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Developing and Using a Common Framework to Evaluate FASD Programs: Results of a Three-Year Canadian Project

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This article discusses a three-year Canadian project that created common Evaluation Frameworks for Fetal Alcohol Spectrum Disorder (FASD) support programs and for FASD prevention programs (i.e., programs serving people living with FASD and programs serving pregnant women and mothers). The project’s mixed-methods approach included a comprehensive literature search and consultations across Canada with multi-disciplinary service providers, program funders, researchers, and evaluators. These activities led to development of three visual “maps” depicting evaluation of: a) FASD support programs; b) FASD prevention programs; and c) FASD programming in Aboriginal communities. In addition, the team provided mentoring and evaluation-related support to program staff, funders and/or partners of five community-based FASD-related agencies. Informed by a social determinants of health lens, the maps are comprised of concentric rings showing programs’: theoretical foundations; activities; program outcomes; and wholistic participant, community and systemic outcomes. The article also shares findings regarding the applicability and utility of the Frameworks and of evaluation-related mentoring.
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Developing and Using a Common Framework to Evaluate
FASD Programs: Results of a Three-Year
Canadian Project
Deborah Rutman
1,2
&Carol Hubberstey
1
&
Nancy Poole
2,3
&Sharon Hume
1
&Marilyn Van Bibber
1,2
Published online: 21 October 2015
#Springer Science+Business Media New York 2015
Abstract This article discusses a three-year Canadian project that created common Evaluation
Frameworks for Fetal Alcohol Spectrum Disorder (FASD) support programs and for FASD
prevention programs (i.e., programs serving people living with FASD and programs serving
pregnant women and mothers). The projects mixed-methods approach included a comprehensive
literature search and consultations across Canada with multi-disciplinary service providers, program
funders, researchers, and evaluators. These activities led to development of three visual maps
depicting evaluation of: a) FASD support programs; b) FASD prevention programs; and c) FASD
programming in Aboriginal communities. In addition, the team provided mentoring and evaluation-
related support to program staff, funders and/or partners of five community-based FASD-related
agencies. Informed by a social determinants of health lens, the maps are comprised of concentric
rings showing programs: theoretical foundations; activities; program outcomes; and wholistic
participant, community and systemic outcomes. The article also shares findings regarding the
applicability and utility of the Frameworks and of evaluation-related mentoring.
Keywords Fetal alcohol spectrum disorder.Program evaluation .Evaluation mentoring .
Evaluation framework .FASD support programs .Social determinants of health
In recent years, the research literature and practice evidence are increasingly emphasizing the
value of a social determinants of health approach in working to prevent Fetal Alcohol
Int J Ment Health Addiction (2016) 14:472482
DOI 10.1007/s11469-015-9597-3
*Deborah Rutman
drutman@uvic.ca
1
Nota Bene Consulting Group, 1434 Vining St., Victoria, BC V8R 1P8, Canada
2
Canada FASD Research Network, Network Action Team on Prevention, Vancouver, BC, Canada
3
British Columbia Centre of Excellence for Womens Health, Vancouver, Canada
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Establishing the effectiveness of such programs has been challenging, in part because they are community-based and/or lack resources, time, knowledge, or expertise to carry out an evaluation of their programs, or they are small programs that have not been the focus of larger studies [16]. As such, many FASD prevention services have not been formally evaluated, have not had the resources or opportunities to conduct a multi-year evaluation, or their evaluations have not been published [17]. ...
... In program evaluation, a Theory of Change is created to show the interconnections between the program's philosophy/approaches; activities; and anticipated outcomes at the client/family, community, and systems levels. As part of the developmental phase of this project, the team and the Program Coordinators/Managers of the eight participating sites collaboratively developed a Theory of Change (depicted in Figures 2-4); this was based on a framework for evaluation of FASD prevention and support programs [17]. In keeping with a collaborative and community approach to developing a Theory of Change, the CCE Theory of Change was created through multiple discussions during the initial face-to-face meeting with all programs in June 2017; following this, the research team revised and finalized the Theory of Change to incorporate all the Program Coordinators' feedback. ...
