Boot Camp Translation: A Tool to Engage Communities for Patient-Centered Outcomes


Welcome to the PBRN webinar on Boot Camp Translation, a tool to engage communities for patient-centered outcomes. Thank you so much for your patience while we had a bit of a late start, but we’re very excited to be with you all today. I would like to briefly review the agenda for this webinar. First, I will explain how to submit a question to our presenters. Then Rebecca Roper, director of the Practice-based Research Network Initiative at the Agency for Healthcare Research and Quality will introduce today’s presenters. Please note that we will have several opportunities for a Q&A session throughout the presentation. This webinar is still pending approval from the American Academy of Family Physicians for CME credit, but we will be offering CME certificates of participation once approved. At the end of the webinar, I will explain how to obtain the CME certificate of participation. After today’s webinar a copy of the presentation slides will be e-mailed to all of today’s participants. The recording of today’s webinar will be posted to YouTube in the coming weeks. We will notify today’s participants when the video becomes available. If at any point during this webinar you have trouble hearing our presenters, please try hanging up the phone or headset and dialing back into the webinar. Today’s presenters have no financial relationship to this work and they will not discuss off-label use and/or investigational use of medications in the presentation. You may submit a question at any time throughout the presentation. To submit a question, time type a question under the question section on the go-to webinar control panel and hit “Send,” as shown in the screenshot on this slide. During the Q&A sessions, as time allows, your questions will be read out loud and our presenters will respond. I will now turn the presentation over to Miss Roper. So good afternoon and thank you to our presenters today. This presentation was given by Jack Westfall and Linda Zittleman and Donald Nease, earlier last month actually — we’re still in the month of July — at the North American Primary Care Research Group PBRN Conference. And we had the opportunity in the last few months of the contract at PBRN Resource Center to put a call out to the PBRN community on what particular topics would be pertinent and need to be further left with the archaeology, so to speak, of PBRN to be recorded. And a very strong response we received with respect to asking these presenters to join us today to give their presentation on Boot Camp Translation: A Tool to Engage Communities for Patient-Centered Outcomes. So Dr. Westfall and Linda Zittleman and Donald Nease will give their presentation in turn. While they all hail from the University of Colorado, Denver, which, as we know, is a high altitude location and a very smart place. They have a down-to-earth presentation for both researchers, and having seen them engage with patient and the inclusivity with which they pursue their work and research, there is a casualness and an openness of engaging, so we look forward to you posting questions. And as you post questions, there will be breaks that they will let us know, and I’ll voice your questions for you, and we’ll have a dialogue with these wonderful presents. So, really, again, I want to appreciate Jack and Linda and Don for pulling this together for, really, an impromptu presentation of what they gave last month, and we’ve had a really strong response. We’ve only had awareness of scheduling this webinar fewer than 72 business hours, and Cindy Brock who is a great friend of the PBRN community, shared it with a large group of folks who were interested in health literacy and patient engagement, and there are others who facilitated making this webinar known, and we have a very strong response of 122 people — for such a popular time for vacations — to join us on this call. So with that, I will turn it over to the folks in Colorado, and look forward to the question-and-answers in our learning process. Jack? Okay. All right. Are we set? Okay. Welcome all. Welcome everybody. Welcome. So this is Linda, and Jack is on. And we just want to piggyback on what Rebecca said, that we are very delighted to be here today and just really thrilled to see such a strong turnout. It’s fun to see that, and humbling, so. What we’re going to cover today is quite a bit of information to help everyone have a comprehensive understanding of Boot Camp Translation, and what we suspect at the end is there will be some great questions and pique your interest to learn even more. So for today is to start with kind of the conceptual description, what is it when we’re talk about boot camp translation, where did it come from, and what do we mean conceptually by that? We also, then, are going to share some results. This slide is a little bit out of order. We’re going to jump next to some results, highlighting three examples of boot camp translation projects, what they consisted of and what the resulting messages and materials were. And then we’re going to get into the nitty-gritty and cover some of the nuts and bolts around the structure of boot camp translation, timeline, who needs to be on your team, what do budgets look like, things like that. And as we go along, we welcome questions. So I’m actually going to turn it over to Jack right now to get us started with that overview of boot camp translation. We’re here from the university. We’re here to help. So this is from the Limon, Colorado, Fire Department. Limon is a small town, a hundred miles east of Denver where I practiced for 12 years as a family doctor. I was the medical director for the ambulance service, and I’m not exactly sure what’s going on here, but I know that the people in that burning house feel like the people in many communities when the university comes out and says, “We’re here to help.” They may have a fire hose but they don’t necessarily know where the fire is. The question becomes it is inherently improbable that an academic researcher can ask a clinical question that matters to a patient. We wonder why it takes so long to translate actual discoveries out into clinical practice. And part of the reason is that the very creation of those discoveries is that the academic medical center and the creation of those discoveries uses medical jargon, constructs and ideas that aren’t really accessible to the run of the mill person on the street or in the field. So boot camp translation is a process by which evidence-based medical information and jargon associated with clinical guidelines and recommendations are translated into concepts, messages, and materials that are locally relevant, meaningful, and engaging to community members. We’re not sure whether to call them patients or community members, so we’ve come up with a new term called “free-range humans.” Free-range humans are the people who are at the interface of the provider and the practice and need the information to help make informed medical decisions. Boot camp translation really addresses two key questions; what is the message to our community, what do we want people to know, and then how do we effectively share that information in a locally-relevant manner. Boot camp translation grew out of the High Plains Research Network. It’s been around for 18 years. It’s a practice-based research network that really links primary care practices with hospitals, ERs, behavioral health offices, public health agencies, and community-based organizations. The Community Advisory Council started about 12 years as a way to add an additional