1. Linkage and Retention Interventions selected for dissemination
Steven Sawicki, MHSA Program Manager, AIDS Institute SPNS Lead, NY-LINKS September, 2013 1

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3. Agenda
Looking Back
Looking Now
Looking Forward

4. Looking Back Creation of UMRG, WNYS and Q&SI collaboratives in NYS
Involvement of more than 60 individual provider organizations in the establishment of base line data and individual testing of interventions
12 face to face learning sessions used to network, share information, and further improve linkage and retention

5. Looking Back Development of regionally based cascades
Involvement of county health departments and multiple state departments and divisions
Work done shared through international program and with QAC, CAC, QOC, the other 5 states involved, and the national evaluators.
Incredible amount of change going on within individual organizations and systems

6. Where we are UMRG—6th learning session WNYS—4th learning session
Q&SI—3rd learning session
Mid and Lower Hudson—1st learning session
Long Island—1st meeting 11/13/13
Central and Eastern NY
Bronx
Brooklyn

7. Where we are going Dissemination of work
Adding in a menu of evidence based interventions to the IAPAC Guidelines previously presented
Solidifying gains made

8. Interventions Selection process The 5 interventions
Summary of each intervention
How to Pick an Intervention to Implement
Timeline

9. Intervention Selection Process
Meeting on June 20 to discuss intervention work
Follow up meeting to pare down list of dozens of identified interventions to 6 or fewer
Interventions were selected based on the following criteria:
Number of existing providers utilizing intervention
Where impact of intervention fell on continuum
Resources required to implement intervention
Diversity of target population impacted
Evidence base supporting intervention
Provider type associated with intervention

10. Intervention selection teams
Each intervention had a team
Teams were assigned to each intervention to:
Develop a summary of the intervention
Develop an intervention package
Teams were comprised of:
NYS DOH staff
NYC DOH MH staff
NYLinks staff
Consumers
Providers
Members of each team were selected based on experience with the particular intervention they were assigned to
Summaries and packages produced by the teams were submitted to HRSA and to the national evaluation team for SPNS--ETAC

11. The 5 Interventions
Artas (Anti-Retroviral Treatment and Access to Services)
Appointment Procedures
Consistent Messaging
Outreach/Return to Care
Peers

12. Summary of Each Intervention
Brief Description
Intervention Impact Area
Target population
Best for agencies who provide…
Core Elements
Duration—how long for each client/patient
Resource requirements
Training needed

13. Anti-Retroviral Treatment and Access To Services (ARTAS)
Brief Description--ARTAS is an individual-level, multi-session, time-limited intervention utilizing a strengths based case management model.
Impact Area—Linkage to Care/Retention in Care.
Target Population--Newly diagnosed individuals or those returning to care after more than a 6 month lapse.
For Agencies that Provide—HIV testing, clinical, supportive services.
Core Elements—1-5 structured sessions with each person, Focus on strengths of the individual, Development of step by step plan to connect to care, Service takes place in the environment of the individual, Advocacy of individual needs related to return to care.

14. Anti-Retroviral Treatment and Access To Services (ARTAS)
Duration—1 to 90 days
Resource requirements—Staff trained in case management/engagement.
Training needed—ARTAS, Motivational Interviewing suggested

15. Appointment Procedures
Brief Description—Standardization of procedures to facilitate making appointments, reminding patients of appointments, and providing follow up after missed appointments.
Impact Area—Linkage to Care/Retention in Care.
Target Population—All individuals who are HIV+. Limited resources may require prioritization—New diagnoses, Out of Care, frequency of no show, last lab status.
For Agencies that Provide—HIV testing, clinical, supportive services.
Core Elements—Patient enrollment, expanded patient contact info acquired, appointment reminders instituted, missed appointment follow up procedures developed, documentation of efforts.

16. Appointment Procedures
Duration—ongoing.
Resource requirements—Staff, time for training.
Training needed—Field safety training if outreach is to be used.

