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Program Integration The Virginia Experience . Virginia Department of Health Division of Disease Prevention . Office of Public Health. Programs Integrated & Rationale . AIDS Program

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Program Integration The Virginia Experience

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Program integration the virginia experience

Program IntegrationThe Virginia Experience

Virginia Department of Health

Division of Disease Prevention

Theresa L. Henry, Director of Field Services

Office of public health

Office of Public Health

Programs integrated rationale

Programs Integrated & Rationale

  • AIDS Program

    • Because of transmission mode the then Bureau of STD Control within the Division of Communicable Disease Control was considered to be the best organizational placement for the program.

Programs integrated rationale1

Programs Integrated & Rationale

  • Hepatitis C Program

    • The Virginia General Assembly appropriated funds to implement a Hepatitis C Awareness and Prevention Program.

Programs integrated rationale2

Programs Integrated & Rationale

  • Hepatitis A and hepatitis B, excluding perinatal, are the responsibility of the Division of Surveillance and Investigation (DSI).

  • DSI did not have the infrastructure or resources to implement a new program.

Programs integrated rationale3

Programs Integrated & Rationale

  • Perinatal hepatitis B is the responsibility of the Division of Immunization.

  • The primary goal of this division is reducing morbidity and mortality associated with vaccine-preventable illness.

Programs integrated rationale4

Programs Integrated & Rationale

  • The then Division of HIV/STD

    • Serviced a population at risk for hepatitis C.

    • Had sufficient resources to support a new program.

    • Interested in including viral hepatitis prevention services in clinical and outreach settings.

Programs integrated rationale5

Programs Integrated & Rationale

  • Pharmacy Services

    • The Bureau of Pharmacy Services was a separate bureau located within the Office of Purchasing and General Services (OPGS).

    • OPGS primarily performs procurement functions.

Programs integrated rationale6

Programs Integrated & Rationale

  • Analysis of Pharmacy Services’ activity showed that 75% of the medications dispensed were for the Division of HIV/STD.

  • Placement within the Division of HIV/STD provided an opportunity to capitalize on existing staff expertise in the Division.

Programs integrated rationale7

Programs Integrated & Rationale

  • TB Prevention and Control

    • The Division of TB Prevention and Control was a separate division within the Office of Epidemiology.

    • Placement within the Division of HIV, STD, and Pharmacy Services provided an opportunity to establish new teams and capitalize on existing staff expertise.

Staff perceptions to the change

Staff Perceptions to the Change

  • AIDS/HIV Program – New program, no merging of staff

    • STD staff were more cautious from the standpoint of the challenge associated with a disease that was unknown.

Staff perceptions to the change1

Staff Perceptions to the Change

  • Hepatitis C Program -New program, no merging of staff

    • HIV/STD staff were excited.

    • Some apprehension from the standpoint of a learning curve with the addition of a “ new” disease.

Staff perceptions to the change2

Staff Perceptions to the Change

  • Pharmacy Services –Involved staff merging

    • Both program area staff were a little cautious at first regarding “fit”.

    • Pharmacy staff morale improved due to changes in work environment.

Staff perceptions to the change3

Staff Perceptions to the Change

  • TB Prevention and Control - Involved staff merging

    • Resistance and caution from TB staff.

    • HIV, STD, and Pharmacy Services staff were more accepting.

Internal barriers

Internal Barriers

  • AIDS Program

    • Program differences

  • Pharmacy Services

    • Organizational structure

Internal barriers1

Internal Barriers

  • TB Prevention and Control

    • Program differences

    • Attitudinal

Addressing internal barriers

Addressing Internal Barriers

  • Pharmacy Services

    • Met with Human Resources.

  • TB Prevention and Control

    • Counseling, some transfers and resignations.

    • Promote as much consistency across programs as possible.

Other barriers

Other Barriers

  • Non support from CDC after the merger between the Division of TB and the Division of HIV, STD, and Pharmacy Services

    • Financial assistance

    • Direct assistance

    • Strong recommendation to re-establish the TB program as a “unit”.

Wins client level

Wins - Client level

  • Delivery of more comprehensive prevention services.

  • Enhanced coordination of client care and services.

Wins health department level

Wins - Health Department Level

  • Resource sharing (human, fiscal, data/information)

    • DIS investigate and follow-up both HIV and STD; collaboration among training staff (HIV, STD, TB).

    • Enhanced surveillance.

    • Integration of TB provided additional match for the Ryan White grant which was a significant financial concern.

Wins health department level1

Wins - Health Department Level

  • Greater cross program planning.

    • Weekly meetings between the Division Director and Program Directors.

    • Medical Director of TB Program is on the ADAP advisory meeting.

  • Leaner organizational structure.

Embarking on program integration

Embarking on Program Integration

  • A leader who strongly believes in integration.

  • Clear definition of program integration.

  • Regular communication across programs.

Starting process again

Starting Process Again

  • Hepatitis C Program

    • Promote viral hepatitis services be the responsibility of one division.

  • TB Prevention and Control

    • More staff involvement in the plan.

    • Follow the plan.

Suggestions for cdc

Suggestions for CDC

  • Support project areas that are integrated.

  • At the CDC level, need to communicate and become more familiar with other division programs.

Suggestions for cdc1

Suggestions for CDC

  • Train public health advisors on STD, TB, HIV, and hepatitis and allow them flexibility to work across program lines.

  • Allow maximum flexibility on how funding can be used.

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