1. HIV & Social Work Across Three Regions Presented through telehealth April 24, 2012

2. HIV and Social Work in the RQHR Heather Temple, BSW/RSW Population & Public Health Services- Provincial HIV Strategy Social Worker 766-7629 Nanette Durand-Ray MSW/RSW & Nancy Wagar, BSW/RSW Infectious Diseases Clinic- Clinical Social Workers 766-3994

3. Since the first documentation of HIV Cases at PPHS (~1986), we have approximately 500 cases on file No concrete way to determine exact numbers of cases in RQHR due to unknown deaths, clients lost to follow-up, and movement in/out of province RQHR STATISTICS

4. RQHR HIV RATES Ministry of Health

5. RQHR HIV mother-to-child transmission rate 7% (4/58) January ‘96 & December ’10 Of the 4 positive infants, none of the mothers received ART We currently have 5 pregnant women engaged in care RQHR PERINATAL STATISTICS- 2010

6. IDU remains the major risk exposure - 77% in 2009 (154/200). Of these: 84% were of Aboriginal origin 47% of those who identified IDU as the primary risk were female - More than 1/3 (34%) were between the ages of 15-29 MSM risk remains <10% Source: HIV and AIDS in Saskatchewan 2009, Annual Report RISK FACTORS

7. Provides medical care, support, and education for people and families living with HIV/AIDS Unit 4E in the Regina General Hospital Regular clinic visits scheduled for clients (out- patients) every 3-4 months, as needed Clinic hours are M-F, 8:00-4:00pm Phone: 766-3915 INFECTIOUS DISEASES CLINIC - RGH

8. Specialists/Physicians: Dr. Karunakaran and Dr. Wong Clinic Nurse: Debbie Rodger Social Worker: Nancy Wagar- part time position. (Returning from maternity leave where she was covered by Nanette Durand-Ray) Dietician: Karen Karst- every 2 nd Tuesday starting in May Pharmacist: Mike Stuber- part time (back up to Linda Sulz) INFECTIOUS DISEASES CLINIC TEAM

9. Primary SW focus on unit is HIV specific, but role includes other ID patient concerns as well Remains within hospital setting (SWADD) Initial Psycho-social assessments for new patients Long –term supportive counseling Provides HIV education Explores support systems Assists with financial challenges and form completion (Drug Coverage, employment/ disability benefits, transportation) Provides community referrals Liases with in-patient hospital units re: counseling, d/c plans Generates homecare referrals Involved in new interdisciplinary/interagency Case Management team ID SOCIAL WORKER’S ROLE

10. Constant challenges with drug coverage (special support programs, immigration) Completing medical reports to maximize benefits (Disability/SAID, EI, CPP) Patients wanting Ensure (currently not covered- incl. in Special Diet supplement) Formula coverage for babies (to be paid for by CTB) Clinic attendance/tracking transient populations Lack of patients with GP’s Increased follow-up with patients in more complex situations (no longer just checking in) ID CLINIC SW CHALLENGES

11. The “HIV Team” is housed within the Communicable Diseases and Sexual Health Programs Department at PPHS, 2110 Hamilton Street 3 Public Health Nurses: - Michelle Bilan (0.8) - Laurel Stang and Rachel Faye (FT) - 766-7625 Social Worker: - Heather Temple (TFT) - 766-7629 PUBLIC HEALTH: COMMUNICABLE DISEASES AND SEXUAL HEALTH PROGRAMS: HIV TEAM

12. Receive all HIV+ labs within the region Assist Dr’s with providing new diagnosis’ if needed, or providing diagnosis Assist Dr’s with new HIV+ clients with completion of mandatory provincial/federal reporting requirements Locate and counsel new and known cases and contacts, provide referrals to/engagement with ID and other agencies Provide pre/post test counselling and testing for HIV in clinic and community Specimen collection, immunizations Assist in navigation of medical system PUBLIC HEALTH HIV NURSES

