Understanding and Refining the System of Care Tuesday, July 6, 1:00-3:00 pm EDT Roles of Peers and...

Understanding and Refining the System of Care

Tuesday, July 6, 1:00-3:00 pm EDT

Roles of Peers and the Planning Process

presenters:Harold J. Phillips

Robert Hewitt

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Introductions, Objectives & Overviews

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INTRODUCTIONS:Project Consumer LINC Background

Cooperative Agreement funded by HRSA

The role of consumers in addressing unmet need and the unaware and the range of available strategies

04/19/23Understanding and Refining the System of Care - Roles of Peers and the Planning Process

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OBJECTIVES:Webinar

To provide a brief overview of the project including the 4 broad strategies

Learn and understand Strategy #1- Understanding and Refining the System of Care

Learn of the peer-led and peer-driven actions of 3 Part A programs have taken as a result of CLINC to better understand their system of care (Strategy #1)


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TOPICS COVERED BY PANELWebinar

Indianapolis: training and technical assistance is helping PLWH make changes to their system of care as this new TGA gains a better understanding of their roles and the system of care.

Detroit: peers are being trained to lead focus groups in an effort to gather more information regarding barriers and needs

New Orleans: an increased knowledge of the system is helping them make decisions about where to place peers at key points of entry and how standards of care can be changed to facilitate the use of peers.


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Volunteer/planning body-based: Understanding and Refining the System of Care PLWH Caucus/Committee

Staff/service-based Linking PLWH into Care Integrated Clinical Care Team


TYPES of MODELSBrief Review of 4 CLINC Strategies

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Two strategies involve consumers primarily as volunteers – as a part or extension of their roles in Ryan White planning and decision making:

Understanding and Refining the System of Care

PLWH Caucus/Committee

Two strategies involve consumers as provider staff, full- or part-time:

Linking PLWH to Care

Interdisciplinary Clinical Care Team


TYPES of MODELS4 Strategies

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TYPES of MODELSFactors to Consider in Reviewing/Applying Models

Your unmet need rate and profile

Current PLWH leadership & participation

Connections to PLWH communities

Service opportunities for PLWH within existing system of care (current provider models)

Capacity of planning body, grantee, providers

Understanding of current system of care

Commitment/readiness – of PLWH, planning body, grantee, providers

Cost issues

Contracting issues


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Benefits and Challenges of Engaging Consumers to Link Other PLWH to Care

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Understanding and Refining the System of Care - Roles of Peers and the Planning Process

What are the most important benefits or “value added” of adopting consumer-based

strategies? What do consumers offer that makes them valuable in such roles?

1.Social Networks – Every PLWH in care knows 2-3 PLWH not in care

2.Flexibility – Play many roles and can change to meet new needs.

3. Assist in the transition to “chronic disease model” – Empower to manage HIV disease.

4.Lower costs than other models

5.Proven Effectiveness of community health workers in other healthcare situations

6.Enhanced consumer involvement in community planning process

ACTIVITY AONLINE POLL

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BENEFITS & CHALLENGESChallenges and Costs

Resistance to change Some provider/clinician resistance to peers, especially in

clinical settings Procurement and contracting issues Few documented models PLWH health issues Challenges of volunteering for PLWH with very limited incomes Income limits for some PLWH Need for initial and ongoing training Need for ongoing supervision for employees, staff support for

volunteers Boundaries and confidentiality issues Retention issues


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BENEFITS & CHALLENGESUnmet Need and Unaware

Effective Strategies for Addressing Each Must Originate From

Estimating: What are the sizes of these populations

Assessing: What are the needs, barriers and gaps of these groups? Note: there may be similarities but there are also differences

Addressing: Implementing strategies, models, services designed to address both unmet need and those who are unaware and out of care


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Learning & Exploring Strategy #1:Understanding and Refining the System of Care

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LEARNING THE STRATEGIESSome Things to Look For

Purpose and use of the strategy

Key components

What needs to be in place to make this strategy work

Who needs to be involved – necessary roles for PLWH groups, planning body, grantee, providers

Costs/resource needs

Unanswered questions


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Volunteer/Planning Body-based Strategies

