Presentation to the CDC on Lessons Learned in managing Project Pride & PrEP education / outreach.

1. PROJECT PRIDE
LESSONS LEARNED
Mikael Wagner
June 19, 2018

2. Presentation Overview & Discussion
 Project lessons learned
 Strategies that worked
 Strategies that didn’t work
 Strategies to continue using
 What could be done differently
 Challenges in reaching priority communities
 Successes
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3. Project Lessons Learned
 Easier to engage individuals than communities. Deliverables were easy to
accomplish once the project was fully staffed.
 Actively engaging communities should be a priority in order to gain trust &
understanding the needs of the priority community.
 People operate under a great deal of misinformation. Many priority group
members didn’t realize they could use PrEP.They thought it was just for
White guys in the Castro or HIV+ people.
 Difficult to implement a project that expands 4 different branches.
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4. Project Lessons Learned
 Communication does not work well across many entities.
 Too many managers and directors and not enough staff doing the
work. Many directors don’t participate fully & many have decided not
to stay informed of what is happening on the project. As a result
communication and progress meeting our goals becomes difficult.
 Communications need to be a priority.
 There is a strong resistance to change.
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5. Project Lessons Learned
 People are protective of old ways of reaching deliverables.
 Asking the question:What are people willing to change within
themselves to achieve what is best for the communities we serve?
 Reaching priority communities directly works best.Too often we
build what we think is needed without engaging the community.
 There is a need to work together as one unit.The project structure
needs to change to facilitate the need.
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6. Project Lessons Learned
 When starting a new project, it’s important to have staff that can
make it a priority.There have been many unaddressed issues,
inefficiencies, many things had been assumed and not discussed.
 Provide adequate training for new staff or a guide book as opposed
to throwing them in to sink or swim.
 Communications is vital. It helps to shadow key staff early on &
listening to stories about what clients were saying, doing & needed.
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7. Project Lessons Learned
 Having a project where staff is not housed in different departments
reporting to different managers.
 Staff members need to be involved in decision making when it
comes to writing proposals or project plans because they are familiar
with the work and know what is needed to succeed without stress.
 Try to shorten the gap between being funded and hiring staff to
achieve deliverables.
 Create realistic deliverables that are achievable.
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8. Project Lessons Learned
 Plan, plan, and plan some more. Always try to hit the ground
running. For example, the Carry Forward took a long time to
approve, but take the time to prepare for the day when it’s approved.
 Being present at cultural events and community engagements to
reach priority communities.
 Ascertain what events should be deleted if it’s not reaching your
priority audience effectively.
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9. Project Lessons Learned
 It’s essential to build a strong team to be successful.
 Project management is necessary to drive a team towards the right
goals and outcomes.
 Less about egos
 Using RBA at the beginning of a project.
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10. Project Lessons Learned
 After attending great workshops on topics such as racial humility,
cultural sensitivity, Lean, RBA, etc. it would be worthwhile to have
follow up with staff so that they can practice or learn how to
implement the information and blend it into their daily work. Usually
nothing happens to support staff on this issue and it’s business as
usual.
 Having the flexibility and ability to change things if they don’t work.
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11. Project Lessons Learned
 Ongoing push back against experienced team members.
 Too many cooks in the kitchen, difficult to cook a meal.
 Having the flexibility and ability to changes things if they don’t work.
 Asking the necessary questions and being honest:
 How much did we do?
 How well did we do it?
 Is anyone better off?
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12. Strategies that worked
 In terms of locating clients, direct provider referrals are the best
source; followed by lists based on an active HIV panel list from the
health network.These people may have not been out of care that
long, making it easier to track them down & to re-engage them.
 For PHNIX Maven, focusing on groups that felt they needed an
alternative solution works well.
 Racial humility training positively impacted the team as a whole &
improved how we work together.
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13. Strategies that work
 New social marketing campaign resonated with our priority populations
because of the research to ascertain what the community needed. It helps
to listen to priority communities.
 When doing PH detailing, it can be difficult to schedule times to meet
providers, but ultimately they were grateful for the information & tools
provided.
 Navigators Community of Practice – well attended central source for
networking, messaging & collective problem solving.
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14. Strategies that work
 Contracting with community organizations that are engaged with
priority communities.
 Campaigns designed by the priority communities and FOR the
priority communities. Creating products that can be used again.
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15. Strategies to continue implementing
 PrEP Navigation –While access has improved for most, low cost
access may be an issues for our priority communities.
 Public Health Detailing was useful to providers and their staff. Lays
the foundation for future programs educating providers on current
trends in prevention and treatment.
 Pharmacy delivered PrEP (Data soon) could be a solid alternative to
PrEP access (stigma, community engagement & expedited access).
 Expansion of City Clinic model to SFHN – Great model to be shared.
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16. Strategies to continue implementing
 Continue involving & receiving campaign input from priority
communities.
 Continue PHNIX Maven so data on individuals can be shared.