13. New temporary position created under provincial HIV strategy- began in March ’11-2014 Assists PHN’s with Case Management and providing social support to cases and contacts Assists PHN’s with locating and completing reporting requirements Provides transportation to access medical care/resources-facilitate 1 st access to ID Clinic Provides individual counselling/support, HIV education, promotes harm reduction strategies Liaises with acute care units/community agencies to assist with providing holistic client centered care. Generates referrals and connects clients with community resources Home/hospital visiting, meeting clients “where they are at” Advocates for and assists at risk and vulnerable clients with navigating health care systems (in hospital and accessing) Involved in new interdisciplinary/interagency Case Management team PUBLIC HEALTH/HIV STRATEGY SOCIAL WORK ROLE

14. Increasing caseload of clients with multiple complex social needs (addictions, mental health, housing) Advocating for clients in ER/acute care settings with concurrent disorders/medical issues Assisting clients with obtaining family physicians Supporting clients in maintaining health within risky social situations PH/STRATEGY SW CHALLENGES

15. The challenge of meeting clients/patient’s needs (medical and social) is being addressed by the Provincial HIV Strategy implementation Funding has been provided for increased support in the community including: –1 TFT Social Worker –3 HIV Community Outreach Workers based at ANHAN, APSS, and SWAP –3 Peer to Peer Community Mentors –1 Acute Care Peer to Peer Coordinator –Housing Coordinator based out of Carmichael Outreach Centre CASE MANAGEMENT IN THE RQHR

16. Case Management (CM) is a collaborative process in a continuum of care that assesses, plans, implements, coordinates, monitors, and evaluates the options, services and care required by a client To date, CM has been provided by the ID Clinic staff and PHN’s. However, due to increasing client complexities in their social circumstances, improved integration and collaboration of care and services for clients provided across a variety of settings is required CASE MANAGEMENT IN THE RQHR

17. HIV Case Management is a process whereby people living with HIV who require short-term or long-term support are better able to achieve positive health and social outcomes and reduce their risk of progression to advanced HIV. CM Team will consist of case managers, outreach staff, and as indicated, health care providers from agencies within the RQHR and community-based organizations CASE MANAGEMENT TEAM IN THE RQHR

18. Currently meets on a bi-weekly basis to consult on clients living with HIV, who require support related to the social determinants of health and/or linkage/retention in care. HIV Case Management process still in preliminary stages: –3 clients formally engaged in HIV Case Management (have signed consent forms) –Currently exploring alternative avenues to engage additional clients in CM CASE MANAGEMENT TEAM

19. Native Health Services Addictions Services Mental Health Services Street Project/Needle Exchange Methadone Clinic Four Directions Sexual Health Clinic RQHR RESOURCES

20. AIDS Programs South Saskatchewan (APSS) All Nations Hope AIDS Network (ANHAN) Street Workers Advocacy Project (SWAP) Carmichael Outreach Centre Regina Food Bank Income Assistance (MSS & Band Funding) Parliament Methadone Clinic Canadian AIDS Treatment Info. Exchange (CATIE) Shelters (My Aunt’s Place, Isabelle Johnson, Souls Harbour/Rescue Mission, Salvation Army…) COMMUNITY BASED RESOURCES

21. Addressing social needs to bring client’s to a stable place where they are able to be active and successful in the management of HIV: –Basic needs 1 st → if cannot be met, reduced ability for change/intervention (Social Determinants of Health) Main issues include: –Poverty –Housing/homelessness/transience –Addictions/mental health –Family violence –Intergenerational/interfamilial –Limited rural resources –Acute care admissions (addictions, pain management, confidentiality, discrimination) –Fear of death/dying/life expectancy CHALLENGES FOR SW AND CLIENTS IN THE RQHR

