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Planning Multi-site
            Evaluations of
     Model and Promising Programs

         Presented by Donna Smith-Moncrieffe
Canadian Evaluation Society Conference (Ontario Chapter)
       October 1, 2009, Ramada Hotel, Toronto
Presentation Outline
   National Crime Prevention Centre (NCPC) mandate

   Multi-site evaluations of model & promising Programs

        Definitions

        Why conduct multi-site evaluations of model and promising
         programs?

        Using Multi-site evaluations to contribute to potential program
         sustainability




                                                                  2
Presentation Outline cont’d
   Planning challenges of multi-site evaluations
      Challenges in the planning stages (8 multi-site
       evaluations)
      Key mitigation strategies for implementing multi-site
       evaluations
      Sample planning charts/tools:



            Stop Now and Plan (SNAP®) program: Quantifying
             fidelity checklists
            Multisystemic Therapy (MST) program: Proposed
             correlation of results with fidelity levels
            Stop Now and Plan (SNAP®): Identifying
             quantifiable benchmarks for between site analysis


                                                               3
NCPC Mandate/Core Activities

Mission statement:

    To provide national leadership on effective and cost-efficient ways to
    both prevent and reduce crime by addressing known risk factors in
    high risk populations and places

Core activities:
 Supporting targeted interventions in local communities



   Building and sharing practical knowledge with policy makers and
    practitioners



                                                                             4
NCPC priorities:

Provide funding for the following target groups/crime issues:

   Children and youth at risk

   Crime prevention in Aboriginal communities

   Prevent recidivism among high-risk groups

   Priority crime issues (youth gang, drug-related crimes)




                                                                5
Model and Promising Programs:
                  NCPC Definitions
                     • Prevention program that meets the highest
                     standards (i.e. peer-reviewed evaluations with
Model Programs       rigorous designs )
                     • Demonstrates significant sustained reduction in
                       problem behaviour or risk factors for criminal
                     offending
                     •Effectiveness is maintained over time


                     •Demonstrates some reductions in problem
                     behaviour or risk factors for criminal offending
Promising Programs
                     •Program components have been evaluated with
                     less rigorous designs (i.e. pre and post tests)

                                                                         6
Definitions: Multi-site evaluations
NCPC criteria used to be considered multi-site:

√ One central evaluation for all sites (multi-center)
√ Intent to deliver the same program in at least 2 or more different
   regional settings
√ Within and between site analysis is conducted and reported in one
   report
√ Intent to implement sites concurrently
√ Differences in setting, target group or additional non-core
   components are apparent


                                                                       7
NCPC Planned Multi-Site Evaluations
                                •2 model programs and 6 promising programs (up to
Type of Multi-site Evaluation
                                4 sites in different Provinces)

                                • Randomized control trial (SNAP® program only)
    Evaluation Designs
                                • Matched comparison group & Cost benefit analysis
                                (where causal links can be established and where
                                variables can be monetized)

  Duration of Evaluations       • 4 to 5 year duration with 1 year follow up


                                • External contracted evaluations
      Contract Type
                                •Competitive process (posting on MERX)
                                                                                   8
Why Conduct Multi-site evaluations
         with Model Programs?
    Building the knowledge base of “what works” for wider
    dissemination across Canada

   Increases confidence that observed impacts
    (effectiveness) can be attributed to the intervention

   Increases knowledge about the program elements that
    contribute most to its effectiveness

   Increases knowledge about the contextual factors that
    contribute to effectiveness



                                                            9
Multi-Site Evaluations: Contributing to
         Potential Program Sustainability
            Disseminate Results
                and encourage
                                             NCPC time-
                the provinces
                                            limited funding
                    to implement
                      effective programs


   Contribute                                                 Identify and
to Treasury Board                                   encourage the development
    reporting                                   of Model and Promising Programs


                       Use
                    multi-Site             Collaborate with
                    evaluations            the provinces and
                    to increase            lead FPT meetings
                    knowledge

                                                                                10
NCPC Challenges:
       Planning Multi-Site Evaluations
   Co-ordinating the timing for all sites

   Ensuring program fidelity within each site is high (80% or
    higher)

   Identify quantifiable benchmarks for key outcomes (increases
    comparability for a between site analysis)

   Variation in program developer involvement

   Delays in contract approvals (at least one project within the
    multi-site needs to be approved before the evaluation contract
    can be processed)

                                                                     11
Mitigation Strategy:
         Addressing Variation in Timing for all Sites
                      Call for proposals in different provinces
                      occurred at different intervals throughout the
Issue/Challenge       year. A number of factors contribute to
                      variation in program development and approval
                      time periods.

