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Setting Up a Peer Review Process for CBOs:
         Conflicts and Challenges
               CCPH- Conference Toronto 2007

 Michael T. Wright, PhD, LICSW, MS   Karl Lemmen, Dipl.-Psych.
 Martina Block, Dipl.-Psych., MPH
 Hella von Unger, PhD

 Research Group Public Health        Deutsche AIDS-Hilfe
 Prof. Rolf Rosenbrock               The National German AIDS
 Social Science Research Center      Organization
 Berlin (WZB)
Project:
Establishing Structures for Quality
Assurance of HIV Prevention for ASOs in
Germany
 – Partners: WZB and Deutsche AIDS-Hilfe (DAH)
 – Funder: Federal Center for Health Education
   (Ministry of Health)
 – Timeline: 2006-2008
 – Needs assessment: 2004-2005
The National German AIDS Service Organisation



                         – Founded in 1983 by the
                           Aids-Hilfe movement
                         – 116 Member ASOs
                         – 1 National Office
Deutsche AIDS-Hilfe E.V.:
Community Focused prevention
Theoretical Basis: Structural Prevention

– Focussing on behavior in
  the social and political
  context
– Enhancing self-esteem
  and self-efficacy (e.g. for
  gay men)
– Working towards legal
  reforms (e.g. regarding
  drug use)
– “Making the healthy
  choice the easy choice!”
Goals of WZB/DAH Project
– National demonstration project to promote quality
  development through participatory research
– Filling the structural gap for quality assurance in
  community work in HIV prevention
– Contributing to the establishment of national
  structures for institutionalizing prevention services
  for socially disadvantaged groups
Guiding Principles
– Action research
– Community-driven questions and explanations
  (local theory)
– Community-driven methods
  (local quality assurance)
– Developing methods which are:
   –   Tailor-made
   –   Practical
   –   Useful
   –   Participatory
   –   Sound
– Focus on quality assurance
Project Components
1. Skill-Building Workshops
   – participatory curriculum, participatory methods
2. Methods Handbook
   – internet based, interactive
3. Individualized Consulting
   – project-driven focus
4. Quality Colloquium (formerly: Peer Review Process)
   – focus on prevention for MSM
5. Network of Researchers
   – promoting a new discussion in German on participatory
     research
Quality Colloquium – Pragmatic Basis

– Workers’ need for input from outside their projects
   – Results of needs assessment
   – More than an idea exchange or problem solving between projects
   – Critical appraisal with no effect on funding
Quality Colloquium – Theoretical Basis
– Quality is not an objective category
   – Defined in the context of a discussion (discourse)
– Various stakeholders play an important role in the
  discussion
   – Community members, project workers, funders, researchers
– Involving key stakeholders in a formal review process
  makes implicit processes explicit
   – Greater transparency
   – Setting of norms which extend beyond the review process
Quality Colloquium – Theoretical Basis
– Provides a forum for producing new forms of
  evidence for public health
– Judicial Principle (Keith Tones)
   –   Decision of a jury (of one’s peers)
   –   Plausibility (“beyond a reasonable doubt”)
   –   Validity of evidence is not restricted to scientific categories
   –   Social consensus plays a central role
– Diffusion of participatory norms
   – Through experience of participants
   – Through changing membership among the reviewers
Quality Colloquium: Structure and Goals
   – Voluntary
   – Question defined by the presenting project
   – Formal feedback on community-based work
      – “diagnostic” function (strengths and weaknesses)
      – not a certification
   – Panel consisting of community member,
     service provider, funder, researcher
      – from a different region than the presenting project
Quality Colloquium: Structure
                          Project
             Funder       Worker

                                    Researcher
 Community
  Member


                                           Moderator


                      Project
Quality Colloquium: Process
1. Information from Projects
    – annual report, completed questionnaire (including a description of their question)
2. Invitation to Reviewers
    – Based on needed expertise
3. Colloquium
    – 4 hours per project
    – Dialogue between project and reviewers until project’s question is answered
    – Feedback from the project to the reviewers and the moderator
    – Meeting of the reviewers to reflect on their work
4. Documentation/ Reflection
    – Project worker summarizes what s/he learned
    – Reviewers summarize as a group what they have learned (with particular attention
        to the review process itself)
5. Diffusion of Results
    – Basic information presented (description of project, question, names of all
        participants, date of the colloquium)
    – Lessons learned by the participants
6. Follow-up with the project
    – What effect has the input had on the work of the project?
Issues for Discussion

