2 Learning Objectives Explore sustainability as it relates to capacity Review Strategic Prevention FrameworkOverview capacityDefine types and levels of capacityExplore capacity in context of MAI grantDiscuss the role of cultural competency in capacity buildingExplore sustainability as it relates to capacity
3 Activity (Tables) - Elevator speech: “What is the SPF Activity (Tables) - Elevator speech: “What is the SPF?” (one or two sentences)
4 SPF – Step 1: Assessment Review Outcome-based prevention focusSPF processStep 1: Profile population needs, resources, and readiness to address needs and gapsDocumenting findings in the online Management Reporting Tool (MRT)Outcome-based px focuses on 1) identifying substance abuse and HIV/AIDS related problems, 2) what we call intervening variables (R&PFs and other factors contributing to the incidence of SA and transmission of HIV/AIDS (permissive norms, availability of drugs, risky sexual behaviors, ) and 3) strategies that the literature on SA and HIV/AIDS Px have found to be effective in addressing these particular contributing factors and problems.SPF – data-driven strategic planning process which guides our comprehensive approach to SA and transmission of HIV/AIDSStep 1: explores the extent of ATOD use and consequences, incidence of transmission of HIV/AIDS, related risky behaviors and contributing factors such as risk and protective factors. This is done by compiling and analyzing lots of qualitative and qualitative data into an epi profile of your community/focus pop (peeling the onion), selecting some priority problems/ contributing factors/ target population to address with your initiative, then looking at what already exists in your community that addresses these problems and contributing factors, what is needed (where the gaps are), and how ready the community is to accept, support and participate in prevention initiatives.
5 Strategic Prevention Framework Step 1: AssessmentProfile population needs, resources, and readiness to address needs and gapsStep 2: CapacityMobilize and build capacity to address needsStep 3: PlanningDevelop a comprehensive strategic planStep 4: ImplementationImplement evidence-based programs, policies, practicesStep 5: EvaluationMonitor, evaluate, sustain, and improveStep 2 involves building our capacity to do each step of the SPF, to assess, to plan, to implement, and to evaluate. It involves building our capacity to organize in ways that will help us do these things. It means bringing together the people in our communities who have a stake in our issue, bringing together our resources, and improving our ability to organize and work together to address needs ID’d in Step 1.Step 1 – We’ll need to build our capacity to assess our population’s needs, resources, and readiness to address these needs and fill the gaps in resources we identify.Step 3 – We’ll need to build our capacity to bring together a group of stakeholders to create a comprehensive plan for how our cmty will address the needs we’ve identified, and the factors contributing to those needs, using strategies and programs shown to be effective.Step 4 – We’ll need to build our capacity to implement p/p/p to carry out strategies, and to begin gathering certain kinds of information about these p/p/p’s which will help us evaluate how effective our p/p/p’s are.Step 5 – We’ll need to build our capacity to monitor and evaluate our efforts, improve our strategies, and sustain the organizations, programs, policies, and practices we’re implementing.
6 Goals of the Minority SA/HIV Initiative Build foundation for delivering and sustaining quality, accessible, state-of-the-science SA and HIV prevention servicesEngage community groups to prevent and reduce the onset of SA and transmission of HIV/AIDSFocus on high risk sub-populationsThe purpose of this initiative is to support an array of activities to assist grantees in building a solid foundation for delivering and sustaining quality and accessible state of the science substance abuse and HIV prevention services. Specifically, the program is intended to engage community-level domestic public and private non-profit entities to prevent and reduce the onset of SA and transmission of HIV/AIDS among the following at-risk racial/ethnic minority subpopulations:reentry populations (i.e., racial/ethnic minorities who have been released from prisons and jails within the past 2 years);men having sex with men (MSM);Black, Latina, or Hispanic women;adolescents (age 12-17);young adults (age 18-24); andolder adults, age 50 and over in communities of color disproportionately affected by SA and HIV/AIDS.In step 2, we assess and build our capacity to do this.
