Scaling up a community-led health promotion initiative: Lessons learned and promising practices from the Healthy Weights for Children Project

The increase in overweight and obesity among children has emerged as an important public health issue. This trend has highlighted the need for accessible and novel approaches to support healthy weights for children and their families to prevent childhood obesity. The purpose of this article is to describe the iterative development and scale-up of a community-led, national-level project to promote healthy weights among Canadian children and families who may be experiencing vulnerabilities. In this project, the Healthy Together program was designed to engage families in an interactive program to support healthy lifestyles. The program also provides a platform for creating supportive environments for healthful lifestyles through practice and policy change. Based on a process evaluation, we describe the iterative development of Healthy Together from Phase 1 through 3 to shed light on processes shaping implementation and scale-up of the program. Lessons learned during each phase were used to refine the program and further expansion. Indicators of successful scale-up include the Healthy Together program’s cross-jurisdictional reach and promising evaluation results in real-world conditions. The practice-based program scaling approach provides practical guidance for planning and implementing similar health promotion programs in diverse communities.     

Teaching Family Policy Through a Policy Practice Framework

This article reports on the development of an innovative family policy practice course for direct practice students that emphasizes experiential learning to develop policy practice skills. The course uses a policy practice framework to understand the creation and implementation of major family legislation. A semester-long project provides students with opportunities to develop skills in advocacy, policy development, and planning by working for social change in the community. The article discusses examples of projects that have been implemented by students, discusses challenges to teaching experiential methods for skill building, and provides critical evaluation of the projects and their relevance for macro practice research.     

Developing a new system to measure outcomes in a service coordination program for youth with severe emotional disturbance

This paper presents information on re-developing an outcome evaluation for a state-funded program providing service coordination utilizing wraparound to youth with severe emotional disturbance (SED) and their families. Originally funded by the Robert Wood Johnson Foundation, the Kentucky IMPACT program has existed statewide since 1990. Changing data needs and limitations of the original evaluation required revamping the program's data collection system. The new evaluation uses the extant knowledge base to improve: (1) design, (2) measures, and (3) utility. A pre-post design with multiple follow-ups provides the framework for data collection. An ecological framework provides a conceptual structure for selecting measures focusing on both the service recipients and their environment. Data collection via a personal digital assistant (PDA) ensures utility of the data for both consumers and researchers. Issues ranging from conceptualization to implementation of the project as well as lessons learned are discussed.     

Assessing local capacity for health intervention

Because of their location within the practice realm, participatory, community-based public health coalitions offer many lessons about implementing and sustaining local interventions. This paper presents a case study of capacity assessment at the local level. Capacity evaluation methods are presented, with emphasis on the theoretical framework used to guide the evaluation. The capacity evaluation framework presented herein was theoretically based and designed to generate practical information to facilitate the adoption of a locally tailored youth obesity prevention program, VERB Summer Scorecard (VSS). Using multiple methods, four aspects of community capacity were assessed, including community, knowledge and skills, resources, and power. Within each category, factors that facilitated or impeded program implementation were distinguished. The evaluation protocol was designed to generate information increasing community capacity to sustain a community-based obesity prevention program. Capacity tables were used as a program-planning tool and as a system for sharing implementation and sustainability requirements with potential adopters. This case study also explores how to use capacity assessment results to empower coalitions to serve as catalysts for development of local programs in other communities.     

The relocation of nursing home residents: An illustration of the advantages gained by planning a new program and designing an implementation evaluation together

This paper describes a collaboration between an evaluation team and the management and staff responsible for relocating nursing home residents to a new, state-of-the-art facility. Both the relocation plan and the implementation evaluation of this plan are detailed in order to illustrate the link between program planning and evaluation. I argue that combining program planning and implementation evaluation activities is of value to a wide range of organizations contemplating the development and implementation of a new program. Then I draw upon the research utilization literature to discuss how the collaborative relationship between the evaluation team and management contributed to the success of both program planning and program evaluation activities.     

