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The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter: Jeffrey Friedman Executive Director 631-329-4398 [email protected]

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Page 1: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

The Center for Substance Abuse TreatmentStrategic Planning for Providers to Improve Business Practices

Arlington, Virginia - October 21–23, 2009

The Center for Substance Abuse TreatmentStrategic Planning for Providers to Improve Business Practices

Arlington, Virginia - October 21–23, 2009

Presenter: Jeffrey Friedman

Executive Director

631-329-4398

[email protected]

Presenter: Jeffrey Friedman

Executive Director

631-329-4398

[email protected]

Page 2: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

New York State MapNew York State Map

Page 3: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Map of Long Island, NYMap of Long Island, NY

Page 4: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Long Island, NYLong Island, NY

Two suburban counties, home to 2.75 million people

Among the most segregated suburbs in the U.S. White communities; Black and Hispanic communities Pockets of intense poverty right next to affluent areas

Annual family income < $25,000 for 64,000 families

Among highest cost of living per capita in the nation

Inadequate public transit

More AIDS cases than 26 states

Two suburban counties, home to 2.75 million people

Among the most segregated suburbs in the U.S. White communities; Black and Hispanic communities Pockets of intense poverty right next to affluent areas

Annual family income < $25,000 for 64,000 families

Among highest cost of living per capita in the nation

Inadequate public transit

More AIDS cases than 26 states

Page 5: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Demographic/Epidemiologic Detail Long Island, NY

Demographic/Epidemiologic Detail Long Island, NY

Long Island Population:

77% White/Caucasian

Hispanic (10%) and Black (8%) residents account for 64%

of the newly diagnosed HIV cases over a recent 12 month

period

30% of newly diagnosed HIV cases were female

Long Island Population:

77% White/Caucasian

Hispanic (10%) and Black (8%) residents account for 64%

of the newly diagnosed HIV cases over a recent 12 month

period

30% of newly diagnosed HIV cases were female

Page 6: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Outreach on Long Island Outreach on Long Island

Page 7: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Outreach on Long Island Outreach on Long Island

Page 8: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Outreach on Long Island Outreach on Long Island

Page 9: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Rapid HIV Testing Outreach InitiativeRapid HIV Testing Outreach Initiative

Long Island community based organizations (CBO) participated in

this initiative from 2001 -2007

Project was a partnership between 3 CBO’s, HIV provider, substance

abuse provider and a local weed and seed provider.

Project was funded through SAMHSA CSAT, TCE initiative.

As a part of this project the OraQuick advanced HIV rapid tests was

utilized during street outreach.

Long Island community based organizations (CBO) participated in

this initiative from 2001 -2007

Project was a partnership between 3 CBO’s, HIV provider, substance

abuse provider and a local weed and seed provider.

Project was funded through SAMHSA CSAT, TCE initiative.

As a part of this project the OraQuick advanced HIV rapid tests was

utilized during street outreach.

Page 10: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

S.M.A.R.T. S.M.A.R.T. ObjectivesObjectivesS.M.A.R.T. S.M.A.R.T. ObjectivesObjectives

• S = Specific

• M = Measurable

• A = Achievable

• R = Realistic

• T = Time-bound

• S = Specific

• M = Measurable

• A = Achievable

• R = Realistic

• T = Time-bound

Page 11: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Overview of Methods to Collect Data / InfoOverview of Methods to Collect Data / Info

• Questionnaires / Surveys

• Checklists

• Observation

• Interviews

• Focus Groups

• Case Studies

• Documentation Review

• Questionnaires / Surveys

• Checklists

• Observation

• Interviews

• Focus Groups

• Case Studies

• Documentation Review

Page 12: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Adding an open-ended question as part of a an accompanying interview can elicit very touching qualitative responses

Adding an open-ended question as part of a an accompanying interview can elicit very touching qualitative responses

• Example: “In your own words, what does it feel like to see the way

you do now, compared to your experience before?”

• Example: “In your own words, what does it feel like to see the way

you do now, compared to your experience before?”

Page 13: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

A few insights into wording survey questionsA few insights into wording survey questions

• Use short and simple sentences

• Short, simple sentences are generally less confusing and ambiguous than long, complex ones.

• Ask for only one piece of information at a time

• For example, "Please rate this lecture in terms of its content and presentation" asks for two pieces of information at the same time.

It should be divided into two parts: "Please rate the lecture in terms of (a) its content, (b) its presentation."

“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ

• Use short and simple sentences

• Short, simple sentences are generally less confusing and ambiguous than long, complex ones.

• Ask for only one piece of information at a time

• For example, "Please rate this lecture in terms of its content and presentation" asks for two pieces of information at the same time.

It should be divided into two parts: "Please rate the lecture in terms of (a) its content, (b) its presentation."

“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ

Page 14: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

A few insights into wording survey questionsA few insights into wording survey questions

• Avoid negatives if possible

• For example, instead of asking expert respondents whether they agree with the statement, “Clean needle

exchange should not be abolished,"

the statement should be rephrased as, “Clean needle exchange should continue." Double negatives

should always be avoided.

