immigrants in the chain nyc and tri-county cohorts service needs and utilization
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Immigrants in the CHAIN NYC and Tri-County Cohorts Service Needs and Utilization. Needs Assessment Meeting March 24, 2010. CHAIN study participants classified as: born in U.S., born in Puerto Rico, born elsewhere - PowerPoint PPT PresentationTRANSCRIPT
Immigrants in the CHAINImmigrants in the CHAINNYC and Tri-County CohortsNYC and Tri-County Cohorts
Service Needs and UtilizationService Needs and Utilization
Needs Assessment Meeting March 24, 2010
BackgroundBackground
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
DemographicsDemographics
PLACE OF BIRTHCHAIN COHORT ENROLLED 2001-2002
New York City Tri-County RegionUS PR Other US PR Other
n= (527) (72) (94) (320) (27) (50)
Female 43% 36% 28% 47% 48% 62%
20-34yrs old 24% 26% 33% 25% 22% 48%
Risk exposure MSM 18% 15% 33% 18% 4% 10%
Problem Drug Use 45 54 16 47 63 10 MSM/ PDU 9 8 4 5 7 2 Hetero/ Oth 29 22 47 31 26 78
Domain: Ambulatory Health CareDomain: Ambulatory Health CareService : HIV Primary CareService : HIV Primary Care
Trends in HIV Primary CareTrends in HIV Primary Care
Need
Adequate Utilization
Always 100%
Domain: Ambulatory Health CareDomain: Ambulatory Health CareService : ARV Treatment SupportService : ARV Treatment Support
Trends in ARV Treatment SupportTrends in ARV Treatment Support
Need for Service: Adequate Utilization:
2001-06 2006-09US 47% 38%PR 38% 29%Oth 48% 40%
New York City
2001-06 2006-09US 57% 51%PR 49% 42%Oth 47% 40%
Tri-County
Domain: Case ManagementDomain: Case ManagementService : Social Service C.M.Service : Social Service C.M.
Who Needs the Service?1. Self reported poor mental health2. In last 6 months had an inpatient, emergency room or
mobile unit visit for psychiatric reasons3. Being homeless or in unstable housing in last 6 months4. During past year used cocaine, crack or heroin, OR5. During past 6 months problem drinking Tri-County 100% of PLWHA
Measure of Adequate UtilizationA 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
Trends in Social Service C.M.Trends in Social Service C.M.
Need for Service: Adequate Utilization:
2001-06 2006-09US 59% 48%PR 65% 51%Oth 54% 44%
New York City
2001-06 2006-09US 100% 100%PR 100% 100%Oth 100% 100%
Tri-County
Domain: Case ManagementDomain: Case ManagementService : Medical C.M.Service : Medical C.M.
Who Needs the Service?1. No HIV primary care in the last 6 months2. Stopped going or no visit to provider in last 6 months3. Missed more than one appointment in last 6 months4. No CD4 or VL test in the past 6 months, OR5. 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.
Trends in Medical C.M.Trends in Medical C.M.
Need for Service: Adequate Utilization:
2001-06 2006-09US 69% 54%PR 51% 58%Oth 47% 47%
New York City
2001-06 2006-09US 100% 100%PR 100% 100%Oth 100% 100%
Tri-County
Domain: Mental HealthDomain: Mental HealthService : Professional Mental Service : Professional Mental
Health Services 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 UtilizationIn the last 6 months received treatment orcounseling from a mental health care professional or clinical social worker
Trends in Mental Health ServicesTrends in Mental Health Services
Need for Service: Adequate Utilization:
2001-06 2006-09US 55% 50%PR 62% 63%Oth 63% 64%
New York City
2001-06 2006-09US 57% 54%PR 67% 60%Oth 48% 50%
Tri-County
Service: Alcohol or Drug Service: Alcohol or Drug TreatmentTreatment
Trends in Alcohol or Drug Trends in Alcohol or Drug TreatmentTreatment
Need for Service: Adequate Utilization:
2001-06 2006-09US 65% 56%PR 57% 52%Oth 37% 24%
New York City
2001-06 2006-09US 65% 56%PR 57% 52%Oth 37% 24%
Tri-County
Service: TransportationService: 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 UtilizationIn last 6 months, received transportation services.
Trends in Transportation ServicesTrends in Transportation Services
Need for Service: Adequate Utilization:
2001-06 2006-09US 17% 11%PR 13% 18%Oth 13% 7%
New York City
2001-06 2006-09US 33% 25%PR 37% 15%Oth 27% 16%
Tri-County
Summary of DifferencesSummary of Differences
Service Highest Need Lowest UtilizationARV Treatment Support NYC Tri-CO
US, OTH US
PR,OTHOTH
Medical Case Management NYC Tri-Co
PR, US--
PR, USUS
Social Service Case Mgmt NYC Tri-Co
PR, US--
PR, USUS
Prof’l Mental Health Services NYC Tri-CO
OTH, PRPR
PR OTH
Alcohol/Drug Treatment NYC Tri-Co
US, PR US, PR
PR, OTHPR, OTH
Transportation NYC Tri-Co
PR US
OTH US
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.