voice to the research that we’re doing, and the community Advisory Council made up of farmers, ranchers, schoolteachers, retired people and students really guide and direct all the research of the High Plains Research Network and helped discover and refine the boot camp translation method. Boot camp translation has steps. It uses local community expertise and research skills, community members and research team partners in these five steps: Evidence, we meet and we learn about the topics that’s affecting the community, whether that’s hypertension or depression, patient-centered medical home, diabetes. It has to do with relevance, determining what information is crucial to pass along to the community. Target; determining what targets, what patients and community members most need that message. Action, what do we want people to do; so the messaging and the translation of this medical jargon isn’t just about facts, it’s about what do you do with these facts and how do you take on an action that will help your life. And then creation, what are the messages and materials and dissemination strategies for actually getting that message out into the community. This occurs over a series of meetings and conference calls that lasts anywhere from 4 to 12 months. Boot camp translation, from a theoretical model, takes meeting together and everybody’s individual expertise, setting a level playing field for the knowledge around a particular topic, whether that’s a medical topic, a behavioral health topic, a clinical topic, distilling that through members and community members expertise in such a way that the information that we share with our communities is locally relevant and actionable. So people know something and go do something. Boot camp translation is not a rhetorical process. It doesn’t just change a couple of words here and there. It’s an iterative process about learning together and co-creating something new that takes the best expertise of the research team and the clinical affects, mixing it with the best expertise of the community to come up with new messaging. It’s all about that expertise; community expertise, personal expertise, research expertise. Everybody who participates in a boot camp translation has some level of expertise. We sort of joke when you join a boot camp translation process there are no observers. We have people who want to come and observe. We have people who come and join us. But the community member said we don’t want people watching, we want people participating. And no matter where you are and what your usual day job is, you have some level of expertise that can contribute to helping translate these complex medical jargon recommendations into something that’s meaningful for our community. So what’s boot camp not? Boot camp is not just a focus group. Boot camp is more than that. It’s this long-term sustainable relationship with a group of community members and patients. It’s not just a series of meetings together or dinners or lunches. It’s not about identifying research questions. It’s really around a long-term relationship that co-creates. I’m going to open it up for a few questions if we have any, and then I’m going to turn it over to Linda. While folks take time, you have the instructions for posing the questions, and we’ll share them. I will let the presenters know that we’ve had a few people articulate again how pleased they are to be able to participate in the session firsthand. We have a very specific question that maybe we can table for discussion at the end of the presentation. They’re just quite excited about this type of activity, wondering where these boot camp translation may be ongoing and viability as a professional position. So that has a particular tangent that’s not quite at this point. While folks post questions, Dr. Westfall, let me ask you one. You’re stressing that this is really a combined effort by the professionals and the community experts, and that there are no wall flowers — my words not yours — in this process. Could you perhaps share with us, in the long term sustainable relationships, an example of how the community has fed you or fed someone else in this ongoing process to help you keep your commitment to this type of boot camp translation, whereby the, quote, unquote, novices are really feeding your desire to continue, either directly or through inspiration? Yeah, Rebecca, that’s a very good comment and question. And I have to say that as we started developing this with the High Plains Research Network Community members, we didn’t really know what we were stumbling upon when we first did it. However, since then, we’ve did sort of refined this method and it’s become an actual method. It’s not just an approach, it’s an actual methodology. And it has totally changed the way that I think about the work that I do and totally changed the way that the High Plains Research Network does it’s work, because it really helps share power and expertise. So the people who have the medical expertise share that with the community and patients, and the patients and communities share their expertise at living a successful life in their community with the researchers, and that combination creates something that’s totally different and totally new. And so it’s been — I can’t imagine doing clinical research or health services research without engaging patients. And this process, the boot camp translation process is such a great process for getting people together on the same page to create new research. I’d like to hear from Don and Linda if they have anything to add on that. Well this is Don, and I’m kind of the new kid to the team here, having negotiated my first boot camp translation a couple years ago. And what impressed me and what’s really had an impact on me is I think what Jack mentioned, but also the fact that in contrast to some of the other engagement things that I had done in the past, that there was a really concrete aspect to this and that there’s a topic, there’s something concrete for both the community members, patients, and the researchers to work on together. So it really brought to life a lot the principles that I had read about and believed in a way that made it very tangible. This is Linda. I would build on that too, having been able to be a part of some boot camp translation projects with groups, Community Academic Partnerships that already been working together for years and really enjoying that work, but also then had the opportunity to do boot camp translation, and just the feedback from those groups, saying how much that process meant to them. It was different than some of the other activities they had done, and to see that partnership and the results, and, as Don said, really, the principles of community engagement and research coming to life through that, it’s been fun to see. So if there are other questions, I think we could take one more question at this point, but I think we should move on to the next section. Okay. Just to let everybody know that the PowerPoint will be provided and we will have a recording of this webinar later on. Rather I’ll leave it up to you, the presenters, some of the questions being posed, I think we’ll address later on, but I’ll highlight them so you can anticipate discussing them as you go forward. To what extent in the planning and the sustainability of the engagement and the co-creation, when the duration may be several months, and even longer, some of your strategies that you use to maintain the engagement of the community members, and I’ll hold off on the rest of the questions until later on. But, really, how do you keep everyone working together is a