EARLY INTERVENTION SERVICES
Cleveland TGA Definition: Counseling individuals with respect to HIV/AIDS; testing (not funded through Ryan White Part A); referrals; other
clinical and diagnostic services regarding HIV/AIDS; periodic medical evaluations for individuals with HIV/AIDS; and providing therapeutic
measures.
The entities through which such services may be provided under the grant include public health departments, emergency rooms, substance abuse and
mental health treatment programs, detoxification centers, detention facilities, clinics regarding sexually transmitted diseases, homeless shelters, HIV
disease counseling and testing sites, health care points of entry specified by eligible areas, federally qualified health centers, and entities described in
section 2652(a) that constitute a point of access to services by maintaining referral relationships.
Proposals must include the following components:
A. Testing (not funded through Ryan White Part A) should detail coordination through other funding sources or agencies
B. Referral Services
 Linkage agreements to work with key points of entry
 Relationship and trust building
 Assessment of immediate need/attitude/knowledge/behaviors/beliefs regarding care
 Health Literacy/Health Education (counseling)
 Access to Linkage and Care
Services should be targeted to the following populations:
 Newly diagnosed
 Receiving other HIV/AIDS services but not in primary care
 Formerly in care – dropped out
 Never in care
 Unaware of HIV status
Early Intervention Services (EIS) will lead the efforts of EIIHA (Early Identification of Individuals with HIV/AIDS). All proposals for EIS must
address coordination with prevention services, counseling and testing centers, as well as RW Part A providers.
HRSA Definition: Early Intervention Services (EIS) includes counseling individuals with respect to HIV/AIDS; testing (including tests to confirm
the presence of the disease, to diagnose the extent of immune deficiency, and to provide information on appropriate therapeutic measures); referrals;
other clinical diagnostic services regarding HIV/AIDS; periodic medical evaluations for individuals with HIV/AIDS; and provision of therapeutic
measures. Support of Early Intervention Services (EIS) that include identification of individuals at points of entry and access to services and
provision of:
 HIV Testing and Targeted counseling
 Referral services
Cleveland TGA- Ryan White Part A Program


EIS Standard of Care
Linkage to care
Health education and literacy training that enable clients to navigate the HIV system of care
All four components to be present, but Part A funds to be used for HIV testing only as necessary to supplement, not supplant, existing funding.
Care and Treatment Goals: The overall goal of Early Intervention Services within the Cleveland TGA is to provide intensive short-term case
management services through the Early Identification of Individuals with HIV/AIDS (EIIHA) initiative for newly diagnosed (Unaware) and Out of
Care PLWHA (Out of Care as defined by HRSA). The TGA’s target populations are:
 African American MSM
 MSM, Ages 45+
 MSM Youth, 13-24
 African American and Hispanic Youth, 13-24
 African American and Hispanic Women
Service Objective:
 To provide short-term intensive case management services through the EIIHA initiative with the focus on newly diagnosed (Unaware) and
Out of Care (OOC) populations
 Medical care linkage to promote healthy outcomes for PLWHA
 Support service referrals to ensure clients have access to services that will promote medical adherence
Program Components: All services are provided to link PLWHA newly diagnosed and out of care to medical care and support services through:
 HIV testing and Targeted counseling
 Referral services
 Linkage to care
 Health education and literacy training that enable clients to navigate the HIV system of care.
Personnel:
Revised and Approved by QI, August 2013
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Cleveland TGA- Ryan White Part A Program
EIS Standard of Care
Staff Qualification
Staff providing care and/or counseling services to clients participating in the Early
Intervention Services program must be trained to provide these services to newly
diagnosed HIV/AIDS clients and to PLWHAs who know their status and are not in
care.
Supervision of all staff is evident through documentation of a senior member with
experience and skill in the field of targeted counseling.
Expected Practice
Personnel files/resumes/applications for employment reflect requisite
experience and education.
Agency protocols for supervision of staff is documented and implemented.
Agency protocol clearly delineates responsibility of supervisor of EIS staff,
to include quarterly report of case records reviewed.
Supervisory files indicated documented sessions for each peer worker as
indicated.
Supervisors must maintain a file on each peer worker supervised and provide
documented evidence of supervised sessions on a monthly basis, at a minimum.
