JACQUES. Changing Lives, Engaging Communities, Supporting Health Systems OVERVIEW

Transcription

1 the JACQUES initiative Changing Lives, Engaging Communities, Supporting Health Systems OVERVIEW The JACQUES Initiative is a program of the Institute of Human Virology at the University of Maryland School of Medicine

2 A Message from the Executive Director Jamie L. Mignano, Executive Director Dear Friends, In March 2018, we had the honor of moving into our new headquarters at The JACQUES Initiative Journey Center, a program of the Institute of Human Virology at the University of Maryland School of Medicine, located at 880 Park Avenue in Baltimore. On October 18, 2018, we celebrated our Grand Opening with many of partners, colleagues and friends, including The Honorable Elijah Cummings and Dr. Robert Gallo, among others, as our special guests. The JACQUES Initiative staff is comprised of more 30 individuals that span 3 generations, diverse in race, gender expression and sexual orientation, driven by our mission to change lives, engage communities and support health systems affected by HIV and Hepatitis C virus (HCV). We are composed of three centers, the Treatment Adherence Center (TAC), the Linkage to Care Center (LCC) and the Journey Center (JC), that function in concert to achieve our mission. This year, the TAC marked 15 years of operations. We opened our doors to more than 1,600 visits per month so that clients could pick up medications daily, weekly or monthly from our integrated pharmacy. Clients don t mind daily visits as they provide structure for adherence to life-saving antiretroviral therapy and because the TAC is a safe place, where dignity and respect are a way of life. Our LCC provides navigation to HIV care, treatment and supportive services. This year, staff interacted with nearly 700 persons living with HIV at the University of Maryland Medical Center and helped clients experience a smooth transition from hospital to outpatient care. Effective outcomes often include time spent with the client in their home or community, or accompanying them to appointments or other social service agencies. Serving as our program s new headquarters, the JC aims to be an internationally recognized community-based venue where individuals gather in fellowship to be the greatest expression of themselves. We promote wellness, health equity, inclusiveness, and social justice. We intentionally integrate wellness and prevention into our model to address the local HIV and Hepatitis C virus (HCV) epidemics. People are visiting the JC for a number of services that include onsite health screenings, peer support, navigation to health and wrap-around services including pre- and post-exposure prophylaxis (PrEP and PEP), health education, social events and support groups in an LGBTQ+ affirming environment. Soon, the community will have access to a youth drop-in center with a science, technology, engineering and math component, yoga, computer lab, clothing closet and much more. Thanks to the support of our funders, specifically the ViiV ACCELERATE! Program and the Baltimore City Health Department-supported Project IMPACT, a meaningful network of providers, community-based organizations and influential community members was created. We are proud to be part of these purposeful networks. It is through these relationships that we built the Journey Center s vision and strategy, in order to create a safe space in the community that would ultimately promote wellness emotional and physical in this community. Sincerely, Jamie L. Mignano, PhD, MSN, MPH, RN 2

3 Organizational Overview The JACQUES Initiative (JI), a program of the Institute of Human Virology (IHV) at the University of Maryland School of Medicine, was established in 2003 and is named for Joe Jacques, a psychologist who helped establish the first HIV support group for Baltimore s most vulnerable persons living with HIV. The program s mission is to change lives, engage communities, and support health systems affected by HIV and Hepatitis C virus (HCV). JI achieves this mission through a holistic approach by leading individuals, their families and communities of the City of Baltimore through a Journey to Wellness. Vision: To facilitate this Journey, we collaboratively support healthcare systems by engaging and linking community members to a continuum of HIV care, HCV care and prevention resources that allow them to live free of or live well with HIV and HCV. Strategy: JI s commitment to health equity is demonstrated by a service delivery model that extends beyond institutions and hospital settings to meet individuals in their neighborhoods, homes and communities. An integrated Data Department builds, implements and manages data sets to enable our staff, partners and stakeholders to make sound, consistent, information-based decisions. IHV s JACQUES Initiative Journey Center comprises our new 7,300 square foot headquarters and intentionally integrates wellness and prevention into our model. The center offers free services including: Walk-in HIV & Hep-C Testing Peer Navigation to HIV and Hep-C Prevention Services, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) Peer Support Health Education Support Groups LGBTQ+ Community Events Youth-friendly programming Computer & Financial Literacy Courses Community Work Space Clothing and Goods Marketplace Social Events personalized linkage individuals education communities health Hepatitis Who We Are: A group of 30 individuals committed to seeing an end to HIV and Hepatitis C in Baltimore. Three generations ages range from staff continuum information clients HIV care medicine Baltimore engagesupport individual HCV access supportive prevention services disparities needs Journey overcoming 3

