Role of Patient Navigators in Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations

As part of the Med-HEART project, CAHPP staff conducted a series of interviews and focus groups with clinic and program staff from nine organizations nationwide to learn more about the role of patient navigators in building a medical home for people living with HIV who are homeless/unstably housed and co-diagnosed with substance use and/or mental health disorders. Results of this qualitative research will be published in the Journal of Public Health Management Practice and are available online ahead of print publication.

Researchers identified ten key responsibilities of patient navigators as part of the HIV care team that seeks to engage this population in care and treatment. The article concludes that patient navigators may be a key component in creating an effective patient-centered medical home for this population.

Article abstract on NCBI’s PubMed site

HIV treatment adherence, measuring severity of client needs, addressing inequities among children

Project implementation leads to better health for vulnerable populations

Implementation.

Every team has been there-you have a goal and have put together a plan to achieve it. But there’s a nagging voice whispering, “Are we missing anything? Is there a better way of doing this? Are there tools out there I can use?” Implementing a project–putting it into effect–is made up of many small decisions which together can spell success or failure. Our team at the Center for Advancing Health Policy and Practice (CAHPP) at Boston University School of Public Health collaborates with organizations to build and strengthen their structural capacity, operate more effective and efficient clinical programs, and improve health care access and service delivery. We have years of experience helping local health departments, community health centers, primary care clinics, community-based organizations, and social services provider agencies implement successful projects that improve the health and well-being of the people they serve.

Our Winter 2017 email newsletter presents three examples from the past and present.

Symposium: Reducing Health Inequities – Advancing Meaningful Change

Symposium: Reducing Health Inequities – Advancing Meaningful Change
Wednesday, February 1, 2017

9 a.m. to 4:30 p.m. ET
Boston University Medical Campus Instructional Building
72 East Concord Street (Hiebert Lounge)
Boston, MA
Live streaming available during event

Sandro Galea, Dean and Robert A. Knox Professor, Boston University School of Public, and Sara Bachman, Interim Director, Center for Innovation in Social Work and Health, Boston University School of Social Work and Director of CAHPP, will host this day-long symposium. Through presentations and panel discussions, speakers from academic institutions, government agencies, and health care organizations will explore why interventions are often insufficient and how public health can take a leadership role in mitigating social determinants of health including race, class, disability, and gender.

Learn more and register

Our commitment to advancing the health and well-being of vulnerable populations

Dear Friends and Colleagues,

As we move into a new presidential term, there is some uncertainty about the future direction of health policy and its implications for vulnerable populations. The Center for Advancing Health Policy and Practice (CAHPP) remains committed to excellence in our role as providers of non-partisan evidence-based analysis, technical assistance, and applied research support to all policymakers and stakeholders as we strive to improve the health care system in the United States.

The team at CAHPP is ready to provide you with guidance about a range of policies and practices, such as:

  • Health insurance and financing for children and youth with special health care needs;
  • Medicaid policy changes, especially as they relate to Medicaid expansion and future financing mechanisms, such as Medicaid block grants;
  • Implementing and evaluating programs that promote the health and well-being of people living with HIV including peer, patient navigation, community health worker, opioid treatment, and jail-based interventions; and
  • Policy changes as they relate to people who face challenges of homelessness, substance use, and/or mental health disorders.

We pledge to continue working in partnership with you to promote access to high-quality, life-extending care, free from stigma and discrimination for every person regardless of age, race/ethnicity, sexual orientation, gender identity, or socioeconomic status. Please reach out to us with your questions; we are here to help.

Sincerely,

The CAHPP team at BUSPH

Nov. 9 Webinar: Beyond Checklists – Care Planning for Children with Special Health Care Needs

Lucile Packard Foundation for Children's Health, Catalyst Center, and Family Voices.

Webinar: Coordinating Care for Children in Families with Complex Social and Health Needs-Research and Practice Date: Wednesday, November 9, 2016 Time: 10 to 11 a.m. PT / 1 to 2 p.m. ET

Webinar slides and recording available on the Lucile Packard Foundation for Children’s Health blog post: Webinar Describes Care Planning Process for Children with Special Health Care Needs

What does it take to create and implement an effective, family-centered plan of care for a child with special health care needs? Our expert speakers will discuss their approaches to the process of care planning in two very different settings-Children’s Hospital of Philadelphia and a small private practice in Vermont.