A visual management tool for program planning,project management and evaluation in paediatric health care

This article describes the development and implementation of a custom-designed Excel-based visual management tool. The tool’s purpose was to support program planning and evaluation by our resource support team within a paediatric health care setting. Our aims in developing it were to 1) establish a streamlined process and supporting tools to efficiently plan and prioritize program directions and activities; 2) track progress; and 3) evaluate and report on our performance, outputs and outcomes. A collaborative approach based on the ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement) change management model and the LEADS (Lead self, Engage others, Achieve results, Develop coalitions, Systems transformation) leadership framework was used to guide the design and implementation processes. Team members reported high perceived effectiveness and efficiency with respect to the tool’s utility in supporting its proposed aims. A graded approach to building knowledge and skills in using the tool, to individual responsibility for data entry, and to accountability by team members facilitated its successful implementation. Administrative support is important for sustainability and continual improvement of the tool to address changing team needs over time.     

Participatory analytic hierarchy process for resource allocation in agricultural development projects

In the framework of 2030 Agenda sustainable agriculture plays a central role. In the field of international aid the participatory approaches to assessment, research, management and budgeting have been widely studied and applied in the last decades, mostly because international aid initiatives, in all their relevant phases from planning through implementation, monitoring and evaluation, are faced with the problem of identifying initiatives that could be successfully and sustainably implemented. The present paper investigates the use of a modified form of analytic hierarchy process, namely the participatory analytic hierarchy process, as a tool for choice criteria elicitation and resource allocation in the framework of an operational planning for agricultural development projects in the Dioceses of Goma, Nord Kivu, Democratic Republic of Congo. During our research, we were able to make use of most frequent inconsistencies in pairwise comparison matrixes in order to stimulate the debate, to adjust local preferences and to build consensus across the group. From an operational point of view, the PAHP methodology was also suited for training the project team and for identifying a shared resource allocation pattern, which matches the existing international guidelines for agricultural development in the region.     

Evaluating development programs: building joint activity

There has been an increasing plea for a participatory approach to development programs. It is argued that for programs to be sustainable, they need to be conceptualized, negotiated and run by all stakeholders jointly. Concurrent with this trend, there has been an increasing demand for program evaluation strategies, which encompass an evaluation of the nature and level of participation of the different stakeholders in the program. This paper proposes a theoretical framework for such evaluation and subsequently provides a practical illustration. Engeström's notions of ‘activity system’ and ‘learning by expanding’, are proposed as a framework for the evaluation of participation and an action evaluation methodology is suggested as the practical tool within such framework. The paper presents a case study of a conservation education program in Africa, which operationalizes the proposed theoretical framework.     

New Curriculum Policy Statement: The Problem of Professional Cohesion–3

This paper presents the Community Learning Center Project, a multicultural training program, as a successful model for the acquisition of culturally relevant social work practice competencies. Cultural pluralism is presented as the underlying framework for the project. The design and model of an evaluation study of the project is described and mechanisms for the implementation of such a culturally relevant effort are suggested.     

Open systems evaluation and the logic model: Program planning and evaluation tools

This paper describes two case management projects and efforts to evaluate outcomes. Lessons learned from the first effort suggest that a tool referred to as the logic model and a particular approach to evaluation called the “open systems” model might be useful to planners and program evaluators. The logic model provides a means of presenting conditions a program is intended to address, activities that constitute a program, short term outcomes resulting from program activities and long term impacts. The open systems perspective emphasizes evaluation as a tool to be used to achieve program objectives as opposed to establishing cause and effect relationships. This paper also describes how the logic model and open systems evaluation were used to facilitate the development of an evaluation plan for a project designed to assist homeless, substance abusing, pregnant women.     

Lessons learned about collaborative evaluation using the Capacity for Applying Project Evaluation (CAPE) framework with school and district leaders

