Dudley (2009) points out that social work practice is usually embedded in programs. While you looked at practice evaluation using single-subject design in Week 3, this week, you shift focus to program evaluation. Program evaluation serves many purposes, including accountability to funders and to the public. Often, funding sources such as government agencies or private foundations requires periodic program evaluations. These evaluations can help provide answers to many different questions, and can contribute to improvement of services. There are a variety of program evaluation models that are appropriate for addressing different questions as well as facilitating the collection and analysis of many different types of data.
To prepare for this Discussion, identify a program within an agency with which you are familiar, which could benefit from process evaluation and outcome evaluation. You do not need to identify the agency in your post. Also, review the different evaluation models highlighted in this week’s resources (needs assessment, program monitoring, client satisfaction study, outcome evaluation, or cost benefit study).
Post a brief summary of the program that you selected. Recommend a program evaluation model that would answer a question relevant to the program. Explain the potential benefits of the program evaluation that you proposed (both process and outcome). Identify 2–3 concerns that stakeholders might have about your proposed evaluation and how you would address those concerns. Then explain 2–3 concerns that stakeholders may have about your proposed program evaluation and how you would address those concerns.
Program Evaluation Studies
TK Logan and David Royse
A variety of programs have been developed to address social problems such as drug addiction, homelessness, child abuse, domestic violence, illiteracy, and poverty. The goals of these programs may include directly addressing the problem origin or moderating the effects of these problems on indi- viduals, families, and communities. Sometimes programs are developed
to prevent something from happening such as drug use, sexual assault, or crime. These kinds of problems and programs to help people are often what allracts many
social workers to the profession; we want to be part of the mechanism through which society provides assistance to those most in need. Despite low wages, bureaucratic red tape, and routinely uncooperative clients, we tirelessly provide services tha t are invaluable but also at various Limes may be or become insufficient or inappropriate. But without conducting eva luation, we do not know whether our programs are helping or hurting, that is, whether they only postpone the hunt for real solutions or truly construct new futures for our clients. This chapter provides an overview of program evaluation in gen – eral and outlines the primary considerations in designing program evaluations.
Evaluation can be done informally or formally. We are constantly, as consumers, infor- mally evaluating products, services, and in formation. For example, we may choose not to return to a store or an agency again if we did not evaluate the experience as pleasant. Similarl y, we may mentally take note of unsolicited comments or anecdotes from clients and draw conclusions about a program. Anecdotal and informal approaches such as these gen- erally are not regarded as carrying scientific credibility. One reason is that decision biases play a role in our "informal" evaluation. Specifically, vivid memories or strongly negative or positive anecdotes will be overrepresented in our summaries of how things are evaluated. This is why objective data are necessary to truly understand what is or is not working.
By contrast, formal evaluations systematically examine data from and about programs and their outcomes so that better decisions can be made about the interventions designed to address the related social problem. Thus, program evaluation involves the usc of social research meLhodologies to appraise and improve the ways in which human services, poli- ci~s, and programs are co nducted. Formal eva l.uation, by its very nature, is applied research.
Formal program evaluations attempt to answer the following general ques tion: Does the p rogram work? Program evaluation may also address questions such as the following: Do our clients get better? How does our success rate compare to those of other programs or agencies? Can the same level of success be obtained through less expensive means?
222 PART II • QUANTITATIVE A PPROACHES: TYPES OF STUD IES
What is the experience o f the typical client? Sho uld this prog ram be terminated and its funds applied elsewhere?
Ideally, a tho rough program eval uation would address more complex questions in three main areas: (1) Does the program produce the intended outcomes and avoid unin- tended negative o u tcomes? (2) For whom does the program work best and un der what conditions? and (3) Ilow well was a p rogram model developed in one setting adapted to another setti ng?
Evaluation has taken an especially p rominent role in practi.ce today because o f the focu~ on evidence-based practice in social programs. Social work, as a profession, has been asked to use evidence-based practice as an ethical obligation (Kessler, Gira, & Poertner, 2005). Evidence-based practice is defined diLTerently, but most definit ions include using program evaluation data to help determine best practices in whatever area of social programming is being considered. In other words, evidence-based practice incl udes using objective indica- tors of success in addition to p ractice or more subjective indicators of success.
