EARLY INTERVENTION SERVICES I. DEFINITION OF SERVICE Support of Early Intervention Services (EIS) that include identification of individuals at points of entry and access to services and provision of: 1. HIV Testing and Targeted counseling 2. Referral services 3. Linkage to care 4. Health education and literacy training that enable clients to navigate the HIV system of care All four components must be present, but Part A funds to be used for HIV testing only as necessary to supplement, not supplant, existing funding. II. DESCRIPTION OF SERVICE SERVICE Early Intervention Services (EIS) includes the 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 enables clients to navigate the HIV system of care All four components to be present in program, 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 MONITORING STANDARD 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 HIV 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 point of entry not included in original scope of work LIMITATIONS Part A funds used for HIV testing only as necessary to supplement, not supplant, existing funding Collaborative Research, LLC Updated March 2013 1 P age
III. EIS SERVICE COMPONENTS Program Outcomes: Clients made aware of HIV status Clients referred to risk reduction services (HIV+ and HIV-) Indicator: Number of clients located and identified as at high risk for HIV Number of clients tested for HIV Number of clients informed of results of HIV test Number of clients referred to risk reduction services and/or HIV medical care Number of HIV+ clients referred to Medical Case Management and Ambulatory Outpatient Medical Care for treatment of HIV. o Time from referral until medical care entry Number of identified barriers preventing or delaying entry into Ambulatory Outpatient Medical Care Number of resolved barriers that prevented entry into Ambulatory Outpatient Medical Care Retention in Ambulatory Outpatient Medical Care defined as receipt of initial viral load and attendance at 3 AOMC visits Service Unit(s): Clients made aware of HIV status EIS Plan to link client to care is documented Successful entry of HIV+ clients into ambulatory outpatient medical care for HIV treatment Performance Measure (Scope of Work): #1: Number of HIV tests administered by EIS staff #2: Number or Percentage of clients testing positive for HIV for HIV tests administered by EIS Staff #3: Number of clients testing negative for HIV that receive counseling on risk reduction and/or are referred to services to reduce risk #4: Number or percentage of clients testing HIV positive referred to ambulatory outpatient medical care for treatment of HIV #4b: Existence of EIS Plan to link clients testing HIV positive to ambulatory outpatient medical care for treatment of HIV #5: Number of clients testing positive for HIV that are successfully linked to ambulatory outpatient medical care (at least 3 visits) #6: Number of clients testing HIV positive successfully retained in AOMC (track at 3, 6, 9 and 12 months post-entry) #7: Number of clients (HIV positive or negative) with documented health literacy assessment Collaborative Research, LLC Updated March 2013 2 P age
Standard Measure Narrative Fraction 1. US (Unaware Specialist) will locate and identify persons at high risk for HIV in community settings, such as homeless shelters, substance abuse treatment facilities, emergency rooms and other location. Review of EIS client files with focus on roster of persons identified with outreach setting, HIV counseling & testing, seropositivity and referrals. # of High Risk Clients Identified # of Estimated High Risk Clients 2. US (Unaware Specialist) will work with HIV testing sources (traditional and non-traditional) to modify process for informing those tested of result, services required and impact in a manner that is most confidential, respectful and yet moves newly diagnosed into service(s). Review of EIS client files. Detail by demographic/ risk factors of individuals and results of test, process for informing. 1) # of HIV tests by EIS staff 2) # of HIV counseling upon testing 3) # of HIV+ tests 3. US (Unaware Specialist) will work with HIV testing sources (traditional and non-traditional) to refer newly diagnosed HIV positive clients to HIV medical care and high risk but HIV negative individuals to needed services to reduce risk for HIV. 4. US (Unaware Specialist) will link clients with HIV primary care and medical case management, offer appointment reminders, accompany clients on health care and case management appointments, help clients understand HIV disease, treatment options and risk reduction behavior, and provide emotional support. 