1. Native American, Alaska Native, Native Hawaiians: Using Community Readiness to Advance HIV/AIDS Prevention Advancing HIV/AIDS Prevention in Native Communities (HAPP)

2. Our target audience: CDC funded Community Based Native Organizations State Health Boards Native Health Boards Indian Health Service Regional Offices And other organizations or tribes serving Native communities We offer our Capacity Building Assistance to:

3. What HAPP offers on this project Community Readiness Assessment Provision of a Readiness Diagnostic Readiness Workshop Community Readiness Action Plan Social Marketing Strategies Follow Up with Technical Support Our first goal is to increase the capacity of an organization or community to implement HIV/AIDS prevention by offering:

4. Assist with development of culturally specific and community specific Social Marketing Strategies Assist with linking and networking to resources Follow Up with Technical Support Our second goal is to utilize those tools to strengthen community capacity for raising awareness about early detection/testing for HIV/AIDS

5. Mobilizing the Community: The Community Readiness Model (Plested, Thurman, Edwards and Oetting) Colorado State University

6. The purpose of community readiness is to provide communities with the stages of readiness for development of appropriate strategies that are more successful and cost effective Purpose of Community Readiness

7. What exactly IS the Community Readiness Model (CRM) A model for community mobilization and change It has nine stages of readiness It measures six dimensions (or aspects) of a community Each dimension has a stage of readiness associated with it Each readiness stage has specific interventions that work most effectively for that stage Integrates culture into the prevention process Trying to implement something when a community is not ready to do can be costly in both human and financial resources, i.e., a waste of time and money

8. Why Use Community Readiness? Mobilizes a community into action while building community ownership Utilizes existing resources, de-emphasizes reliance on money as THE answer Provides a tool for evaluation of efforts Requires no outside ‘experts’ – YOU are the expert for your community/organization! Creates a community vision which translates into a higher degree of sustainability Provides the structure for culturally-appropriate strategies

9. Why is it important to integrate culture into prevention and intervention? Culture... ~ determines how we interpret issues that concern us, or symptoms that affect us or our community ~ determines how we seek care and support ~ determines how we communicate our concerns to others ~ determines how we react to and respond to education and intervention ~ should also influence how prevention or intervention is delivered

10. Dimensions of Community Readiness

11. A. Community Efforts (Programs, activities, policies, etc.) B. Community Knowledge of the Efforts C. Leadership (includes appointed leaders and influential community members) D. Community Climate E. Community Knowledge About the Issue F. Resources for Prevention Efforts (people, time, money, space, etc.) Dimensions Of Community Readiness

12. Stages of Community Readiness

14. 1 - No Awareness Issue is not generally recognized by the community as a concern “It’s just the way things are!” Issue may be overlooked or ignored Behavior may be expected of one group and not another

15. 2 - Denial / Resistance Some recognition by some community members that the behavior is a concern Little or no recognition locally Feeling that nothing needs to be done locally “It’s not our concern!” “We can’t do anything about it!”

16. 3 - Vague Awareness General feeling by at least some in the community that there is a local concern and that something should be done about it No immediate motivation No identifiable leadership Community climate does not motivate action Issue and causes are stereotyped

17. 4 - Preplanning Clear recognition by some in the community that it is a local problem and something should be done about it Identifiable leadership, but efforts are not focused or detailed Discussion, but no real planning Climate is beginning to acknowledge the necessity of addressing the problem

18. 5 - Preparation Planning is going on and focuses on details General information about local problems and pros and cons of efforts Leadership is active and energetic Resources (people, money, time, etc.) are actively being sought Community climate offers modest support

19. 6 - Initiation Information is available to justify the efforts Activity and action is underway, but still viewed as a new effort Staff are being trained Great enthusiasm in leaders, as limitations and issues have yet to be met Improved attitude in community members is reflected by continued modest support

20. 7 - Stabilization One or two efforts are running, supported by administrators/community decision-makers Programs and activities are viewed as stable Staff are trained and experienced No in-depth evaluation of effectiveness as yet Climate supports activities

21. 8 - Confirmation / Expansion Standard efforts are now in place and leadership supports expanding and improving services Efforts are being evaluated and modified New efforts are being developed, resources are being sought to serve more groups Climate may challenge specific efforts, due to increased knowledge, but remains supportive

22. 9 – High Level Of Community Ownership Detailed and sophisticated knowledge of prevalence, risk factors, and causes exist Efforts target general populations with programs serving specific risk factor and/or high risk groups Staff are highly trained and cross trained Leadership and community involvement is high Evaluation to modify programs and policies Community holds efforts accountable to needs

23. Remember!! A Community’s Readiness is based on the “Community’s truth” “Community’s Truth” vs “The Reality” Perception is reality Sometimes the two truths are different Community Readiness scores are based on the “community’s truth” – example: leadership

24. Process For Using The Community Readiness Model Community Change! Identify Issue Define “Community” Conduct Key Respondents Interviews Score to Determine Readiness Level Develop Strategies/Conduct Workshops

25. Each Dimension Receives A Community Readiness Stage Score

26. Dimension A: Efforts 6: Initiation Dimension B: Knowledge of efforts 4: Preplanning Dimension C: Leadership 3: Vague Awareness Dimension D: Climate 3: Vague Awareness Dimension E: Knowledge of issue 2: Denial Dimension F: Resource 5: Preparation Example of a Community Diagnostic

