Transcript RPAR Evaluation - Temple University

Evaluation of a Rapid Policy Assessment and Response
Intervention: Szczecin, Poland
Case P (1 ), Chintalova-Dallas R (2), Lazzarini Z (2)(4), Burris S (3)(4)
(1) Fenway Community Health, USA (2) University of Connecticut Health Center, USA (3) Temple University Law School, USA (4) Center for Law and the Public’s Health at Georgetown and Johns
Hopkins Universities, USA
Background: Rapid Policy Assessment and Response
(RPAR) is a community-level action research intervention
process. Using the RPAR “tool kit” a research team, in
Szczecin, Poland, collected laws and policies “on the
books” that were relevant to IDU health and, through
qualitative research, investigated how these laws were
actually implemented “on the streets.”
Results
The RPAR Toolkit
The RPAR toolkit is a manual of training materials and tools
designed to be used by anyone to conduct an RPAR. It is a
flexible system designed to be adapted to unique situations to
assist in a community process of identifying ways to change
policies and practices to improve the health of drug users.
The toolkit includes:
Researchers worked with a Community Action Board (CAB)
of key stakeholders to conduct research, interpret the
findings and develop a plan of action.
• A detailed training manual
We conducted a process evaluation of the Polish
implementation of the RPAR process to assess
• The feasibility of the process
• Effectiveness of the process in identifying policy-related
problems and identifying solutions influencing the risk
environment for IDUs
• The production of community-level efforts to promote
change.
• Tools for collection of existing epidemiological, criminal
justice, and legal data.
Methods: To conduct a process evaluation we
For more information about the RPAR and to download
preliminary RPAR toolkits in English, Russian and Polish
versions, please visit our website
examined all the materials developed by the Polish team
including the weekly process notes written by the Polish
team, all collected secondary epidemiological, legal and
policy data, results of evaluation survey of CAB
members and the Final Report and the Action Plan. We
conducted 5 individual interviews with members of the
team, surveyed 16 CAB members and evaluated the
completeness of the legal data collected.
“Taking part in [CAB] meetings was to me enormous
experience. I became familiar with many different
aspects of drug addiction and ways to limit its negative
effect. Most solutions to this problem, at this time,
cannot be implemented in prison institutions. It is
necessary to change regulations and mentality of
prison staff.” CAB member
• Draft agendas, analytic exercises, and other materials to
assist the CAB members
• Interview Guides for all types of individual and focus group
interviews
• Data organization forms
• Research ethics information and guidelines, including data
protection protocol, subject recruitment and consent training,
and basic concepts necessary for completing the NIH webbased human subjects certification program
http://www.RPAR.org/
• Feasibility: The RPAR was designed as a 36 week process. The Polish
team was able to complete the research activities of the RPAR process
within a 44 week period. Despite unanticipated barriers and a longer time to
completion, it was feasible to implement and complete the project. Barriers
to implementation included : 1) Resistance on the part of officials to sign
consent forms, be taped, or saying anything “on the record” 2) Difficulty
obtaining complete “Law on the books” legal data 3) Rules governing
NGOs that made it difficult for them to accept donations or initiate programs
without “official” support 4) Difficulty recruiting and interviewing IDUs from
local minority groups.
• Completeness: Two members of the US team independently evaluated
the completeness of collected data. Data collected for all categories except
law on the books was 80 percent complete or better.
Law on the books
Epidemiological data: disease
Epidemiological data: IDUs
Criminal justice data
Percent Complete
18
80
88
97
• Activities: The Polish team completed all the RPAR activities, conducting
3 focus groups with providers, 24 individual interviews with lawyers, a judge,
police, physicians, drug treatment providers, prison officials and others, and
14 individual interviews with injection drug users. The team conducted legal
and epidemiological analysis of available data and led the CAB in seven
meetings, coordinating analytic exercises such as power mapping in the
effort to identify areas where change could result in an improvement in the
health of drug users.
• Effectiveness: The RPAR CAB identified a number of issues related to
the health of injectors in Szczecin, including a number of findings not
identified previously. These included
•
•
•
The failure of the criminal justice system to utilize legallymandated and available treatment services for drug users;
An emerging rural epidemic of injected amphetamine use;
Evidence of a poor fit between current drug use-related health
services and needs.
Efforts to promote community change: The CAB includes members who
are lawyers, professors, physicians, defense attorneys, harm reduction
workers, and others. Some are continuing to work to change policy in
Szczecin. Projects that are continuing include developing a training
curricula for judges and prosecutors about provisions in the law for drug
treatment of convicted drug users and other legal issues, and work with local
officials in rural areas regarding amphetamine use. There is an on-going
evaluation to assess the implementation of the action plan and changes in
policy and law related to the health of IDUs in Szczecin.
Suggestions for improvement
CAB members felt that the already-diverse CAB would
have been improved with the addition of prosecutors,
aldermen, other officials and several mentioned that drug
users should have been invited to join the CAB. One said,
“Should have invited a representative drug
dependent [person] who has considerable
experience with dependency….in order to
understand, how this population responds
toward particular methods of treatment.”
Conclusions: The Rapid Policy Assessment and
Response process can be used to mobilize local capacity to
identify policies and implementation practices that improve or
aggravate the social health risk environment for drug users.
There were barriers to implementation and the process
should be adapted to local conditions for maximum efficiency.
Summarized sample of action plan recommendations
• Organize seminars for judges and prosecutors ssociated in
the region of Szczecin.
• Diagnose drug use patterns in small towns and villages in the
region.
• Add funds for drug counteraction to the city budget.
• Disseminate a paper to defense lawyers outlining legal
strategies for the defense of drug users.
This research was supported by NIDA/NIH Grant # 5 R01 DA17002-02 PI: LAZZARINI, ZITA . The
findings and conclusions expressed are those of the authors and not necessarily of NIH, NIDA, or the
US Government.
The development of RPAR was supported by the International Harm Reduction Development Program of
the Open Society Institute in 2001-2002.