7 Best Processes1 for Implementing the Strategic Prevention Framework 1. Analyzing Information About the Problem,Goals, and Factors Affecting ThemCollecting & Analyzing Data About theProblem and Contributing FactorsA. AssessmentB. Capacity10. Documenting Progress andUsing FeedbackDocumenting Progress and3. Defining Organizational Structureand Operating MechanismsDefining Organizational Structureand Identify ResourcesE. Evaluation9. AssuringAssuring Technical Assistance12. Sustaining the WorkSustaining the Work8. Implementing EffectiveInterventionsImplementing Effective7. Developing LeadershipDeveloping LeadershipDifferent points of view (next 2 slides)In thinking about the capacities we will need in order to do this, one conceptual framework that is very helpful is this one used by public health.This model shows what kinds of processes other public health initiatives have found to be effective, processes that build capacity to effectively implement the SPF and to effectively address whatever the public health issue is which we are addressing, in our case SA and the transmission of HIV/AIDS - reviewOur projects will want to build our capacity to use these same processes.What kinds of capacities/abilities would we need to collect and analyze data…C. PlanningD. Implementation4. Developing a framework ormodel of changeDeveloping aModel of Change1Best processes identified through a literature review conducted by Dr. Renee Boothroyd, University of Kansas – used with permission.5. Developing and UsingStrategic and Action PlansDeveloping and UsingStrategic Action Plans
8 Develop Comprehensive Skills Required to Implement SPF(Core Competencies)1. Analyzing Information About the Problem,Goals, and Factors Affecting ThemAssess Community Needs and ResourcesA. Assessment10. Documenting Progress andUsing FeedbackSustain Projects andInitiativesB. Capacity3. Defining Organizational Structureand Operating MechanismsCreate and Maintain Coalitions & Partnerships11. Making Outcomes MatterEvaluate Initiatives9. AssuringBuild LeadershipE. Evaluation12. Sustaining the WorkSecure Ongoing Funding7. Developing LeadershipEnhance Cultural Competence8. Implementing EffectiveInterventionsInfluence Policy Development6. Arranging Resources forCommunity MobilizationImprove OrganizationalManagement & DevelopmentIt’s also helpful to look at building capacity to implement the SPF process to address SA and HIV/AIDS from the angle of skills we will need.In our projects, we will want to build our capacity/ability to…What kinds of capacities/abilities would we need to assess community needs and resources…These public health conceptual frameworks may help us focus our capacity-building on specific processes and skills.So now let’s look at HOW we might assess our capacity for implementing the SPF and effectively addressing SA and HIV/AIDS in our communities.8. Implementing EffectiveInterventionsDevelop InterventionsC. PlanningD. Implementation4. Developing a framework ormodel of changeDevelop ComprehensiveStrategic Plans.5. Developing and UsingStrategic and Action PlansDevelop Action Plans
9 Building Capacity- Is it Possible? A shoe factory sends two marketing scouts to the field to study the prospects for expanding business.One sends back a telegram saying,SITUATION HOPELESS STOP NO ONE WEARS SHOESThe other writes back triumphantly,GLORIOUS OPPORTUNITY STOP THEY HAVE NO SHOES!(The Art of Possibility, Rosamund Stone Zander & Benjamin Zander)In order to do all this and implement programs, policies, and other changes designed to reduce the likelihood of SA and the transmission of HIV/AIDS, we’ll need to have a positive outlook and a creative approach to collaborating with our community, involving our focus populations in every step, and mobilize our resources in ways that benefit all our stakeholders.
10 Capacity - Definition The ability to mobilize stakeholders resources …in order to implement programs, policies, and other changes designed to reduce the likelihood of substance abuse and transmission of HIV/AIDSIn the context of the SPF and this initiative, capacity means…
11 Mobilizing Stakeholders State SA, HIV/AIDS prevention authorities (CDC, SSA)Service recipients (substance users, injection drug users, GLBTQ populations, recovering community)SA and HIV treatment providers, counseling servicesCommunity-based organizations (coalitions, minority, Planned Parenthood, GLBTQ organizations, etc.)Public healthMediaBusiness community (bar owners, GLBTQ-serving)Law enforcement and justice agenciesReligious and fraternal organizationsHealthcare providersState, local, tribal, Veteran’s governmental agenciesOthers with a stake in reducing SA & HIV/AIDSIf we are to successfully use the SPF to address the unique problems, risk factors and needs of our focus population and sub-groups within that focus population in the context of our community, we will need to bring all our stakeholders to the effort, and keep them involved. We’ll need to really integrate our initiatives into the fabric of our community. And we’ll need to make sure that what we do in our project benefits all our stakeholders.What are stakeholders? Who are our stakeholders?We want to really involve these stakeholders in every step of developing our plan, implementing p/p/p’s, and evaluating whether our programs and services are reaching our focus population, are being implemented as planned, are having their intended effects.Involve these folks in step 1 (how would you?), step 3 (how?) , step 4 (how?), and step 5 (how?).
