2007 Needs Assessment

2007 Needs Assessment

Ryan White Part A Year 18

Chapter 5: Surveys: Client

Satisfaction and Needs

Assessment, Barriers to

Collaboration, Hours of Service

ƒ

Client Satisfaction and Unmet Needs

ƒ

Summary of Findings 2006 Client

Satisfaction Survey

ƒ

Results from the 2006 Provider Survey on

Barriers to Collaboration

ƒ

Care and Treatment Committee Needs

Assessment

ƒ

Service Locations and Hours of

CLIENT

SATISFACTION

AND UNMET

NEEDS

Data from the

2006-2007 RYAN WHITE

CLIENT SATISFACTION

SURVEY

• Conducted 844 client satisfaction interviews

among PLWHAs at 14 Ryan White Part A Case

Management (CM) provider sites from 12/11/06 to

3/14/07. CM sites were intended to minimize

opportunities for duplicate responses.

• Target number of surveys per CM provider was

based on the proportion of CM clients in 11-month

SDIS sample,

10/01/05 through 08/31/06.

• PLWHAs at each site were interviewed about all

core RW services they received, regardless of

provider, as well as about unmet needs.

• PLWHAs received $10 Publix or Winn-Dixie gift

cards as incentive for participation.

• Borinquen

• CARE Resource

• Community Case Management

• Community Health of South Dade

• Economic Opportunity Family Health Center

• Empower U

• Helen Bentley Community Health Center

• Mercy Hospital

• Miami Beach Community Health Center

WHERE DID WE GO?

• MOVERS

• PHT/Liberty City

• PHT/North Dade

• PHT/PET Center

• PHT/SFAN

• The Village (Clients interviewed at other

providers’ locations)

HOW DID WE DECIDE HOW MANY CLIENTS TO

SURVEY?

WHO RESPONDED TO OUR SURVEY?

6%

7%

7%

5%

60+ years

20%

25%

16%

21%

51 to 60 years

46%

52%

45%

47%

41 to 50 years

22%

14%

25%

20%

31 to 40 years

6%

2%

6%

7%

20 to 30 years

N=844

N=81

N=343

N=419

AGE

1%

0%

2%

1%

Transgender

33%

27%

17%

47%

Female

66%

73%

81%

52%

Male

N=844

N=81

N=343

N=419

GENDER

N=844

N=81

N=343

N=419

TOTAL

NON HISPANIC

WHITE / OTHER

HISPANIC

NON HISPANIC

BLACK / HAITIAN

ETHNICITY

HOW MUCH SCHOOLING DO THEY HAVE?

3%

7%

4%

<1%

Post graduate degree

13%

22%

20%

6%

College graduate

19%

27%

22%

14%

Some college

3%

2%

4%

2%

Trade School

31%

19%

23%

39%

High School graduate / GED

28%

20%

20%

36%

Some High School

4%

2%

6%

3%

8th grade or less

N=843

N=81

N=343

N=418

HIGHEST LEVEL OF

SCHOOLING COMPLETED

N=844

N=81

N=343

N=419

TOTAL

NON HISPANIC

WHITE / OTHER

HISPANIC

NON HISPANIC

BLACK / HAITIAN

ETHNICITY

WHAT IS THEIR INCOME SITUATION?

7%

18%

9%

3%

$1,701+

9%

13%

10%

7%

$1,276 - $1,700 [151% - 200% FPL]

5%

3%

6%

5%

$1,151 - $1,275 [136% - 150% FPL]

12%

13%

13%

10%

$851 - $1,150 [100% - 135% FPL]

48%

39%

46%

52%

$1 - $850 [<100% FPL]

20%

16%

17%

22%

$0

N=825

N=80

N=334

N=410

TOTAL MONTHLY INCOME

40%

25%

37%

49%

Part time

60%

75%

63%

51%

Full time

N=257

N=28

N=134

N=95

EMPLOYED:

69%

65%

61%

77%

No

31%

35%

39%

23%

Yes

N=843

N=18

N=342

N=419

ARE YOU CURRENTLY EMPLOYED?

N=844

N=81

N=343

N=419

TOTAL

NON HISPANIC

WHITE / OTHER

HISPANIC

NON HISPANIC

BLACK / HAITIAN

ETHNICITY

WHAT IS THEIR LIVING SITUATION?

Some other place

4% 2% 3% 6% A temporary shelter 5% 9% 1% 7% A residential program 1% 0% 2% 0% A mobile home 35% 40% 41% 30%

An apt. building with more than 4 units

18% 7%

22% 17%

An apt. building with 4 units or less

33% 33% 29% 36% A single-family home N=843 N=81 N=343 N=418

THE PLACE WHERE YOU LIVE IS:

5% 0% 4% 8% 3+ Adults / 1+ Children 15% 14% 17% 13% 3+ Adults / 0 Children 9% 10% 5% 11% 2 Adults / 1+ Children 28% 28% 36% 22% 2 Adults / 0 children 5% 0% 2% 9% 1 Adult / 1+ Children 37% 48% 36% 36% 1 Adult / 0 Children N=748 N=69 N=319 N=359 PEOPLE IN HOUSEHOLD N=844 N=81 N=343 N=419 TOTAL NON HISPANIC WHITE / OTHER HISPANIC NON HISPANIC BLACK / HAITIAN ETHNICITY

WHAT BENEFITS DO THEY RECEIVE?

1%

4%

1%

2%

VA BENEFITS

N=834

N=80

N=337

N=416

1%

1%

1%

2%

WIC

N=835

N=80

N=338

N=416

2%

1%

1%

2%

TANF

N=833

N=81

N=335

N=416

40%

37%

36%

43%

SOCIAL SECURITY

N=839

N=81

N=339

N=418

39%

33%

29%

49%

FOOD STAMPS

N=835

N=80

N=338

N=416

20%

25%

21%

18%

MEDICARE

N=838

N=81

N=339

N=417

6%

9%

7%

4%

PAC WAIVER

N=828

N=81

N=334

N=412

38%

25%

34%

42%

MEDICAID

N=839

N=81

N=340

N=417

TOTAL

NON HISPANIC

WHITE / OTHER

HISPANIC

NON HISPANIC BLACK /

HAITIAN

HOW ABOUT HOUSING ASSISTANCE?

13%

14%

16%

11%

OTHER

N=208

N=14

N=64

N=129

6%

0%

8%

5%

PUBLIC HOUSING

N=209

N=14

N=65

N=129

23%

7%

15%

29%

SECTION 8

N=209

N=14

N=65

N=129

59%

79%

62%

55%

HOPWA/CARRFOUR

N=209

N=14

N=65

N=129

TYPE OF ASSISTANCE

74%

80%

80%

68%

No

26%

20%

20%

32%

Yes

N=817

N=75

N=336

N=405

RECEIVE HOUSING

ASSISTANCE?

N=844

N=81

N=343

N=419

TOTAL

NON HISPANIC

WHITE / OTHER

HISPANIC

NON HISPANIC

BLACK / HAITIAN

ETHNICITY

WHEN WERE THEY DIAGNOSED WITH HIV AND

WHAT IS THEIR CURRENT STATUS?

