Domain I: Planning and Evaluation Flashcards
The Behavioral Health Continuum of Care
is a _____________________
classification system that presents the scope of behavioral health interventions and services, including: promotion of health, prevention of illness/disorder, treatment, and maintenance/recovery.
Continuum of Care: Prevention
focuses on interventions that occur prior to the onset of a disorder and which are intended to prevent the occurrence of the disorder or reduce risk for the disorder.
Continuum of Care: Promotion
involves interventions (e.g., programs, practices, or environmental strategies) that enable people “to increase control over, and to improve, their health.”
What are the three types of Prevention interventions?
Universal - focus on the “general public or a population subgroup that have not been identified on the basis of risk.”
Selective - focus on individuals or subgroups of the population “whose risk of developing behavioral health disorders is significantly higher than average.”
Indicated - focus on “high-risk individuals who are identified as having minimal but detectable signs or symptoms” that foreshadow behavioral health disorders, “but who do not meet diagnostic levels at the current time.”
What is included in Treatment according to the Behavioral Health Continuum of Care model?
case identification and standard forms of treatment (e.g., detoxification, outpatient treatment, inpatient treatment, medication-assisted treatment).
What is included in Recovery according to the Behavioral Health Continuum of Care model?
standard treatment, Long Term treatment, & After Care/Rehabilitation
What is included in Maintenance according to the Behavioral Health Continuum of Care model?
interventions that focus on participation in long-term treatment to reduce relapse/reoccurrence, and aftercare including rehabilitation and recovery support.
behavioral health (def’n)
“a state of emotional/mental well-being and/or choices and actions that affect health and wellness”
used to describe the service systems surrounding the promotion of mental health, the prevention and treatment of mental health disorders and substance use disorders, and recovery support
What are the 6 CSAP prevention strategies?
- Dissemination of Informatiom
- Prevention Education
- Alternative Activities
- Community based processes
- Environmental Approaches
- Problem Identification & Referral
** see study guide book for what occurs during each strategy **
Environmental strategies are prevention efforts aimed at ____________________________________
changing or influencing community conditions, standards, institutions, structures, systems and policies. Environmental strategies enhance public health by altering the physical, social, legal, and economic conditions that influence behavior.
Data collected during the assessment step of the SPF helps to answer what questions?
● What are the problems and related behaviors that are occurring in the community?
● How often are the problems and related behaviors occurring?
● Where are the problems and related behaviors occurring?
● Which populations are experiencing more of the problems and related behaviors?
● What are the risk and protective factors that influence problems and related behaviors in the community?
Strategies focused on changing the community environmental context that influence individual behavior include:
● Enhance access/reduce barriers — Improving systems and processes to increase the ease, ability and opportunity to utilize systems and services (e.g., access to treatment, childcare, transportation, housing, education, cultural and language sensitivity).
In prevention efforts, this strategy can also be “turned around” to ‘reduce access/enhance’ barriers, for example, reducing access and enhancing barriers to purchasing alcohol, tobacco products or marijuana for people under 21.
● Change consequences (incentives/disincentives) — Increasing or decreasing the probability of a specific behavior that reduces risk or enhances protection by altering the consequences for performing that behavior (e.g., increasing public recognition for desired behavior, individual and business rewards, taxes, citations, fines, revocations/loss of privileges).
● Change physical design — Changing the physical design or structure of the environment to reduce risk or enhance protection (e.g., parks, landscapes, signage, lighting, outlet density).
● Modify/change policies — Formal change in written procedures, by-laws, proclamations, rules or laws with written documentation and/or voting procedures (e.g., workplace initiatives, law enforcement procedures and practices, public policy actions, systems change within government, communities and organizations).
● Various Communication Strategies
Prevention professionals use __________________ to plan prevention initiatives.
SAMSHA Strategic Prevention Framework (SPF)
What is the SPF?
5 step planning process that guides the selection, implementation, and evaluation of evidence-based, culturally appropriate, sustainable prevention activities
The SPF begins with ___________________ and depends on ________________________
a clear understanding of community needs; the involvement of community members in all stages of the planning process.
What are the 5 steps of the SPF?
- Assessment - Collect data to define behavioral health problems and needs within a geographic area.
- Capacity - Mobilize and/or build capacity within a geographic area to address identified needs.
- Planning - Develop a comprehensive, data-driven plan to address problems and needs identified in the assessment phase.
- Implementation - Implement evidence-based prevention programs, policies, and practices.
- Evaluation - Measure the impact of implemented programs, policies and practices.
** Sustainability and cultural competence should be integrated into all steps of the SPF.
In the SPF, the first step ASSESSMENT helps communities ______________________________
better understand the extent and nature of behavioral health problems present in the community
- AKA needs assessment
What should be considered to prioritize results from Assessment?
