1. Positive Living Navajo AIDS Network, Inc. Melvin Harrison, Executive Director Marco Arviso, Arizona Medical Case Manager

2. Objectives Define Medical and Psychosocial case management Describe “linkage to care” List examples of individual, group and community level interventions.

3. What is Case Management? Early access to and maintenance of comprehensive health care and social services. Improved integration of services provided across a variety of settings. Prevention of disease transmission and delay of HIV progression. Increased knowledge of HIV disease. Greater participation in and optimal use of the health and social service system. Reinforcement of positive health behaviors. Personal empowerment. An improved quality of life.

4. What is Medical Case Management? Medical Case Management (MCM) is traditional case management with the purpose of : 1)retaining clients in medical care and 2)achieving positive health outcomes for clients of NAN Inc. -HIV Medical Case Management Guidelines District of Columbia 2010

5. Client Demographics Average age: 46 Age range: 22-74 New Mexico – 18 Arizona – 42 Average CD4-328.4 Average Income- $402.00 67% have reported substance use in the last year 3 clients looking for suitable housing for winter 1 client self reported as homeless

6. Phoenix, AZ Pittsburgh, PA 2.5 hours 1.75 hours 1.5 hours 2.5 hours 60 clients

7. Active Cases- Enrollment on CM

8. AZ Active Cases 2012- Gender n=60

9. Active Cases- Status n=60

10. Active Client- Risk

11. How does the process of Case Management work? If you know that you are positive and need case management... If you are recently diagnosed in a clinical setting… If you are tested at a mobile unit and are newly infected... Contact NAN for Case Management

12. Assessment Contact NAN Inc. Case Manager and set up an appointment for an intake interview where we will discuss your health concerns and plan your care. Health Financial Social support Practical Needs Education/Employment Mental Health Risk Substance Abuse Legal

13. Working with Primary Care Providers The goal of Medical Case Managers is to provide a client with the skills, information and support to follow mutually agreed upon treatment adherence recommendations of healthcare professionals to achieve optimal health. Taking all medications as prescribed Making and keeping appointments Addressing barriers to care and treatment and involving the clients belief of Cultural Traditional Medicine where necessary

14. Team Care Meetings Meetings with I.H.S. Care team to discuss mutual clients Evaluation – CD4 – Viral Load – STI – Mental Health – ADAP (AIDS Drug Assistance Program) Future appointments Referrals Progress notes

15. Other Services Travel Reimbursement Emergency Financial Request(clients in Crisis) – Wood/coal delivery – Utilities – Housing Transitional Housing Ceremonial Assistance Social Support

17. Barriers Funding – Transportation – Housing Confidentiality/stigma – Fear of Gov systems Substance Abuse

18. Solutions Anti stigma approach to media Substance Abuse facility addressing MSM/T unique needs

19. Questions Thank you