19%

25%

16%

20%

AIDS

25%

15%

22%

30%

HIV with symptoms

56%

60%

62%

50%

HIV with no symptoms

N=828

N=80

N=339

N=408

HIV STATUS

7%

7%

7%

7%

2006

25%

20%

25%

25%

2001 - 2005

27%

25%

28%

26%

1996 - 2000

24%

25%

25%

24%

1991 - 1995

17%

23%

15%

18%

Before 1991

N=840

N=81

N=342

N=416

YEAR OF DIAGNOSIS

N=843

N=81

N=343

N=419

TOTAL

NON HISPANIC

WHITE / OTHER

HISPANIC

NON HISPANIC

BLACK / HAITIAN

ETHNICITY

HOW SICK ARE THEY (VIRAL LOAD)?

1%

0%

2%

2%

0%

2%

2%

500,000+

1%

5%

2%

0%

3%

1%

1%

100,001 - 500,000

2%

0%

2%

0%

2%

1%

4%

50,001 - 100,000

5%

9%

8%

5%

4%

5%

5%

10,001 - 50,000

10%

9%

14%

12%

8%

7%

12%

401 - 10,000

5%

9%

3%

12%

5%

6%

3%

51 - 400

45%

50%

49%

49%

52%

40%

37%

50 or less

30%

18%

20%

20%

25%

40%

36%

Don't know/No answer

N=832

N=22

N=59

N=59

N=277

N=196

N=219

VIRAL LOAD

TOTAL

F

M

F

M

F

M

N=843

N=81

N=343

N=419

TOTAL

NON HISPANIC

WHITE / OTHER

HISPANIC

NON HISPANIC

BLACK / HAITIAN

ETHNICITY

HOW SICK ARE THEY (CD4 COUNT)?

27%

45%

37%

42%

27%

26%

18%

500+

16%

14%

22%

12%

20%

14%

15%

351 - 500

16%

18%

14%

14%

18%

15%

16%

201 - 350

14%

9%

8%

10%

13%

11%

20%

Zero - 200

27%

14%

19%

22%

22%

34%

31%

Don't know/No answer

N=832

N=22

N=59

N=59

N=277

N=196

N=219

CD4 (T-CELL) COUNT

TOTAL

F

M

F

M

F

M

N=843

N=81

N=343

N=419

TOTAL

NON HISPANIC

WHITE / OTHER

HISPANIC

NON HISPANIC

BLACK / HAITIAN

ETHNICITY

HOW SATISFIED ARE OUR CLIENTS?

3%

5%

92%

N=131

PHARM

1%

5%

94%

N=116

MNTL

HLTH

OUT

SA

RES

SA

DENT/

ORAL

MED

CASE

MGMT

0%

8%

8%

2%

3%

Dissatisfied/

Very Dissatis.

0%

6%

7%

7%

6%

Somewhat

Satisfied

100%

86%

85%

91%

90%

Very Sat./

Satisfied

N=13

N=49

N=447

N=748

N=789

AVERAGE RYAN WHITE PART A SATISFACTION LEVELS

BY SERVICE CATEGORY

WOULD OUR CLIENTS RECOMMEND THIS

AGENCY TO SOMEONE WHO IS HIV+?

10%

90%

N=135

PHARM

1%

99%

N=116

MNTL

HLTH

OUT

SA

RES

SA

DENT/

ORAL

MED

CASE

MGMT

0%

16%

11%

7%

8%

No / Not

Sure

100%

84%

89%

93%

92%

Yes

N=13

N=49

N=446

N=750

N=788

AVERAGE RYAN WHITE PART A RECOMMENDATION LEVELS

BY SERVICE CATEGORY

HOW LONG DOES IT TAKE OUR CLIENTS TO

GET TO THEIR RYAN WHITE SERVICE

PROVIDERS?

4%

28%

53%

N=134

PHAR*

2%

31%

67%

N=113

MENTAL

HLTH

OUT

SA

DENT/

ORAL

MED

CASE

MGMT

0%

0%

2%

2%

More than 2

hours

18%

22%

20%

20%

Between 1

and 2 hours

82%

78%

78%

78%

Less than 1

hour

N=13

N=443

N=755

N=797

AVERAGE TIME IT TAKES TO GET TO PROVIDER,

BY SERVICE CATEGORY

UNMET NEEDS: CLIENTS IN CARE

MEDICAL SERVICES - MULTIPLE RESPONSE

2%

Other Outpatient Medical Services

1%

Primary HIV Care

1%

Home Health Care

3%

Specialty Medical Care

3%

Eye Care/Eye Glasses

4%

Medications (not eligible)

86%

No need for additional services

IN THE PAST 12 MONTHS, WAS THERE ANY MEDICAL

SERVICE YOU NEEDED AND COULD NOT GET?

UNMET NEEDS: CLIENTS IN CARE

DENTAL SERVICES - MULTIPLE RESPONSE

5%

Other Dental Services

1%

Root Canal

1%

Implants

2%

Crowns, Bridges

2%

Cavities, Fillings

3%

Extraction

3%

Dentures

3%

Just can’t get appointment - waiting too long

15%

Cleaning/Oral Hygienist/Checkup

70%

No need for additional services

IN THE PAST 12 MONTHS, WAS THERE ANY DENTAL

SERVICE YOU NEEDED AND COULD NOT GET?

UNMET NEEDS: CLIENTS IN CARE

OTHER SERVICES - MULTIPLE RESPONSE

4%

Other Services

1%

Utility Payments

1%

Legal Aid

1%

SSI

1%

Bus Pass, Transit Pass

3%

Food Stamps/Food Bank

7%

Housing, Rent Assistance

81%

No need for additional services

IN THE PAST 12 MONTHS, WAS THERE ANY OTHER

SERVICE YOU NEEDED AND COULD NOT GET?

MAJOR FINDINGS

+ Non-Hispanic Blacks and Haitians are the largest

group in care, with significantly lower SES levels,

greater reliance on support services and greater

HIV/AIDS impairment than Hispanics or

non-Hispanic whites.

+ Overall satisfaction levels are excellent for most

service categories. Dental / Oral Health and

Residential Substance Abuse show lowest relative

satisfaction levels.

+ Most clients can get to most providers in less than

one hour. Pharmacy and Mental Health clients

MAJOR FINDINGS, cont’d

+ Client needs for additional health care services

are minimal, and most needs can be addressed

through expansion of existing services. With few

exceptions (e.g., eyeglasses), the unmet needs are

in the medical care formularies.

+ Unmet need is most acute for oral health

services, reflecting unmet demand for basic

services and system capacity issues.

+ “Other services” with unmet need reflect

pressing social and economic support issues,

with housing mentioned most frequently.

SUMMARY OF

FINDINGS

RYAN WHITE PART A

2006 CLIENT SATISFACTION

SURVEY

• Conducted 844 client satisfaction interviews

among PLWHAs at 14 Ryan White Part A Case

Management (CM) provider sites from 12/11/06 to

3/14/07. CM sites were intended to minimize

opportunities for duplicate responses.

