the center for substance abuse treatment strategic planning for providers to improve business...
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The Center for Substance Abuse TreatmentStrategic Planning for Providers to Improve Business Practices
Arlington, Virginia - October 21–23, 2009
The Center for Substance Abuse TreatmentStrategic Planning for Providers to Improve Business Practices
Arlington, Virginia - October 21–23, 2009
Presenter: Jeffrey Friedman
Executive Director
631-329-4398
Presenter: Jeffrey Friedman
Executive Director
631-329-4398
New York State MapNew York State Map
Map of Long Island, NYMap of Long Island, NY
Long Island, NYLong Island, NY
Two suburban counties, home to 2.75 million people
Among the most segregated suburbs in the U.S. White communities; Black and Hispanic communities Pockets of intense poverty right next to affluent areas
Annual family income < $25,000 for 64,000 families
Among highest cost of living per capita in the nation
Inadequate public transit
More AIDS cases than 26 states
Two suburban counties, home to 2.75 million people
Among the most segregated suburbs in the U.S. White communities; Black and Hispanic communities Pockets of intense poverty right next to affluent areas
Annual family income < $25,000 for 64,000 families
Among highest cost of living per capita in the nation
Inadequate public transit
More AIDS cases than 26 states
Demographic/Epidemiologic Detail Long Island, NY
Demographic/Epidemiologic Detail Long Island, NY
Long Island Population:
77% White/Caucasian
Hispanic (10%) and Black (8%) residents account for 64%
of the newly diagnosed HIV cases over a recent 12 month
period
30% of newly diagnosed HIV cases were female
Long Island Population:
77% White/Caucasian
Hispanic (10%) and Black (8%) residents account for 64%
of the newly diagnosed HIV cases over a recent 12 month
period
30% of newly diagnosed HIV cases were female
Outreach on Long Island Outreach on Long Island
Outreach on Long Island Outreach on Long Island
Outreach on Long Island Outreach on Long Island
Rapid HIV Testing Outreach InitiativeRapid HIV Testing Outreach Initiative
Long Island community based organizations (CBO) participated in
this initiative from 2001 -2007
Project was a partnership between 3 CBO’s, HIV provider, substance
abuse provider and a local weed and seed provider.
Project was funded through SAMHSA CSAT, TCE initiative.
As a part of this project the OraQuick advanced HIV rapid tests was
utilized during street outreach.
Long Island community based organizations (CBO) participated in
this initiative from 2001 -2007
Project was a partnership between 3 CBO’s, HIV provider, substance
abuse provider and a local weed and seed provider.
Project was funded through SAMHSA CSAT, TCE initiative.
As a part of this project the OraQuick advanced HIV rapid tests was
utilized during street outreach.
S.M.A.R.T. S.M.A.R.T. ObjectivesObjectivesS.M.A.R.T. S.M.A.R.T. ObjectivesObjectives
• S = Specific
• M = Measurable
• A = Achievable
• R = Realistic
• T = Time-bound
• S = Specific
• M = Measurable
• A = Achievable
• R = Realistic
• T = Time-bound
Overview of Methods to Collect Data / InfoOverview of Methods to Collect Data / Info
• Questionnaires / Surveys
• Checklists
• Observation
• Interviews
• Focus Groups
• Case Studies
• Documentation Review
• Questionnaires / Surveys
• Checklists
• Observation
• Interviews
• Focus Groups
• Case Studies
• Documentation Review
Adding an open-ended question as part of a an accompanying interview can elicit very touching qualitative responses
Adding an open-ended question as part of a an accompanying interview can elicit very touching qualitative responses
• Example: “In your own words, what does it feel like to see the way
you do now, compared to your experience before?”
• Example: “In your own words, what does it feel like to see the way
you do now, compared to your experience before?”
A few insights into wording survey questionsA few insights into wording survey questions
• Use short and simple sentences
• Short, simple sentences are generally less confusing and ambiguous than long, complex ones.
• Ask for only one piece of information at a time
• For example, "Please rate this lecture in terms of its content and presentation" asks for two pieces of information at the same time.
It should be divided into two parts: "Please rate the lecture in terms of (a) its content, (b) its presentation."
“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ
• Use short and simple sentences
• Short, simple sentences are generally less confusing and ambiguous than long, complex ones.
• Ask for only one piece of information at a time
• For example, "Please rate this lecture in terms of its content and presentation" asks for two pieces of information at the same time.
It should be divided into two parts: "Please rate the lecture in terms of (a) its content, (b) its presentation."
“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ
A few insights into wording survey questionsA few insights into wording survey questions
• Avoid negatives if possible
• For example, instead of asking expert respondents whether they agree with the statement, “Clean needle
exchange should not be abolished,"
the statement should be rephrased as, “Clean needle exchange should continue." Double negatives
should always be avoided.
