1. ASSESSMENT OF THE ADMINISTRATIVE MECHANISM NORTH CENTRAL TEXAS HIV PLANNING COUNCIL Brian Emerson, Dr. Witold Migala and Jamie Schield, Planning Coordinator, North Central Texas Planning Council INTRODUCTION/BACKGROUND METHODS CONCLUSION References Thanks to: RESULTS DISCUSSION Ryan White Part A Planning Councils are tasked by legislation to “assess the efficiency of the administrative mechanism in rapidly allocating funds to the areas of greatest need within the eligible area, and at the discretion of the planning council, assess the effectiveness, either directly or through contractual arrangements, of the services offered in meeting the identified needs.” Every year the administrative mechanism’s assessment, as well as various consumer studies, has had the issue of “red tape” appear as a burden to clients, agencies, and contract administrators, which impacts the delivery of services and processes to rapidly allocate funds. Most importantly, these structural barriers can negatively impact linkage and maintenance of clients in care. This year’s assessment of the administrative mechanism focuses specifically on these structural barriers. The assessment originated from results of prior assessments, one-on-one interviews with frontline personnel, and other service providers. Structural barriers include functions that impede access to care, ranging from paperwork requirements to eligibility requirements and/or system resources. Several themes were identified as possible barriers to accessing HIV/AIDS services. The Evaluation Committee decided to survey staffs of Ryan White funded programs and HIV service providers to identify potential barriers in providing healthcare/service to clients and possible life hacks (i.e., short cuts) that may facilitate access to care. In addition, the adequacy of funding activities and if funding met client satisfaction were also evaluated. Using Survey Monkey ™, a questionnaire was sent to staffs of Ryan White funded programs and HIV service providers (n=92) to identify potential barriers in providing healthcare/service to clients and possible life hacks (i.e., short cuts) that may facilitate access to care This questionnaire originated from results of prior assessments, one-on-one interviews with frontline personnel, and other service providers. Data was collected from providers at different levels of management, provider and client demographics, and barriers to care – language, paperwork and collaboration with other agencies. The data was exported from Survey Monkey in Microsoft Excel format. The initial data cleaning was performed in Microsoft Excel. The analysis was performed in Microsoft Excel and SAS 9.3 The frequencies of the responses were used in the analysis. The open ended questions were grouped together by themes. The themes were utilized to determine the most common responses. Of the 92 providers, the Committee received responses from over half (52 responses) of the staff that provide services to people living with HIV/AIDS (PLWHA). PROVIDER DEMOGRAPHICS: The survey questionnaire was able to poll providers at different levels of management, interaction with clients, and length of time at the agency and/or working with clients. This assured a well-representative assessment of opinions on potential administrative and system barriers. Frontline personnel (44%), followed by management (23%), executive (17%), and administrative personnel (14%). Forty-four percent of the respondents spend 50% of their time with clients. A question inquired about the length of time working with HIV/AIDS patients, and the majority have worked 6 years plus at 42% and 0-2 years at 27%. The question related to length of employment at the current provider showed a higher percentage of new employment, 0-2 years at 35%, and second highest at 6-10 years at 23%. CLIENT DEMOGRAPHICS: The majority of the clients are male with an average of 62%, females at 35% and transgender at 3%. The majority of clients who received services from these providers were in the 35-44 year old group. The majority of the race/ethnicity of the client base was African American (See Figure One). STRUCTURE and SYSTEM BARRIERS: The question: “What are the main structural barriers experienced by patients new to the system” response was paperwork at 50%. “What are some of the barriers you encounter in assessing clients?” The majority of the responses revolved around 4 themes: language, paperwork, transportation, and information. Providers identified paperwork and transportation as the major areas in need of change to enhance access to services (See Figure Two). Additional, excessive paperwork was listed as a hindrance in providing care. The respondents were asked about the documentation required to provide services, proof of diagnosis at 69% and photo id at 56% were the most frequent responses (See Figure Three). A questions was asked about what change would make it easier for clients to have access to services, and the highest response was changing paperwork at 38% Figure One Figure Two Figure Three Responses are not mutually exclusive The grouping of themes from open ended questions provided an insight into the personnel’s experience in working with HIV positive people. The finding could lead to different areas and/or ideas in ways to provide the best possible service to HIV positive population. The themes transportation and redundancy of information pinpoints the struggle HIV positive people have in receiving the highest level of care. The transportation barrier provides a possible avenue to work with the Fort Worth Transportation Authority to increase bus services or routes. Paperwork and redundancy of information barriers could lead to an incentive to revisit the paperwork required for services for each agency. An investigation into this barrier might lead to an increase in agencies working together and/or sharing the required paperwork. The documented barriers should warrant an investigation into how to limit the major barriers associated with assisting new or existing clients. Major limitations in assessing services for existing and new clients will have to be addressed in the future to maintain the fight against HIV. The paperwork barrier will need to be revisited in the future, since clients faced with the redundancy and amount of information required. The transportation barrier warrants some changes if possible. The ability to maintain mobility in today’s age is vital in day to day life. A discussion with the Fort Worth Transportation Authority is needed about increasing frequency of bus services or adding more possible routes. In the rural areas, the transportation burden may persist without an access to a vehicle or ride to the needed physician or case worker appointments. The limitations experienced by providers creates an awareness and adds topics for discussion. Hopefully, additional resources or ideas can limit the burdens experienced by people living with HIV. The fight against the epidemic must continue. The survey demonstrated numerous areas where providers believe burdens are experienced. Black/African Americans were listed as population who has the highest barrier to care. These barriers could be the results of Black/African American HIV positive population having the highest rate of people living with HIV and that this specific population is a majority in the client demographics. 1 Texas Department of State Health Services. (2013). Texas HIV Surveillance Report 2013 Annual Report. Retrieved from http://www.dshs.state.tx.us/hivstd/reports/default.shtm Dr. Kurian, Jamie Schield, Gil Flores, Bola Mudasiru and Dr. Migala