– Fear of being “judged” vs.
  Creating a supportive atmosphere of critical
  appraisal
– Building a pool of reviewers (particularly funders)
– Nationally or regionally based?
– Incentives for projects to present their work
– Incentives for reviewers
Advice/ Feedback 1

– Interesting model – extension of community advisory board model
  (“board swapping”) overcoming conflicts of interest
– Comparability of regions?
   – Would probably be adapted over time to the culture and
      context of each region
– Legitimizing the boards over time important, incorporation/
  recognition from other review processes
– Follow-up with the board: Effects on the board members in their
  own work as a result of serving on the board
– Discussion period between the review board and the project is
  important – very different than other review processes –
  opportunity to clarify the points – crucial to the success
Advice/ Feedback 2
–   Bias and accountability
     – Importance of work ahead of time on the part of the reviewers, reflecting on
         their own bias in the rule (managing their ego in the context of the role) –
         not the typical role in everyday work
     – Change process at individual level over the course of the discussion – your
         mind might change during the discussion – Need for reflection as a group
         in between?
–   Importance of a common language among all reviewers and respect for
    difference/ homogeneity of perspectives – a key task of the moderator
–   Practicality/ Representation
     – Might need more community representation to assure balance of view/
         opinion
     – Diversity of reviewers, or always the same people
     – Administration of the process
–   Accountability
     – What happens if the project of low quality?
Advice/ Feedback 3
–   How do you assure a commonness in the view of quality among the reviewers?
     – Discussion among the reviewers as a way to achieve that
–   Conflict between the project and the review panel – how to resolve
–   Setting up a culture of discourse is central element
     – How best to do that?
     – How much structure (training) or developed as one goes
–   How are peers chosen? (Bias)
     – Boundaries, type of feedback
–   Role of the facilitator in driving the process – does that distract from participatory
    intent
–   How does the group come to concensus?
     – Open-ended or consensus driven?
–   How does it relate to other models?
     – Continuous Quality Improvement
     – Other practice models around quality

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Wright, lemmen et al peer review process-ccph-conference-toronto2007