• Target number of surveys per CM provider was

based on the proportion of CM clients in 11-month

SDIS sample,

10/01/05 through 08/31/06.

• PLWHAs at each site were interviewed about all

core RW services they received, regardless of

provider, as well as about unmet needs.

• PLWHAs received $10 Publix or Winn-Dixie gift

cards as incentive for participation.

• Borinquen

• CARE Resource

• Community Case Management

• Community Health of South Dade

• Economic Opportunity Family Health Center

• Empower U

• Helen Bentley Community Health Center

• Mercy Hospital

• Miami Beach Community Health Center

WHERE DID WE GO?

• MOVERS

• PHT/Liberty City

• PHT/North Dade

• PHT/PET Center

• PHT/SFAN

• The Village (Clients interviewed at other

providers’ locations)

HOW DID WE DECIDE HOW MANY CLIENTS TO

SURVEY?

WHO RESPONDED TO OUR SURVEY?

ETHNICITY

NON HISPANIC

BLACK / HAITIAN

HISPANIC

NON HISPANIC

WHITE / OTHER

TOTAL

N=419

N=343

N=81

N=844

GENDER

N=419

N=343

N=81

N=844

Male

52%

81%

73%

66%

Female

47%

17%

27%

33%

Transgender

1%

2%

0%

1%

AGE

N=419

N=343

N=81

N=844

20 to 30 years

7%

6%

2%

6%

31 to 40 years

20%

25%

14%

22%

41 to 50 years

47%

45%

52%

46%

51 to 60 years

21%

16%

25%

20%

60+ years

5%

7%

7%

6%

HOW MUCH SCHOOLING DO THEY HAVE?

ETHNICITY

NON HISPANIC

BLACK / HAITIAN

HISPANIC

NON HISPANIC

WHITE / OTHER

TOTAL

N=419

N=343

N=81

N=844

HIGHEST LEVEL OF

SCHOOLING COMPLETED

N=418

N=343

N=81

N=843

8th grade or less

3%

6%

2%

4%

Some High School

36%

20%

20%

28%

High School graduate / GED

39%

23%

19%

31%

Trade School

2%

4%

2%

3%

Some college

14%

22%

27%

19%

College graduate

6%

20%

22%

13%

WHAT IS THEIR INCOME SITUATION?

ETHNICITY

NON HISPANIC

BLACK / HAITIAN

HISPANIC

WHITE / OTHER

NON HISPANIC

TOTAL

N=419

N=343

N=81

N=844

ARE YOU CURRENTLY EMPLOYED?

N=419

N=342

N=18

N=843

Yes

23%

39%

35%

31%

No

77%

61%

65%

69%

EMPLOYED:

N=95

N=134

N=28

N=257

Full time

51%

63%

75%

60%

Part time

49%

37%

25%

40%

TOTAL MONTHLY INCOME

N=410

N=334

N=80

N=825

$0

22%

17%

16%

20%

$1 - $850 [<100% FPL]

52%

46%

39%

48%

$851 - $1,150 [100% - 135% FPL]

10%

13%

13%

12%

$1,151 - $1,275 [136% - 150% FPL]

5%

6%

3%

5%

$1,276 - $1,700 [151% - 200% FPL]

7%

10%

13%

9%

$1,701+

3%

9%

18%

7%

WHAT IS THEIR LIVING SITUATION?

ETHNICITY NON HISPANIC

BLACK / HAITIAN HISPANIC

NON HISPANIC

WHITE / OTHER TOTAL

N=419 N=343 N=81 N=844 PEOPLE IN HOUSEHOLD N=359 N=319 N=69 N=748 1 Adult / 0 Children 36% 36% 48% 37% 1 Adult / 1+ Children 9% 2% 0% 5% 2 Adults / 0 children 22% 36% 28% 28% 2 Adults / 1+ Children 11% 5% 10% 9% 3+ Adults / 0 Children 13% 17% 14% 15% 3+ Adults / 1+ Children 8% 4% 0% 5%

THE PLACE WHERE YOU LIVE IS:

N=418 N=343 N=81 N=843

A single-family home 36% 29% 33% 33%

An apt. building with 4 units or less 17% 22% 7% 18%

An apt. building with more than 4 units 30% 41% 40% 35%

A mobile home 0% 2% 0% 1%

A residential program 7% 1% 9% 5%

A temporary shelter 6% 3% 2% 4%

Some other place 2% 1% 2% 2%

WHAT BENEFITS DO THEY RECEIVE?

ETHNICITY

NON HISPANIC BLACK /

HAITIAN

HISPANIC

WHITE / OTHER

NON HISPANIC

TOTAL

N=417

N=340

N=81

N=839

MEDICAID

42%

34%

25%

38%

N=412

N=334

N=81

N=828

PAC WAIVER

4%

7%

9%

6%

N=417

N=339

N=81

N=838

MEDICARE

18%

21%

25%

20%

N=416

N=338

N=80

N=835

FOOD STAMPS

49%

29%

33%

39%

N=418

N=339

N=81

N=839

SOCIAL SECURITY

43%

36%

37%

40%

N=416

N=335

N=81

N=833

TANF

2%

1%

1%

2%

N=416

N=338

N=80

N=835

WIC

2%

1%

1%

1%

N=416

N=337

N=80

N=834

VA BENEFITS

2%

1%

4%

1%

HOW ABOUT HOUSING ASSISTANCE?

ETHNICITY

NON HISPANIC

BLACK / HAITIAN

HISPANIC

NON HISPANIC

WHITE / OTHER

TOTAL

N=419

N=343

N=81

N=844

RECEIVE HOUSING

ASSISTANCE?

N=405

N=336

N=75

N=817

Yes

32%

20%

20%

26%

No

68%

80%

80%

74%

TYPE OF ASSISTANCE

N=129

N=65

N=14

N=209

HOPWA/CARRFOUR

55%

62%

79%

59%

N=129

N=65

N=14

N=209

SECTION 8

29%

15%

7%

23%

N=129

N=65

N=14

N=209

PUBLIC HOUSING

5%

8%

0%

6%

N=129

N=64

N=14

N=208

OTHER

11%

16%

14%

13%

WHEN WERE THEY DIAGNOSED WITH HIV AND

WHAT IS THEIR CURRENT STATUS?

ETHNICITY

NON HISPANIC

BLACK / HAITIAN

HISPANIC

NON HISPANIC

WHITE / OTHER

TOTAL

N=419

N=343

N=81

N=843

YEAR OF DIAGNOSIS

N=416

N=342

N=81

N=840

Before 1991

18%

15%

23%

17%

1991 - 1995

24%

25%

25%

24%

1996 - 2000

26%

28%

25%

27%

2001 - 2005

25%

25%

20%

25%

2006

7%

7%

7%

7%

HIV STATUS

N=408

N=339

N=80

N=828

HIV with no symptoms

50%

62%

60%

56%

HIV with symptoms

30%

22%

15%

25%

HOW SICK ARE THEY (VIRAL LOAD)?

