Evaluation of a Rapid Policy Assessment and Response Intervention: Szczecin, Poland

1. Evaluation of a Rapid Policy Assessment and Response Intervention: Szczecin, Poland Case P (1), Chintalova-Dallas R (2), Lazzarini Z (2)(4), Burris S (3)(4) (1) Fenway Community Health, USA (2) University of Connecticut Health Center, USA (3) Temple University Law School, USA (4) Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities, USA • Results • Feasibility: The RPAR was designed as a 36 week process. The Polish team was able to complete the research activities of the RPAR process within a 44 week period. Despite unanticipated barriers and a longer time to completion, it was feasible to implement and complete the project. Barriers to implementation included : 1) Resistance on the part of officials to sign consent forms, be taped, or saying anything “on the record” 2) Difficulty obtaining complete “Law on the books” legal data 3) Rules governing NGOs that made it difficult for them to accept donations or initiate programs without “official” support 4) Difficulty recruiting and interviewing IDUs from local minority groups. • Completeness: Two members of the US team independently evaluated the completeness of collected data. Data collected for all categories except law on the books was 80 percent complete or better. Percent Complete • Law on the books 18 • Epidemiological data: disease 80Epidemiological data: IDUs 88Criminal justice data 97 • Activities: The Polish team completed all the RPAR activities, conducting 3 focus groups with providers, 24 individual interviews with lawyers, a judge, police, physicians, drug treatment providers, prison officials and others, and 14 individual interviews with injection drug users. The team conducted legal and epidemiological analysis of available data and led the CAB in seven meetings, coordinating analytic exercises such as power mapping in the effort to identify areas where change could result in an improvement in the health of drug users. • Effectiveness: The RPAR CAB identified a number of issues related to the health of injectors in Szczecin, including a number of findings not identified previously. These included • The failure of the criminal justice system to utilize legally- mandated and available treatment services for drug users; • An emerging rural epidemic of injected amphetamine use; • Evidence of a poor fit between current drug use-related health services and needs. • Efforts to promote community change: The CAB includes members who are lawyers, professors, physicians, defense attorneys, harm reduction workers, and others. Some are continuing to work to change policy in Szczecin. Projects that are continuing include developing a training curricula for judges and prosecutors about provisions in the law for drug treatment of convicted drug users and other legal issues, and work with local officials in rural areas regarding amphetamine use. There is an on-going evaluation to assess the implementation of the action plan and changes in policy and law related to the health of IDUs in Szczecin. • Background:Rapid Policy Assessment and Response (RPAR) is a community-level action research intervention process. Using the RPAR “tool kit” a research team, in Szczecin, Poland, collected laws and policies “on the books” that were relevant to IDU health and, through qualitative research, investigated how these laws were actually implemented “on the streets.” • Researchers worked with a Community Action Board (CAB) of key stakeholders to conduct research, interpret the findings and develop a plan of action. • We conducted a process evaluation of the Polish implementation of the RPAR process to assess • The feasibility of the process • Effectiveness of the process in identifying policy-related problems and identifying solutions influencing the risk environment for IDUs • The production of community-level efforts to promote change. • The RPAR Toolkit • The RPAR toolkit is a manual of training materials and tools designed to be used by anyone to conduct an RPAR. It is a flexible system designed to be adapted to unique situations to assist in a community process of identifying ways to change policies and practices to improve the health of drug users. • The toolkit includes: • A detailed training manual • Draft agendas, analytic exercises, and other materials to assist the CAB members • Tools for collection of existing epidemiological, criminal justice, and legal data. • Interview Guides for all types of individual and focus group interviews • Data organization forms • Research ethics information and guidelines, including data protection protocol, subject recruitment and consent training, and basic concepts necessary for completing the NIH web- based human subjects certification program • For more information about the RPAR and to download preliminary RPAR toolkits in English, Russian and Polish versions, please visit our website • http://www.RPAR.org/ • Suggestions for improvement • CAB members felt that the already-diverse CAB would have been improved with the addition of prosecutors, aldermen, other officials and several mentioned that drug users should have been invited to join the CAB. One said, • “Should have invited a representative drug dependent [person] who has considerable experience with dependency….in order to understand, how this population responds toward particular methods of treatment.” Conclusions: The Rapid Policy Assessment and Response process can be used to mobilize local capacity to identify policies and implementation practices that improve or aggravate the social health risk environment for drug users. There were barriers to implementation and the process should be adapted to local conditions for maximum efficiency. Methods:To conduct a process evaluation we examined all the materials developed by the Polish team including the weekly process notes written by the Polish team, all collected secondary epidemiological, legal and policy data, results of evaluation survey of CAB members and the Final Report and the Action Plan. We conducted 5 individual interviews with members of the team, surveyed 16 CAB members and evaluated the completeness of the legal data collected. • Summarized sample of action plan recommendations • Organize seminars for judges and prosecutors ssociated in the region of Szczecin. • Diagnose drug use patterns in small towns and villages in the region. • Add funds for drug counteraction to the city budget. • Disseminate a paper to defense lawyers outlining legal strategies for the defense of drug users. “Taking part in [CAB] meetings was to me enormous experience. I became familiar with many different aspects of drug addiction and ways to limit its negative effect. Most solutions to this problem, at this time, cannot be implemented in prison institutions. It is necessary to change regulations and mentality of prison staff.” CAB member This research was supported by NIDA/NIH Grant # 5 R01 DA17002-02 PI: LAZZARINI, ZITA . The findings and conclusions expressed are those of the authors and not necessarily of NIH, NIDA, or the US Government. The development of RPAR was supported by the International Harm Reduction Development Program of the Open Society Institute in 2001-2002.