Slide 1

Report
Strategies for Effective NHAS Partnership with Community Based
Organizations
HIV Prevention Leadership Summit | December 13, 2010 | Washington, D.C.
Getting on the same page…
• The majority of community-based organizations are on board
– Reflect standard operating procedure
– Want this initiative to succeed in the interest of current and future endeavors
• We got what we were asking for
– Eager to partner in formative process
• Not excited about having the future dictated to us
– 12-city initiative is exciting
• One-size-fits-all approaches have never worked
• Tailored strategies promise new progress
• CDC will establish new standards for reviewing State and local prevention
plans to ensure that Federal funds are used in a manner addressing people
living with HIV and reflecting populations with greatest need.
• Community and organizational understood goals:
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Reduce and/or eliminate HIV incidence
Improve individual access to/engagement in high-quality medical care
Facilitate antiretroviral treatment access and adherence
Connect those in need with supportive services to optimize health outcomes
Eradicate HIV-related stigma and discrimination from our community
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Three Key Opportunities
• Doing a better job of treating the whole person
• Resolving the funding stream dilemma
• Addressing the social drivers of HIV vulnerability
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Treating the Whole Person Where They Are
CBO’s should embrace 12-city initiative
NHAS Objectives
• CDC will continue to evaluate all existing HIV prevention programs every
five years to ensure that Federal dollars support programs that are
effective and have demonstrated improved health outcomes.
• HHS OS and relevant agencies will consult with States and other
jurisdictions prior to allocating prevention funding to targeted populations
and communities to ensure coordination of efforts.
Partnership Opportunity
• Recalibrate program protocols to provide greater flexibility in funding
announcements/applications to design programs that meet the needs of
the client entering the door
• Maximize the potential of short-term opportunities such as PEP, PrEP,
and TLC+
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From This Integrated Care AIDS Service Org
Black Men’s Initiative
Supportive Housing Programs
Individual, Group and Community
Level Interventions targeting Men of
Color Who Have Sex With Men
Case Management, Primary Care Support,
Treatment Education, Mental Health
Services, Substance Use Counseling,
Advocacy, Structured Socialization
Youth Development for Health, for
Young Men of Color Who Have Sex
with Men
HRA Housing (Scatter-Site)
Supportive
Housing
Programs
Women’s Housing (Scatter-Site)
HUD Housing (Scatter-Site)
FROST’D @ Harlem United
Harm Reduction ♦Syringe Exchange
♦HIV/HCV Testing and Linkage to
Care and Treatment ♦ Overdose
Prevention
Prevention
Services
Transitional Housing
(Scatter-Site)
Testing Services
Emergency Congregate Housing
(Foundation House North & South)
Permanent Congregate Housing
Building Bridges Mental Health
Program
Dental
Clinic
Federally
Qualified Health
Center & Related
Services
(Westside &
Eastside)
Vocational Education Program
Adult Day Health
Center West
Medical Care, Adherence
Support, Nutrition
Counseling,
Substance Use
Counseling, Structured
Socialization, Pastoral
Care, Expanded Syringe
Access Program
Primary
Care
Adult Day Health
Center East
Healthcare for the
Homeless
COBRA Case
Management
Fully Bilingual (Spanish/English)
Case Management, Treatment
Education, Support Groups, Harm
Reduction Counseling, Auricular
Acupuncture, Primary Care Support
Healthcare & related
services for the homeless
in Central & East
Harlem
Assessment,
Intensive Case
Management,
Advocacy, Crisis
Intervention
Rapid HIV testing: Risk and Zone
Based approaches ♦ STD and
Hepatitis C Screening ♦ Innovative
Recruitment Strategies ♦Connection
to Healthcare ♦ADAP & Medicaid
Enrollment ♦ Uptown Health Link:
HIV Awareness and Prevention
Services for Upper Manhattan ♦
Peer Training Services
Evening Food &
Nutrition
Nutritional Assessment
and Support, Treatment
Education,
Psycho-Social Support
Mental Health
Services
Crisis Intervention,
Individual and Group
Psychotherapy,
Medication Management,
Expressive Therapies
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To This Integrated Healthcare Service
Organization
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Medical Home Model: Principles for Quality
Care
Principles developed by the American College of Physicians
• Personal physician in physiciandirected practice
• Whole person orientation
• Coordinated care, integrated across
settings
• Quality and safety emphasis
• Enhanced patient access to care
• Supported by payment structure
that recognizes services and value
Team-based care:
NP/PA
RN/LPN
Medical Assistant
Care Coordinator
Office Staff
Nutritionist
Health Educator
Behavioral Health
Pharmacist
Case Manager
Social Worker
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Available Doesn’t Mean Accessible
Recognize the strength of community-based organizations
•
Immediately arrest preventable transmission through combination prevention
approaches, inclusive of:
• Individual behavior interventions (condom access, HIV education, HIV testing)
• Biomedical prevention (PEP, PrEP, Microbicides, Vaccines)
• Systemic intervention (patient and peer navigation)
• Structural intervention (community outreach)
•
CBOs must be included and find ways to become part of the conversation
• Innovate new ways of partnership building on effective comprensive models
• Helping Our Men Evolve (HOME) - Black Men’s Initiative
• Don’t let perfect be the enemy of good
• Identify new way to embrace, rather than resist change to optimize shifts in the
environment
• Prefer direct partnership over dictatorship
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Revisit Strategic Partnerships
Community Health Clinics are Essential to our Success
• 18.8 million socioeconomically disenfranchised individuals with
limited or no access to health care visit CHCs each year
• Can only account for less than 800,000 HIV tests administered
– Partially explained by an infrastructure issue. Presents a strong prospect for
quality improvement.
