Achievements & Lessons Learned-B: Center for Community Health, Education, and Research

Knowledge Item: CA-Initiative Impact-99B
Major Achievements and Lessons Learned: 1994-1999

Center for Community Health, Education, and Research

The CCHER is a culturally competent psychosocial educational counseling program that has addressed the emotional and educational needs of HIV-positive Haitians in Boston.

In 1999, the Evaluation and Dissemination Center asked each project to state its major achievements and the lessons it had learned from conducting the project. Those stated achievements and lessons learned are reproduced here (with minor editing) as reported to the Evaluation and Dissemination Center. The summary statements given here are those aspects of the program's experiences that the Project Director wished to emphasize.

Achievement 1: Creation of a psychosocial counseling curriculum specifically for the Haitian community. The project created the opportunity for in-depth dialogue among Haitian professionals to discuss the psychosocial factors relevant to Haitian consumers. It allowed staff to explore cultural issues and beliefs related to HIV in a way that hadn't been addressed previously and to tailor an educational counseling curriculum specific to our target community.

Key Elements for
Success:

Frank, honest, discussion about cultural issues.

Factors that Limited
Success:

None listed.

Factors that Ensured
Success:

Culturally competent staff willing to address the needs of all Haitians, regardless of socioeconomic status.

*Achievement 2:* Creating (or beginning to create) a mindset in a community based agency of thinking in terms of evaluation and outcomes - i.e. that education, counseling, outreach and other programming that we do here at CCHER has specific measurable goals and objectives and understanding that this is how we work to see that our programming is effective, ultimately helping us plan appropriate programming for our community. Another achievement along these lines is the many national and local presentations the team has done, increasing staff professionalism, and raising the agency's visibility while sharing the important and significant work they are doing for the Haitian community.
Key Elements for Success: Outside consultants providing key advisory roles in evaluation design and plan and helping to integrate a research-oriented mindset into the agency, staff understanding data collection, taking part in data collection.	Factors that Limited Success: Getting all staff to adhere in this notion of formal evaluation and research; staff outside of the SPNS project may not always have the time to fully observe, comprehend the evaluation of the project. Data collection among staff who are so busy providing hands-on services sometimes is not realistic.	Factors that Ensured Success: Evaluator (consultant) who has knowledge and understanding of the agency culture and community; continued sharing and reinforcement of project findings and work with staff as whole.

*Achievement 3:* Creation of a resource manual for providers detailing culturally specific psychosocial challenges of the Haitian HIV consumer and offering specific approaches to working with the Haitian consumer. We are aware of no other such detailed resource specifically for Haitians as this manual which is nearing completion.
Key Elements for Success: Ability to organize a team to best capture our work in writing and produce a great product, skills of CCHER counselors to appropriately capture the challenges and approaches of their experiences of working with consumers during the project, staff working together to best express a culturally relevant manual.	Factors that Limited Success: Never enough time and resources!!! Lack of experience among us in putting together a printed, published manual.	Factors that Ensured Success: Good collaboration and communication among staff working on this manual.

*Achievement 4:* Providing in-depth psychosocial counseling and discussion with Haitians living with HIV, something missing here at the agency prior to the SPNS project. Prior to the project, there was seldom the opportunity for Haitian consumers to spend adequate time with CCHER staff for in-depth discussion about the psychosocial issues related to their HIV. The SPNS project has allowed staff to provide critically needed one-to-one counseling for consumers and address the tremendous psychosocial burdens that many carry along with them.
Key Elements for Success: Flexibility of counseling approach, such as going to where the consumer is at (home, hospital). This is a critical element in successfully delivering counseling services to this population; culturally competent counselors who are non-judgmental.	Factors that Limited Success: Consumers who may be resistant to counseling and who are not able or willing to open up and discuss personal, taboo issues; consumers who may be reluctant to seek counseling services from a fellow Haitian out of fear.	Factors that Ensured Success: Culturally competent counselors who are non-judgmental.

