AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
TAMMI FLEMMING: Good afternoon. I wanted to say good morning. I have no idea why but I’m going to go through this really quickly and then we’ll take a quick break and I think we’ll get to the more interesting part of this session. Sorry about that. I forget this is my boss here. We’ll get to more of the details, more of the details involved with seeing how it works on the ground and I’m happy to have Leticia and Cara here today. So this should take about 10 minutes because I’ll get, we’ll get more details from them as the way they implement. All right. I’m going to have a problem seeing this.
So I’ll talk about what we actually provide at PPV. We start where, intensive startup tier, and what that means is Geri talked about the phone calls and the implementation, but initially, once the planning is done for the program, I would say we have an average of three or four phone calls before the first planning session. And that, those phone calls really helped them to think about how to engage residents, how to recruit community mappers, because that’s going to be the first component that you implement. You know, what, how do you provide stipends for getting folks to volunteer, because that’s going to become an issue? How do you make sure there’s consistency throughout the program? So those conversations happen. I think on the average right now we’re looking at three or four one hour phone calls, at least before we do the first training, logistical things and like that. We also provide continual training, so we have a certain amount of calls that we have initially but after all the components are on the ground, we want to continue to really provide TA and assistance when it comes to implementation, so we can help with some things, because we have the, I guess the site from a national perspective and also to be able to connect them with other peers, other sites that’s doing the same thing or who may have had the same kind of problems. We can share the way that they resolved the issues and implementation. We talk about developing a monthly call, but we’re actually, we’re doing monthly calls now.
It gets, sometimes it’s more calls than once a month because of where they are in implementation, because of the local problems and things that’s gone on, on the site, you may have to have it more, sometimes less, depending on the site they may be able to get things going and they have a relatively easy flow of things for a while, but then they catch up. But we try to make sure we’re on a continual basis. Conduct routine site visits. Right now we do at least three site visits in the first year and that’s because of the trainings that’s going on and then we will have annual site visits. But there’s also other site visits that may happen depending on funding opportunities and other partnership opportunities. We would like to create a presence and be a support to the sites. One of the major things that we find is providing funding information. We had this conversation. I would love to hear what some of the responses to the question I have developed. But it’s really, it’s going to be a really hard, difficult to balance providing support for funding, then having the sites become almost like dependent on the national organization for fund development and tools. So we provide information. We have the web based funding guide where the sites can go on and state-by-state look at what’s available to their site our lesson on reproductive health.
So there’s all types of funding available, Title V, Title X, TANIF. We also have List Serves so we can provide what other sites are doing, what common sites are doing and how they’re being creative around getting funding and different funding sources involved. We also, we are creating right now, we have actually we’re in the process of creating templates for proposals and a three year grant cycle, for a three year grant cycle so sites can look at that information and kind of sculpt it to their specific sites and help them with developing funding materials. All the sites have the same training, the standardized training and all of them are happening at the same time in implementation. So, we have to insure fidelity of the model, we want to make sure that every site get the same information, they’re trained the same way, and that they implement the core components the same way. We talked about some of the flexibility of the model, but the core component has to be laid out the same way in the same order in every site. There are also some additional components and ideas that we layout with the sites, but the core components must remain, you have to be, they have to be standardized.
So the first training we, the first training is the planning and training and you’ll see that goes in with all the partners. The partners are there. They talk about implementation. Talk about the time frame and the timeline. The second training is usually when myself and (inaudible) that data analysis comes in. And we do community-mapping training. At the community mapping training, that’s where we train the community residents, the volunteers to do actually do the surveys. There are five components of the surveys. We’re actually getting perceptions of the adults in the community, the adolescents in the community. We do provider surveys because we want perceptions and we want reality. We get service on providers and we do a community resource inventory. So we not only get what the adults think and what the teens think, we also say, you believe this, but this is actually what’s in your community. And looking at that data helps to really start to build a consensus process in that community. The community mapping usually takes about six to eight weeks and at the end of that training, at the end of that process we will come back for the third training, which is the walkers and talkers training. And here is where we train the key identified residents to become walkers and talkers.
So they’re taught on communication skills. They’re taught how to recruit and engage other residents, how to conduct the home health parties, what a home health party is, how to disseminate the community mapping data, because everyone will not get a three or four hour presentation on the results. Some folks you may just want to give a fact sheet. You don’t want to go into the resident’s home and take two hours reading statistics. So you want to really work with them on how that work, how that work is disseminated. There’s also networking between sites. We’re scheduling a regional conference call. We have a web based list serve. We have list serve for the walkers and talkers. We have list serves for the program coordinators, list serves for the partnerships so that we can share data on a continual basis on whether there be finances, funding, program implementation, lessons learned, we share this with all the sites on a continual basis. The annual conference, Geri has already talked about. And period of peer schedule site visits, we talked a little bit about that this morning and we’ll share some more with you this afternoon.
