Ain�t No Mountain High Enough

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					  Ain’t No Mountain High
          Enough
Climbing the Peaks of Program
          Excellence

Facilitators:
                           Christina Borbely
                          Kerrilyn Scott-Nakai

 Produced and Conducted by the Center for Applied Research Solutions, Inc. for the
              California Department of Alcohol and Drug Programs
                          SDFSC Workshop-by-Request
                 March 22, 2006 Ventura County

                 Authored by Christina J. Borbely, Ph.D.
Safe and Drug Free Schools and Communities Technical Assistance Project
                     Trail Map
• Why Are We Doing This
  – Value
  – Opportunities
     • Opportunity for Recognition
• Advanced Program Essentials
  – Program Essentials
  – Key Considerations
• Advancing Program Through Evaluation
  – Methodology: Design & Instrumentation
  – Data Plan & Analysis
  – Reporting
    Why Are We Doing This?

• The Value of Advancing Programs
• Opportunities for Advancing Programs
                    Value
• Replicating innovative strategies
  – Fill in gaps
  – Integrate latest science and/or practice


• Making contribution through dissemination
  – Participate in science-service dialog
  – Advance the field
  – Provide effective program to others
              Opportunities
• Expansion
  – Demonstrate need/value of new or additional
    funding
  – Bolster capacity to sustain programming
• Recognition
  – Validation from field
  – Potential for supplemental support/resources
  – Publications
   Opportunity for Recognition
Validation from the Prevention Field:

• Service to Science
• NREPP
• Exemplary Programs
    National Registry of Effective
   Prevention Programs (NREPP)
NREPP is coordinated by the Center for Substance Abuse
  Prevention (CSAP) under the federal Substance Abuse
  and Mental Health Services Administration (SAMHSA)

NREPP is:
“a system designed to support informed decision making
   and to disseminate timely and reliable information about
   interventions that prevent and/or treat mental and
   substance use disorders.”


http://modelprograms.samhsa.gov/template.cfm?page=nre
   ppover
   Original NREPP Designations
• A program will be considered “Model” if the NREPP review team
  appointed your program as an effective program, and an agency
  agrees to participate in CSAP’s dissemination efforts. Model
  programs also provide training and technical assistance to
  practitioners who wish to adopt a program in order to ensure that the
  program is implemented with fidelity.

• A program is considered “Effective” if it is science-based, and
  produces consistently positive patterns of results. Only programs
  positively effecting the majority of intended recipients or targets are
  considered effective.

• A program will be considered “Promising” if it provides useful and
  scientifically defensible information about what works in prevention,
  but has yet to gather sufficient scientific support to standards set for
  effective/model programs. Promising programs are sources of
  guidance for prevention practitioners, although they may not be as
  prepared as Model programs for large-scale dissemination.
                Evidence-Based Programs
        ●Conceptually Sound and Internally Consistent
   ●Program Activities Related to Conceptualization
   ●Reasonably Well Implemented & Evaluated




 Promising Programs                   Effective Programs
                                •Consistently Positive Outcomes
●Some Positive Outcomes        ●Strongly Implemented & Evaluated




                                        Model Programs
                                    ●Available for Dissemination
                               ●Technical Assistance Available
                               from Program Developers
NEW NREPP: Eligibility Criteria
• Open submission; review based on alignment of
  intervention with NREPP priorities
• SAMHSA's three Centers -- the Center for Mental Health
  Services, the Center for Substance Abuse Prevention,
  and the Center for Substance Abuse Treatment -- will
  establish priorities for the types of interventions to be
  reviewed and highlighted on NREPP.
• Priorities will be established and provided to the public
  annually through notices on the NREPP Web site.
• These priorities based on dialogues with treatment and
  prevention stakeholders as well as with SAMHSA's
  Federal partners
 NEW NREPP: Review Criteria
“the sole requirement for potential inclusion
  in the NREPP review process is for an
  intervention to have demonstrated one or
  more significant behavioral change
  outcomes.”
 NEW NREPP: Review Process
• A trained Ph.D.-level evaluation specialist works with
  applicants to assure that adequate materials have been
  submitted before initiating an NREPP review.
• The evaluation specialist serves as collaborator in the
  application process and liaison to the reviewers.

