Second Meeting of EU Prevention Standards Partnership

Santiago, Spain, 3 & 4 September 2009 SUMMARY

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1. ATTENDANCE
Project and collaborating partners: Jess Moran Iglesias; Rachele Donini, Francesca Romani; Nadia Vimercati; Artur Malczewski; Diana Bolano, Diana Serban; Katalin Felvinczi, Katalin Simon; Harry Sumnall, Angelina Kurtev; Gregor Burkhart, Marica Ferri Other participants: Pilar Farjas Abada (Health Minister), Sagrario Prez Castellanos (Director of Public Health)

2. CONTENT OF MEETING (see Agenda)

Work Package 5 - Presentation of review of guidance: Collation and selection of documents, review methodology, findings Discussion of review and results Work Package 6 - Research: Timelines incl. Field Testing Methodology for Delphi online survey and Focus Groups Proposal for Delphi online survey questionnaire Sampling frame for Delphi survey and Focus Groups Dissemination of results: Partner strategies EMCDDA assistance Presentation of standards Phase II grant application: Discussion of appropriate funding stream Introduction to SharePoint

3. RESULTS/ CONCLUSIONS
See also summary from Savona working group for earlier discussions and conclusions. 3.1. Work Package 5 - Presentation of review of guidance LJMU presented the finalised review of standards and guidelines (see slides). The draft report documenting the review methodology was presented. The long list of standards representing a synthesis of all reviewed standards was distributed.

Changes since the presentation at Savona working group include: The Italian document was replaced with another document that was considered more appropriate for the review. The new document was translated and included in the review/synthesis of standards as well as the coverage rating. The three-level structure of the synthesis was refined and finalised. Level 1 (project cycle): no changes, the project cycle will remain as it is. Descriptions of the project cycle steps are contained in the draft report. Level 2 (components): additional components added to refine the structure - in total 46 components might be reduced through Delphi survey. Level 3 (attributes): the synthesis was finalised and the final list of attributes generated. In recognition that all three levels represent the EU standards, level 3 was renamed from standards to attributes; in total ca. 1250 attributes. It was suggested that if the standards were used to rate interventions, the rating should be conducted on level 2 (instead of level 3). The level 3 attributes would then inform which grade of attainment has been achieved on the level 2 component. This suggestion was accepted by project partners. A rating with the current list of standards is thus feasible, and a significant reduction of level 3 standards is not necessary. Coverage: Three different ways of interpretation were presented: 1) to show which documents have contributed to which sections of the synthesised standards; 2) to show which components are currently more or less broadly covered across documents; 3) to indicate potential areas for improvement in national documents. It was agreed that this interpretation explained the table and its purposes clearly. The rating distinguishes between information given in a checklist or summary box in the document, and information given in the remaining text. This distinction enables a better comparison of the different documents, and an assessment of the importance assigned to a component. In light of the considerations raised by the Savona working group, the numerical rating of individual country documents was removed. Members of the Savona working group concluded that their considerations (e.g. purpose of the rating, level of detail) were well incorporated in the final results and presentation; the new coverage rating was accepted. Guidelines: No changes since Savona presentation. It was confirmed that the research should focus on quality standards only. Guidelines will be referenced and presented in their entirety. Discussion: The draft report and list of standards were generally accepted. The question was raised how the list of standards will be updated to include new national developments. It was agreed that at the current stage the list of standards will constitute the benchmark for national standards, i.e. countries need to update their documents in line with the newly developed EU drug prevention standards. The importance of an update of the list of standards in the future was recognised. This is beyond the scope of the current project and could form a part of the Phase II project. Specific interventions were excluded from the review, however the report will include an overview of specific interventions. A review of specific interventions might form a separate, new project (proposed by EMCDDA). It was also discussed how the findings of this review could be utilised in other fields. The review methodology of synthesising documents might be of interest for other areas where a range of different standards exists, and EMCDDA proposed to publish a corresponding methodological report. The list of standards could also be adapted to other areas (see http://www.adapte.org/). However this type of dissemination would have to form part of the Phase II project.

It was noted that it can be difficult to gain an overview of the standards content. For example, due to the chronological structure of the standards, aspects of staff qualification and staff development can be found under 5.4 Setting up a competent team, 7.1 Training staff before implementation, and 8.4 Supporting staff during implementation. A solution should be found to increase the usability of the standards for the reader (e.g. providing an index).

