1. Before we begin, a little about our format… Presentation by seminar speakers (approx. 40 min.) Followed by question and answer session (approx. 20 min.) **************************************************** Please press *6 on your telephone keypad to mute your line (to un- mute your line, press *6 again) If you are experiencing difficulty with your phone connection, dial *0 for the conferencing service operator Questions submitted prior to the web seminar will be addressed first during the Q&A For questions that arise during the presentation, click on the “hand” button and type your question or wait to be called on to ask your question over the phone Welcome to the Acci ó n Mutua web-seminar

2. Acción Mutua is a capacity building assistance (CBA) program of AIDS Project Los Angeles in collaboration with the César E. Chávez Institute of San Francisco State University Funded by the Centers for Disease Control and Prevention

3. Retaining Clients in HIV Prevention Programs Ted Duncan Centers for Disease Control and Prevention

4. 4 Focus of the Presentation Addresses issues related to client retention not the retention of volunteers, staff or board members Addresses issues related to client retention not the retention of volunteers, staff or board members Based primarily on lessons learned from CBO facing challenges with client retention, not peer review literature searches Based primarily on lessons learned from CBO facing challenges with client retention, not peer review literature searches

5. 5 Presentation Objectives Describe what client retention is and why it is important Describe what client retention is and why it is important Describe the guiding principles for retention Describe the guiding principles for retention Identify retention strategies Identify retention strategies Describe how to plan for retention Describe how to plan for retention

6. 6 What is Retention? Maintaining client participation for the duration of the intervention cycle Maintaining client participation for the duration of the intervention cycle –Multi-session group level or individual level interventions: Completion of all sessions required for the delivery of the intervention –Completion of all sessions required to complete prevention plan

7. 7 Why is Retention Important? To realize full effect of an intervention, clients must receive full dosage. To realize full effect of an intervention, clients must receive full dosage. –The “effectiveness” of an effective intervention was demonstrated among those who completed it and not those who dropped out –No intervention is effective if people do not stay in it. A client who does not complete the intervention or service cycle is taking the place of a client who may have. A client who does not complete the intervention or service cycle is taking the place of a client who may have.

8. 8 Retention Rate Proportion of people starting an intervention who complete it Proportion of people starting an intervention who complete it What is an acceptable rate? What is an acceptable rate? It depends on: It depends on: –The population –The intervention –Requirements of the funder –Standards of the agency –External factors

9. 9 Guiding Principles of Retention Provide high quality customer service Provide high quality customer service Understand the characteristics of the target population Understand the characteristics of the target population Implement and deliver services that are appropriate for the target population and setting Implement and deliver services that are appropriate for the target population and setting Provide services and interventions that are meaningful to target population Provide services and interventions that are meaningful to target population

10. 10 Guiding Principles of Retention (continued) Communicate with clients Communicate with clients Be responsive to their needs and their need for agency services Be responsive to their needs and their need for agency services Set objectives for retention rates and then monitor them Set objectives for retention rates and then monitor them Revise retention strategies as needed Revise retention strategies as needed Anticipate barriers to retention and plan around them Anticipate barriers to retention and plan around them

11. 11 Major Facilitators/Barriers to Retention Location: Is it safe, convenient, easy to get to, and in a “zone of comfort”? Location: Is it safe, convenient, easy to get to, and in a “zone of comfort”? Environment: Is it comfortable and confidential? Environment: Is it comfortable and confidential? Quality of interaction: Is it inclusive, non- judgmental, non-coercive, and speaks to the person and their issues? Quality of interaction: Is it inclusive, non- judgmental, non-coercive, and speaks to the person and their issues? Expectations: Are participants clear on the intervention, process, and commitment? Expectations: Are participants clear on the intervention, process, and commitment? Convenient: Are there opportunities to access other services? Convenient: Are there opportunities to access other services?

12. 12 Major Facilitators/Barriers to Retention (continued) Schedule: Is it on the “right” day and at the “right” time? Schedule: Is it on the “right” day and at the “right” time? Amenities: Are refreshments and food available? Amenities: Are refreshments and food available? Competing priorities: Is there anything else in a person’s life that may interfere, but can be planned around? (For instance, childcare needs for women) Competing priorities: Is there anything else in a person’s life that may interfere, but can be planned around? (For instance, childcare needs for women) Social opportunities: Do people have the opportunity to socialize casually? Social opportunities: Do people have the opportunity to socialize casually?

13. 13 Retention Strategies Organized, effective implementation of intervention or service Organized, effective implementation of intervention or service Communication Communication –Telephone calls –Post cards –Reminders at scheduled visits for other services –Newsletters –Email messages –Reminders at the end of each session

14. 14 Retention Strategies (continued) Set an objective for retention rate. Set an objective for retention rate. –Example: 80% of all clients who enroll in each cycle of Safety Counts will complete all sessions Monitor retention rate to determine whether objectives are being met. Monitor retention rate to determine whether objectives are being met. Try to understand why the objective was not met. Try to understand why the objective was not met. Revise retention strategy or objective as appropriate. Revise retention strategy or objective as appropriate.

