Transcript 2002 Needs Assessment: NYC DOHMH Initiatives to Address

Nina Rothschild, DrPH
Needs Assessment Committee
October 7, 2011
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The HIV Health and Human Services Planning
Council of New York sets priorities and
allocates resources for a broad range of medical
and social support services to address the
multiplicity of needs experienced by People
Living with HIV/AIDS (PLWHAs).
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Planning Council members include health care
and social support service providers,
advocates, consumers, and governmental
representatives, all of whom have input into
the process of setting priorities and allocating
resources.
The Planning Council provides guidance to the
New York City Department of Health and
Mental Hygiene (DOHMH) as it develops RFPs
and provides guidelines for offering services to
address identified needs.
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In 2002, the Planning Council commissioned
McClain and Associates, Inc., to conduct a
formal assessment of the needs of PLWHAs in
the New York Eligible Metropolitan Area
(EMA).
In 2004, McClain and Associates delivered an
update to the 2002 needs assessment.
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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)
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Clients needing numerous services (especially
women with children, the homeless, AODs,
MICAs, immigrants/undocumented, recent
detainees/releasees, and the unconnected)
confront challenges when attempting to avail
themselves of opportunities and sort out the
demands of multiple agencies and sources of
funding.
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To address the complicated needs of these
populations and offer more coordinated care
for high-need clients, the 2002 needs
assessment suggested several strategies:
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Intensive case management
Co-located services (one-stop shopping)
Low-threshold services (minimal barriers)
Enhanced referral arrangements between agencies
Transportation services not limited to one ride per
day or permitted only in the context of primary care
visits (for less ambulatory clients)
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Homelessness has an especially harsh effect on
very vulnerable individuals and creates
obstacles that inhibit clients’ ability to
participate in a broad range of services,
including their ability to remain in care and to
make the most effective use of opportunities
offered. Managing the new medications can be
particularly tricky for homeless individuals if
they don’t have refrigerators and a place where
they can prepare food.
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The 2002 needs assessment highlights the
importance of diminishing the number of
homeless individuals in general and homeless
PLWHAs in particular but doesn’t offer a
specific plan of action.
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Providers are culturally insensitive and may
hold stigmatizing attitudes toward various
populations, including youth, men who have
sex with men (MSM), substance users, and
individuals suffering from mental illness.
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To address issues of cultural sensitivity, the
2002 needs assessment promotes training of
providers, engaging peer outreach workers,
and incorporating clients into decision-making
about designing and implementing programs
(e.g., community advisory boards, or CABs).
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Clients from several populations have
insufficient knowledge, including not
comprehending how to engage with the health
care system and not possessing accurate
information about side effects associated with
combination medications.
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To address this lack of information, the 2002
needs assessment suggests developing
different approaches according to the
particular population and engaging the schools
in the effort (to reach youth) and utilizing peer
educators (to reach drug users).
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Working collaboratively, Planning Council members and staff of
the NYC DOHMH have developed several programs and projects
to address needs identified in 2002.
These programs and projects include:
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medical case management/care coordination to promote entry into and
maintenance in care
housing services to reduce homelessness, enhance quality of life, promote
engagement with the health care and social support system, and facilitate
adherence to medication regimens
the Positive Life Workshop for PLWHAs grappling with their diagnosis or
with returning to care
the consumer focus groups and Consumer Advisory Board Survey to gain
client input into program design and implementation
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The PC allocates approximately $31 million to
the medical case management/care
coordination program ($26 million in base
funds and $5 million in MAI funds), launched
in 2009.
Care coordination creates a medical home and
offers resources to health care providers to
manage HIV as a chronic illness.
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Care coordination and primary care must be
co-located or offered by organizations that
have entered into a formal agreement and
established a care network.
Case management can take place face-to-face,
by phone contact, and through any other forms
of communication.
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Key care coordination activities include:
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Initial assessment of service needs and development
of a comprehensive service plan
Evidence-based health promotion and treatment
adherence intervention
Support in accessing social services and benefits and
coaching
Patient navigation to retain PLWHAs in treatment
and care
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In FY 2010, 3,191 clients received Base-funded medical
case management
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YMSM of Color: 1.8%
LGBT: 22.8%
Women of Color: 35.1%
Immigrants: 10%
In FY2010, 594 clients received MAI-funded medical
case management
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YMSM of Color: 0.7%
LGBT: 9.9%
Women of Color: 37.4%
Immigrants: 7.2%
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Permanent, transitional and emergency
housing is provided through Ryan White and
through HOPWA (Housing Opportunities for
People with AIDS) funded programs in
combination with City tax levy funded rental
assistance for PLWHA.