Formal program evaluations can be found on just about every topic. For instance, Fraser, Nelson, and Rivn rd ( 1997) h ave examined th e effectiveness of family preservation services; Kirby, Korpi, Adivi, and Weissman ( 1997) have evalu ated an AIDS and preg- nancy prevention middle school program. Mo rrow- Howell, Beeker-Kemppainen, and Judy ( 1998) evaluated an interven tion designed to reduce the risk of suicide in elderl y adult clients of a crisis hotline. Richter, Snider, and Gorey ( 1997) used a quasi-experimental design to study the effects of a g roup work interven tio n on female sur vivors of childho od sexual abuse. Leukefeld and colleagues ( 1998) examined the effects of an I IlV prevention intervention with injecting drug and crack users. Logan and colleagues (2004) examin ed the effects of a drug co urt in terven tion as well as the costs of drug co urt compared with t he economic benefits of the drug court progra m.
Basic Evaluation Considerations
Before beginning a program eva luntion, several issues must be initially considered. These issues are decisions 1 hat are critical in determining the evaluation methodology and goals. Although you may not have complete answers to th ese qu estions when beginning to plan a n evaluation, these ques tion s help in developing th e plan and must be answered before a n evaluation ca n be carried out. We can 1.um up these considerations with the following questions: who, what, where, when, and why.
First, who will do the evaluation? This seems like a simple question at first glance. llowever, this particular consideration has major implications for the evaluation results. P rogram evaluators ca n be categorized as being either in ternal or external. An internal evaluator is someone who is a program staff member or regular agency employee, whereas an external evaluator is a professional, on contract, hired for the specific purpose of evalu- a tion. Th ere are adva ntages nnd disa dvan tages to using either type of evaluato r. For example, the internal evaluator probably will be very familia r with the staff and the program . This may save a lot of planning time. The d isadvnn tage is that eva luatio ns com- pleted by an internal eva luator may be considered less valid by outside agencies, including the funding source. The external evaluator gene rally is thought to be less biased in terms of evaluation outcomes beca use he or she has no persona l investment in the program. One disadvantage is that an externa l evaluator frequently is viewed as an "o utsider" by the staff w ithin an agency. This may affect the amount of time necessar)' to conduct the eva lua tion or cause problems in the overall evaluation if agency staff are reluctant to cooperate.
CHAPTER 13 • P ROGRAM E VALUATION S1 UD I ES 223
Second, what resources are available to conduct the evaluation? Hiring an outside eval- uator ca n be expensive, whi le having a staff person conduct the evaluation m ay be less expensive. So, in a sense, you may be trading credibility for less cost. In fact, each method- ological decision will have a trade-off in credibility, level of information, and resources (including time and mo ney). Also, t he amount and level of infor mation as well as the research design .. ciU be determined, to some e11."1ent, by what resources are available. A comprehensive and rigorous eval uation does take significant resources.
Third, where will the information come from? If an eval uation can be done using exist- ing data, the cost will be lower than if data must be collected from numerous people such as clien ts and/or staff across m ultiple sites. So having some sense of where the data will come from is important.
Fou rth, when is the evaluation information needed? In o ther wo rds, what is the time- fra me for the evaluation? The timeframe will affect costs and design of research methods.
Fifth, why is the evaluation being conducted? Is the evaluation being conducted at the request of th e fun ding so urce? Is it being cond ucted to improve services? Is it being con- ducted to document the cost-benefit trade-off of the program? If future program funding decisions will depend on the results of the evaluation, then a lot more importance will be attache d to it than 1f a new manager simply wants to know whether clients were satisfied with services. The more that is riding on an evaluation, the more attention will be given to the methodology and the more threa tened staff ca n be, especially if they think that th e purp ose of the evaluation is to down size and trim excess employees. In other words, there arc many reasons an evaluation is being considered, and these reasons may have implica- tions for the evaluati on methodology and implemen tation.
Once the issues described above have been considered, more complex questions and trade-offs will be needed in planning the evaluation. Specifically, six ma in issues guide and shape the design of any program evaluation effort and m ust be given thoughtful and delib erate consideration.