                      •Within site analysis is feasible but between site
Implications          analysis and pooling is not feasible until all of the
                      sites are at similar stages

                      •NCPC encouraged organizations to develop key model
                      and promising programs (prioritizing exercise)
Mitigation Strategy
                      • NCPC funded “knowledge to practice” seminars to
                      train organizations in the development of model and
                      promising programs (helps prioritize key programs)

                                                                              12
Mitigation Strategy:
        Ensuring Fidelity is High in each Site
                      Sponsoring organizations potentially deviate
                      from the intended program. Fidelity problems
Issue/Challenge       result from varying interpretations of the
                      program, inability to attract the proper target
                      group or intentions to test a new component
                      that is not part of the model.

Implications          •Between site analysis and interpretation is unreliable
                      when each site implements the program differently.

                      • Develop quantifiable fidelity check lists
                      • Ensure funds for frequent fidelity checks are available
Mitigation Strategy
                      •Ensure research and evaluation staff are available to
                      support program officers developing model and promising
                      programs
                                                                                  13
Mitigation Strategy:
Ensuring Fidelity is High in each Site (cont’d)
Sample : Quantifiable fidelity checklist (note: this is not the full checklist)
√ Target Group Population Met:                                         8/10

√ 12 Cognitive Behavioural group Sessions                              10/12
           Sessions delivered weekly within 3 months
           Delivered by a trained facilitator
           Approved manuals used (weekly documentation)


√ 12 Cognitive Behavioural concurrent parenting sessions     10/12

Fidelity Level: High            Total Score: 28/34 or 82.4%
____________________________________________________________
Fidelity Legend
No Fidelity:       0-29%
Low Fidelity:     30-69%
Moderate Fidelity: 70-79%
High Fidelity:     80-100%



                                                                                  14
Mitigation Strategy:
 Sample MST: Proposed Correlation of
     Results with Fidelity Levels
                     Site 1        Site 1    Site 2    Site 2
                     (MST)         (Control) (MST)     (Control)
MST re-conviction    59.3%         69.2%      59.3% 58.3%,
Rates (%)

(known data)
MST                  75% or        Usual      55% or   Usual
Levels of Fidelity   Mod Level     Services   Low      Services
(%)                                           Level
(proposed)
Recommendation       Further                  Further explore
                     exploration              weak areas of
                     not                      fidelity
                     required
                                                                  15
Mitigation Strategy: Identifying
                          Quantifiable
               Benchmarks for Between Site Analysis
                       Data are not present for all outcomes of
                       interest or they vary significantly between
                       studies. Significance testing types also vary
Issue/Challenge
                       (Statistical significance, Clinical Significance
                       and Effect Sizes).

                       •The benchmark set for sites may be atypical
Implications           leading to an inaccurate interpretation of
                       program efficacy

                      • Use meta-analysis results if available
                      (standardizes results)
Mitigation Strategy
                      • Set benchmarks using results that have been
                      produced only from programs implemented with
                      high levels of fidelity
                                                                      16
Sample Planning Chart:
Identifying Benchmarks for Key Outcomes
Key         Target                     Site   Site      Site   Site
Outcome                                1      1         2      2
            (At 12 weeks only)
s                                      SNAP   Control   SNAP   Control



Conduct-    Moderate   effect sizes
Type        ½ SD change
Behaviour
            Stat. Sign. changes
(CBCL)
            (p<0.05)

Police      100%   ↓ at 6 months
Contact     80% ↓ after 6
            months
            70-75%↓ l (annually
            after program
            completion                                            17
Planning Challenges Cont’d:
        Variation in Program Developer Involvement

                      Program developers for promising and model
                      programs vary in their involvement.
Issue/Challenge       Licensing requirements and fee schedules are
                      also variable.

