Transcript 12-16-16_Project Hero Check Hep C Monthly

Project HERO
Patient Navigation
Program
Monthly Meeting
December 16, 2016
NYC Health Department
Agenda
• Check-in
• Program Progress and Discussion: Care
Coordination & Following up with Patients
• Active patients and care cascade
• Care coordination services and Medical Evaluation
• Case Presentation: Arman Altug, Hepatitis
Education Project in Seattle Washington
Data & Reporting Clarifications
• Check Hep C ID – not agency ID - is
• Check Hep C Patient ID begins with first letter of
city, two letters of state abbreviation
• Example: Albuquerque: ANM001
• Do not enter spaces in when entering dates
• Do not enter data on participants until they are
“enrolled”
• All services should have a date after enrollment
Program Progress: Enrollment
(October 1, 2016 – November 30, 2016)
Enrolled in November
0
Active Patients
0
0
0
0
0
Yajaira Melendez, Kiara Caraballo, Tatiana
Vera at Montefiore
1
6
Morgantown
Providence
0
0
0
4
0
0
Arman Altug, MSW; Rachel Nickel, MSW,
LICSW; Renee Schuls, MSW, LCSW at
Hepatitis Education Project
0
0
Total
1
10
Albuquerque
Baltimore
Kimberly Fuller at Johns Hopkins University
Boston
Bronx
Ellie MacGregor at Lifespan
San Francisco
Jordan Akerley at Shanti Project;
Pauli Gray at San Francisco AIDS
Foundation
Seattle
Program Progress: Care Cascade
(October 1– November 30, 2016)
*enrolling sites: NY, RI, and WA*
Coordinating Care and
Following Up with Patients
Patient Navigation Service Level
Patient Navigation Service Level
After completing the Assessment, indicate a service level to the patient
based on support needed:
Low intensity:
• Need four minimum Patient Navigation encounters
• Need few reminders, can attend visits independently, and minimal
support in accessing referrals, or getting through HCV medical
evaluation and treatment
• Have a history of adherence to medications
• May be at low risk for HCV reinfection after treatment
High intensity:
• Need more than four Patient Navigation encounters
• Need multiple reminders, and regular accompaniment, or support in
accessing supportive referrals, or getting through medical evaluation
or treatment
• Struggles adhering to medications as prescribed
• May be at high risk for HCV reinfection after treatment.
Health Promotion
Care Coordination Services
Assessment & Referral: Mental Health
Assessment & Referral: Alcohol Use
Assessment & Referral: Drug Use
Assessment & Referral:
Housing, Transportation & Referrals
Case Presentation
Arman Altug
Hepatitis Education Project
Hepatitis Education Project Case Consult
Case Manager: Arman Altuğ
Client Alias: PA
1621 S. Jackson St,
Suite 201
www.hepeducation.org / 1-800-218-6932 /
What Does HEP Do?
• Founded in 1993 by a group of patients and doctors.
• Current staff is 8 people.
• 3 programs:
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Medical Case Management Program
Prevention and Outreach Program (POP!)
Prison Program
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Lobbying
Legal advocacy
Global consulting
Safe Consumption Sites – Vocal WA
• Advocacy:
• Will be starting a HBV program soon (very soon!)
• Are looking into starting a syringe exchange program.
1621 S. Jackson St,
Suite 201
www.hepeducation.org / 1-800-218-6932 /
Who is Arman?
• That’s me!
• Much of my past work has been around issues related to
immigration and refugees.
• My role at HEP:
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Medical Case Management Program
Prevention and Outreach Program (POP!) w/ focus on:
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Immigrant/refugee populations
American Indian/Alaskan Native populations
Prison Program
Hepatitis B
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Outreach
Education
Advocacy
1621 S. Jackson St,
Suite 201
www.hepeducation.org / 1-800-218-6932 /
Who is R2D2?
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30 years old
Non-Hispanic White
Male
Seasonal worker
• Not always in housing; sometimes stays with family or
friends, currently stays outside
• Believes he got HCV through sharing drug equipment, met
him at the needle exchange where he got tested. Both
Antibody and Viral Load were positive
1621 S. Jackson St,
Suite 201
www.hepeducation.org / 1-800-218-6932 /
What is Motivational
Interviewing?