12 Mobilizing ResourcesResources: the types and levels of assets that exist in a community prevention system that can help meet SA & HIV/AIDS prevention planning and implementation demandsWhen we think of mobilizing “resources,” we mean…In the context of the MAI grant and the SPF, our “community prevention system” is the organizations, people, knowledge, skills, and money we can bring together into an organized way to reduce the occurrence, consequences, and risk factors for SA and the transmission of HIV/AIDS, and to increase protective factors.How do we know what resources we have to bring to addressing the needs and gaps ID’d in Step 1 and what our community’s current capacity/ability is to reduce the consequences of SA and transmission of HIV/AIDS, change substance use and sexual behaviors, and reduce risk factors and increase protective factors in our focus populations?Assess capacity, then develop a plan to build capacity in areas we need to, as identified by our assessment.
13 What Capacities Do We Assess? Human capacitiesPersonnelKnowledgeSkillsFiscalTechnicalData managementOrganizationalCoalitionsWhat do we assess? When consider “resources,” often look at 4 types… and we assess these types of capacities.Human-PersonnelWhat staff does our project need to build our community’s capacity/ability to mobilize and organize stakeholders (ask for examples)What staff are needed to run programs, implement policies, and make other changes to prevent and reduce the onset of SA and transmission of HIV/AIDS (ask for examples)What staff are needed to work effectively with our identified subpopulation (ask for examples)What kinds of knowledge are needed (ask participants for examples, e.g., knowledge of SA and HIV/AIDS transmission, knowledge of EBIs, knowledge of gate-openers, knowledge of culture and sup-population…)What skills do they need (ask participants for examples, e.g., networking, communication, researching, writing, organizing, collaborating, evaluation…)FiscalWhat funds, grants, other resources (media, print shops, health services, government services, business owners) exist in the community that we could collaborate with?TechnicalWhat resources/skills exist in our community for data collection, analysis, storage and presentation; for media production; for technical writing; for policy formation; for program delivery and management; for evaluation…OrganizationalWhat coalitions, community organizations, clubs, or other groups are working on these same or similar issues? What knowledge and skills do they bring?We assess these resources/capacities and then we make a plan to build these capacities so that we can more effectively organize our communities to prevent and reduce the onset of SA and transmission of HIV/AIDS among our selected subpopulations.So how do we know what capacities/abilities/resources we have and what ones we need to build?
14 Assessing Capacity at the Community Level Determine what resources you have (human, technical, fiscal, and organizational) to…collect and analyze dataassess and increase community readinessselect strategies to address needsimplement policies, programs, & practicesevaluate effectivenesssustain effortsWe’ll identify what resources (people, money, technical- tools, organizational- coalitions/skills) we have in our cmty to…
15 Examples of Capacities State levelWorkforce knowledge, skills and competenciesInfrastructure, such as coalitionsData systems (CDC, SSA)Knowledge of cultural protocols in sub- populationsSub-populations’ capacity for prevention (people, skills, funds…)Community levelCommunity orgs addressing SA and HIV/AIDS issuesLeadership within the coalition and the communityPrevention knowledge at the community levelResources allocated and available to address SA & HIV/AIDAlthough the MAI initiative is focused on community-level efforts, we also want to take advantage of state-level resources available to communities, that will help us mobilize and organize our community.These are the kinds of resources and capacities states and communities might access and/or work to develop
16 How Do We Assess Capacity? Use capacity assessment tools to:Identify our strengthsIdentify gaps in knowledge and skills, and resourcesFocus capacity building where it will be most effective in meeting our goalsCap Asst Tools can help us…
17 Capacity Assessment Form (Community Level) Communities assess their capacity to carry out effective preventionAssess 5 areas of capacityRate themselves currentlyRate how important they believe each indicator is to the success of their prevention effortLarge gap scores indicate focus areas for building capacityRefer to Handout, “Capacity Assessment Form (Cmty)” – one example from Nebraska (others exist) – REVIEW FORMThe form can be used by both SA and HIV/AIDS prevention practitioners to assess a number of areas pertaining to their cmty’s capacity to carry out effective preventionThe form lists, in the left hand column, five areas of capacity to assess. The first four areas pertain to capacity building; the fifth pertains to sustaining capacityEach area has a number of indicators which are presented in the form of statements.These statements reflect ideal conditions within a cmty that will support effective prevention efforts.Preventionists can rate their cmty against these statements.They can then rate how important they believe that indicator, or statement, is to the success of cmty prevention efforts.When comparing the importance of that area to how a cmty assesses itself, a gap score is determined.Larger gap scores indicate a condition that is important to the success of prevention efforts, but on which you ranked your cmty as weak. These would be areas on which to focus when planning to build capacity at the cmty level.Review the form/define terms- who might be the “ prevention agencies,” “ prevention system members,” “the prevention system” in a cmty? What are some examples from your own communities?Participants: take a moment to review the “Knowledge, Skills and Abilities” section, reflecting on your own community; this reflection will prime your thinking for the Capacity Building action plan development session that follows this overview.