Schools, districts, and state-level educational organizations are experiencing a great shift in the way they do the business of education. This shift focuses on accountability, specifically through the expectation of the effective utilization of evaluative-focused efforts to guide and support decisions about educational program implementation. In as much, education leaders need specific guidance and training on how to plan, implement, and use evaluation to critically examine district and school-level initiatives. One specific effort intended to address this need is through the Capacity for Applying Project Evaluation (CAPE) framework. The CAPE framework is composed of three crucial components: a collection of evaluation resources; a professional development model; and a conceptual framework that guides the work to support evaluation planning and implementation in schools and districts. School and district teams serve as active participants in the professional development and ultimately as formative evaluators of their own school or district-level programs by working collaboratively with evaluation experts.The CAPE framework involves the school and district staff in planning and implementing their evaluation. They are the ones deciding what evaluation questions to ask, which instruments to use, what data to collect, and how and to whom results should be reported. Initially this work is done through careful scaffolding by evaluation experts, where supports are slowly pulled away as the educators gain experience and confidence in their knowledge and skills as evaluators. Since CAPE engages all stakeholders in all stages of the evaluation, the philosophical intentions of these efforts to build capacity for formative evaluation strictly aligns with the collaborative evaluation approach.     

Lessons learned about collaborative evaluation using the Capacity for Applying Project Evaluation (CAPE) framework with school and district leaders

Schools, districts, and state-level educational organizations are experiencing a great shift in the way they do the business of education. This shift focuses on accountability, specifically through the expectation of the effective utilization of evaluative-focused efforts to guide and support decisions about educational program implementation. In as much, education leaders need specific guidance and training on how to plan, implement, and use evaluation to critically examine district and school-level initiatives. One specific effort intended to address this need is through the Capacity for Applying Project Evaluation (CAPE) framework. The CAPE framework is composed of three crucial components: a collection of evaluation resources; a professional development model; and a conceptual framework that guides the work to support evaluation planning and implementation in schools and districts. School and district teams serve as active participants in the professional development and ultimately as formative evaluators of their own school or district-level programs by working collaboratively with evaluation experts. The CAPE framework involves the school and district staff in planning and implementing their evaluation. They are the ones deciding what evaluation questions to ask, which instruments to use, what data to collect, and how and to whom results should be reported. Initially this work is done through careful scaffolding by evaluation experts, where supports are slowly pulled away as the educators gain experience and confidence in their knowledge and skills as evaluators. Since CAPE engages all stakeholders in all stages of the evaluation, the philosophical intentions of these efforts to build capacity for formative evaluation strictly aligns with the collaborative evaluation approach.     

Planning an integrated agriculture and health program and designing its evaluation: Experience from Western Kenya

Multi-sectoral programs that involve stakeholders in agriculture, nutrition and health care are essential for responding to nutrition problems such as vitamin A deficiency among pregnant and lactating women and their infants in many poor areas of lower income countries. Yet planning such multi-sectoral programs and designing appropriate evaluations, to respond to different disciplinary cultures of evidence, remain a challenge. We describe the context, program development process, and evaluation design of the Mama SASHA project (Sweetpotato Action for Security and Health in Africa) which promoted production and consumption of a bio-fortified, orange-fleshed sweetpotato (OFSP). In planning the program we drew upon information from needs assessments, stakeholder consultations, and a first round of the implementation evaluation of a pilot project. The multi-disciplinary team worked with partner organizations to develop a program theory of change and an impact pathway which identified aspects of the program that would be monitored and established evaluation methods. Responding to the growing demand for greater rigour in impact evaluations, we carried out quasi-experimental allocation by health facility catchment area, repeat village surveys for assessment of change in intervention and control areas, and longitudinal tracking of individual mother-child pairs. Mid-course corrections in program implementation were informed by program monitoring, regular feedback from implementers and partners’ meetings. To assess economic efficiency and provide evidence for scaling we collected data on resources used and project expenses. Managing the multi-sectoral program and the mixed methods evaluation involved bargaining and trade-offs that were deemed essential to respond to the array of stakeholders, program funders and disciplines involved.     

Enhancing program review for evaluation and management

Program review has not received the attention it warrants as a program evaluation tool despite its wide use for evaluation and management purposes. The use of the program review will probably endure on the strength of its face validity and irrespective of other developments in the field of program evaluation. Evaluators should realize this and, accordingly, attempt to improve its effectiveness. This paper presents one organization's approach to achieving this objective through the explication of development principles, implementation guidelines and review items. This paper also discusses benefits that can be expected from a systematic development of this tool and presents various research directions and potentials in this area.     