• A scientific review of the intervention is conducted by two
  independent Ph.D.-level reviewers.
• Completed review summaries, including descriptive
  components, reviewer ratings, and explanations are
  provided to the applicant for approval before they are
  posted on the NREPP Web site.
NEW NREPP: Application Process
Application materials include one or more of the
  following types of documents:
• formal evaluation reports,
• published and unpublished research articles,
• narrative sections of grant applications,
• training materials, and
• implementation or procedural manuals.
• concise summary of the intervention that
  includes the intervention name, a description of
  its main components, the population(s) targeted,
  and the behavioral outcomes targeted.
  The Exemplary Program Awards
• The Exemplary Program Award is designated by CSAP
• The Exemplary Awards program recognizes prevention
  programs in two tracks: Promising Programs—those that
  have positive initial results but have yet to verify
  outcomes scientifically, and Model Programs—those that
  are implemented under scientifically rigorous conditions
  and demonstrate consistently positive results.

• The Exemplary Awards recognize prevention programs
  that are innovative and effective and that successfully
  respond to the needs of their target populations, both as
  Promising Programs and Model Programs.
        Exemplary Program Award:
            Review Process
• A multifaceted procedure is used identify and select Promising
  Programs to receive an Exemplary Substance Abuse Prevention
  Program Award annually. All nominated programs submit to a three-
  level review process.

• First, state agency personnel and national organizations submit their
  formal nominations.
• Applications are then reviewed by experts in the field of substance
  abuse prevention and former Exemplary Substance Abuse
  Prevention Program Award winners.
• Finally, the National Review Committee reviews and scores the top
  applications according to eight criteria and recommends those that
  merit an Exemplary Substance Abuse Prevention Program Award.
  Final selections are made jointly by NASADAD, CADCA, and
  SAMHSA/CSAP.
        Exemplary Program Award
           Application Process
• Applications for the Innovative Programs may be obtained
  from State Alcohol and Drug Agencies, the NASADAD/NPN
  Web page (www.nasadad.org) and office.

• Applicants must submit their application to their national
  nominating organization (see application appendix) for sign-off.
  Applicants should then return the original signed, completed
  application (including cover sheet) and three copies to the
  NASADAD/NPN central office in Washington, D.C. For more
  information about the application process, call or write:
                                                        NASADAD/NPN
                                         808 17th Street, NW, Suite 410
                                                 Washington, DC 20006
                                       Attention: Exemplary Programs
                                          Web page: www.nasadad.org
                                        E-mail: amoghul@nasadad.org
                                     (202) 293-0090, Fax (202) 293-1250
       Exemplary Program Award
           8 Review Criteria
•   Philosophy
•   Background and need (program planning)
•   Goals and objectives
•   Population(s) to be served
•   Activities and strategies
•   Community coordination
•   Evaluation
•   Program management
         Service to Science
• Service to Science is a national initiative
  supported by SAMHSA/CSAP to enhance
  the evaluation capacity of innovative
  programs and practices that address
  critical substance abuse prevention or
  mental health needs.

http://captus.samhsa.gov/northeast/special_
  projects/service_to_science/main.cfm
  Service to Science Academy
• Designed to enhance capability of community-
  based prevention strategies, programs or
  practices that demonstrate effectiveness.
• Each Academy is customized to support the
  needs of the groups/organizations and programs
  accepted to attend,
• Emphasis on the development of a strong
  evaluation and/or research design.
• Participants receive training and technical
  assistance helping them move along the
  evidence-based continuum
     Service to Science Academy:
           Eligibility Criteria
1. Primarily focused on ATOD prevention, but may also
   address the prevention of violence, HIV/AIDS, STDs,
   etc. Expected outcomes or areas of focus include, but
   are not limited to, efforts to decrease high-risk behaviors
   by children or adults; eliminate use of illicit drugs; reduce
   underage use of alcohol, tobacco, and other drugs, and
   decrease DUI/DWI rates.
2. Nominated for recognition by a State Alcohol and Drug
   Agency, by the Community Anti-Drug Coalitions of
   America (CADCA), or by other national organizations or
   their affiliates.
3. Able to document and demonstrate success in the form
   of quantifiable outcome data.
4. In operation for a minimum of two (2) years.
     Service to Science Academy:
            Review Criteria
•   Philosophy
•   Needs Assessment
•   Population Served
•   Goals & Objectives
•   Activities & Strategies
•   Evaluation
•   Program Management
•   Community Coordination
   Service to Science Academy:
       Application Process
• The application to attend a Service to
  Science Academy is a modified National
  Association of State Alcohol & Substance
  Abuse Directors (NASADAD) application
  for Innovative/Exemplary Programs.
• Applications are reviewed by a panel who
  makes recommendations for acceptance
  to the Academy.
                      Application Criteria as
Live it!
                        Program Practice
• SDFSC Santa Cruz County: Service to Science Academy
           Santa Cruz County submitted an application and was awarded a program slot
           with the current cohort for the Service to Science Academy. The Santa Cruz
           team will receive a series of trainings and technical assistance to assist them
           in moving their program towards being recognized as a model or promising
           program.