L Defining the goal of the program evaluation
2. Un dersta ndi ng the level of infor mation needed for the program evaluation
3. Determining the methods and analysis that need to be used for the program evaluation
4. Consider in g issues that might a ri se and strategies to keep the eval uation on course
5. Developing results into a useful fo rm at for the program stakeholders
6. Providing practical and useful feedback about the program strengths and weak- nesses as well as providing infor matio n about next steps
Defining the Goal of the Program Evaluation
It is essen tial that the evaluator has a firm understanding of the short- and long-term objectives of the evaluation. Imagine being hired for a position but not being given a job descrip tio n or informed aboul how the job fits into the overall organization. Without knowing why an evaluation is called for or needed, the evaluator might attempt to answer a d ifferent set of c.1uestio ns from those of interest to the age ncy director or advisory board. The management might want Lo know why the majo rity of clients do not return after one or two visits, whereas the evaluator might think that his or her task is to determ ine
224 PART II • QUANTITATIVF APPROACHES: TYPlS Or SIUDIES
whether clien ts who received group therapy sessions were better off than cl ien ts who received ind ividua l counseling.
In defini ng the goals of t he prog ram evaluation, severa l steps should be taken. First, the program goals should be examined. These can be lea rned through examining official program docum ents as well as through talking to key program stakeholders. In clarifying the overall purpose of the evaluation, it is critical to talk with different program "stake- holders." Scriven ( 199 1) defines a program stakeholder as "one who has a substantial ego, credibility, power, futures, or other capital invested in the program . . .. This includes program staff and many who arc no t ac tively invo lved in the day-to-day operations" (p. 334) . Stakeholders incl ude both supporters and opponents of the program as well as program clients or consumers or even potential consumers or clients. lt is essential that the evaluator obtain a variety of different views about the program. By listening and con- sidering stakeholder perspectives, the evaluator can ascertain the most important aspects of the program to target for the evaluation by looking for overlapping concerns, ques- tions, and comments from the various stakeholders. However, it is important th at the stakehol ders have so me agreement on what program success means. Otherw ise, it may be d ifficult to conduct a satisfactory evalua tio n.
It is also important to consult the extant literature to understand what similar programs have used to evaluate their outcomes as well as to understand the theoretical basis of the program in defining the program evaluation goals. Furthermore, it is critical that the evaluator works closely with whoever initia ted the evaluation to set priorities for the evaluation. This process should identify the intended o utcomes of th e program an d which of those outco mes, if not all of them, will be evaluated. Takin g the eval uation a step further, it may be important to include the exam ination of un intended negative outcomes that may result from the program. Stakeholders and the literature will also help to deter- mine those kinds of outcomes.
Once the overall purpose and priorities of the evaluation a re established, it is a good idea to develop a written agreement, especially if the eva I uator is an external one. Misunderstandings can and will occu r m onths later if things are no t wr itten in black and white.
Understanding the Level of Information Needed for the Program Evaluation
The success of the program evaluation revolves around the evaluator's ability to develop practical, researchable questions. A good rule to follow is to focus the evaluation on one or two key questions. Too many questions can lengthen the process and overwhelm the evaluator with too much data that, instead of facilitating a decision, might produce inconsistent findings. Sometimes, funding sources require only that some vague unde- fined type of evaluation is conducted. The funding sources m ight nei ther expect nor desire disserta tio n-quality researc h; they simply migh L expect "good fa ith" efforts when beginning eva luation processes. Other agencies may be quite demand ing in the types and forms of data to be provided. Obviously, the choice of methodology, data collection procedures, and reporting formats will be strongly affected by the purpose, objectives, and questions exam ined in the study.
It is important to note the difference between general research and evaluation. In resea rch, th e investigator often· focuses on q uestions based on theoretical considerations o r hypotheses gene rated to hu ilcl o n research in a specific area of study. Altho ugh
CHAPTER 13 • PROGRAM EVALUATION $ TUU I ES 22 5
prog ram evaluatio ns m ay foc us on an intervention derived from a theory, the evalua- tio n questions should, first and foremost, be driven by the program's objectives. The eval- uator is less con ce rned with buildi ng o n prior litera ture o r cont ributing to the development of practice theory than with determinin g whether a program worked in a specific community or location.
T here are actually two main types of evalu ation questi ons. There are quc~>tions that focus on client outcomes, such as, "What impact did the program have?" Th ese kinds of questions are addressed by using outcome evaluation methods. Then there are questions that ask, "Did the program achieve its goals?" "Did the program ad here to the spec ified procedures or standards?" o r "vVh at was learned in operating this program?" These kinds of questions are addressed by using process evaluation methods. We will examine both of these two types o f evaluation approaches in the following sec tions.