“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ
• Avoid negatives if possible
• For example, instead of asking expert respondents whether they agree with the statement, “Clean needle
exchange should not be abolished,"
the statement should be rephrased as, “Clean needle exchange should continue." Double negatives
should always be avoided.
“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ
A few insights into wording survey questionsA few insights into wording survey questions
• Ask precise questions
• Questions may be ambiguous because a word or term may have vastly different meanings to different people.
• For example, if we ask substance-using clients to “rate your interest in recovery, this word ‘recovery’ might mean “recovering from an addiction to substance use" to some, but may mean “time in an in-patient substance use program” to others.
• Always specify a frame of reference. For example, in the question, "How often did you receive food from the soup kitchen?" the time reference is missing.
• It might be rephrased as, "How many meals have you received at the soup kitchen within the past six months?"
“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ
• Ask precise questions
• Questions may be ambiguous because a word or term may have vastly different meanings to different people.
• For example, if we ask substance-using clients to “rate your interest in recovery, this word ‘recovery’ might mean “recovering from an addiction to substance use" to some, but may mean “time in an in-patient substance use program” to others.
• Always specify a frame of reference. For example, in the question, "How often did you receive food from the soup kitchen?" the time reference is missing.
• It might be rephrased as, "How many meals have you received at the soup kitchen within the past six months?"
“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ
A few insights into wording survey questionsA few insights into wording survey questions
• Minimize bias
• People tend to answer questions in a way they perceive to be socially desired or expected by the questioner and they often look for clues in the questions.
• Many apparently neutral questions can potentially lead to bias.
• For example, in the question, "Within the past month, how many Alcoholics Anonymous meetings have you missed due to your evening job?“, respondents may perceive the desired responses to be "never" to the first question.
• This question could be rephrased as two related questions, "Within the past month, how many times did your evening job commitment clash with Alcoholics Anonymous meetings?
How many times did you give priority to your evening job?"
“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ
• Minimize bias
• People tend to answer questions in a way they perceive to be socially desired or expected by the questioner and they often look for clues in the questions.
• Many apparently neutral questions can potentially lead to bias.
• For example, in the question, "Within the past month, how many Alcoholics Anonymous meetings have you missed due to your evening job?“, respondents may perceive the desired responses to be "never" to the first question.
• This question could be rephrased as two related questions, "Within the past month, how many times did your evening job commitment clash with Alcoholics Anonymous meetings?
How many times did you give priority to your evening job?"
“This section tailored / adapted from How to Design a Questionnaire”; Wai-Ching Leung, Student BMJ
Typical Questions Asked / Answered
during Process Evaluation
Typical Questions Asked / Answered
during Process Evaluation
1) Are the services being provided those which were intended?
2) Are the people being enrolled in the project those who were identified as most in-need
and in / from the geography identified as most in-need?
3) Are the participants receiving the types of services that they need?
4) Are all partnering organizations functioning together with focus?
• Basically: “How’s it going?!”
1) Are the services being provided those which were intended?
2) Are the people being enrolled in the project those who were identified as most in-need
and in / from the geography identified as most in-need?
3) Are the participants receiving the types of services that they need?
4) Are all partnering organizations functioning together with focus?
• Basically: “How’s it going?!”
Overall Lessons Learned about Outreach in the field
Overall Lessons Learned about Outreach in the field
Recruit staff from target communities (whenever possible)
Dress casually in the field, professionally in the office
Use an outreach van as opposed to conducting outreach using
fixed location
Refrain from putting any signs on outreach vehicle
Build trust in the community before introducing services
Recruit staff from target communities (whenever possible)
Dress casually in the field, professionally in the office
Use an outreach van as opposed to conducting outreach using
fixed location
Refrain from putting any signs on outreach vehicle
Build trust in the community before introducing services
Overall Lessons Learned about Outreach
Overall Lessons Learned about Outreach
Lessons Learned: MobilityLessons Learned: Mobility
Deploying a mobile office dramatically improves capacity to
serve.
The van/r.v. transformed our entire outreach dynamic. Instead
of us waiting for people to ‘drop in’ to a storefront and soup
kitchen, we were able to park the van --(on a rotating basis)-- in
key areas of the community.
We would canvas these zones by foot, and gain gradual trust and
recognition by community members, including by at-risk
individuals who became interested in the services we offered.
Deploying a mobile office dramatically improves capacity to
serve.
The van/r.v. transformed our entire outreach dynamic. Instead
of us waiting for people to ‘drop in’ to a storefront and soup
kitchen, we were able to park the van --(on a rotating basis)-- in
key areas of the community.
We would canvas these zones by foot, and gain gradual trust and
recognition by community members, including by at-risk
individuals who became interested in the services we offered.
Overall Lessons Learned about Outreach
Overall Lessons Learned about Outreach
Lessons Learned: StaffingLessons Learned: Staffing
Complexity/challenges associated with recruiting and retaining staff.