The file must include:
 Date, time, and content of supervisory session
 Results of the case review addressing, at a minimum, completeness and
accuracy of records, compliance with Standards and effectiveness of
service provided.
Agency staff who provide direct care services shall possess a current certification
as an HIV prevention counselor, or have advanced training/experience in the area
of HIV and/or infectious disease specialty.
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Revised and Approved by QI, August 2013
Supervision evident in client charts; personnel files indicated supervisor
role, to include job description and reflect requisite experience and
education.
Personnel files/resumes/applications for employment reflect requisite
experience, education, and certification.
Cleveland TGA- Ryan White Part A Program
EIS Standard of Care
Training:
Training
Expected Practice
Agency staff is trained, certified, and/or licensed to provide early intervention
services with documented competency assessments completed annually, or
more often as needed.
Personnel files reflect training/certification and/or licensure to provide EIS
services to include documented competency assessments completed annually at
a minimum.
All newly hired EIS staff have a minimum of ten (10) additional hours of Personnel files reflect completed orientation with additional training as
orientation covering target populations and the HIV service delivery
indicated. Personnel files reflect a signed job description.
system in the Cleveland TGA, including but not limited to:
a. The full complement of HIV/AIDS services available within the TGA
b. How to access such services (including how to ensure that particular
sub-populations are able to access services, i.e., undocumented
individuals)
c. The Ryan White Part A Standards of Care (Universal and individual
Service Category standards)
d. Education on applications for eligibility under entitlement and benefit
programs other than Ryan White services (i.e., Medicaid, Medicare,
WIC, OHDAP, SNAP, etc.)
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Revised and Approved by QI, August 2013
Cleveland TGA- Ryan White Part A Program
EIS Standard of Care
Description of Service (HRSA Program Monitoring Standards):
STANDARD
Support of Early Intervention Services
(EIS) that include identification of
individuals at points of entry and access
to services and provision of:
 HIV testing and Targeted
counseling
 Referral services
 Linkage to care
 Health education and literacy
training that enable clients to
navigate the HIV system of
care
All four (4) components to be present,
but Part A funds to be used for HIV
testing only as necessary to
supplement, not supplant, existing
funding.
PERFORMANCE
MEASURE/METHOD
Documentation that:
1. Part A funds are used for HIV testing
only where existing federal, state, and
local funds are not adequate, and
Ryan White funds will supplement
and not supplant existing funds for
testing
2. Individuals who test positive are
referred for and linked to health care
and supportive services
3. Health education and literacy training
is provided that enables clients to
navigate the HIV system
4. EIS is provided at or in coordination
with documented key points of entry
5. EIS services are coordinated with
HIV prevention efforts and programs
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Revised and Approved by QI, August 2013
MONITORING STANDARDS
1. Establish memoranda of understanding
(MOUs) with key points of entry into care
to facilitate access to care for those who
test positive
2. Document provision of all four required
EIS service components, with Part A or
other funding
3. Document and report on numbers of HI
tests and positives, as well as where and
when Part A-funded HIV testing occurs
4. Document that HIV testing activities and
methods meet CDC and state
requirements
5. Document the number of referrals for
health care and supportive services
6. Document referrals from key points of
entry to EIS programs
7. Document training and education sessions
designed to help individuals navigate and
understand the HIV system of care
8. Establish linkage agreements with testing
sites where Part A is not funding testing
but is funding referral and access to care
and education, system navigation services
9. Obtain written approval from the grantee
to provide EIS services in points of entry
not included in original scope of work
LIMITATIONS
Cleveland TGA- Ryan White Part A Program
EIS Standard of Care
QUALITY MANAGEMENT:
Program Outcomes: The goal of EIS is to decrease the number of Unaware and Out of Care individuals with HIV/AIDS by increasing access to
care.
Indicators:
 Number of newly diagnosed (Unaware) brought into care
 Number of Out of Care (OOC) returned to care
EIS SoC
STRUCTURE
Agency staff providing
direct care services shall
have documented
experience and/or
certification as appropriate
to provide EIS counseling,
testing, referral services,
and linkages to care.
