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AACO's Client Services Unit (CSU) Update


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Evelyn Torres and Sebastian Branca's update on AACO's Client Services Unit (CSU), Housing Services Program (HSP), and Quality Improvement (QI) programs

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AACO's Client Services Unit (CSU) Update

  1. 1. Philadelphia Departmentof Public HealthAIDS Activities Coordinating OfficePlanning Council MeetingMay 9, 2013
  2. 2. Client Services Unit(CSU)
  3. 3. CSU Mission Help HIV infected and at-risk individualsunderstand their needs and makeinformed decisions about possiblesolutions Advocate on behalf of those who needspecial support Reinforce clients’ capacity for self-relianceand self-determination through◦ education◦ collaborative planning◦ problem solving
  4. 4. CSU Responsibilities Intake services to HIV positiveindividuals requesting casemanagement services Information and referral services for allother AACO funded programs Process individuals’ requests forsubsidized housing Feedback about funded providers Local Case Management CoordinationProject
  5. 5. CSU Information Health Information Helpline is open 8 a.m. to 6 p.m.Monday through Friday1-800/215-985-2437 Staffing:◦ 1 Manager◦ 1SW Supervisor◦ 1Housing Supervisor◦ 4 City Social Workers◦ 2 Housing Staff◦ 1 Data Specialist◦ 1 Training Coordinator Staff speak Spanish◦ Other languages available through PDPH
  6. 6. CSU Waiting List 186 people as of 5/7/13 Followed by CSU Intake Workers◦ Emergency◦ Urgent Emergencies and other priority populationsare immediately referred to MCM providers◦ SCI Clients CSU workers facilitate HIV medicalappointments for all clients reporting no HIVmedical care in last three months
  7. 7. Intake Data
  8. 8. MCM IntakesCalendar year Intakes2007 18732008 20922009 23562010 23102011 20872012 2038
  9. 9. 2012 Intake Demographics11.5%18.4%69.4%0.6%0.1% 0.5%3.1% 0.2%Client RaceHisp/LatinoWhiteBlackAsianHawaiianNative AmerOtherUnknown66.5%32.2%1.3%Client Gendermalefemaletrans. M->F
  10. 10. 2012 Intake Demographics30.0%13.3%46.6%1.1%3.3%1.6%13.7%Risk factor/Mode of transmissionMSMIDUHeteroBloodPerinatalOtherUnknown6.3%15.8%40.2%7.2%27.0%2.3% 0.7%Insurance typePrivateMedicareMedicaidOther publicNo insuranceOtherUnknown
  11. 11. Calendar Year 2012: Client needs at intake (N=2038)AllClientsLatinoMSMAfr. Amer.MSMYouth13-24NewlyDiagnosed(w/in 1 year ofintake)Number of intakes 2038 182 280 150 239Percent of total intakes 100.0% 8.9% 13.7% 7.4% 11.7%Service CategoryBenefit Assistance 59.0% 71.4% 50.0% 54.7% 55.6%Housing Assistance 51.7% 41.2% 56.1% 41.3% 34.3%TransportationAssistance31.2% 20.3% 32.5% 24.7% 34.3%Mental HealthTreatment29.1% 22.5% 30.0% 28.0% 32.2%Medical Insurance 27.6% 37.9% 26.1% 40.7% 38.1%Medical Care 23.1% 37.9% 14.6% 48.7% 40.6%
  12. 12. Calendar Year 2012: Client needs at intake (N=2038)AllClientsLatinoMSMAfr. Amer.MSMYouth13-24NewlyDiagnosed(w/in 1 yearof intake)Number of intakes 2038 182 280 150 239Percent of totalintakes100.0% 8.9% 13.7% 7.4% 11.7%Service CategoryMedications 20.3% 37.9% 12.5% 30.0% 28.9%Rental Assistance 17.6% 29.7% 11.8% 11.3% 9.6%Food Bank/HomeDelivered Meals17.2% 8.8% 21.4% 8.7% 13.0%Support Groups 14.4% 13.2% 13.9% 17.3% 16.3%Dental Care 11.0% 17.0% 11.4% 28.0% 23.4%HIV Education/RiskReduction10.4% 22.0% 7.5% 33.3% 41.0%Substance Abuse 8.5% 6.0% 5.7% 2.0% 6.3%
  13. 13. Housing ServicesProgram(HSP)
  14. 14. HSP Funding The AACO Housing Services Program(HSP) is 100% funded by thePhiladelphia Office of Housing &Community Development (OHCD) The HSP receives $0 from RyanWhite funds◦ RW funding can not be used to providepermanent housing◦ Federal and State funding for housingcontinues to decline