1. Understanding & Refining the System of Care

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VOLUNTEER-BASED STRATEGIES | STRATEGY #1

Purpose

To understand, assess, and make refinements in the system of HIV/AIDS care to make it easier for PLWH with various backgrounds and characteristics to:

1. Find out about available services

2. Get eligibility determined so they can enter the system of care

3. Obtain needed services and remain in care


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Approach

Engages PLWH in Ryan White planning bodies, committees, and caucuses in a leadership role to:

Identify and analyze barriers to access in the system of care – overall and for specific PLWH populations

Explore and recommend actions to reduce or eliminate these barriers and increase access to care


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Key Components/Steps

Form a PLWH leadership group for action

Analyze the current system of care

Explore ways to overcome access and retention barriers

Decide on needed changes in the system of care

Agree on actions the planning body can take

Recommend solutions requiring grantee action


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Models for Analyzing the Current System of Care

Population Access Exercise

Community meetings with providers and PLWH

Lead focus groups to help gather more information regarding various population groups

PLWH-led data review – unmet need and other needs assessment and cost & utilization data


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Decisions/Actions Planning Bodies Can Make

Changes in priorities or resource allocations – such as funding or expanding resources for a service category

Directives to the grantee (Part A) about how best to meet priorities – e.g., refined funding models

Changes in Standards of Care – e.g., call for use of peer community health workers


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Decisions/Actions By or Involving the Grantee

Service approach and contract changes to address identified barriers – requirements around outreach, intake, language/cultural competence, follow up

Linked and jointly funded prevention and care outreach efforts

Funding of new service models using PLWH as peer community health workers

New links with prevention or other points of entry


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Ongoing Actions Led by the Planning Body

Targeted community awareness building

PLWH-led outreach and training

Other social marketing

Tasks often led by PLWH caucus/committee (Strategy #2)


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VOLUNTEER-BASED STRATEGIES | STRATEGY #1Requirements

Roles: PLWH members of planning body or PLWH committee in lead role; planning body involvement & staff support needed

Costs: Analysis & recommendations supported as part of ongoing planning body activities (administrative costs); implementation costs may involve program or administrative costs

Training: Primarily related to understanding Ryan White & the system of care, using data, facilitation & communications skills


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VOLUNTEER-BASED STRATEGIES | STRATEGY #1Benefits

Engages and strengthens PLWH involvement and leadership

Increases visibility of Ryan White services

Provides solid base of knowledge for action

Often more cost-effective to change the system of care than to help individual PLWH overcome systemic barriers

Identifies low-cost steps to improve access to care and improve services

Helps prepare for adoption of new service models


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VOLUNTEER-BASED STRATEGIES | STRATEGY #1Challenges

Hard to implement if PLWH involvement is limited or weak

Requires genuine outreach to PLWH not generally involved in the community planning process, non-Ryan White providers, and others whose voices are not already being heard

Community meetings need to be well planned, coordinated, and facilitated

Must avoid having non-PLWH dominate the information-gathering process


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Indianapolis: Training & Capacity Building Technical AssistanceHelping Peers Understand their Roles and the System of Care

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INDIANAPOLIS | STRATEGY #1

Background

Training and capacity building technical assistance for peers played key roles in helping members build more valuable skill sets towards understanding and applying public health, fiscal and program data.

Indianapolis 1 of 5 Transitional Grant Area’s (TGA’s) established in 2006

Prior to 2006, unmet need in the area was estimated at 43.5%. Current figures put unmet need at 38.5%

In 2009 the number of new clients at 340, re-enrolled at 640 and new clients/never been in care at 76

Indianapolis Council has a greater than 33% consumer make-up


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Building Blocks/Readiness

Membership is diversified as it is distinct with PLWH in key positions of leadership on the Council

Take seriously their role in being link to the community by participation in:

Community festivalsHealth fairsWorkshops and forums discussing the council and Ryan White Services

Have been able to build on this commitment and energy of our PLWH Membership


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Results of CLINC ParticipationThose who attended CLINC training in Nashville returned to their

own Planning Council and facilitated a similar CLINC Training helped entire council have the same understanding of what we needed to do.

