Using Rapid Assessment and Response Methodology: Waterloo Region's Experience Ontario Harm Reduction Distribution Program Conference

Transcription

1 Using Rapid Assessment and Response Methodology: Waterloo Region's Experience Ontario Harm Reduction Distribution Program Conference February 12, 2013

2 Before we begin Who has completed, or been involved in, a Rapid Assessment and Response (RAR) project? Who has heard of the Rapid Assessment and Response (RAR) process?

3 Before we begin A quick note about this presentation Slides on RAR methodology taken from: World Health Organization (2003). Rapid Assessment and Response Technical Guide. World Health Organization (1998). The Rapid Assessment and Response Guide on Injecting Drug Use.

4 Presentation Outline What is a rapid assessment and response (RAR) process? When and where would you use a RAR? Advantages and Disadvantages Who do you involve? Waterloo Region's experience Tools and Resources

5 What is a Rapid Assessment and Response (RAR) Process? " is designed for those who wish to assess, within a city or region, the current situation regarding drug injecting and who wish to use this information to develop interventions to reduce the adverse health consequences of injecting." World Health Organization (1998). The Rapid Assessment and Response Guide on Injecting Drug Use.

6 What is a Rapid Assessment and Response (RAR) Process? " is a means for undertaking a comprehensive assessment of a public health issue in a particular study area, including the characteristics of the health problem, population groups affected, settings and contexts, health and risk behaviours, and social consequences. It identifies existing resources and opportunities for intervention, and helps plan, develop and implement interventions." World Health Organization (2003). Rapid Assessment and Response Technical Guide.

7 World Health Organization (1998). The Rapid Assessment and Response Guide on Injecting Drug Use.

8 RAR: Implementation Identify issue as priority for action Establish Core RAR Team Conduct initial community consultation Identify parameters of the RAR Establish community consultation process Build and train the RAR Team

9 RAR: Implementation Conduct advocacy Develop the RAR plan Undertake field work Translate findings into action plan Implement interventions Monitor, evaluate and sustain the difference

10 RAR Principles Multiple methods and data sources Inductive approach Multi-level analysis Reliability, validity and triangulation Adequacy for public health response

11 RAR Principles Speed Cost-effectiveness Practical relevance to interventions Strengthening local responses Use of existing information

12 World Health Organization (1998). The Rapid Assessment and Response Guide on Injecting Drug Use.

13 RAR: Outcomes RAR teams established and trained in RAR Community Advisory Boards established and communities mobilised Local RAR capacity built New information and knowledge

14 RAR: Outcomes An intervention action plan and proposals for interventions developed New interventions established and existing interventions modified Strategic links strengthened

15 When use an RAR? Useful for public health issues where individual and group behaviour are important. According to the WHO, these include. but are not limited to: HIV/AIDS and STIs. Substance use (alcohol, tobacco and other drugs). Sexual behaviour and other sexual and reproductive health issues. Violence, injury and accidents. Nutrition and mental health.

16 When use an RAR? RARs vary in focus. They may look at: A particular health issue (such as HIV/AIDS, STIs, pregnancy, TB) A particular affected population (individuals aged 15 to 24, persons who use drugs, truck drivers, prisoners, refugees, etc.) or setting (such as prisons, tourists resorts) A particular health risk or behaviour (e.g. such as sexual behaviour, diet, tobacco)

17 RAR: Advantages Builds on accepted social science methods Has advantages over some existing social methods An effective way to assess current realities and develop targeted interventions based on local data

18 RAR: Common Problems Team composition Lack of flexibility about methods, data and analysis Having no RAR plan Uncertainty about use of qualitative methods Access - consequences of easy options

19 RAR: Common Problems Failing to show how recommendations emerge from the RAR and relate to evidence Inadvertent bias - investigators language, ideas, beliefs Lack of proper involvement of the affected/beneficiary population and stakeholders

20 Waterloo Region's Experience with RAR Baseline Study of Substance Use, Excluding Alcohol, in Waterloo Region Funding Waterloo Region Board of Health Research Team Community Advisory Group

21 Baseline Study Framework World Health Organization's Rapid Assessment and Response Guide on Injecting Drug Use Main Purpose To provide local information on drug use that can be used to guide current and future program planning initiatives and service development Five key objectives

22 Baseline Study cont'd Methods A review of secondary data sources CAMH monitor, DATIS, OSDUHS, HIV diagnostic testing data, needle exchange data, reportable disease data, emergency room visits Key informant interviews (26) Focus group with persons who use drugs (6) Four focus groups with service providers, health care providers and Waterloo Regional Police Service (33) An online survey for service and health care providers (over 75 respondents)

23 Baseline Study: Demographics The following factors were considered when selecting individuals for the individual interviews: Age Socio-economic status Ethno-cultural identity Geographical location Experience using services Type and method of illicit substances used

24 Baseline Study: Recruitment Criteria Persons who participated in the interviews were individuals who: Self-identified to have used drugs illegally (including misuse of prescription drugs) on a regular basis. Regular basis was defined as using drugs at least six times in the past 12 months. Are currently living, or lived within the past year, in Waterloo Region for at least three months and has used drugs at least two times while living in the region. Note: An analysis of the interview data reveals that most individuals interviewed used drugs on a daily or weekly basis.