Process Evaluation Process evaluations offer a "snapshot" of the program at any given time. Process evalua- tions typically describe the day-to- day program effo rts; program modifica tions and changes; outs ide even ts that infl uenced the program; people and institutions involved; culture, customs, and traditions that evolved; and sociodemographic makeup of the clien- tele (Scarpitti, In ciardi, & Pottieger, 1993). P rocess evaluation is conce rned with identify- ing p rogra m st rengths and weaknesses. T his level of p rogram cvalua rion can be usefuhn several ways, including providing a contex-t within wh ich to interpret program outcomes and so that other agen ci es o r localities wishin g to sta rr sim ilar programs ca n benefit with- out havin g to make the same mistakes.
As an example, Bentelspacher, DeSilva, Goh, and La Rowe ( 1996) conducted a process eva luation o f the cultural co mpatibility of psychoed ucational fam ily grou p treatment with eth n ic Asian cl ients. As another example, Logan, Williams, Leukefeld, an d Minton (2000) conducted a detailed process evaluation of the drug court programs before under- taking an outcome evalual ion of the same programs. T he Loga n et al. sl udy used multiple m ethods to condu ct the process evaluati o n, including .in-depth i nterviews with the program administra tive personnel, inten,iews with each of five judges involved in the progr am, surveys a nd face- to -face interviews with 22 randomly selected current clients, and surveys of all program staff, 19 community treatment provider representatives, 6 ran – domly selected d efense attorney representatives, 4 prosecu tin g attorney representatives, l representative 6:om the probation and parole offi ce, 1 representa tive from the local co unty jail, an d 2 police depa rtmen l representatives. In all, 69 different individuals repre- senting I 0 different agency perspectives provided information about the drug court program. Also, all agency documents were ex amined and analyzed , observations of vari- ous aspects of the program process were conducted, and client intake data were analyzed as pa rt of the process evaluation. The results were all integrated an d compiled into one co mprehensive repo r t.
What makes a process evaluation so important is that resea rchers often have relied only on selected program outcome indicators such as termination and grad uation rates or number of rearrests to determine effectiveness. However, to better understand how an d why a program such as drug court is effective, an analysis of how the p rogram was con cep- tualized, implemented, and revised is needed. Consider this exan1ple-say one outcome eva luation of a drug cou rt p rogram showed a gra duat ion rate of 80% of those who began the program, while another outcome evaluation found that only 40o/o of those who began the program graduated. Then, the graduates of the second program were more likely to be free from substance usc an d crimin al behaviors at the l2- month foUow-up than the graduates
226 PART II • QuANTITATIVE APPROACHES: TYPES OJ SJUDIES
from the first program. A process evaluation could help to explain the specific differences in facto rs such as selection (how clients get into the programs), treatment plans, monitor- ing, program length, and other program features that may influence how many people graduate and slay free from drugs and criminal behavior at follow-up. Tn other words, a process evaluation, in contrast to an examina tion of program outcome only, can provide a clearer and more com prehensive pictm e of how drug cou rt affects those involved in the program. More specifically, a process evaluation can provide information about program aspects that need to be improved and those that work well (Scarpilli, Inciard i, & Pottieger, 1993). Finally, a process evaluation m ay help to facilita te replicatio n of the drug cou rt program in other areas. This often is referred to as technology transfer.
A different but related process evaluation goal might be a description of the failures and depa r tures from the way in which the interventio n o riginally was designed. How were the staff trained and hired? Did the intervention depart from the treatment manual rec- ommendations? Influences that shape and affect the intervention that clients receive need to be identified because they affect the fidelity of the treatment p rogram (e.g., delayed funding or staff hires, ch anges in policies or procedu res). "/hen program implementation deviates significantly from what was intended, this might be the logical explanation as to why a program is not working.
Outcome or Impact Evaluation Outcome or impact evaluation focuses on the targeted objectives of the program, often looking at variables such as behavior change. For example, many drug t reatment programs may measure outcomes or "success" by the number of clients who abstain from drug use. Questions always arise, though. For instance, an evaluation might reveal that 90% of those who graduate from the program abstai n from drug use 30 days after the prog ram was com- pleted. However, only 50% report abstai ning from drug use 12 months after the program was completed. Would key stakeholders involved all consider that a success or failure of the progr am? This exam ple brings up three critical issues in outcome evaluations.