“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ

• Avoid negatives if possible

• For example, instead of asking expert respondents whether they agree with the statement, “Clean needle

exchange should not be abolished,"

the statement should be rephrased as, “Clean needle exchange should continue." Double negatives

should always be avoided.

“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ

Page 15: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

A few insights into wording survey questionsA few insights into wording survey questions

• Ask precise questions

• Questions may be ambiguous because a word or term may have vastly different meanings to different people.

• For example, if we ask substance-using clients to “rate your interest in recovery, this word ‘recovery’ might mean “recovering from an addiction to substance use" to some, but may mean “time in an in-patient substance use program” to others.

• Always specify a frame of reference. For example, in the question, "How often did you receive food from the soup kitchen?" the time reference is missing.

• It might be rephrased as, "How many meals have you received at the soup kitchen within the past six months?"

“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ

• Ask precise questions

• Questions may be ambiguous because a word or term may have vastly different meanings to different people.

• For example, if we ask substance-using clients to “rate your interest in recovery, this word ‘recovery’ might mean “recovering from an addiction to substance use" to some, but may mean “time in an in-patient substance use program” to others.

• Always specify a frame of reference. For example, in the question, "How often did you receive food from the soup kitchen?" the time reference is missing.

• It might be rephrased as, "How many meals have you received at the soup kitchen within the past six months?"

“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ

Page 16: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

A few insights into wording survey questionsA few insights into wording survey questions

• Minimize bias

• People tend to answer questions in a way they perceive to be socially desired or expected by the questioner and they often look for clues in the questions.

• Many apparently neutral questions can potentially lead to bias.

• For example, in the question, "Within the past month, how many Alcoholics Anonymous meetings have you missed due to your evening job?“, respondents may perceive the desired responses to be "never" to the first question.

• This question could be rephrased as two related questions, "Within the past month, how many times did your evening job commitment clash with Alcoholics Anonymous meetings?

How many times did you give priority to your evening job?"

“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ

• Minimize bias

• People tend to answer questions in a way they perceive to be socially desired or expected by the questioner and they often look for clues in the questions.

• Many apparently neutral questions can potentially lead to bias.

• For example, in the question, "Within the past month, how many Alcoholics Anonymous meetings have you missed due to your evening job?“, respondents may perceive the desired responses to be "never" to the first question.

• This question could be rephrased as two related questions, "Within the past month, how many times did your evening job commitment clash with Alcoholics Anonymous meetings?

How many times did you give priority to your evening job?"

“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ

Page 17: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Typical Questions Asked / Answered

during Process Evaluation

Typical Questions Asked / Answered

during Process Evaluation

1) Are the services being provided those which were intended?

2) Are the people being enrolled in the project those who were identified as most in-need

and in / from the geography identified as most in-need?

3) Are the participants receiving the types of services that they need?

4) Are all partnering organizations functioning together with focus?

• Basically: “How’s it going?!”

1) Are the services being provided those which were intended?

2) Are the people being enrolled in the project those who were identified as most in-need

and in / from the geography identified as most in-need?

3) Are the participants receiving the types of services that they need?

4) Are all partnering organizations functioning together with focus?

• Basically: “How’s it going?!”

Page 18: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Overall Lessons Learned about Outreach in the field

Overall Lessons Learned about Outreach in the field

Recruit staff from target communities (whenever possible)

Dress casually in the field, professionally in the office

Use an outreach van as opposed to conducting outreach using

fixed location

Refrain from putting any signs on outreach vehicle

Build trust in the community before introducing services

Recruit staff from target communities (whenever possible)

Dress casually in the field, professionally in the office

Use an outreach van as opposed to conducting outreach using

fixed location

Refrain from putting any signs on outreach vehicle

Build trust in the community before introducing services

Page 19: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Overall Lessons Learned about Outreach

Overall Lessons Learned about Outreach

Page 20: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Lessons Learned: MobilityLessons Learned: Mobility

Deploying a mobile office dramatically improves capacity to

serve.

The van/r.v. transformed our entire outreach dynamic. Instead

of us waiting for people to ‘drop in’ to a storefront and soup

kitchen, we were able to park the van --(on a rotating basis)-- in

key areas of the community.

We would canvas these zones by foot, and gain gradual trust and

recognition by community members, including by at-risk

individuals who became interested in the services we offered.

Deploying a mobile office dramatically improves capacity to

serve.

The van/r.v. transformed our entire outreach dynamic. Instead

of us waiting for people to ‘drop in’ to a storefront and soup

kitchen, we were able to park the van --(on a rotating basis)-- in

key areas of the community.

We would canvas these zones by foot, and gain gradual trust and

recognition by community members, including by at-risk

individuals who became interested in the services we offered.

Page 21: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Overall Lessons Learned about Outreach

Overall Lessons Learned about Outreach

Page 22: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Lessons Learned: StaffingLessons Learned: Staffing

Complexity/challenges associated with recruiting and retaining staff.