Magnitude - Which problem/behavior is most widespread in the community?
Severity - Which problem/ behavior is most serious?
Trend - Which problem/ behavior is getting worse or better?
Changeability - Which problem/behavior are you most likely to influence with your prevention efforts?
What are the types of resources that need to be assessed to address the problem?
● Fiscal resources – such as grants and donations, and tangible, physical resources such as meeting space and supplies
● Human resources – such as trained staff, consultants, volunteers, stakeholders, partners, local champions
● Organizational resources – such as vision and mission statements aligned with the prevention effort, and organizational policies, organizational budgets, and technology
● Community resources – such as previous efforts to address the problem, local policies and regulations, community awareness of the problem
What are the 9 stages of readiness according to the Community Readiness Model?
STAGE 1 – Community Tolerance/No Knowledge: The community or leaders do not generally recognize that there is a problem. Community norms may encourage or tolerate the behavior in social contexts.
STAGE 2 – Denial: There is some recognition by some members of the community that the behavior is a problem, but little or no recognition that it is a local problem.
STAGE 3 – Vague Awareness: There is a general feeling among some in the community that there is a local problem and that something ought to be done, but there is little motivation to act.
STAGE 4 – Preplanning: There is clear recognition by many that there is a local problem and something needs to be done. There may be a committee to address the problem, but no clear idea of how to progress. No action to address problem/beginning stage of acknowledging the necessity of dealing with the problem
STAGE 5 – Preparation: The community has begun planning and is focused on practical details. Leadership is active and energetic. Decisions are being made and resources are sought and allocated. Pros/Cons of prevention activities , actions, and/or policies may not be based on collected data
STAGE 6 – Initiation: Data are collected that justify a prevention program. Action has begun. Staff are being trained. Stereotypes exist of risk factor knowledge
STAGE 7 – Institutionalization/Stabilization: Several planned efforts are underway and supported by community decision makers. Staff are trained and experienced. No in-depth evaluation for effectiveness; No perceived need for change or expansion
STAGE 8 – Confirmation/Expansion: Programs have been evaluated and modified/Support for expansion and/or improvement in efforts to deal with the problem; Leaders support expanding funding and scope. Data are regularly collected and used to drive planning.
STAGE 9 – Professionalism/High Level of Community Ownership: Universal, selective, and indicated efforts are in place for a variety of focus populations. Staff is well trained and experienced. Effective evaluation is routine and used to modify activities. Community involvement is high.
What are the 3 ways to increase resources and improve readiness?
1) Engage diverse community stakeholders
2) Develop and strengthen a prevention team
3) Raise community awareness of the problem to be addressed
What are the 3 tasks involved in planning prevention program/intervention according to the SPF?
- Prioritize risk and protective factors associated with the identified priority
- Select prevention interventions that are evidence based, most likely to influence the identified risk factors (conceptual fit), and feasible and relevant to the focus population (practical fit).
- Develop a comprehensive, data-driven prevention plan
Planning stage of SPF: Prioritizing Risk and Protective Factors
IMPORTANCE and CHANGEABILITY can be used to help decide which risk or protective factors to address with prevention interventions
- Importance - how much/how strongly a risk or protective factor impacts the targeted behavioral health problem in a community
- Changeability refers to 3 issues:
● Whether the community has the capacity to change a particular risk or protective
factor
● Whether a suitable evidence-based intervention exists to address a particular problem
● Whether change can be brought about in a reasonable time frame
3 criteria for Selecting effective interventions with good “fit” (planning stage of SPF)
● Effectiveness: Is the intervention effective?
● Conceptual fit: Will the intervention(s) impact the selected risk or protective
factor?
● Practical fit: Is the intervention appropriate to the community, and/or the specific population or subgroup of focus?
Questions to ask to assess conceptual fit
● Does it address the targeted problem?
● Does it address the risk/protective factors and conditions associated with the
problem?
● Does it focus on a relevant population and/or context?
Questions to ask to assess practical fit
● Is it feasible? Does the community have the resources needed for the
intervention?
● Is there synergism? Does the intervention add to or reinforce other prevention interventions?
● Is the community ready? Will stakeholders and the community support the intervention?
● Is the intervention culturally relevant? Will the cultural groups that are the focus of the intervention be receptive to it? Are they involved in the planning and implementation?
A comprehensive prevention plan (planning stage of SPF) includes:
● A description of the priority problem and why it was selected
● A list of the prioritized risk factors and how they were prioritized
● A description of community resources, resource gaps, readiness, cultural issues, and how challenges will be addressed
● A description of the interventions chosen to address the selected risk factors
● A logic model with short- and long-term outcomes
● An action plan with timetables, roles, and responsibilities for implementing interventions.
