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Steering Committee Notes
Face to Face: June 6, 2000

 Steering Committee Meeting Notes

June 6, 2000

10:30 a.m. – 3:00 p.m.

Embassy Suites

Washington, D.C.

Presentation of Implementation/Fidelity Assessment

Sharon Togut & Matt Johnsen, R.O.W. Sciences, Inc.

Matt talked about the COSP FACIT pilot results.  The traditional site or the COSP chooses members of the focus groups.  Packets of materials are provided to the sites.

Sharon mentioned that a year and a half has passed and that there are new sites and services offered that need to be added to the Service Matrix.  She asked that people look through the Service Matrix, look through all the services, check their sites, and make sure this list is inclusive of all the services that people who enter your program could potentially receive.  There is a key in the back that tells you exactly which programs are being described.  Please return your updated information by June 23.

The Service Matrix was passed out and opened up to discussion.  Susan objected to the matrix, and said that services listed did not reflect reality for their programs.  She wanted the minutes to read: “That characterization of the services people in the control group receive come from the client interview rather than what is put on this grid.”   Sharon explained that a program might change within 18 months in their service delivery model, and that these changes were not relayed to them.  This was the point of her passing out the matrix and asking for updates.

All sites have been visited.

All of the reports from reviewers have not been returned, but R.O.W. hopes to get them soon.  The site reviews are eco-centered approaches that focus on the relationship of one organization to the other service delivery organizations within the network. We look at exchanging information in the referral process, both referring or receiving referrals from other organization, and in the transferal of information from one organization to the other. 

Mark asked how the service integration would be conducted.  Matt responded that we would use the grantee center and how integrated they are with the other service providers.  Prior to each site visit, they blind the sites, and will concentrate on the grantee center.  R.O.W. is using the same questions, review forms and other documents used in the

ACCESS project, which has had previous publications.  Lorraine asked how service integration worked in the ACCESS program.  Matt explained that early in the demonstration the ACCESS program found a relationship in system integration and improvements in client symptoms.  The predominate effect was found in housing, however, not in substance abuse and psychiatric symptoms.

Steering Committee Working Lunch.

Cost Subcommittee Report

Brian Yates, Chair

Visits will be the basic unit of consumer participation with conversion to hours according to side studies at select sites.  Consumer participation will be reported quarterly. A spreadsheet has been developed for that.  Each consumer who is in the COSP, except for Connecticut and Pennsylvania, will report the number of visits to the COSP and the TMHS separately for each quarter.  For each consumer in the TMHS alone, except for CT and PA, the number of visits will be reported each quarter. The data collection is in quarters and it will be in sync, as Rita suggested, with the schedule already developed for the Common Protocol. The unique ID numbers will be the same as in the CP and will be used to report visits.

Budget figures will be used for the COSP.  Track 1 for all sites, Track 2 as sites wish.  All sites will report volunteered activities and donated resources.  There will be two sets of input cost figures, one that will include and one that will exclude volunteered activities and donated resources, so that both perspectives will be presented. Brian will put his summary on the freedrive.

Research Subcommittee Report

Greg Teague, Chair

The mission of the committee was to further elaborate the research questions through integration with the CC’s analysis planning. It was suggested that the committee identify the hierarchy of hypotheses (revise logic model).  Another suggestion was that we have primary hypotheses that would be used for power analysis. A preliminary CAP discussion led to the phrase “I am not alone”, and other aspects of social inclusion and empowerment that should be measured.  

Work groups need to be identified.  The process of getting work done means:

·        Significant use of designated listserve

·        Periodic synthesis of content (by subcommittee chairs, a few reasonable people, and the CC)

·        Conference calls as needed

·        Ad hoc f2f meeting

·        Referrals to Publications Subcommittee (This is unclear at this time.)

·        Work groups self-defined by participation

·        Timelines: implications for cross-site baseline analysis plan by 2001

Matt said that one of the elements brought up in the Common Ingredients meeting was the system integration.  He suggested it be rephrased.  Greg said that is what we need to do with the logic model to make the language clearer.

Greg explained that there were several categories of research questions and hypotheses in the research plan from the CC report.  It was suggested that this become the framework for thinking about the types of questions and analyses there are.  The work group should follow the content.  A memo was put out to articulate some of the subdomains of a research question that needed to be more specific.  Greg said that there was no response to the memo that he and Rise sent out on the frameworks.

Logistics Subcommittee

Sarah Lickey-Diwan

Some sites are experiencing recruitment fears (fears of being randomized to control, maximum length of time between baseline and COSP utilization, eligibility criteria for TMHS due to varied interpretations of logistics manual, and eligibility criteria for COSP due to the restrictions of three or fewer visits within the past six months). 

Tracking issues include: Will the Tennessee tracking database meet quarterly report needs?  The answer is yes.  What can sites track in common in terms of COSP utilization?  The answer is date of first (TN database and COST), last (a rolling date), and withdrawal from COSP attendance (TN database)).  What should first quarterly reports include?    Tracking and attendance are all OK. 

In answer to a question, Sarah said a date field was in the Tennessee database.  It was decided to add a field to the Common Protocol that records that date of first use.

The CC requested uniform multi-site policy for four different things:

·        For assessing competency to give Informed Consent.  Sarah said the committee realized that we actually do have somewhat of a uniform policy and that is, we all follow our local IRB guidelines.

·        Collection of information on people who don’t want to be a part of the study.  The committee decided as a group to stick with “No” means “No” principle and local IRB policy.  Some sites might want to collect some information on a person that is visibly accessible, for example, how many males and females there are.  If any local sites want to do that they should check with their local IRB policies before pursuing it.