ETHNICITY

NON HISPANIC

BLACK / HAITIAN

HISPANIC

NON HISPANIC

WHITE / OTHER

TOTAL

N=419

N=343

N=81

N=843

M

F

M

F

M

F

TOTAL

VIRAL LOAD

N=219

N=196

N=277

N=59

N=59

N=22

N=832

Don't know/No answer

36%

40%

25%

20%

20%

18%

30%

50 or less

37%

40%

52%

49%

49%

50%

45%

51 - 400

3%

6%

5%

12%

3%

9%

5%

401 - 10,000

12%

7%

8%

12%

14%

9%

10%

10,001 - 50,000

5%

5%

4%

5%

8%

9%

5%

50,001 - 100,000

4%

1%

2%

0%

2%

0%

2%

100,001 - 500,000

1%

1%

3%

0%

2%

5%

1%

500,000+

2%

2%

0%

2%

2%

0%

1%

HOW SICK ARE THEY (CD4 COUNT)?

ETHNICITY

NON HISPANIC

BLACK / HAITIAN

HISPANIC

NON HISPANIC

WHITE / OTHER

TOTAL

N=419

N=343

N=81

N=843

M

F

M

F

M

F

TOTAL

CD4 (T-CELL) COUNT

N=219

N=196

N=277

N=59

N=59

N=22

N=832

Don't know/No answer

31%

34%

22%

22%

19%

14%

27%

Zero - 200

20%

11%

13%

10%

8%

9%

14%

201 - 350

16%

15%

18%

14%

14%

18%

16%

351 - 500

15%

14%

20%

12%

22%

14%

16%

500+

18%

26%

27%

42%

37%

45%

27%

HOW SATISFIED ARE OUR CLIENTS?

AVERAGE RYAN WHITE PART A SATISFACTION LEVELS

BY SERVICE CATEGORY

CASE

MGMT

MED

DENT/

ORAL PHARM

MNTL

HLTH

RES

SA

OUT

SA

N=131

92%

5%

3%

N=116

94%

5%

1%

N=789 N=748 N=447

N=49

N=13

Very Sat./

Satisfied

90%

91%

85%

86%

100%

Somewhat

Satisfied

6%

7%

7%

6%

0%

Dissatisfied/

Very Dissatis.

3%

2%

8%

8%

0%

WOULD OUR CLIENTS RECOMMEND THIS

AGENCY TO SOMEONE WHO IS HIV+?

AVERAGE RYAN WHITE PART A RECOMMENDATION LEVELS

BY SERVICE CATEGORY

CASE

MGMT

MED

DENT/

ORAL PHARM

MNTL

HLTH

RES

SA

OUT

SA

N=135

90%

10%

N=116

99%

1%

N=788 N=750 N=446

N=49

N=13

Yes

92%

93%

89%

84%

100%

No / Not

Sure

8%

7%

11%

16%

0%

HOW LONG DOES IT TAKE OUR CLIENTS TO

GET TO THEIR RYAN WHITE SERVICE

PROVIDERS?

AVERAGE TIME IT TAKES TO GET TO PROVIDER,

BY SERVICE CATEGORY

CASE

MGMT

MED

DENT/

ORAL

PHAR*

MENTAL

HLTH

OUT

SA

N=134

53%

28%

4%

N=113

67%

31%

2%

N=797

N=755

N=443

N=13

Less than 1

hour

78%

78%

78%

82%

Between 1

and 2 hours

20%

20%

22%

18%

More than 2

hours

2%

2%

0%

0%

MAJOR FINDINGS

+ Non-Hispanic Blacks and Haitians are the largest

group in care, with significantly lower SES levels,

greater reliance on support services and greater

HIV/AIDS impairment than Hispanics or

non-Hispanic whites.

+ Overall satisfaction levels are excellent for most

service categories. Dental / Oral Health and

Residential Substance Abuse show lowest relative

satisfaction levels.

+ Most clients can get to most providers in less than

one hour. Pharmacy and Mental Health clients

RESULTS FROM THE

RYAN WHITE PROGRAM

2006 PROVIDER SURVEY ON

BARRIERS TO COLLABORATION

May 3, 2007

Dennese Neal

Robert Ladner

Sponsored by the

Care and Treatment Committee

Miami-Dade HIV/AIDS Partnership

2121 Ponce de Leon Boulevard, Suite 250, Coral Gables, FL 33134 p (305) 445-1076 | f (305) 448-332 | www.aidsnet.org

A.

BACKGROUND & METHODOLOGY

One goal of the 2006-2008 Miami-Dade HIV/AIDS Partnership’s Comprehensive Plan is to eliminate barriers to care and treatment for Persons Living With HIV/AIDS (PLWHA), to ensure that there are no obstacles to receiving care from the providers funded through the Ryan White Title I (Part A) Program. As a Partnership standing committee, the Care and Treatment Committee is tasked with monitoring progress towards achieving this goal, including addressing ways to improve collaboration among

HIV/AIDS providers across the continuum of care. In the Comprehensive Plan’s first year, the committee conducted a survey of Title I providers, to identify service gaps and barriers to collaboration. This report is a summary of the findings from that survey.

At the July 2006 Care and Treatment meeting, committee members decided to begin the survey process by holding two focus groups, one with case managers and another with consumers of Ryan White-funded services, to discuss and identify collaboration issues and barriers to obtaining or receiving services. Results from these groups would then be used to develop survey questions.

Behavioral Science Research (BSR) conducted both of these focus groups in August 2006.

+

services that included dissatisfaction with dental services, frustration with the ADAP enrollment process, lack of support services for women, inconsistent information given and lack of knowledge on program eligibility by case managers. The experience of the PLWHA clients was that despite inter-agency agreements and a stated willingness to refer from one agency to another when client needs required it, agencies were reluctant to make the referrals and personnel in the agencies were often less informed about treatment options than the PLWHA clients who were there for treatment.

+ The case manager focus group identified specific issues and barriers to providing services, including inconsistent requirements for services, lack of cooperation among some providers, and the AIDS Drug Assistance Program (ADA) enrollment process. Case managers expressed interest in receiving training on out-of-network providers, domestic violence, disclosure, and improving customer service.

The committee reviewed survey instruments used from prior years, along with surveys used by other Ryan White EMAs. Questions of interest were gathered and then pared down to concentrate on those questions specific to evaluating the network of referrals and barriers to collaboration in client care. The survey tool was finalized in September and approved for distribution. The survey was emailed in early October to executive directors at 28 Ryan White-funded provider agencies. A total of 23 providers (82%) responded to the survey.

B.

PROVIDER RESPONDENT CHARACTERISTICS

Nine of the providers who responded to the survey (39%) were AIDS Service Organizations (ASOs), eight (35%) were health care providers - (hospitals, clinics, or Federally Qualified Health Centers [FQHCs] - and six (26%) agencies listed themselves as "other." "Other" agencies included a substance abuse treatment center, a pharmacy, a social service agency, a legal services agency, a child welfare not-for-profit agency and a not-for-profit dental clinic.