Tasks that encompass the implementation stage of the SPF
- Deliver programs and practices
- Balance fidelity with planned adaptations
- Establish implementation supports and monitor implementation
What does DELIVERING PROGRAMS AND PRACTICES (part of implementation stage of SPF) do?
● Increase community awareness of the problem and of the intervention(s) selected to address it.
● Introduce the intervention to stakeholders to obtain their buy-in and expand partnerships.
● Select settings where the intervention will be implemented, and provide resources and support as needed.
● Develop and carry out an action plan detailing what is to occur, who is responsible, and a timeline.
What should be done in order to establish implementation supports and monitor implementation (part of implementation stage of SPF)
● Build leadership and administrative support in the settings where the intervention is happening
● Provide training for the people implementing the intervention if they do not have the necessary skills
● Monitor the delivery of the program and make mid-course corrections as needed. Your evaluation activities can help you to monitor implementation of the intervention.
Fidelity (def’n)
the degree to which an evidence-based prevention program is implemented as its developer intended.
Adaptation (def’n)
how an intervention is changed and customized to meet local needs and circumstances.
modifications made to a chosen intervention such as audience, setting, and/or intensity of program deliver
Why is it important to balance fidelity and adaptation when implementing a prevention intervention?
changes to an intervention can compromise its effectiveness.
Guidelines for adaptation of an intervention
● Select programs with the best practical fit to local needs and conditions
● Consult with the program developer
● Retain core components of the original intervention
● Add, rather than subtract
What does the evaluation do in the SPF model?
● Helps to assess the progress and impact of an intervention
● Identifies what does and does not work in a particular setting
● Is used to improve implementation and performance
● Helps determine which interventions and outcomes should be sustained
What are the different types of evaluation?
Process - occurs during the implementation of an intervention, and monitors how the intervention was carried out
Outcome - looks at short-term and long-term results, to see what changes occurred due to the intervention
What question does the process evaluation answer?
“Did we do what we said we would do?”
- Process evaluation describes how the intervention was implemented
What question does the outcome evaluation answer?
“Did our intervention make a difference— did it impact the risk factors and problems we wanted to address?”
- documents effects achieved after the intervention is implemented, such as short- and long-term changes in a population group’s knowledge, attitudes, skills, or behavior
What does process evaluation data help to determine?
● Were interventions implemented as planned?
● Who participated and for how long?
● What adaptations were made?
● Were the resources sufficient?
● What obstacles were encountered?
What should a prevention specialist consider when selecting interventions?
- Effectiveness
- Conceptual Fit
- Practical Fit
What does outcome evaluation data help to determine?
● What changes actually occurred
● How these changes compare to what the intervention was expected to achieve
● How these changes compare with those not exposed to the intervention
What can evaluation results be used for?
Improve programs, sustain positive outcomes, and improve a community’s overall plan for addressing behavioral health problems and promoting wellness
To help obtain funding or to build community awareness and support for prevention
What are some types for reporting evaluation results?
- Brief stakeholders regularly, throughout the process, not just at the end.
- Create a dissemination plan, tailored to the various audiences that need to see the results, including the focus population
- Select appropriate reporting formats. Think carefully about the best venues or vehicles for delivering results.
- Help stakeholders understand the data. Remember that each stakeholder has their own interests, and will be most interested in findings that relate to these interests.
What are the components of the Institute of Medicine’s (IOM) Continuum of Care?
- promotion
- Prevention: universal, selective, indicated
- Case Identification
- Standard Treatment
- Maintenance: Long-term treatment, after-care, and rehabilitation
What is an assessment/needs assessment?
systematic gathering and examining of data related to a health problem within a community, as well as related conditions and consequences
** Identifies the problems, populations most affected, conditions that put the community at risk, and what within the community can protect against the problems being identified
When are adaptations of a prevention program more effective?
when underlying program theory is understood, core components have been identified, and both the community and needs of a population of interest have been carefully defined
An assessment is a process of _______________, _______________, and _____________ information about your community. What should an assessment include?
gathering; analyzing, and reporting
should include:
● geographic and demographic info
● collective review of needs and resources within a community that indicates what the current problems are that could be addressed by a coalition
What are the 2 assumptions of the IOM continuum of care model?
- The possibility of prevent the occurrence of a health consequence - can happen at anytime throughout the continuum of care model
- Different strategies/approaches to prevention will be needed - based on where target population is among the continuum of care model in addressing the problem/behavior
What are the 3 types/levels of prevention?
