CDPH Ryan White Part A Early Intervention Services (EIS ...

1 CDPH Ryan White Part A Early Intervention Services (EIS) learning collaborative series Meeting #2 Tuesday, September 20, 2016 Agenda Welcome learning collaborative Structure & Requirements Recap EIS Service Category Refresher Quality Improvement Check-In: Where Your Agency Should Be Agency EIS Program PresentationsoAustin CBCoMount Sinai Root Cause Analysis as a QM/QI Tool Coaching Team Meeting & Discussion CloseGoals for Today s Meeting1) Gain a solid understanding of CDPH learning collaborative structure and )Obtain new ideas about EIS program best ) Understand root-cause analysis as a QM/QI )Identify concrete next steps in the QIP Mission and VisionPublic Health Institute of Metropolitan Chicago (PHIMC) enhances the capacity of public health and health care systems in Illinois to promote health equity and expand access to Services .

2 How We WorkPHIMC leads efforts to strengthen the public health infrastructure in Illinois through: Organizational Development System Transformation Fiscal Management Program ImplementationHow does PHIMC fit into Ryan White Part A? Technical assistance provider partnering with CDPH to implement Ryan White Quality Management (RW QM) across the Chicago EMA. Prior to March 2015, MATEC was lead on this project for 14 years. MATEC contracted primarily with Training Resources Network-Ms. Susan Thorner s consulting CDPH RWQM Program partnership between PHIMC and the Chicago Department of Public Health s Quality Management (QM) Unit to provide training, technical assistance, and capacity building support to Ryan White Part A funded agencies in an effort to maintain sustainable internal QM infrastructure across the Chicago is RWQM Implemented?

3 QM Site Visit Implementation learning Collaboratives Webinars Support core MATEC Trainings Generating QM Newsletter/Online QM Resources Participation in Community Planning Efforts, CAHISC and the MAG Updating CDPH Standards of Care Audit Tool Creation & Data Collection Sub-recipient and CAHISC member surveys Conflict Resolution Training & Grievance AccessPHIMC and CDPH collaborate on the following items:What is Quality Management (QM) Assurance (QA) or Quality Improvement (QI)? Quality Management: Allfunctions to evaluate and improve QM committee + QM plan + QM site visits from funder, etc. Quality Assurance: Checking Program Monitoring Site Visits Quality Improvement: Enhancing Increasing percentage of AOMC clients receiving STI screeningWhat is a learning collaborative ?

4 Model developed by the Institute for Healthcare Improvement (IHI) in 1994, later adopted by NQC & HRSA Since 2000, NY State Health Department has tested LC model with RW Parts A-D In 2008, NQC published LC guide for RW providers nationwide Implementing quality improvement & identifying best practices Designed for clinical is a CDPH Ryan White Part A learning collaborative (LC)? One Ryan White core service category selected based on CDPH Quality Management site visits from previous year. At least four LCs occur in given grant period (March 1st-Feb 28th). Agencies that received QM site visit in previous year are required to attend. Open to all CDPH RW Part A funded should attend an CDPH RW Part A LC? CDPH Ryan White Part A-funded agencies Designated members of RW quality improvement team ORagency staff implementing the service category in question For 2016 EIS focused series , this may include:-Member of RW QI team-Program Managers-EIS specialists -LTC staff-Anyone else instrumental in implementing EISWhat are the requirements for LC participants?

5 Register and attend four learning Collaboratives. Complete and present on one quality improvement project for your agency by January 25, 2017. Work with and report to assigned coach as to improve quality of designated RW program(s) at your agency!2016 Early Intervention Services (EIS) learning collaborative series : Structure Four provider meetings Best Practices Presentations from EIS Providers Quality Improvement Tips, Tricks, Trends Built in time to meet with coaches & teamAcknowledging the challenges with utilizing EIS in an LC format Brand new service category Limited data Standards of care do not include measurable indicators Intervention contains non-clinical/social componentsWhat We Know: The 4 Buckets of Early Intervention Services (EIS) HIV Counseling and Testing Linkage to Care Referrals Health LiteracyApplying the NHAS Indicators to EIS NHAS Indicator 4: Increase percentage of newly diagnosed person linked to HIV medical care within one month of their diagnosis to at least 85%.

