Part VI: Implementation

VI. IMPLEMENTATION 

A. Implementation 
B. Program Launch 
  1. Regional Coordinator Training
  2. Tentative Dates & Sites Identification
  3. Recruitment of Participants
  4. Curriculum Pilot Test
C. Technical Assistance
D. Regional Education Sessions

VI. IMPLEMENTATION

A. IMPLEMENTATION METHODS

The implementation phase of the project occurred during the months of January through April 2003. Technical assistance calls were conducted throughout the project to assist the regional coordinators and troubleshoot any problems with recruitment, logistics, or evaluation procedures as they arose. Ongoing advice and assistance by telephone was also available through an identified staff member to provide technical assistance support.

B. PROGRAM LAUNCH

1. Regional Coordinators Training Workshop

The launching of the regional educational session began with the Regional Coordinators Training Workshop, a full-day session held in Ft. Lauderdale in December 2002. Over 30 regional coordinators and regional trainers from across the state were in attendance. They served as the project's representatives in the local communities in which the educational sessions were held. The purpose of the day's activities were threefold: (1) to acquaint the regional coordinators with the materials that had been developed to assist them in their outreach and marketing efforts, (2) to introduce the training curriculum, and (3) to outline the administrative procedures for implementation of the statewide sessions. (See Attachment G)

Each participant left with the outreach and marketing materials, the consumer toolkit, evaluation materials and draft versions of the Trainer's Manual.

The curriculum was presented by inviting speakers to present several of the modules as they might occur at a regional session. Given the time allowed, it would not have been possible to take participants through all the modules thoroughly, but, at a minimum, an overview was presented of all the curriculum content. Workshop participants were able to review a draft of the entire Trainer's Manual. In this instance, as in so many sessions to follow, response to the subject matter depended a great deal on the presentation skills of the trainer in front of the room. 

Participants were asked to evaluate the training workshop and suggest recommendations for improvement in the proposed format and materials. Several suggested that the focus for the training should have been on training issues rather than content. Suggestions with regard to the curriculum content were made, including further development of the materials presented, and improvements to the module on cultural considerations. Almost 90% of the participants felt either somewhat or fully prepared to facilitate the educational sessions at the end of the one-day training workshop. The evaluation results were used to design/refine the pilot test program. As the project moved forward with implementation of sessions around the state, valuable lessons were learned and suggestions were provided through the technical assistance and evaluation efforts of the Health Council of South Florida. 

The expectation at this point was that the regional sessions would be one day events. (See Attachment H) Certain modules had been designated by the Advisory Committee as "core" modules - those topics that were deemed essential to basic knowledge regarding end of life. It was, therefore, recommended that these modules be given priority in all training sessions. However from the first pilot session forward, response to the information on clergy self care (not a core module) was very positively identified by participants as among the most important information gained from their participation. In light of this feedback, and in keeping with the project's commitment to maintain flexibility, the recommendation to give priority to what management deemed as "core" was dropped in favor of the expressed needs of clergy in the community.

2. Tentative Dates and Sites Identification

Following the Regional Coordinators Training, each regional coordinator identified three to five tentative dates in the target counties for the educational sessions. A training calendar was created to guide the process and facilitate coordination among the regions.

The regional coordinators were also asked to recruit additional trainers who could provide diversity and augment the competencies of the trainers who attended the workshop. Regional trainers were strongly urged to collaborate with their local hospices and end of life coalitions. Information about the project was disseminated to the local coalitions through the Florida Hospice and Palliative Care Organization.

3. Recruitment of Participants for Educational Sessions

In order to inform the local clergy and to promote sessions, each regional coordinator identified and compiled a list of potential clergy, lay leaders, clergy groups/associations, clergy in training groups, places of worship, hospices, and leaders of community-based organizations. Each region conducted a mailing of the project marketing brochure and/or flyer to their respective target communities. Almost 5,800 outreach brochures were mailed to promote the educational sessions throughout the participating regions. The South Florida Region also conducted an initial mailing of more than 200 outreach brochures in South Miami-Dade County for the pilot test of the project. (See Table 1)

The recruitment process included:

• Identification of clergy groups/associations, community based organizations, places of worship and lay leaders.
• Selection of potential participants for the clergy sessions and mailing list development.
• Dissemination of outreach/marketing materials: mail-outs, follow-up phone calls, publication of press releases, flyers and announcements in local newspapers and religious bulletins/publications, Public Service Announcements on local radio stations, and posting the flyers on the local health councils' websites.
• Pre-registration of participants.

