1. I HEART QM: ONE CBO’S
EXPERIENCE WITH QUALITY
MANAGEMENT
Joshua Ferrer
Cascade AIDS Project
August 15, 2011

2. Summary
Diffusion of Effective Behavioral Interventions (DEBI)
Outcome Monitoring and DEBIs
Community-based Organization Behavioral
Outcomes Project (CBOP)
Cascade AIDS Project (CAP) and CBOP
Results from CBOP
Lessons Learned
Tips for CBOs

3. DEBI Project
Consists of twenty-nine individual, group and
community-level interventions.
Opportunity for CBOs to implement evidence-based
interventions to prevent spread of HIV & STDs.
Rigorously evaluated and proven effective.
Clinical settings vs. “real-life” settings.

4. Outcome Monitoring
Measures outcomes by collecting data before and
after an intervention occurs.
Examples of data include client attitudes, skills,
beliefs.
Answers the question: “Did the expected outcomes
occur?”
Does not address causality.
Can present challenges for CBOs to conduct.

5. CDC and CBOP
In 2006 CDC awarded funds to seven directly
funded CBOs to implement outcome monitoring.
Conducted on Healthy Relationships (HR).
Baseline data collection from December 2006 –
January 2008 (14-month period).
Goal of 100 participants enrolled at baseline with
80% retained at 90-day and 180-day follow-ups
per CBO.

6. Healthy Relationships
Group-level intervention for HIV+ individuals.
Intervention study conducted in Atlanta from 1997-
1998.
Randomized control trial showed several positive
effects on sexual risk behavior of intervention
participants.

7. Cascade AIDS Project
Largest ASO in Oregon and SW Washington.
Serves Portland-Metropolitan area.
Over 70% of PLWHA in Oregon reside in area.
Directly funded by CDC since 2004.
From 2004-2006 offered HR through sub-contract
with other CBO.

8. CAP and CBOP
HR sub-contract brought back in-house Fall 2006.
Hired Prevention with Positives Coordinator and
Research Project Monitor.
Re-branded intervention as +alk.
Target population for intervention of MSM.

9. CBOP Recruitment
Medical & social service providers.
Internet outreach (i.e. Craigslist).
Printed materials and advertisements.
Refer a friend program.
Targeted cycles with other groups (i.e. bear and
leather community).

10. CBOP Recruitment
Internal referrals
Creating link between housing/care & prevention.
All-staff presentations and updates.
Referral contests and recognition of staff.
Training on providing prevention messages for care
staff.

11. Quality Management
Established agency-wide quality management
committee.
Increasing awareness of quality management and
outcome monitoring.
QM moment at all-staff meetings.
Inter-departmental Plan, Do, Study, Act (PDSA)
cycles.

12. CBOP Results*
Baseline 105 participants
90 –day 78 participants (74%)
180-day 75 participants (71%)
Incentive offered at each data collection point.
Strong willingness of individuals to participate.
Several factors behind high retention rate.
Follow-up data collection offered opportunities to
provide referrals into additional care and services.
* See Heitgard JL et al. Reduced Sexual Risk Behaviors Among People Living with HIV: Results from the Healthy
Relationships Outcome Monitoring Project. AIDS Behav. 2011 Mar 9. (Epub ahead of print).

13. CBOP Results
Overall participant risk behaviors declined at 90-
day and 180-day follow-ups.
Number of sex partners and sex events.
Number of unprotected sex events and sex events while
intoxicated.
Mean number of unprotected sex acts remained
high.
Baseline 90-day 180-day
CAP 57% 56% 48%
All CBOs 41% 29% 26%

14. CBOP Results & Serosorting
Data does not reflect whether participants engaged
in serosorting.
Anecdotal evidence suggests high rates of
serosorting amongst CBOP participants.
Intervention as written and piloted in late 1990’s
did not account for presence of serosorting.
Implications for prevention with positives and public
health.
Changes to our implementation of HR as a result.

15. Lessons Learned
Change in culture of organization and attitude
towards role of QM.
HIV+ individuals can be successfully recruited into
outcome monitoring.
Outcome monitoring provides:
A useful and effective way to ensure programs are
achieving their desired results.
Opportunity to make programmatic changes to reflect
an ever changing and evolving disease.

16. Tips for CBOs
Creating agency-wide buy-in.
Pointing to cost effectiveness.
Don’t underestimate willingness of program
participants to help.
Importance of closing the loop.

17. Acknowledgments
The HR/CBOP team at CAP
Michael Anderson-Nathe
Bethany Carey
Adrian Sanchez
Michael LaClair
CBOP Project Officers and staff at CDC
Fellow CBOP agencies
Individuals participating in HR/CBOP at CAP