Our moderator is the author of Achieving a Shared Plan of Care with Children and Youth with Special Health Care Needs, a report that describes the key content of a comprehensive and integrated care plan, and lists the steps necessary to create one. To make the most effective use of the webinar time, we suggest that registrants read the report in advance of the webinar.

Speakers

Annique K. Hogan.Annique K. Hogan, MD, graduated from the University of Toledo College of Medicine and Life Sciences and completed her Residency in Pediatrics at the Children’s Hospital of Philadelphia (CHOP). Her work focuses on the care of children with medical complexity and improving transitions of care between the inpatient and outpatient settings. She is the Medical Director of the CHOP Compass Care program and the Integrated Care Service, both serving the needs of medically complex and fragile children. Taking a patient and family-centered approach, she will discuss the process of developing care plans in a manner that promotes shared decision-making, patient and family engagement, and optimal communication.

Jill S. Rinehart.Jill S. Rinehart, MD, FAAP, is a partner in a small private pediatric practice in Burlington, Vermont, and Clinical Associate Professor of Pediatrics at the University of Vermont College of Medicine. She has worked both locally and nationally to advance the practice of care coordination and medical home transformation. She is lead faculty for Vermont’s Pediatric Care Coordination Learning Collaborative, helping practices throughout the state unify their efforts to help care for children with special health care needs. Dr. Rinehart will discuss techniques for achieving shared plans of care with families, including care mapping, care conferencing, and problem-solving conversation strategies.

Moderator

Jeanne W. McAllister.Jeanne W. McAllister, BSN, MS, MHA, is an Associate Research Professor of Pediatrics at Indiana University School of Medicine, Children’s Health Services Research Division. As co-founder and former director of New Hampshire’s Center for Medical Home Improvement, she brings more than 30 years of health care experience to the arena of health care improvement, education, and research.

This webinar is the third in our series on care coordination, and builds on the work that began with the Lucile Packard Foundation for Children’s Health’s 2015 national symposium, “Designing Systems That Work for Children with Complex Health Care Needs.” This webinar will build on the previous webinars in this series, Take Action on Care Coordination and Research and Practice Perspectives-Coordinating Care for Children with Social Complexity.

Webinar slides and recording available on the Lucile Packard Foundation for Children’s Health blog post: Webinar Describes Care Planning Process for Children with Special Health Care Needs


The Catalyst Center, the National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs, is a project of the Center for Advancing Health Policy and Practice at Boston University School of Public Health.

CAHPP presentations from Ryan White conference now available

From August 23 – 26, CAHPP staff and partners participated in the 2016 National Ryan White Conference on HIV Care & Treatment in Washington DC. Program recipients such as direct HIV care providers and others involved in HIV care and treatment came together to learn the latest advances in HIV care. Presentation slides from three projects are now available on the CAHPP website:

Evaluating innovative models of care that link people who are homeless and living with HIV to care

The Medical Home-HIV Evaluation & Resource Team (Med-HEART) serves as the evaluation center for the Special Project of National Significance (SPNS) Initiative Building a Medical Home for Multiply Diagnosed HIV Homeless Populations. The Med-HEART team is currently evaluating models of care that link HIV-positive individuals who face challenges of homelessness and mental health or substance use issues with needed services and resources. CAHPP staff, together with partner Boston Health Care for the Homeless Program and nine HIV provider demonstration sites nationwide, presented the initiative’s work through several events:

    • Ryan White Conference Homeless Institute
      This institute consisted of three 90-minute workshops:

      Ryan White Conference 2016.
      Photo collage thanks to Amelia Broadnax.

      1. Homeless Institute 101: Providing care to people who are homeless/unstably housed: Barriers and facilitators to achieving the National HIV/AIDS Strategy goals (Thur Aug. 25 3:30 – 5:00 pm ET, Session ID: 6424)

      2. Homeless Institute 201: Using interdisciplinary teams to provide care to people living with HIV/AIDS who are homeless/unstably housed (Fri Aug. 26 8:00 – 9:30 am ET, Session ID: 6425)

      3. Homeless Institute 301: Leveraging resources to sustain programs for HIV care and housing for people living with HIV (Fri Aug. 26 10:00 – 11:30 am ET, Session ID: 6426)

    • Presentation: Everybody loves a good story: Using digital media to capture & share patient stories (Wed Aug. 24 10:30 am – 12:00 pm ET, Session ID: 6529)

 