Difficult to say if CLINC Participation is a direct result but it did re-enforce and brought clarity to PLWH council members.

Consumer committee has increased its membership

PLWHA, through facilitated training and capacity building, continues to increase their knowledge and understanding of the various demographic breakdowns as well as the RW lexicon


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INDIANAPOLIS | STRATEGY #1Results of CLINC Participation

Our consumers have taken an active role in developing the needs assessment and comprehensive plan thereby becoming valuable partners in our health planning efforts

Two-4 hour sessions to discuss data in-depth as part of priority setting and resource allocation.

Over 75% of the participants were PLWH. Their input was also considered before moving to final approval.

A series of community meetings to introduce resource guide, explain planning process, obtain additional data, and recruit or the council.

Nearly 60 PLWHA attended.


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Changes Confirmation of essential needs and barriers found in the needs

assessments used in FY 2010 planning process.

Most needed services identified: access to primary medical care, medications, increased case management, and medical transportation.

Directives regarding cultural and linguistic competency are now included

Identified need to better market to the Hispanic/Latino community and increase program visibility, revision to the special populations were additional changes

MAI to help improve retention and entry into care; EIS will help us identify and bring individuals into care


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Poll Results

Let’s Look at the results of our online poll……….


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Detroit:Peer Led Focus Groups to Gather New Knowledge

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DETROIT | STRATEGY #1

Background The Detroit EMA covers urban Detroit, suburban, and rural areas so it is geographically diverse with the largest concentration of HIV providers found in Wayne County covering the urban area of Detroit.

Detroit’s HIV Epidemic has impacts for the entire State

Large numbers of those late to care, lost to care and out of care.

Unmet need for those with HIV 46%, those with AIDS 32% according to 2009 Estimates.

Stigma, lack of health education, and lack of knowledge of Ryan White all contribute to the problem


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Our Council has been asking the tough questions about services and the system

We have been receiving additional training and technical assistance some though HRSA and some from our own budget

We have expanded some of our needs assessment efforts, which have raised additional questions

General feel among some of the membership that we need to do and think about things differently


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Following CLINC training in St. Paul, returned to give small presentation at full council meeting. A more comprehensive presentation at November Consumer

Committee meeting. April 2010 Mosaica Team 2-day Training on CLINC Part A/B as

part of a collaborative effort between the State of MI and Detroit




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April 2-Day CLINC Training Attendees: ALL ABOARD Detroit EMA Planning Council Members Members of the Statewide Planning Body Part A & B Grantee & State Prevention Staff Providers from across the State Consumers from across the State

Training confirmed the need for additional information regarding some special populations, those in areas outside of Detroit

Our planning council also needs more information on the services available outside of Wayne County and additional information on key points of entry



Results of CLINC

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DETROIT | STRATEGY #1Change: Peers Led-Focus GroupsMosaica Perspective + Comprehension + Increased Knowledge

Base equals a valuable skill set: Able to ask those questions of why one is out of care with

empathy Familiar with problems/issues related to entering care and

enable us to get a deeper understanding of the issues Help clients to relax and develop trust Gives our consumer committee a sense of direction and

purpose Able to assist in creating recommendations based on data


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DETROIT | STRATEGY #1Changes

30 hours focus group training (12 Peer Leaders)

New to care/Returned to care in last year

Working with pharmaceutical companies on venues, dinners and $25.00 gift card for those who participate

Directives for CLINC Peer Navigator Models using 2009 carryover and waiting for HRSA approval in following categories: Primary Care, Medical Case Management, Early Intervention Services, Outreach, Non-medical Case management, Health Education/Risk Reductions, Treatment Adherence

TA on reviewing standards of care and adjusting to allow peer models.


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What Are Some Of The Other Ways That CLINC Participants Have

Looked to Enhance Their Understanding of the System of Care

Made Changes in the System

Briefly share some of your experiences with us as we get ready to hear from our final presenters in New Orleans.


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New Orleans: Increased knowledge of the system leading to better peer placement and changes in the standards of care

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New Orleans | STRATEGY #1

Background

Participation in the CLINC workgroup led to the grantee’s development of a vision for a peer-led outreach intervention to connect to care those who know their status but do not access medical care.