4 Organizational Overview (Continued) Diverse in race, gender, gender identity and sexual orientation Our professional identities include: y Nursing ysocial Work y Pharmacy y Public Health y Health Care Administration y Data Management y Research y Community Outreach y Case Management y Coaching Our Funders: IHV s JACQUES Initiative implements clinical and community programming with the financial support of the following funders: US Centers for Disease Control and Prevention ViiV Healthcare s ACCELERATE! Initiative US Health Resources and Services Administration Corporate partners: Gilead Sciences, Maryland Department of Health Janssen Pharmaceuticals, and Walgreens Baltimore City Health Department Individual philanthropy IHV s JACQUES Initiative program highlights include: In collaboration with the AIDS Education and Training Center, educated over 3,000 health professions students (medicine, nursing, pharmacy, dentistry, and social work) through a nationally-recognized didactic and hands-on Preparing the Future interprofessional curriculum since For the past 4 years, JI has supported the policy, infrastructure development, and implementation of routine HIV and Hepatitis C tests in clinical settings, resulting in over 60,000 testing encounters. Support over 1,600 visits per month at our integrated pharmacy for daily, weekly and monthly observed antiretroviral therapy to achieve viral suppression, supporting over 1,300 individuals since In collaboration with the third largest provider of Pre-Exposure Prophylaxis (PrEP) in Baltimore City. CDC-recognized model for Peer Navigation to HIV Prevention services. the Journey to Wellness Staff IHV s JACQUES Initiative is the organization that houses the Journey Center, which functions in concert with the Treatment Adherence Center and Linkage to Care Center for service delivery. JACQUES initiative Changing Lives, Engaging Communities, Supporting Health Systems 4

5 Staff Highlight David Lee Callahan Outreach Worker I/Treatment Coach Treatment Adherence Center My journey to wellness began in May 2008 at Brockbridge Correctional Facility. While there, I met with a social worker for assistance with medical insurance, primary care, housing, transportation, substance abuse treatment, and anything I needed upon release back into the community. It was during that meeting with the social worker, I was able to speak with Kelley Stewart from the JACQUES Initiative over the phone. Ms. Stewart informed me of the services offered at the JACQUES Initiative and Curtis Mitchell and David Callahan, Treatment Coaches from the TAC asked if I needed any of those services. At that time, I informed her that the social worker filled out an application for medical assistance and will be receiving medical service at the Veterans Hospital. I also informed her that I will be enrolling into The Maryland Center for Veterans Education and Training (MCVET) once I was released. MCVET is a long term substance abuse treatment facility for veterans. Upon my release in January 2011 to MCVET, I contacted Kelley to let her know of my whereabouts and thanked her for her assistance. While attending classes at Baltimore City Community College, I was able to obtain (with the assistance of Jamie Mignano) an internship at JAQUES Initiative, in March It wasn t until that time, some three years later (while at MCVET), I was able to meet Kelley in person. My internship duties was HIV testing and counseling at the Dental School. Kelley shared office space with my internship supervisor, Don Kirk. When a position for Treatment Coach opened in Kelley s department, Don suggested I apply for that position. Let me just say, I fought with Don tooth and nail about wanting to focus more on my studies than to work full-time. He finally convinced me to apply and it was the best thing to happen to me in a while. In July 2014, I was offered and accepted a contractual position of Outreach Worker I/ Treatment Coach. Soon after my hire, I began facilitating the JI substance abuse group, later repurposed and renamed as The What Now Addictions and Support Group to address all types of addictions. I have also participated in the Living Well sessions, which are an experiential portion of the Preparing the Future program for professional students. I left the JACQUES Initiative Treatment Adherence Center in July 2016 due to my hours being cut. It was a little unsettling that I had to inform Kelley that I had to leave but I held off leaving as long as I could. During that time Kelley and I spoke on occasions about the disappointment we both felt about my unfortunate departure. We also had some discussions about me returning if the opportunity presented itself. And guess what? The opportunity presented itself. Although it was seven weeks later, I was brought back as a full-time State employee. It is comforting to know that the University of Maryland and the JACQUES Initiative believes in giving second chances. I am continuously learning about barriers to adherence, medications and empowering clients. I recently graduated from Baltimore City Community College and started this fall semester at University of Baltimore. Thus far, it has been a pleasure working under the guidance of Kelley Stewart, Lisa Langer and my colleagues at the JACQUES Initiative Treatment Adherence Center. 5