17. Consistent Team Based Messaging
Brief Description—Positively phrased and action oriented messages are delivered by all members of the care team.
Impact Area—Linkage to Care/Retention in Care.
Target Population—All HIV+ individuals who are newly engaging or re-engaging in care.
For Agencies that Provide—HIV testing, clinical, supportive services.
Core Elements—List of newly engaging and re-engaging patients, brief care message delivered by all staff on care team, longer care message developed and delivered by specifically indicated members of care team, tool to track messages and delivery process.

18. Consistent Team Based Messaging
Duration—ongoing.
Resource requirements—Staff, time for training.
Training needed—Use of scripted messaging, teachback, motivational interviewing suggested.

19. Outreach/Return to Care
Brief Description—Systematic search for individuals who have been out of care for longer than 6 months. Engagement of those individuals back to care.
Impact Area—Retention in Care.
Target Population—HIV+ individuals with at least one HIV medical visit within the last two years who have not been seen in primary care for 9 months or longer.
For Agencies that Provide—Clinical, supportive services.
Core Elements—Maintained care roster to identify out of care patients, case finding efforts, field outreach, care determination process, re-engagement and case closure process.

20. Outreach/Return to Care
Duration—ongoing.
Resource requirements—Staff, time for training.
Training needed—Field safety training for outreach, Case finding training.

21. Peer Support
Brief Description—Utilizing the skills of peers to better engage patients in the system.
Impact Area—Linkage to Care/Retention in Care.
Target Population—HIV+ individuals who are newly diagnosed, transferring their care, or returning to care after not being seen for 6 months or longer.
For Agencies that Provide—HIV Testing, Clinical, supportive services.
Core Elements—Identification of new, transferring or returning patients, Peers trained in engagement, Use of standardized, consistent messages, Contact schedule and process recording.

22. Peer Support Duration—1 to 90 days.
Resource requirements—Staff, time for training.
Training needed—Confidentiality, engagement and communication.

23. Key Components to consider in Intervention Selection
Current status
Use of regional cascade along with individual organization data related to linkage and retention.
Awareness of competing interventions.
Organizational resources.
Commitment and ability to track required data.
Ability to test and measure change and outcomes.
Ability to run intervention through August of 2015 and participate in statewide evaluation process

24. 1,2,3,5 1,2,3,4,5 1 Artas 2 Appointment Procedures
3 Consistent Messaging
4 Outreach/Return to Care
5 Peer Support
1,2,3,5
1,2,3,4,5

25. Next Steps Introductory Webinars Pilot Phase
Revision and finalization of interventions
Assessment package developed
Individual webinars for each intervention ?????
Process within each learning session to look at best way to impact the regional cascades
Providers select interventions and receive TA
Beginning of evaluation
Statewide dissemination process begins—Webinars, workshops, presentations, conferences.

26. Timeline Pilot Phase begins November through February
Sites that meet minimal criteria volunteer, choose intervention, receive TA around implementation, and report process
Adjustments made to interventions as needed during this period
By end of pilot, in February, interventions have been revised and are ready for full dissemination.
6 to 8 sites to be involved in Pilot
While Pilot phase is running.
Introductory webinars will be held
Sites not involved in Pilot prepare for dissemination

27. Upcoming Webinars Tuesday, November 12th, 2013, 11:00 AM
Wednesday, November 13th, 2013, 3:00 PM
Thursday, November 14th, 2013, 10:00 AM, 2:00 PM
Friday, November 15th, 2013, 1:00 PM

28. Upcoming Stakeholder MEetings
December 4th, 2013, Western New York State—Batavia, NY
December ?? th, Mid and Lower Hudson—Newburgh (date is tentative)
December 17th, Upper Manhattan—TBD
December 20th, 2013, Queens and Staten Island—90 Church St., Manhattan

29. Contact Information
Steven Sawicki, NYSDOH, SPNS Lead
Clemens Steinbock, NYS Director of Quality Initiatives
Bruce D. Agins, Medical Director,
Website at
Blog at