3.2. Work Package 6 - Research A) Timelines incl. Field Testing (see last pages of slides) The aims and timelines for work package 6 were presented. It was discussed whether to merge Focus Groups and Field Testing. It was decided not to merge Focus Group and Field Testing. Changes to previous agreements: Only 1 day of Field Testing will be held (instead of 1-5). Timeline: 1 day of Field Testing in June or July 2010. Report on this session to be delivered to LJMU by end of July. August and September 2010 will be used to analyse the results. Field Testing is different from Focus Groups: Different audience (practitioners and users, rather than policy makers), Discuss standards as a whole (and not only individual components); Focus is on implementation of final standards (rather than changing draft list of standards); Might include feedback on rating system to be provided with standards. Further details on Field Testing methodology to be discussed at Milan meeting (June 2010). Approximate timelines (especially deadlines for reports) are available on SharePoint calendar. EMCDDA suggested to use EDDRA level 1 projects for field testing phase, and this option was discussed. It was noted that in some countries there are not many EDDRA level 1 projects, or that these are not the most relevant contacts to retrieve information from. It was concluded that the face-to-face field testing session will be sufficient. B) Methodology for Delphi online survey and Focus Groups As requested by the Savona working group, a detailed handout outlining the Delphi survey and Focus Group methodology was presented. The methodology was accepted by the group. A report is available on SharePoint documenting previous consultations conducted by LJMU. Most relevant is Chapter 2 (page 29ff) on Methods. It was agreed that partners read this chapter in preparation for the Focus Groups and Field Testing sessions. The allocation of standards to partners for the Focus Groups was discussed. It was clarified that the allocation takes into account that: all standards must be discussed by two different partners, all partners must discuss a similar amount of standards, the same standards must not discussed by both Italian partners; standards are distributed between Western and Eastern European partners (not always possible); standards were allocated to partners who have these topics also in their regional/national document (not always possible). Content Focus Groups: It was highlighted that Focus Groups need to incorporate the reality of drug prevention, and not only what would be ideal. It was discussed whether Focus Groups need to reach consensus. It was concluded that it is not necessary to reach agreement in the Focus Groups. Disagreement will show how the standards need to be improved or tailored to different target audiences (e.g. content of standards, weak points and difficulties, implementational issues). It is important to record all results of the Focus Groups.

Example invitational letter and agenda: It was highlighted that the example letters and agenda contained in the methodology booklet are examples. Partners should adapt the agenda to their own needs, e.g. it is possible to have half days instead of full days. The invitational letter may also include the address of the survey, so that participants can access the survey directly without having to return the contact form. (The form is a requirement in UK as proof that participants have given their consent to participate in the survey.) Invitational letters should be personalised (e.g. not Dear Sir but Dear Mr. Smith) to increase the response rate.

C) Proposal for Delphi online survey questionnaire The draft questionnaire for the Delphi online survey was presented and generally accepted. The layout of the questionnaire needs to be clearer (e.g. question 31 I would like to develop my skills in this area as a separate question). An additional question was requested regarding what professional roles/ backgrounds are considered best to conduct/ implement drug prevention programmes (i.e. in Italy mostly psychologists other roles?). It was proposed to rate the priority of components rather than their importance in order to avoid high ratings on all components (i.e. everything may be important, but not everything is a priority item). st It was agreed that if a component is not approved at all in the 1 round, it will not be included nd in the 2 round of the survey. Countries may add 1-2 national questions that will only be asked in their country version of the questionnaire. These questions (and corresponding possible answers) need to be submitted to LJMU in English and the national language by the end of October. 3.3. Delphi and Focus Group sampling frame The 10 sectors to be covered were presented, as well as core roles that must be covered by all partners (1 core role per sector). Each role has been assigned to only one sector. The sampling frame consists of mandatory core roles (same across all partners, or choice between 2 roles) and additional roles that will vary between countries. Minimum numbers of additional roles are specified for each sector. To ensure availability of core roles across partners, two options are offered where no role was available for all partners. Each partner should contact at least 75 persons (several persons per role). Availability of roles was discussed with partners, and some partners indicated availability of additional roles. The sampling frame was updated after the meeting to incorporate these additions. The final and updated documents consist of the sampling frame and the sampling guide. Identification of participants in terms of sampling frame: Participants will receive partner-specific URLs to retrieve the questionnaire (e.g. http://www.survey.ljmu.ac.uk/UKstandards1). There will be no usernames/ passwords, no specific login-procedures. It was agreed that this will facilitate participants access to the questionnaire. It was decided that the invitational letter (or the letter with the URL to the survey) should include a code that participants have to enter in the survey. This will enable their identification in terms of sampling frame categories. The Delphi online survey will include a field where this code can be entered.