  • 1. Setting Up a Peer Review Process for CBOs: Conflicts and Challenges CCPH- Conference Toronto 2007 Michael T. Wright, PhD, LICSW, MS Karl Lemmen, Dipl.-Psych. Martina Block, Dipl.-Psych., MPH Hella von Unger, PhD Research Group Public Health Deutsche AIDS-Hilfe Prof. Rolf Rosenbrock The National German AIDS Social Science Research Center Organization Berlin (WZB)
  • 2. Project: Establishing Structures for Quality Assurance of HIV Prevention for ASOs in Germany – Partners: WZB and Deutsche AIDS-Hilfe (DAH) – Funder: Federal Center for Health Education (Ministry of Health) – Timeline: 2006-2008 – Needs assessment: 2004-2005
  • 3. The National German AIDS Service Organisation – Founded in 1983 by the Aids-Hilfe movement – 116 Member ASOs – 1 National Office
  • 5. Theoretical Basis: Structural Prevention – Focussing on behavior in the social and political context – Enhancing self-esteem and self-efficacy (e.g. for gay men) – Working towards legal reforms (e.g. regarding drug use) – “Making the healthy choice the easy choice!”
  • 6. Goals of WZB/DAH Project – National demonstration project to promote quality development through participatory research – Filling the structural gap for quality assurance in community work in HIV prevention – Contributing to the establishment of national structures for institutionalizing prevention services for socially disadvantaged groups
  • 7. Guiding Principles – Action research – Community-driven questions and explanations (local theory) – Community-driven methods (local quality assurance) – Developing methods which are: – Tailor-made – Practical – Useful – Participatory – Sound – Focus on quality assurance
  • 8. Project Components 1. Skill-Building Workshops – participatory curriculum, participatory methods 2. Methods Handbook – internet based, interactive 3. Individualized Consulting – project-driven focus 4. Quality Colloquium (formerly: Peer Review Process) – focus on prevention for MSM 5. Network of Researchers – promoting a new discussion in German on participatory research
  • 9. Quality Colloquium – Pragmatic Basis – Workers’ need for input from outside their projects – Results of needs assessment – More than an idea exchange or problem solving between projects – Critical appraisal with no effect on funding
  • 10. Quality Colloquium – Theoretical Basis – Quality is not an objective category – Defined in the context of a discussion (discourse) – Various stakeholders play an important role in the discussion – Community members, project workers, funders, researchers – Involving key stakeholders in a formal review process makes implicit processes explicit – Greater transparency – Setting of norms which extend beyond the review process
  • 11. Quality Colloquium – Theoretical Basis – Provides a forum for producing new forms of evidence for public health – Judicial Principle (Keith Tones) – Decision of a jury (of one’s peers) – Plausibility (“beyond a reasonable doubt”) – Validity of evidence is not restricted to scientific categories – Social consensus plays a central role – Diffusion of participatory norms – Through experience of participants – Through changing membership among the reviewers
  • 12. Quality Colloquium: Structure and Goals – Voluntary – Question defined by the presenting project – Formal feedback on community-based work – “diagnostic” function (strengths and weaknesses) – not a certification – Panel consisting of community member, service provider, funder, researcher – from a different region than the presenting project
  • 13. Quality Colloquium: Structure Project Funder Worker Researcher Community Member Moderator Project
  • 14. Quality Colloquium: Process 1. Information from Projects – annual report, completed questionnaire (including a description of their question) 2. Invitation to Reviewers – Based on needed expertise 3. Colloquium – 4 hours per project – Dialogue between project and reviewers until project’s question is answered – Feedback from the project to the reviewers and the moderator – Meeting of the reviewers to reflect on their work 4. Documentation/ Reflection – Project worker summarizes what s/he learned – Reviewers summarize as a group what they have learned (with particular attention to the review process itself) 5. Diffusion of Results – Basic information presented (description of project, question, names of all participants, date of the colloquium) – Lessons learned by the participants 6. Follow-up with the project – What effect has the input had on the work of the project?
  • 15. Issues for Discussion – Fear of being “judged” vs. Creating a supportive atmosphere of critical appraisal – Building a pool of reviewers (particularly funders) – Nationally or regionally based? – Incentives for projects to present their work – Incentives for reviewers
  • 16. Advice/ Feedback 1 – Interesting model – extension of community advisory board model (“board swapping”) overcoming conflicts of interest – Comparability of regions? – Would probably be adapted over time to the culture and context of each region – Legitimizing the boards over time important, incorporation/ recognition from other review processes – Follow-up with the board: Effects on the board members in their own work as a result of serving on the board – Discussion period between the review board and the project is important – very different than other review processes – opportunity to clarify the points – crucial to the success
  • 17. Advice/ Feedback 2 – Bias and accountability – Importance of work ahead of time on the part of the reviewers, reflecting on their own bias in the rule (managing their ego in the context of the role) – not the typical role in everyday work – Change process at individual level over the course of the discussion – your mind might change during the discussion – Need for reflection as a group in between? – Importance of a common language among all reviewers and respect for difference/ homogeneity of perspectives – a key task of the moderator – Practicality/ Representation – Might need more community representation to assure balance of view/ opinion – Diversity of reviewers, or always the same people – Administration of the process – Accountability – What happens if the project of low quality?
  • 18. Advice/ Feedback 3 – How do you assure a commonness in the view of quality among the reviewers? – Discussion among the reviewers as a way to achieve that – Conflict between the project and the review panel – how to resolve – Setting up a culture of discourse is central element – How best to do that? – How much structure (training) or developed as one goes – How are peers chosen? (Bias) – Boundaries, type of feedback – Role of the facilitator in driving the process – does that distract from participatory intent – How does the group come to concensus? – Open-ended or consensus driven? – How does it relate to other models? – Continuous Quality Improvement – Other practice models around quality