5. Primary care outreach workers will help clients overcome the barriers that prevent them from accessing care on a regular basis and refer clients to appropriate support services including evaluation of HEALTH LITERACY. 6 Primary care outreach workers will follow-up with clients and referral agencies regarding retention in care (attachment) at 3, 6 and 9 month intervals post-linkage Review of EIS client files Detail by location of HIV test, services that were referred and location and demographic/ risk factors of individuals Review of client files or roster of persons identified documenting specific activities related to engaging in HIV medical care. Review of client files or, roster of persons identified with documentation of linkage to support or other services aimed at reducing barriers to care entry or re-entry. 100% of sampled client files document referrals and follow-up on all referrals 1) # of individuals referred to services that are HIV+ 2) # of individuals referred to services that are not HIV+. 3) Documented EIS Plan to link HIV+ clients to HIV medical care # of Clients linked to Care* Total # of Clients Referred * Linked = validate attendance at HIV medical care with CD4/Viral Load confirmation Time from HIV diagnosis to entry HIV medical # of Clients with identified barriers Total # of EIS clients # Clients with identified barriers resolved thru referral Total # of EIS clients # Clients evaluated for Health Literacy Total # of EIS Clients # of Client identified, referred, with case findings Total # of EIS Clients Collaborative Research, LLC Updated March 2013 3 P age
GOALS OF THE NATIONAL HIV/AIDS STRATEGY NEW HAVEN EMA MEASURES DATA SOURCE 1 1 Reducing New HIV infections a By 2015, lower the annual number of new infections by 25% (from 56,300 to 42,225). # of new HIV infections in EMA CT DOH Epidemiology DATA SOURCE 2 US/EIS STAFF CHART AUDITS FOR PRIOR YEAR SOC by SERVICE EIS b Reduce the HIV transmission rate, which is a measure of annual transmissions in relation to the number of people living with HIV, by 30% (from 5 persons infected per 100 people with HIV to 3.5 persons infected per 100 people with HIV). # newly diagnosed in EMA # PLWHA in EMA Numerator: 1a Denominator: CT DOH Epidemiology EIS c By 2015, increase from 79% to 90% the percentage of people living with HIV who know their serostatus (from 948,000 to 1,080,000 people). # aware of HIV status Total population in EMA EIS 2 Increasing Access to Care and Improving Health Outcomes for People Living with HIV NEW HAVEN EMA MEASURES DATA SOURCE 1 SOC by SERVICE a By 2015, increase the proportion of newly diagnosed patients linked to clinical care within three months of their HIV diagnosis from 65% to 85% (from 26,824 to 35,078 people). # Newly diagnosed in EMA in HIV Medical care within 3 months of referral Total # of Newly Diagnosed in EMA Numerator: Chart Audits (2011) Denominator: 1a. EIS & AOMC IV. DATA REPORTING Part A service providers are responsible for documenting and keeping accurate records of Ryan White Program Data/Client information, units of service, and client health outcomes. Reporting units of service are a component of each agency s approved work plan. Please refer to the most current work plan, including any amendments, for guidance regarding units of service. Summaries of service statistics by priority will be made available to the Planning Council by the Grantee for priority setting, resource allocation and evaluation purposes. The Chart Audit Tool for Early Intervention Services is attached on the next page Collaborative Research, LLC Updated March 2013 4 P age