Results from the 2006 Barriers to Collaboration Survey page 3

Agency type 0% 10% 20% 30% 40% 50% FQHC HIV/AIDS Service Organization Other Health Center/Clinic Hospital

Of the 23 providers, 17 (74%) had provided HIV/AIDS-related services for 10 years or more, five (22%) had provided services for five to nine years, and one agency (4%) had provided services for less than four years.

C. SOURCES OF FUNDING

Two questions specifically requested information regarding HIV/AIDS funding sources for the agencies. While all providers (100%) received Ryan White Title I (Part A) as a source of funding for their agencies, 13 agencies (57%) self-reported that they also received Medicaid (nine with PAC waiver), 11 agencies (48%) received Medicare, 11 (48%) also received private insurance., and six agencies (43%) indicated “other sources of funding”. “Other sources” included HOPWA, federal and state grants (i.e., CDC, Florida Children’s Medical Services), private grants (i.e., United Way, Alliance for Human Service, Dade Community Foundation, Broadway Cares), state and local general revenue funds, and charity.

Sources of funding covering costs of HIV/AIDS services

4% 17% 22% 22% 26% 39% 39% 43% 48% 48% 57% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Ryan White Title IV

Ryan White Title III Medically Needy Self Pay, Patient Fees Ryan White Title II State general revenue Medicaid Waiver Other Medicare Private Insurance Medicaid Ryan White Title I

Among these funding streams, 52% reported Title I as the largest source of funding, with the balance divided among other Ryan White Program Titles, General Revenue, Medicaid, and HOPWA.

D. SERVICES

Providers were asked to review a list of HIV/AIDS services and check (1) services they provided at their agency, (2) if the service was funded by Title I and (3) if the service was funded from another source. Because a program may receive both Ryan White and non-Ryan White funding, the percentages of the providers in the funding columns may add to more than the percentage of providers providing the service. Core Ryan White Program services for FY 07-08 are indicated by asterisks (*). Please note that these are self-reports of funding sources; there may be some inaccuracies in reported funding sources columns because of confusion between agency-level funding and service-specific funding. These funding source issues will be addressed in a subsequent analysis of actual expenditures and funding sources for FY 06-07.

Agencies providing specific services to HIV/AIDS clients

and proportions of providers funded for that service

by Title I and by other sources

Services % providers providing this service % providers funded by Title I % providers funded by other sources Case management (*) 65% 57% 26% HIV/AIDS prevention/education 52% -- 35%

Counseling/mental health services (*) 48% 26% 26% HIV/AIDS counseling and testing 48% -- 44%

Outreach 48% 30% 22%

Transportation vouchers 48% 35% 17%

Safer sex /risk reduction services 43% -- 35%

Outpatient medical care (*) 39% 30% 22%

Prescription drugs (*) 35% 9% 26%

Oral health care (*) 30% 26% 9%

Treatment adherence counseling (*) 30% 4% 26%

Substance abuse treatment (*) 26% 13% 13%

Financial assistance/vouchers 22% -- 17%

STD testing and treatment 22% -- 17%

HIV/AIDS Specialty Care – Adults (*) 21% 17% 13%

Legal services 17% 4% 9%

Women’s medical care (*) 17% 9% 13%

HIV/AIDS Specialty Care – Children (*)

13% 9% 9%

Housing 13% -- 13%

Permanency planning 13% 4% 4%

Child care/day care 9% 4% 4%

Results from the 2006 Barriers to Collaboration Survey page 5

HIV/AIDS Primary Care – Children (*) 9% 4% 9% Complementary/alternative therapy 4% 0% 0% Home healthcare (*) 4% 4% 4% Insurance services (*) 4% 4% 0% Respite care 4% 4% 0% Transportation vans 4% 4% 0% Other: Optometry (*) 4% 0% 4%

Other services: Vocational 4% 0% 4%

Other: Referral to specialty care 4% 4% 0%

Other: Podiatry (*) 4% 0% 0%

D.1

Services clients need most but not provided at responding providers

Providers were asked to indicate the two services clients needed most that were not provided at the responding agency. The most common unmet need response was housing, cited by 20% of the providers in the survey, followed by substance abuse treatment (11%) and case management (9%). Note that these are not necessarily “unmet needs” of PLWHAs: many of the “client need” services not be provided by one specific agency may be available at other Ryan White-funded agencies.

Service Service

Housing 20% Testing (not specified) 2%

Substance abuse treatment 11% Dermatology 2%

Case management 9% Insurance services 2%

Mental health counseling 6% Respite care 2%

Financial assistance/Vouchers 6% Support services 2%

Food services 6% Utility assistance 2%

Medications 6% Oral health care 2%

Outpatient medical care 4% Hepatitis care 2%

Transportation assistance 4%

D.2

Difficulty accessing services for clients

Providers were asked which service they considered the most difficult for HIV/AIDS clients to access and to enumerate the reasons why the service was difficult to access. Again, housing was the top ranked hard-to-access service (47%), followed by outpatient medical care (11%). Please see chart below.

Most difficult services for HIV/AIDS clients to access

Reasons why it is difficult for clients to access particular services (from provider comments) Housing 47%

Difficult to find affordable housing. Limitations in housing market. HOPWA waitlist is a long process. Lack of agencies providing housing assistance. Housing funding is limited. Outpatient medical care 11% Hard to engage undocumented clients in medical treatment.

Specialty services are difficult to access. ADAP 4% Paperwork process is very involved.

Results from the 2006 Barriers to Collaboration Survey page 6

Most difficult services for HIV/AIDS clients to access

Reasons why it is difficult for clients to access particular services (from provider comments) Dental 4% Clients report dental work not completed because "funds run

out" midway through treatment.

Disability benefits 4% Screening and approval process is lengthy and cumbersome. Legal services 4% Only two agencies provide this service, long waits (decreased

to one agency, effective March 2007).

Prescription drugs 4% Frequent changes to medication regimen means clients have to shift pharmacies based on formulary and funding source. Transportation 4% Inability to get transit passes for PLWHAs who don't qualify

for Golden Passport or MDT Disability Pass. Utility assistance 1% Few resources cover financial assistance. Substance abuse treatment 1% Few slots available expressly for youth.

E.

CAPACITY & CHALLENGES IN PROVIDING SERVICE

As a measure of service capacity, the Ryan White-funded providers were asked: If their client

populations were to expand by 10% but there were no increases in staff or funding, would they be capable of providing service to the additional client load? Eleven agencies (49%) responded that they had the capacity to accommodate a 10% increase in clients, citing experienced staff, their anticipation of program growth, the ability to expand other services, and adequate available resources. The agencies that could handle a 10% increase in client caseload included six AIDS service organizations, one hospital, one FQHC, two health centers, and one legal services agency.

