug Use, Sexual BehaviorIntentions for Alcohol, Drug Use, Sexual Behavior Attitudes about Alcohol, Drug Use, Sexual BehaviorAttitudes about Alcohol, Drug Use, Sexual Behavior Contextual MeasuresContextual Measures
RacismRacism AculturationAculturation Family DynamicsFamily Dynamics Abuse History (women only)Abuse History (women only) School & Peer Dynamics (youth only)School & Peer Dynamics (youth only)
DemographicsDemographics
Weaknesses of ProcessWeaknesses of Process
Participatory process took extra timeParticipatory process took extra time
Compromises had to be made among Compromises had to be made among conflicting points of viewconflicting points of view
Items/scales used not always identical Items/scales used not always identical to original versionsto original versions
Strengths of the Process
The highly participatory team-building approach used to develop the cross-site tool allowed the PCC to: Gain the trust of the program participants Build ownership and buy-in of the tool among
the grantees Develop collaborative relationships between the
grantees and the PCC. Collaborate across all levels of the initiative Include feedback from consumers, youth,
women, local and national experts. Develop instruments that were culturally
appropriate, youth friendly and sensitive to gender and sexual identity
A Social Network Approach to the Evaluation of Community Capacity to Provide HIV/ATOD Prevention Services
Rodolfo R. Vega, Ph.DJackie Nolan, MPH Maya Mauch, MPH Maggie Castoires
Alexander Ely Aisha Moore
Lucille Perez, MD
GFA 99-03 Program Goals GFA 99-03 Program Goals In order to expand capacity and to counter the In order to expand capacity and to counter the
disproportionate increase of HIV/AIDS and disproportionate increase of HIV/AIDS and substance abuse needs in African American substance abuse needs in African American and Hispanic/Latino or other minority and Hispanic/Latino or other minority communities, the goals of this program are to:communities, the goals of this program are to:
Increase the targeted prevention capacity of communities which are experiencing an increase in substance abuse and HIV/AIDS, especially with respect to provision of substance abuse and HIV/AIDS prevention services that are age and language appropriate, culturally adapted, and gender and sexual orientation appropriate for African American, Hispanic/Latino, and other racial/ethnic minority youth; and for African American, Hispanic/Latino, and other racial/ethnic minority women, and minority women and their children.
Need for tools to assess capacity Need for tools to assess capacity building efforts at the community building efforts at the community levellevel
Lack of measurement tools to Lack of measurement tools to assess capacity building efforts at assess capacity building efforts at the community levelthe community level
Context is not taken into Context is not taken into account account
Available measurement Available measurement approaches tend to focus solely approaches tend to focus solely on the organization and often on the organization and often ignore the context in which the ignore the context in which the organization operates. organization operates.
Context is not taken into Context is not taken into account account
Organizations operate in communities Organizations operate in communities rich in resources. rich in resources.
Part of these resources are other Part of these resources are other organizations or institutions proving organizations or institutions proving prevention services. prevention services.
No one single agency or entity can No one single agency or entity can adequately perform all the functions of adequately perform all the functions of an effective and comprehensive an effective and comprehensive prevention efforts. prevention efforts.
Our evaluation approachOur evaluation approach
We developed our evaluation We developed our evaluation approach borrowing elements approach borrowing elements from:from:
Systems theorySystems theory Social network analysis Social network analysis Inter-organizational relations Inter-organizational relations
theory theory
Community Capacity: A Community Capacity: A definition definition
The sum of the actual or potential The sum of the actual or potential community assets and resources community assets and resources that can facilitate the that can facilitate the development, implementation, and development, implementation, and coordination of prevention coordination of prevention activities.activities.
HIV/AIDS and Substance Abuse HIV/AIDS and Substance Abuse prevention services prevention services
A community with an ideal A community with an ideal HIV/AIDS prevention system will HIV/AIDS prevention system will have a core number of agencies, have a core number of agencies, organizations or resources organizations or resources providing basic prevention providing basic prevention services. services.
Prevention ComponentsPrevention Components Access to epidemiological dataAccess to epidemiological data HIV Counseling and TestingHIV Counseling and Testing Case ManagementCase Management Housing ServicesHousing Services Health EducationHealth Education STD diagnosis and TreatmentSTD diagnosis and Treatment LGBT ServicesLGBT Services Mental Health ServicesMental Health Services Public Information CampaignPublic Information Campaign Strategic planStrategic plan Medical servicesMedical services Alcohol and Drug TreatmentAlcohol and Drug Treatment Reproductive Health ServicesReproductive Health Services
Process Process
IdentifyIdentify AssessAssess Facilitate Facilitate
Identification of existing Identification of existing resourcesresources
Community Resources ModuleCommunity Resources Module
Contact program directorsContact program directors
Survey existing links Survey existing links
Type of data collected Type of data collected LocationLocation AgenciesAgencies Type of prevention servicesType of prevention services Referral Patterns Referral Patterns Type of interorganizational activitiesType of interorganizational activities Basis of activity Basis of activity Frequency of contactFrequency of contact Length of relationLength of relation Perceived TrustPerceived Trust Perceived cultural competency Perceived cultural competency
Indicators of capacity building at Indicators of capacity building at the community levelthe community level
Our HIVP and SAP Initiative has over 600 Our HIVP and SAP Initiative has over 600 service providers and organizations service providers and organizations involved. involved.