particular area of interest. So I look forward, Linda, to you continuing on, and we’ll have some more questions and answers later. Great. Thank you. That’s a great question, and we will definitely address that. So we like photos so we thought we would include a couple of photographs here for you. This is a photograph from a kickoff meeting out in Fort Morgan, Colorado. This is our kickoff meeting, which we’ll describe in more detail later, but, again, just showing that everyone in this photo is learning all about the topic. I think this was for COPD actually. Sitting together and learning together. Facilitation, which we’ll also talk about in more detail, is very essential to successful boot camp translations. We take lots of notes in our meetings, lots of flip chart sheets all over the wall. Some of which you can read. And just more notes. So what we’d like to do now is transition and actually give some brief examples of three different boot camp translation projects that each were done with unique communities and had unique results. So I’m going to turn this over to Jack to give us the first example. So I’d like to thank the Patient-Centered Outcomes Research Institute at this point also for providing funding for us to test this method and really refine it. I think we have done several of these boot camp translations in the Rural High Plains Research Network, and it was working. We did it on colon cancer prevention — and it’s kind of confusing because this keeps auto — it keeps forwarding automatically, so we’ll try to come back to that, sorry — and on asthma and on patient-centered medical home. It worked really well in rural but we weren’t sure it if it worked other places, so we tried it. And we got a grant in PCORI, and we’re trying it in ten other communities, and this is trying it in an urban Latino population on hypertension. We did this boot camp translation around hypertension and home blood pressure management. They had an expert talk about hypertension and came up with this messaging around hypertension, and they really focused on do you know your numbers and engaging your family in your care of your hypertension. The next one, another one — another example I’ll turn over to Linda. Okay. And I apologize for this advancing. We’ll keep just putting it back. So the next example we have was done with the High Plains Research Network Community Advisory Council. This was actually the first project where we used this process. This was a large CDC-funded study that aimed to increase awareness around colon cancer and colon cancer prevention, and increase screening rates. And over the course of a year or so, the group learned all about colon cancer and developed messages and materials that they thought would really resonate with their local rural community. They came up with a set of four main messages that they thought were essential for their community members to know about colon cancer. One was very educational. Colon cancer serves the second leading cause of cancer deaths in the U.S. It is preventable, testing is worth it, and talk to your doctor today. In this example, the group really wanted to provide some education around the topic to motivate people, testing is worth it. And then the action item was to talk to your doctor today to learn more about this and determine which type of test might be the best for you. The concept of this being a preventable type of cancer was really one of the key examples of translating evidence-based guidelines, and translating medical jargon into language that they thought would resonate with their local community. That concept of colon cancer being preventable was new. And that was a very meaningful message that they wanted to relate to the rest of their community. And they came up with a multi-component intervention that was implemented in nine counties in northeast Colorado, including a series of ads and personal stories in the local newspapers. They said everyone reads the local newspaper, let’s utilize that resource. So here is an example of an ad that was in the newspaper. Personal stories, this was the front page of a local newspaper, a local community member. These are all local community members who agreed to be part of these materials to share their stories. We gave talks at local clubs and organizations. Again the Community Advisory Council said we can do kind of some mass media type of approaches, newspapers for example, but we really also want that more active approach of sitting in a room, learning from somebody, being able to ask questions directly. So this is a photograph of, actually, one of our advisory counsel members giving a talk at the Haxton Gun Club. That is an audience that we likely would not have reached as effectively without the help of this partnership. We had mugs that were given out by the local practices, our “Got polyps” logo on it. And then another good example of the ideas that community member partnerships, academic partnerships can bring to the table is with this farm auction flyer, which typically includes information about farm auction equipment. But we, instead, converted it to include information about colon cancer and just displayed these all over communities. And, again another example of materials that incorporated local bases with the programs main messages. These were disseminated all over the community as well. Linda? Yeah. You have to go back to the previous slide. We can see that one of the cards is in Spanish, I believe. Yes. And so one of the questions came up with understanding different cultures while translating to other languages can be done quite precisely, how else do you support engagement of the community with different cultures and contextual relevancy within the different cultures which may be, in part and form, by speaking different languages. Yeah, so that’s a great question. The boot camp translation is around translating medical jargon into understandable language. Sometimes that also requires, then, translating that into other languages. In Colorado the most common that we work with is Spanish, and so we rarely simply translate. We co-create and trans-create the messages so that it’s not just taking the English and translating it into Spanish. We actually did the hypertension and home blood pressure boot camp translations in both English and Spanish and came up with vastly different types of messaging for those two populations. In addition, another example was the “Got polyps” mug, and for the Spanish community, the Mexican immigrant community that are common in northeast Colorado where this occurred, there is no “Got milk” campaign in Mexico, and so that sort of using that catch phrase does not translate culturally. And so we worked with our community members who are Spanish speaking and came up with a second message, which is underneath that, that says, “Polypos provengano los tenga,” as a culturally appropriate co-creation of a message. And so boot camp translation, it’s important to work closely with partners and community members who are either bilingual or enmeshed in the community and the culture so that you can trans-create messaging. Thank you. That’s wonderful. All right, so this is Don speaking now, and I’m going to talk to you about our third example of the boot camp translation that we’ve done, and this was done with our CaReNet, Colorado Research Network Patient Advisory Committee. So CaReNet, along with High Plains Research Network, one of our snowcap PBRNs here in Colorado. And CaReNet had a patient advisory council that has been part of CaReNet’s work in fact-based research and in the community for about eight to ten