·        Do we want to have the COS staff blind to the identity of study participants?  The advantages of keeping the COSP staff blind are that it avoids having a two-tier kind of system where their research participants get some kind of special attention or special outreach that the others don’t get.   One disadvantage is that it limits our ability to do outreach, to get our numbers up and to get people involved.  Another disadvantage is that two of our COSPs cannot keep the COSP blind because it is completely impossible for at least two of the sites, and it was clear that a multi-site policy for blinding for COSP wasn’t possible.

·        Research blind and all associated nuances were assigned to the Logistics Committee, but it is going to follow the FRP principle, and I believe that one of the first things we’ll be taking up on the list serve after this meeting.

The following plans are in place for contacting or reinforcing follow-up interview participation:

·        2 month phone call to check in

·        Same interviewer

·        Thanks and reminder letters

·        Call in advance

·        Call several times over the 4 month window

CAP Subcommittee

Zahira Duvall

Five chapters are complete on the book.  She thanked Rise for her technical assistance on the statistical analysis portion of the CC presentation. Work on the book will continue over the listserve. 

There was a small discussion clarifying the issues with the baseline data collection, analyses, and the implications of having a scientific blind.   Brian said that the logistics manual states that the baseline data should be examined by individual sites and by the multi-site study after three months of data collection, and periodically thereafter. The committee wants to know if it is OK for the sites to talk about the baseline data.  Crystal said it was fine to look to the baseline data to tell about your recruitment, but cautioned there should be no discussion about outcomes.

Next Steps

Tom Summerfelt, SC Chair

Tom made the following announcements:

·        The September 9-12th Face to Face will be held at the Embassy Suites in Washington D.C.

·        Pat Corrigan is the Year 2 Steering Committee Chair

Tom congratulated the group on the collaboration of people with different expertise.  He felt the group is able to work together very well.

To do list:

·        Postings to the freedrive

·        Tracking data base and manual

·        Glossary from CC (Zahira asked for more plain language)

·        F2F June 2000 presentations

·        Multi-site analysis (Joe and Rise)

·        Cost Study (Matt and Brian)

·        Research (Greg)

·        Logistics (Sarah)

·        To Dos

·        Timeline

To Do Lists

The CC list:

·        Update the Calendar on the website on an ongoing basis

·        Develop an interim scientific blind policy for SC review

·        Create a descriptive narrative about standard processes for estimating volunteer and donated resources

·        Post the June F2F minutes for review

·        Communicate with sites about future meeting dates, time and lodging information

The SC List:

Tom said everyone should have received two copies of the brochure and a voting sheet to give input/approval to Rita.  A lengthy discussion ensued.  Susan and Brian added their personal perspectives about the inequality of the information contained in the brochure.

Other concerns about the brochure were:     

·        Who gets the brochure?  (anyone who needs a first introduction to COSP)

·        Space proportional to site representation on the SC

·        Inserts (group opted to “ditch the insert”)

·        Amount of space allocated to each site (CC to advise sites)

·        Publication of sites’ telephone number (contact info is site’s decision)

A motion was made by Susan that, “Descriptions of the COSP multi-site Study intended for distribution beyond the COSP participants will give equal emphasis to the individual sites, the CC, and the Federal Representatives, in proportion to their membership on the SC.  Descriptions of the sites, the CC, the Federal participation will have an equivalent level of detail.  Such materials will drafted in a manner so that the reader will be left with the impression that the individual sites, the CC and the Federal Government are equal stakeholders in the project.” 

Brian seconded the motion, but proposed striking the language of equal and proportionate to their votes since the CC and Feds only get one vote and the sites get twice as much.

Susan said she was happy with that.

Zahira expressed impatience with the extended discussions and time spent trying to get approval for the brochure when she needs the brochure NOW.

Tom said that since there were no objections the motion passed unanimously.

 Other SC chores:

·        Develop new quarterly reporting format that removes duplicative efforts by sites and CC

·        Formulate a process for input/modification of interviewer procedures

·        Agenda for next conference call (Friday, June 30)

1.Brochure

2. Study blind

All:

·        Ensure that F2F minutes are available for review

·        Cost identification of side study collaborators (Brian)

·        Research: RQ articulated and posted

·        Logic model revisions

·        Primary hypotheses identified for power analysis

·        Logistics (Plan to review decisions in light of baseline data, develop and post fully articulated scientific blind motion with nuances)

  The CAP List:

·        Continue to work with CI Book

·        Work at coordinating representation throughout work group to ensure adequate representation of CAP members

The Sites’ List:

·        Make a renewed commitment to meet deadlines with proper notice, especially quarterly reports and data submission

·        Continue to educate and communicate within our own sites

·        Response to Teague and Goldstein memo to the listserve of 5/19

Timeline:

·        Year 2 through Year 4 timeline (R.O.W. could begin to analyze baseline data as early as July or August.  Program implementation and Fidelity Assessment are ongoing.)

·        Site visits will begin in Year 3

·        Preliminary preview of baseline data results could be shared with committees as early as January

·        Follow-up questionable due to lack of consensus on study blind

·        Reporting out of preliminary results of FACIT could begin as site visits are completed

·        In Year 4 the final twelve-month interview and data analyses could occur in April 2002.

Brian asked if the CC could realistically handle the projected May 2002 ending date for baseline data collection?  The feeling was July and August would clearly not be enough time to analyze the data, that four to five months would be better.   Another concern was if money would be available for Year 5.   The CMHS would probably have to budget more money at the end of the study so people could continue to write papers.   Tom said there is recognition that a no-cost extension will probably be necessary.   Tom encouraged everyone to participate in the discussion, and said he hoped to have a finalized timeline by the September F2F.

Matt thanked Tom for his leadership over the past years.

 Meeting adjourned.