• SDFSC Butte County: NPN Exemplary Program Award
           Butte County submitted 3 of their prevention programs for review: Friday Night
           Live Mentoring, Friday Night Live, and Youth Nexus. Two of these programs
           are being recognized nationally, with only 6 programs receiving this national
           recognition by the National Prevention Network Research.

• Andrea Taylor, Ph.D.: NREPP Model Program Status
           Andrea Taylor evolved a local program, Across Ages, an
           intergenerational mentoring program that promotes positive youth
           development and helps prevent school failure, substance abuse and
           teen pregnancies into to an NREPP Model Program that is
           implemented nation-wide. The process spanned 1991-1998.
    Advanced Program Essentials
Put Your Finger On It…

•   Logic Model
•   Core Components
•   Documented Need and Value
•   Defining Population
•   Defining Need for Service within the
    Community
             Logic Model
“ A logic model is a systematic and visual
  way to present and share your
  understanding of the relationships among
  the resources you have to operate your
  program, the activities you plan, and the
  changes or results you hope to achieve.”

(W.K. Kellogg, Logic Model Development
  Guide, 2004)
      Value of a Logic Model
     A Picture is Worth a 1000 Words
• Builds understanding about what the
  program is, what it’s expected to do and
  what measures of success will be used.
• Provides a research-based theory behind
  your strategies
• Promotes communication and a common
  understanding amongst staff and funders
     Core Program Components

What are the “active ingredients” in the
 formula for program success?

• In theory, core components must be
  implemented precisely as intended in
  order to achieve demonstrated outcomes.
• Core components cannot be adapted.
    Define Core Components
Core components might be:

• program structure (e.g. the sequence of
  sessions or context of delivery),
• program content (e.g. specific concepts or
  skill sets), or
• method of delivery (e.g. “homework”
  assignments, classroom infusion, or youth-
  led group activities).
             Define Population
• Institute of Medicine (IOM) Classifications
       Universal preventive interventions are activities
       targeted to the general public or a whole population
       group that has not been identified on the basis of
       individual risk.
        Selective preventive interventions are activities
       targeted to individuals or a subgroup of the population
       whose risk of developing a disorder is significantly
       higher than average.
        Indicated preventive interventions are activities
       targeted to individuals in high-risk environments,
       identified as having minimal but detectable signs or
       symptoms foreshadowing disorder or having biological
       markers indicating predisposition for disorder but not yet
       meeting diagnostic levels.
         Defining Need for Service
– Integrating key stakeholders in process
                                                              Strategic Prevention Framework

  • Bonus points for youth             Assessment         Capacity          Planning        Implementation Evaluation
                                                                                                              Report
                                       Assemble data                                                       immediate &
  • Representative of community       collection review
                                        team, define
                                                                                                           intermediate
                                                                                                             outcomes
                                      substance abuse                  Determine domain(s)

– Strategic Prevention Framework
                                           problem                     of concentration and
                                                            Examine      prioritize risk and                        Outline
                                                            internal                            Develop logic      process
                                                                         protective factors
                                     Identify and define resources,                          models for overall evaluation
                                    target population for                                         program,
  • Needs/Resource Assessment                                skills,
                                    reduction/prevention readiness             Examine
                                                                       program/intervention
                                                                                                components
                                                                                                                 from action
                                                                                                                     plans

                                                                                options
  • Strategic Planning                Identify risk and       Build
                                      protective factors collaboration
                                                                          Address cultural
                                                                                               Develop action Assess long-
                                                                                                  plans for          term
                                                                                               documentation outcomes/
                                                            through

  • Evidence-based Implementation
                                                                              relevancy
                                      Develop tentative teaming and                                                general
                                         theory of, or    networking                             Document,          impact
                                     pathway to, change                        Explore        review, improve
                                                            Examine     fidelity/adaptation        quality      Communicate
                                                                               balance
                                       Identify existing community                                              outcomes to
                                          prevention       resources                           Revisit fidelity       key
                                        resources that        and         Select "best-fit"          and        stakeholders
                                      target problem & readiness:             program/       adaptation issues to build
                                        risk/protective     external        intervention        as necessary       support
                                            factors         capacity

                                                                       Choose to innovate                      Re-measure
                                       Perform gap                                                             outcomes &
                                     analysis of needs                                                         supplement
                                      and resources                                                           final report if
                                                                                                                necessary
          Key Considerations