Moving research findings into practice to improve health outcomes along the HIV Care Continuum

The Dissemination and Evaluation Center will adapt and replicate adaptations of four past HRSA HIV interventions, design a multisite evaluation plan focused on implementation science, and disseminate successful practices to the field. Staff from CAHPP and partner AIDS United shared initiative results to date in a presentation entitled Moving Research Findings into Ryan White Practice: Adapting to the Real World (Fri Aug. 26 8:00 – 9:30 am ET, Session ID: 6157)

MAI Results from a randomized control trial evaluating a peer enhanced navigation intervention

The Minority AIDS Initiative Retention and Re-Engagement in HIV Care Project, completed in 2014, focused on providing better access to resources, housing and proper care for racial/ethnic minority communities where the HIV/AIDS epidemic continues to grow. CAHPP staff evaluated the effectiveness of a peer-enhanced intervention at three clinic locations and presented their findings in a presentation titled Implementing and evaluating a peer-enhanced navigation intervention: Results from a randomized control trial (Wed Aug. 24 3:30 – 5:00 pm ET, Session ID: 5942). Staff from partner Brooklyn PATH Center presented about their experience implementing the intervention and incorporating it into their clinic practice.

About the Ryan White Conference

The 2016 National Ryan White Conference on HIV Care & Treatment is the premiere event for comprehensive HIV care and treatment, attended by Ryan White HIV/AIDS Program recipients, people living with HIV, stakeholders, and health care and service delivery providers. The conference is sponsored and funded by Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB).

CAHPP awarded $6 million project using community health workers

The Center for Advancing Health Policy and Practice (CAHPP) at the School of Public Health has received a $6 million grant to improve HIV care by increasing the integration of specially trained community health workers. Sara Bachman, director of CAHPP, is the principal investigator on the three-year cooperative agreement with the Health Resources & Services Administration (HRSA). The project will draw on the knowledge and experience of community health workers to improve access to, and retention in, healthcare for people living with HIV.
Full announcement on BU School of Public Health website

Guiding organizations to expand access and improve retention in HIV Care: MDPH’s Strategic Peer-Enhanced Care and Retention Model

Massachusetts Department of Public Health SPECTRuM intervention manual.Although current medical treatments have improved health outcomes for many people living with HIV, engagement and retention in health care and adherence to antiretroviral treatment continues to be a challenge. In 2011, the Massachusetts Department of Public Health (MDHP), Bureau of Infectious Disease and Laboratory Sciences, undertook the Strategic Peer-Enhanced Care and Retention Model or SPECTRuM project. From its inception, CAHPP staff and consultants worked with the MDPH and its partner sites to develop and evaluate two interventions that work together to enhance prompt linkage to care, intensively support retention in care, and improve adherence to prescribed treatments. CAHPP documented these efforts and worked with the MDPH team and clinic staff to create an implementation manual that describes the service approaches and lessons learned from the initiative, including many of the assessment tools and direct care resources used.

“This was a true partnership from the first grantee meeting,” recalls Sophie Lewis, Service Planning Manager, Office of Health Care Planning, Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health. “The BU staff’s breadth of experience around the peer component and knowledge of evaluation helped inform the development of both the peer-nurse component and the data evaluation. The impact of this project has been significant. We are looking at different mechanisms to improve linkage to care, using surveillance data much more effectively and efficiently, and developing closer partnerships with health centers and community-based organizations, all as a result of SPECTRuM.”

“This was a true partnership from the first grantee meeting. We are looking at different mechanisms to improve linkage to care, using surveillance data much more effectively and efficiently, and developing closer partnerships with health centers and community-based organizations, all as a result of SPECTRuM.”

MDPH staff will bring copies of the intervention manual to the Ryan White conference next month, where they will present their work on SPECTRuM to other HIV health care and service delivery providers in a workshop.

View SPECTRuM project

CAHPP staff to present innovations in HIV care at Ryan White Conference in August

From August 23 – 26, Ryan White HIV/AIDS Program recipients such as direct HIV care providers and others involved in the HIV care and treatment will get together to learn the latest advancements in HIV care and treatment at the 2016 National Ryan White Conference on HIV Care & Treatment in Washington DC. CAHPP staff Jane Fox and Serena Rajabiun will participate and present work on three projects.