years. Most of the folks that are part of this group, actually they were originally recruited as part of a diabetes-related project. Many of them have had diabetes, and as Jack mentioned, we had a pilot award from PCORI, and this group was interested in taking on the topic of diabetes health management. So we used the boot camp translation process to develop messaging around that that are our CaReNet practices could put into use with their patients. So, as I mentioned, the CaReNet PBRN is one of our snowcap PBRNs that really is focused on primarily urban underserved FQHC practices. We also have some of our residency practices here in the area that are part of CaReNet. And here you see the first product that the group came up with. As we were presenting that first day, the science around diabetes, what sorts of things are important in terms of self-management, one of the strong messages that we heard from our group was when you’re first diagnosed with type two diabetes you really can only take in so much, and there are some things that are very important for patients to hear. And so we took that, and this actually — we had an idea about we needed a first page. But this actually then, the group worked on during the first series of telephone calls, and we developed and refined each of these bullet points here that you can live a healthy life with type two diabetes. There’s a lot to learn about diabetes. It’s okay if you don’t know everything right now. There are some things that you will need to do, and there are some things that we, or your practice, will do, including blood tests, education, regular checkups, look at your feet. And then finally this last bullet I really like, that it’s important. Patients said, you know, we need to know that you guys are here for us. So that was embodied in that last point. And they also felt it was really important that this be something that both patient and the provider put their signature to; that this is really kind of an agreement between those two folks. And then we went on beyond that, after we had developed that first bit, to go ahead and develop an entire small booklet for practices to — after they’ve gone through the first page with the patient and when the patient’s ready, the booklet actually provides a way to sort of guide them through various aspects [indiscernible]. So, you know, again, hopefully as you’re looking at these slides, listening to us talk, you’re getting reinforcement that this is not just a series of focus groups. It’s not just a rhetorical process. But we’re really working with folks who have very real expertise. Both as community members, as folks who may have experience with a particular illness that’s related to the topic, and that mix is really where magic happens. We really take very seriously the fact that we’re giving our participants pretty high-level education in the topic that we’re focusing on. That’s important, because they need to get to a level of expertise around a topic so that then you can work with them to sort of back off a little bit to what, then, can be disseminated into the community. Again, it’s a very collaborative process. Once folks kind of get engaged with this, we generally have very high degree of participation. Folks tend to stay engaged with it. And I think the last bullet point here, we’ll talk a little bit more about later on, but there really is active facilitation. There is some degree of work that facilitators for the process do to help keep things moving along and to work things that are going to be actionable and inseminateable. Okay. Linda? All right, now we’d like to transition to some of the nitty-gritty details about boot camp translation. So for the next two minutes we’re going to cover descriptions of the team that you need to assemble, the process itself, estimated timelines, and budgets, and what impacts those things. So I’m briefly just going to outline here the general cast of characters who participate in boot camp translation. And in a few minutes, we’ll expand of the description of each of these roles in more detail. But what’s really key for boot camp translation teams is this partnership between academic researchers or staff research team members and free-range humans, as we say. That partnership is really the heart of this process. We have on the team a facilitator, a co-facilitator — and we’ll talk about that model more — a coordinator. It’s very helpful to have administrative support. You have a medical expert, and then, of course, you have your community partners. So we’ll expand on those in a few minutes. First I want to cover — we’ve been talking about meetings. Don referenced phone calls. And some of you might be thinking, what are they talking about? What actually goes on here? So the boot camp translation process, it uses a series of in-person meetings combined with conference calls. I’ll get to a sample timeline in a minute. I’d say, on average, well not on average, it’s a range actually, that a participant could participate the voting to boot camp translation process would be anywhere from 20 to 40 hours, and as we stated earlier, boot camp translations can last — we recommend a minimum of four months, and up to a year. So what happens is we have a kickoff meeting. Here’s a sample timeline. And the kickoff meeting is really the heart. It’s the anchor for what happens going forward. And at this kickoff meeting is when we bring in our medical experts, who really devote the whole morning basically to learning all about the given topic. And this is where, as a group, we come away with a common set of information, a common set of facts, and common language around the topic, and it’s very important, because everyone will be coming in with different experiences related to the topic, different levels of education, if you will, around the topic. Because we really want to have a level playing field and give everyone that same information, including the academic teams as well. Then, in the afternoon of that kickoff meeting, we transition, to, really, the beginning of that translation, what does this mean, what does this information mean, what did you learn, what struck you, just asking the group specifically for their reactions about what they learned. And then also beginning to say what is it that you think is really essential for your community. And we begin — it’s a good hour-and-a-half to two-hour discussion and reaction to this medical presentation. The conference calls, then, are used to supplement the progress. What we do is have a 30-minute conference call. And we’re really, really strict about this being 30 minutes. In our experience of doing the boot camp translations with multiple groups, we have found that that amount of time is not only adequate to discuss a task, but the participants really appreciate that. We’re very strict about that because if we go long, the next round, the next call, people might say, “You know, I can’t be on the call for 45 minutes, I can’t be on the call for an hour, so I’m not going to be on the call at all.” So when we say 30 minutes, we really emphasize that. And if we’re not able to complete our task on that call, we just pick it up at the next one. So if you think of boot camp translation as kind of a — it’s a series of expanded thought and then contracted thought, very focused tasks and questions. And then we come back again to meet in person, and we kind of expand our thought again. So recap where we’ve been but come back together as a group for, then, a shorter meeting, usually two to three hours, to bring the conversation up to a higher level again. So we do this in-person meeting, two