Project HERO Patient Navigation Program Monthly Meeting December 16, 2016 NYC Health Department

Agenda Check-in Program Progress and Discussion: Care Coordination & Following up with Patients Active patients and care cascade Care coordination services and Medical Evaluation Case Presentation: Arman Altug, Hepatitis Education Project in Seattle Washington 1min Required trainings are printed in agenda, pull these up before meeting: Check Hep C online training (for all). All modules can be completed in 2 hours at once or throughout the week. (Best viewed in Google Chrome. Go to: hepfree.nyc/check-hep-c-online-training and enter password: projecthero) Viral Hepatitis 101 offered at the NYC Health Department, OR confirm completion of equivalent Hepatitis C basics training at the NYC Health Department, NYS AIDS Institute or your organization. (Go to: bit.ly/ttapnyc) “Online Learning: Overview of Motivational Interviewing” offered online at NYS AIDS Institute www.hivtrainingny.org (Go to: bit.ly/aidsinstitute) Measures are used as a guide to ensure patients complete these defined steps to complete medical evaluation and start treatment.

Data & Reporting Clarifications Check Hep C ID – not agency ID - is Check Hep C Patient ID begins with first letter of city, two letters of state abbreviation Example:    Albuquerque: ANM001 Do not enter spaces in when entering dates Do not enter data on participants until they are “enrolled” All services should have a date after enrollment 1min Required trainings are printed in agenda, pull these up before meeting: Check Hep C online training (for all). All modules can be completed in 2 hours at once or throughout the week. (Best viewed in Google Chrome. Go to: hepfree.nyc/check-hep-c-online-training and enter password: projecthero) Viral Hepatitis 101 offered at the NYC Health Department, OR confirm completion of equivalent Hepatitis C basics training at the NYC Health Department, NYS AIDS Institute or your organization. (Go to: bit.ly/ttapnyc) “Online Learning: Overview of Motivational Interviewing” offered online at NYS AIDS Institute www.hivtrainingny.org (Go to: bit.ly/aidsinstitute) Measures are used as a guide to ensure patients complete these defined steps to complete medical evaluation and start treatment.

Program Progress: Enrollment (October 1, 2016 – November 30, 2016) Enrolled in November Active Patients Albuquerque Baltimore Kimberly Fuller at Johns Hopkins University Boston Bronx Yajaira Melendez, Kiara Caraballo, Tatiana Vera at Montefiore 1 6 Morgantown Providence Ellie MacGregor at Lifespan 4 San Francisco Jordan Akerley at Shanti Project; Pauli Gray at San Francisco AIDS Foundation Seattle Arman Altug, MSW; Rachel Nickel, MSW, LICSW; Renee Schuls, MSW, LCSW at Hepatitis Education Project Total 10

Program Progress: Care Cascade (October 1– November 30, 2016) *enrolling sites: NY, RI, and WA* Highlight: Bed-Stuy Family Health Center – getting patients through 1st medical visit Boom! Health – treatment completion Harlem United – outreach

Coordinating Care and Following Up with Patients

Patient Navigation Service Level

Patient Navigation Service Level REVIEW Patient Navigation Service Level After completing the Assessment, indicate a service level to the patient based on support needed: Low intensity: Need four minimum Patient Navigation encounters Need few reminders, can attend visits independently, and minimal support in accessing referrals, or getting through HCV medical evaluation and treatment Have a history of adherence to medications May be at low risk for HCV reinfection after treatment High intensity: Need more than four Patient Navigation encounters Need multiple reminders, and regular accompaniment, or support in accessing supportive referrals, or getting through medical evaluation or treatment Struggles adhering to medications as prescribed May be at high risk for HCV reinfection after treatment. (3 min)

Health Promotion

Care Coordination Services

Assessment & Referral: Mental Health

Assessment & Referral: Alcohol Use

Assessment & Referral: Drug Use For the purpose of this study, all of the participants should be initially marked as having used within the last year or having used ever in the Database. Drug use included injection and intranasal in the past year. Injection ever and/or in a substance use treatment program also included.

Assessment & Referral: Housing, Transportation & Referrals

Hepatitis Education Project Case Presentation Arman Altug Hepatitis Education Project

Hepatitis Education Project - Case Consult Case Manager: Arman Altuğ Client Alias: PA 1621 S. Jackson St, Suite 201 Seattle, WA 98144 www.hepeducation.org / 1-800-218-6932 / 206-732-0311

What Does HEP Do? Founded in 1993 by a group of patients and doctors. Current staff is 8 people. 3 programs: Medical Case Management Program Prevention and Outreach Program (POP!) Prison Program Advocacy: Lobbying Legal advocacy Global consulting Safe Consumption Sites – Vocal WA Will be starting a HBV program soon (very soon!) Are looking into starting a syringe exchange program. DRC: https://www.travmed.com/pages/democratic-republic-of-congo-formerly-zaire Ethiopia: https://www.travmed.com/pages/Ethiopia Kenya: https://www.travmed.com/pages/kenya Nigeria: https://www.ncbi.nlm.nih.gov/pubmed/25665986 / Niger J Clin Pract. 2015 Mar-Apr;18(2):163-72. doi: 10.4103/1119-3077.151035. / Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: a systematic review and meta-analysis. Musa BM1, Bussell S, Borodo MM, Samaila AA, Femi OL. HCV: https://www.travmed.com/pages/nigeria Somalia: https://www.travmed.com/pages/somalia 1621 S. Jackson St, Suite 201 Seattle, WA 98144 www.hepeducation.org / 1-800-218-6932 / 206-732-0311