(EIS) Standard of Care Early Intervention Services New Haven-Fairfield Counties Ryan White Part A HIV Chart Review: Early Intervention Services PROGRAM SITE: CHART #s: REVIEWER(S): REVIEW DATE: STRUCTURE ( Who ) 1 2 3 4 5 6 7 8 9 10 1 EIS Staff Meet criteria for EIS or Unaware Specialist Qualifications EIS Staff Orientation & Training 2 10 hours of HIV-specific training per year for staff serving RW clients? Document quarterly face-to-face meeting of EIS Staff with PS to hand off patients, document collaboration 3 Recordkeeping Requirements Chart is properly stored & secure; chart is clearly organized; entries legible 4 Letters of Collaboration with other HIV Prevention & Testing providers 5 MOUs with key points of entry into care to facilitate access to care PROCESS ( How ) IDENTIFY 1 2 3 4 5 6 7 8 9 10 Process to Identify Individuals at High Risk of Being HIV+ 6 Process documented to identify and locate individuals at risk of HIV+ (detail of client demographics (race/ethnicity, zip code, gender, risk) 7 HIV Testing by EIS Staff Number of HIV tests administered with detail by demographics, risk group INFORM 1 2 3 4 5 6 7 8 9 10 Results of HIV Tests (obtain data from CT DPH) 8 HIV+ tests Total # of tested (detail by demographics, risk) REFER 1 2 3 4 5 6 7 8 9 10 Referrals to Ambulatory Outpatient Medical Care if HIV+ 9 # & detail (client) referred to AOMC (date, AOMC provider documented) Total HIV+ clients identified 10 Referrals to Other Services (HIV+) including OTL* clarify services HIGH RISK HIV+ for prevention services, list services HIV+ Clients referred to other services (detail by Service, provider, reason) Total # of HIV+ Clients 11 Referrals to Services to Reduce Risk (HIV-) including OTL HIV- Clients referred to other services (detail by Service, provider, reason) Total # of HIV- Clients OUTCOME ( What ) LINK 1 2 3 4 5 6 7 8 9 10 HIV+ Clients Linked to Care (validate AOMC by first Viral Load test result) 12 HIV+ Clients with first Viral Load documented at AOMC provider Total # of HIV+ Clients Referred to Care SPECIFY TIMEFRAME? Suggested: 1 month to be linked to care, 6 months to transition EIS to MCM 13 Timeliness of AOMC Care Entry (detail by Special Population) Time elapsed from HIV+ diagnosis to first Viral Load (suggested 1 month) * OTL Outreach, Testing & Linkage Collaborative Research, LLC Updated March 2013 5 P age
(EIS) Standard of Care Early Intervention Services BARRIER IDENTIFICATION & RESOLUTION (detail next page) 1 2 3 4 5 6 7 8 9 10 14 Barrier Identification Documentation that barriers to care entry and/or retention are assessed 15 Barrier Resolution Documentation that barriers to care entry and/or retention are resolved 16 Health Literacy Evaluation Documentation that health literacy is evaluated HIV MEDICAL CARE RETENTION 1 2 3 4 5 6 7 8 9 10 HIV Medical Care Retention Documentation that HIV+ client is retained in 17 AOMC at 3, 6 and 9 months post-linkage LISTING OF POSSIBLE INVENTORY OF IDENTIFICATION IDENTIFICATION MEANS 18 ID High Risk of HIV+ 1 2 3 4 5 6 7 8 9 A B C D E F G H I J K L ID OF HIGH RISK OF HIV-Positive Partner Notification (integrate with DIS) STD inclusive Diagnosis in Emergency Department Diagnosis while Pregnant Diagnosis while Inpatient for other reason Street Outreach Targeted Outreach to Special Populations (list) Through CT HIV Counseling & Testing site (list) At CT Department of Health Through general Health Fair Insurance Physical (list what kind) Blood or Plasma donation (list when, where) Specialty Care provider BARRIER IDENTIFICATION & RESOLUTION 19 Barrier Identification A B C D E F G H I J K L Barrier inventory LISTING OF POSSIBLE INVENTORY OF BARRIER Identification of possible barriers to AOMC entry and/or retention Homeless Recently or serially incarcerated Monolingual Actively using Mental health issues Violent Physically disabled Stigmatized Issues with disclosure of status No transportation Health Literacy (complete #15) Other (please specify) 1 2 3 4 5 6 7 8 9 10 HEALTH LITERACY LISTING OF POSSIBLE ELEMENTS OF EVALUATION Collaborative Research, LLC Updated March 2013 1 2 3 4 5 HEALTH LITERACY 6 6 Page 7 8 9 10
(EIS) Standard of Care Early Intervention Services 20 Documentation that health literacy is evaluated: A B C D E F G H I Health Literacy - Aware of HIV status and meaning - Aware of HIV Labs and meaning - Aware of HIV transmission given status - Aware of HIV medicine & side effects, importance of taking meds on time and regularly - Aware of possible other medical complications from HIV - Aware of medical complications related to other diseases with HIV diagnosis - Aware of other risks (Hepatitis C is using) Aware of other medication complications (if on mental health or other physical health meds and HIV medicine) - Other (List) New addition Program Monitoring Standards HAB Measures Indicates National HIV/AIDS Strategy Goal Refers to Scope of Services Outcome Collaborative Research, LLC Updated March 2013 7 P age