using surveillance to link to care: effective implementation ... hiv conf...surveillance- based...
TRANSCRIPT
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2016 Lake County Health Department and Community Health Center
Using Surveillance to Link to Care: Effective Implementation of Surveillance Based Services
Valerie Johansen, MPH
Sara Zamor, MPH
Lake County Health Department & Community Health Center
October 2016
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Prevention Services
Learning Objectives
All participants will be able to:
• Identify and develop new strategies for conducting Surveillance Based Activities.
• Understand ways to build relationships with individuals and community partners to successfully link and retain individuals in care.
• Recognize ways to maximize strengths and resources in their own agencies to increase reengagement and linkage to care for challenging populations.
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Prevention Services
Lake County Health Department & Community Health Center
3
703,462 residents in Lake
County
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Prevention Services
Lake County Health Department & Community Health Center
Federally Qualified Health Center & Local Health Department ‒ Provides comprehensive, coordinated, and continuous care for
patients who receive primary care through the Community Health Centers – 7 Clinical Locations
‒ Mental Health and Substance Abuse services
‒ Responding to the functions of a local health department: assessment, assurance, and policy development
Two Governing Bodies ‒ Community Health Center Governing Council
‒ Board of Health
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Prevention Services
STI Program STI Program bridges the divide between Prevention and Care by conducting activities such as:
‒ Counseling and Testing for STI, HIV, and HCV
‒ STI treatments
‒ Surveillance for Chlamydia, Gonorrhea, Syphilis, HCV & HIV
‒ Linkage to Care/Early Intervention Services
‒ Outreach/Data to Care/Surveillance Based Services
‒ PrEP/PEP Clinics & Navigation
‒ Medical Benefits Coordination & Navigation
‒ Medication Adherence and Risk Reduction Counseling in Ryan White Ambulatory Clinic
‒ QI for both Prevention and Care
‒ Social Media Outreach/Marketing
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Prevention Services
Surveillance- Based Services (SBS) Model
Bridges the gap between Prevention and Care
‒ Seeks out those who are newly diagnosed or those who have fallen
out of care
‒ Links individuals to services (not just medical care)
‒ Reduces the rate of HIV transmission
‒ Improves the Quality of Life for People Living with HIV
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Prevention Services
Lake County Health Department SBS Model
Our Philosophy:
Focusing on the individual in need rather than our roles, titles or job descriptions.
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Prevention Services
Lake County Health Department SBS Model
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100%
[VALUE]%
[VALUE]% [VALUE]%
[VALUE]%
% o
f P
eop
le
HIV Cascade *Bars are Percentages of Total # of People who are HIV+
HIV Care Continuum for Lake County 2015
HIV+ (a)
Diagnosed (b)
Linked to Care (c)
Prescribed ARTs (d)
Virally Suppressed (e)
972
848
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Prevention Services
Lake County Health Department SBS Model
Utilizes Prevention experts in a Community Health Center setting to deliver the intervention
Cross-trained, Bilingual Staff
‒ DIS Workers
‒ EIS/Linkage Workers
‒ DASA QHEIC Certified Counselors
‒ IDPH Certified STI & HIV Counselors
‒ Medication Adherence Counselors
‒ Surveillance Staff
‒ Medical Benefits Navigators
‒ PrEP/PEP Navigators
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Prevention Services
Lake County Health Department SBS Model
Surveillance Based Services Process
1. Acknowledgement of Cases
2. Weekly “Cascade” Meetings
3. Case Disposition Completed
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Prevention Services
Cascade Meeting
Who Is There
‒ STI Program Staff
‒ Ryan White Medical Case Managers
What Is Discussed
‒ New SBS cases
‒ EIS/Linkage Clients
‒ New Syphilis and/or HIV+ Clients
‒ Partners of Syphilis and/or HIV+ Individuals
‒ Case Management Clients
‒ PrEP Clients
‒ Client Viral Load Suppression Data
‒ Retention Data
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Prevention Services
Cascade Meeting • Assignment of new cases to staff
• Review Current Caseloads
‒ SBS
‒ EIS/Linkage
‒ PrEP
• Review monthly viral load and gap in medical visit data
• Reassignment of cases based on staff strengths and/or relationship with clients
• Determine field visits – weekly
• Utilize the “checklist”
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Prevention Services
Cascade Meeting • The “Checklist” was developed to:
‒ Ensure consistency and thoroughness for each case/client investigated
‒ Ensure completeness of investigation
‒ Document work completed
‒ Track communication between STI Program and client (i.e. returned letters/returned calls)
‒ Capture information for required fields in PROVIDE
‒ Allow for quicker closure of case/client
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Prevention Services 14
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Prevention Services
Lake County Health Department SBS Model Inventory of Available Resources
• In House
‒ INEDDS
‒ Medi
‒ Electronic Medical Record
• Community/Agency Partners
‒ Pharmacies
‒ Veterans Affairs Hospital
‒ Military Services
‒ Substance Abuse Treatment Programs
‒ County Jail
‒ IDPH STI and HIV Section
‒ Local Hospitals
‒ Private Providers
‒ County/City Clerk
‒ Housing Programs/Homeless Shelters
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Prevention Services
Lake County Health Department SBS Model Useful Websites/Apps
‒ Advanced Background Check
‒ PIPL
‒ White Pages Reverse Lookup
‒ Zillow
‒ Google Maps
‒ Social Media
Facebook, Adam for Adam, GRINDR, TINDER, Mobile Patrol, etc.…
‒ Illinois/Wisconsin Department of Corrections
‒ County Corrections
Search for Obituaries, Professions, Other Contact Information
‒ Tax Assessor
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Prevention Services
Lake County Health Department SBS Model
Next Steps…
Investigative Procedures
1. Phone calls
2. Letters
3. Field visits
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Prevention Services
Lake County Health Department SBS Model
Phone Calls
‒ Never mention HIV, right?