Who is Arman? That’s me! Much of my past work has been around issues related to immigration and refugees. My role at HEP: Medical Case Management Program Prevention and Outreach Program (POP!) w/ focus on: Immigrant/refugee populations American Indian/Alaskan Native populations Prison Program Hepatitis B Outreach Education Advocacy 1621 S. Jackson St, Suite 201 Seattle, WA 98144 www.hepeducation.org / 1-800-218-6932 / 206-732-0311

Who is R2D2? 30 years old Non-Hispanic White Male Seasonal worker Not always in housing; sometimes stays with family or friends, currently stays outside Believes he got HCV through sharing drug equipment, met him at the needle exchange where he got tested. Both Antibody and Viral Load were positive 1621 S. Jackson St, Suite 201 Seattle, WA 98144 www.hepeducation.org / 1-800-218-6932 / 206-732-0311

What is Motivational Interviewing? Draw upon the intrinsic motivation within client Goal oriented, it’s not just exploring problems Often times you have the client identify goals All along, supporting clients to make changes, and directing client to pursue goals Key Skills: Open-ended questions, affirmation, reflective listening, and summarizing. Non-judgemental, and non-confrontational 1621 S. Jackson St, Suite 201 Seattle, WA 98144 www.hepeducation.org / 1-800-218-6932 / 206-732-0311

Motivational Interviewing AKA What Does R2D2 Want? Wants to make some changes A lot of shame and negative feeling around using, strong commitment to making some changes Highlight that it sounds like he knows what he wants to do, and assure him that they are doable Wants to start a Suboxone program Does not want to do methadone because too rigid - wants the freedom of being prescribed treatment that he can take at home State that this understandable, and that a lot of people feel the same Wants insurance Don’t ask him why he hasn’t applied already Wants to be cured of HCV Discussed current medications and how to access them Did not push that he needs to get that done first, just explored what it would look like Wants support throughout the process Ask him what that would look like, and discuss level of support If you are not able to provide a certain level of support, explore alternative sources (e.g. family, friends, other programs) 1621 S. Jackson St, Suite 201 Seattle, WA 98144 www.hepeducation.org / 1-800-218-6932 / 206-732-0311

Care Coordination AKA How R2D2 Will Achieve What Wants? How to make some changes Working as a team, with R2D2 in the middle He identifies what steps he wants to take first, in this case it was accessing Suboxone How to start a Suboxone program Connect him with a provider that we know very well and have regular contact with Discuss this provider with R2D2, he is happy with the suggestion Knows that he can always change provider if not happy, and we will help him with that! How to get insurance Connect him with a Patient Navigator – me! Now on Medicaid How to be cured of HCV In WA it is fairly straight forward, used to be different. Discuss when he would like to start He has been interested in starting sooner than his original plan How to support throughout the process Phone calls Has asked that we remind him why he is doing this Harm Reduction!!! 1621 S. Jackson St, Suite 201 Seattle, WA 98144 www.hepeducation.org / 1-800-218-6932 / 206-732-0311

What is Harm Reduction? Practical level: Ways to reduce harm during various activities, mainly drug use and sexual activities. E.g. Not sharing equipment, using contraception, getting tested, knowledge about viruses On a more philosophical level: “Harm Reduction values life, choice, respect and compassion over judgement, stigma, discrimination and punishment” Goes hand in hand with motivation interviewing in a lot of ways, however I would say goes one step even further by focusing completely on what the person wants. E.g. If a client wants to keep using, that is the end of that conversation and I respect their decision. I won’t bring up treatment unless at some point in the future they say they would be interested. 1621 S. Jackson St, Suite 201 Seattle, WA 98144 www.hepeducation.org / 1-800-218-6932 / 206-732-0311

Harm Reduction (HR) Approach AKA R2D2 is Human! HR towards making some changes A lot of shame and negative feeling around using, has been emotional throughout process “I want to get better”, emphasize that he is already good, but wants to make changes Language matters HR towards starting a Suboxone program R2D2 disappeared for a while, during which was using – couldn’t be reached for around 1 month Ask him if he felt ready once we were back in touch Inform him that the provider we’re connecting him to has a nuanced understanding of addiction and recovery (which she does) HR towards insurance Do the application together and take time off to actually talk, didn’t just focus on getting insurance done – not always easy! Offer him something to drink and eat HR towards being cured of HCV This is not the end goal, but part of the process It’s just one of many things that we’re working on, however for us it is the key thing although not necessarily for R2D2 Don’t push our agenda, try to incorporate it in a way that R2D2 is comfortable HR support throughout the process Depending on relationship, talk about injecting practices, along with other drug use and sexual practices focusing on the action, not the person Suspend judgement 1621 S. Jackson St, Suite 201 Seattle, WA 98144 www.hepeducation.org / 1-800-218-6932 / 206-732-0311

Questions? www.hepeducation.org / 1-800-218-6932 / 206-732-0311 1621 S. Jackson St, Suite 201 Seattle, WA 98144 www.hepeducation.org / 1-800-218-6932 / 206-732-0311

Contact Us Let us know if you have questions or concerns, or need help with any aspect of the program. Early identification is the key to prevention! ☺ Angie Woody Program Assistant awoody@health.nyc.gov Nirah Johnson, LMSW, Director of Capacity Building and Program Implementation njohnso2@health.nyc.gov