This total includes linkages to 553 This total includes linkages to 553 agencies and organizations plus 47 agencies and organizations plus 47 funded-programs. funded-programs.
Service links in the communityService links in the community
Epidem iologic alD ata
HIVP and S APT argetedCapac ityInitiative
M edic ationS ervic es
S T DD x & T x
F am ily p lanning
Hous ingHealthEduc ation
A lc o h o l & D ru gT x
P artnerCouns eling
Cas eM anagem ent
Couns eling &T es ting
Reproduc tiveHealth
LG BT S ervic es
M ental Health
P ublic InfoCam paign
S trateg ic P lan
M edic al Care
7 7
28
67
49642648
55
33
3723
34
422654
20
Organizations associated with Organizations associated with the Initiativethe Initiative
S c ho o lsF a ith -b ased
O rgan iza t io n s
C o lleges /Univers itiesHealth-C are P ro vid ers
74 5 4
5 06 0
HIV/AIDS and Substance abuse HIV/AIDS and Substance abuse prevention services prevention services
We seek to develop community We seek to develop community capacity to develop a capacity to develop a comprehensive and competent comprehensive and competent system of HIV/AIDS and substance system of HIV/AIDS and substance abuse prevention services by abuse prevention services by fostering collaborative relations fostering collaborative relations between the program to existing between the program to existing community resourcescommunity resources
Facilitate linkages to resources Facilitate linkages to resources
Mediate relation between the Mediate relation between the agency and the service provideragency and the service provider
Social Network AnalysisSocial Network Analysis
A collection of methods for the A collection of methods for the systematic study of relational systematic study of relational patterns of people, organizations, patterns of people, organizations, communities and other social communities and other social entities. entities.
Linkages to Prevention Linkages to Prevention ComponentsComponents
Epi
MedicalCare
LGBTServices
STDDx & Tx
Health Education
HousingCM
AODTX
ReproductiveHealth
StrategicPlan
Mental Health
San JuanN=2
C&TC&T
PublicInfo
1 1
3
0
1
1
2006
1
0
34 1 1 1 1
0
0
1001
2
2
Linkages to Prevention Linkages to Prevention ComponentsComponents
Epi
MedicalCare
LGBTServices
STDDx & Tx
Health Education
HousingCM
AODTX
ReproductiveHealth
StrategicPlan
Mental Health
QuebradillasN=4
C&TC&T
PublicInfo
43 3
2
1
1128
4
3
32
32 3 1
3
1
0013
3
0
2
41
1 1 1
0
1
100
2
0
1
1 23
3 1
1
1
1012
2
1
Linkages to Prevention ComponentsLinkages to Prevention Components
Epi
MedicalCare
LGBTServices
STDDx & Tx
Health Education
HousingCM
AODTX
ReproductiveHealth
StrategicPlan
Mental Health
Ponce N=3
C&TC&T
PublicInfo
31 1
2
1
1224
1
4
22
11 4 1
1
3
1235
7
4
1
10
1 1 0
1
0
000
4
0
2
Linkages to Prevention Linkages to Prevention ComponentsComponents
Epi
MedicalCare
LGBTServices
STDDx & Tx
Health Education
HousingCM
AODTX
ReproductiveHealth
StrategicPlan
Mental Health
AreciboN=2
C&TC&T
PublicInfo
01 2
0
1
0000
0
0
13
21 0 1
1
1
1003
3
0
1
Organizations associated with Organizations associated with the Initiative: San Juanthe Initiative: San Juan
S c ho o lsF a ith -b ased
O rgan iza t io n s
C o lleges /Univers itiesHealth-C are P ro vid ers
1 1
0 0
1
11
0
Organizations associated with the Organizations associated with the Initiative: QuebradillasInitiative: Quebradillas
S c ho o lsF a ith -b ased
O rgan iza t io n s
C o lleges /Univers itiesHealth-C are P ro vid ers
2 2
12
0
10
11 0
3 30
0
11
Organizations associated with the Organizations associated with the Initiative: PonceInitiative: Ponce
S c ho o lsF a ith -b ased
O rgan iza t io n s
C o lleges /Univers itiesHealth-C are P ro vid ers
2 4
2
0
30
30
0
2
4
8
Organizations associated with Organizations associated with the Initiative: Arecibothe Initiative: Arecibo
S c ho o lsF a ith -b ased
O rgan iza t io n s
C o lleges /Univers itiesHealth-C are P ro vid ers
2 2
02
1
10
0