One of the critical issues in outcome evaluations is related to understanding for whom docs the program work best and under what conditions. In other words, a more interest- ing and important question , rather than just asking whether a program works, would be to ask, "Who are those 50% of people who remained abstinent from drug use 12 mo nths after completing the program, and how do they differ from the 50% who relapsed?" It is not unusual for some evaluation questions to need a combination of both process and im pact evaluation m ethodol ogies. For example, if it turned o ut that r esults of a particular evaluatio n showed that the program was not effective (impact), then it might be useful to know why it was not effective (process ). Tn such cases, it would be important to know how the program was im plemented, what changes were made in the pro gram during the im plementation, what problems were experienced dur ing the implem entation, and what was done to overcome those problems.
Another important issue in outcome evaluation has to do with the timing of meas ur- ing the o utcomes. Ou tcome effects are usually measured after treatmen t or postin terven- tion. These effects may be either short term or long term. immediate outcomes, or those generally measured at the end of the treatment or intervention, might or might not pro- vi de the same resu lts as one would get later in a 6- or 12-m onth follow- up, as highlighted in the exa mple above.
The third important issue in outcome evaluation has to do with what specific measures were used. Is abstinence, for example, the only measure of interest, or is reduction in use something that might be of inte rest? Refra inin g from cri minal activity or holding a steady
CHAPTER l3 • PROGRAM EVALUATION STUOIES 2 27
job may also be an important goal of a subslance abuse program. If we only m easure abstinence, we would never know about other kinds of outcomes the program may affect .
These last two issues in outcome evaluations have to d o with the evaluation methodol- ogy and analysis and are add ressed in more detail below.
Determining the Methods and Analysis That Need to Be Used for the Program Evaluation
The next step in the evaluation process is to determine the evaluation design. There are several interrelated steps in this process, including determining the (a) sources of data, (h) research design, (c) measures, (d ) analysis of change, and (e) cost- benefit assessment of the program.
Sources of Data Several main so urces of data can be used for evaluat ions, includ ing quali tative informa- tion and quantitative information.
Qualita t ive Data Sources
Qualitative data sources are often used in p rocess evaluations and might include o bsen a- tions, analysis of existing program documents such as policy and procedure manuals, in – depth interview data, or focus group data. There are, however, trade-offs when using qualitative data so urces. On the positive side, q ua litative evaluation data provide an "in- depth" snapshot of var ious topics such as how the program functions, what staff think are the positive or negative aspects of the programs, or what clients really think of the O'erall program exp eriences. Reporting cl ients' experiences in their own words is a characteristic of qualitative evaluations.
Interviews arc good for collecting qualitative or sensitive data such as values and atti – tud es. This method requires an interview prolocol or questionnaire. These usual!) are structured so that respondents are asked questions in a specific order, but they can be semistructured so t.hat there are fewe r topics, and the interviewer has the ability to cha nge the order based on a "reading" of the client's responses. Surveys can request information of clients by mail, by telephone, or in person. They may or may not be 1>clf-administered. So, besides considering what data are desi red, evaluators must be concerned with prag- matic considerations regarding the best way in which to collect the desired data.
Pocus groups also offer insight in to cer tain aspects of the program or program func- tioning; participants add their input, and input is interpreted and discussed by other group members. This discussion component ml!y provide an opportunity to uncover information that might otherw ise remain undiscovered such as the m eaning of certain things to different people. Focus gro ups typically are small inform al groups of persons asked a series of questions that start out very general and then become more specific. Focus groups are increasingly being used to provide evaluative info rmation about human services. They work pa rt icula rly well in identifying t he questio ns that might be important to ask in a survey, in testing planned procedures or the phrasing of items for the spec ific target population, and in exploring possible reactions to an intervention or a service.