6 Staff Highlight Rhonda Carr Community Outreach Worker My role as a Community Outreach Worker has allowed me to go into the places healthcare providers could not traditionally reach. I am able to reach people who are living with HIV who are out of care, newly diagnosed and who are at high risk for becoming HIV positive with information and education that they would not normally seek or even know existed. My own experiences as someone who happens to be a Transgender woman and native of West Baltimore who has lost a number of close friends to HIV has enabled me to approach this work with empathy and understanding. I was inspired to work in this field when I reflected on my life and how many loved ones died because of lack of knowledge. I vowed to help my community take advantage of all the resources available for them. Robert C. Gallo, MD and Rhonda Carr Before involving myself with this work, I was clueless of my future. I was a sex worker for years, and even still I knew there was more purpose to my life. Throughout this period, I lost many friends to HIV. It was not because the help for my community was lacking, it was because the community had no one to look up to for help. Medical mistrust killed my community. My community was looking for someone who looked like them and shared some of their experiences and could provide care without judgment of choices that they have made. To now be the person my community can trust and to help them seek the resources that they need to live a healthier life is something that is very dear to me. My reputation within the community helps me in many ways to encounter people who have medical mistrust issues. I am able to take them by the hand and to ensure them I am on your side. It s such a pleasure to see how many of my friends and associates are now educated on the U=U campaign (Undetectable = Untransmittable), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). I have witnessed seeing people rise from feeling that they cannot go on to smiling and living life with so much power. One of the most memorable moments I have had since starting in my role at the JACQUES Initiative, was with a client that we encountered at a local pharmacy for community rapid screening. As a result of the test she discovered that she was HIV positive. Her reaction was that she was going to die and worry of what her children would think. Fortunately, I was there with another co-worker to sit with her to hold her hand, accompany her to get a confirmatory test and link her to care. I am so glad that we were there to help her in her time of need. Now today she is in care with a positive attitude and also educating others on HIV. This is only one example of why community outreach workers are needed. Now that the JACQUES Initiative Journey Center is open, we can impact the community in many new ways and I for one am so excited to empower my community with different resources and events in this space. Community members are able to build skills on whatever they need to live well from computer literacy, resume building and food resources. The JACQUES Initiative program continues to be a bridge from the community to a life of wellness, with love and care. 6

7 Journey Center Our Vision: The JACQUES Initiative (JI) Journey Center, a program of the Institute of Human Virology (IHV) at the University of Maryland School of Medicine, aims to be an internationally recognized community-based venue where individuals gather in fellowship to be the greatest expression of themselves ultimately promoting wellness, health equity, inclusiveness, and social justice. Well positioned as IHV s JACQUES Initiative headquarters, our Journey Center seeks to intentionally integrate wellness and prevention into our community engagement model to address the local HIV and Hepatitis C virus (HCV) epidemics. Data July 2017 to June persons identifed with chronic Hepatitis C 80 persons navigated to HIV prevention (PrEP & PEP) 81% persons successfully navigated to PrEP by JI staff 10,874 people tested for HIV 3,402 people tested for Hep C 9,520 number of servicelearning hours peformed by UMB students Mission: Provide comprehensive HIV & HCV prevention services through a holistic approach to community members in need Staff: 2 Program Managers, 2 Program Specialists, and 8 Community Health Workers Our HIV and HCV Prevention Toolkit has Expanded: We are currently in a new era in HIV Prevention and Hepatitis C treatment, with the availability of new programs and medications that can help our community stay healthy. Science has empowered us with medications that prevent HIV and cure Hepatitis C. We also know that when someone who is HIV positive is successfully treated for HIV, they will not spread the disease sexually. Persons at risk or living with HIV and Hepatitis C now need to be empowered with this knowledge and engaged in services. A Holistic Model: The JI Prevention Team works to engage community members and create personalized care plans according to the member s needs, not only those needs that are disease specific. In line with this holistic approach, JI staff recruit community members from clinical and community settings in order to engage them in program services, focusing on improving health outcomes. JI focuses on key populations to include sexual and gender minorities, youth ages and African-Americans. Strategies: Interventions include personalized care plans, community engagement and the development of infrastructure in healthcare settings to address gaps in the HIV and HCV continuums of care. Interventions are carried out through peer navigation; linkage to pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP); health education and risk reduction; non-medical case management; screening for HIV, HCV and sexually transmitted infections (STIs); social networking & community engagement; capacity building with future and current clinicians and service providers. Key Partners: State of Maryland-Department of Health s Prevention & Promotion Administration, Baltimore City Health Department, ViiV ACCELERATE!, University of Maryland, Baltimore, University of Maryland Medical Center-Downtown & Midtown Campuses, University of Maryland AIDS Education and Training Center, University of Maryland Center of Addiction Medicine Funding: Ryan White Part A EIS, Ryan White Part B EIS and MAI Outreach, CDC (Project IMPACT), CDC (HIV Prevention), ViiV ACCELERATE! Testing As A Bridge 7