25 Baseline Study: Recruitment Criteria cont'd Service/Healthcare Providers: An employee that currently (or within the past year) provides a service to individuals that use drugs. An employee who has worked in this capacity in Waterloo Region for at least 1 year. Waterloo Regional Police Service: An individual who has experience, through the course of their work in policing, interacting with persons who use drugs in Waterloo Region. An individual who has worked in this capacity in Waterloo Region for at least 1 year.

26 Baseline Study: Demographics Self-identified Gender Frequency % Female 8 25 Male Total Year of Birth Frequency % 1960 to to to to present 1 3 Did not disclose 4 13 Total

27 Baseline Study: Demographics Municipality Frequency % Cambridge Kitchener North Dumfries 1 3 Waterloo 1 3 Wilmot 1 3 Total Income Level Frequency % Under $15, $15,000 to $ 24, $25,000 to $49, $50,000 to $74, $75, Total

28 Baseline Study: Findings Description of Drug Use in Waterloo Region Crack, cocaine, cannabis (marijuana) and prescription drugs are the most prevalent drugs used in Waterloo Region Drug use and trafficking occurs throughout the region. There are some variations in terms of patterns of drug choice Many persons who use drugs recognize that sharing needs is a dangerous practice; however, many reported that they share crack pipes and other drug-related equipment

29 Baseline Study: Findings Health Needs and Community Response Persons who use drugs reported significant health issues Many persons who use drugs chose to avoid accessing health care unless absolutely necessary Over half of the interviewees reported that their social network would be unlikely to seek medical help on their behalf in the event of an overdose Concurrent disorders Mental health and addictions

30 Baseline Study: Findings Social Needs and Community Response The lack of affordable housing was described as one of the most pressing issues There are numerous (and significant) barriers to receiving supports and treatment: Wait times Insufficient treatment options Lack of after hour supports Transportation Participants from the Waterloo Regional Police Service expressed a desire to assist persons that use drugs in seeking treatment. They also expressed a desire to collaborate with organizations serving the drug using population.

31 Baseline Study: Findings Outreach Individuals contacted by outreach workers viewed the contact as helpful Individuals not yet contacted by an outreach workers were reluctant to consider this approach Service providers state that youth and seniors are populations that do not receive effective outreach programs

32 Baseline Study: Benefits Provided local information on substance use. Data is still used for planning and implementation purposes. "Arms length" approach; use of community researchers; support from academia Information used in subsequent initiatives, including the Waterloo Region Integrated Drugs Strategy Relationship building Starting point for future studies and surveillance

33 Baseline Study: Challenges Growing pains / differing agendas / "buy-in" Varying definitions of "rapid": Project was not completed in the suggested 12 weeks Recruitment Funding allocation Did not complete the full RAR cycle Limitations with methodology

34 Baseline Study: Did we follow the RAR model? Yes and no

35 RAR: Outcomes RAR teams established and trained in RAR Community Advisory Boards established and communities mobilised Local RAR capacity built New information and knowledge

36 RAR: Outcomes An intervention action plan and proposals for interventions developed New interventions established and existing interventions modified Strategic links strengthened

37 Tools World Health Organization Rapid Assessment and Response Technical Guide (2003). The Rapid Assessment and Response Guide on Injecting Drug Use (IDU-RAR) (Version 5) (1998). The Rapid Assessment and Response Guide on Psychoactive Substance Use and Sexual Risk Behaviour (SEX-RAR) (2001).

38 Tools World Health Organization cont'd The Rapid Assessment and Response Guide on Psychoactive Substance Use and Especially Vulnerable Young People (EVYP-RAR) (1998). eillance%20guidelines/substance%20use%20surveillance/e vyp_rapid%20assess.pdf

39 Tools RAR Examples Kingston "high risk youth, drug use and hepatitis c in kingston, ontario" (2009). Waterloo Region "Baseline Study on Substance Use, Excluding Alcohol, in Waterloo Region" (2008). /resources/substanceuse.pdf Victoria "Missed Opportunities: Putting a Face on Injection Drug Use and HIV/AIDS in the Capital Health Region" (2000). RARE_report-Drug_CRD.pdf

40 Questions?

41 Chris Harold Manager, Information and Planning Infectious Diseases, Dental and Sexual Health Region of Waterloo Public Health t ext