15. 15 Retention Strategies (continued) Tailor strategies to fit the type of Intervention Tailor strategies to fit the type of Intervention Interventions delivered to individuals Interventions delivered to individuals –Engage and get to know the individual –Communicate interest in the client as a person –Utilize good communication –Provide support – someone to listen to them –Involve significant others

16. 16 Retention Strategies (continued) Ask why those who enrolled in the intervention dropped out Ask why those who enrolled in the intervention dropped out –Clients who dropped out, clients who didn’t drop out, key informants Is there a pattern to the reasons for dropping out? Is there a pattern to the reasons for dropping out? Can you plan around the reasons? Can you plan around the reasons?

17. 17 Retention Strategies (continued) For interventions delivered to groups Think about retention strategies from the perspective of gender, race/ethnicity, behavior, etc. Think about retention strategies from the perspective of gender, race/ethnicity, behavior, etc. Communicate concern of the welfare of absent participants Communicate concern of the welfare of absent participants Convey to absent participants that he/she was missed by the group (handwritten note, telephone call, etc.) Convey to absent participants that he/she was missed by the group (handwritten note, telephone call, etc.)

18. 18 Retention Strategies (continued) Use incentives Use incentives Identify what appeals to target population Identify what appeals to target population Offer choices and combinations Offer choices and combinations Make sure incentives are culturally appropriate Make sure incentives are culturally appropriate Check with funder before offering cash Check with funder before offering cash Consider Consider –Food and refreshments –Gift certificates –Raffles –Cards –Small gifts (Calendars, pens, toiletries, etc.) –Recognition: Certificate of Completion or Graduation Ceremony

19. 19 Retention Strategies (continued) Try to identify the characteristics of those who complete the intervention as opposed to those who drop out. Try to identify the characteristics of those who complete the intervention as opposed to those who drop out. Is there a pattern? Is there a pattern? Once risk and eligibility is established, screen for characteristics that are associated with likelihood of completion. Once risk and eligibility is established, screen for characteristics that are associated with likelihood of completion.

20. 20 Retention Strategies (continued) Pay attention to the point in an intervention cycle clients drop out. Pay attention to the point in an intervention cycle clients drop out. Is there a pattern? Is there a pattern? If so, what happened in the session immediately before that may have contributed to clients not coming back? If so, what happened in the session immediately before that may have contributed to clients not coming back? Can you fix it? Can you fix it?

21. 21 Retention Planning Before the intervention or services Before the intervention or services During the delivery of the intervention or services During the delivery of the intervention or services Follow up to the delivery of the intervention or service Follow up to the delivery of the intervention or service

22. 22 Retention Plan ning (continued) Specific strategies to maintain participation depend on: Specific strategies to maintain participation depend on: –The nature of the intervention or service –The characteristics of the target population –Organizational needs, resources, and capacity

23. 23 Retention Planning (continued) What environment would be most comfortable What environment would be most comfortable Take culture into consideration Take culture into consideration Ensure physical comfort Ensure physical comfort Provide a sense of safety Provide a sense of safety Be sure there is comfort with staff providing service or implementing intervention Be sure there is comfort with staff providing service or implementing intervention Ensure confidentiality of setting Ensure confidentiality of setting

24. 24 Retention Planning (continued) Plan retention during recruitment Plan retention during recruitment Develop screening tools Develop screening tools In screening, try to identify potential barriers and plan for addressing them In screening, try to identify potential barriers and plan for addressing them Ensure client is appropriate for the intervention Ensure client is appropriate for the intervention Assess client’s ability to complete intervention Assess client’s ability to complete intervention

25. 25 Retention Planning (continued) Secure client contact information at enrollment Secure client contact information at enrollment Get contact information of two people who do not live with the client but would know whereabouts Get contact information of two people who do not live with the client but would know whereabouts Obtain permission to make contact Obtain permission to make contact

26. 26 Retention Planning (continued) Build a sense of ownership during intervention or service delivery Build a sense of ownership during intervention or service delivery –Involve them in the retention process –Solicit their input on why some people drop out –Encourage a mutually supportive atmosphere to complete intervention Use process monitoring to see if retention strategies are effective Use process monitoring to see if retention strategies are effective

27. 27 Retention Planning (continued) Utilize intake process Utilize intake process –Explain purpose of intervention –Be honest about requirements and expectations –Don’t use coercion –Secure client buy-in –Build client confidence to complete the intervention

28. 28 The Bottom Line Use evidence to make decisions about retention Use evidence to make decisions about retention Plan for retention before starting the intervention Plan for retention before starting the intervention Screen clients for risk, eligibility, and appropriateness for the intervention Screen clients for risk, eligibility, and appropriateness for the intervention Set retention objectives and retention rates Set retention objectives and retention rates Attempt to understand why people drop out of an intervention find ways of addressing the causes Attempt to understand why people drop out of an intervention find ways of addressing the causes Keep trying! Keep trying!

29. Questions & Answers iGracias ~ Thank You!

30. For more information on this presentation, contact: Ted Duncan CDC 1600 Clifton Road, MS-E40 Atlanta, GA 30333 tfd2@cdc.gov

31. Future Acción Mutua web seminars: Latino Gay Men and Crystal Meth: A Conversation with Rafael Diaz, PhD September 14, 2007 11am PT Social Marketing with Patrick “Pato” Hebert September 27, 2007 11am PT Please register at accionmutua@apla.org