Occupational therapy students' contribution towards enabling potential in a semi-rural community

Occupational therapy students at the University of Pretoria engage in a 7-week service learning fieldwork in their fourth year. This fieldwork takes place in a semi-rural community. The article reports on a successful project where the students enabled adult learners with disabilities to improve their engagement in meaningful activities and trained the learners in selected prevocational skills. The students included a teacher from the center and she was given the opportunity to expand her skills in teaching as well. The ZOPP model of community project planning was used and proved to be a useful tool for students who have limited time for planning, implementation and evaluation of a project.     

Register data in the evaluation and program planning of addiction treatment programs: Using Sweden as an example

Data from large-scale registers is often underutilized when evaluating addiction treatment programs. Since many programs collect register data regarding clients and interventions, there is a potential to make greater use of such records for program evaluation. The purpose of this article is to discuss the value of using large-scale registers in the evaluation and program planning of addiction treatment systems and programs. Sweden is used as an example of a country where register data is both available and is starting to be used in national evaluation and program planning efforts.The article focuses on possibilities, limitations and practicalities when using large-scale register data to conduct evaluations and program planning of addiction treatment programs. Main conclusions are that using register data for evaluation provides large amounts of data at low cost, limitations associated to the use of register data may be handled statistically, register data can answer important questions in planning of addiction treatment programs, and more accurate measures are needed to account for the diversity of client populations.     

An organizational model to distinguish between and integrate research and evaluation activities in a theory based evaluation

Theory-based evaluation (TBE) is an evaluation method that shows how a program will work under certain conditions and has been supported as a viable, evidence-based option in cases where randomized trials or high-quality quasi-experiments are not feasible. Despite the model's widely accepted theoretical appeal there are few examples of its well-implemented use, probably due to time and money limitations necessary for planning and a confusion over the definitions between research and evaluation functions and roles. In this paper, we describe the development of a theory-based evaluation design in a Math and Science Partnership (MSP) research project funded by the U.S. National Science Foundation (NSF). Through this work we developed an organizational model distinguishing between and integrating evaluation and research functions, explicating personnel roles and responsibilities, and highlighting connections between research and evaluation work. Although the research and evaluation components operated on independent budgeting, staffing, and implementation activities, we were able to combine datasets across activities to allow us to assess the integrity of the program theory, not just the hypothesized connections within it. This model has since been used for proposal development and has been invaluable as it creates a research and evaluation plan that is seamless from the beginning.     

An organizational model to distinguish between and integrate research and evaluation activities in a theory based evaluation

Theory-based evaluation (TBE) is an evaluation method that shows how a program will work under certain conditions and has been supported as a viable, evidence-based option in cases where randomized trials or high-quality quasi-experiments are not feasible. Despite the model's widely accepted theoretical appeal there are few examples of its well-implemented use, probably due to time and money limitations necessary for planning and a confusion over the definitions between research and evaluation functions and roles. In this paper, we describe the development of a theory-based evaluation design in a Math and Science Partnership (MSP) research project funded by the U.S. National Science Foundation (NSF). Through this work we developed an organizational model distinguishing between and integrating evaluation and research functions, explicating personnel roles and responsibilities, and highlighting connections between research and evaluation work. Although the research and evaluation components operated on independent budgeting, staffing, and implementation activities, we were able to combine datasets across activities to allow us to assess the integrity of the program theory, not just the hypothesized connections within it. This model has since been used for proposal development and has been invaluable as it creates a research and evaluation plan that is seamless from the beginning.     

A principles-focused evaluation of community mental health short-term case management

Principles-focused evaluations allow evaluators to appraise each principle that guides an organization or program. This study completed a principles-focused evaluation of a new community mental health intervention called Short Term Case Management (STCM) in Toronto, Canada. STCM is a time limited intervention for clients to address unmet needs and personalized goals over 3 months. Findings showcase that a principles-focused evaluation, assessing whether program principles are guiding, useful, inspiring, developmental and/or evaluable (GUIDE), is a practical formative evaluation approach. Specifically, offering an understanding of a novel intervention, including its key components of assessment and planning, support plan implementation and evaluation and care transitions. Findings also highlight that STCM may work best for those clients ready to participate in achieving their own goals. Future research should explore how best to apply the GUIDE framework to complex interventions, including multiple principles, to increase evaluation feasibility and focus.