Over time, our most successful outreach staff have shown:

Extreme passion for outreach / giving back to their community

Direct history living in disadvantaged communities

‘Street smarts’ / knowledge of local hangouts

High capacity for accurate data recording

Complexity/challenges associated with recruiting and retaining staff.

Over time, our most successful outreach staff have shown:

Extreme passion for outreach / giving back to their community

Direct history living in disadvantaged communities

‘Street smarts’ / knowledge of local hangouts

High capacity for accurate data recording

Page 23: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Lessons Learned: Cultural Competency

Lessons Learned: Cultural Competency

Cultural competency directly impacts receptivity and results.

We discovered that:

To our target population, “Shirt + tie” equals either “Police”

or “Immigration,” both feared in the minds of many of our

highest-risk clients;

Outreach workers who are native Spanish speakers and/or

bilingual make initial contact with many of our clients more

easily.

Cultural competency directly impacts receptivity and results.

We discovered that:

To our target population, “Shirt + tie” equals either “Police”

or “Immigration,” both feared in the minds of many of our

highest-risk clients;

Outreach workers who are native Spanish speakers and/or

bilingual make initial contact with many of our clients more

easily.

Page 24: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Lessons Learned: Persistence Lessons Learned: Persistence

Don’t underestimate the labor intensiveness of the outreach

process.

It took us some time to learn of the following: It most often takes

more than one encounter, and sometimes up to 10 encounters with

the same person, before that at-risk individual will accept or

request services.

And the person still may not. As a result, it takes a lot longer than

initially envisioned to attract the target number of unduplicated

people served.

Don’t underestimate the labor intensiveness of the outreach

process.

It took us some time to learn of the following: It most often takes

more than one encounter, and sometimes up to 10 encounters with

the same person, before that at-risk individual will accept or

request services.

And the person still may not. As a result, it takes a lot longer than

initially envisioned to attract the target number of unduplicated

people served.

Page 25: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Lessons Learned: Holistic Approach

Lessons Learned: Holistic Approach

• We learned that in order to build enough trust among our target

population, we have often needed to address an array of

needed/valued services:

Access to substance abuse treatment

Nutrition assistance

Housing assistance

Employment and social services assistance

Assistance accessing primary medical care

• We learned that in order to build enough trust among our target

population, we have often needed to address an array of

needed/valued services:

Access to substance abuse treatment

Nutrition assistance

Housing assistance

Employment and social services assistance

Assistance accessing primary medical care

Page 26: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Overall Lessons Learned about Outreach in the field

Overall Lessons Learned about Outreach in the field

Client Locator Form:

Directly asks clients, upon intake, where they tend to hang out, their regular daily

routines, who can help us find them later, and what aliases and nicknames they use;

Two years later we added fields for the client’s physical description (including

height, weight, ethnicity, visible tattoos) and where precisely we encountered the

client for initial encounter/intake.

And it was also imperative that we implement classic data verification, thereby

diminishing any chance for erroneous, malicious, or incomplete data entry that

could arise due to competing concerns among those with differing roles and

positions. 

Client Locator Form:

Directly asks clients, upon intake, where they tend to hang out, their regular daily

routines, who can help us find them later, and what aliases and nicknames they use;

Two years later we added fields for the client’s physical description (including

height, weight, ethnicity, visible tattoos) and where precisely we encountered the

client for initial encounter/intake.

And it was also imperative that we implement classic data verification, thereby

diminishing any chance for erroneous, malicious, or incomplete data entry that

could arise due to competing concerns among those with differing roles and

positions. 

Page 27: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Locator Information FormLocator Information Form

Page 28: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Overall Lessons Learned EvaluationOverall Lessons Learned Evaluation

To assure consistent project feedback leading to continuous

quality improvement, our project evaluator performed both

qualitative and quantitative analysis.

The two main elements of this type of evaluation were:

Participation of all stakeholders; and

Reflexivity, demonstrated by continuous re-examination of

goals and activities.

To assure consistent project feedback leading to continuous

quality improvement, our project evaluator performed both

qualitative and quantitative analysis.

The two main elements of this type of evaluation were:

Participation of all stakeholders; and

Reflexivity, demonstrated by continuous re-examination of

goals and activities.

Page 29: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

Overall Lessons Learned EvaluationOverall Lessons Learned Evaluation

We achieved these goals as the evaluator worked

synchronistically with the staff, making periodic

presentations to the advisory board and to other

organizations that wished to share the learning's

of project as they arose.

We achieved these goals as the evaluator worked

synchronistically with the staff, making periodic

presentations to the advisory board and to other

organizations that wished to share the learning's

of project as they arose.

Page 30: The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices Arlington, Virginia - October 21–23, 2009 Presenter:

The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices

Arlington, Virginia - October 21–23, 2009

The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices

Arlington, Virginia - October 21–23, 2009

Presenter: Jeffrey Friedman

Executive Director

631-329-4398

[email protected]

Presenter: Jeffrey Friedman

Executive Director

631-329-4398

[email protected]