1. Immigrants in the CHAIN NYC and Tri-County Cohorts Service Needs and Utilization Immigrants in the CHAIN NYC and Tri-County Cohorts Service Needs and Utilization Needs Assessment Meeting March 24, 2010

2. Background CHAIN study participants classified as: born in U.S., born in Puerto Rico, born elsewhere NYCDOH took the lead in defining a set of service domains, service need, and utilization measures Minor differences in need definition between Tri-County and NYC “Need” includes those currently using service “Unmet need” =% without adequate service utilization among those with need for service Compare 2006-2009 with earlier interview period 2001-2006

3. Demographics PLACE OF BIRTH CHAIN COHORT ENROLLED 2001-2002 New York CityTri-County Region USPROtherUSPROther n= (527)(72)(94) (320)(27)(50) Female43%36%28%47%48%62% 20-34yrs old24%26%33% 25%22%48% Risk exposure MSM18%15%33%18%4%10% Problem Drug Use455416476310 MSM/ PDU984572 Hetero/ Oth292247312678

4. Domain: Ambulatory Health Care Service : HIV Primary Care Who Needs the Service? All Individuals Measure of Adequate Utilization One or more visits to HIV Primary Care Physician in last six months

5. Trends in HIV Primary Care Need Adequate Utilization Always 100%

6. Domain: Ambulatory Health Care Service : ARV Treatment Support Who Needs the Service? 1. CD4 count< 200 & not on ARV 2. Not completely adherent to ARV meds or 3. Receiving support services for ARV meds Measure of Adequate Utilization Receiving support services for taking ARV’s from professional providers

7. Trends in ARV Treatment Support Need for Service:Adequate Utilization: 2001-062006-09 US47%38% PR38%29% Oth48%40% New York City 2001-062006-09 US57%51% PR49%42% Oth47%40% Tri-County

8. Domain: Case Management Service : Social Service C.M. Who Needs the Service? 1. Self reported poor mental health 2. In last 6 months had an inpatient, emergency room or mobile unit visit for psychiatric reasons 3. Being homeless or in unstable housing in last 6 months 4. During past year used cocaine, crack or heroin, OR 5. During past 6 months problem drinking  Tri-County 100% of PLWHA Measure of Adequate Utilization A case manager did one or more of the following last 6 months: -Developed or revised a plan for dealing with needs, -Made referrals for social services, -Helped filling out forms for benefits or entitlements

9. Trends in Social Service C.M. Need for Service: Adequate Utilization: 2001-062006-09 US59%48% PR65%51% Oth54%44% New York City 2001-062006-09 US100% PR100% Oth100% Tri-County

10. Domain: Case Management Service : Medical C.M. Who Needs the Service? 1. No HIV primary care in the last 6 months 2. Stopped going or no visit to provider in last 6 months 3. Missed more than one appointment in last 6 months 4. No CD4 or VL test in the past 6 months, OR 5. Had any of the above problems at prior interviews AND had a case manager helped in getting or referring for medical services in the last 6 months  Tri-County: 100% of PLWHA Measure of Adequate Utilization During the last 6 months a case manager helped in getting or referring for medical services.

11. Trends in Medical C.M. Need for Service:Adequate Utilization: 2001-062006-09 US69%54% PR51%58% Oth47% New York City 2001-062006-09 US100% PR100% Oth100% Tri-County

12. Domain: Mental Health Service : Professional Mental Health Services Who Needs the Service? 1. Self reported poor mental health 2. In the 6 months had inpatient, emergency room or mobile unit visit for psychiatric reasons, OR 3. In the last 6 months received counseling from a mental health care professional or clinical social worker Measure of Adequate Utilization In the last 6 months received treatment or counseling from a mental health care professional or clinical social worker

13. Trends in Mental Health Services Need for Service:Adequate Utilization: 2001-062006-09 US55%50% PR62%63% Oth63%64% New York City 2001-062006-09 US57%54% PR67%60% Oth48%50% Tri-County

14. Service: Alcohol or Drug Treatment Who Needs the Service? 1. During past year used cocaine, crack or heroin, 2. During past 6 months heavy or problem drinking OR 3. Reported receiving drug or alcohol treatment was important Measure of Adequate Utilization In last 6 months received any form of alcohol or drug treatment

15. Trends in Alcohol or Drug Treatment Need for Service:Adequate Utilization: 2001-062006-09 US65%56% PR57%52% Oth37%24% New York City 2001-062006-09 US65%56% PR57%52% Oth37%24% Tri-County

16. Service: Transportation Who Needs the Service? In last 6 months reported one or more: 1. Report need for transportation assistance 2. Did not get or delayed getting medical care or social services due to lack of transportation Measure of Adequate Utilization In last 6 months, received transportation services.

17. Trends in Transportation Services Need for Service:Adequate Utilization: 2001-062006-09 US17%11% PR13%18% Oth13%7% New York City 2001-062006-09 US33%25% PR37%15% Oth27%16% Tri-County

18. Summary of Differences ServiceHighest NeedLowest Utilization ARV Treatment Support NYC Tri-CO US, OTH US PR,OTH OTH Medical Case Management NYC Tri-Co PR, US -- PR, US US Social Service Case Mgmt NYC Tri-Co PR, US -- PR, US US Prof’l Mental Health Services NYC Tri-CO OTH, PR PR OTH Alcohol/Drug Treatment NYC Tri-Co US, PR PR, OTH Transportation NYC Tri-Co PR US OTH US

19. Acknowledgements A Technical Review Team (TRT) provides oversight for the CHAIN Project. In addition to Peter Messeri, PhD, Angela Aidala, PhD, Maiko Yamagido and Maria Caban, MA of Columbia University’s Mailman School of Public Health, TRT members include, Nina Rothschild, DrPH, Mary Irvine, DrPH, Fabienne Laraque, MD, Yoran Grant, PhD, Daniel Weglein, MD, NYCDOHMH; Julie Lehane, PhD, Tom Petro, Westchester County DOH; Mary Ann Chiasson, DrPH( Chair) and Roberta Scheinmann, MPH, Public Health Solutions. This presentation based on analyses of CHAIN cohort service needs and patterns of service utilization prepared by Maiko Yomogida and Peter Messeri. Funding for this research was provide by a grant from the NYCDOHMH as part of its Ryan White CARE Act grant, H89 HA 0015, from the US Health Resources and Services Administration (HRSA), HIV/AIDS Bureau with the support of the HIV Health and Human Services Planning Council. Its contents are solely the responsibility of the report authors and do not necessarily represent the official views of the U.S. Health Resources and Services Administration, the City of New York, or Public Health Solutions.