to three conference calls, an in-person meeting, two or three conference calls, and we repeat that as needed to really get through the work. This sample timeline is an eight- or nine-month amount of time that was allowed. This is an actual real boot camp translation timeline that we used for the diabetes boot camp translation. Depending on the complexity of your topic, it may be shorter. Depending on your projects timelines you may need to time to complete this more quickly, but we really, really encourage that you take your time going through this process. You’ll also notice that these activities are spread out by a few weeks. We don’t meet weekly. You want to allow enough time in between meetings and calls so that people — so that you, as the facilitation team, can get the work done. And you also, people have lives so we want to be sensitive to that. Budget: How much money does it cost to do boot camp translation? We’ve been asked that question a lot. Our response is that it varies. It’s dependent on a few factors. But, typically, we would recommend allowing $25,000 to $40,000 for a boot camp translation. I would put about 30,000 as the standard. Things that will effect and impact the amount of money that you’ll need for your boot camp is your personnel, who is on your team, what salary level are they at; travel. For example, when we did boot camp translations in rural Colorado, we need to include a pretty substantial travel budget. That’s going to increase your overall budget obviously. And then it’s really important to include at least a small amount of money to create mockup materials. So what is it that the group is coming up with? You have the messages, how are those messages being disseminated? And it’s good to allow budget for creation of those. You can have a greater budget if you actually want to produce those in large amounts. And this slide I’m not going to walk through in too much detail, but just know you have a sample budget here that outlines the various categories of expenses and some of the details. So let’s talk about the team. As we said, the facilitation of boot camp translation is really essential. We use a co-facilitation model, a lead facilitator, and a co-facilitator. The co-facilitator, as listed here, really is the leader, sets the tone of the entire process. We really recommend that as a lead facilitators you have at least intermediate, if not advanced facilitation skills. If you’ve never facilitated a group, we recommend you not try it for the first time doing boot camp translation. Provides focus and direction, helps identify key concepts, and really is facilitating decision-making over and over throughout this process. Analyzes data and established this relationship with the community. I’m quickly going to go over the co-facilitator. So the co-facilitator in several models such as myself, I am the co-facilitator usually, and I also do a lot of the coordination. If you’re able to have a separate person do coordination, that’s great. But the co-facilitator really understands and helps direct all aspects of the boot camp translation. This person is really the primary link between the community and the academic partner. This person has the most regular contact with the community partners. It’s very essential to have good interpersonal communication skills, coordination, facilitation skills, and research skills. A good relationship with the facilitator is very important. You will be working very closely together, so understanding each other’s strengths and weaknesses. Usually people have — they’re able to balance each other and be a good team by recognizing those. And as I said, a lot of the coordination work is setting up the meetings, sending out e-mails between calls and meetings and that type of work to really enhance and foster that relationship building with your community partners. So, Don, did you have anything that you wanted to add about the facilitation? Yeah. I was just going to comment that, as I mentioned earlier, I came to this process a few years ago, but I had done a lot of work with small-group facilitation in some other areas prior to this. I think what struck me as I came in to the boot camp translation process, really, that the importance of these two roles and how they work together. So, you know, as you’re sitting there listening to us and thinking about, gee, you know, is this something I want to do or could I do, you know, thinking about who you might bring in as a facilitator or a co-facilitator, and really spending a lot of time in prep with that person, making sure that, you know, as small an item as how are you going to signal me when you need help? You know, I always tell folks that there’s kind of a point in the afternoon of the initial kickoff session where my brain just starts to shut down as a facilitator, and I’m usually looking for help from my co-facilitator, and so you know, being able to signal that person, I need you to step up here. And I think the other thing that Linda mentioned strength and weaknesses. I think also we all have our blind spots. There may be things that may be going on in the group process that we’re not cognizant of, and so it’s always helpful to have that other person to sort of fill those in. Right. Yeah, so I’ll just add in a little bit here, mostly in terms of the team approach to boot camp translation and how important the broader team is, and the preparation for the boot camp translation. So you saw the timeline that Linda put up of, you know, over a 4-to-12-month period, kickoff meetings and phone calls. But during the time that we’ve sort of been refining boot camp translation, we realize that the amount of work that it takes to prepare for those face-to-face meetings and those phone calls is substantial. And we recommend that you consider at least a three-to-one preparation time so that for every hour of face-to-face time with the boot camp translation team and community members you have three hours of preparation for that, for each member. So as the facilitator, it’s three hours of prep; for the co-facilitator, it’s three hours of prep for each hour of face-to-face time. So you get a very solid picture that this is not for the weak of heart, and it’s not for people who are trying to do this on the margin of your time. This is an investment in time; that good boot camp translation takes preparation time to prepare materials, to review notes, to review the follow-up themes that come out of the notes, to deliver those back out to the community. There’s lots of preparation and work between meetings. So we recommend that you consider a minimum of three-to-one prep time for each hour of face-to-face time. Linda. Great. Yeah, I’ve been asked questions before, why do I really need a co-facilitator? And having assisted a newer facilitation team through their first boot camp translation recently, we discussed that. And they both said at the beginning they were wondering, do we really need to, and at the end they said there’s no way we would do this solo. It’s more fun, first of all, and given the work, too, that Jack described, it’s just essential for success. So, moving on, another really key member of the boot camp translation team is the medical expert. And Don, did you want to cover this one? Sure. So the medical expert is the person that you’re bringing in to educate your group on specific health topics that you’re addressing with the group. And, generally, this talk is going to be focused around sort of setting the stage, why is this particular topic important, giving a little bit of the basics around what the disease physiology is, and then a