Using RE-AIM Framework to Evaluate CTIP Endeavors

Consolation East Africa  in Collaboration with Tom Omwenga of Child AID Kenya

RE – AIM stands for Reach, Effectiveness orEfficacy, Adoption, Implementation and  Maintenance or sustainability. Its application to health interventions is applied in these slides

REACH is defined as The number, percent of target audience, and representativeness of those who benefit. Key Issues:  Does program reach those at highest risk or the most vulnerable?  Are different interventions required?

EFFECTIVENESS: Change in temporally appropriate outcomes, and impact on quality of life and anyadverse outcomes. Key Issues:  Logic model helps to clarify anticipated :  Logic model helps to clarify anticipated effects; quality of life provides common metric across conditions and interventions; anticipate
unintended consequences.

ADOPTION: Number, percent and representativeness of settings and clinicians who end up adopting the suggested methods for example the likelihood that 30% of recipients to a campaign will heed to the message of the campaign. Key Issues:  Need to focus on “denominator” and barriers among non-users.  Do initial adoptees include peer opinion leaders?

IMPLEMENTATION: Extent to which a program or policy is delivered consistently, and the time andcosts of the program. Key Issues:  Consistency across staff, program components, and time.  Balance between fidelity components, and time.  Balance between fidelity and local customization.

MAINTENANCE: Individual long-term effects and attrition.   Extent of continuation, discontinuation, modification, or sustainability of program. Are the changes being sustained as a result of the program? Key Issues:  Does attrition bias results; qualitative approaches to understanding program adaptation.

RE-AIM has been used by organizations to  to evaluate practicality and
generalizability of evidence-based interventions.  It uses both qualitative and quantitative data. It can also be used as an action research tool, a tool to aid in planning and networking. Hence in summary it helps understand the disparities i.e. who participates and who benefits; costs involved and cost effectiveness, the effects of different interventions and how to combine different factors to produce composite interventions.

RE-AIM therefore can be used for interventions that also do:

Reach large numbers of people, especially those who can most benefit

It can widely be adopted  by different settings

Be consistently implemented by staff members with moderate levels of training and expertise

Produce replicable and long-lasting effects (and minimal negative impacts) at reasonable cost

Organizations working to address the challenge of human trafficking could use this tool to assess their interventions in social support, legal assistance, prevention, advocacy and victim support.

The Child AID Kenya an organization working to address the challenge of Child Sexual Abuse and Exploitation has been using the  RE –AIM framework  as a tool during different phases in  project planning and implementation. Here they use a different sets of questions for each element of RE-AIM.

 

REACH

What percentage of target population will participate in the program?

  • These are the groups  we reached:
    • Professionals at provincial administration office across- Area Advisory Councils (AAC) level:  Leadership for  area advisory councils (AACs), NGOs/CBOs who sit at AACs – participation in AACs:

Per AACs

  • 2 schools each, 2 teachers per school (guidance and counseling) especially involved in school life skills curriculum/or guidance and counseling teachers
  • Student Volunteers – at least 1 per AAC
  • Youth & sports coaches  – 2 per area
  • Community leaders, ex. faith based(pastors/Imam) and other leaders  in legal organized community groups, women, parents,  Area residents associations etc.
  • Business community/or Merchant networks. Ex. domestic workers’ employment bureaus/or Agencies; small bars and restaurant owners

Efficacy:

  1. Will the program be effective?
  2. Is the program achieving the outcomes you set?
  3. Is the program producing unintended consequences?
  • Established a check list of actions to monitor at TOT organization level
  • Are organizations actually using the materials?

Adoption:

  1. What percent of targeted settings are estimated to participate?
  2. Are the participating settings representative of all targeted?
  • Do TOTs deliver trainings in their organizations?
    • Do Advisory committee plan activities for the following/next year?

Implementation

  1. Will the program be delivered as intended? How?
  2. Are different components delivered as intended?What parts of the program are adaptable without consequences?
  • Do TOTs continue doing training?

Maintenance:

  1. Does the program keep participants engaged? Produce long – lasting effects?
  2. Can organizations sustain the program over time?
  • Retention of knowledge by individual trainees.
  • Change in practice continues.
    • TOTs continue  to do training, does  advisory council develop plans/additional activities related to CSA/E prevention, are there other groups/settings in AAC that want to receive TOT training?
    • Advisory Committee continues to keep it in the plan.
    • Community  Members continue to generate new ideas for how to apply in their committee/community.
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