Nine agencies (39%) responded that they could not provide services if their caseload were to increase by 10% without commensurate increases in funding. Those agencies included two AIDS service

organizations, two hospitals, three health centers, one dental clinic, and one pharmacy. The remaining agencies were not able to say whether they could (or couldn't) provide services with their existing budget. The agencies that felt they did not have the capacity to see more clients with existing funding levels had the following comments about a 10% increase in caseload:

+ Clients would incur longer waits for an appointment.

+ An increase in client load would cause a financial burden for agency and the staff.

+ Agency capacity is limited because of physical space limitations.

+ Case managers are already at maximum capacity and could not handle more clients.

+ Standards of care for some services would be compromised.

E.1

Major challenges currently faced in providing services to people living with

HIV/AIDS

Providers were given a list of five potential challenges faced by agencies providing services to people living with HIV/AIDS, and were asked to indicate which challenges were significant to their agency. For those challenges that were significant, the providers were asked to explain how these challenges impact their agency and service provision. The specific challenges are outlined below.

Results from the 2006 Barriers to Collaboration Survey page 7

Challenges created by limited funding - twenty agencies responded (87%)

+ Increased caseloads for case managers

+ Inadequate funding impacts operations by encouraging overbilling to maintain service provision level, resulting in unreimbursed services and dependency on sweeps to recoup service costs

+ Inability to fill empty positions because of uncertainty about funding

+ Creates unstable system with increased staff turnover, not able to pay competitive wages or to provide good benefits to staff

+ Inability to increase services

Challenges created by HIV/AIDS clients with co-morbidities - nine agencies (39%)

+ Drug interactions with antiretroviral meds complicates treatment

+ Dually-diagnosed with Hepatitis C is more difficult to treat along with other diseases

+ Treating co-morbid clients requires additional time and effort, more staff time, higher cost per client

+ Coordination of client transportation to different locations, follow up, length of stay in different locations

+ Perinatally-infected youth developing resistance to ARVs

+ Increase in non-compliance to medication regimens

+ Psychosocial co-morbidities complicate treatment and adherence

+ Lack of short and long term nursing home care for PLWAs in non-emergency medical crisis

+ Increased need to collaborate with other providers

Challenges faced from facility limitations - eight agencies (35%)

+ Time constraints when sharing space with other clinics

+ No space for expansion; no room for necessary or additional staff

+ Not enough funds to rent additional space needed for client services

Challenges faced from staffing limitations - nine agencies (39%)

+ Not enough case managers for client load – ratio too high

+ Difficulty retaining staff because of funding fluctuations

+ Need to monitor staff hours, more hours spent with client with co-morbidities and adherence issues

+ Not able to provide clients optimum levels of service, follow up is mediocre

+ Could benefit from capacity building

Other challenges - eight agencies (35%)

+ Case managers from other agencies don’t understand particular eligibility, treatment, appointment protocols that [our agency] requires

+ Clients do not have updated reassessments, which prevents [agency] from servicing the client. This impacts continuity of care and health maintenance

+ Case managers do not understand service guidelines. Need to train case managers on different guidelines for different services and/or hold case management agencies accountable for not following these guidelines

+ The Service Delivery Information System (SDIS) and programming delays cause burdens for providers who are unable to bill accurately and timely. Information requested in reports such as

Results from the 2006 Barriers to Collaboration Survey page 8

CADR is not easily accessible or available in the SDIS

+ Multiple issues with treatment adherence, homelessness, poverty, and mental health limit the ability of clients to adhere to plans of care and to make better health care choices. Challenges keeping certain clients in care because of economic problems

+ Excessive paperwork and high caseloads

+ Difficulty in locating and obtaining adequate and appropriate housing

+ Wait time for clients to see a case manager: some clients wait over a month to get an initial appointment

+ Oral health care clients are often lost to care when referred out

F.

REFERRALS AND PROVIDERS

Providers were asked to list the most commonly made outbound referrals by staff for services at non-Ryan White-funded providers or agencies. The most common outbound referral was housing (12%), followed by Transportation ( 10%). Note that in some cases, the outbound referral target agency is another Ryan White-funded provider.

Service Agency

Housing

12%

City of Miami/HOPWA program, MD Housing agency, FEMA (rental assistance), Salvation Army shelter Transportation (bus pass, voucher) 10% Miami-Dade Transit, United Way

Food stamps 6% DCF, Florida One Stop, AFDC, Frankie Shannon Rolle Vocational (skills training) 5% Dept of Education, Dept of Vocational Rehab

Food bank 4% Pass It On Ministry

Cash/Financial assistance 3% DCF, Frankie Shannon Rolle Utility assistance 3% Community Action, St. Stephens Legal services 3% Legal services (provider not specified)

Medicaid 3% DCF

Medications 3% ADAP, GR

Social security 3% SSA

Specialty services 3% Mercy Hospital

Medical care 2% MOVERS, Economic Opportunity Family Health Center Substance abuse treatment 1% Village

HIV Testing 1% Empower U

Medical case management 1% Children’s Medical Services Clothing assistance 1% SoBe Clothing Thriftshop

PAC Waiver 1% (no agency specified)

Extractions and fillings (dental) 1% (no agency specified) Children and Families 1% Dept. of Education Furniture & Clothing 1% Salvation Army

Case management 1% SFAN

Results from the 2006 Barriers to Collaboration Survey page 9

A set of statements in the survey addressed the network of referrals and collaborations among Ryan White provider agencies. Provider respondents were asked to review a list of Ryan White providers and

indicate:

(A) If they received client referrals from any of these providers; (B) If they referred clients to any of these providers;

(C) If any barriers existed in making referrals to these providers; and (D) If a formal referral agreement existed with these providers.

Responses to this table indicate high levels of collaboration among provider agencies in the Ryan White provider network.

+ As expected, agencies providing case management services made the most outbound referrals (i.e., more agencies reported receiving referrals from these providers than from other providers). Provider agencies identified as making the most referrals were: Empower U (78% of other agencies reported receiving referrals from this provider); The Village (74%); South Florida AIDS Network (SFAN) and Mercy (both with 65%); and Christ Crusaders (61%).

+ Provider agencies receiving the highest number of referrals (i.e., most frequently listed as agencies to which referrals were made) were: Mercy Hospital (83%); Dr. Alfonso (75%); Food for Life (70%); Legal Services (70%); and SFAN (70%).

Overall, the existence of barriers to referrals was low. Only seven agencies were cited as having referral problems, and only two agencies (Mercy Hospital and Dr. Alfonso) had more than one agency reporting referral problems. These two providers were also the most frequently referred-to of all agencies in the study.

All agencies indicated having some type of formal agreements with other Ryan White providers. The highest percentage of agreements reported were with Mercy Hospital, Miami Beach Community Health Center, SFAN and Empower U.