8 Linkage to Care Center Our Vision: The JACQUES Initiative (JI) Linkage to Care Center, a program of the Institute of Human Virology (IHV) at the University of Maryland School of Medicine, envisions a Baltimore where 90% of People Living With HIV/AIDS (PLWH) are retained in ongoing HIV care and 80% of PLWH are virally suppressed. Data July 1, 2017 to June 30, 2018 Linkage to Care Plus (LTC+) 55% virally suppressed 645 Total Number PLWH seen by the LTC team 73% New HIV diagnoses linked to care within 30 days 65% out of care clients re-linked to care within 90 days Mission: The Linkage to Care Center (LTCC) provides patient navigation to persons living with HIV who are hospitalized. For patients with additional medical and psychosocial needs, intensive short-term case management (90 days) is provided to facilitate transition to the community and outpatient setting through the Linkage to Care Plus (LTC+) program. Staff: 1 Nurse Coordinator, 1 Nurse Advisor, 2 Linkage to Care Navigators, 2 Community Health Workers, and 1 Administrative Assistant Rationale: Poor engagement in HIV care is associated with morbidity, mortality, increased hospitalizations and readmissions and transmission of HIV. Hospitalization is a touch point where intervention can occur to improve gaps in the HIV continuum of care. Strategies: The LTC Center draws upon smart screening algorithms that promote routine HIV testing and linkage to care at UMMC s Downtown and Midtown Campuses. This infrastructure prompts the LTC team when there is a PLWH in the hospital through in-basket notifications. The LTC team assesses hospitalized PLWH and builds a patient-centered intervention for each individual including linkage to HIV care, re-linkage to HIV after a gap in care, health literacy and advocacy, peer support, case management and care coordination. Key Partners: University of Maryland Medical Center, University of Maryland Midtown Campus, University of Maryland Center for Infectious Disease, a partnership with IHV, Project PLASE, Health Care for the Homeless, Empowering Minds, New Vision, HopeSprings, and doctors with specialties including vision and dental Funding: Ryan White Part A Medical Case Management, Mental Health; Ryan White Part B Home/Community-Based Care, Mental Health; HRSA Using Community Health Workers to Retain PLWH in Care, EIS (for linkage to care) The Linkage to Care team prepares to see a patient in the hospital 8

9 Treatment Adherence Center Our Vision: The JACQUES Initiative (JI) Treatment Adherence Center, a program of the Institute of Human Virology (IHV) at the University of Maryland School of Medicine, envisions Baltimore s most vulnerable persons living with HIV achieving 80% viral suppression. Data July 1, 2017 to June 30, new referrals to the TAC 392 Clients enrolled in the TAC 83% TAC clients are Virally Suppressed Mission: The Treatment Adherence Center s (TAC) holistic care mission is to enable HIV+ clients to achieve timely viral load suppression and immune reconstitution and to build an empowered mental and behavioral foundation for a lifetime of wellness. Staff: 1 Program Specialist, 1 Corrections Counseling Associate, 4 Treatment Coaches, and1 Community Outreach Worker Rationale: Poor adherence to Antiretroviral Therapy is associated with morbidity and mortality. Highly supportive peer support and regular interactions with a team of skilled staff provides comradery, emotional support and an early warning system for falling out of care and potential treatment failure. Strategies: Through consultation with primary providers, key stakeholders (i.e. Maryland Department of Public Safety and Correctional Services, Baltimore City Health Department, etc.) and patient interviews, barriers to adherence are thoroughly identified, targeted by priority, and an integrated approach to a resolution will be achieved. A variety of educational tools, treatment modalities, and adherence support services are tailored to the specific needs of each patient to ensure success on their journey to wellness. Key Partners: Maryland Department of Health (MDH), BCHD, DPSCS, Wexford Health, Heaven s Kitchen, Moveable Feast, Project PLASE, University of Maryland Center of Infectious Diseases (CID) IHV Medical and Clinical Staff Funding: Ryan White Part A MAI Outreach, MAI Medical Transportation, Ryan White Part B: Health Education Risk Reduction, Psychosocial 30 clients referred from corrections system for linkage to care 117 PLWH enrolled in Support Groups Treatment Adherence Center staff: Dawn Snowden, Kelley Stewart, David Callahan, Kathy Bennett, Curtis Mitchell and Nicole Edwards 9