• Paradigm shift: HIV is not someone else’s problem. It is not okay
for people to receive episodic health care without being offered an
HIV test.
– Current USPSTF guidelines embrace community health centers
– Routine testing is vital in areas where the HIV epidemic is generalized
• Case management should include focus on medical care and
treatment support
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Funding Dilemma
End fragmentation of care - NHAS heralds opportunity for more
synergistic funding and administration
• CBOs have to treat the whole person and have to overcome challenges to meet program
deliverable while responding to the needs of the individual
• Competing needs are essential to retention in health care and treatment adherence
• AIDS Adult Day Health Care Centers are an excellent model for comprehensive care
under one reimbursement stream
• Fragmented care can result from varied interpretations in Medicaid licensing
• Health care
• Mental health
• Addiction and subtance use
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Addressing Social Drivers of
HIV Vulnerability is Key
Public Service Announcement
Let this presentation serve as a clarion call for all providers,
including some of us in this room, to get real about and confront
our character and moral challenges that inhibit our ability to
provide the best standard of care to every individual that walks
through our doors. Every person deserves to be treated with full
respect and dignity irrespective of their socioeconomic
circumstances, incarceration history, sexual orientation,
substance use, disability, or mental health condition
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Important Opportunity to Program More
Comprehensively
DOL, SSA, DOJ, and HHS OS will develop a joint initiative to consider ways
to help individuals living with HIV access income supports, including job
skills and employment.
• Many social and structural issues inhibit the success of HIV prevention efforts and contribute to
ongoing HIV vulnerability among the most marginalized populations.
• Effective strategies to combat the following social drivers are urgently needed:
• homo-hatred
• racism
• addictophobia
• convictophobia
• xenophobia
• Economic inequalities and employability
• Driving a great deal of risk for her and him
• Occassional gifts and money can be tied to expectations of condomless sexual reciprocity
• Homelessness
• Housing is critical to prevention and health care
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Important Opportunity to Program More
Comprehensively
DOL, SSA, DOJ, and HHS OS will develop a joint initiative to consider ways
to help individuals living with HIV access income supports, including job
skills and employment.
• Health care access
• Health literacy
• Trust of the system
• Relationship with provider
• Openness and honesty is key
• Agency-preservation is critical
• Personal safety
• Education inequity and access
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HCH Services – An Integrated Care Model
Dental Clinic
- Diagnostic X-rays and Exams
- Preventive Care
- Emergency Care
- Restorations
-Endodontics
-Prosthodontics
-Periodontics
- Oral Surgery
- Referral to outside specialists for
complex Surgical Procedures
Mental Health and Substance
Use Services
Crisis Intervention, Individual And
Group Psychotherapy, Medication
Management, Expressive Therapies
Primary Care clinic
(Westside & Eastside)
Federally
Qualified
Health Center
GYN, Health Education,
Directly Observed Therapy,
Psychiatry services,
Preventive Health Services,
Management Of Chronic
Conditions
Other services
Referrals, Outreach, and Case
Management.
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Contact Information
Kali D. Lindsey
Senior Director of Federal Policy
[email protected]
(212) 801-2455
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