Linkage and Retention
Interventions selected for
dissemination
Steven Sawicki, MHSA
Program Manager, AIDS Institute
SPNS Lead, NY-LINKS
September, 2013
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Agenda
• Looking Back
• Looking Now
• Looking Forward
Looking Back
• Creation of UMRG, WNYS and Q&SI
collaboratives in NYS
• Involvement of more than 60 individual
provider organizations in the establishment of
base line data and individual testing of
interventions
• 12 face to face learning sessions used to
network, share information, and further
improve linkage and retention
Looking Back
• Development of regionally based cascades
• Involvement of county health departments and
multiple state departments and divisions
• Work done shared through international
program and with QAC, CAC, QOC, the other
5 states involved, and the national evaluators.
• Incredible amount of change going on within
individual organizations and systems
Where we are
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UMRG—6th learning session
WNYS—4th learning session
Q&SI—3rd learning session
Mid and Lower Hudson—1st learning session
Long Island—1st meeting 11/13/13
Central and Eastern NY
Bronx
Brooklyn
Where we are going
• Dissemination of work
• Adding in a menu of evidence based
interventions to the IAPAC Guidelines
previously presented
• Solidifying gains made
Interventions
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Selection process
The 5 interventions
Summary of each intervention
How to Pick an Intervention to Implement
Timeline
Intervention Selection Process
• Meeting on June 20 to discuss intervention work
• Follow up meeting to pare down list of dozens of
identified interventions to 6 or fewer
• Interventions were selected based on the following
criteria:
Number of existing providers utilizing intervention
Where impact of intervention fell on continuum
Resources required to implement intervention
Diversity of target population impacted
Evidence base supporting intervention
Provider type associated with intervention
Intervention selection teams
Each intervention had a team
Teams were assigned to each intervention to:
Develop a summary of the intervention
Develop an intervention package
Teams were comprised of:
NYS DOH staff
NYC DOH MH staff
NYLinks staff
Consumers
Providers
Members of each team were selected based on experience with the
particular intervention they were assigned to
Summaries and packages produced by the teams were submitted to HRSA
and to the national evaluation team for SPNS--ETAC
The 5 Interventions
• Artas (Anti-Retroviral Treatment and Access
to Services)
• Appointment Procedures
• Consistent Messaging
• Outreach/Return to Care
• Peers
Summary of Each Intervention
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Brief Description
Intervention Impact Area
Target population
Best for agencies who provide…
Core Elements
Duration—how long for each client/patient
Resource requirements
Training needed
Anti-Retroviral Treatment and
Access To Services (ARTAS)
Brief Description--ARTAS is an individual-level, multi-session, time-limited
intervention utilizing a strengths based case management model.
Impact Area—Linkage to Care/Retention in Care.
Target Population--Newly diagnosed individuals or those returning to care
after more than a 6 month lapse.
For Agencies that Provide—HIV testing, clinical, supportive services.
Core Elements—1-5 structured sessions with each person, Focus on
strengths of the individual, Development of step by step plan to connect to
care, Service takes place in the environment of the individual, Advocacy of
individual needs related to return to care.
Anti-Retroviral Treatment and
Access To Services (ARTAS)
Duration—1 to 90 days
Resource requirements—Staff trained in case management/engagement.
Training needed—ARTAS, Motivational Interviewing suggested
Appointment Procedures
Brief Description—Standardization of procedures to facilitate making
appointments, reminding patients of appointments, and providing follow up
after missed appointments.
Impact Area—Linkage to Care/Retention in Care.
Target Population—All individuals who are HIV+. Limited resources may
require prioritization—New diagnoses, Out of Care, frequency of no show,
last lab status.
For Agencies that Provide—HIV testing, clinical, supportive services.
Core Elements—Patient enrollment, expanded patient contact info acquired,
appointment reminders instituted, missed appointment follow up procedures
developed, documentation of efforts.
Appointment Procedures
Duration—ongoing.
Resource requirements—Staff, time for training.
Training needed—Field safety training if outreach is to be used.
Consistent Team Based Messaging
Brief Description—Positively phrased and action oriented messages are
delivered by all members of the care team.