  15. 15. What is HSP Centralized intake for applicantsseeking permanent rental assistance(subsidized housing) The main referral source for housingsponsors providing HousingOpportunities for People With AIDS(HOPWA) or HIV/AIDS Shelter PlusCare (S+C) housing
  16. 16. What HSP Does Process and evaluate individualapplications for housing Maintain the waiting list Provide training to southeastern PAservice providers Provide ongoing TA to providers All services at no cost Do not provide emergency housing
  17. 17. HSP Scope 8 housing sponsors 663 housing slots out of 1015 slots◦ 522 HOPWA◦ 131 S+C 89% tenant based 11% project based
  18. 18. Waiting List290 applicants on the waitinglist as of 5/7/13◦ Priority 1- 9 months wait time(includes homeless individuals)◦ Priority 2- 4 year wait time◦ Priority 3- 5 year wait time
  19. 19. Quality Management in theEMA
  20. 20. What is Quality Management The QM process includes:◦ Quality assurance◦ Outcomes monitoring and evaluation◦ Continuous quality improvement The goal is to use high quality data tocontinually improve access to high qualityclinical HIV care It’s about knowing if clients are clinicallybetter off today than yesterday, and makingimprovements for the HIV care system to bebetter tomorrow
  21. 21. The AACO QualityImprovement (QI) Process Collect and monitor data to assess clientoutcomes◦ Local and HAB performance measures◦ Other available data Use data to improve client outcomes◦ Ongoing feedback to providers Benchmarking Trends◦ QIPs◦ Regional QI Meetings◦ Individual TA
  22. 22. Outcome Monitoring in theEMAPerformance MeasuresSystem Measures◦ Appointment AvailabilityDisparities in Care
  23. 23. Medical Measures 27 measures for medical (O/AMC)services 9 MCM measures 5 oral health measures Measures for all other services Mental Health Substance Abuse
  24. 24. O/AMC Performance in the EMA
  25. 25. Medical Case Management(MCM) Measures Retention in MCM services Linkage to HIV medical care Mental Health History and TreatmentStatus Substance Abuse History andTreatment Secondary Risk Assessment Medication Assessment and Counseling Care Plan Medical Visits Unmet need
  26. 26. Performancemeasures2008 2009 2010 2011 2012 (1/1-9/30)Retention inMCM (< or = 10weeks afterintake) 76% 81% 80% 78% 82%Retention inHIV medicalcare for clientsgetting MCM 87% 92% 95% 97% 96%MCM Performance Measures
  27. 27. EMA’s Baseline Performance forMCM
  28. 28. Oral Health Care PerformanceMeasuresCY 2011 Dental and medical history 95% Dental treatment plan 91% Oral health education 66%
  29. 29. Monitoring and Feedback Strong emphasis on feedback Quickly highlights trends, strengths andneeds Data visualization is critical in gettingattention of program leadership Benchmarking contextualizes data and cancapitalize on competitiveness of providers Assists in prioritizing QIPs
  30. 30. Performance Feedback Reports
  31. 31. Performance Feedback Reports
  32. 32. Quality Improvement Projects• Expanded to all core services in 2012• Grantee provides feedback to providers onall plans and requires revisions as needed• In 2012, 168 QIPs were collected andreviewed EMA has defined key measures and setautomatic thresholds for QIPs Programs may still select other measuresfor improvement in addition to any requiredQIPs
  33. 33. Criteria For Evaluating QualityImprovement Projects Focus on systems and processes Are data-driven Utilize a sound QI process (e.g. FOCUSPDSA) Investment by program leadership Incorporation of consumers in the QIprocess Produces desired improvements◦ ISU analysis demonstrates that QIPs work
  34. 34. Consumers and CQI PDPH emphasizes consumers in the QIprocess◦ Consumers on QI teams or committees◦ Obtain input from Consumer AdvisoryBoards during key stages of a QI process◦ Consumer focus groups◦ Client surveys to obtain client inputrelating to causes for low performance orproposed action steps
  35. 35. Questions or Comments