 Reporting of new cases & updating of known cases in ISCHTR.
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17. Strategies that didn’t work
 Not much luck with eHARS based lists because of so much in and out
migration here & no efficient way to tracking people when they leave
the state. Should not be the primary source of lists.
 Contingency Management program that didn’t get clients into
mental health & substance abuse services – too many challenges.
 Linking patients back to providers is a lot of work – not sustainable.
May work better if integrated to a system like PHNIX.
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18. Strategies that didn’t work
 Maintaining full staffing. Each year money goes unspent, but we are
unable to hire staff.This has negatively impacted the quality &
amount of work that gets done.
 Data to PrEP (STD Hx) – developing algorithms was time consuming
& imperfect at identifying potential candidates.
 Hiring a new team to coordinate the project was a detriment in terms
of time to hire, orient, & integrate into DPH hierarchy.Temp staff
seeking permanent jobs in year 2 resulting in a smaller staff.
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19. Strategies that didn’t work
 Inter-departmental coordination is essential for a project of this
magnitude. PHD struggles with communication and transparency.
Result: Directors feeling uninformed & reluctant to accommodate
innovation & change.
 Staff roles & responsibilities were never clearly defined.
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20. What could be done differently
 Hire contract staff, instead of hiring through DPH & wasting time.
 Project Manager, the most crucial component of a project should
have been the first person hired rather than the last person hired.
 Those closest to the work and those with credible experience should
be given more authority & autonomy.
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21. What could be done differently
 Holding all team members, director or manager, accountable.
 Better communications among teams.
 Reduction in micro-management behaviors towards staff.
 Partnering with community organizations that represent our priority
communities and who are already doing the work well.
 Do a better job of monitoring grantees to make sure they are on
track to achieve deliverables.
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22. What could be done differently
 Lot of focus from the CDC on DTC list data to the exclusion of other
types of referrals.This prevents CDC from seeing the large portion of
our work.The focus should be extended to include other referral
sources and improving workflows related to them.
 Need for more coherent security & data sharing policies between HIV
& STD that facilitate fieldwork. Separation between HIV surveillance
and staff working to administer HIV related services is an artificial
stumbling block that needs to be removed.
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23. What could be done differently
 Instead of being in a Lean workshop, it would have been better to
meet with management in a more naturalistic way. Important to get
down in the trenches with staff to hear their concerns & needs.
 More active listening when suggestions and requests are presented
by staff instead of disregarding them. Stop making decisions on how
things were done, rather than allowing team innovation.
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24. Challenges in Reaching Priority
Communities
 Lack of commitment from SFDPH to take the time and exert the effort
required to establish trust and to demonstrate true commitment to
improving the lives of all San Franciscans.
 Stigma, not a big surprise, but the current administration frightens many
in our priority communities.
 Mistrust of public health, hospitals, clinics, doctors, etc.
 The initial media group hired had no idea how to reach priority
communities well.The campaign was painful and failed.
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25. Challenges in Reaching Priority
Communities
 Lack of cultural sensitivity towards Latinos. Also a lack of
Latino/Latina staff from this group, despite the demographics.
 Lack of sensitivity towardsTrans issues, making it difficult to reach
Trans women from all groups. Stigma prevails.
 Many cultural and racial sensitivity training are conducted, but goes
in one ear and out the other for many staff.
 Internal institutional racism towards Black & Latino staff.
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26. Challenges in Reaching Priority
Communities
 Blocking from some Directors and Managers who want to continue
doing things the way it was always done in the good old days.
 Not listening to experienced staff or staff assigned to working in
priority communities.
 Struggling to educate that the Black or African American and the
Latino priority audiences are a community or family joined together.
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27. Challenges in Reaching Priority
Communities
 Lack of respect shown when PHD wants to push into a community
without building trust or a relationship.
 Internal lack of empowerment and support for Black & Latino staff.
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28. Successes in Reaching Priority
Communities
 Facilitation of great partnerships with priority communities.
 Being able to listen to the needs of our priority communities.
 Increasing our partnership with external partners.
 Helping people in our priority populations as a result of Project Pride
efforts. Persons of color have been re-linked to HIV Care, got on PrEP
or became aware of PrEP.
 Being able to engage, serve, and learn more about our priority
communities.
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29. Successes in Reaching Priority
Communities
 Commitment of project team to reach priority communities and to
support each other 100%.
 The Ask About PrEP, PrEP Supports andViva PrEP,Texting, & Social
Media.
 Attending community engagement events and activities during off
hours.
 Helps us to know more when we hear from consumers and agency
staff.
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30. Successes in Reaching Priority
Communities
 Staying consistent in the message we want to share and the
commitment made to priority communities. Building and
maintaining trust is essential.
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31. “We cannot seek achievement for
ourselves & forget about progress &
prosperity for our community. Our
ambitions must be broad enough to
include the aspirations and needs of
others, for their sakes and for our own.”
Cesar Chavez
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