Program Development for Community-Based Practice

By Hui-Fen Mao 2012/10/11

1. Program Development

--Including planning, development of implementation strategies, and evaluation.

* “Program” vs. “Clinical service”

-- Systematic efforts to achieve preplanned objectives such as changes in knowledge, attitudes, skills, and behaviors to maintain or improve function and /or health (health promotion and education) in a number of settings (schools, worksites, community agencies…).

Program Planning （範例：台北縣偏遠地區社區復健方案）2. Principles of Program Planning

- A process of establishing priorities, diagnosing causing of problems, and allocating resources to achieve objectives.

1) Plan the process (preplanning): overlook the success approach—who should be involved（可能參與OT、負責人）, when the planning should occur, what process will be followed （計畫申請規定）, what internal and external resources (attitudes, policies, available expertise, time, space, money, priorities) （行政、理監事支持度）, and fit with the organization’s mission. （發展OT新型服務）2) Plan with people:

- “the principle of relevance” * “Successful programs begin by considering the perceived needs of clients.”

- “ the principle of participation” (to enroll the clients with more active role) “The more effective meeting the goal as the clients more actively involved.”(provide feedback active role in design….)

- “ the concept of collaboration”: (stakeholders share the same goals and interest) *Advantages-- duplication of effort, more creative problem solving, better services. （與衛生所、PT）

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3) Plan with data: knowledge in issue and associated factors (population/ environment), quantitative information (i.e. existing programs) / qualitative (attitude, beliefs, or barriers)

4) Plan for performance: (long-range planning) (i.e. routine services, 專職OT)

5) Plan for priorities: greatest need or effect （甫出院回家之神經疾患個案、獨居或家庭支持差、輕中度失能）

6) Plan for evaluation: “Doing right things” . “Doing things right”.

- By systematic collection and analysis program and client information.

- Built into the program design and spelled out in the program plan

7) Plan for measurable outcomes: clear objectives with some baseline data / match the objectives (ADL, QOL, Care load)

3. Planning Process (Table 6-1, p.99, Fig. 6-1, p. 100)

1) Preplanning –

- Identify/state the problem and the target population

- Identify existing information regarding issue of concern (from data, professional judgment, observation, existing literature, concerned individuals, or agencies).

- Answer the key questions of who, what, and why

- Assess the internal and external resources and barriers

- Determine the goals of, and an approach for, the need assessment

2) Needs assessment: 3 sources of data for needs assessments

* Table 6-2 Data collection methods for needs assessment

- Literature review

- Secondary data

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- Survey (simple, meaningful, reliable)

- Group process (open forums, focus groups, nominal group), build rapport

* Select methods related to: characteristics of the target group, the type of information desired, resources available, the amount of interaction desired with the audience.

3) Data analysis and interpretation (more than an statistical exercise)

- less on inferential statistics, more on identification of need, risk, seriousness of a problem, and access to services

- interpret findings, set priorities regarding needs, suggest ways of addressing needs, to provide the direction and rationale for program planner to develop an effective intervention.

4. Program Plan Development: based on a merging of the findings of the needs assessment, theories, and available resources

1) The role of theory—the assumption of the cause of problem and best way to change, no single theory

2) Putting the plan together:

a. Goals—quantify statement of a desired change in the status of a priority health need. Long term and broad in scope. Not directly measurable, bet attainable.

b. Objectives—specific, measurable

*who/what(action/performance)/when(time frame)/how much(to what degree/standard of performance/level) (table 6-3) (Please list examples.)

- Health objective: changes of the health status

- Program objective: address the process of the intervention (new service plan)

- Learning objective: address the knowledge, attitudes, or skills the program will attempt to effect to encourage specific behaviors

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- Behavioral (impact) objective: to describe what the program will encourage people to do to reduce risk or improve health. Reflect the program strategies.

- Resource objective: address the material support or essential services the program plans to provide

c. Strategies—ecological perspective in health promotion, beyond the individual level for the effectiveness, influenced by the environment (reciprocal causation)

*Ecological health promotion Planning Model (Simon-Morton et al, 1995)--5 societal levels: Factors to consider

- Intrapersonal—individual characteristics that influence behavior (knowledge, attitude…)

- Interpersonal—family, friends, peers, and groups that provide social identity, support, and role definition

Organizational—agencies and their rules, regulations, policies, procedures, programs, and resources

Community—social networks, norms, trends, and standards that constrain or promote desired action

Public policy—local or central government policies, laws, and programs that regulate or support desired action (Examples: table 6-4, 6-5)

d. Evaluation plan—include stakeholders, potential clients and clients

* Steps for developing an evaluation plan: (P.113)

* Level of evaluation: process, impact (intermediate effect), and outcome (long-term effect) (Table 6-6)

* Characteristics and distinctions among the levels of program evaluation

4) Program Evaluation

- to investigate the effectiveness to optimize the outcomes, efficiency, and quality of health care

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5. Program Implementation

-- Steps (p.115)

6. Program Evaluation

At program level not individual level

7. Institutionalization

Study Questions

1. (Assume a program) What steps would you take to assess need? Who would you involve? What questions would you want answered?

2. How would you use occupational therapy concepts to shape an intervention strategy for a specific population?

3. Write a goal, two learning objectives, and two behavioral objectives for this program.

4. For the same program, describe possible interventions at each of the five societal levels.

5. List several specific pieces of information you would record to conduct process evaluation of your program.

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