1. Laying the Foundation for Success: SDPI Demonstration Projects Overview November 17, 2010 SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program Initiative: Year 1 Meeting 1

2. Overview –Background –Planning Year –Implementation –Transition

3. Background Special Diabetes Program for Indians –Balanced Budget Act 1997 Prevention/Treatment of Diabetes in AIANs Administered by the IHS –2002 Reauthorization Congressional direction – develop a competitive grant program to demonstrate diabetes prevention and also address the most compelling complication of diabetes (cardiovascular disease) Evaluation required

4. SDPI Competitive Grant Program –Tribal Consultation –IHS Director decision $27.4 million/year x 5 years –Grants to 60-70 programs ($23.3 million) –Administration, Coordination, Evaluation ($4.1 million) –“Competitive”- programs compete for funding Demonstration Projects –Programs implement activities in 1 of 2 areas »Diabetes Prevention; Cardiovascular Disease Risk Reduction –Collaborative development of activities –Comprehensive Evaluation, Coordinating Center

6. Special Diabetes Program for Indians –2007 Reauthorization Medicare, Medicaid, and SCHIP Extension Act Extended SDPI for an additional year at the same funding level

7. Final Timeline –FY 2004 RFA, Selection of Programs –FY 2005 Planning Year –FY 2006-2009 Implementation of Activities Comprehensive Evaluation –FY 2009-2010 Transition to documentation of activities and outcomes with a smaller dataset and fewer forms

8. Planning Year 6 meetings November 2004 – October 2005 ­Collaborative process involving grantees, IHS, and Coordinating Center ­Developed a common set of activities and an evaluation to be implemented in a diverse group of communities and cultures by program staff with varying levels of experience and expertise Operations Manual ­Core Elements ­Evaluation design and instruments IRB application template Names and Logos

9. Collaborative Process

11. Collaborative Process – Reporting Out

12. Diabetes Prevention Program –Recruit and screen to find people with pre- diabetes –Goal: 48 people per year –Teach 16 session DPP curriculum in group sessions –Individual coaching on physical activity, weight loss –Retention/After Core –Community activities –Outcomes – weight loss, lifestyle changes, prevention of diabetes Core Elements – Required Activities

13. Diverse set of 36 grant programs –One size doesn’t fit all! –Must implement and evaluate a common set of activities Grant Programs encouraged to adapt to local setting, culture, circumstances –Technical Adaptations – format of curriculum, flexibility on timing, order of classes, adding content, adding pictures, local foods, interactive activities, local speakers –Cultural Adaptations – translation, prayers/blessings, local traditions, talking circles, traditional games, culturally-specific examples, encourage cultural perspectives, communication styles, local images/designs Adaptation of Program Activities

14. Process – did programs successfully implement the activities, lessons learned? Outcomes – did participants improve on short-term, intermediate and long-term outcomes? What factors were associated with successful participants and programs? Evaluation Design

15. Evaluation Design – Participant Level Recruitment Screening Consent Baseline Assessment DPP Curriculum (16 Sessions) Follow up Assessment Annual Assessment Time 0 ---------------------------------------- 4-6 months ---------- 1 year --------------- -2 year ------------  Lifestyle Coaching, Community Based Activities Annual Assessment

16. Evaluation Design – Program Level Measurements ­Provider: demographic, professional background -Program: recruitment, retention, After Core, team activities -Organization: organization effectiveness -Community: community stakeholders’ perspective

17. Planning Year - Lessons Learned Grantees ­Start vs. plan -Wide range of programs, experience, and expertise requiring diverse technical assistance and training needs -Communication/collaboration -Staff turnover -Stakeholder support -Common activities vs. local variation -Public health program evaluation vs. research

18. Implementation - Continuing the Collaborative Process Seven additional meetings ­Technical assistance workshops, sharing challenges and solutions, group discussions by staff position, Operations Manual revisions ­Semi-annual progress reports to provide feedback Ongoing technical assistance ­Coordinating Center visits, website, quarterly technical assistance conference calls, one-on-one conference calls, support by e-mail and phone, Tips of the Week (TOTW)

19. Implementation - Challenges & Lessons Learned Organizational ­Availability of specialized space, hiring and purchasing regulations, local stakeholder support (providers, management, and community leaders), communications, adequate computer hardware and software, internet access Grants Management - Access to funds, allowable items/incentives, carryover Programmatic ­Recruitment, retention, access to patient records, scheduling, staff turnover and re-training

20. Transition Transition from program evaluation to program documentation with a smaller dataset and fewer forms –Program Evaluation 12 types of participant-level forms 8 types of program-level forms –Program Documentation 5 types of participant-level forms 5 types of program-level forms

21. Summary –SDPI Demonstration Projects are a success –Many lessons learned –Beyond the Demonstration Projects – SDPI Initiatives 38 programs, including 9 new award recipients Continue or newly implement Diabetes Prevention Program Document activities and outcomes Disseminate information and best practices from the SDPI Demonstration Projects to other IHS, Tribal, and Urban Indian health settings

22. Questions?