2 11 2011HomevisitsforTribalCommunities

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					Home Visiting in Tribal Communities:
       Using the OPRE Review
              One Sky Center
            R. Dale Walker, MD
          Douglas A. Bigelow, PhD
             19 February 2011
                   Outline

• Frameworks for use in planning

• Logic model details

• Cultural appropriateness criteria

• Intervention details

• Creating, operating a planning coalition

9/29/2012           Using the OPRE Review    2
            Developing a Community-Driven
                     Best Practice
      Goal: An evidence-informed, community-driven program


1. Community Assessment &
                                       Coalition
   Planning Process:


2. Cultural Validity                   Criteria

3. Evidence-informed
   program design                      Logic Model

9/29/2012                 Using the OPRE Review              3
            Best Practice includes Culture

                              Practice




                                Best
                              Practice

                 Science                           Culture


9/29/2012                  Using the OPRE Review             4
              Practice
              (Service)
                                          Culture
                                          Philosophies

                                          Belief about causes of problems and
                                          solutions

              Best Practice               Local innovation, trial and error

                                          Medicinal use of wild plants and
                                          minerals

                                          Healing procedures

                                          Oral transmission of knowledge
Science &
Scholarship
                                          Community evaluation and acceptance




9/29/2012                     Using the OPRE Review                              5
                                           Home Visiting
                                               Education
                                         Training/Demonstration
       Services/Resources               Support/Encouragement
             Income support                     Linking
                LE/Justice                                                Child
              Physical MD
                                                                             Safe
             Mental Health
                                                                           Healthy
                Sobriety
                                                                        School ready
               Education                      Parent
                  Food
                                               Knowledge
            Emergency Shelter
                                                 Skills
                                               Motivation
                                              Performance


             Local Context                                          Culture
                 Employment
                                                                  Vision/Aspiration
                   Housing
                                                                      Morale
                  Recreation
                                                                       Values
        Community Activities/Events
                                                                     Principles
                Social Structure
                                                                       Stories
                    Politics
                                                                       Images


9/29/2012                             Using the OPRE Review                            6
                                           Home Visiting
                                               Education
                                         Training/Demonstration
       Services/Resources               Support/Encouragement
             Income support                     Linking
                LE/Justice                                                Child
              Physical MD
                                                                             Safe
             Mental Health
                                                                           Healthy
                Sobriety
                                                                        School ready
               Education                      Parent
                  Food
                                               Knowledge
            Emergency Shelter
                                                 Skills
                                               Motivation
                                              Performance


             Local Context                                          Culture
                 Employment
                                                                  Vision/Aspiration
                   Housing
                                                                      Morale
                  Recreation
                                                                       Values
        Community Activities/Events
                                                                     Principles
                Social Structure
                                                                       Stories
                    Politics
                                                                       Images


9/29/2012                             Using the OPRE Review                            7
                                           Home Visiting
                                               Education
                                         Training/Demonstration
       Services/Resources               Support/Encouragement
             Income support                     Linking
                LE/Justice                                                Child
              Physical MD
                                                                             Safe
             Mental Health
                                                                           Healthy
                Sobriety
                                                                        School ready
               Education                      Parent
                  Food
                                               Knowledge
            Emergency Shelter
                                                 Skills
                                               Motivation
                                              Performance


             Local Context                                          Culture
                 Employment
                                                                  Vision/Aspiration
                   Housing
                                                                      Morale
                  Recreation
                                                                       Values
        Community Activities/Events
                                                                     Principles
                Social Structure
                                                                       Stories
                    Politics
                                                                       Images


9/29/2012                             Using the OPRE Review                            8
                                           Home Visiting
                                               Education
                                         Training/Demonstration
       Services/Resources               Support/Encouragement
             Income support                     Linking
                LE/Justice                                                Child
              Physical MD
                                                                             Safe
             Mental Health
                                                                           Healthy
                Sobriety
                                                                        School ready
               Education                      Parent
                  Food
                                               Knowledge
            Emergency Shelter
                                                 Skills
                                               Motivation
                                              Performance


             Local Context                                          Culture
                 Employment
                                                                  Vision/Aspiration
                   Housing
                                                                      Morale
                  Recreation
                                                                       Values
        Community Activities/Events
                                                                     Principles
                Social Structure
                                                                       Stories
                    Politics
                                                                       Images


9/29/2012                             Using the OPRE Review                            9
                                           Home Visiting
                                               Education
                                         Training/Demonstration
       Services/Resources               Support/Encouragement
             Income support                     Linking
                LE/Justice                                                Child
              Physical MD
                                                                             Safe
             Mental Health
                                                                           Healthy
                Sobriety
                                                                        School ready
               Education                      Parent
                  Food
                                               Knowledge
            Emergency Shelter
                                                 Skills
                                               Motivation
                                              Performance


             Local Context                                          Culture
                 Employment
                                                                  Vision/Aspiration
                   Housing
                                                                      Morale
                  Recreation
                                                                       Values
        Community Activities/Events
                                                                     Principles
                Social Structure
                                                                       Stories
                    Politics
                                                                       Images


9/29/2012                             Using the OPRE Review                            10
                                           Home Visiting
                                               Education
                                         Training/Demonstration
       Services/Resources               Support/Encouragement
             Income support                     Linking
                LE/Justice                                                Child
              Physical MD
                                                                             Safe
             Mental Health
                                                                           Healthy
                Sobriety
                                                                        School ready
               Education                      Parent
                  Food
                                               Knowledge
            Emergency Shelter
                                                 Skills
                                               Motivation
                                              Performance


