Strategies for Effective NHAS Partnership with Community Based Organizations

HIV Prevention Leadership Summit | December 13, 2010 | Washington, D.C.

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Getting on the same page…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:– 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 OpportunitiesThree 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 AreTreating the Whole Person Where They Are

CBO’s should embrace 12-city initiativeCBO’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 From This Integrated Care AIDS Service Org

COBRA Case Management

Assessment, Intensive Case Management,

Advocacy, Crisis Intervention

Supportive Housing Programs

Case Management, Primary Care Support, Treatment Education, Mental Health Services, Substance Use Counseling, Advocacy, Structured Socialization

Mental Health Services

Crisis Intervention, Individual and Group

Psychotherapy, Medication Management,

Expressive Therapies

Testing ServicesRapid 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

Black Men’s Initiative

Individual, Group and Community Level Interventions targeting Men of

Color Who Have Sex With Men

Youth Development for Health, for Young Men of Color Who Have Sex

with Men

Evening Food & Nutrition

Nutritional Assessment and Support, Treatment

Education, Psycho-Social Support

Women’s Housing (Scatter-Site)

Transitional Housing (Scatter-Site)

Permanent Congregate Housing

Prevention Prevention ServicesServices

Federally Federally Qualified Health Qualified Health Center & Related Center & Related

ServicesServices

Supportive Supportive HousingHousing Programs Programs

Adult Day Health Center East

Fully Bilingual (Spanish/English) Case Management, Treatment

Education, Support Groups, Harm Reduction Counseling, Auricular

Acupuncture, Primary Care Support

Adult Day Health Center West

Medical Care, Adherence Support, Nutrition

Counseling, Substance Use

Counseling, Structured Socialization, Pastoral

Care, Expanded Syringe Access Program

HUD Housing (Scatter-Site)

HRA Housing (Scatter-Site)

Dental Clinic

Primary Care

(Westside & Eastside)

Emergency Congregate Housing(Foundation House North & South)

FROST’D @ Harlem UnitedHarm Reduction ♦Syringe Exchange ♦HIV/HCV Testing and Linkage to

Care and Treatment ♦ Overdose Prevention

Healthcare for the Homeless

Healthcare & related services for the homeless

in Central & East Harlem

Vocational Education Program

Building Bridges Mental Health Program

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To This Integrated Healthcare Service To This Integrated Healthcare Service OrganizationOrganization

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Medical Home Model: Principles for Quality Medical Home Model: Principles for Quality CareCare

• Personal physician in physician-directed 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

Principles developed by the American College of PhysiciansPrinciples developed by the American College of Physicians

Team-based care:NP/PA

RN/LPNMedical AssistantCare Coordinator

Office StaffNutritionist

Health EducatorBehavioral Health

PharmacistCase ManagerSocial Worker

Team-based care:NP/PA

RN/LPNMedical AssistantCare Coordinator

Office StaffNutritionist

Health EducatorBehavioral Health

PharmacistCase ManagerSocial Worker

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Available Doesn’t Mean AccessibleAvailable Doesn’t Mean Accessible

Recognize the strength of community-based organizationsRecognize 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

• 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 PartnershipsRevisit 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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End fragmentation of care - NHAS heralds opportunity for more synergistic funding and administration

Funding Dilemma Funding Dilemma

• 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

• 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 Addressing Social Drivers of HIV Vulnerability is KeyHIV Vulnerability is Key

Public Service AnnouncementPublic 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

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 Important Opportunity to Program More ComprehensivelyComprehensively

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

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 Important Opportunity to Program More ComprehensivelyComprehensively

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

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 ModelHCH Services – An Integrated Care Model

Primary Care clinic (Westside & Eastside)

GYN, Health Education, Directly Observed Therapy,

Psychiatry services, Preventive Health Services,

Management Of Chronic Conditions

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

Other services

Referrals, Outreach, and Case Management.

Federally Federally Qualified Qualified

Health CenterHealth Center

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Contact InformationContact Information

Kali D. Lindsey

Senior Director of Federal Policy

Klindsey@harlemunited.org

(212) 801-2455

Kali D. Lindsey

Senior Director of Federal Policy

Klindsey@harlemunited.org

(212) 801-2455