The community mapping data analysis is really important and one of the things that we at PPV provide is once community mapping is complete, once it’s completed, they send all of that data to us for analysis. So Sara Beth and our team at PPV does all the data entry. They do all the coding for the data, for the open ended question and then we come out with a basic slideshow template, but also, after we go to the sites, we ask them, tell us what else you want from this data, what other information you want us to look at and extract because it’s their data. Now we send them all that paperwork back, because we don’t have no where to store it but after it is entered, we do a little work with each site, so each site has the basic template for sites specific, they may have questions, for all they may have had questions more around religion. They want to look at some core relation between religious activities and teen pregnancy rate. Another site may want to look at the differences in what they were sent to the adolescent girls versus the adolescent boys because they seem to jump right out when we looked at the data analysis, the mixed messages on the door messages. I’m talking kind of fast and I’m getting a little nervous.
So we provide insight with that analysis report. We give them that data back and we try to work with their partners at the local level. Most of the sites have a research partnership, a University that they’re working with, so they continuously use that data. But also they have to begin to do message development with that data. So they have to do focus groups. They have to come up with what’s the top importance of the data and the key information that they’re going to share. We’re definite partners because it’s going to be one set of data you want to share with the community residents but other data you want to share with the providers, because remember we did the inventorial services, the physician surveys, and the provider surveys. We have a couple of sites where we’ve had really a hard time getting providers engaged and really willing to complete the survey. But we see that as a really, that’s not really bad; it’s not all bad. Sometimes you can use that as a way to go back and say this is what we got and did you know that 30 percent of the community had identified you as a resource. I know we couldn’t get you engaged initially, but this is a time that we can come back and engage those partners in this process. This analysis saves the sites up to $10,000 for both times. So we do this in the first year of implementation and in the third year, sorry.
GERI SUMMERVILLE: That’s because PPV pays for that (inaudible) and asked that before we start a national replication of it, they used to have to contract out of the University to do all the (inaudible) for them and we do them for free for the sites now.
TAMMI FLEMMING: It’s not really for free, but it don’t cost the sites anything.
UNKNOWN SPEAKER: And it saved evaluation baselines.
GERI SUMMERVILLE: Right.
TAMMI FLEMMING: Yes. We have the universal data collection system and I want to kind of make sure get everything because Sara Beth to make sure I don’t leave anything out, so she gave me some notes. So again, we talk about standardizing this. So all the sites are collecting the same data because we have a template of the survey. We also have a lot of sites that add a couple of questions based on the local realities if they need to collect additional information. But the information that comes to us is specific around the standardized tools. We have a web based user-friendly data collection system so we analyze all the initial data for community mapping. But program data, how many folks are coming into the home health parties? What are some of the interesting questions you have? Are you seeing people come to more than one party? That kind of information could be entered entirely on data system from the sites. The only person who gets the information, they’re able to download reports and Sara Beth gets it and she can share it but other sites can’t get other sites information. We collect implementation and outcome data and Sara Beth wants me to make sure I say we also are doing ethnography stuff.
So the sites are also trained and each walking and talking staff are given little notebooks where they’re doing observation and writing down key points and they have to put in on the online journal things that happen on a weekly basis, so that we can look at what’s going on and some of that helps us make some decisions around program changes or program implementation at the local level. All sites have continual access to current data reports. So they can go in today and pull down their current report or they go into tomorrow on home health parties. So they can look at numbers on a daily basis, on a monthly basis, but also Sara Beth will be able to show them a comparison that if three sites came on at the same time where you are relative to other sites that’s implementing at the same time. And I want to go through this but I do want to get some help on these two slides. We, there are four stages of development for the Plain Talk. And we look at, some of these they look like they’re broken out into zero to 18 months, zero to three. Some of them are happening concurrently. So I want you to think about that as we look at it. So from zero to 18 months, that’s when they’re doing the development. The stakeholder decisions, they’re getting partnerships together, identifying partners and having meetings.
Am I going okay? And they begin to align the resources on local and state to really discuss this issue and whether it’s important in the community, and to the community and to the partners. Stage two is the planning stage from zero to three months, kicks off when the fundings are secure. So this only starts once they have the full year, the first year funding. So we don’t start anything until all the money is there for the first year. Then we identify the target area, the population, start talking about a sample for the community mapping process and identifying key residents in the community who may become community mappers, ultimately walkers and talkers. And we conduct the community mapping usually the end of the first quarter, the community mapping has begun to be implemented. From the 12th to the 24th month we’re doing program implementation. So remember I said after the analysis is done, we come back and disseminate that information to the community. So the initial core group is usually the mappers, the administrative partners, the program staff. We come back and do a thorough presentation of all the data that has been collected during the community mapping process.
So the first portion of the walkers and talkers training is actually like a three-hour presentation on the data that was collected. So they know what the community perceptions are. Then know what resources are already available in their community to begin this work. So we disseminate that. Dissemination happens throughout at that point. Once you collect that data that happens at your local meetings, at your home health parties all the way throughout the program and you find different ways to do it with fact sheets, with formal presentations, informal presentations, or what not. You train the walkers and talkers as I said, and the home health parties are usually beginning to be implemented by the end of the second quarter.
And then you move to stage four where activities are similar. We redo community mapping in stage four to really compare the community to it self. Remember Geri talked about comparing it to it self. So in the third year community mapping is done again. And the community at that point think about either have the results done, what they were supposed to do, given that we’ve implemented the program the right way and we can begin to expand the neighborhood or either replicate in other neighborhoods in that community. And this where all the sites come in 2005 update, site update, and where they were as far as the four stages.