*Achievement 5:* Making an impact on consumers' lives. We know consumers have increased their knowledge and understanding of HIV/AIDS and sexuality as a result of the counseling program and while not yet specifically analyzing data-driven quantitative outcomes, qualitative data to date has shown us that the counseling program has indeed made a difference in consumers' lives. Consumers themselves have acknowledged that they have received vital information on sex, drugs, condoms, HIV risk reduction and that the counseling allowed them to explore issues, in their own language, related to living with HIV.
Key Elements for Success: Culturally competent approach of the project; topics that are relevant to the Haitian consumer.	Factors that Limited Success: Quantitative data collected may not tell the whole story for the impact on consumers; a great number of data questionnaires may be overwhelming to some enrollees. Qualitative data needs to complement the quantitative data. Also, competing priorities, crises, and survival issues among our consumers may at times limit the ability of the enrolled consumer to engage in scheduled counseling sessions with their CCHER counselor and maintain the flow the program.	Factors that Ensured Success: Dedication, skills, persistence of our Haitian counselors in data collection, delivering the counseling program and follow-up with consumers.

1. Lesson Learned: Creating a research mindset within a small community-based agency is a long process and can't happen overnight. Staff often wear so many hats within the agency that they are often devoted to providing hands-on services to meet the needs of consumers instead of being data-driven evaluation- or research-oriented.

How related to achievements: Not specified.

2. Lesson Learned: Providing psychosocial counseling to Haitian consumers living with HIV is a complex process and one that takes time, effort, and has many challenges. Consumers bring many burdens with them as well as other survival issues that may be higher priority.

How related to achievements: Flexibility and adaptation is key.

3. Lesson Learned: Creating a curriculum and implementing a project of this magnitude takes much time and effort, often times, significantly longer then anticipated. CCHER did not enroll clients into the project until the end of year 2, after two years of the project development process, longer than anticipated and planned.

How related to achievements: Not specified.

4. Lesson Learned: Be humble. Reducing barriers, changing behaviors, promoting adherence among target population happens in small increments and take a long period of time. Outcomes that may not seem significant to the larger field of HIV providers, but have nonetheless tremendous significance to those of us here at CCHER working all day with Haitian consumers. Quantitative data alone will not capture the whole story. Qualitative data, especially among the target population, is necessary to fully understand the impact the program has had on our consumer group.

How related to achievements: Not specified.

5. Lesson Learned: Consumers need continued reinforcement and long term counseling to address many issues that are going to promote and sustain the kinds of changes necessary to prevent HIV transmission among the Haitian community. This project and the informal short term counseling it has provided is just the groundwork for continued efforts needed in the community.

How related to achievements: Not specified.

Completed By: Eustache Jean-Louis, M.D., M.P.H.
Last Updated: July 1999

Project Resource Page

Center for Community Health, Education, and Research

Evaluation Data

Service Population Demographics

Service Referrals

Last Updated: August 02, 2001; data through June 15, 1999; analyses conducted January 2000.

Knowledge Base Citation: The Knowledge Base and this Knowledge Item were designed and authored by G. J. Huba, Ph.D.; in collaboration with Lisa A. Melchior, Ph.D.; A. T. Panter, Ph.D.; and the staff of The Measurement Group. Cite this work as "Huba, G. J., Melchior, L. A., and Panter, A. T. (1998 - 2001). The Measurement Group Knowledge Base on HIV/AIDS Care. On the World Wide Web: http://www.TheMeasurementGroup.com."

Questions or Comments: Contact The Measurement Group.

Use of Knowledge Base Information: Acceptable Uses and Limitations.

Collaborators from Participating Projects: Cooperative Agreement Steering Committee 1999.

Participating Projects: This Knowledge Base is based on the service delivery experiences of 27 Cooperative Agreement Projects on Innovative Models of HIV/AIDS Care. These projects and the Evaluation and Dissemination Center which produced this Knowledge Base were funded by the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) as Special Projects of National Significance (SPNS) between 1994 and 1999.

Why This Evaluation was Conducted: Editorial.

More Information: Design of this Knowledge Base.

Recommended Citation Format for Web Materials: American Psychological Association Publication Manual Section, Revised 2001.

Work on the Knowledge Base and the cross-cutting evaluation was supported in part by Grant Number 5 U90 HA 00030-05 from the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau's (HAB) Special Projects of National Significance (SPNS). The contents of this Knowledge Base are solely the responsibility of The Measurement Group and do not necessarily represent the official views of HRSA or HRSA/HAB's Special Projects of National Significance nor may they represent the positions of the individual grantees whose projects are included in the cross-cutting evaluation.