Positive LivingNavajo AIDS Network, Inc.

Melvin Harrison, Executive DirectorMarco Arviso, Arizona Medical Case Manager

Objectives

• Define Medical and Psychosocial case management

• Describe “linkage to care”• List examples of individual, group and

community level interventions.

What is Psychosocial Case Management?

• Early access to and maintenance of comprehensive health care and social services.

• Improved integration of services provided across a variety of settings.

• Prevention of disease transmission and delay of HIV progression.• Increased knowledge of HIV disease.• Greater participation in and optimal use of the health and social

service system.• Reinforcement of positive health behaviors.• Personal empowerment.• An improved quality of life.

What is Medical Case Management?

Medical Case Management (MCM) is traditional case management with the primary purpose of :

1) retaining clients in medical care and2) achieving positive health outcomes for clients

of NAN Inc.

-HIV Medical Case Management GuidelinesDistrict of Columbia 2010

Client Demographics

• Average age: 46 • Age range: 22-74• New Mexico – 18• Arizona – 42 • Average CD4-328.4 • Average Income-

$402.00

•67% have reported substance use in the last year •3 clients looking for suitable housing for winter•1 client self reported as homeless

Phoenix, AZPittsburgh, PA

2.5 hours

1.75 hours

1.75 hours

1.5 hours1.5 hours

2.5 hours

60 clients

Active Cases- Enrollment on CM

19961997

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20120

2

4

6

8

10

12

14

16

n=60

Series 1

AZ Active Cases 2012-Gender

n=60

Male; 45

Female; 10

Transgender M-F; 5

Active Cases-Status

n=60

HIV50%AIDS

47%

unknown3%

Active Client- Risk

55%32%

10%

2% 2%

Risk

MSMHeteroUnkIDUMSM/IDU

How does the process of Case Management work?If you know that you are positive and need case management...

If you are recently diagnosed in a clinical

setting…

If you are tested at a mobile unit and are

newly infected...

Contact NAN for Case Management

Linkage to Care:

AssessmentContact NAN Inc. Case Manager and set up an appointment for an intake interview where we will discuss your health concerns and plan your care.

•Health•Financial•Social support•Practical Needs•Education/Employment•Mental Health

•Risk•Substance Abuse•Legal

Working with Primary Care ProvidersThe goal of Medical Case Managers is to provide a client with the skills, information and support to follow mutually agreed upon treatment adherence recommendations of healthcare

professionals to achieve optimal health.

• Taking all medications as prescribed• Making and keeping appointments• Addressing barriers to care and treatment and• Involving the clients belief of Cultural Traditional Medicine where necessary

Team Care Meetings

Meetings with I.H.S. Care team to discuss mutual clients• Evaluation

– CD4– Viral Load– STI– Mental Health– ADAP (AIDS Drug Assistance Program)

• Future appointments• Referrals• Progress notes

Individual Interventions-Care Plans

• Travel Reimbursement • Emergency Financial Request(clients in Crisis)– Wood/coal delivery– Utilities – Housing

• Transitional Housing• Ceremonial Assistance • Social/educational Support • Client/family education/disclosure

Group Interventions•Gathering of Clans• Monthly • Informal • “special guests”

•Healthy Relationships• 5 session cycle• Reducing stress• Disclosure

•Annual Client Summit• Wellness • Updates

•Many Men, Many Voices• Annual• Specifically adapted for PLWHA

Barriers

• Funding– Increased number of clients– Transportation– Housing

• Confidentiality/stigma– Fear of Gov systems

• Substance Abuse

Solutions

• Anti stigma approach to media • Substance Abuse facility addressing MSM/T

unique needs

Questions

Thank you