4. Curriculum Pilot Test

A pilot test of the curriculum, presented as a one-day workshop was conducted on January 13, 2003 by the Health Council of South Florida. Twenty-one people attended the program including ministers, chaplains, pastors, caregiver support staff and bereavement counselors. The pilot test confirmed that the program format, agenda, schedule, including the time allotments for material coverage were suitable for the educational program. The content of the modules was also extremely well received and the evaluations of the trainers received favorable scores. The Dying Process was considered the most useful program component. Based on pre-test and post-test results, about half of the participants indicated an increase in their overall knowledge of end-of-life care issues. By the end of the session, however, using a retrospective assessment of knowledge, nearly two-thirds of participants indicated an increase in their overall knowledge of end-of-life issues. They indicated that the program was of particular interest because it included not only information about death and dying, but also the options available for those at end of life, caregiving and needs of the dying, followed by self care for clergy. Many participants remarked that few programs include the importance of the clergy taking care of themselves. (See Attachment I) 

C. TECHNICAL ASSISTANCE

The pilot test program format, agenda, schedule and summary results of the evaluation were presented to the regional coordinators in a technical assistance conference call on January 17, 2003. This information was provided so that the coordinators could benefit from the lessons learned and the challenges faced during the recruitment phase and pilot educational program. A video of the pilot program was prepared and disseminated to the regions. It provided highlights of the five-hour pilot test session. It showcased some of the modules as presented by the featured speakers, captured interaction with the participants and modeled how to summarize the materials presented. Other topics covered in the technical assistance calls included the outreach and marketing materials, consumer materials, regional coordinators' toolkit, contract review and regional deliverables. Timelines and procedures were discussed in full detail. The regions were encouraged to tailor their sessions in length, time of day, and module content to the respective communities' needs and interests.

A second technical assistance conference call occurred on February 25, 2003. This call provided technical assistance to the regional coordinators on the presentation of the summary reports and the educational session evaluation results. The training calendar was reviewed for clarity and coordination. Attendance at the preliminary sessions was discussed and suggestions were provided on different proven recruitment strategies to buttress attendance. The format for the evaluation reporting process was described for the first set of deliverables as contained in the interim report. A two-page model reporting format was distributed to each region and the well-attended Hollywood Hills evaluation results were provided as a model for compiling the evaluation data for each educational session.

A third and final technical assistance call was held on April 9, 2003. An extensive debriefing occurred on the implementation of the educational sessions. A discussion was held on the profile of the participants in sessions, the best practices for recruitment such as the use of local media (TV and radio), the needs of the clergy participating in the sessions, and areas for future exploration such as advance care planning and practical guidance on how to complete the various forms (e.g., living wills, health care surrogates, durable power of attorney, etc.). Specific reporting requirements and project deliverable deadlines were also covered.

In terms of reporting tools, instruments were developed both for the regional coordinators and the statewide regional coordinator that codified the technical assistance and project oversight during the field experience. Selected items are contained in Attachment J.

D. REGIONAL EDUCATION SESSIONS

Following the pilot test (on January 13, 2003), 21 educational sessions were conducted in the six regions across the state from February 5, 2003 through April 23, 2003. (See Attachment K for a list of the sessions as displayed by health planning district.)

Each region held between three and four sessions. All sites offered the
program at different locations with the exception of Treasure Coast Health Council which conducted two at its office and were later combined as one session/site. Three regions determined that it was necessary to cancel a single session, largely due to the need to allow more time for advertisement and recruitment to take place. Only one cancelled due to poor registration in March.

Momentum was generated as the program became publicized across the local communities. "Word of mouth" advertisement in particular, prompted a surge in overall participation. During the initial 11 sessions there were 236 participants and two cancellations. In the latter sessions, there were 377 participants with a single cancellation, and an increased participation rate of nearly 60%. This informal advertisement complemented the distribution of the program flyers and encouraged more clergy to attend. As momentum grew, the project team began to realize a greater return on its investment and generated a stronger outcome of increased program participation.

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