Design a program for a health and wellness program for a multi-culturally and economically diverse population in a community-based setting. Include these components in the program design: Clearly identify the components of a comprehensive health and wellness program for this type of population, with examples Will the program be short-term or long-term, or open-ended depending on the goals and objectives of the program? What instruments will you use to measure the outcomes of the program? Who are the key constituents (stakeholders) that will be involved in the design of this particular program? How will you seek funding for your program? Include a socio-economic and multi-cultural perspective that draws from existing national, regional or local programs Describe the administrative tasks, functions in the design and administration process Planning steps (1-15) included as outlined in Chapter 4 to incorporate the above information. Part B: Create a health wellness program for a private corporation (workplace) that meets the stated requirements described above. Below are the 15 planning points: Step 1: Review the Needs Assessment It is suggested that the planners conduct a review of the needs assessment data and the resulting decisions that have been made up to this point. This review will help to determine if the most appropriate recommendations for the direction and outcome of the program have been made to meet the needs of the target population. It is possible for the planning committee to identify additional data that are useful to shaping the intervention, which were not undiscovered or overlooked in the initial needs assessment process. A large amount of data may have been collected as part of the needs assessment, but during a review, a skillful planning committee can organize and synthesize the information into a format that provides meaning and value, which may not have been obvious during the initial examination of the data (Aspen Reference Group, 2002). Step 2: Convene an Advisory Panel or Planning Committee As described in an earlier chapter, community members should be involved in the entire planning process, as they are important contributors to the development of all aspects of the program, from conducting the needs assessment to evaluating the program (Aspen Reference Group, 2002; W. K. Kellogg Foundation, 1998). For a number of reasons, it is necessary to involve or consult with appropriate community members at the very beginning of the program planning process and to include them on an advisory panel or planning committee. As with the needs assessment process, target population and stakeholder involvement is necessary during the planning and implementation stage. The involvement of target population members will help to develop program ownership, which is critical for their eventual involvement in and acceptance of the program. Target population members can provide the planners with critical insight into the target population that could make or break the efforts toward the desired outcome of the program. It is important that the program be founded on the philosophical position that it is being done with the community rather than to the community (Rainey & Lindsay, 1994). If a coalition or advisory board was formed prior to the needs assessment, its members may form the basis for the program planning committee. When there is an existing committee structure, it will be important to review constituencies that will need to be represented for the program planning part of the process. Important contacts for inclusion on any coalition or board include potential program providers, as well as potential program clients or potential consumers. Representatives from a local college or university might also be considered, as they may offer skills and possible resources to assist with program planning and implementation. College professors might have areas of expertise that are needed by the planning committee, or a college class might assist in conducting some of the activities of the project as part of a course requirement. Consider representatives that will enhance the work of the committee and prove to be helpful to the success of the new program. When putting together a list of potential program planning advisory board members, consider individuals that can be described as follows: _ Are well respected by the target audience and can provide valuable links to the community _ Represent the various groups within your target population and have the ability to provide relevant input for program planning _ Have knowledge of the target audience, members and their lifestyles, attitudes, and resources _ Bring to your committee a number of skills and resources that will be useful to the program (Aspen Reference Group, 2002; Breckon, Harvey & Lancaster, 1994) To encourage a potential candidate to take a position on an advisory board or committee, it is recommended that he or she be contacted personally through a face-to-face discussion or telephone conversation. When a personal contact is not possible, a letter or e-mail that reaches out to potential board members may be necessary. Regardless of how the initial contact is made, the following information may prove useful for informing the potential board member of the fundamentals of the program being developed (Keyser et al., 1997): _ A statement on the purpose or intent of the contact _ The name of a key contact person, his or her title, and organization (including a brief overview of his or her role in this project) _ A description of the target population _ The area of emphasis of the program and the health concern or issue to be addressed _ Program justification _ A solicitation of support from the receiver _ Ways that the potential candidate may connect with the key contact (e Step 3: Assess and Establish a Budget for Program Planning A budget must be considered for the planning phase of the project. Subsequently in this chapter, program budgets will be addressed, but a budget for program planning is important to facilitate the planning process. Because a budget for planning is often overlooked, it is added here as a separate step. This step is important, because resources are needed for conducting the initial research and putting together the groundwork that is required prior to piloting and implementing the program. Creating