Evaluating innovative models of care that link people who are homeless and living with HIV to care

 

The Medical Home-HIV Evaluation & Resource Team (Med-HEART) serves as the evaluation center for the Special Project of National Significance (SPNS) Initiative Building a Medical Home for Multiply Diagnosed HIV Homeless Populations. The Med-HEART team is currently evaluating models of care that link HIV-positive individuals who face challenges of homelessness and mental health or substance use issues with needed services and resources. CAHPP staff, together with partner Boston Health Care for the Homeless Program and nine HIV provider demonstration sites nationwide, will present the initiative’s work through several events:

  • An institute consisting of three 90-minute workshops:
    1. Homeless Institute 101: Providing care to people who are homeless/unstably housed: Barriers and facilitators to achieving the National HIV/AIDS Strategy goals
      (Thur Aug. 25 3:30 – 5:00 pm ET, Session ID: 6424)
    2. Homeless Institute 201: Using interdisciplinary teams to provide care to people living with HIV/AIDS who are homeless/unstably housed
      (Fri Aug. 26 8:00 – 9:30 am ET, Session ID: 6425)
    3. Homeless Institute 301: Leveraging resources to sustain programs for HIV care and housing for people living with HIV
      (Fri Aug. 26 10:00 – 11:30 am ET, Session ID: 6426)
  • Presentation: Everybody loves a good story: Using digital media to capture & share patient stories
    (Wed Aug. 24 10:30 am – 12:00 pm ET, Session ID: 6529)
  • Presentation: Understanding and addressing stigma to promote engagement in HIV care
    (Wed Aug. 24 3:30 am – 5:00 pm ET, Session ID: 6428).

Moving research findings into practice to improve health outcomes along the HIV Care Continuum

 

The Dissemination and Evaluation Center will adapt and replicate adaptations of four past HRSA HIV interventions, design a multisite evaluation plan focused on implementation science, and disseminate successful practices to the field. Staff from CAHPP and partner AIDS United will share initiative results to date in a presentation entitled Moving Research Findings into Ryan White Practice: Adapting to the Real World (Fri Aug. 26 8:00 – 9:30 am ET, Session ID: 6157)

MAI Results from a randomized control trial evaluating a peer enhanced navigation intervention

 

The Minority AIDS Initiative Retention and Re-Engagement in HIV Care Project, completed in 2014, focused on providing better access to resources, housing and proper care for racial/ethnic minority communities where the HIV/AIDS epidemic continues to grow. CAHPP staff evaluated the effectiveness of a peer-enhanced intervention at three clinic locations and will present their findings in a presentation titled Implementing and evaluating a peer-enhanced navigation intervention: Results from a randomized control trial (Wed Aug. 24 3:30 – 5:00 pm ET, Session ID: 5942). Staff from partner Brooklyn PATH Center will be presenting about their experience implementing the intervention and incorporating it into their clinic practice.

Session descriptions can be found by searching on session ID numbers in the Ryan White Conference Program Book. Select presentations will be available on the CAHPP website following the conference.

About the Ryan White Conference

The 2016 National Ryan White Conference on HIV Care & Treatment is the premiere event for comprehensive HIV care and treatment, attended by Ryan White HIV/AIDS Program recipients, people living with HIV, stakeholders, and health care and service delivery providers. The conference is sponsored and funded by Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB).

Award-winning poster: Does trauma-informed case management improve HIV outcomes among people who are homeless?

Congratulations to our partner Harris Health System of Houston, TX, whose poster Trauma Informed Care for HIV+ homeless patients tied for first place at the VITAL 2016 conference in Boston last month. Harris Health staff analyzed data collected as part of the Medical Home Evaluation and Resource Team (Med-HEART) project to explore the question: Can Trauma-Informed-Care-based case management improve health outcomes for HIV-positive patients who are homeless with mental health or substance use issues? The study showed that using a Trauma-Informed-Care approach to case management improved engagement in care rates by 87% and viral load suppression rates by 44% among 157 patients, results that suggest trauma-informed-care-based case management as a promising approach to improving management of HIV disease among homeless patients.

VITAL2016 is an annual conference held by America’s Essential Hospitals where health care leaders from across the country convene to discuss crucial issues that impact their patients and communities. A similar poster outlining this research earned Harris Health a first-place prize at the American Conference for the Treatment of HIV (ACTHIV) in Dallas, TX in April.

View Harris Health’s poster Trauma Informed Care for HIV+ homeless patients

Harris Health Poster.
Click to enlarge.