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SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program Initiative: Year 1 Meeting 1. Laying the Foundation for Success: SDPI Demonstration Projects Overview. November 17, 2010. Overview. Background Planning Year Implementation Transition. Background.

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Laying the foundation for success sdpi demonstration projects overview

SPECIAL DIABETES PROGRAM FOR INDIANS

Diabetes Prevention Program Initiative: Year 1 Meeting 1

Laying the Foundation for Success: SDPI Demonstration Projects Overview

November 17, 2010


Overview
Overview

  • Background

  • Planning Year

  • Implementation

  • Transition


Background
Background

  • Special Diabetes Program for Indians

    • Balanced Budget Act 1997

      • Prevention/Treatment of Diabetes in AIANs

      • Administered by the IHS

    • 2002 Reauthorization

      • Congressional direction – develop a competitive grant program to demonstrate diabetes prevention and also address the most compelling complication of diabetes (cardiovascular disease)

      • Evaluation required


  • SDPI Competitive Grant Program

    • Tribal Consultation

    • IHS Director decision

      • $27.4 million/year x 5 years

        • Grants to 60-70 programs ($23.3 million)

        • Administration, Coordination, Evaluation ($4.1 million)

        • “Competitive”- programs compete for funding

      • Demonstration Projects

        • Programs implement activities in 1 of 2 areas

          • Diabetes Prevention; Cardiovascular Disease Risk Reduction

        • Collaborative development of activities

        • Comprehensive Evaluation, Coordinating Center



  • Final Timeline

    • FY 2004 RFA, Selection of Programs

    • FY 2005 Planning Year

    • FY 2006-2009 Implementation of Activities Comprehensive Evaluation

    • FY 2009-2010 Transition to documentation of activities and outcomes with a smaller dataset and fewer forms


Planning year
Planning Year

  • 6 meetings November 2004 – October 2005

    • Collaborative process involving grantees, IHS, and Coordinating Center

    • Developed a common set of activities and an evaluation to be implemented in a diverse group of communities and cultures by program staff with varying levels of experience and expertise

  • Operations Manual

    • Core Elements

    • Evaluation design and instruments

  • IRB application template

  • Names and Logos





Core Elements – Required Activities

  • Diabetes Prevention Program

    • Recruit and screen to find people with pre-diabetes

    • Goal: 48 people per year

    • Teach 16 session DPP curriculum in group sessions

    • Individual coaching on physical activity, weight loss

    • Retention/After Core

    • Community activities

    • Outcomes – weight loss, lifestyle changes, prevention of diabetes


Diverse set of 36 grant programs

One size doesn’t fit all!

Must implement and evaluate a common set of activities

Grant Programs encouraged to adapt to local setting, culture, circumstances

Technical Adaptations – format of curriculum, flexibility on timing, order of classes, adding content, adding pictures, local foods, interactive activities, local speakers

Cultural Adaptations – translation, prayers/blessings, local traditions, talking circles, traditional games, culturally-specific examples, encourage cultural perspectives, communication styles, local images/designs

Adaptation of Program Activities


Evaluation design
Evaluation Design

  • Process – did programs successfully implement the activities, lessons learned?

  • Outcomes – did participants improve on short-term, intermediate and long-term outcomes? What factors were associated with successful participants and programs?


Evaluation Design – Participant Level

Recruitment

Screening

Consent

DPP Curriculum

(16 Sessions)

Baseline Assessment

Follow up Assessment

Annual Assessment

Annual Assessment

Lifestyle Coaching, Community Based Activities

Time 0 ---------------------------------------- 4-6 months ---------- 1 year --------------- -2 year ------------


Evaluation design program level
Evaluation Design – Program Level

  • Measurements

    • Provider: demographic, professional background

    • Program: recruitment, retention, After Core, team activities

    • Organization: organization effectiveness

    • Community: community stakeholders’ perspective


Planning year lessons learned
Planning Year - Lessons Learned

  • Grantees

    • Start vs. plan

    • Wide range of programs, experience, and expertise requiring diverse technical assistance and training needs

    • Communication/collaboration

    • Staff turnover

    • Stakeholder support

    • Common activities vs. local variation

    • Public health program evaluation vs. research


Implementation continuing the collaborative process
Implementation - Continuing the Collaborative Process

  • Seven additional meetings

    • Technical assistance workshops, sharing challenges and solutions, group discussions by staff position, Operations Manual revisions

    • Semi-annual progress reports to provide feedback

  • Ongoing technical assistance

    • Coordinating Center visits, website, quarterly technical assistance conference calls, one-on-one conference calls, support by e-mail and phone, Tips of the Week (TOTW)


Implementation challenges lessons learned
Implementation - Challenges & Lessons Learned

  • Organizational

    • Availability of specialized space, hiring and purchasing regulations, local stakeholder support (providers, management, and community leaders), communications, adequate computer hardware and software, internet access

    • Grants Management

      - Access to funds, allowable items/incentives, carryover

  • Programmatic

    • Recruitment, retention, access to patient records, scheduling, staff turnover and re-training


Transition
Transition

  • Transition from program evaluation to program documentation with a smaller dataset and fewer forms

  • Program Evaluation

    • 12 types of participant-level forms

    • 8 types of program-level forms

  • Program Documentation

    • 5 types of participant-level forms

    • 5 types of program-level forms


Summary
Summary

  • SDPI Demonstration Projects are a success

  • Many lessons learned

  • Beyond the Demonstration Projects – SDPI Initiatives

    • 38 programs, including 9 new award recipients

    • Continue or newly implement Diabetes Prevention Program

    • Document activities and outcomes

    • Disseminate information and best practices from the SDPI Demonstration Projects to other IHS, Tribal, and Urban Indian health settings



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