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Since the 1990s, a number of multi-service prevention programs working with women who have substance use, mental health, or trauma and/or related social determinants of health issues have emerged in Canada. These programs use harm reduction approaches and provide outreach and “one-stop” health and social services on-site or through a network of services. While some of these programs have been evaluated, others have not, or their evaluations have not been published. This article presents interim qualitative findings of the Co-Creating Evidence project, a multi-year (2017–2020) national evaluation of holistic programs serving women at high risk of having an infant with prenatal alcohol exposure. The evaluation utilizes a mixed-methods design involving semi-structured interviews, questionnaires, focus groups, and client intake/outcome “snapshot” data. Findings demonstrated that the programs are reaching vulnerable pregnant/parenting women who face a host of complex circumstances including substance use, violence, child welfare involvement, and inadequate housing; moreover, it is typically the intersection of these issues that prompts women to engage with programs. Aligning with these results, key themes in what clients liked best about their program were: staff and their non-judgmental approach; peer support and sense of community; and having multiple services in one location, including help with mandated child protection.
... that provides the information and tools developed and/or compiled through the project. 21,22 what is an FAsd-informed approach? ...
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There is growing appreciation among health and social care providers, especially those working in community-based programs with women or young people with substance use problems and/or who have experienced violence, maltreatment, or trauma, that a high number of their program participants may have been prenatally exposed to alcohol or have fetal alcohol spectrum disorder (FASD). This article provides a conceptualization of the key components of an FASD-informed approach. Drawing on the emerging literature and the author's research identifying the support needs and promising approaches in working with women, young adults, and adults with FASD, as well as evaluations of FASD-related programs, the article discusses what an FASD-informed approach is, why it is centrally important in working with women, adults, and young people who may have FASD, underlying principles of an FASD-informed approach, and examples of FASD-informed adaptations to practice, programming, and the physical environment. In this discussion, the benefits of using an FASD-informed approach for service providers and women living with FASD and their families, as well as conceptualization of FASD-informed policy and systems are highlighted.
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Rutman, D., Poole, N., Hume, S., Hubberstey, C., & Van Bibber, M. (2014). Building a framework for evaluation of Fetal Alcohol Spectrum Disorder prevention and support programs: A collaborative Canadian project. The International Journal Of Alcohol And Drug Research, 3(1), 81-89. doi:10.7895/ijadr.v3i1.122 Aims: This article discusses a Canadian project that is designed to identify promising evaluation methods and create common evaluation frameworks for FASD prevention programs serving pregnant women and mothers, and FASD supportive intervention programs serving youth and adults living with FASD. A social determinants of health perspective guided the project. Design: The project has employed a mixed-methods approach including a literature search, documentary review, and an iterative set of consultations with program providers, program managers, government managers and funders, researchers, and evaluators in the context of their work across Canada and internationally. Results: The project’s processes led to the development of three visual “maps” comprised of concentric rings that depict theoretical foundations; activities and approaches; formative outcomes; and participant, community and systemic outcomes. The three visual frameworks depict evaluation of 1) FASD prevention programs; 2) FASD support programs; and 3) FASD programs in Aboriginal communities. Conclusions: The development of visual maps to depict common evaluation frameworks promotes individual and collective action towards applying the frameworks on the part of community-based services and governments across Canada, on the service and systemic levels. Program providers, researchers, and system planners have indicated that the maps have wide-ranging applications.
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Basics of community-based evaluation
  • K Hutchinson
  • K Van Der Woerd
Hutchinson, K. & van der Woerd, K. (2010). Basics of community-based evaluation. Retrieved from: http:// ebookbrowse.com/caiwebinar-basics-of-community-based-evaluation-nov-16-2010-pdf-d36769698