                      NCPC involvement in customizing budgets,
                      developing program theories, fidelity checklists
Implications          and quality assurances will vary and require
                      increased FTE involvement

                      •Plan all 8 multi-site evaluations on a case by
                      case basis
Mitigation Strategy
                      • Assess licensing and quality assurance
                      requirements in the early stages of project
                      development.
                                                                        18
Summary:
        Planning High Standard Multi-site
                  Evaluations
√ Ensure central co-ordination approach is used (i.e. One evaluation
   firm oversees all evaluations for each site)

√   Enhance fidelity and quality assurance checks
      √Target population is well defined and each site adheres to the criteria
      √ Core set of instruments are used for all sites (including same risk assessment)
      √ Quality assurance procedures are implemented (including fidelity checklists)
      √ All sites implement core components (additional non-core components are recognized
         and analyzed accordingly)


√ Identify   quantifiable benchmarks/targets for key outcomes

√ Correlate fidelity levels with key outcomes to explain variation
   between sites


                                                                                      19
Contact Information
                Donna Smith-Moncrieffe
               Senior Evaluation Advisor
Public Safety Canada, National Crime Prevention Center
               Telephone: 416-952-0423

       E-mail: donna.smith-moncrieffe@ps.gc.ca




                                                         20

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Planning Multi-Site Evaluations