‒ Call Unblocked
‒ Leave a general message
Scenarios
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Prevention Services
Lake County Health Department SBS Model
Letters
‒ Agency Letterhead Only
‒ Give direct-line phone number
‒ Use Code Name
‒ Multiple Languages
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Prevention Services 20
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Prevention Services
Lake County Health Department SBS Model
Field Visits
‒ In Pairs
‒ County/Company Car
‒ Ask Questions
‒ Various Locations
Scenarios
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Prevention Services
Lake County Health Department SBS Model Additional Strategies for Networking
‒ Pharmacies
‒ Private Providers
‒ Local Hospitals
Emergency Departments
Case Managers
Grand Rounds
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Prevention Services
Lake County Health Department SBS Model
‒ Ryan White Case Management
‒ Early Intervention Services
‒ Dental Services
‒ Mental Health Services
‒ Medication Adherence Counseling
‒ Availability and Access to English, Spanish & LGBTQ Support Groups
‒ ACA, Medicare C & D and other Insurance Enrollments
‒ ADAP/PAP
‒ Pharmaceutical Patient Assistance Programs
‒ Partner Notification and Testing
‒ PrEP/PEP
‒ Housing Services
‒ Health Education/Literacy
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It’s More Than Just Medical… SBS activities have afforded the STI Program to offer not just Linkage to Care services to people living with HIV
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Prevention Services
Lake County Health Department SBS Model Outcomes
Oh, do we have stories!
‒ Sensitive professions
‒ Phone calls from out of the country
‒ Individuals with aliases
‒ Individuals with stolen identities
‒ Immigration
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Prevention Services
Lake County Health Department SBS Model Outcomes
Tied into our Program Key Performance Indicators and our Agency Strategic Plan
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Prevention Services
Lake County Health Department SBS Model Successes
In 2015:
• 263 Services Provided
• 185 Unique Individuals Served
• 48 Linked/Relinked to Care
• 181 Offered/Accepted Partner Services
• 25 Risk Reduction Counseling Sessions Conducted
• 3 Found to be Deceased
• 21 Found to be Out of Jurisdiction
• 4 Found to be Negative
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Prevention Services
Lake County Health Department SBS Model Challenges
What isn’t a Challenge?
‒ Stigma
‒ Staff time
‒ Funding
‒ Out of date/incomplete information
‒ Utilizing social media
‒ Unresponsive Patients
‒ Being perceived as “Big Brother”
‒ Balancing public health outcomes and patient health with patient privacy and patient self determination
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Prevention Services
Lake County Health Department SBS Model Recommendations
Maximizing Limited Resources to Maximize Outcomes
‒ Stay client-centered: keep client needs first
‒ Partner with surveillance staff to introduce SBS workers to private providers and hospitals
‒ Make Friends
‒ Integrate Surveillance and Data to Care as much as possible
‒ Integrated Data Collection System
Go Beyond Integrated Planning to Integrated Working
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Prevention Services
Lake County Health Department SBS Model Recommendations
• Integrated Database
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Prevention Services
Conclusion
What Is Your Experience?
• Successes
• Interesting Stories
• Challenges
• Different Approaches
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Prevention Services
Thank you!
• Sara Zamor, MPH STI Program Coordinator
• Valerie Johansen, MPH Community Health Specialist
Lake County Health Department
STI Program
2400 Belvidere Rd
Room 1132
Waukegan, IL 60085
847.377.8450
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3010 Grand Avenue Waukegan, Illinois 60085
847.377.8000 phone
http://www.health.lakecountyil.gov
2016 Lake County Health Department