Laying the Foundation for Success: SDPI Demonstration Projects Overview

1. 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

2. Overview • Background • Planning Year • Implementation • Transition

3. 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

4. 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

6. Special Diabetes Program for Indians • 2007 Reauthorization • Medicare, Medicaid, and SCHIP Extension Act • Extended SDPI for an additional year at the same funding level

7. 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

8. 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

9. Collaborative Process

10. Collaborative Process

11. Collaborative Process – Reporting Out

12. 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

13. 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

14. 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?

15. 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 ------------

16. Evaluation Design – Program Level • Measurements • Provider: demographic, professional background • Program: recruitment, retention, After Core, team activities • Organization: organization effectiveness • Community: community stakeholders’ perspective

17. 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

18. 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)

19. 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

20. 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

21. 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

22. Questions?