discussion of so what are the official guidelines or recommendations, what’s the evidence around how to best address this particular issue or topic. And so that is typically done over about a two-and-a-half to three-hour period. And what we do is we tell our medical experts that they should pitch this talk about the level of a talk that might be given to medical students or residents. So you’re really pitching it a good bit above what might be the typical sort of community talk that’s given to the rotary club or the Chamber of Commerce, because you really do want to hit kind of a definite level of expertise there. The other thing is that, so as we’re coaching the medical expert, which is, again, a very important part of this, we tell them that, you know, to plan for that talk that they might give to medical students or residents that might typically take an hour or so, that that’s going to naturally stretch out to about two-and-a-half to three hours. Because we want the community members, our participants to ask lots of questions. And we usually tell the expert if nobody’s asked a question by the third, fourth, or fifth slide in, we’re going to go ahead and do that, sort of get the group going. Some other things on this slide that are important to consider is that this person needs to be comfortable in the role of an expert and sort of know where the boundaries of their knowledge are and how to deal with questions that come up. They need to not have a particular agenda, and what that means is they need to not feel like there’s a particular direction that they want to steer the group in to recommend a specific intervention or messaging or something like that. Oftentimes the person can be identified by the academic partner if it’s a community group that’s sort of priming this. And you know, we’ve used folks from all different kinds of specialty backgrounds. I will say that sometimes folks that are primary care specialists actually can pitch this sometimes at a little bit better level, because they’re not necessarily worried about getting too deep into the weeds, but usually are pretty good about pitching it appropriately for the group. And then finally, we encourage the medical expert to participate as much as possible, even after that first day. So if they can participate on a phone call, that’s great. I think it’s really helpful for them to be listening in to hear what the group is talking about, because oftentimes when we go back to another in-person or face to-face meeting down the road, we’ll invite that expert back in. Okay, tell us about the topic that we didn’t get onto the table in our first kick-off session. And I’ve had the fortune to sit in both the facilitator role and in the medical expert role, and they are very different. And one thing that we picture medical experts — one of the nice things about being in the expert role is you don’t have to worry about facilitating the group. Facilitators are going to handle that, handle the questions, that sort of thing. So that’s important as well. Great. Thanks, Don. Briefly, just another very helpful support person is to have administrative support, someone to help manage your grants, help with logistics. If you have that resource available it always makes any project actually go much more smoothly. So let’s talk about the community partners. Here, again, are some more images from various meetings. We have photos from meetings. We have photos from presentations. People often say, “Well what community member should be part of this? What do they actually do?” We’ll talk a little bit later about, if we can, if there’s time, about recruitment, but, really focusing on the role of the community member. So just to step back, we’ve talked about the concepts of boot camp translation. We’ve talked about the medical experts, that kickoff the meeting, the essential role of that education. But what do you actually do next? As we transition to that translation piece, this is really the community members’ part. They bring their own unique perspective and experiences to the table. These are folks who are experts at living in their community. One piece that’s very important that I think people get hung up on sometimes is thinking that they need a group that’s representative, that they’re representing their town or their county, or a specific ethnic group for example. We’re pretty clear that that’s a big burden for somebody to carry. What we ask is that community members come to the table with their personal experience, their knowledge of what it’s like to live in their community, however that may be defined. And when we’re talking about community here, we can be talking about a geographic area or a specific group of people defined however we want to define that community. We’ve had people who are heads of local organizations to work, lay people. What’s important is that there is diversity, diverse educational levels, backgrounds, ages, socioeconomic statuses. You want your group to mirror the larger community that you’re trying to reach, not be representatives but mirror that. The role of the community members — I just want to tap into this quickly — is then to take the information, and partnering with the academic team, over the course of the meetings and the conference calls, just to say as we said at the beginning, what is it that we think is really essential for our community to know. Some boot camp translations, as you’ve seen in the examples, have a set of main messages, these main concepts that the group thought was essential. They also help identify those more detailed pieces of information. Medical information that could be included in some of the materials that are disseminated; so main messages, what are the other detailed information, and what’s the tone we want. They really help shape that, and they make sure it’s culturally relevant for their community. I like this quote from one of the members of our Community Advisory Council in the High Plains Research Network, Ned Norman. He said “There are a lot of people in the community who want to help and who are curious. All you have to do is ask.” This is Jack, and I just want to sort of interject here. I think one of the barriers to patient and community engagement, often, is sort of not knowing who to ask, who do I ask, who do I ask. You know, do I get the head of the hospital, do I get the board president, do I get the superintendent, do I get the city council. And, you know, Ned Norman is a farmer, and he makes this point that there are a lot of people in the community who are interested in helping out their community, and who frequently just get bypassed and aren’t asked to participate in much of anything, and that he pushes us a lot. Just ask people. Ask people. Find somebody and ask them. And you’re going to find out that a lot of those people are going to be eager to help participate with you in your research and program development. So we have a couple slides left, but I think, in the interest of time, we know that there are at least a few questions that have already been asked, and we want to make sure we get to those. So I think what we will do is you’ll still have the rest of the set of slides, which one of them is a particularly fun one, “How to successfully fail at boot camp translation.” But I think we’ll now go to question-and-answer period, and we’re anxious to chat with you about your questions and comments. Okay, thank you. So going back to the wonderful sample budget that you have for us, Linda, and then Jack also gave us a three to one for every hour of live engagement with members of the community, three hours in preparation. But