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The Planning Council allocates approximately $10
million to housing, including emergency rental
assistance, housing placement assistance, transitional
housing, and housing referral coordination for
PLWHA in commercial SRO hotels and in need of
harm reduction. In FY 2010, the following numbers of
clients received services:
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Emergency Rental Assistance: 312
Housing Placement Assistance: 568
Transitional Housing: 569
Housing Referral Coordination: 258
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As of 2009, 75.5% of HIV-positive individuals
who accessed HIV services in the NY Eligible
Metropolitan Area lived in stable housing (own
or rent).
Most Ryan White-funded housing placement
services are reimbursed on a performance basis
to encourage placement into permanent
housing.
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The Planning Council’s Integration of Care
Committee is meeting later in October to begin to
develop a new housing services directive.
Committee members will examine different
housing models, listening to presentations from
housing providers and reviewing published
literature on the topic, to develop a model of care
that addresses the needs of the PLWHA
population.
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NYC DOHMH, in partnership with Voices of
Community Activists and Leaders (VOCAL) and
the Corporation for Supportive Housing (CSH), is
proposing to develop an Integrated HIV/AIDS
Housing Plan (IHHP) for New York City.
The goal of the IHHP is comprehensive planning
and coordination of local resources to meet the
housing and service needs of low-income PLWHA
in NYC.
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DOHMH is proposing two HOPWA (Housing
Opportunities for People with AIDS) activities
as Special Projects of National Significance
(SPNS):
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A permanent housing placement program to
facilitate accessibility of affordable housing
A support service program to promote sustainability
of permanent housing
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Positive Life Workshop
Launched in Fall 2011
Workshops are coordinated by DOHMH and led by peers
HIV education workshop series for persons recently
diagnosed with HIV or out of the care system for the
previous nine months
 Goals are empowerment and skill-building
 Provides participants with knowledge, motivation, and
skills to bolster the immune system, improve treatment
adherence, limit risk behaviors, and develop health
enhancing routines.
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Topics covered include immune health,
introduction to self-management and beliefs,
adherence, addressing co-factors, health action
planning, introduction to social health, physical
health, body care, nutrition, risk behaviors,
drug and alcohol use, sexual health, HIV
disclosure, stigma, stress, grief and depression,
emotional health, patient-provider relationship,
self-monitoring, and more.
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The pilot of the Positive Life Workshop was
just executed on September 28, 29, and 30.
A total of 10 introductory workshops and 6
intensive workshops are planned per calendar
year.
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In the introductory session, 18 attended and 17
graduated for a retention rate of 94%.
For the intensive follow-up course, 11 attended and 9
graduated for a retention rate of 82%.
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The HIV Health and Human Services Planning
Council of New York actively seeks out
consumer input to enhance services.
Forums for consumer input include consumer
focus groups and Community Advisory Board
(CAB) surveys to determine priorities, unmet
needs, and barriers to care for PLWHAs.
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A total of ten consumer focus groups in 2009
were held in each borough, for men and for
women, for transgender individuals and for
youth, in English and in Spanish, to
understand better what aspects of the
HIV/AIDS health care and social support
system meet PLWHAs’ needs and what could
be improved.
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Currently, the Planning Council is conducting a survey
designed to understand better the operations of agency
CABs for eliciting and utilizing consumer input on
program services.
Information from this survey will contribute to
guidelines and recommendations for New York City’s
portfolio of 90 Ryan White-funded agencies’ CABs.
The information will clarify operational procedures
and provide information about the best consumer
recruitment, engagement, retention in care, input, and
feedback practices.
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The Needs Assessment Committee is currently
embarking on another needs assessment with
assistance from DOHMH staff.
With information obtained from this needs
assessment, the Planning Council and the
DOHMH will be able to continually refine the
process of setting priorities and allocating
resources in order to create a system of care to
address the multiple medical, psychosocial, and
support service needs of PLWHAs.