18 Outcome-Based Prevention Step : Focus Capacity Building HereSubstance Abuse& HIV/AIDS Patterns & ConsequencesContributingFactorsEvidence-Based Programs,Policies &PracticesIn step 2, where do we want to focus our capacity building? (C/C/IVs)Process: Strategic Prevention Framework
19 SPF Logic Model for Reducing High Risk Drinking 18-25 y/o Step 2: Focus Capacity Building HereContributingFactorsConsumptionPatternStrategiesSocial Norms Accepting and/or Encouraging Binge DrinkingMedia Advocacy to Increase Community Concern About Binge DrinkingYoung Adult Binge DrinkingThis is a logic model Tracy Johnson drafted, which he’ll use in his Step 3 presentation tomorrow.It’s a logic model for reducing high risk drinking (binge drinking) among young adults, agesIn step 2, where do we want to focus our capacity building?In step 3, we’ll identify EVI’s (media advocacy) to address the contributing factors. At that point, where will we want to focus our capacity building (on strategies).
20 Building Capacity Identify gaps from community capacity assessment Create an action plan to address gapsWith our state’s readiness level in mind, we want to address gaps we IDd in capacity assessment.Refer to handout, “Capacity Building- Organizational/Infrastructure Development Logic Model” (K. Johnson)“Organizational/Infrastructure Development” is another way of saying “Capacity Building”This capacity building plan is equally applicable at all levels (state/cmty/org)The model presents goals, objectives, action steps and desired outcomes for planning to build capacity (at any level.) Read the goal of capacity building in the model- what does that mean? (common language)This is accomplished by building capacity in five areas (factors): structures and formal linkages, champion and leadership roles, resources, administrative policies and procedures, and expertise.Address these factors through actions (assess, plan, implement, eval, reassess) to build capacity.The center column is the Action Plan
21 MRT – Sample Entry: Advisory Group Our Project Advisory Board includes:State CDC and SSA representativesService recipientsSub-population representativesSA & HIV/AIDS specialistsState public health representativesState, Tribal, Veteran’s government representativesNow let’s take a look at what a series of MRT entries might look like for capacity.Advisory Board – expert resources to oversee the SPF process for this initiativeYou’ll have an opportunity to talk about how to build capacity around your Advisory Group and Governing Board in the action plan development session following this presentation.
22 MRT – Sample Entry: Governing Board Our Project Governing Board includes:Project ManagerSubstance abuse expertsHIV/AIDS expertsFocus population expertsEvidence-based interventions, planning & implementation expertsEpidemiologistEvaluatorGoverning Board – oversees and facilitates the actual work involved in the SPF stepsProject Manager – knowledge of data-driven process & diverse funding resources, stakeholder connections, leadership skillsEpi – knowledge and skills in needs assessmentYou’ll have an opportunity to talk about how to build capacity around your Advisory Group and Governing Board in the action plan development session following this presentation.
23 MRT – Sample Entry: Collaborators Our Project Collaborators include:Service recipientsSub-population representativesSA & HIV/AIDS specialistsGLBTQ specialistsLocal public health representativesBusiness representativesLaw enforcement and justice repsHealth care/service providersLocal, tribal, government representativesCollaborators – participate in certain SPF steps (assessment, capacity, EBI selection/planning/implementation, evaluation) and assure cultural and focus population responsiveness of processes, materials, communications, programs. Assure initiative is imbedded into fabric of community, other health promotion efforts. Run everything by these collaborators.You’ll have an opportunity to talk about how to build capacity around your Collaborators in the action plan development session following this presentation. You’ll also be addressing capacity building in relation to project staff this afternoon, although there is no “staff” MRT entry required.
24 MRT – Sample Entry: Guiding Principles Cultural CompetenceSustainabilityContinuous Quality ImprovementParticipatory InvolvementOur project is fully imbedded in the community. Our collaborators provide input into each SPF step, and sub-population focus groups review all project reports, recommendations and materials.Must show how initiative incorporating 4 guiding principles.