EIS service providers will
have MOUs on file with
key points of entry into care
to facilitate access to care
for those who test positive.
Outcome Measure
All agency EIS staff will
have documented
experience in the field of
case management services,
to include EIS counseling,
health education, referral
services, linkages to care,
and HIV testing.
EIS providers will maintain
working relationships with
key points of entry into care
(ER, Homeless Shelters,
HIV testing sites, etc.) to
facilitate access to care for
those who test positive.
Numerator
Denominator
Goal/Benchmark
All EIS staff
providing direct
care services to
PLWHA in the
Cleveland TGA
All EIS staff
Agency Files
100% of EIS staff will have
documented experience and/or
certifications to provide EIS
services.
All EIS providers
who have MOUs
on file for key
points of entry
All EIS providers
Agency Files
100% of EIS providers will have
documented MOUs on file for
key points of entry into care to
facilitate access to care for those
who test positive.
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Revised and Approved by QI, August 2013
Data Source
Cleveland TGA- Ryan White Part A Program
EIS SoC
PROCESS
Agency staff will have
documented evidence of
orientation training in case
management services.
Supervision of unlicensed
EIS staff is documented
through client case reviews
and kept in secure staff file.
Outcome Measure
EIS staff will have
documented training
provided, at a minimum
annually, for case
management services.
All EIS staff will be
supervised and have
documentation of such
supervision in staff file.
EIS SoC
OUTCOME
EIS Service Provider shall
ensure client attends an initial
visit with an HIV Specialist.
The initial visit must take
place within 90 days of
identification and must include
CD4 count and viral load
screening.
EIS Service Provider shall
provide client health education
concerning the HIV disease
process, risk reduction, and
maintenance of the immune
system.
Outcome Measure
EIS Standard of Care
Numerator
Denominator
Data Source
Goal/Benchmark
All EIS staff with
documented
training in case
management
All EIS staff
Agency Files
100% of EIS staff will have
documented training provided in
case management services, at a
minimum annually.
All EIS staff with
documented
evidence of
supervision
All EIS staff
Agency Files
100% of EIS staff will be
supervised and have
documentation in staff files of
results of each supervised
session.
Numerator
Denominator
Data Source
Goal/Benchmark
Documentation of initial
medical visit in client files.
Number of newly
enrolled EIS clients
with documentation
of attendance to
initial medical visit
Number of newly
enrolled EIS clients
Client Charts
CAREWare
75% of newly enrolled EIS clients
will have documentation of
attendance to an initial medical visit
in their files.
Documentation of health
education and literacy
assessment completed in client
files.
Number of newly
enrolled EIS clients
with documentation
of health
education/literacy
assessment
completed
Number of newly
enrolled EIS clients
Client Charts
75% of newly enrolled EIS clients
will have documentation of health
education given regarding HIV
disease process, risk reduction, and
maintenance of the immune system,
to include a health literacy
assessment.
CAREWare
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Revised and Approved by QI, August 2013
Cleveland TGA- Ryan White Part A Program
EIS SoC
OUTCOME
EIS Service Providers will ensure
linkages to mental health and
psychosocial support services to
clients demonstrating need for
behavioral health services as
indicated by the clinician’s
assessment of the patient’s needs.
EIS clients will attend at least one
medical visit before transitioning
to Medical Case Management
Services.
EIS Standard of Care
Outcome Measure
Numerator
Documentation of
mental health,
psychosocial support
services linkages based
on clinician’s
assessment.
Number of newly enrolled
EIS clients with referrals to
mental health and support
services
Number of newly
enrolled EIS clients
Documentation of
transition from EIS to
Medical Case
Management services.
Number of newly enrolled
EIS clients transitioned to
Medical Case Management
Services
Number of newly
enrolled EIS clients
with at least one
medical visit
documented
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Revised and Approved by QI, August 2013
Denominator
Data Source
Goal/Benchmark
Client charts
75% of newly enrolled
EIS clients will have
documentation of mental
health and psychosocial
support service referrals
in client files, where
indicated a need.
75% of EIS clients will
be transitioned from EIS
to Medical Case
Management services
after documented
evidence of at least one
medical care visit in an
HIV setting.
CAREWare
Client Charts
CAREWare