for your cost and resource funding, these types of activities is top on the mind of folks listening in today. Is the sample budget given, does that correspond to the schedule that you had earlier in the presentation, with respect to meetings within the community members, the BCT process sample timeline? This is Linda. Oops. You know, it doesn’t, no, it doesn’t specifically link. Those were not match timelines and budgets. But I think they’re very representative or a good starting point. And they’re pretty good. I think, you know, we have on that sample timeline — or that sample budget that the facilitator and the co-facilitator have different amounts. The co-facilitator is a much greater amount. Probably because their timeframe is probably five or six to one, and the facilitator is two or three to one, but probably more on the three to one. So if you think about a 40-hour boot camp translation, that would be 120 hours of prep time. So that’s somewhere in the 5 to 6% FTE range, and so federal grants cap at 180, so a facilitator who is at the max would be in $5,000 to $7,000 range for that. So it’s about indicative of the effort. Okay. And with respect to funding — and I’ve seen this in applications that have come in that I’ve seen reviewed — articulation that the boot camp translation for identifying and developing and testing and intervention is part of the process, and the budget associated with it through our line items within the budget of federal grants that I have seen, is that traditionally how you have sought funding to support Boot Camp Translation activities? So this is Jack, and I’ll let everybody weigh in on this. We’ve sought funding every which way we could possibly imagine. We have not held a bake sale for Boot Camp Translation yet, but just about. So, yes, we’ve put these in sort of in the sample budget format into federal grants and state grants. We’ve put them into local foundation programs and projects. Several have been funded by local Colorado philanthropic organizations that want to see program development. The catch there is the “grantsmanship” of how you talk about Boot Camp Translation as either a research method or a program development method. I think it requires some nuance in the writing of the grants to the different funders. Yeah, and I’ll just chime in. This is Don. I think that the sample budget here that we gave really reflects the Boot Camp Translation process itself. You’ll see in there there’s a line item for graphic design, and that’s really to kind of work with the designer to mock up whatever your group is coming up with. I’ll give a shout out to AHRQ for being a funder. One of the difficulties that we run into sometimes in writing applications or grants that include Boot Camp Translation is we don’t know what the Boot Camp Translation group is going to come up with, so we want to test. And so, unlike most of the grants that we typically write where we know what the intervention is going to be, but the group is going to create that. And so I think our AHRQ-funded In Step Project was one where we were fortunate to be able to include the money to actually test the products that came out of the Boot Camp Translation as a part of that, which was really helpful. We’re continuing to work on that and kind of improve our ways of selling that to funders, but that’s an important piece. So there’s lots of support questions that maybe we can double back to the more detailed support questions. You’ve got several folks out there who would like to jump into your booth, so to speak, and learn more about Boot Camp Translation in an ongoing project. In addition to your publications, are there other activities that are going on or other ways by which folks can familiarize themselves and get some firsthand experience in Boot Camp Translation? So this is Linda, and in regards to other resources, as you mentioned, Rebecca, we do have some manuscripts available. Earlier in the slide deck there was a list of various videos that are available that describe Boot Camp and also describe some projects that use the Boot Camp Translation process. We’ve also created a Boot Camp Translations guidebook, which has just recently completed, which is very exciting. It dives into a lot of detail, and we’re very excited about those Boot Camp Translations guidebooks. And there also is training. We actually do have an upcoming three-day training session in November. And I’d be happy to send out more information specifically about that to be shared. We’ve done three trainings thus far here in Colorado. People from all over the country, though, have come, which is very exciting. And so those — and one in Oregon, that’s right. And the training is really structured to include both information but also role playing and giving people a hands-on opportunity to participate in a mock Boot Camp Translation. Plus, we’re now adding a special day, really devoted to those nuances of facilitating Boot Camp Translation. This is Jack, and I’ll just throw in one more possibility for folks is we have provided Boot Camp Translation facilitator kickoffs where somebody in Wisconsin may want to have a Boot Camp Translation, and several members of our team will go out, work with them prior to the meeting, and then co-facilitate with them on the kickoff meeting, and then hand it over to them so that they have that first day under their belt and can continue. And then we offer mentoring and coaching services along with that over the six — you know, 4 to 12 months of the Boot Camp Translation. Don has done those in Iowa and Wisconsin. I’ve worked with a group in North Carolina and in Southern Colorado around that. So there’s lots of opportunities. I think the book will be coming out and will be disseminated later in August, and then this training is November 16th through 18th, so would love to have people consider signing up for training on Boot Camp Translation. Okay, great. And we’ll follow up with you, Dr. Westfall, to get that announcement when the book comes out so we can share it to the PBRN community at large. And maybe, Linda, if you could send us the information about the training, and rather than just send immediately out these PowerPoints with the PDF of the PowerPoint, we can include a list of those references up front in the text or the email that will go out to folks on this call, and also through the PBRN listserv so we can facilitate a one-stop shopping, given the high level of interest. Sounds good. So a question was raised early on with respect to expertise — and you all have talked about the co-creation and, really, the recognition and the validation that everyone who comes to this process, whatever their background, is seeking to apply their own expertise. But a nice reflection was composed early on in the presentation that talked about successful community projects in the past have really relied on the community strength that they bring to the process, as opposed to particular health-care needs that are driving the action. Are there different strategies that you use in defining and cultivating expertise? Don did talk about, over time, the expertise of all folks evolving, but in the recognition of meeting a need and a gap, which may be driving your composition or framing of the research question, or perhaps the development of resource materials to get people engaged in pursuing and understanding recommended preventive care, for example. But are there firsthand experiences you could elaborate on on the role that the community plays based on their expertise versus you needing to seek out other expertise to address the particular gaps? Yeah, so this