10 Preparing the Future (PTF) Educational Program A collaboration between the Institute of Human Virology s AIDS Education and Training Center, the JACQUES Initiative and the six professional schools at the University of Maryland Baltimore: School of Medicine, School of Nursing, School of Dentistry, School of Pharmacy, School of Social Work, and the Francis K. Cary School of Law The PTF program prepares students to work together to improve patient outcomes and reduce health disparities related to the human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Interprofessional education provides classroom and hands on curriculum specifically for health & human service professionals and will help participants incorporate key goals of the National Priorities for HIV and the Viral Hepatitis Action Plan into future practice. Through an advisory committee of content experts and UMB faculty from each discipline, the learning curriculum is updated on an ongoing basis to assure content is current and relevant. In addition to participating in the advisory committee, JI coordinates community outreach experiences for the students who participate in the program. Outreach experiences include HIV and HCV testing, neighborhood canvasing for health education, and interactions with clients who receive services from the JI program. PTF offers didactic and experiential interprofessional learning, which is a transformative experience, that extends beyond HIV and Hepatitis C to give students a deeper dive into concepts of cultural competence, social justice, race, and health disparities. In Spring 2018, we implemented a new course component on trauma-informed care, which was so well received that we incorporated the content into all future course offerings. We provide a menu of options allowing all students to have access to HIV information through an interprofessional approach, as well as a clinical pathway for those students interested in HIV as a specialty. PTF by the Numbers In the academic year, we educated 588 students through 20 different course offerings! PTF Advisory Committee Trauma Informed Care Expert Kathleen Connors, MSW University of Maryland School of Medicine Program Director Pharmacy Neha Pandit, PharmD, AAHIVP, BCPS Associate Professor Infectious Diseases/Pharmacotherapy Vice Chair for Research and Scholarship Department of Pharmacy Practice and Science University of Maryland School of Pharmacy Medicine Sarah Schmalzle, MD Assistant Professor of Medicine, Division of Infectious Diseases Assistant Program Director, Infectious Disease Fellowship Medical Director, Center for Infectious Diseases Institute of Human Virology, University of Maryland School of Medicine Nursing Marik Moen, PhD, MSN, MPH, RN University of Maryland, Baltimore Clinical Instructor Nursing/AETC Hazel Jones-Parker, DNP, RN University of Maryland, Baltimore Nurse Educator Outreach/Service Learning Alexandra Reitz, BS University of Maryland, Baltimore Academic Coordinator Executive Director, JACQUES INITATIVE Jamie Mignano, PhD, MSN, MPH, RN Institute of Human Virology, University of Maryland School of Medicine Dental Sharon Varlotta, RDH Clinical Assistant Professor University of Maryland School of Dentistry Administrative Support/ AETC Director Abby Plusen, MSSW Director of Education Institute of Human Virology, University of Maryland School of Medicine Law Sara Gold Clinical Law Instructor University of Maryland, Baltimore Clinical Law Instructor Social Work Susan Westgate, MSW University of Maryland, Baltimore Non-Adjunct Faculty Consultant Jasmin Haley, RDH, BSDH, CDA Founder and CEO, Beyond The Prophy, LLC 10

11 Preparing the Future In the Words of the Students I learned a lot and it was a really interesting and fun experience. The interdisciplinary nature was what made this course so excellent. I gained a real appreciation for what all the different specialties bring to the table with the common objective of bettering the patient s health. I also improved my knowledge of HIV-specific medicine and routine care for patients with this disease. I just want to commend you on including the LGBTQ Cultural Competence presentation in your class. I have just realized today that although we are all in social work not all of us are respectful and aware of this population. I really hope there could be a push for the classes to be more inclusive of all marginalized groups that are important and not just the ones that each professor holds dear to them. I loved this experience. I feel like I got more out of having experiential learning and working with other professions than I have gotten out of any of my classes here at UMB so far. I m extremely grateful to have had this opportunity. It was one of the best experiences I have had so far in my schooling. It made me a much better counselor and more confident talking with patients from different backgrounds. As a result of PTF, I will be more willing to ask for input from other professions and try to understand their points of view when we have different plans. I definitely see the value in having different professions working together and have developed a deeper understanding of how we can all work together. 11

12 the JACQUES initiative initiative Changing Lives, Engaging Communities, Supporting Health Systems Journey Center 880 Park Ave., Suite 300 Baltimore, MD Linkage to Care Center 725 W. Lombard St., Suite S502 Baltimore, MD Treatment Adherence Center 300 Armory Place, Suite D Baltimore, MD Mailing address: 880 Park Ave., Suite 300 Baltimore, MD The JACQUES Initiative is a program of the Institute of Human Virology at the University of Maryland School of Medicine