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Draw upon the intrinsic motivation within client
Goal oriented, it’s not just exploring problems
Often times you have the client identify goals
All along, supporting clients to make changes, and directing
client to pursue goals
• Key Skills: Open-ended questions, affirmation, reflective
listening, and summarizing.
• Non-judgemental, and non-confrontational
1621 S. Jackson St,
Suite 201
www.hepeducation.org / 1-800-218-6932 /
Motivational Interviewing
AKA
What Does R2D2 Want?
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Wants to make some changes
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Wants to start a Suboxone program
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Don’t ask him why he hasn’t applied already
Wants to be cured of HCV
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Does not want to do methadone because too rigid - wants the freedom of being prescribed
treatment that he can take at home
State that this understandable, and that a lot of people feel the same
Wants insurance
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A lot of shame and negative feeling around using, strong commitment to making some changes
Highlight that it sounds like he knows what he wants to do, and assure him that they are doable
Discussed current medications and how to access them
Did not push that he needs to get that done first, just explored what it would look like
Wants support throughout the process
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Ask him what that would look like, and discuss level of support
If you are not able to provide a certain level of support, explore alternative sources (e.g. family,
friends, other programs)
1621 S. Jackson St,
Suite 201
www.hepeducation.org / 1-800-218-6932 /
Care Coordination AKA
How R2D2 Will Achieve What Wants?
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How to make some changes
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How to start a Suboxone program
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Connect him with a provider that we know very well and have regular contact with
Discuss this provider with R2D2, he is happy with the suggestion
Knows that he can always change provider if not happy, and we will help him with that!
How to get insurance
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Working as a team, with R2D2 in the middle
He identifies what steps he wants to take first, in this case it was accessing Suboxone
Connect him with a Patient Navigator – me! Now on Medicaid
How to be cured of HCV
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In WA it is fairly straight forward, used to be different.
Discuss when he would like to start
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He has been interested in starting sooner than his original plan
How to support throughout the process
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Phone calls
Has asked that we remind him why he is doing this
Harm Reduction!!!
1621 S. Jackson St,
Suite 201
www.hepeducation.org / 1-800-218-6932 /
What is Harm Reduction?
• Practical level: Ways to reduce harm during various activities,
mainly drug use and sexual activities.
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E.g. Not sharing equipment, using contraception, getting tested,
knowledge about viruses
• On a more philosophical level: “Harm Reduction values life,
choice, respect and compassion over judgement, stigma,
discrimination and punishment”
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Goes hand in hand with motivation interviewing in a lot of ways, however
I would say goes one step even further by focusing completely on what
the person wants.
E.g. If a client wants to keep using, that is the end of that conversation
and I respect their decision. I won’t bring up treatment unless at some
point in the future they say they would be interested.
1621 S. Jackson St,
Suite 201
www.hepeducation.org / 1-800-218-6932 /
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Harm Reduction (HR) Approach
AKA
R2D2 is Human!
HR towards making some changes
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HR towards starting a Suboxone program
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Do the application together and take time off to actually talk, didn’t just focus on getting insurance done – not always easy!
Offer him something to drink and eat
HR towards being cured of HCV
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R2D2 disappeared for a while, during which was using – couldn’t be reached for around 1 month
Ask him if he felt ready once we were back in touch
Inform him that the provider we’re connecting him to has a nuanced understanding of addiction and recovery (which she
does)
HR towards insurance
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A lot of shame and negative feeling around using, has been emotional throughout process
“I want to get better”, emphasize that he is already good, but wants to make changes
Language matters
This is not the end goal, but part of the process
It’s just one of many things that we’re working on, however for us it is the key thing although not necessarily for R2D2
Don’t push our agenda, try to incorporate it in a way that R2D2 is comfortable
HR support throughout the process
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Depending on relationship, talk about injecting practices, along with other drug use and sexual practices focusing on the
action, not the person
Suspend judgement
1621 S. Jackson St,
Suite 201
www.hepeducation.org / 1-800-218-6932 /
Questions?
1621 S. Jackson St,
Suite 201
www.hepeducation.org / 1-800-218-6932 /
Contact Us
Let us know if you have questions or concerns, or need help with
any aspect of the program.
Early identification is the key to prevention! ☺
Angie Woody
Program Assistant
[email protected]
Nirah Johnson, LMSW,
Director of Capacity Building and Program Implementation
[email protected]