Impact Area—Linkage to Care/Retention in Care.
Target Population—All HIV+ individuals who are newly engaging or reengaging in care.
For Agencies that Provide—HIV testing, clinical, supportive services.
Core Elements—List of newly engaging and re-engaging patients, brief care
message delivered by all staff on care team, longer care message developed
and delivered by specifically indicated members of care team, tool to track
messages and delivery process.
Consistent Team Based Messaging
Duration—ongoing.
Resource requirements—Staff, time for training.
Training needed—Use of scripted messaging, teachback, motivational
interviewing suggested.
Outreach/Return to Care
Brief Description—Systematic search for individuals who have been out of
care for longer than 6 months. Engagement of those individuals back to
care.
Impact Area—Retention in Care.
Target Population—HIV+ individuals with at least one HIV medical visit
within the last two years who have not been seen in primary care for 9
months or longer.
For Agencies that Provide—Clinical, supportive services.
Core Elements—Maintained care roster to identify out of care patients, case
finding efforts, field outreach, care determination process, re-engagement
and case closure process.
Outreach/Return to Care
Duration—ongoing.
Resource requirements—Staff, time for training.
Training needed—Field safety training for outreach, Case finding training.
Peer Support
Brief Description—Utilizing the skills of peers to better engage patients in
the system.
Impact Area—Linkage to Care/Retention in Care.
Target Population—HIV+ individuals who are newly diagnosed, transferring
their care, or returning to care after not being seen for 6 months or longer.
For Agencies that Provide—HIV Testing, Clinical, supportive services.
Core Elements—Identification of new, transferring or returning patients,
Peers trained in engagement, Use of standardized, consistent messages,
Contact schedule and process recording.
Peer Support
Duration—1 to 90 days.
Resource requirements—Staff, time for training.
Training needed—Confidentiality, engagement and communication.
Key Components to consider in
Intervention Selection
Current status
Use of regional cascade along with individual organization data related to
linkage and retention.
Awareness of competing interventions.
Organizational resources.
Commitment and ability to track required data.
Ability to test and measure change and outcomes.
Ability to run intervention through August of 2015 and participate in statewide
evaluation process
1
Artas
2
Appointment Procedures
3
Consistent Messaging
4
Outreach/Return to Care
5
Peer Support
1,2,
3,5
1,2,
3,4,
5
Next Steps
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Introductory Webinars
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Pilot Phase
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Revision and finalization of interventions
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Assessment package developed
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Individual webinars for each intervention ?????
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Process within each learning session to look at best way to impact the
regional cascades
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Providers select interventions and receive TA
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Beginning of evaluation
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Statewide dissemination process begins—Webinars, workshops,
presentations, conferences.
Timeline
• Pilot Phase begins November through February
•Sites that meet minimal criteria volunteer, choose intervention, receive TA
around implementation, and report process
•Adjustments made to interventions as needed during this period
•By end of pilot, in February, interventions have been revised and are
ready for full dissemination.
•6 to 8 sites to be involved in Pilot
• While Pilot phase is running.
•Introductory webinars will be held
•Sites not involved in Pilot prepare for dissemination
UPCOMING WEBINARS
Tuesday, November 12th, 2013, 11:00 AM
Wednesday, November 13th, 2013, 3:00 PM
Thursday, November 14th, 2013, 10:00 AM, 2:00 PM
Friday, November 15th, 2013, 1:00 PM
UPCOMING STAKEHOLDER MEETINGS
December 4th, 2013, Western New York State—Batavia,
NY
December ?? th, 2013 Mid and Lower Hudson—Newburgh
(date is tentative)
December 17th, 2013 Upper Manhattan—TBD
December 20th, 2013, Queens and Staten Island—90
Church St., Manhattan
Contact Information
•Steven Sawicki, NYSDOH, SPNS Lead
svs03@health.state.ny.us, 518-474-3813
•Clemens Steinbock, NYS Director of Quality
Initiatives cms18@health.state.ny.us
•Bruce D. Agins, Medical Director,
bda01@health.state.ny.us
•Website at http://www.newyorklinks.org
•Blog at http://linkandretain.wordpress.com/