1 in+care Campaign Webinar February 12, 2013

2 Ground Rules for Webinar Participation Actively participate and write your questions into the chat area during the presentation(s) Do not put us on hold Mute your line if you are not speaking (press *6, to unmute your line press #6) Slides and other resources are available on our website at incareCampaign.org All webinars are being recorded

3 Agenda Welcome & Introductions, 5min Data Review and Discussion of Retention Strategies Collected Through the Campaign, 10min Project THRIVE, 25min Panel Dialogue and Q&A Session, 15min Updates & Reminders, 5min

4 Improvement Strategies Exercise Michael Hager, MPH MA NQC Manager

5 Improvement Strategies Discussion Participant Submissions Network-wide linkage agreements / MOUs Use data to identify targets for special interventions to retain patients Hire a linkage coordinator to manage patient referral progress Rely on community planning processes to identify weak points for linkage within service delivery system / continuum of care Initiate special projects for linkage, when funding is available (SPNS Linkage to Care and CDC CAPUS) Network leads can build up Bridge Counseling services Health Literacy Education that focuses on Life Skills as part of linkage to care Patient handed info on next appointment and activities/goals/objectives to meet before leaving current appointment Case conferencing around individual patients and their needs

6 Submit Improvement Updates!

A Project of the Alamo Area Resource Center THRIVE

Jacob Wasonga, EIS and Re-entry Outreach Specialist Loraine Diaz, EIS Specialist Kristin Thompson, EIS Case Manager Jesús Ortega, Director of EIS and Care Retention

AARC provides the broadest spectrum of supportive services to mostly unduplicated clients (Persons Living With HIV/AIDS) in San Antonio. AARC’s services are provided to PLWHA’s who know their status and who are recently diagnosed of who are not in primary medical care. Services are provided in coordination with HIV testing and counseling sites, as well as primary medical care providers. In March 2012, AARC expanded the Early Intervention Services (EIS) program to include testing in non-traditional locations such as: parks, libraries, churches, parole boards, colleges, and universities.

 December EISST was funded by Ryan White Part A and Ryan White Part B – SD.  December 2008 – One EIS Case Manager and One EIS Specialist were hired.  January First clients were enrolled.  August 2009 – Added additional EIS Specialist.  November 2009 – Funded by Baptist Healthcare Foundation.  May 2010 – EISST was funded by Ryan White Part A MAI (Minorities) and Ryan White Part B – State Services.  June 2010 – Added EIS Outreach.  March 2012 – Added HIV Testing and Counseling.

The primary goal of EIS is to facilitate early access to medical care and remove barriers to ensure medical adherence. EIS activities provided by AARC include assistance and support with:  Initial Intake and Assessment.  Case Management (short term, intensive, and client-centered).  Referrals to access HIV medical management services.  Applying for entitlement program benefits.  Targeted outreach on clients who are out of medical compliance for six months or longer.  Targets unconventional sites for HIV testing & counseling.

 Initial Intake  Gather general socio demographic information  Program General Overview  Address immediate barriers to care  Case Management /Assessment (short term, intensive, and client-centered)  Identifying and screening clients for eligibility and determining the need for services  Assessing each client’s medical and psycho-social history in order to link their needs with available resources  Completing Acuity Scale created by Administrative Agency’s Quality Management/Quality Improvement Plan in order to evaluate client’s level of need  Developing a service plan that is updated regularly which is based on the client’s needs and goals with strategies for completion  Implementing the plan in a timely manner

 Referrals to access HIV medical management services:  AIDS Drug Assistance Program (ADAP)  Health Insurance Continuation Program (HICP)  Local drug reimbursement program  Nutritional assessment & counseling  Dental care  Mental health and Substance abuse treatment services  Home health services  Medical Transportation  Food  Housing  Applying for entitlement program benefits such as:  Medicare or Medicaid  Veteran's Administration

 Targeted outreach on clients who are out of medical compliance for six months or longer which is conducted via:  Telephone and Internet Outreach  Social Media sites such as Facebook.com and Myspace.com  Incarceration status on VineLink.com  Verifying living/death status on Legacy.com  Utilize various person locator websites  Active Street Outreach  Street corners  Convenient stores  Local Bars  Fixed Site Outreach  Homeless Shelters  Correctional Facilities  Residential Outreach  Notice of Visit

 HIV Testing and Counseling targets unconventional sites and high risk populations with the purpose of :  Promoting risk reduction  Distributing male and female condoms  Identifying new HIV positive cases  Linking new cases to EIS and medical care  Reducing HIV stigma with education  Providing referrals to community resources as needed

Other Activities:  Monitoring the efficacy and quality of services through periodic re-evaluation.  Advocating on behalf of clients to decrease service gaps and remove barriers to services.  Help and empower clients to develop and utilize independent living skills and strategies.  Discharge or transfer clients who no longer require Early Intervention Services.

