strategies for service provision for setting for complex...
TRANSCRIPT
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Priority 2 - Research Evidence Panel Session:
Rehabilitation Interventions and Strategies for Older Adults Living with HIV
A Dr. Peter Centre
Perspective
May 12, 2016
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Strategies for service provision for HIV and Aging in an integrated
setting for complex health issues, mental illness, and addiction
Rosalind Baltzer Turje
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Dr. Peter Centre (DPC)
• Vancouver’s Dr. Peter Centre provides care and support to people living with HIV and coping with social disparities and concurrent health issues including: mental health conditions, addiction, hepatitis C, physical disabilities, homelessness, and trauma.
• Employs a specific model of care, program goals are improved adherence to HIV treatment and improved overall health.
• The DPC provides three programs:
1) Day health program
2) 24-hour specialized nursing care residence
3) Enhanced supported housing program
3
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An understanding of the person(s)
• Observations • Formal assessments • Lived experience
• Complexity of health issues • Mental Illness and addiction • Trauma • Social issues
• Frailty
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Understanding the Implications for service
• Risks • Environmental
• Physical
• Psychological
• Capacity
• New learning
• Adapting
• Skills and Knowledge
• Clinical Practice
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Considerations for Services
Shifting services to meet the mixed needs and issues
• Safety
• Comfort
• Predictability
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Employment as Rehabilitation: peer research associates at the Dr. Peter
Centre share their experience
Sean Grieve, Patrick McDougall, Norman Rossetti,
and Dan Wilson
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Peer Research Associates (PRAs)
• In the last 4 years, we’ve employed 12 Peer Research Associates on different projects
• I spoke with three 50+ PRAs about their experience
• All three identify with the Lazarus Effect
• “When I interviewed for the job, it had been 137 years since my last job interview.”
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Re-entry into the workforce
• It’s a return to: • “Normalcy”
• “Pride”
• “Respectability”
• “Routine”
• “’What are you doing now, Dad?’ I can say: ‘I’m working.’”
• “I can pay my own way if we go to a restaurant.”
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Cautionary notes
• “It’s stressful to take on the idea of going back to work.”
• “It has to be a rehabilitation that’s gradual.”
• “I see people who try to go back to work full time too quickly, and then they get fired. At first they’re worried about a gap in their resume, then it becomes how to explain getting fired.”
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Stigma
HIV and aging places individuals at the intersection of multiple points of stigma in terms of re-entering the workforce (and sometimes internalized stigma).
• “You’re OLD and you have HIV.”
• “Ageism is huge in the gay community.”
• “Every time I call in sick, I feel it’s a result of me having HIV… I feel unreliable.”
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Challenges
Re-entering the workforce as a paid employee after a lengthy gap as a result of health challenges associated with HIV and other comorbidities can bring multiple challenges in the areas of adapting to:
• Advances in technology
• Language and terminology
• Sick time
• Current (versus past) workload capacity and ability
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A job: an internalized stigma buster
Working in a supportive environment can act to mitigate internalized stigma linked to HIV and aging.
• “Reverses that internal thought pattern that says: ‘you’re worthless.’”
• “When you get a job back, you get your life back. And it gives other people living with HIV a sense of hope.”