an advisory or planning committee, developing the materials of the program, and preparing the necessary documents all require staffing, time, and financial support. Program success depends on this planning process, and cutting corners here can result in a program that fails to meet the needs of the target population and fails to produce the program desired outcome. Step 4: Write and Review a Mission Statement The mission statement is a narrative statement describing the focus of the program, which often includes the program intent and philosophy (McKenzie & Smeltzer, 2001). Developing a mission statement is a critical step in creating a strong foundation for the development of program goals and objectives and is a program activity that must be accomplished very early in the planning process. A mission statement may have been written as part of the needs assessment process, so it is important to review any existing mission statements before proceeding. 72 Chapter 4: Program Planning: The Big Picture Step 5: Write and Review Program Goals and Program Objectives The program goals evolve from the mission statement, and the objectives evolve from the goal or goals. Once the mission statement is in place, the task of developing the outcome or goal of the project, along with the specific objectives, needs to occur (NACCHO, n.d.). Objectives outline in measurable terms the desired changes that should occur in the target population as a result of the intervention and provide the basis of evaluation for the program (McKenzie & Smeltzer, 2001). Suggestions for developing a mission statement, program goals, and objectives are provided in an earlier chapter. If goals and objectives were developed as part of a needs assessment process, they will need to be reviewed and possibly adjusted. Step 6: Select a Theory or Theories on Which to Base Your Program One or more theories or specific constructs from the professional literature is needed to guide the planners in developing or selecting the intervention required to meet program goals and objectives (Glanz & Rimer, 1997). Successful health education programs are grounded in a theoretical foundation that is reflective of the current research and understandings of the profession. Chapter 6 reviews some of the most commonly used theories in health education and health promotion.-mail address and cell and office phone numbers) Step 7: Review Other Programs to Generate Program Strategy Alternatives Those involved in the program planning process need to identify potential strategies that address the goals and objectives that have been identified (NACCHO, n.d.). To ensure success for the intervention, it is important to base the new program on other successful programs. A wide review of the professional literature and other professional documents, paying attention to programs and strategies that have been deemed successful through some type of evaluation, will help to generate a list of potential strategies and activities. Many foundations and professional associations or organizations offer lists of evidence-based or science-based programs that should be examined for potential use in the project. In the manual Getting to Outcomes: Methods and Tools for Planning, Evaluation, and Accountability, Fetterman (2000) provides a list of criteria for determining if a program is evidence-based and it includes the following: _ The degree to which the program is based upon a well-defined theory or model Program Planning Steps 73 Checkpoint 4.1 What are some of the most commonly used theories and models for describing health behavior? _ The degree to which the population serviced received sufficient interventions _ The quality and appropriateness of the data collection and data analysis procedures used _ The degree to which there is strong evidence of a cause and effect relationship The use of science-based programs is encouraged but not always possible. There also exists in the literature programs that have demonstrated effectiveness but do not meet the science-based criteria. Practice-based programs or �best practices from the field� can be found in the professional literature in professional journals, through foundations and government organizations, and on Web sites (Fetterman, 2000). A search of best practices may provide the planners with strategies or intervention suggestions that can be adopted to meet the needs of the program or intervention being developed. Once a literature review for successful programs has been conducted, followup telephone calls to staff associated with those programs may assist in providing additional details and insight that is not apparent in the available literature. A conversation with the appropriate staff member or director could provide the planners with feedback on a number of issues, such as the location and need for resources, overcoming implementation barriers, and evaluation strategies. Step 8: Assess and Establish the Budget for Program Implementation Review the financial arrangements for the program by looking at the money provided by the main funding source and any funding from another party or organization. Assess the allocated budget and its parameters to determine if it is sufficient to perform the tasks and activities of the program. Identify the resources for program implementation�those that already exist and those to be developed or purchased�and determine if they will be sufficient to achieve the program goals. The budget should include allocation for staffing, program supplies and materials, facilities and space, marketing resources, and other operational expenses (Breckon, Harvey & Lancaster, 1994). For a more detailed examination of potential budget items and considerations, the following questions for the planners from the Community Tool Box located at https://ctb.lsi.ukans.edu/ are provided (Rabinowitz, 2003): _ What are the activities that will do the most to advance your cause and mission that you can carry out with the resources you have? _ How many staff positions will it take to run the activities and do it well? _ How much money will go to staffing (salary, consultant fees, fringe benefits) and from what sources will staff members be compensated? 74 Chapter 4: Program Planning: The Big Picture _ What else will be needed to run the program and its activities (space, supplies, equipment, phone and other utilities, insurance, travel, indirect costs, etc.)