Funding best practices, interview with a funder. The Mpowerment Project.

We had the opportunity to interview Jonathan Radigan about funding HIV prevention initiatives like the Mpowerment Project. Jonathan works at the Vermont Department of Health. Jonathan is the Training and Technical Assistance Specialist for the HIV, STD and Hepatitis Program. Jonathan has 22 years experience in the HIV prevention field, the last 12 years at the Vermont Department of Health. 

RELATED:  What is the Mpowerment Project? Download Module 1: Mpowerment Overview.

Carlos (GLAM), Jonathan Radigan  (VT DOH) and Mike (GLAM)

Do you think it is important that Health Departments (HD) continue to fund and fully support behavioral interventions like the Mpowerment Project (MP)?

Our state relies on CDC to fund nearly all of our HIV prevention efforts. There is an emphasis on biomedical interventions like antiretrovirals (ARV) adherence for PLWH and PrEP for negative people at high risk for HIV acquisition because they’re highly effective.

At the PrEP Forum in March of 2014 , Greg Rebchook of the Center for AIDS Prevention Studies (CAPS) pointed out that “bio-behavioral” might be a better term for these medication-centric interventions. For PrEP or ARVs to work best, people will engage in a host of behaviors to protect their health, avoid transmission or improve outcomes. One needs to make and keep medical appointments and take these meds as prescribed. Condoms or low risk sexual behaviors will remain part of the mix for many patients to help stop the spread of other STIs that PrEP and ARVs don’t address.

Based on all of this, it seems logical and perhaps essential that HDs continue to fund and support behavioral interventions like MP when they are inclusive of biomedical options. 

How can community level interventions like MP continue to be relevant given the advent of PrEP and an increased focus on testing and treatment for HIV?

If PrEP, testing and ARV treatment are viewed as having bases in behavior – and – if young gay, bi and other MSM continue to represent a disproportionate number of HIV and other STI cases – then community level interventions like MP are relevant.

MP has multiple entry points for young MSM: as volunteers in Advisory Group, Formal Outreach and Core Group and as participants in M-Groups or sponsored social events. These components offer both structured and unstructured opportunities for gay and bi men to connect and communicate.

Participation in MP components can prompt conversations about PrEP, ARVs, boyfriends, hook-ups, hand-jobs, condoms and more. This emphasis on peer-to-peer communication about health and happiness enhances MP’s relevance.

Carlos, GLAM coordinator attending the Mpowerment Training.

Have you ever found yourself in the position of being a champion for MP? Have you had to defend its continued use?  If so how did that go?  What did you say?

Independent analysis demonstrates that MP can be highly cost effective (Rand), yet the need for anywhere from 1.5-2.5 FTE to run the intervention can give community planners and HDs pause. I find that people recognize the value of this project once they understand the premise.

"I don’t have to work to defend MP,
rather, I have to work to fund MP."

That said, it can be really difficult to find the resources needed, simply because there’s so little funding available to our state and the funding priorities aren’t a perfect fit for our low incidence and prevalence. I don’t have to work to defend MP, rather, I have to work to fund MP.

The MP project we support has taken initiative to include the full range of biomedical options into their MP programming and conversations. They’ve been welcoming to all MSM regardless of HIV status and have brought HIV positivity out of the closet. Our MP provider offers HIV/HCV testing and individual risk reduction counseling. They’ve linked newly diagnosed participants to both medical case management and HIV care. These efforts enable us (HD) to direct more federal funding to their MP project – as they address a wider number of priorities (e.g.: condom distribution, testing, linkage to care, etc.).

A GLAM Formal Outreach Event.

We receive a lot of requests from HD's asking about evaluation; what type of evaluation do you expect of your Agency/MP?

We evaluate all of our funded interventions in several ways that include process and outcome measures. With MP specifically, we set targets for each of the project’s components and then require quarterly reporting and data submissions from the agency that implements the project. At the HD, we assess if process measures are being met (e.g.: #s of MGroups/quarter; #s of MGroup participants/quarter, etc.).

We also require outcome measures. For those, we provide our grantee with a pre-/post-assessment tool. That pre-/post-assessment seeks to measure MGroup participants’ attitudes toward risk reduction, toward talking to peers about risk reduction, intentions to reduce risk in future and feelings about risk taking.

The MP project that we fund collects the data. The HD analyzes it and passes along relevant, non-identifying info to our funder, the CDC. We perform annual site visits to all of our funded agencies including our MP provider.

RELATED: 5 important questions for the Mpowerment Project to ask itself. 

Sometimes we have seen agencies funded to do Mpowerment as one of a whole slew of Evidence Based Interventions, seemingly without enough funding to do all of them well (i.e. 2 staff given funding to do Counseling and Testing, Mpowerment, Many Men Many Voices and PCC). What advice would you give to an agency that finds them selves in this predicament?