1 st Medical Appointment Mental health and substance abuse assessment and services Health Education and Risk Reduction Class Nutrition Assessment

Tracked with Primary Medical or Infectious Disease Provider:  FFACTS Clinic  Centro Med Comprised of two separate appointments to meet the completion of the Milestone:  First medical appointment includes lab work and meeting with a medical social worker  Second medical appointment (scheduled within two weeks of first appointment) includes obtaining lab results and medication therapy if needed

Referred for initial Mental Health and Substance Abuse Screening to AARC’s counseling services or other mental health provider of clients’ preference Conducts Bio-psycho-social assessment addressing:  Medical history and current/former medication therapy  Psychological symptoms and severity  Household dynamics  Substance use

Client is referred to Peer Treatment Advocacy (PTA) education program.  PTAs are medically compliant HIV+ volunteers who receive HIV/AIDS training in order to teach their peers and act as a role model Client receives initial comprehensive education on:  HIV 101  Medical Adherence  Medication Adherence  Risk Reduction Client completes pre and post test for completion of milestone. Client may continue to access PTA program for more intensive education on individual needs

Client is referred to a registered dietician (RD) at the FFACTS or Centro Med Clinics Client must complete initial assessment to meet milestone which includes:  Comprehensive nutrition education based on client’s needs  Subjective and objective assessment of client’s current nutritional habits  Client creates goals with RD to improve deficits in nutrition and exercise Additional education is provided for clients with severe nutritional deficits or clients requesting further evaluation

Upon completion of the Milestones, clients must demonstrate a decrease in needs, maintain medical adherence, and an increase towards self sufficiency to transition out of the Thrive Program by:  Continuing on to Primary Case Management  Being discharged from EIS but maintaining an ACTIVE status with AARC where client self – refers for needed services Clients are tracked up to six months post transition for medical adherence. Early Intervention Services of South Texas (EIS)

Age Groups RDRUDC < **429** and over16 Total 893

Status% Newly Diagnosed59.97% Returning to Care40.03% Total100.00% 742 Positive Individuals

Medically Re-Activated or Transitioned StatusUDC% Compliant with Medical Care % Non-Compliant with Medical Care % Total %

Type of Marketing  VIA Bus Shelters  Junior Poster Billboards  Posters  Advertising in local Publications  Commercials  HIV/AIDS National Awareness Days  Community Events and Health Fairs Marketing Determined by:  Zip Codes of Newly Diagnosed in Past 3 years  Zip Codes of Lost to Care Population  Demographics of Target Population

July and August 2009 expanded Marketing Plan to include Spanish Billboards and Bus Shelters 2010, updated and extended existing Billboards and Bus Shelters 2011, Expanded Bus Shelters 2012, updated and extended existing Billboards and Bus Shelters

VIA BUS SHELTERS JUNIOR POSTER BILLBOARDS

Marketing Plan

Success of the THRIVE Program can be attributed to:  The intensive case management component  Targeted Outreach Component  The cooperation of the medical providers  The program design  Peer Treatment Advocate Program  Dedicated Staff  Marketing Campaign  Client’s dedication and success

For Programmatic or Marketing Information Contact:  Randy Hinkle, Programs Manager– For Client Services Contact:  Jesús Ortega, Director of EIS–  Kristin Thompson, EIS Case Manager  Loraine Diaz, EIS Specialist–  Jacob Wasonga, EIS & Re-Entry Specialist–

40 Time for Questions and Answers

41 Let us know your experiences in the chat room! How do consumers in San Antonio view Project THRIVE? Speaking from Experience: Retention on a Patient-by-Patient Basis

42 Let us know your experiences in the chat room! What things do staff members for a program like Project THRIVE need to know about local people with HIV to do their job? Speaking from Experience: Retention on a Patient-by-Patient Basis

43 Let us know your experiences in the chat room! What is the relative strength of a Milestones-based approach rather than a fully individualized service plan? Speaking from Experience: Retention on a Patient-by-Patient Basis

44 Announcements

45 Campaign Webinar: Social Service Providers Have a Role in Retention! Date Pending – to be announced! Combined Journal Club and Partners in+care Webinar: Our Experiences and Retention in+care – to be announced! Campaign Webinar: Patient Experience Evaluation and Retention To be announced! March Topic – Patient Experience Evaluation April Topic – Viral Suppression as the Ultimate Goal May Topic – Youth, Transition, and Retention in+care June Topic – Latinos and Retention Upcoming Events

46 Campaign Office Hours: Mondays & Wednesdays 4-5pm ET Wednesday, February 13 – Care in Context: identifying the social needs of PLWH Monday, February 18 – Campaign Offices Closed, No Office Hours Wednesday, February 20 – Collaboration to Maximize Retention Efforts Monday, February 25 – Open Space, no set topic Wednesday, February 27 – Successful Partnerships with Social Services Providers Monday, March 4 – Open Space, no set topic Wednesday, March 6 – Integration of Retention Dialogues into Community Processes and Conversations Data Collection Submission Deadline: April 1, 2013 Improvement Update Submission Deadline: February 14, 2013 Upcoming Deadlines and Office Hours

47 MedScape Retention in HIV Care Series Technical Working Group working on articles for a new Medscape Today News Series. We recommend that you subscribe to HIV/AIDS MedPlus to be informed of new and exciting articles in this series! Published Pieces: HIV Care Retention and the Goal of an AIDS-Free Generation Improving Retention in HIV Care in Resource-Limited Settings Implementing QI in HIV Clinics to Improve Retention in Care Monitoring Rates of Retention in HIV Care Across the State How Health Departments Promote Retention in HIV Care Improving Retention in HIV Care: Which Interventions Work? Engaging in HIV Care: What We Learned from AIDS 2012 How Should We Measure Retention in HIV Care? Retention In HIV Care: The Scope of the Problem

48 Partners in+care Partners in+care Private Facebook Group is live! Share tips, stories and strategies Join a community of PLWH and those who love them for more Partners in+care website is live! Join our mailing list (a list-serv version of the FB Group)

49 Campaign Headquarters: National Quality Center (NQC) 90 Church Street, 13 th floor New York, NY Phone incareCampaign.org youtube.com/incareCampaign