25 MRT – Sample Entry: Accomplishment & Barrier An active coalition of community stakeholders with the knowledge, skills and resources to accomplish a comprehensive needs assessment has been established.This accomplishment enhanced our project’s capacity to collect and analyze data, involve our focus population in our needs assessment processes, and identify resources and service gaps.Document both initiative’s accomplishments and barriers.
26 MRT – Sample Entry: Accomplishment & Barrier No centralized state or local data management system exists.This barrier impacted our project’s capacity to easily access data across silos, centrally archive data, and compare data documented using differing protocols.
27 MRT – Sample Entry: T/TA Report Data management TA was delivered by the Project Epidemiologist to address data recording, storage and access across silos. Topics included:Online data reporting systemCross-silo collaboration for data sharingData access protocolsDocument T/TA delivered to the initiative, in this case based on capacity needs.
28 MRT – Sample Entry: Conclusions & Recommendations A strong coalition has the knowledge, skills and resources to perform a comprehensive needs assessment.The effectiveness of this coalition enhances our project’s capacity to understand the impact of SA and HIV/AIDS within our target population and our community, & to utilize focus groups to understand what is required in order to address these needs.Conclusion statements can focus on strengths of the initiative or can be more holistic in nature.
29 MRT – Sample Entry: Conclusions & Recommendations A coordinated data management system is needed to enhance the utility and application of needs assessment data.A coordinated data management system would enhance our project’s capacity to ensure a comprehensive, accurate needs assessment, easy access to data recorded using common protocols, and effective data comparisons.Statements of recommended improvements or enhancements to the prevention system which would increase the effectiveness of the initiative and/or recommended improvements of the initiative itself.
30 Ensuring Cultural Competence in Capacity Building “A set of behaviors, attitudes and policiesthat come together in a system, agency, orprogram or among individuals, enablingthem to function effectively in diversecultural interactions and similarities within,among, and between groups.”Source: U.S. Department of Health and Human ServicesHanerThe purpose of integrating Cultural Competency in the SPF process is to ensure that Substance Abuse and HIV/AIDS Prevention services are assessed, developed, delivered, and evaluated based on a comprehensive understanding of the specific cultural characteristics and needs of the priority populations selected by the community-based organizations providing integrated services to at-risk minority populations.
31 Integrating Cultural Competence into Capacity Building Key Questions:How do we examine community resources and readiness?► Key Stakeholders► Gate Keepers and Gate Openers► Collaborating Partners► Existing Services and Resources► Non-traditional Networks and Support SystemsHaner
32 Integrating Cultural Competence into Capacity Building Key Questions (continued):What policies are in place or need to be developed to improve cultural competence?► Recruitment► Retention► Training► Communications► Community InputHaner
33 Ensuring Cultural Competence in Capacity Building How do we identify and mobilize mutually acceptable goals and objectives?► Collaborative Process► Dynamic and Fluid► Sometimes feels “messy”► Negotiating Differences► RepresentationHaner
34 Ensuring Cultural Competence in Capacity Building How do we check cultural representation?► Language► Gender► Age► Ability► EducationHow do we ensure tools and technology are culturally competent?How do we ensure a safe and supportive environment for all participants?Haner
35 Elements of Sustainability in SPF Step 2: Capacity Building What elements of sustainability are present in Step 2?How do we know if those elements are present (what are possible indicators, and how can we began to measure them)?>>>Guiding questionsMarcus
36 Action Areas For SPF Step 2: Capacity Building 1. Structures and Formal Linkages2. Policies and Procedures3. Resources (step 2)4. Expertise5. Quality and Accountability6. Effectiveness7. Reach and Alignment8. Relationships (step 2)9. Champions10.OwnershipMarcus
37 Guiding Questions for Step 2: Capacity Building Are key community stakeholders supportive of the goals and efforts of the SPF process?Are any of these relationships creating a barrier to achieving, demonstrating, or sustaining the strategy’s positive outcomes of our SPF process?Which current resources are needed to carry out a plan to address the issues identified in Step 1?Of these resources, which is insufficient or is vulnerable?How have you communicated your evaluation needs and expectations to your evaluator?Marcus
38 Capacity Building IS Sustainability Building capacity of: Staff (knowledge and skills related to data, sub-populations, SA & HIV/AIDS issue expertise)Funding (diversify, resource-sharing, non-traditional, private, public)Technical capacity (data management, access to training needed to implement p/p/p’s)Organizations (coalitions, sub-population representation, community groups, issue experts)CREATES sustainability. If these capacities are high, your project is sustainable. This takes an alert project manager keeping an eye on the big picture and creating buy-in and multiple champions in various sectors of the community.