It was discussed how partners will know if they are fulfilling the requirements of the sampling frame. It was agreed that after recruitment (i.e. sending out invitations) partners will send LJMU a list of who they have contacted and how these individuals correspond to the sampling frame (LJMU will send an example of how such a sheet could look like). In the middle of both rounds of the Delphi questionnaire (after the first week of each round), LJMU will send information to partners on who has answered the questionnaire. This will enable partners to follow-up missing participants in a targeted manner.

3.4. Dissemination of results A) Partner strategies Partners presented strategies on how to disseminate the results of the findings in their regions/ countries. UK presented their dissemination strategy visually (see here). Similar categories across the dissemination strategies emerged (e.g. dissemination through printed and online reports, publications in other media, routine e-mailing lists, existing annual conferences, training, online information portals for professionals, certification systems, local administrations etc.). It was noted that the contacts generated through Delphi survey, Focus Groups and Field Testing could be used for dissemination of the standards. It should be distinguished between dissemination channels that are directly under control of the partner organisation and other possible dissemination channels that are not under direct control of the partner organisation. Some partners already have the necessary frameworks to provide (regional) training before the Phase II project (e.g. Italy-ASL2 would incorporate standards into annual training course for teachers in the region). Other partners could learn from this experience, i.e. how to incorporate training in the standards into existing training frameworks. The Italian partners noted that they have additional experiences on this topic from the earlier Religo project. The Polish partner raised the issue that the Polish national standards and the EU drug prevention standards will be published and disseminated at the same time, which might cause confusion. It was noted that the Polish (draft) standards are fully included in the EU standards, and that the EU document would therefore present additional standards, but would not be in contradiction or conflict with the Polish national document. The importance of costs influencing the dissemination strategy was noted (i.e. less printed materials, more online dissemination). The involvement of other agencies, such as the Canadian Centre on Substance Abuse or the United Nations Office on Drugs and Crime (UNODC), was highlighted. The UNODC have agreed to disseminate the results of the project through their own channels (e.g. website e.g. http://www.unodc.org/youthnet/youthnet_action_planning_activities.html, mailing lists, conferences and other events). B) EMCDDA assistance It is intended to publish the findings as an official EMCDDA report. A final conference in Lisbon with Focal Point presence to launch the report was suggested. There is no official commitment from the Reitox network. It was noted that the Reitox manager is aware of the problems regarding the Focal Points visibility and sustainability. The standards project will be presented at the next Focal Point meeting in November as an example of how Focal Points can achieve relevance, visibility and usefulness at the national level. The importance of translating the standards for dissemination was highlighted. Funding from Reitox could be used to finance translation of the standards. Focal Points should be asked how their national/regional standards are disseminated and implemented, and how mandatory they are (e.g. part of a certification system). This could inform

the dissemination of this projects findings, as well as put pressure on the countries to disseminate their standards. It was suggested to disseminate information on the programme via the EMCDDA Drugnet newsletter and at the EDDRA manager meetings. It was agreed that information on the Drugnet newsletter should be provided when the standards are ready for dissemination (e.g. with a link for download). Standards will be the topic of the next EDDRA manager meeting, and the standards project will be presented at that meeting.