228 P!IRT II • QuANTITATIVE APP ROACHF.S: TYPES OF SruOI[S
On the other hand, qualitative studies Lend to use small samp les, and care mus t be used in analyzing and interpreting the information. FurLhermore, although both qualitative and quantitative data are su bject to m ethod bias and threats to validity, qualitative data may be more sensitive to bias depending on how participants are selected to be inter- viewed, the nu mber of observations or focus groups, and even subtleties in the questions asked. With qualitative approaches, the evaluator often has less abil ity to account for alter- n ative expla nation s because th e data are more limited. Making strong conclusions about representativeness, validity, and reliability is more difficult with quali tative d ata corn- pared to something like an average rating of satisfaction across respondents (a quantita – tive measu re). Yet, an average rating do es not tell us much about why parti cipants a re satis fi ed with the program or why they may be dissatisfied with other aspects of the p rogram. Thus, it is often imperative to use a mixture of q ualitative and quantitative information to evaluate a program.
Quantitative Data Sources
Two main types of quantitative data sources ca n be used for program evalu ations: sec- ondary data and original data.
Secondary Data. One option for ob taining needed data is to use existi ng data. Collecting new data often is more expensive than using existing data. Examining the data on hand an d already available always is a good llrst step. H owever, the evaluator migh t want to rearrange or reassemble the data, for example, dividing it by quarters or combining it into 12 -m onth periods that help to reveal patterns and trends over t ime. Existing data can come from a variety of places, including the following:
Client records maintained by the program: These may include a host of demographic and service-related data items about the population served.
Program expense and financial data: T hese can help the evaluator to determ ine whether one intervention is much more expensive than another.
Agenc.y annual reports: These can be used to identify trends in service delivery and program costs . The evaluator can compare an n uil l reports from year to year and can develop graphs to easily identify trends wilh clientele and programs.
Databases maintained by the state health department and other state agencies. Public data such as births, d eaths, and divorces are available from each state. Furthermore, mos t state agencies produce annual reports that may reveal the number of clients served by program, geographic region, and on occasion, selcc t·ed sociodemographic variables (e.g., race or age).
Local and regional agencies. Planning boards for mental health services, child protec- tion, school boards, and so forth may be able to furnish statistics on outpatient and in patien t services, special school populations, or child abuse cases.
The federa l government. The fed era l governmen t collects and maintains a large amount of data on many different issues and topics. State and national data provide bench- marks fo r comparing local demographic or social indicators to national-level demo- graphic or social indicators. For instance, if you were worki ng as a cancer educator whose objective is to red uce the incidence of b reast cancer, you might want to consult cancercontrolplanct.ca ncer.gov. That Web site w ill furnis h natio nal -, state-, and
CHAPTER 13 • PROGRAM EVAlUA II ON S TUD ICS 229
county-level data on the nwnber of new cancer cases and deaths. By compariso n, it will be possible to determine if the rate in one county is higher than the state or national average. Demographic information about communities can be found at www.census.gov.
Foundations. Certain well-established foundations provide a wealth of information about problems. For example, the Annie E. Casey Foundation provides an incredible Kids Count Data Book that provides an abundance of child welfare-related data at the state, national, and county level. By using their data, you could determine if infant mortality rates were rising, teen births were increasing, or high school dropouts were decreasing. You can find the Web site at www.aecf.org .
lf existing data cannot be used or cannot answer all of the eva luation q uestions, then o riginal data rnust be coll ec lcd.
Original Data Sources. There a re rnan y typ es or evalua ti o n designs (rom wh ich to choose, and no single one will be ideal for every project. Th e specific approach chosen for the eva luation will depend on the purpose of the evaluation, the research questions to be explored, the h oped-to r or in ten d ed res ults, the quali ty and vo lume of data available or needed, and staff, time, and financial reso urces.
The evaluation design is a critical decision for a number of reasons. Without the appropriate evaluation design, confidence in the resuiL<> of the evaluation might be lack~ ing. A strong evaluation design minimizes alternative explanations and assists the evalua- tor in gauging the true effects attributable to the intervention. In other words, the evaluation design directly affects tl1e interpretation that can be made regarding whether an intervention should be viewed as the reason for change in clients' behavior. Howewr, there are trade offs with each design in the credibility of information, causality of an)' observed changes, and resources. These trade- off.~ must be carefully considered and discussed with the program staff.
Quantitative designs include surveys, pretest-posttest studies, quasi-experiments with noncquivalcnt control groups, lo ngit u dinal designs, and randomized experimental designs. Quantitative approaches transform answers to specific questions into numerical data. Outcome and impact evaluations nearly always are based on quantitative evaluation desig ns. Als
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