Primary, Secondary, and Tertiary
Goal of Primary Prevention
goal: Reduce INCIDENCE of disorder (occurrence of NEW cases)
Secondary Prevention
Reduce Prevalence (total number of new and old cases)
Tertiary Prevention
Reduce the consequences and complications arising from disorder/problem once it has manifested
Universal Prevention provides the population with _________________ and _______________________ to prevent the problem
Knowledge/Information and Skills
What is the Drug Abuse Continuum?
Use, Misuse, Abuse, Dependence, Addiction
What are the 7 steps of the Community Prevention Planning Model (Hawkins, 1992)
- Assess Community Readiness
- Needs Assessment - levels of risk and protective factors within the community
- Prioritize Results - Risk/Protective Factors data from assessment into priorities
- Conduct Resource Assessment - examine what resources are in the community that are reducing prioritized risk factors and enhancing protective factors
- Identify Target Populations
- Identify appropriate Programs/Services - Apply “best practices” and “guiding principles”
- Logic Model & Evaluation
What are the two primary activities that take place during needs assessment?
Data Collection and Data Analysis
Data Collection
Gathering of information that is either archival (already exists) or primary (data that are created)
Data Analysis
An examination of data to establish meaning and set priorities for community change
Data Literacy
the ability to access, understand, and interpret information in order to identify questions, find answers, and support decisions
Three steps to improve the process of a needs assessment
Step 1: Define your purpose and scope
Step 2: Gather the archival data
Step 3: Decide on the need for primary data
Archival Data
already exists
- Can provide baseline during needs assessment
Primary Data
Data collected firsthand
According to The National Institute of Drug Abuse (NIDA) prevention guidelines, what are 3 areas for developing and implementing evidence-based prevention strategies?
- Risk and Protective Factors
- Prevention Planning
- Prevention Program Delivery
Logic Model
roadmap for understanding how the program problem connects to the program activities that you are using to predict the program outcomes
- Identifies what the program is, what it is expected to do, and what measures of success that will be used
Public Health Model (PHM)
Requires an understanding of the agent, host, and environment and how they interact. Also involves a plan of action for influencing all three. Agent = substance, host = individual, environment = conditions
All 5 steps of The Strategic Prevention Framework (SPF) work around a _____________________________
Sustainable and Cultural competent Center
Sustainability
prevention initiative/prevention program and activities can continue beyond initial funding
Cultural Competence
respect for culture and diversity of community being served
Communities That Care (CTC)
This model is designed marshaling community resources to address problematic behavior in adolescents.
5 Steps of CTC model
- Get started
- Get organized
- Develop community profile
- Create a plan
- Implement and evaluate
What is involved in the first step of the CTC model?
Identify lead agency, key stakeholders, and staffing needs
What is involved in the 2nd step of the CTC model?
Development of a community prevention board, or work with an existing coalition to gain support for the community change initiative
What is involved in the 3rd step of the CTC model?
- Develop community risk and protective factors profile
- Identify community resources and gaps in resources needed to address community needs
What is involved in the 4th step of the CTC model?
Develop action plan to align the need, resources, and outcomes for strategies to strengthen protective factors
What is involved in the last step of the CTC model?
Maintain fidelity to the plan that was created in 4th step of CTC, while also monitoring any adaptations and outcomes over time
Evaluation
The systematic collection and analysis of information gathered (data) - it is not random or haphazard
Evaluation provides information on program _________________________
activities, characteristics, and outcomes
- Answers questions such as Who, What, How, Why
What is the evaluation used for?
- Reduce uncertainty
- improve effectiveness
- Make better decisions about the prevention program/strategy being implemented
Process Evaluation
Involves analyzing how implementation activities are delivered
Outcome Evaluation
Measures a program’s results and helps determine whether a program or strategy produced the changes it intended to achieve
What does a process evaluation include?
- Who delivers the strategy and how often?
- To what extent is the strategy implemented as planned?
- How is the intervention received by the target population and program staff?
- What are barriers to intervention delivery?
- Was the data used to make improvements/refinements? If so, what changes were made?
A comprehensive outcome evaluation will include:
- An assessment of the impacts of each program component
- Data from a population group
- Choices of evaluation designs
- What worked in comparison with what you thought would work?
Outcomes or impact
Look at how the participants lives were changed or affected by the program activities
- Includes both short term and Long term outcome measures
Outputs
The number of opportunities the program has to create changes, such as the number of clients served and how many hours the program was in the field
Archival Data can be critical to understanding ____________________________________
the general scope and magnitude of a community health problem
Primary Data is needed to evaluate ____________________ and assess ____________________
EVALUATE the implementation activities
ASSESS short-term and long-term outcomes of the prevention initiative
3 main ways to collect data to assess impact of prevention program/strategy
- posttest only
- pretest and posttest
- pretest and posttest with a comparison group