C) Presentation of standards It was suggested to produce different sets of standards for different target audiences (e.g. policy makers, practitioners) that would include only those standards relevant to these groups (e.g. standards on funding for policy makers; standards on cultural sensitivity for practitioners). However it was argued that all printed documents should have the same content (i.e. all standards included); only the format of presentation (i.e. the appearance) should differ and match the target audience. Producing different sets of standards would dilute the outcomes of the project. In the online version, it would be possible to select only relevant standards. It was highlighted that the standards should be the same for all target audiences at level 1 and level 2, and only at level 3 standards should be targeted for different groups. It was suggested to provide an additional document on practical issues connected with implementing the standards (e.g. findings from Field Testing). It was noted that the types of target audience might differ between partner countries/ regions. 3.5. Phase II grant application The development of standards and guidelines is highly valued in EMCDDAs 3 years working plan and in the new EU Action Plan. EMCDDA proposed to set up training academies (like EU-DAP faculty) for the training of trainers, and to propose in analogy a prevention standards training faculty for JLS funding. An official commitment from Reitox might be possible in future years. EMCDDA is planning to set up a European Society for Prevention Research. A relevant EU funding stream was presented (see slides) in line with the earlier agreement to apply for a follow-up project. The suggested Phase II matches the identified call for proposals in several priority areas. Max. 500.000,00 are available under this call. All partners are eligible for application (checked with EU). All partners were interested in participating in the grant application. It was discussed whether to involve other partners. Several EU countries (e.g. Sweden, Germany, Czech Republic, Ireland) would probably be interested in participating. It was also discussed whether to involve European countries that are not part of the EU, as well as countries outside Europe (for example Canadian Centre on Substance Abuse (CCSA)). However, the number of project partners must be limited to ensure cost-effectiveness and feasibility of the project. (to be discussed further at Poland meeting) A meeting focussing on the grant application will be held in Poland at the end of 2009. This meeting will be independent of the current project. Travel, accommodation, and meals will incur at partners own expenses. It was decided to hold this meeting earlier than originally intended (December 2009 latest February 2010). Partners (who), activities (what), budget and timelines need to be agreed at that meeting. It needs to be decided whether the actual training would be sub-contracted to other agencies (e.g. national drug prevention charities, or a European-wide organisation). However subcontracting would increase the costs of the project. One session of the meeting will be used as an informal update on the standards project.

3.6. Introduction to SharePoint The SharePoint site was presented and its functionalities were discussed. Partners welcomed the site.

3.7. Other issues The Galician Health minister welcomed the participants and expressed her interest in and support for prevention work in general and the standards project in particular. Marica Ferri was introduced to the participants. She will be commencing her work at the EMCDDA in October 2009, and will be responsible for the EDDRA database and the support of the standards project. Final report: It was suggested to include a section in the final report showing how politics and individual national cultures influence drug prevention practice, e.g. how institutional changes (new government, changes in personnel responsible for drug prevention) impact on drug agencies work as developments that are outside of drug agencies control. This suggestion was accepted. Such a chapter could include individual sections submitted by each partner or one chapter spanning across partner countries. It could also draw on EMCDDAs report on national drug policies (2006). Volunteers would need to be identified to produce this chapter of the report. Partners agreed that such volunteers would be available. In line with the suggestions adopted by the Savona working group, it was agreed that the final report needs to include practice- and policy-oriented conclusions and recommendations for the future (next steps). These recommendations should emphasise the need for continuity and stability despite political changes, and the need to implement the newly developed standards. Financial report: Partners only need to fill out the sheet sent out by Sue Jackson (no invoices or time sheets to be submitted now). However receipts as well as time sheets should be kept for later audit. The larger part of the funding for the first year should have been spent already, a small amount can be carried over to the second year. The spent money should show everything, including co-financed expenditures. Budgeted accommodation at official meetings consists of 2 nights for 2 persons. Expenditures in relation to the Savona working group should be listed under Other costs. However this amount cannot be very high. It is possible to list some elements such as flights to Savona under Travel. Financial issues: An issue that concerned most partners is that public officials / civil servants are not eligible to receive the grant as paid income. Thus they are working towards the project without receiving additional pay. Only sub-contracted staff (e.g. consultants, temporary staff, third parties) are eligible to be paid out of the received funding. A related topic was that the fixed salaries are not as high in the partners countries as was agreed in the funding application, therefore the money cannot be spent on salaries. The main costs should ideally be under for public officials, however due to these limitations most costs currently fall under not for public officials. It is not clear what else (other than salaries) the funding could be spent on or how this amount could be justified, as salaries represent the main cost item in projects. The Spanish partner requested an official document from LJMU documenting the agreed fixed rates regarding daily allowance etc. For the grant application regarding Phase II these financial issues must be resolved.

It was decided to inform the EU of the situation, and it was suggested to write a common letter to the EU project officer asking for advice.