27. Each Community Readiness Score has Strategies that are most effective at that level Following are some examples Of the types of activities that Communities have told us are Most effective at those stages

28. 1 - No Awareness Identify potential supporters Visit with them, one on one Present at existing and established small groups Use the “Indian Grapevine” Search for online resources (posters, educational information) that can be duplicated or ordered Phone calls to friends - inform others, get them excited and solicit their support – be creative! Strategies… Goal: Raise awareness of HIV/AIDS

29. 2 - Denial / Resistance Continue strategies from previous stage Meet with people who are likely to provide HIV/AIDS services (medical, substance abuse, etc) Distribute flyers, brochures, educational info (information must be brief and concise) Put information in church bulletins, tribal newsletters, etc. Choose places where they are likely to be seen Remember that media must be low intensity but visible Goal: The issue does exists in this community Strategies…

30. 3 - Vague Awareness Continue strategies from previous stage Attend/have booth at special events: potlucks, dances, health fairs, tribal “holidays” etc. where you can distribute your information Identify all potential local data sources, programs and efforts Focus on topics that the community may be more “ready” to address that relate to HIV infection – underage drinking, meth use, STDs or substance use Publish newspaper editorials/articles and creative media consistent with community visibility - things that might be read Goal: Community can make positive changes Strategies…

31. 4 - Preplanning Establish a working group focused on HIV/AIDS prevention Share local data and information that you have gathered with key people who might support your cause Use media for newspaper articles/posters Conduct informal surveys about what people know about HIV/AIDS resources and needs Identify “Best Practices”, effective curricula, DEBIs, and other programs which may be appropriate for Native audiences Goal: Develop concrete strategies Strategies…

32. 5 - Preparation Remember to always continue strategies from previous stage Organize and present local statistics, local efforts, and survey information to the community through tribal newsletter, local newspaper, radio, cable television, dinners, etc. (Compile the facts: local statistics, local stories, emotional cost to the community, consequences to the community, future impact on the community, financial cost to the community) Begin searching for potential funding for prevention and resources for HIV testing through tribe, state, federal, foundations, etc.) HIV/AIDS basic information can be presented to tribal councils, department staff, county work - NETWORK Goal: Gather pertinent information Strategies…

33. 6 - Initiation If local data sources are non-existent or unreliable, plan how to begin accurate local data collection Inform other community providers and leaders through multi- disciplinary meetings, tribal council, in-service trainings, etc. and talk about the progress of your efforts Network with existing resources to enhance your referral system Sponsor or co-sponsor larger community events Plan publicity efforts associated with start up of activity, program or efforts. Begin discussion about basic evaluation efforts Goal: Provide community specific information Strategies…

34. 7 - Stabilization Remember again, always continue strategies from previous stage Plan community events to maintain support for HIV/AIDS efforts and testing Introduce evaluation results through multiple media sources Review efforts/activity progress on a quarterly basis Maintain business and other support for the effort/activity Increase and further develop media exposure to reach community, use evaluation data Goal: Stabilize efforts or establish programs Strategies…

35. 8 – Confirmation And Expansion Formalize networking with MOCs, MOUs or other collaborative agreement Publish a localized resource directory (HIV, health, etc.) Expand community awareness through: speakers bureaus, events, media, etc. Continue to maintain and report trends from data base Continue to survey and solicit public opinion Utilize evaluation to improve efforts and provide feedback to community and other professionals Goal: Expand and enhance services Strategies…

36. 9 - High Level Of Community Ownership Keep your community informed about your efforts Diversify funding resources, identify new sources Maintain and expand local business and community support Continue to track evaluation data trends for grant writing to expand program Work on related issues Goal: Maintain momentum, grow and use what’s learned Strategies…

37. Ways in which the CRM has been Applied Drug Use Alcohol Use Intimate Partner Violence Child Abuse Head Injury Environmental Trauma Transportation Issues Cultural Competency HIV / AIDS Suicide Environmental / Weather Conditions Animal Control Issues…..and many more

38. Successes of Community Readiness It’s been used in over 1,000 communities throughout the United States It’s been used Internationally as well as Nationally The manual is being translated into both Chinese and Spanish It’s been used in the context of research, evaluation, and grass roots efforts It has been the focus of over 25 published articles in this country and others.

39. Who Can Use the Model? Any individual or group who wants to effect healthy change in a “community” concerned citizens professionals administrators Evaluators who need to assess progress pre and post Project Directors who want to increase the potential of effectiveness in their strategies Organizations who want to look at organizational or system readiness to deal with an issue

40. Community Readiness Training and Technical Assistance Team Barbara Plested * bplested@aol.com Pamela Jumper Thurman * pjthurman@aol.com Martha Burnside * martha.burnside@colostate.edu Andrea Israel * andrea.israel@colostate.edu Irene Vernon *irene.vernon@colostate.edu

41. HIV /AIDS Prevention Project Website www. happ.colostate.edu

42. The Great Law of the Six Nations Iroquois Confederacy “In our every deliberation we must consider the impact of our decision on the next seven generations.”