  • 1. Planning Multi-site Evaluations of Model and Promising Programs Presented by Donna Smith-Moncrieffe Canadian Evaluation Society Conference (Ontario Chapter) October 1, 2009, Ramada Hotel, Toronto
  • 2. Presentation Outline  National Crime Prevention Centre (NCPC) mandate  Multi-site evaluations of model & promising Programs  Definitions  Why conduct multi-site evaluations of model and promising programs?  Using Multi-site evaluations to contribute to potential program sustainability 2
  • 3. Presentation Outline cont’d  Planning challenges of multi-site evaluations  Challenges in the planning stages (8 multi-site evaluations)  Key mitigation strategies for implementing multi-site evaluations  Sample planning charts/tools:  Stop Now and Plan (SNAP®) program: Quantifying fidelity checklists  Multisystemic Therapy (MST) program: Proposed correlation of results with fidelity levels  Stop Now and Plan (SNAP®): Identifying quantifiable benchmarks for between site analysis 3
  • 4. NCPC Mandate/Core Activities Mission statement: To provide national leadership on effective and cost-efficient ways to both prevent and reduce crime by addressing known risk factors in high risk populations and places Core activities:  Supporting targeted interventions in local communities  Building and sharing practical knowledge with policy makers and practitioners 4
  • 5. NCPC priorities: Provide funding for the following target groups/crime issues:  Children and youth at risk  Crime prevention in Aboriginal communities  Prevent recidivism among high-risk groups  Priority crime issues (youth gang, drug-related crimes) 5
  • 6. Model and Promising Programs: NCPC Definitions • Prevention program that meets the highest standards (i.e. peer-reviewed evaluations with Model Programs rigorous designs ) • Demonstrates significant sustained reduction in problem behaviour or risk factors for criminal offending •Effectiveness is maintained over time •Demonstrates some reductions in problem behaviour or risk factors for criminal offending Promising Programs •Program components have been evaluated with less rigorous designs (i.e. pre and post tests) 6
  • 7. Definitions: Multi-site evaluations NCPC criteria used to be considered multi-site: √ One central evaluation for all sites (multi-center) √ Intent to deliver the same program in at least 2 or more different regional settings √ Within and between site analysis is conducted and reported in one report √ Intent to implement sites concurrently √ Differences in setting, target group or additional non-core components are apparent 7
  • 8. NCPC Planned Multi-Site Evaluations •2 model programs and 6 promising programs (up to Type of Multi-site Evaluation 4 sites in different Provinces) • Randomized control trial (SNAP® program only) Evaluation Designs • Matched comparison group & Cost benefit analysis (where causal links can be established and where variables can be monetized) Duration of Evaluations • 4 to 5 year duration with 1 year follow up • External contracted evaluations Contract Type •Competitive process (posting on MERX) 8
  • 9. Why Conduct Multi-site evaluations with Model Programs? Building the knowledge base of “what works” for wider dissemination across Canada  Increases confidence that observed impacts (effectiveness) can be attributed to the intervention  Increases knowledge about the program elements that contribute most to its effectiveness  Increases knowledge about the contextual factors that contribute to effectiveness 9
  • 10. Multi-Site Evaluations: Contributing to Potential Program Sustainability Disseminate Results and encourage NCPC time- the provinces limited funding to implement effective programs Contribute Identify and to Treasury Board encourage the development reporting of Model and Promising Programs Use multi-Site Collaborate with evaluations the provinces and to increase lead FPT meetings knowledge 10
  • 11. NCPC Challenges: Planning Multi-Site Evaluations  Co-ordinating the timing for all sites  Ensuring program fidelity within each site is high (80% or higher)  Identify quantifiable benchmarks for key outcomes (increases comparability for a between site analysis)  Variation in program developer involvement  Delays in contract approvals (at least one project within the multi-site needs to be approved before the evaluation contract can be processed) 11
  • 12. Mitigation Strategy: Addressing Variation in Timing for all Sites Call for proposals in different provinces occurred at different intervals throughout the Issue/Challenge year. A number of factors contribute to variation in program development and approval time periods. •Within site analysis is feasible but between site Implications analysis and pooling is not feasible until all of the sites are at similar stages •NCPC encouraged organizations to develop key model and promising programs (prioritizing exercise) Mitigation Strategy • NCPC funded “knowledge to practice” seminars to train organizations in the development of model and promising programs (helps prioritize key programs) 12
  • 13. Mitigation Strategy: Ensuring Fidelity is High in each Site Sponsoring organizations potentially deviate from the intended program. Fidelity problems Issue/Challenge result from varying interpretations of the program, inability to attract the proper target group or intentions to test a new component that is not part of the model. Implications •Between site analysis and interpretation is unreliable when each site implements the program differently. • Develop quantifiable fidelity check lists • Ensure funds for frequent fidelity checks are available Mitigation Strategy •Ensure research and evaluation staff are available to support program officers developing model and promising programs 13
  • 14. Mitigation Strategy: Ensuring Fidelity is High in each Site (cont’d) Sample : Quantifiable fidelity checklist (note: this is not the full checklist) √ Target Group Population Met: 8/10 √ 12 Cognitive Behavioural group Sessions 10/12  Sessions delivered weekly within 3 months  Delivered by a trained facilitator  Approved manuals used (weekly documentation) √ 12 Cognitive Behavioural concurrent parenting sessions 10/12 Fidelity Level: High Total Score: 28/34 or 82.4% ____________________________________________________________ Fidelity Legend No Fidelity: 0-29% Low Fidelity: 30-69% Moderate Fidelity: 70-79% High Fidelity: 80-100% 14
  • 15. Mitigation Strategy: Sample MST: Proposed Correlation of Results with Fidelity Levels Site 1 Site 1 Site 2 Site 2 (MST) (Control) (MST) (Control) MST re-conviction 59.3% 69.2% 59.3% 58.3%, Rates (%) (known data) MST 75% or Usual 55% or Usual Levels of Fidelity Mod Level Services Low Services (%) Level (proposed) Recommendation Further Further explore exploration weak areas of not fidelity required 15
  • 16. Mitigation Strategy: Identifying Quantifiable Benchmarks for Between Site Analysis Data are not present for all outcomes of interest or they vary significantly between studies. Significance testing types also vary Issue/Challenge (Statistical significance, Clinical Significance and Effect Sizes). •The benchmark set for sites may be atypical Implications leading to an inaccurate interpretation of program efficacy • Use meta-analysis results if available (standardizes results) Mitigation Strategy • Set benchmarks using results that have been produced only from programs implemented with high levels of fidelity 16
  • 17. Sample Planning Chart: Identifying Benchmarks for Key Outcomes Key Target Site Site Site Site Outcome 1 1 2 2 (At 12 weeks only) s SNAP Control SNAP Control Conduct- Moderate effect sizes Type ½ SD change Behaviour Stat. Sign. changes (CBCL) (p<0.05) Police 100% ↓ at 6 months Contact 80% ↓ after 6 months 70-75%↓ l (annually after program completion 17
  • 18. Planning Challenges Cont’d: Variation in Program Developer Involvement Program developers for promising and model programs vary in their involvement. Issue/Challenge Licensing requirements and fee schedules are also variable. NCPC involvement in customizing budgets, developing program theories, fidelity checklists Implications and quality assurances will vary and require increased FTE involvement •Plan all 8 multi-site evaluations on a case by case basis Mitigation Strategy • Assess licensing and quality assurance requirements in the early stages of project development. 18
  • 19. Summary: Planning High Standard Multi-site Evaluations √ Ensure central co-ordination approach is used (i.e. One evaluation firm oversees all evaluations for each site) √ Enhance fidelity and quality assurance checks √Target population is well defined and each site adheres to the criteria √ Core set of instruments are used for all sites (including same risk assessment) √ Quality assurance procedures are implemented (including fidelity checklists) √ All sites implement core components (additional non-core components are recognized and analyzed accordingly) √ Identify quantifiable benchmarks/targets for key outcomes √ Correlate fidelity levels with key outcomes to explain variation between sites 19
  • 20. Contact Information Donna Smith-Moncrieffe Senior Evaluation Advisor Public Safety Canada, National Crime Prevention Center Telephone: 416-952-0423 E-mail: donna.smith-moncrieffe@ps.gc.ca 20