Preparing for COPE: A Mixed Methods Study on Community Facilitators' Experiences in Leading Psychoeducational Group Interventions

Abstract

Background: Group work in community-based settings highlights relationship building and resource connections. Facilitators working in non-traditional settings with community groups face a unique set of experiences and challenges that require distinct preparation and adaptation. Although prior studies have examined skills required and mapped facilitation mechanisms, few have examined preparedness and adaptation for community-based group work in relation to their fidelity to content in manualized programs. This study examined the preparedness of facilitators to deliver community-based psychoeducation groups from the manualized curriculum, Communities Organizing for Power through Empathy (COPE), that covers stress, coping, caregiving, and community assets. We used data from facilitators' surveys, individual in-depth interviews, and intervention fidelity monitoring tools to examine the relationship between facilitators' preparation, adaptation, and delivery of the COPE curriculum.

Methods: We examined facilitators' preparation and adaptation of the COPE intervention using a convergent mixed methods design. The intervention was delivered by two trained Community Facilitators to 36 groups (8-15 participants per group) from 21 Community-Based Organizations as part of a CBPR study. Facilitators completed a pre-series demographic survey prior to training and, after facilitating a series, a post-series survey including standardized measures of Acceptability (AIM), Intervention Appropriateness (IAM), Feasibility (FIM), preparation, and adaptation. Facilitators also participated in an hour-long in-depth interview using a semi-structured interview guide. A standardized tool was used to monitor fidelity to the intervention highlighting facilitators’ strengths, weaknesses, and content delivered, then rated using the Learning Action Cell Session (LAC) Checklist for Facilitators. We used multiple linear regression to assess how well scores from the adaptation and preparedness scales predicted intervention fidelity monitoring, controlling for facilitators' licensure status and level of education. Using Braun and Clarke’s (2006) six steps of thematic analysis, we analyzed transcribed facilitator interviews and then mapped qualitative results to quantitative findings with an integration matrix.

Results: Facilitators revealed that continuous iterations with COPE trainers, the use of concise prompts, and apportioning of roles with co-facilitators helped them to adapt. One LCSW explained that he prepared by “Just reviewing the material at home in detail. My co-facilitator and I got together and kind of worked through how we were going to divide up the sections and stuff. But other than that, it was the material.” Another LCSW who facilitated at three institutions shared, “We worked on our strengths and our weaknesses. To see who was better at what part. I told my cofacilitator to do the brain part and she's like, I've never done that, but I'm going to work it out.”

Implications: The findings of the study underscore the unique challenges and experiences which facilitators need to adequately prepare and adapt to when implementing intervention curricula with community groups. Longitudinal findings from the larger CBPR research on the impact of COPE may contribute additional findings on the successes and limitations of facilitators in delivering the COPE curriculum.