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Connecting clients to culturally appropriate HIV services using a peer based Health System Navigator intervention. The Fenway Institute Allison Jones Donald Graham, MSW, LICSW Judy Bradford, Ph.D. SETTING. Boston, MA 7th largest urban area in U.S. Pop = 5.8 million

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The Fenway Institute Allison Jones Donald Graham, MSW, LICSW Judy Bradford, Ph.D.

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The fenway institute allison jones donald graham msw licsw judy bradford ph d

Connecting clients to culturally appropriate HIV services using a peer based Health System Navigator intervention

The Fenway Institute

Allison Jones

Donald Graham, MSW, LICSW

Judy Bradford, Ph.D.


Setting

SETTING

Boston, MA

  • 7th largest urban area in U.S.

  • Pop = 5.8 million

  • Population is 28% AA, 14% Hisp, 57% White, 8% Asian

    “HIV services for people of color in this town have critical gaps in coordination and care.”

    Gary Daffin, Executive Director,

    Multicultural AIDS Coalition


The agencies

THEAGENCIES

Multicultural AIDS Coalition (MAC)

  • Annual Budget = $2M

  • Staff = 20 F/T, 7 P/T

  • Historical focus on building capacity within HIV community-based organizations serving communities of color.

Fenway Community Health (FCH)

Annual budget = $13M

Staff = 165

Research staff = 43

Multiuse LGBT-focused Federally Qualified Community Health Center with mature research department.


Process of partnering

PROCESS OF PARTNERING

  • The Fenway Institute identifies the Multicultural AIDS Coalition a a partner agency for grant that requires access to communities of color.

  • MAC and Fenway leadership meet and identify common interests:

    • expanding HIV services for communities of color

    • enhancing the research/evaluation capabilities of community-based agencies.

  • Fenway/MAC leadership work together to use MAC experience to identify service gaps in the local continuum of care for people of color.


Service gaps

MAC identified key service gaps, especially:

The lack of coordination/data sharing between different providers

The lack of in-field services to stabilize people into HIV care

SERVICE GAPS


Response to service gaps

RESPONSE TO SERVICE GAPS

HEALTH SYSTEM NAVIGATION:

A new and untested peer based intervention guiding individuals through the continuum of HIV services, from Prevention through CTR into stabilization in culturally competent HIV care.


What is health system navigation

WHAT IS HEALTH SYSTEM NAVIGATION?

  • Skill-set, based on proven successful models, that front-line or field staff workers can use to supplement existing skills

  • Staff are systematically trained through the Health System Navigation Training Academy


Training academy

TRAINING ACADEMY

  • The Health System Navigation Training Academy includes professional training in:

    • motivational interviewing

    • the stages of change theoretical model

    • strengths perspective

    • individual and agency-level data

  • The five day intensive academy ensures that the intervention is understood by all staff and is implemented according to protocol.


Goal of health system navigation

GOAL OF HEALTH SYSTEM NAVIGATION

  • The goal of Health System Navigation is to identify HIV+ individuals from underserved populations who are not in care and assist them in stabilizing into HIV medical care.

    • Stability in medical care is defined as visiting a medical provider as often as applicable HIV treatment protocol dictates.


What do health system navigators do

WHAT DO HEALTH SYSTEM NAVIGATORS DO?

  • Identify people at very high risk for HIV and assist these individuals in getting tested

  • Identify HIV+ people who know their status but are not in care

  • Once HIV+ individuals are identified, HSNs work with them one-on-one, connecting them with resources, until they are visiting a medical provider as often as current treatment protocols dictate.

  • Underserved populations being focused on in this project are largely:

    • people of color

    • transgender people

    • injection drug users

    • ex-incarcerated


Next steps

NEXT STEPS

  • Recruit and train a variety of frontline staff in Boston on the Health Systems Navigation skill-set at the first HSN Training Academy.

  • Train HIV health service agency staff on the value and role of Health Systems Navigation in their continuum of services

  • Identify additional resources to continue to expand the number of staff city-wide following the Health System Navigation process.


Next steps cont d

NEXT STEPS (cont’d)

  • Identify and secure funding resources for a unique identifier database tracking system:

    • to allow provider-verification of referral usage

    • to help identify unstable clients who need more services

    • to help link unstable clients with in-field stabilization like Health System Navigation without being dependent upon a referral


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