? While attempting to identify the necessary personnel to be involved in the project, planners should consider hiring from the target population (Aspen Reference Group, 2002; W. K. Kellogg Foundation, 1998). Staffing with members of the community helps to increase program acceptance and provides valuable insight into the community and its members. For many programs, having sufficient funding is a primary concern. An investigation into the possibility of donated or shared resources with other community programs, such as building space or large equipment items, might help to address some funding limitations. Finding low-cost or donated program materials, such as curriculum and other educational items, may be possible through voluntary health agencies or government offices. Grants and financial gifts from foundations, government agencies, community groups, and businesses is another way to increase funding for a program (McKenzie & Smeltzer, 2001). Opportunities for seeking soft money, such as grants, will require an investigation into the potential funding sources that exist and an examination of the types of projects or programs that are funded by those sources. Interviewing staff members from similar programs, contacting government offices for potential funding, and working with a local college or university and its research office are a few suggestions for getting started in the pursuit of soft money. Step 9: Estimate Time Often, a timetable of the specific tasks and activities of the program is developed to assist those involved in the process by informing them of when the activities are to take place and who is responsible for each activity. Planners often develop timelines that reflect the implementation and evaluation process. Including the entire planning process on the timetable can be most helpful (McKenzie & Smeltzer, 2001). Planners need to develop a timeline that flows logically, is realistic, and will assist in achieving the goal by the program deadline. In order to prepare a timeline many planners use a Gantt timeline and chart out the project activities on a day-to-day, week-to-week, or month-to-month basis. A wealth of information on this charting method exists in the professional literature and on the Web. Step 10: Select Strategies and Activities At this point, planners need to consider which intervention strategies and activities can best help to achieve the program goals. Again, a review of the literature for effective intervention details is an important step to consider. Several Program Planning Steps 75 potential strategies should be identified for each objective. The selection of the strategies and activities of the intervention is a process that takes some time and investigation to successfully accommodate the target population and meet the program objectives. Those involved in strategy selection must attempt to identify potential barriers to the implementation of each strategy identified (NACCHO, n.d.). Reviewing the needs assessment information may identify some barriers, as will a look at the professional literature. Talking with others who may have used the strategy in similar situations can also reveal potential barriers to using the strategy. The existence of implementation barriers does not rule out the use of a strategy, but the barriers must become part of the discussion of whether to incorporate a particular strategy into the program. The program planning group should investigate, outline, and discuss the details of all strategies being considered for inclusion in the program before making final selections, based upon a mutually agreed upon set of criteria. During this process, the group should consider program strategies that accomplish the following: _ Fit with the resources and needs of the community _ Consider the beliefs, values, and practices of the community _ Reflect field testing (have shown success in the field) _ Dispel health misconceptions (Aspen Reference Group, 2002) _ May be related to other strategies under consideration _ Support the theoretical framework of the program (NACCHO, n.d.) In the literature on successful or similar programs, there may appear references to curricula or canned interventions that can be purchased for use with the program being developed. There are a number of national curricula or health programs that have been shown to be effective and are worth consideration for adoption. According to Lohrmann and Wooley, effective health education curricula should include the following eight characteristics: _ Are research-based and theory-driven _ Include basic, accurate information that is developmentally appropriate _ Use interactive, experiential activities that actively engage students _ Provide students an opportunity to model and practice relevant social skills _ Address social or media influences on behavior _ Strengthen individual values and group norms that support healthenhancing behaviors _ Are of sufficient duration to allow students to gain the needed knowledge and skills 76 Chapter 4: Program Planning: The Big Picture _ Include teacher training that enhances effectiveness (1998, p. 44) The MAPP process suggests that, at this point in the program planning process, a report be drafted by the planning committee (NACCHO, n.d.). The report should synthesize and outline the program planning decisions. The report then becomes a written reference point for the program planning committee during the program adoption and implementation processes. It can also be shared with advisory councils, boards of directors, and the community at large. Step 11: Plan Evaluation By this point in the process, the development of an evaluation plan should have been initiated. Evaluation should be designed as a continuous process so that even the planning process itself is evaluated (Aspen Reference Group, 2002). It is important to select evaluation methods and questions that will facilitate process, impact, and outcome evaluation. What data need to be collected and when are they collected are critical considerations for a comprehensive evaluation. Evaluation instruments and record-keeping methods must be developed so that the necessary data are available for the evaluators (Aspen Reference Group, 2002). The planner or planners may not have the expertise and