Training of Trainers

1. Assessing Community Readiness and Implementing Culturally Appropriate Interventions within Aboriginal Communities Training of Trainers

2. Purpose • To provide Community Trainers with the knowledge and skills to train community facilitators who in turn will be able to: • assess their community’s readiness to address risk reduction; • determine culturally appropriate prevention and intervention approaches; • implement the approaches to effectively reduce risk and reduce vulnerability for HIV infection; and, • provide wise practices that demonstrate successful application of the community readiness model for risk reduction and features various case studies outlining lessons learned.

3. Agenda Pre-Training Questionnaire Module 1: The Issue: The Need for Culturally Appropriate Interventions in Aboriginal communities Module 2: Community Planning Module 3: Community Readiness Model Module 4: Conducting Your Community Readiness Assessment Module 5: Moving From Assessment to Action Planning Evaluating Your Risk Reduction Action Plan Final Questions/Answers Post-Training Questionnaire Workshop Reflections and Closing

4. Additional Agenda • The training is one day • There are 6 Modules: Module 1 – 4 are designed to inform them about the community readiness model and how to conduct the assessment Module 5 will give them knowledge and skills to engage the community in a workshop – presenting their community readiness results (including definition of readiness) and to develop their strategies/action plan.

5. Additional Agenda • A Reflection process after the conclusion of each module – to provide an opportunity for participants to share their thoughts about the process, ask questions, or table any concerns. • Before Module 1: • complete a “confidential” Pre-Training Questionnaire. • After the completion of the Modules : • information on evaluation will be shared, • question period • Post-Training Questionnaire.

6. Module 1 (ex.1): The Issue • Aboriginal people are overrepresented in the HIV epidemic in Canada. • 1979 to Dec 2008: 21,300 AIDS cases reported: • 16,824 (79%) included information on ethnicity. • 690 were reported to be Aboriginal people. • Aboriginal people only make up 3.8% of the population.

7. Module 1 (ex.1): The Issue • In 2008, PHAC surveillance data demonstrated that: • Aboriginal people make up a growing % of HIV+ test reports and reported AIDS cases; • Injecting drug use is a key mode of transmission especially for women (Aboriginal female cases: 64.4% - 53.7% for Aboriginal male cases); • Aboriginal youth are diagnosed at a younger age than non-Aboriginal youth.

8. Module 1 (ex.1): The Issue • Walk with Me Pathway To Health: • That the number of people with HCV in Canada is increasing at a steady rate; • PHAC - major mode of contracting HCV is sharing of contaminated needles /other needle works among injection drug users; and, • Estimates indicate more than 1500 HIV+ Aboriginal people are co-infected with HCV - presents other health management and outcome complications.

9. Module 1 (ex.2): The Issue • Exercise • Explain - Risk Factors vs. Risky Behaviours • Brainstorm: • “What are some risk factors for infection, and risky behaviours that people engage in that place them at high risk for HIV and/or HCV infection?”

10. Module 1 (ex.3): The Issue • Exercise • Target populations with escalated risk? • Brainstorm: • “Which specific populations are experiencing escalated rates of infection?” • “What is the issue that leads to higher risk?”

11. Module 1 (ex.4): The Issue • Exercise • Abstinence-based approaches are more common in Aboriginal communities, but culturally appropriate intervention approaches are also needed to reduce the risk. • Brainstorm: • “Why are risk reduction intervention approaches needed? To either compliment or replace abstinence-based approaches?”

12. Module 2: Community Planning

13. Module 2: Community Planning“Walk with Me Pathway to Health”

14. Module 3: Community Readiness Model Definition: • Model for community change; • Integrates its culture, resources and level of readiness; • Brings community together, builds cooperation and increases its capacity for prevention and intervention; • Recognizes community uniqueness different stages of willingness and ability; • Readiness is “the degree to which a community is prepared to take action on an issue”. • Risk reduction to prevent HIV /HCV infection.

15. Module 3: Community Readiness Model Risk reduction

16. Module 3: Community Readiness Model Dimensions: A. Community Efforts B. Community Knowledge of the Efforts C. Leadership D. Community Climate E. Community Knowledge about the Issue F. Resources Related to the Issue

17. Module 3: Community Readiness Model Stages of Readiness • No Awareness • Denial / Resistance • Vague Awareness • Preplanning • Preparation • Initiation • Stabilization • Confirmation/ Expansion • High Level of Community Ownership

18. Module 1 -2-3: Reflections • Experience: • What did you learn from the module(s)? • What did you need to know in order to prepare for community readiness? • Identify: • How was the experience significant to you? • What do you understand better about yourself? • Your role? • Analyze: • What helped you to learn? • What do you feel about what you learned? • Generalize: • How will you apply what you learned to being a Facilitator of Community Readiness? • Is there anything that you would change about the process?