22. Increasing regional cultural awareness and integration Increasing departmental collaboration and streamlining of program access, specific to the HIV population, has resulted in clients receiving more holistic care Increasing numbers of supports available to clients Increasing awareness of HIV in the greater community and motivation to make positive changes Working from client-centered, harm reduction, strength- based philosophies that intend to meet all clients “where they are at” Working towards timely, low-barrier access to and coordination of care and services that provide support for people living with HIV Increasingly holistic care and services that are client-driven Efforts being made to enable culturally safe environments, focused on needs identified by and with the client STRENGTHS WITHIN THE RQHR

23. HIV SOCIAL ISSUES – THE PRINCE ALBERT PICTURE Presented by: Barb Bowditch Case Manager Prince Albert Positive Care Program

24. Client Profile - majority Aboriginal - majority have addiction issues -large number living in First Nation communities - transient - homeless - Come from within our health region, other health regions, northern communities and both Provincial Correctional Centre's

25. My role: - Client centered -support for clients in office, home visits, in hospital and via telephone - outreach support in First Nation Communities - support for HIV+ Inmates in both Provincial Correctional Centers' - support to family members - Housing assessment and intake - discharge planning – Correctional Centers' and hospital.

26. -assist with disclosure – partners, family members and children -act as a referral agent – HIV nurse, housing coordinator, addiction services detox, methadone program etc. - client advocate -confidentiality breach – care -HIV education – client, family, in community and inmates. -transportation for clinic appointments, blood work, Saskatoon appointments, Detox and Treatment Centers.

27. Issues and Challenges: - disappear after diagnosis -not ready to accept diagnosis - not ready start treatment/compliance - trust issues - isolated communities - transportation – rural and First Nation community -mental health

28. - addiction - homelessness - lost to follow up - transient population - large case load - limited human resources (Positive Care Program)

29. Strengths: -Accessibility - trust - committed staff and physicians - transportation -Nurse Practitioner on site 2 days per week - Housing Coordinator -Addiction worker on site 2 afternoons per week

30. Successes: -clients stable once housed -clients seeking addiction services -One – Stop Shop - Partnerships - Outreach

31. Opportunities for Improvement: - On-site Mental Health worker - Pharmacist on site on clinic days - Increase Positive Care Program staff - Increase outreach services – assisting communities to deliver care in their community - Enhance spiritual care provider services – i.e. Elders -Peer support network -Support group

32. Presented by: Shelly Glum, BSW/RSW Social Worker Positive Living Program Saskatoon Health Region HIV, SOCIAL WORK AND SASKATOON

33. Background Positive Living Program, May 2011 Partnership with Mental Health and Addiction Services The people we work with, who we see ROLE

34. Partnerships WSCC, MHAS, CBO’s, PLP, STC and other SHR programs Case Management Services STRENGTHS

35. Mental Health and Addictions Housing Income Security Food Security Prisons Hospitalizations, palliative care CHALLENGES

36. Prevalence of concurrent disorders regarding mental health MENTAL HEALTH AND ADDICTIONS

37. Addition to Maslow’s Hierarchy (for folks who use drugs) Self-Actualization Esteem Needs Sense of Belonging Safety Physiological Needs The Drugs/The Score/The $ for Drugs

38. So much more needed than “affordable” Supportive, transitional, harm reduction, etc. Out of the “core” HOUSING

39. “Not enough money” means so much more Social programs do not meet basic needs INCOME SECURITY

40. SAP Shelter amounts: Single $459; Childless Couple $537 SAP Basic Allowance: $255 + $50 + $20 + $140 = $465 Working poor INCOME SECURITY (CONT’D)

41. SAP Rates = food bank Most money going into shelter Special diet allowance goes into shelter, big issue for those experiencing wasting Nutrition supplement access FOOD SECURITY

42. Stigma when inside Transition to community challenges Partnership development needed PRISONS

43. Addiction management Transition to Community upon Discharge Challenges Assist with discharge planning Many people dying but not accessing palliative care HOSPITALIZATIONS/ PALLIATIVE CARE

44. Continue to build partnerships Mental health and addictions workers on site (Nine Circles model) Support Group AREAS OF IMPROVEMENT

45. Questions