A B C D PROVIDER % of agencies receiving referrals from this provider % of agencies referring clients to this provider % of agencies reporting barriers to referral with this agency % of agencies reporting referral agreements with this agency

AIDS Healthcare Foundation 13% 22% 0% 4%

Alfonso, Rafael, D.D.S 22% 74% 9% 22%

Better Way of Miami 22% 35% 0% 17%

Borinquen Health Care Center 57% 65% 4% 35%

Care Resource 57% 52% 0% 44%

Center for Haitian Studies 26% 22% 0% 17%

Center for Positive Connections 48% 48% 0% 39%

Center for Information and Orientation 26% 17% 0% 13%

Children’s Home Society 13% 13% 0% 22%

Results from the 2006 Barriers to Collaboration Survey page 10

A B C D PROVIDER % of agencies receiving referrals from this provider % of agencies referring clients to this provider % of agencies reporting barriers to referral with this agency % of agencies reporting referral agreements with this agency

Community Case Management 52% 35% 0% 17%

Community Health of South Dade (CHI) 39% 35% 0% 22%

Douglas Gardens CMH Center 35% 52% 0% 26%

Economic Opportunity Family Health

Center 48% 48% 0% 30%

Empower U 78% 61% 0% 48%

Food for Life Network 22% 70% 0% 39%

Helen B. Bentley Family Health Center 48% 52% 4% 22%

HIV Education and Law Project 13% 30% 0% 17%

Jewish Community Services of S Florida 22% 35% 0% 9%

Legal Services of Greater Miami 17% 70% 0% 22%

Mercy Hospital 65% 83% 9% 56%

Miami Beach Community Health Center 39% 61% 0% 48%

M.O.V.E.R.S 61% 35% 0% 22%

PHT/Liberty City 39% 30% 0% 26%

PHT/North Dade Health Center 35% 39% 4% 22%

PHT/PET Center 57% 65% 0% 43%

PHT/SFAN 65% 70% 4% 48%

Union Positiva 39% 35% 0% 26%

UM Comprehensive AIDS Program 35% 48% 0% 26%

Village South 74% 65% 4% 26%

F.2 Provider

responsiveness

Respondents were asked to indicate which providers were most responsive to referrals from their agency. Mercy Hospital was selected as the provider most responsive to client referrals because of staff

responsiveness to inquiries. Miami Beach, MOVERS and SFAN also received praise for their willingness to cooperate with others in providing service to clients.

Providers MOST responsive to client referrals from your agency Reasons

Mercy 17% Staff knowledgeable, professional & dependable. Work with case managers.

Pharmacy provides adequate service, prompt response to request or questions. Very sensitive to clients needs.

Results from the 2006 Barriers to Collaboration Survey page 11

Referrals for specialty care handled in a prompt manner. Great follow-up with requested information.

Miami Beach Community Health Center

9% MBCHC schedules dental appointments quickly.

Commitment to provide community health and mental health to the public sector of Miami Beach

MOVERS 6% MOVERS very responsive to taking walk-ins and making client appointments within a week of screening and intake.

SFAN 6% Staff is committed to seeing clients receive services even though short staffed. SFAN’s program size makes services easy to access for clients with limited resources.

Care Resource 4% Care Resource responds to individual client needs, provides quality services, and responds in a timely manner.

Food for Life 4% No waitlist HIV Education and

Law Project, Inc.

4% Equally responsive Empower U 4% (no reasons given) Alfonso, Rafael, DDS 4% (no reasons given) All providers 4% (no reasons given)

St. Stephen’s Ministry 4% St. Stephen’s Ministry accommodates requests for service for all clients- no one denied service and receives an expedient reply. Union Positiva 2% Referrals processed in a timely manner. Great follow-up with

requested information.

The Village South 2% Communication with an actual person. Messages and calls returned. When asked which agencies were least responsive to outbound referrals, only 20% of the providers responded. The data from those agencies is below:

Providers LEAST responsive to client referrals from your agency Reasons

Mercy (includes Special Immunology Services)

17%

Pharmacy has bad customer service. Clients complain staff is rude. More obstacles attempting to access medications available through ADAP for clients.

SIS does not respond in a timely manner, difficult to schedule appointments and follow through is poor.

Clients’ appointments are cancelled while client is there due to paperwork.

Medical clinic has a waitlist.

St. Luke's 4%

St. Luke’s requires clients to have a 30 day supply of HAART medications before entering into residential treatment. Most clients referred to this agency are actively using addicts who are non-compliant to HAART treatment or have not been prescribed medications.

Dr. Alfonso 4%

Staff responsive, but wait time for appointments can be extensive. Clients state his office does not return calls and reschedules appointments frequently.

Results from the 2006 Barriers to Collaboration Survey page 12

G. THE RYAN WHITE PROGRAM SERVICE DELIVERY SYSTEM

+ Thirteen provider agencies (56%) responded YES: these included six ASOs, one hospital, one FQHC, one health center and four “Other”.

+ Nine provider agencies (39%) responded responded NO: these included three ASOs, two hospitals [note that both UM and JMH responded individually], three health centers, and one legal service agency. Comments from those providers who answered negatively centered on frustration with the process for enrolling clients into care, lack of support for youth, long waitlists, and social and economic issues outside the purview of most agencies.

Specific comments (in the words of the providers) on problems with the existing HIV/AIDS service system included:

ƒ Delays with enrollments - Depends upon service. Case management enrollment delays impact access to medications. Intake process is lengthy and cumbersome for clients. “Too much paperwork” (despite an understanding that assessments and documentation are required).

ƒ Lack of services for youth - Financial support for housing, transportation, education expenses, and substance abuse treatment lacking for youth. More funding and programs need to be developed, especially around children, education and prevention.

ƒ Lack of housing – The problem of insufficient safe, affordable and clean housing is critical. Not enough housing available to address the needs of the HIV/AIDS population. Housing instability is a major obstacle to treatment adherence and healthy living.

ƒ Social and economic difficulties – Some HIV-infected clients have serious economic and social difficulties (i.e. homeless, no family support, not eating properly, no proper hygiene). Most clients are focused on solving these issues before taking care of their health, which is

deteriorating. Survival issues take precedence over health care; lack of economic support leads to delayed entry to care, more serious illness and higher costs of treatment.

ƒ Lack of hospice - A problem when a client is in the final stages of disease and cannot obtain hospice assistance because there is no residential hospice available.

Specific suggestions (in the words of the providers) for improving the HIV/AIDS service system included:

Assessment

ƒ Assessment or consent features in SDIS should not block agencies from billing services for clients who have all eligibility documentation collected.

ƒ Decrease paperwork or streamline the assessment tool Improving access to clients

ƒ Some services are scattered for clients. They should not need to travel far for pharmacy and some specialist services. Vocational services specific to the population need to be tailored to meet the medical needs and circumstances of clients.

Results from the 2006 Barriers to Collaboration Survey page 13

Office of Strategic Business Management’s (OSBM) Role

ƒ Expand the role of the Ryan White Program with OSBM so that OSBM staff can access

additional funding (grants, awards) to complement the care already provided to the community by Ryan White. The development of this resource would enhance programs at the community level as well as at the individual agency level. Consider a comprehensive HIV/AIDS office for Miami Dade County that handles Ryan White in collaboration with the Miami Dade County Health Department.