Advancing Programming

• What’s the yardstick?
• How do I measure up?
• Where do I want to go from here?
  Considerations: Participation
• Recruitment
  – Are we meeting target #s consistently?
  – Are we using strategic recruitment methods?
• Retention:
  – Do we have sufficient completion rates?
  – Have we defined a program graduate/drop-out?
  – What do we do to encourage retention?
      Considerations: Fidelity
• Fidelity
  – To what degree are we consistently
    implementing core components? Is this
    sufficient?
  – What system do we use to reflect on areas of
    challenge? How does that inform our
    process?
  – What method do we use to monitor
    implementation across sites? Are we vigilant
    enough? Does feedback get incorporated?
    Considerations: Innovation
• Degree to which program is novel, cutting edge,
  innovative.
  – How is this different than what’s already available?
  – What aspects of the program are unique?
• Grounded but Innovative: program alignment
  with already-proven models of service
  – What proven methods are incorporated in what we
    do?
  – Did we take an evidence-based strategy to the “next
    level” or use it in a novel way?
   Considerations: Population
• How culturally appropriate are services
  to identified population?
  – Program content
  – Program materials (e.g. translation)
  – Staff (training and protocol)
  – Tested across ethnic/cultural groups
  – Link to evidence-based strategies
    demonstrated with specific populations
    Considerations: Marketing
• Have materials/curriculum been
  “packaged”
  – Sequencing
  – Branding
  – Training protocol tested and
    established/documented
    Considerations: Replication
• Protocol
   – Program curriculum
   – Training process
   – Evaluation
• Packaged program materials
   – Curriculum
   – Evaluation
• Strategic replication
   – Varied populations
   – Varied context
      Advancing Programs through
              Evaluation
•   Rigor
•   Methodology
•   Data Plan & Analysis
•   Reporting
    Increasing Evaluation Rigor
         Across the Board

Methodology/Design

       Instrumentation to Analysis

                                 Reporting
 Tips for Optimal Evaluation Rigor
• Use external evaluator to lend credibility
  – Especially valuable for publishing findings

• Conduct evaluation of replication sites
  – Evidence of impact in varied settings; populations

• Evaluate program effect and sustainability of
  effect
  – Pre/post demonstrates immediate effects
  – Follow up (longitudinal) proves how those effects are
    sustained.
     Advancing Methodology
• Process & Outcome
• Evaluation Design
• Tips for Optimal Design
Role of Process and Outcome Methods

            Process                          Outcome

 •   Allows for continuous         •   The outcome evaluation
     learning about how the            focuses on producing clear
     program is working as it is       evidence concerning the
     implemented                       degree of program impact on
                                       program participants.
 •   Focuses on clearly
     describing and assessing      •   Assesses the immediate or
     program design and                direct effects of program
     implementation.                   activities (as compared to
                                       long-term impact).
 •   Makes it possible to answer
     questions concerning “why”
     and “how” programs operate
     the way they do and what
     can be done to improve
     them.
     Level of Rigor:
Outcome Evaluation Design
      Pre and Post with Control
           (Random Assignment)



    Pre and Post with Comparison


     Pre and Post with Follow-Up
          Pre and Post Only


 Post-Test Only—Hindsight Comparison
NREPP Source of Evidence Hierarchy
        Tip for Optimal Design:
             Matched Data
Making a Match
  – Requires tracking of individuals
  – Allows for analysis of individual-level impact,
    not just aggregate level
  – Can control for “dosage” or other factors
             Tip for Optimal Design:
                Longitudinal Data
Looking at the long run…

The majority of programs use a pre/post
 assessment schedule.
  – The utilization of follow-up points is
    recommended based on length of program
    • Consider a follow up point at 1, 3, 6, 9, or 12
      months after completion.
    • Programs with continuous enrollment vs. cohorts of
      youth need
       – strong tracking systems
       – Continuous evaluation schedule (e.g. every 3 or 6
         months)
       Tip for Optimal Design:
        Comparison Groups
Shall I compare thee to a summer’s day…

Comparison groups can sometimes be fairly
 easy to develop

  • School data
  • Low dosage service groups can sometimes
    be utilized—make the distinction between
    program drop-out versus evaluation drop-out
  • Use standardized measures and compare
    program groups to school, district, state
    results.
        Tip for Optimal Design:
            Control Groups
Control freak!

