1 The 2002 Planning Council Needs Assessment Nina Rothschild, DrPH

2 The last formal needs assessment in the New York EMA was released in This presentation will provide an overview of the last needs assessment for historical context as we move forward.

3 Participants The 2002 needs assessment was conducted by McClain and Associates, Inc. with input from: – Mayor’s Office of AIDS Policy Coordination – New York City Department of Health – New York State Department of Health – MHRA (now known as Public Health Solutions) – CHAIN research team at Columbia University Mailman School of Public Health – High Needs Index Project – Center for Health Policy Studies – Planning Council work groups, planning committees, and the PWA AG

4 Components of the 2002 Needs Assessment Epi profile (esp. the prevalence of HIV/AIDS within specific sub- populations) Appraisal of service needs within populations, incorporating input from PLWH, providers, researchers, as well as community representatives Resource inventory (paints a full picture of services from a variety of funding sources) A synopsis of provider capacity and capability (focusing on whether services listed in the resource inventory are available, comprehensive, and suitable for PLWH) Examination of service gaps (looks at data on needs, resources, and obstacles in order to facilitate the process of setting priorities and allocating resources)

5 Data The 2002 needs assessment employed quantitative and qualitative data.

6 Common Findings PLWHAs are able to obtain treatment and care in NYC Housing constitutes a noteworthy unmet or partly unmet need for PLWHAs The precise number of PLWHs is not known, but the total population of PLWHAs and their families in NYC is very large, and these individuals do try to find treatment and care A substantial amount of qualitative and data regarding characteristics and needs of PLWHAs exists, but data gaps persist

7 Epi Profile Characteristics of the bulk of living AIDS cases: – 41% IDU – 74% male – 76% people of color – 35% Manhattan residents

8 Epi Profile, Cont’d Demographic trends – Increasing proportion of AIDS diagnoses are in women – Increasing proportion of AIDS diagnoses are among people of color – Increasing proportion of AIDS diagnoses are in heterosexuals – Majority of new AIDS cases are in people over 39 years of age

9 Special Needs Populations Infants and children (under 13 years old) Youth (13-24 years old) IDUs Men of color who have sex with men White men who have sex with men Women of child-bearing years (13 years and older) Other substance users MICA Immigrants and undocumented persons Homeless persons Detained inmates and recent releasees

10 Resource Inventory Service mappings: – Higher concentration in lower and northern Manhattan and the Bronx – Case management and drug treatment more widely dispersed than health services – Housing services more concentrated in Manhattan and south and central Brooklyn – Few sites offering supportive mental health services

11 Core HIV/AIDS Services in NYC CARE Act Title I HOPWA HASA Counseling and testing Prevention and education Surveillance and research Anti-discrimination and protection Other funding (Title II, Title III, Title IV, other HUD, CDC, and substance abuse funding)

12 Assessment of Provider Ability and Competence Minority neighborhoods in Brooklyn and Manhattan partake of the largest portion of technical assistance services, but the services have a less than optimal impact because of an insufficient supply of culturally appropriate TA providers Most TA services use classroom-style learning and training with insufficient impact. More individualized strategies needed Areas of emphasis going forward: – Program evaluation – Staff training and development – Information systems and data management – Benchmarking and program comparison – QA – Management training

13 Challenges and Opportunities Clients with multiple service needs Lack of cultural sensitivity and stigmatization by providers (specific pops: youth, MSM, substance users, and the mentally ill) Lack of client awareness (how to access the health care system, misinformation regarding side effects of meds) in a number of pops Suggested strategies: use schools to reach youth and use peer educators to reach substance users

14 Service Gaps and Unmet Need Health care services and financial coverage are generally available to PLWHAs in NYC Homelessness and unstable housing is the most persistent problem Potential gaps in mental health and AOD services merit additional investigation Potential gap in dental services merits additional investigation Remain aware of the needs of PLWHAs who know their status but are not in care

15 Gaps in Data and Evaluation Much of the data is qualitative (garnered via unstructured interviews and focus groups and not necessarily generalizable to the population as a whole); quantitative data is not as readily available CHAIN is the primary source of quantitative data but employs client self-reports (lacking objective, third party verification) Needed: a client-level database to track service needs and utilization over time

16 Follow-Up from 2002 Needs Assessment Report was distributed to Planning Council members Report was discussed in committees and work groups Information was incorporated into subsequent Ryan White grant applications Report factored into the Comprehensive Strategic Plan for HIV/AIDS Services