Training

ƒ Conduct trainings for Ryan White-funded agency staff on referral process including required documentation; refresher meetings highlighting changes in SDIS, RW policies and introduction of case management ideas and experiences to help improve program(s).

ƒ More training for case managers on documentation required by agencies to which they refer clients.

Building collaborative relationships

ƒ All HIV providers need to continue working together to enhance collaboration and to maximize limited resources.

ƒ Need for more providers in the community to provide service. Make the pay rate more attractive.

ƒ Expansion of services to include children, education and prevention.

ƒ Collaboration with the Social Security office that would expedite the approval of benefits for a client (e.g. the # of hospitalizations for AIDS-related illnesses within a six month period; resistance to medication therapy; etc.)

ƒ Streamline process for obtaining disability assistance for clients.

ƒ Ryan White case managers need to improve communication with [substance abuse] residential programs. The program is not always aware of what the outside case manager has arranged. Case managers need to improve their responsiveness to [substance abuse] residential programs during the discharge planning process: they have poor follow through in assisting with discharge planning.

Expansion of case management services

ƒ Expand case management services by having case management at clinic sites, so that they are more involved with clinical personnel, thus enhancing communication between case management and medical providers. With separate systems, there’s little communication between providers and case managers. Maybe case managers from various agencies could be assigned to specific clinics.

ƒ Case managers should be held more ‘accountable’ for doing their job completely. Example, not using the formulary, calling pharmacy to see if drugs are covered, sending clients to pharmacy with referrals not completed, resulting in the client having to return to them or pharmacy calling for a complete and accurate referral.

Substance abuse residential

ƒ Substance abuse residential 1) determining reasonable length of stay for clients 2) alternate funding sources available at Federal, State and local level 3) enhance collaboration and maximize resources.

Results from the 2006 Barriers to Collaboration Survey page 14

Housing

ƒ More resources are need to adequately and appropriately house clients in a timely manner.

ƒ Increase decent, affordable housing for low-income people. Provide easy access to places where clients can have receive meals during the day. Create more job opportunities for ex-offenders and clients willing to work part-time.

ƒ

H.

SUMMARY AND DISCUSSION

The findings from this 2006 survey show the Miami-Dade Ryan White Program has a working network of service providers for those services that can be provided under Ryan White Program funding. There are scattered instances of problems with referrals, but these are correlated with the volume of referrals directed to specific providers. There is some evidence of inter-program criticism and responsibility shifting, not unexpected but also not widespread. In general, the referral system appears to be functioning well, and there appear to be no significant system-wide barriers to collaboration or obstacles to referral. The most widespread issue – and one which is a serious concern to representatives of many provider agencies in Miami-Dade County – is the economic burden faced by PLWHA clients who may be

receiving adequate health care but who are living on the streets, or who have other serious life issues that preoccupy them and make HIV/AIDS care more difficult and expensive. Chief among these concerns is housing, the major identified concern and the service to which the majority of extramural referrals are directed. Other survival issues such as food, utility costs, legal services (including help for persons who are undocumented), mental illness and employment assistance are frequently mentioned, but do not have the sense of urgency that housing assistance has. In the opinions of the providers, survival issues complicate care.

Even as the PLWHA population in Miami-Dade County continues to grow, both in sheer numbers and in economic neediness, Ryan White Program funding continues to shift away from economic support services for PLWHAs. As this shift in service prioritization continues, it will not be possible to simply re-direct Ryan White funding as a response to very real needs within the HIV/AIDS community. At the very least, Ryan White case managers must, therefore, be highly trained and pro-active in identifying and accessing economic and social support services outside the Ryan White funding stream (and outside the purviews of their own agencies) for their clients in care.

There are other areas of concern identified in the data in this report, and it is important for the Care and Treatment Committee to review the report in detail, to integrate these findings into the comprehensive annual Needs Assessment process in the summer of 2007.

Miami-Dade County HIV/AIDS Partnership

Care and Treatment Committee

Needs Assessment

Providers’ Perspectives on the Need for

Expansion of Services and Outreach Hours

Phone Survey Results

June 2007

This report was funded entirely by the Ryan White HIV/AIDS Treatment Modernization Act of 2006 from the Health Resources and Services Administration through the Miami-Dade County Office of Strategic Business Management.

Representatives from Ryan White Part A funded agencies participated in a phone survey aimed at gaining their perspective on whether there was a need to expand services beyond traditional 8:00 a.m. - 5:00 p.m. operating hours.

The survey, conducted by Behavioral Science Research, asked providers about their current operating hours, the types of services they provide, requests they have received for services outside of current operating hours, and their perspective on whether their agency needed to expand service hours (Please note that for the purpose of this report “outside current operating hours” refers to services available on weekdays after 5:00 p.m. and/or on Saturdays). Providers were also asked to note whether or not they had the capacity, in terms of staff and funding, to expand their services.

The table below provides a list of the providers who participated in this survey. Some agencies provide both outreach and other services (i.e., medical care, case management, etc.), others provide outreach services only, and some provide services but not outreach. For the purpose of this report, results are organized in two sections in order to distinguish providers’ responses regarding the need for expanded services other than outreach and outreach services.

Agency Provider Services Other than Outreach

Provider of Outreach Only Provider of Both Outreach and Other Services AIDS Healthcare Foundation X

Better Way of Miami X

Borinquen Health Care Center

X

The Center for Positive Connection

X Economic Opportunity

Family Health Center

X

Food for Life Network X

Mercy Hospital X

Miami Beach Community Health Center

X

PHT Liberty City X

PHT North Dade Health Center

X

PHT PET Center X

The Village South X

Center for Haitian Studies X

Community Case Management X Care Resource X Community Health of South Dade X Empower U X

Helen B. Bentley Family Health Center X M.O.V.E.R.S X PHT SFAN X University of Miami Comprehensive AIDS Program X

Providers of Services N = 20

Hours of Operation

• 14 out of 19 service providers’ normal hours of operation include some service hours after 5:00 p.m.

o Services are provided after 5:00 p.m. on a regular basis ranging from once a week to five days a week.

o Collective hours outside of normal operating hours range from 5:30 p.m. – 9:00 p.m.

• Two providers have a physician on-call 24 hours a day, 7 days a week.

• Seven providers have regular weekend hours. Of those, three agencies provide regular services one weekend day per week; three provide weekend services less than once a month; one agency provides services by appointment every Saturday between 8:00 a.m.- 2:00 p.m. The remaining 13 agencies do not provide any regular weekend hours. Types of Services Provided

• The types of services provided after hours are:

o Case management.

o HIV counseling and testing.

o Primary care and OB/GYN services.

o Delivery and pick up of clients.

ƒ Two providers stated that all agency services were available after 5:00 p.m.

Requests for Additional Services Outside of Normal Operating Hours

• Ten providers have not received any requests for services outside their normal operating hours. Five providers have received occasional requests for services outside normal operating hours (these include emergency care and medical services).

• The types of services that clients request outside of normal operating hours are varied and include:

o Case management.

o Substance abuse treatment.

o Medical services.

o Crisis mental health.

o STD testing.

o Prescription medications.