– Controls groups require resources and may
  deter participants due to randomization.
  • The trick is in the approach and the ability to
    provide services at a later date.
   Advancing Instrumentation
• Standardized v. Locally Developed
• Tips for Optimal Instrumentation
               Survey Options

Pros                            Pros
• Already developed, lots of
                                • Can tap into novel program
  choices.
                                  aspects/impact
• Psychometrics established
                                • Can be tailored to
• Allows for comparison of
  results—national, state,        population
  district levels               • No cost
• Scoring and analysis
  sometimes available
Cons
                                Cons
• Cost
                                • Don’t know reliability/validity
• May not be specific to your
  population                    • Doesn’t allow for
• May not capture novel           comparison
  aspects of program
 Tip for Optimal Instrumentation
• Next level of locally developed measures
  – “performance measure”/psychometrics of
   instruments
     • reliability & validity (done by your evaluator)


• Track at individual level
  – Confidential Ids
  – Develop comprehensive database
  Advancing Data Management &
           Processing
• Data Plan
• Sample Size
• Data Analysis
                Data Plan
• Develop plan for analyzing data based on
  proposed outcomes (logic model)
  – What questions to ask of the data?
  – What piece of the data answers each
    question?
  – Potential sub-group comparisons
  (e.g. by gender, dosage, site)
    Tips for Optimal Data Plan
• Specify cutoff points for baseline
  assessment (Defined for program)
  e.g. Baseline assessments are defined as those
    completed prior to session 2 of the curriculum.
• Define completers vs. dropouts
  e.g. Parents attending 85% of sessions are defined as
    program “completers”; less than 10% are defined as
    “dropouts”.
• Ensure matched pre/post
  – Individual vs. aggregate level findings
   Planning a Sample Size
How Much Wood should a Woodchuck Chuck?
• Sample size (N): refers to population
  participating or being measured (e.g. # of
  participants; # of sites)
• Power: Probability of finding a true effect
  – Type I error: state a finding when there isn’t one (a false positive)
  – Type II error: state no finding when there is one (a false
    negative)
• Sample size & Power
  – Influences types and sensitivity of analysis
  – Larger sample size increases power
     Tips for Optimal Data Plan:
       Strategic Sample Size
• Calculate necessary sample size for
  appropriate statistical power
     http://www.surveysystem.com/sscalc.htm
    http://www.macorr.com/ss_calculator.htm


• Resource limitations: consider using a
  strategic sub-sample
      Data Analysis:
Beyond Percentage Reporting
• Means with standard deviation
  – SD reflects the variability of values


• Tests of significance (comparative analysis)
  – Correlations
     As participation level increases, attendance rate
      significantly increases.
  – Chi square analysis
     Youth demonstrated statistically significant
      improvements in communication skills over time.
   Tips for Optimal Data Analysis:
      Techniques & Strategies
• Leverage variability in data/dosage to
  program advantage
  e.g. Youth who completed the program were more likely
    to have negative attitudes toward use than youth who
    did not complete the program.


• Identify potential comparison data sets
  (e.g. school records)
  e.g. School records show that participating youth had
    significantly fewer discipline referrals than the general
    student population.
 Advancing Reporting Methods
• Venues for Dissemination
• Cater to the Crowd
• Tips for Optimal Reporting
        Where to Disseminate
•   Evaluation Reports
•   Summary Reports
•   Applications
•   Grants
•   Press Release
•   Professional Publications
•   Academic/research Publications
       Cater to the Crowd

– What information is relevant to your audience?
   • Note preferred models/frameworks, rhetoric
   • Highlight information that is of value to them


– To what extent is detail or brevity important to your
  audience?

– Are pieces of program information weighted
  differently (e.g. a reviewer point system)

– Work with your evaluator in developing a brief
  findings report as well as a full evaluation report
  Tips for Optimal Reporting:
            Frame It

• The evaluator is responsible for providing the
  full and objective picture

• Program Director may choose to highlight the
  most positive findings when reporting to
  funders or stakeholders—if appropriate

• Wording can make a difference! The same
  findings can be written in a variety of ways—
  be conscious of the wording.
       Tips for Optimizing Reporting:
                The Message
• Say It In Pictures
   – The appropriate use of charts and graphs can be
     a powerful tool in conveying findings.


• Bring It Home
   – The use of personal quotes and case examples
     can be powerful when they are used to
     supplement key quantitative findings.
   – Personal experiences make the impact real to the
     reader
   – However, when misused they can make the
     evaluation seem less credible
  Climbing the Mountain: What’s
         Your Next Step?
• Action Planning Exercise
  – Defining short-term, intermediate, and long-
    term goals (e.g. 1 yr, 3yr, and 5 yr goals)
    • Programmatic Goals
    • Evaluation Goals
    • Opportunity Goals
  – How can we support you in your climb to the
    top?
    • Customized TA and Training plans

				
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