resources to conduct all phases of the evaluation, and an outside or external evaluator may need to be consulted (Rainey & Lindsay, 1994). If an external evaluator is needed for the project, it is suggested that the evaluator be brought in during the planning phase to develop the evaluation plan as early as possible in the process. Step 12: Determine and Establish Cooperative Agreements and Linkages with Other Appropriate Community Agencies A successful program has at its wheel a planner who knows the importance of politics and the necessity of working with the key decision-makers and other community agencies at the local level. A review of the current programming that is being offered to the target population must be conducted. Do similar programs exist for this group? Will the program meet needs not currently being met or addressed? Determine how the new program will differ, strengthen, or enhance what already exists and if avenues for collaboration are present (Fetterman, 2000; Rainey & Lindsay, 1994). Collaborative relationships for intervention development and delivery may take many forms, including an advisory committee, a consortium, a network, or a task force. The goal of this relationship must be explored, as the outcome could be that of sharing information, coordinating services for the target population, or working to advocate for a policy or environmental change. The following questions may help in determining if there are political barriers to the program, and may help develop the potential for cooperative relationships: Program Planning Steps 77 _ What agencies and organizations are already involved with this health concern and might perceive your program as a threat? _ What can be done to gain the support and endorsement of those agencies? _ Should a coalition of interested groups be formed to address the health concern? (Rainey & Lindsay, 1994) Step 13: Write Component-Specific Behavior and Learning Objectives Once the activities and strategies of the project have been identified, and possibly purchased or developed, it may be time to reevaluate the objectives. This reevaluation is useful to determine if the existing objectives are still adequate for meeting the program goal or goals. An intervention often contains a number of different components or actions that target different behaviors or environmental factors. Each component must include objectives that are specific to each targeted action or behavior. For example, if a program focuses on physical activity, diet, and exercise, then a set of objectives must be developed for each of the three sets of behaviors. One set of objectives must be targeted toward physical activity, one toward diet, and one toward exercise. At this step in the planning process, additional learning objectives may need to be written to reflect the full scope of the intervention and all that it is developed to impact. Step 14: Pilot-Test the Intervention Prior to a full program implementation, it is suggested that a pilot test of the intervention be conducted. A pilot test, with a small group that represents the target population, is helpful to identify potential flaws or problems with the intervention. The information that results from this step could result in corrections that could save valuable resources and time later on. Common problems that may be uncovered during a pilot test generally deal with potential flaws in the actual design or delivery of the intervention. A process evaluation of the pilot test that examines the intervention program, strategies, materials, and implementation could result in information that necessitates adjustments to the implementation (McKenzie, Pinger & Kotecki, 2002). Some questions to ask during the process evaluation of the pilot test to determine if you need to finetune the implementation are as follows: _ Were program materials pretested? _ Is the message appropriate for the target audience in terms of language, values, and educational levels? _ Is the message appropriate to meet the stated objectives? _ Is the program appropriate to meet the stated objectives? (Rainey & Lindsay, 1994) 78 Chapter 4: Program Planning: The Big Picture _ Was the intervention implemented as planned? _ Was the person conducting the intervention well received? Step 15: Implement the Program This step involves carrying out the activities that make up the intervention, while attempting to meet objectives and, ultimately, the program goal. Implementation can be conducted after the pilot test results are analyzed and any resulting adjustments are made to the intervention (McKenzie, Pinger & Kotecki, 2002). Once the program is revised, it is suggested that the program be phased in rather than completely implemented. McKenzie and Smeltzer (2001) offer four approaches to phasing in a program: 1. By different program offerings 2. By placing an initial limit on the number of participants 3. By choice or location within the target population community 4. By participant ability or skill level (start with beginner-level programming) Fetro (1998) identifies several factors or program characteristics that contribute to the successful implementation of a coordinated school health program. These characteristics, if present, assist the planner of a community or health promotion program in conducting a successful implementation as well. These characteristics include a clear underlying purpose with potential outcomes; a perceived value in addressing identified needs; adaptability; replicability; consistency with the institution�s mission and vision; ease of implementation; credibility with staff and the community; a capacity for broadening the knowledge base of the target population; and the potential for the program to enhance, supplement, or support existing programs (Fetro, 1998). Jose and Dee decided to split their programming planning efforts by creating two new committees. One will focus on community programming interventions, and the other will work with the coordinated school health program to focus on school-age youth. The coalition will continue to exist but will meet less frequently. Some coalition members have become members of the new planning committees. The planning committees have broken into smaller work groups to establish budgets, write mission statements, define goals and objectives, and research intervention ideas.