19. Module 4: Conducting Your Community Readiness Assessment • Three Steps to conducting interviews: • Prepare and plan; • Conduct; and, • Score. • To prepare: • Identify who you want to interview; • Have a thorough understanding of the questions; and, • Contact interviewees and arrange interview.

20. Module 4: Conducting Your Community Readiness Assessment • Exercise: Brainstorm and list key respondents ….. • “ Who are some potential key respondents in your community?” (Ask yourselves … are they connected to the issue? Are any of them “gatekeepers” in the community – respected, well connected people?) • Once listed “Explain why these respondents are appropriate for this issue.”

21. Module 4: Conducting Your Community Readiness Assessment • Read the Interview Questions and Discuss; • A – Community Efforts (Programs, Activities, Policies, etc.) • B – Community knowledge of efforts - In your community, how much of a concern is providing services that reduce risk and risky behavior associated to HIV and AIDS an HCV infection? • C – Leadership - For the “leaders” in your community, how much of a concern is reducing risk? • D – Community Climate - Are there ever any circumstances in which members of your community might think that denying services to individuals who are “under the influence or who practice other risky behaviours should be tolerated? Please explain. • E - Knowledge about the issue – How knowledgeable are community members about risk reduction. Please explain. (such as: dynamics, signs symptoms, statistics, effects on family and friends, etc.) • F – Resources for prevention efforts (time, money, people, space, etc.) On a scale from 1-10, what is the level of expertise and training among those working on providing services to reduce risk? With 1 being “very low” and 10 being “very high”. Please explain.

22. Module 4: Conducting Your Community Readiness Assessment • Practice Interviewing and Recording • Score the interviews • Using the Anchored Scoring sheet guide and recording on the Assessment Scoring Sheet, create a score for each of the six dimensions. Remember interviews are scored by dimensions not by individual questions.

23. Module 4: Conducting Your Community Readiness Assessment • Scoring Process • Presentation, Exercise and Samples of Risk Reduction Strategies

24. Module 5: Moving from Assessment to Action Planning • “WORKSHOP tool CRM presentation”

25. Module 4: Reflections • Experience: • What did you learn from the module(s)? • What did you need to know in order to prepare for community readiness? • Identify: • How was the experience significant to you? • What do you understand better about yourself? Your role? • Analyze: • What helped you to learn? • What do you feel about what you learned? • Generalize: • How will you apply what you learned to being a Facilitator of • Community Readiness? • Is there anything that you would change about the process?

26. Module 5: Moving from Assessment to Action Planning Exercise - “Brainstorming Intervention Strategies” STRENGTHS • “What strengths does a community have that will help reduce the risk of HIV and/or HCV infection?” CONCERN • “What are the concerns or obstacles to implementing strategies focused on reducing the risk?” RESOURCES • “What are our resources that support strategies for reducing the risk for HIV and HCV infection?”

27. Module 5: Moving from Assessment to Action Planning

28. Module 5: Reflections Experience: • What did you learn from the module(s)? • What did you need to know in order to prepare for community readiness? Identify: • How was the experience significant to you? • What do you understand better about yourself? Your role? Analyze: • What helped you to learn? • What do you feel about what you learned? Generalize: • How will you apply what you learned to being a Facilitator of Community Readiness? • Is there anything that you would change about the process?

29. Evaluation Logic Model • Illustrates how and why a program or strategy works • Shows, “…how all the program goals, activities, and expected outcomes link together” (Shackman, 2010). Goals • Goals describe future expected outcomes or states. • They provide programmatic direction - focusing on ends rather than means. • For example, your goal may be to reduce the spread of HIV and HCV in your community by delivering programs and services that effectively reduce and/or change risky behaviours.

30. Evaluation Objectives • Objectives are clear, realistic, specific, measurable, and time-limited, statements of action which when completed will move towards goal achievement. • Objectives tell how to meet a goal. For example, objectives may be: • To raise community awareness about risky behavioursthat may lead to HIV infection; • To reduce risk by promoting safer sex practices.

31. Evaluation Inputs • What are the resources that will go into accomplishing your goal? Resources can be funds, people, capital items, etc. Activities • Activities include services, products, and more. They serve your goal and are clearly linked to the objectives. Example: Objective • To raise community awareness about risky behaviours that may lead to HIV infection.. Activities • Series of workshops • Information brochures about HIV and HCV.

32. Evaluation Outcomes • Outcomes are the preferred consequences of achieving the set out goals. • Short term outcomes • Intermediate outcomes • Long Term outcomes • Quantitative measures - measured in numbers. • Qualitativemeasure are descriptive, cannot me counted.

33. Closing CAAN 6520 Salish Drive Vancouver, BC V6N 2C7 Email: info@caan.ca Internet: http://www.caan.ca Ph: 604 266-7616 Fax: 604 266-7612 Toll free: 1 888 285 2226