is Jack. And this is an interesting concept. The cool thing about Boot Camp Translation is that it is a long-term process, and it creates a long-term relationship. And our Boot Camp Translations typically, you know, have been anywhere from 6 to 12 months, but then many of those groups continue to meet and we continue to meet with them and they continue to be engaged in other work. And so that level of their own personal expertise around combining sort of medical care, health care, their own personal experiences, their cultural expertise becomes sort of overlapping. And you start getting to see really cool sort of overlap in the Venn diagrams of people’s knowledge about their community, their language, their culture, then with the medical care or a recommendation or a guideline on a particular issue. What we really try to do as an approach is for community engagement is asset identification and really building the asset shed within the community. So Boot Camp Translation is a method for building a community of solutions that identifies problem sheds and then identifies asset sheds, and pulls those assets together. And that’s the really nice part about this is that over time and through this 6 to 9 months or 12 months you get to know people both on a personal level, a community, and a professional level in such a way that those assets really become — they come together and start shining and they really do things that you weren’t expecting at the beginning. And so I used a couple of language — a couple of words in there that I think are important. Community engagement is an approach to your world and an approach to your work. Boot Camp Translation is a methodology for doing community engagement. And so that approach — the approach really that we use is around asset identification and development so that we can create locally relevant solutions. Did that answer the question, whoever asked that? I think it’s a very thoughtful answer. So with respect to another question that’s posed is as some of the examples given really resonate with public health issues, and if you could elaborate on working with representatives of the public health organizations and some of your activities and where they fit in in the development process? Well, this is Jack. I’ll just jump in again because I think this is important. This is part of that approach to building a community of solution and identifying the asset shed. And the public health organizations are often part of that asset shed. And so you start thinking about the primary care practices and the other medical practices and the public health agencies, of course, patients and community members or free range humans. And then there’s a host of community-based organizations that, while they may not have health in their name, they do health care kinds of things. And oftentimes they address social determinants of health or health education and literacy. And so, you know, while some of these look very public healthy, the goal is to link all of this sort of public health and primary care into common language so that people in the community, people in the practice, practicing providers are all using the same locally relevant language so that there can be conversations for informed decision-making. And this is Linda. I’ll just add another comment, and I also wrote it down as it relates to the previous question about expertise. What we’ll often do, depending on the topic, is ask the group who else needs to be at the table. And we’ve often added — or asked somebody from, whether it’s a formal public health agency, like the local state health agency, or a community-based organization that is health-oriented, to join the group for that specific Boot Camp Translation, that rounds out the experience at the table and the perspective at the table. And it also helps create those linkages within the group. That’s fabulous. So there is a question that’s really about PBRNs and building collaborations, and to that I’ll ask our folks at the resource center. We just came out with the PBRN network of networks, so to speak. They are learning communities, and there are eight of them. We call them the P30s, which they have multiple members within each of the P30s. So there are a collation of PBRNs. And we have highlights of what they are doing, which Snowcap and High Plains are included in some of those P30s. And if you look at the front end of those PBRN P30 profiles, we talk about the different strategies for collaboration, both across PBRN universities and some non-traditional partners and some real specialty partners, including DARTNet. They may be informative for you. So, the folks at Apt, when we send out this PowerPoint presentation, we’ll just include the notation for these recently developed project profiles. So, with that, I would say we’ve had a very thorough discussion. We look forward to sharing with folks the additional information about the book that you have coming out, some additional information and opportunities for the November Boot Camp Translation training camp, I guess. And thank you very much for the explanation about Boot Camp Translation as being one means, a method for pursuing community engagement. And we talked about cultural diversity. I’m just trying to see whether I’m overlooking a major question. Rebecca, this is Jack. Can we mention one other dissemination or where people can learn about Boot Camp Translation? Oh, sure. We forgot. So the North American Primary Care Research Group is a binational organization committed to primary care research. And Boot Camp Translation will have both a workshop and a breakout session that has lots of examples and methodology components to Boot Camp Translation at NAPCRG this October. People can look up, just Google “napcrg.org,” NAPCRG.org, and they can find out about the annual meeting. Boot Camp Translation will have a strong presence there with both posters, podium presentations, and a workshop. That’s fabulous. So, with that, I say thank you very much to Jack and Linda and Dawn. You guys were real peaches, clearing your calendar to help us record this webinar. And I also want to thank the 120 people out there interested in Boot Camp Translation land who joined us at such last minute invitation. And kudos to the team with Christina at Apt. It’s not easy to put one of these webinars together with the technicality. And, with that, Christina will give instructions about how to receive CME credit for having participated in this webinar. And, believe it or not, we have a few more national webinars. I’ll be sending out a notice for an August 7th webinar that we’re putting together quite quickly. And we have a scheduled August 18th webinar on “Adaptive Trial Design and Learning Evaluation.” And September 9th we’re delighted to present the “Using Rapid Cycle Research to Reach Goals” guidance document that is the culmination of a learning group that was supported by the PBRN community, and the very wise and witty guidance by Dave Gustafson and Dr. Kim Johnson. So, with that — oh, you can see the August 7th, 12:30 to 2:00 p.m., DARTNet, “Data Exploration of Linkages Between Existing Health Data and Patient Reported Outcomes in PBRN Research.” So we’re really trying to squeeze out every bit of energy that we can to record these wonderful presenters in the resources that we have for the next couple of months so that they are available to you. All right, I thank you all very much. And, Christina, if you can just put the information up about the CME, and we’ll follow up. And thank you all for your thoughtful questions. Take care.

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