6 NHAS Indicator 5: Increase the percentage of person with diagnosed HIV infection who are retained in HIV medical care to at least 90%.NHAS Indicator 6: Increase the percentage of persons with diagnosed HIV infection who are virally suppressed to at least 80%.Steps to selecting an EIS Quality Improvement ProjectStep 1: Select an NHAS 2: Select one of the buckets of 3: Identify small-scale 4: Conduct Improvement Projects: Where You Should BeStep 1: Select an NHAS 2: Select one of the buckets of 3: Identify small-scale 4: Conduct Plan, Do, Study, Act cycle(s), also known as PDSAsStep 4: Conduct PDSA(s)PDSAs are a small part of a larger quality improvement project. How do they fit into the larger project?Quality Improvement Projects: Where You Should BeQIP vs.

7 PDSAE xample QIP: Increase % of clients linked to PDSA: One peer navigator makes home visits for short period of is essential to illustrate where you are, where you want to go, and where you end questions about the Process?Ask your coach and your team!EIS Program PresentationsAustin CBC Cook County Health & Hospital Systems Community-Based OrgMount Sinai Hospital Hospital SystemAustin CBC InitiativeEarly Intervention Services (EIS) PROJECT SNAPSHOTS eptember 2016 EIS Team:EIS Coordinator: Chamille Johnson, CHES EIS Specialist: Lasheena Miller(2)Medical Case Manager (s): Cerese Depardieu, Lajanice Page(2) Peer Navigator (s)PROJECT FUNDED SCOPES HIV Testing and Counseling Referral Services Linkage to care and/or Re-engagement to care Health Education and Literacy TrainingSCOPES PROGRESS TO DATEA ctivityGoalUnduplicatedClientsUnitsof ServiceCounseling/Testing400265269 Health Education/ Literacy2825171 Referral Linkage to Care-Primary121414 Referral to Specialty Care281539 HIV Testing and Counseling Project Goals coincide with NHAS goals to increase the amount of individuals tested and aware of their HIV status.

8 HIV Testing and counseling conducted at CCHHS Austin Clinic onsite daily Weekly at Austin Community Area Food pantry. Testing conducted monthly at outreach activities and special community events Mobile testing w/partner Community Based Organization Association House HIV testing and counseling sessions Client is provided with personalized risk assessment SMART GOALS are discussed and client centered behavioral change set. Client is provided with demonstration as needed Condoms Clients who qualify for PrEPare referred to care and/or Re-engagement to care EIS specialist enrolls Ryan White eligible clients who are newly diagnosed or have been out of HIV care for 6+ months:1. EIS Linkage Coordinator will follow up with client regarding Confirmatory test result by scheduling appointment once results become available via Cerner.

9 2. EIS Linkage Coordinator or EIS Specialist will schedule follow up appointment in Cerner with an assigned clinician. 3. EIS Linkage Coordinator or EIS Specialist will refer client to Ryan White Medical Case Management onsite for case management Services , Program intake, and referrals to other supportive Services . 4. Client sees EIS Specialist, Peer Navigator or Linkage coordinator for counseling, and Health Education/Literacy Training. Client sees LCSW for Mental Health Screening. 5. Client receives EIS Services until deemed ready for case closure by EIS staff. Clients are referred for linkage through Outreach, Offsite/onsite HIV testing, Referrals from local CBO s, CCHHS, and CDPH STI AppointmentEIS Peer Navigator greets patient, provides guidance on how to navigate clinical Services , offers peer support, information on CAB, support groups and peer to client arrival, CBC multidisciplinary team has pre-clinic case conference to discuss client, their needs, referrals and action sees medical provider, EIS Specialist, Mental Health Provider, and Medical Case Management for Intake.

10 Depending on clients needs, Substance abuse counselor, prevention specialist, PharmD, ALCC and benefits counselor are available Services EIS specialist makes specialty care referrals for clients based upon their needs: Referrals to internal and external specialty care providers. All clients are screened by medical case management and receive medication adherence Services . INTERNAL: Clinical Therapist, Substance Abuse Counselor, Medical, DRS, Correction case management, Prevention for Positives Behavioral Intervention Mpowerment, AOMC Care, PrEPreferrals, PharmD, Benefits EXTERNAL: , New age Services Methadone clinic, Vital Bridges, CORE Center, Haymarket, CDPH DIS for partner Services . EIS Specialist documents the date the referral was made, the referral follow up date, and the results of the referral on the clients individualized referral plan form.