New Orleans has the second highest AIDS case rate in the nation (CDC, 2007).

The unmet need estimate has improved but requires further attention. In 2007, unmet need was 49%; in 2008, it was 46%; in 2009, it was 43%.

The 2008 Needs Assessment revealed: Consumer Need Rank #4 Referrals for Service with 9% Reported Consumer Gap; Consumer Need Rank #11 Counseling about living with HIV with 6% Gap; Consumer Need Rank #12 Opportunities to talk to HIV peers with 11% Gap.


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New Orleans | STRATEGY #1Building Blocks/Readiness With a strong commitment to reduce unmet need through

innovative programs and 49% of planning council members being HIV positive, the community was ready to take advantage of resources through CLINC.

Since standard points of entry have more formalized mechanisms for bringing individuals into the Ryan White care system, custom tailored peer-driven interventions were desired by consumers.

Lack of knowledge about basic health literacy and service navigation was repeatedly evident in the data. 17% of needs assessment respondents reported not knowing where to access HIV treatment.

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New Orleans | STRATEGY #1Building Blocks/Readiness The council endorsed a peer-based model to improve service

navigation and health literacy among the out of care population due to the anticipated cost-effectiveness and outcome-effectiveness. The engagement of PLWHA to deliver the intervention was strengthened by the council’s promotion of peer-based models.

Consumer participation in routine council activities and comfort with system navigation and using data in decision making was a prerequisite.

Other requirements: patience, persistence, commitment to completing the work necessary to implement a new project and enthusiastic peers!

Resources are available through Mosaica and the Peer Center. Tools are available online related to training curriculums, job descriptions, confidentiality and boundaries, etc. Ongoing support and supervision needs must be factored into the planning process.

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Results of CLINC

The existing PLWHA leadership committee informed the development of the Hand in Hand project. The project leverages peer social networks as an intervention to identify, educate and bring into care individuals who can be most difficult to reach.

Once certified, peers work with individuals who they personally know to be HIV positive, yet out of care. Peers share information related to health literacy and service navigation and help the individual make a medical care appointment and attend the first and second medical appointments with the individual. Once the individual has attended the appointments, the peers are thanked for their volunteer work with a gift card.

4 individuals have been linked to care in the 4 months since peers were certified.

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Changes

The collaborative Hand in Hand project, supported and implemented by the grantee and planning council, is a pilot project. Pending evaluation and demonstrated success, the model may become fully integrated.

As a complementary planning activity, the PLWHA committee also worked with the Service Delivery Committee to update Standards of Care for select service categories, such as psychosocial support services, to explicitly promote the work of trained peers in clinic settings.

Ensuring appropriately qualified peer participants was a key requirement. A training plan was developed which included a 3-day base training coordinated (based on the Training of the Trainer curriculum through the Boston University Peer Center) and facilitated by peers and an additional project-specific Hand in Hand orientation was conducted by staff.

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New Orleans | STRATEGY #1Changes At this time, the Hand in Hand project is funded under Early

Intervention Services as a pilot project being supported by Maintenance of Effort funds from the Grantee’s General Fund.

With the Hand in Hand project, as envisioned by the Community Coalition, the primary cost was related to the 3-day base training requirement. The cost for space, meeting support, presenters and materials can vary depending on the number of participants and potential in-kind sponsors. The cost for incentives will vary depending on the number of successful referrals to medical care.

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Questions for Our Panel

I’LL START: FOR MOST OF YOU ADDITIONAL TA PLAYED A ROLE, HOW IMPORTANT IS TECHNICAL ASSISTANCE IN BEING ABLE TO IMPLEMENT THIS STRATEGY?

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Questions for Our Panel

ADDITIONAL QUESTIONS

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CLOSING

FOR MORE INFORMATION ON ANY OF THE STRATEGIES WWW.MOSAICA.ORG

ALSO WE WILL SEE YOU AT THE ALL GRANTEES MEETING IN WAHSINGTON IN AUGUST

THANK YOU TO ALL THE PANELIST TODAY


Understanding and Refining the System of Care Tuesday, July 6, 1:00-3:00 pm EDT Roles of Peers and...

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