I’ve shared how embedding other programs into MP may be essential in the current funding and program environment. However, there’s another part to your question that I find highly problematic - the problem of under-resourcing an MP project. The implementing agency and the funder both need to be cautious about including program goals beyond MP.

I would caution agencies about taking on too much programming with insufficient staffing levels. And I recognize just how difficult or unavoidable a situation that can sometimes be. It can be particularly fraught for a non-profit to say to their health department or funder, “No, we can’t do all of those things without additional support.” I put the onus on funders to ensure that they avoid that situation in the first place.

CAPS provides guidance on the resources needed to properly implement MP. Everyone should start there, consider the resources needed for add-on programs and then fund adequately. Some funders, HDs in particular, ought to consider how they’ll support all the training needs that go along with all these disparate program components.

Who pays for travel to a PCC or MP training? How is the program staff supported in accessing training for other embedded components? These are questions that HD’s or other funders should consider and address directly. As an aside, I have to mention that we’re only able to fund our MP provider at the “copper” level; lower than ideal. However, we provide additional funds to cover the other embedded components as well as training.

GLAM Outreach.

What advice would you have for other HD's and contract monitors  who want to know if their MP is being implemented with fidelity?

These actions support fidelity: 

• Fund adequately.
• Ensure MP training for program staff is accessible.
• Write contract objectives that match the full range of MP components.
• Make data collection relate to the grant objectives.
• Name fidelity in the contract and then support implementation.

We also try to be flexible about meaningful adaptation. To me, that’s adaptation based on client input or the realities of the jurisdiction in which your MP is functioning. Vermont is rural. We have few or none of the structural supports that MP counts on – like gay bars, gay media or gay-centric venues or neighborhoods. As a consequence, our MP provider creates “pop-up” spaces at larger public venues and encourages volunteers to host small events. That’s meaningful adaptation to the realities of this locale.

RELATED:  8 ways to provide agency leadership for the Mpowerment Project.

We’ve found in our research that agency staff can sometimes be afraid of their Project Monitor and that this can interfere with honest dialogue that could really help improve implementation. Do you have any best practices on encouraging an open dialogue between funders and the agency ED, MP supervisor and, Mpowerment Project staff ?

I don’t like that this happens, but it’s understandable when someone’s job or a program you love is on the line. The funder/grantee relationship is inherently unequal. Provide ongoing support to the program leadership, coordinators and their program components. Be respectful and encouraging. Provide meaningful feedback: name what you see is working and offer guidance on what could make things better from your perspective. At the end of the day, if you believe that the implementing agency is relevant and connected to the young Gay and Bisexual men you hope to see served, then step back and let them do their work.

Climbing higher with GLAM.

How do you foster trust so that Agencies and MP staff can come to you if problems might arise?

Demonstrate openness and a willingness to work through those problems each time they arise. Think of the whole enterprise as a partnership between the HD and the implementing agency – so that responsibility for achieving or maintaining success is a shared experience.

People who monitor Mpowerment projects can also build trust when they demonstrate a deep understanding of the program components.  It communicates that the feedback is well-informed and can be trusted.

In light of declining dollars going to community based programs, do you have any advice about where else programs can look to fund their programs besides state HDs—specifically, local government, county boards of health, certain foundations?

I’m not well positioned to answer this in any specific way. It’s been over a decade since I have found myself in this place. My general advice would be to be sure to follow funders’ proposal guidance to the letter. Proposals that illustrate strong connections with key partners (e.g.: medical services, case management) are often viewed very favorably. Explain your premise in clear and concise language. Reviewers love brevity and it’s rare.

Any other advice would you have for other HDs who funding a MP? (What did we miss?)

I keep thinking about the Mpowerment Project guidance on conducting community assessment. It’s an essential first step for new programs under consideration. I’d encourage existing projects to revisit this step from time to time to stay relevant.

Through community assessment, you can learn about the concerns of the young Bisexual and Gay men in your service area. You’ll also learn where they gather, what media or apps they use, how they recreate and much more. The assessment also helps identify key stakeholders, potential collaborators and likely advisors if the process moves toward implementation.

I’ve often thought about how a thorough community assessment can be an opportunity for your agency to demonstrate that you’re serious about cultural competence. First engage in respectful and open dialogue with the men you hope to serve and then apply what you learn from them to your project design. It’s one of the many things to love about MP.

RELATED: 16 steps for starting the Mpowerment Project in your community.

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Mpowerment Project:  GLAM, Burlington VT.

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Agency funded:  Pride Center of Vermont. 
Vermont Department of Health, HIV, STD and Hepatitis Program.

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