The following conferences were advertised, and partners participation in these conferences was strongly encouraged: 24-26 September 2009: 20th annual ESSD conference (European Society for Social Drug Research). Belfast, Northern Ireland. http://www.essd-research.eu/en/upcomingevents/annual-conference.html (LJMU - oral presentation on standards project) 1-4 November 2009: The 6th International G-I-N Conference (Guidelines International Network). Lisbon, Portugal. http://www.gin2009.net/ (LJMU - poster on standards project) 25-29 April 2010: Harm Reduction 2010. IHRAs 21st International Conference. Liverpool, England. http://www.ihra.net/Liverpool/Home 7-9 June 2010: Club Health 2010. The 6th International Conference on Nightlife, Substance Use and Related Health Issues. Zurich, Switzerland. http://www.clubhealth.org.uk/conference/ 21-24 September 2010: The Safety 2010 Conference. 10th World Conference on Injury Prevention & Safety Promotion. London, England. http://www.safety2010.org.uk/

4. ACTION ITEMS
Who Poland ASL-Milan All partners Action to take MEETINGS Send possible meeting dates for beginning of December to LJMU Send possible meeting dates for end of May/ beginning of June to LJMU Agree on dates for both meetings via Doodle (will be sent out by LJMU) DRAFT REPORT & LIST OF STANDARDS Provide feedback on draft report and long list of standards to LJMU (Word versions for track changes are available on Sharepoint draft report word, standards word) Confirm that publishing details of new document included in review are correct Deliver technical report METHODOLOGY Plan/organise Delphi survey, Focus Groups, Field Testing session (participant recruitment, necessary resources etc.) Design codes for sampling frame identification Update example invitational letter to include code for sampling frame identification Provide 1-page overview of Methodology with key facts (e.g. how many people) SAMPLING FRAME Check updated versions of sampling frame and sampling guide (some changes made after Santiago meeting!) Send sampling frame to LJMU indicating chosen core & additional roles and which persons have been contacted Send sampling frame for UK as example to partners Send updates on response rates during both survey rounds DELPHI QUESTIONNAIRE Provide feedback on Delphi survey questionnaire Provide feedback on training needs section in Delphi survey questionnaire Translate the questions and other necessary text for the questionnaire Optional: If partners want to include 1-2 national questions provide these questions (and corresponding answers) in English and own language Report on Delphi Survey Translate phrases for questionnaire software (i.e. buttons, error messages etc.) Write descriptions of components or steps for Delphi survey More Info tab Send partners what needs to be translated for survey Finalise Delphi survey incorporating feedback Deadline Mid-September October 2009

All partners

End of September

Italy LJMU All partners LJMU

October 2009 December 2009 Autumn 2009 September October October 2009

All partners

November 2009 December 2009 November 2009 Jan/Feb 2010 Beginning October Beginning October End of October End of October

LJMU

All partners

February/March 2010 28 September Beginning October Beginning October Beginning November

HU, PL, RO LJMU

All partners

LJMU

All partners

LJMU

All partners EMCCDA

All partners

LJMU

All partners

LJMU

HU LJMU

FOCUS GROUPS Let LJMU know if they disagree with the components they have been assigned to cover in Focus Groups Read field testing report chapter 2 Deliver report on Focus Groups Deliver summary report of research (incl. Field Testing session) Prepare a presentation that partners can translate/adapt and use for the introduction at the Focus Group meetings DISSEMINATION Send LJMU their Powerpoint presentations on dissemination (from Santiago meeting) for upload on SharePoint Produce visual summary similar to LJMU and send to LJMU Send practitioners tools (e.g. check list for quality standards, also from other areas) to LJMU Decide on format of rating, e.g. narrative, checklist, numerical Summarise dissemination strategies Collect tools on how to train practitioners PHASE II Prepare funding bid for second project phase (training of practitioners) Ask Focal Points how national/regional standards are disseminated and implemented, and whether standards are mandatory (e.g. part of certification system) SHAREPOINT Register with SharePoint Submit e-mail addresses of colleagues who need to be added to SharePoint (LJMU will then send invitation) Contact LJMU if any problems registering or using site Send pictures from meetings to LJMU for upload to SharePoint Upload pictures from meetings Clarify how Sharepoint members can update details Provide links to guideline databases such as GIN, SAMHSA etc. FINANCIAL Submit sheets for financial report Resolve financial issues Write common letter to EU project officer asking for advice Send Spanish partner official document from LJMU documenting the fixed agreed rates regarding daily allowances etc. OTHER Katalin Felvinczi to forward information on similar work by Pompidou Group Check if/how Pompidou Group work should be integrated

January 2010 Jan/Feb 2010 April/May 2010 July 2010 Jan/Feb 2010

November 2009 November 2009 Ongoing Milan meeting Spring 2010 Ongoing December 2009 March 2010

September 2009 September 2009 September 2009 October 2009 October 2009

Mid-September December 2009 November 2009 October 2009

September 2009 Autumn 2009

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