Over time, our most successful outreach staff have shown:
Extreme passion for outreach / giving back to their community
Direct history living in disadvantaged communities
‘Street smarts’ / knowledge of local hangouts
High capacity for accurate data recording
Complexity/challenges associated with recruiting and retaining staff.
Over time, our most successful outreach staff have shown:
Extreme passion for outreach / giving back to their community
Direct history living in disadvantaged communities
‘Street smarts’ / knowledge of local hangouts
High capacity for accurate data recording
Lessons Learned: Cultural Competency
Lessons Learned: Cultural Competency
Cultural competency directly impacts receptivity and results.
We discovered that:
To our target population, “Shirt + tie” equals either “Police”
or “Immigration,” both feared in the minds of many of our
highest-risk clients;
Outreach workers who are native Spanish speakers and/or
bilingual make initial contact with many of our clients more
easily.
Cultural competency directly impacts receptivity and results.
We discovered that:
To our target population, “Shirt + tie” equals either “Police”
or “Immigration,” both feared in the minds of many of our
highest-risk clients;
Outreach workers who are native Spanish speakers and/or
bilingual make initial contact with many of our clients more
easily.
Lessons Learned: Persistence Lessons Learned: Persistence
Don’t underestimate the labor intensiveness of the outreach
process.
It took us some time to learn of the following: It most often takes
more than one encounter, and sometimes up to 10 encounters with
the same person, before that at-risk individual will accept or
request services.
And the person still may not. As a result, it takes a lot longer than
initially envisioned to attract the target number of unduplicated
people served.
Don’t underestimate the labor intensiveness of the outreach
process.
It took us some time to learn of the following: It most often takes
more than one encounter, and sometimes up to 10 encounters with
the same person, before that at-risk individual will accept or
request services.
And the person still may not. As a result, it takes a lot longer than
initially envisioned to attract the target number of unduplicated
people served.
Lessons Learned: Holistic Approach
Lessons Learned: Holistic Approach
• We learned that in order to build enough trust among our target
population, we have often needed to address an array of
needed/valued services:
Access to substance abuse treatment
Nutrition assistance
Housing assistance
Employment and social services assistance
Assistance accessing primary medical care
• We learned that in order to build enough trust among our target
population, we have often needed to address an array of
needed/valued services:
Access to substance abuse treatment
Nutrition assistance
Housing assistance
Employment and social services assistance
Assistance accessing primary medical care
Overall Lessons Learned about Outreach in the field
Overall Lessons Learned about Outreach in the field
Client Locator Form:
Directly asks clients, upon intake, where they tend to hang out, their regular daily
routines, who can help us find them later, and what aliases and nicknames they use;
Two years later we added fields for the client’s physical description (including
height, weight, ethnicity, visible tattoos) and where precisely we encountered the
client for initial encounter/intake.
And it was also imperative that we implement classic data verification, thereby
diminishing any chance for erroneous, malicious, or incomplete data entry that
could arise due to competing concerns among those with differing roles and
positions.
Client Locator Form:
Directly asks clients, upon intake, where they tend to hang out, their regular daily
routines, who can help us find them later, and what aliases and nicknames they use;
Two years later we added fields for the client’s physical description (including
height, weight, ethnicity, visible tattoos) and where precisely we encountered the
client for initial encounter/intake.
And it was also imperative that we implement classic data verification, thereby
diminishing any chance for erroneous, malicious, or incomplete data entry that
could arise due to competing concerns among those with differing roles and
positions.
Locator Information FormLocator Information Form
Overall Lessons Learned EvaluationOverall Lessons Learned Evaluation
To assure consistent project feedback leading to continuous
quality improvement, our project evaluator performed both
qualitative and quantitative analysis.
The two main elements of this type of evaluation were:
Participation of all stakeholders; and
Reflexivity, demonstrated by continuous re-examination of
goals and activities.
To assure consistent project feedback leading to continuous
quality improvement, our project evaluator performed both
qualitative and quantitative analysis.
The two main elements of this type of evaluation were:
Participation of all stakeholders; and
Reflexivity, demonstrated by continuous re-examination of
goals and activities.
Overall Lessons Learned EvaluationOverall Lessons Learned Evaluation
We achieved these goals as the evaluator worked
synchronistically with the staff, making periodic
presentations to the advisory board and to other
organizations that wished to share the learning's
of project as they arose.
We achieved these goals as the evaluator worked
synchronistically with the staff, making periodic
presentations to the advisory board and to other
organizations that wished to share the learning's
of project as they arose.
The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices
Arlington, Virginia - October 21–23, 2009
The Center for Substance Abuse Treatment Strategic Planning for Providers to Improve Business Practices
Arlington, Virginia - October 21–23, 2009
Presenter: Jeffrey Friedman
Executive Director
631-329-4398
Presenter: Jeffrey Friedman
Executive Director
631-329-4398