             Local Context                                          Culture
                 Employment
                                                                  Vision/Aspiration
                   Housing
                                                                      Morale
                  Recreation
                                                                       Values
        Community Activities/Events
                                                                     Principles
                Social Structure
                                                                       Stories
                    Politics
                                                                       Images


9/29/2012                             Using the OPRE Review                            11
                        Logic Model

8. Long term (Impact)

7. Medium term

6. Short term




5. Operations Manual


4. Theory of Change


3. Strategy
 9/29/2012                Using the OPRE Review   12
                         1. Causes
Problem                               Causes


• Injury                              • Parenting role performance

• Lack of development                 • Family strength/dysfunction

• Not ready for school                • External factors




9/29/2012                 Using the OPRE Review                   13
                 1. Causes                               Goals
Parent                                       Child
• Delivery (birth)                           • Cognitive & emotional
• Parenting knowledge                          development
      – (of child development)               • Health
• Parenting skills                           • School readiness
• Non-abuse                                  • (ameliorated developmental
• Non-neglect                                  delays, if any)




9/29/2012                        Using the OPRE Review                 14
            2. Target Population
                                • Developmental
• Kids are the TP                 deficiency (re school)

• Abused kids                          – Physical
                                       – Cognitive
• Neglected kids                       – Emotional




9/29/2012           Using the OPRE Review                  15
             3. Intervention Strategy
• In home (“place-                        • Parent needs
  based”)                                        – Counseling
• Trained Peer-parents                           – Problem-solving
• Professional staff                             – Access to resources
                                                       • Income; education;
      – (RNs; MSWs)                                      employment; treatment
• Links to resources                      • Context-specific needs
      – Navigate and access                      –    Culture
                                                 –    Family dynamics
                                                 –    Employment
                                                 –    Neighborhood

9/29/2012                     Using the OPRE Review                              16
                3. Strategy: Visits
• Content (visit)

• Frequency/intensity
      – One per week


• Duration
      – 3 months to 2 years


9/29/2012                Using the OPRE Review   17
            4. Theory of Change

• Place-based

• Staff characteristics

• Local context and culture




9/29/2012            Using the OPRE Review   18
                    Intervention:
            Criteria for Cultural Validity
•   Longevity
•   Teachings (based on)
•   Values (based on; incorporated)
•   Principles (based on; incorporated)
•   Elder’s approval
•   Community feedback/evaluation/acceptance
•   Contribution to advancement of the people

9/29/2012              Using the OPRE Review    19
                   Intervention:
                     Activities
• Experience, observation, listening, participating

• Traditions, ceremonies, daily observances

• Stories, songs, artwork

• Oral, modeling, practice, animation

• Language, worldview, teachings, experience

9/29/2012               Using the OPRE Review         20
                   Intervention:
                     Materials

• Settings                        • Sensory Substances

• Dress; Regalia                  • Food

• Symbols; Graphics;              • Fun
  Pictures

9/29/2012             Using the OPRE Review              21
               Intervention:
                 Personnel

• Enthusiasm                  • Charisma

• Confidence                  • Credibility

• Caring, compassion          • Community status

• Vision, knowledge           • Peer group status

9/29/2012         Using the OPRE Review             22
              5. Program Manual
• Intervention activities          • Detailed procedures

• Materials                        • Process milestones

• Personnel                        • Short-term outcomes
  characteristics
                                   • Long-term outcomes
• Training and supervision


9/29/2012              Using the OPRE Review               23
            6. Short-term Outcomes

• Parents’ knowledge

• Parents’ attitudes (incl. bonding)

• Parents’ skills/performance

• Child health

9/29/2012           Using the OPRE Review   24
            7. Medium-term Outcomes

• Child development

• Child school readiness

• Child school performance

• Child health and thriving

• Family strength and function

9/29/2012           Using the OPRE Review   25
            8. Long-term Outcomes

• Parental health and thriving
• School enrollment, retention, achievement,
  and graduation rates
• Non-delinquency

• Child-as-adult Employment



9/29/2012           Using the OPRE Review      26
                         Create a Coalition
Agreed-upon goals
Vision & mission statements
Action plan
Structure for the coalition
Identify need for specialists
Resources
(coalition ideas from the University of Kansas Community Tool Box
    http://ctb.ku.edu)

9/29/2012                     Using the OPRE Review                 27
             Coalition Rules
Open communication
Inclusive & participatory
Constant networking
Achievable goals
Creative meetings
Keep promises
Acknowledge and use the diversity of the
 group

9/29/2012         Using the OPRE Review     28
                                       Coalition
   Train leaders in all sectors that have the vision, commitment, and respect necessary to lead a
    collaborative.
   Identify a facilitator to bring the different groups together.
   Find the information necessary to understand issues and possible solutions.
   Promote community empowerment.
   Identify the stakeholders.
   Make a commitment to collaborate.
   Establish procedural ground rules.
   Teach potential participants process skills.
   Build trust, learned process skills, and explored beliefs.
   Identify problems.
   Clarify a vision and develop a mission statement.
   Keep the process open and get input from community members.
   Create options for solving problems.
   Formulate goals, objectives, and an action plan.
   Implement the action plan.
   Evaluate the results.
   Celebrate every success, large and small




9/29/2012                                 Using the OPRE Review                                      29
            Action Plan (Coalition)
• Who, what, when action plan
• Resource plan
• Communication plan
      – (who should know what?)
•   Ensure follow through on plan
•   Keep track of progress
•   Keep everyone informed
•   Celebrate

9/29/2012              Using the OPRE Review   30
             Contact us at
             Contact us at
         503-494-3703
                   E-mail
      Dale Walker, MD
   onesky@ohsu.edu
Or visit Contact us at            20




         503-494-3703
 9/29/2012                   31

				
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