Linkage and Retention Interventions selected for dissemination Steven Sawicki, MHSA Program Manager, AIDS Institute SPNS Lead, NY-LINKS September, 2013 1

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Agenda Looking Back Looking Now Looking Forward

Looking Back Creation of UMRG, WNYS and Q&SI collaboratives in NYS Involvement of more than 60 individual provider organizations in the establishment of base line data and individual testing of interventions 12 face to face learning sessions used to network, share information, and further improve linkage and retention

Looking Back Development of regionally based cascades Involvement of county health departments and multiple state departments and divisions Work done shared through international program and with QAC, CAC, QOC, the other 5 states involved, and the national evaluators. Incredible amount of change going on within individual organizations and systems

Where we are UMRG—6th learning session WNYS—4th learning session Q&SI—3rd learning session Mid and Lower Hudson—1st learning session Long Island—1st meeting 11/13/13 Central and Eastern NY Bronx Brooklyn

Where we are going Dissemination of work Adding in a menu of evidence based interventions to the IAPAC Guidelines previously presented Solidifying gains made

Interventions Selection process The 5 interventions Summary of each intervention How to Pick an Intervention to Implement Timeline

Intervention Selection Process Meeting on June 20 to discuss intervention work Follow up meeting to pare down list of dozens of identified interventions to 6 or fewer Interventions were selected based on the following criteria: Number of existing providers utilizing intervention Where impact of intervention fell on continuum Resources required to implement intervention Diversity of target population impacted Evidence base supporting intervention Provider type associated with intervention

Intervention selection teams Each intervention had a team Teams were assigned to each intervention to: Develop a summary of the intervention Develop an intervention package Teams were comprised of: NYS DOH staff NYC DOH MH staff NYLinks staff Consumers Providers Members of each team were selected based on experience with the particular intervention they were assigned to Summaries and packages produced by the teams were submitted to HRSA and to the national evaluation team for SPNS--ETAC

The 5 Interventions Artas (Anti-Retroviral Treatment and Access to Services) Appointment Procedures Consistent Messaging Outreach/Return to Care Peers

Summary of Each Intervention Brief Description Intervention Impact Area Target population Best for agencies who provide… Core Elements Duration—how long for each client/patient Resource requirements Training needed

Anti-Retroviral Treatment and Access To Services (ARTAS) Brief Description--ARTAS is an individual-level, multi-session, time-limited intervention utilizing a strengths based case management model. Impact Area—Linkage to Care/Retention in Care. Target Population--Newly diagnosed individuals or those returning to care after more than a 6 month lapse. For Agencies that Provide—HIV testing, clinical, supportive services. Core Elements—1-5 structured sessions with each person, Focus on strengths of the individual, Development of step by step plan to connect to care, Service takes place in the environment of the individual, Advocacy of individual needs related to return to care.

Anti-Retroviral Treatment and Access To Services (ARTAS) Duration—1 to 90 days Resource requirements—Staff trained in case management/engagement. Training needed—ARTAS, Motivational Interviewing suggested

Appointment Procedures Brief Description—Standardization of procedures to facilitate making appointments, reminding patients of appointments, and providing follow up after missed appointments. Impact Area—Linkage to Care/Retention in Care. Target Population—All individuals who are HIV+. Limited resources may require prioritization—New diagnoses, Out of Care, frequency of no show, last lab status. For Agencies that Provide—HIV testing, clinical, supportive services. Core Elements—Patient enrollment, expanded patient contact info acquired, appointment reminders instituted, missed appointment follow up procedures developed, documentation of efforts.

Appointment Procedures Duration—ongoing. Resource requirements—Staff, time for training. Training needed—Field safety training if outreach is to be used.

Consistent Team Based Messaging Brief Description—Positively phrased and action oriented messages are delivered by all members of the care team. Impact Area—Linkage to Care/Retention in Care. Target Population—All HIV+ individuals who are newly engaging or re-engaging in care. For Agencies that Provide—HIV testing, clinical, supportive services. Core Elements—List of newly engaging and re-engaging patients, brief care message delivered by all staff on care team, longer care message developed and delivered by specifically indicated members of care team, tool to track messages and delivery process.

Consistent Team Based Messaging Duration—ongoing. Resource requirements—Staff, time for training. Training needed—Use of scripted messaging, teachback, motivational interviewing suggested.

Outreach/Return to Care Brief Description—Systematic search for individuals who have been out of care for longer than 6 months. Engagement of those individuals back to care. Impact Area—Retention in Care. Target Population—HIV+ individuals with at least one HIV medical visit within the last two years who have not been seen in primary care for 9 months or longer. For Agencies that Provide—Clinical, supportive services. Core Elements—Maintained care roster to identify out of care patients, case finding efforts, field outreach, care determination process, re-engagement and case closure process.

Outreach/Return to Care Duration—ongoing. Resource requirements—Staff, time for training. Training needed—Field safety training for outreach, Case finding training.

Peer Support Brief Description—Utilizing the skills of peers to better engage patients in the system. Impact Area—Linkage to Care/Retention in Care. Target Population—HIV+ individuals who are newly diagnosed, transferring their care, or returning to care after not being seen for 6 months or longer. For Agencies that Provide—HIV Testing, Clinical, supportive services. Core Elements—Identification of new, transferring or returning patients, Peers trained in engagement, Use of standardized, consistent messages, Contact schedule and process recording.

Peer Support Duration—1 to 90 days. Resource requirements—Staff, time for training. Training needed—Confidentiality, engagement and communication.

Key Components to consider in Intervention Selection Current status Use of regional cascade along with individual organization data related to linkage and retention. Awareness of competing interventions. Organizational resources. Commitment and ability to track required data. Ability to test and measure change and outcomes. Ability to run intervention through August of 2015 and participate in statewide evaluation process

1,2,3,5 1,2,3,4,5 1 Artas 2 Appointment Procedures 3 Consistent Messaging 4 Outreach/Return to Care 5 Peer Support 1,2,3,5 1,2,3,4,5

Next Steps Introductory Webinars Pilot Phase Revision and finalization of interventions Assessment package developed Individual webinars for each intervention ????? Process within each learning session to look at best way to impact the regional cascades Providers select interventions and receive TA Beginning of evaluation Statewide dissemination process begins—Webinars, workshops, presentations, conferences.

Timeline Pilot Phase begins November through February Sites that meet minimal criteria volunteer, choose intervention, receive TA around implementation, and report process Adjustments made to interventions as needed during this period By end of pilot, in February, interventions have been revised and are ready for full dissemination. 6 to 8 sites to be involved in Pilot While Pilot phase is running. Introductory webinars will be held Sites not involved in Pilot prepare for dissemination

Upcoming Webinars Tuesday, November 12th, 2013, 11:00 AM Wednesday, November 13th, 2013, 3:00 PM Thursday, November 14th, 2013, 10:00 AM, 2:00 PM Friday, November 15th, 2013, 1:00 PM

Upcoming Stakeholder MEetings December 4th, 2013, Western New York State—Batavia, NY December ?? th, 2013 Mid and Lower Hudson—Newburgh (date is tentative) December 17th, 2013 Upper Manhattan—TBD December 20th, 2013, Queens and Staten Island—90 Church St., Manhattan

Contact Information Steven Sawicki, NYSDOH, SPNS Lead svs03@health.state.ny.us, 518-474-3813 Clemens Steinbock, NYS Director of Quality Initiatives cms18@health.state.ny.us Bruce D. Agins, Medical Director, bda01@health.state.ny.us Website at http://www.newyorklinks.org Blog at http://linkandretain.wordpress.com/