I HEART QM: ONE CBO’S EXPERIENCE WITH QUALITY MANAGEMENT
I HEART QM: ONE CBO’SEXPERIENCE WITH QUALITYMANAGEMENT Joshua Ferrer Cascade AIDS Project August 15, 2011
Summary Diffusion of Effective Behavioral Interventions (DEBI) Outcome Monitoring and DEBIs Community-based Organization Behavioral Outcomes Project (CBOP) Cascade AIDS Project (CAP) and CBOP Results from CBOP Lessons Learned Tips for CBOs
DEBI Project Consists of twenty-nine individual, group and community-level interventions. Opportunity for CBOs to implement evidence-based interventions to prevent spread of HIV & STDs. Rigorously evaluated and proven effective. Clinical settings vs. “real-life” settings.
Outcome Monitoring Measures outcomes by collecting data before and after an intervention occurs. Examples of data include client attitudes, skills, beliefs. Answers the question: “Did the expected outcomes occur?” Does not address causality. Can present challenges for CBOs to conduct.
CDC and CBOP In 2006 CDC awarded funds to seven directly funded CBOs to implement outcome monitoring. Conducted on Healthy Relationships (HR). Baseline data collection from December 2006 – January 2008 (14-month period). Goal of 100 participants enrolled at baseline with 80% retained at 90-day and 180-day follow-ups per CBO.
Healthy Relationships Group-level intervention for HIV+ individuals. Intervention study conducted in Atlanta from 1997- 1998. Randomized control trial showed several positive effects on sexual risk behavior of intervention participants.
Cascade AIDS Project Largest ASO in Oregon and SW Washington. Serves Portland-Metropolitan area. Over 70% of PLWHA in Oregon reside in area. Directly funded by CDC since 2004. From 2004-2006 offered HR through sub-contract with other CBO.
CAP and CBOP HR sub-contract brought back in-house Fall 2006. Hired Prevention with Positives Coordinator and Research Project Monitor. Re-branded intervention as +alk. Target population for intervention of MSM.
CBOP Recruitment Medical & social service providers. Internet outreach (i.e. Craigslist). Printed materials and advertisements. Refer a friend program. Targeted cycles with other groups (i.e. bear and leather community).
CBOP Recruitment Internal referrals Creating link between housing/care & prevention. All-staff presentations and updates. Referral contests and recognition of staff. Training on providing prevention messages for care staff.
Quality Management Established agency-wide quality management committee. Increasing awareness of quality management and outcome monitoring. QM moment at all-staff meetings. Inter-departmental Plan, Do, Study, Act (PDSA) cycles.
CBOP Results* Baseline 105 participants 90 –day 78 participants (74%) 180-day 75 participants (71%) Incentive offered at each data collection point. Strong willingness of individuals to participate. Several factors behind high retention rate. Follow-up data collection offered opportunities to provide referrals into additional care and services.* See Heitgard JL et al. Reduced Sexual Risk Behaviors Among People Living with HIV: Results from the HealthyRelationships Outcome Monitoring Project. AIDS Behav. 2011 Mar 9. (Epub ahead of print).
CBOP Results Overall participant risk behaviors declined at 90- day and 180-day follow-ups. Number of sex partners and sex events. Number of unprotected sex events and sex events while intoxicated. Mean number of unprotected sex acts remained high. Baseline 90-day 180-day CAP 57% 56% 48% All CBOs 41% 29% 26%
CBOP Results & Serosorting Data does not reflect whether participants engaged in serosorting. Anecdotal evidence suggests high rates of serosorting amongst CBOP participants. Intervention as written and piloted in late 1990’s did not account for presence of serosorting. Implications for prevention with positives and public health. Changes to our implementation of HR as a result.
Lessons Learned Change in culture of organization and attitude towards role of QM. HIV+ individuals can be successfully recruited into outcome monitoring. Outcome monitoring provides: A useful and effective way to ensure programs are achieving their desired results. Opportunity to make programmatic changes to reflect an ever changing and evolving disease.
Tips for CBOs Creating agency-wide buy-in. Pointing to cost effectiveness. Don’t underestimate willingness of program participants to help. Importance of closing the loop.
Acknowledgments The HR/CBOP team at CAP Michael Anderson-Nathe Bethany Carey Adrian Sanchez Michael LaClair CBOP Project Officers and staff at CDC Fellow CBOP agencies Individuals participating in HR/CBOP at CAP