Improving Linkage and Retention in HIV Care: Insights from Community Health Workers

our agenda for the presentation is to go
through a few learning objectives cover the community health worker project and
its goals I’ll introduce you to our two main speakers today we’ll talk about
models of care and activities in the field from our CHW presenter and we’re
really excited to have a question and answer session at the end so the goals
of today’s webinar are to provide you all with a brief overview of this
community health worker project and the goals of project activities to describe
two models of care where community health workers have been integrated into
the care team at 2 Ryan White hiv/aids program funded medical provider sites
that are participating in the project to provide current examples of the job
roles and functions of community health workers by community health workers
themselves talking about their work experiences in the field and as I
mentioned to provide a time for questions and answers from all of you
attending today so at this time I to provide a brief overview of the
community health worker initiative on which this webinar is based as I
mentioned this is a cooperative agreement funded through the minority
aids initiative fund of the Secretary of Health and Human Services it’s
administered by the health resources and Services Administration hiv/aids Bureau
in the division of community hiv/aids programs and this three-year project is
funded by the Bureau in Boston University is funded as the technical
assistance and evaluation center for the project the four goals
this initiative are to increase the utilization of community health workers
in order to strengthen the healthcare workforce improve access to health care
and health outcomes for people living with HIV especially race racial and
ethnic minority individuals to assist Ryan White hiv/aids program funded
medical providers with the support they need to integrate community health
workers into their multidisciplinary teams to develop tools materials and
resources to help increase the use of community health workers in HIV care
settings and finally to evaluate the effectiveness of community health
workers on linkage and retention in HIV care and to assess community health
worker models that are implemented by Ryan White hiv/aids program funded
providers as the funded technical assistance and evaluation center for
this initiative the team at the Center for innovation in social work and health
at Boston University employed a competitive process to select the ten
sites that we were working with on this initiative this map shows the ten funded
sites that we’ve been working with on the project and as you can see from the
map the sites are scattered all across the country the ten funded sites are
about 70% urban and 30% rural and they’re focused in areas that serve a
high proportion of racial and ethnic minorities living with HIV and these
areas also comprise locations where retention and viral suppression rates
are much lower than the US average this slide shows a brief overview of the
initiative later in the year we’ll be conducting a more in-depth webinar on
the project lessons learned emerging best practices highlights from to
training curriculum we are developing and other information about
implementation and since you’re registered for this
webinar we will be automatically notifying you of that webinar and other
future webinars using your information and be sure to be on the lookout for her
supper announcements for future webinars as well so in general for this project
we’re interested in developing an effective model that successfully
integrates community health workers into HIV
multidisciplinary treatment teams we’re providing the ten CHW sub-award sites
with training and direct technical assistance on implementing community
health worker programs we also created a space for peer to peer learning that on
the project which we’re calling learning sessions and we’re conducting a
multi-site evaluation to assess the effectiveness of project activities
including the CHW program activities at each sub award site later in the summer
we’ll be starting to disseminate our main deliverables including a community
health worker implementation guide and as I mentioned to training curriculum now it’s my pleasure to introduce our
two community health worker speakers who have been participating in the
initiative the first presenter is Peter Williams a Support Specialists CHW at
East Carolina University adult specialty care clinic in Greenville North Carolina
and our second presenter is Savi Bailey a community health worker at Legacy
Community Health in Houston Texas so I’d love to welcome Peter and Savi and
invite them at this time to tell you about a little bit about
their agency Peter why don’t you start us off
thank you very much Allison good afternoon ladies and gentlemen my name
is Peter Williams empowered as a community health worker Support
Specialist at ECU adult specialty care clinic located in Greenville North
Carolina it is my honor and privilege to share insights with all the attendees on
the webinar today adult specialty care accommodate general infectious disease
care hospital follow-up clinical trials we have an on-site lab and infusion
center as well as an international travel clinic our adult specialty care
clinic also implements an ID fellowship program serving about 600 Ryan White
eligible clients from 30 rural counties on the Eastern Carolina coastline
working with the professional staff of roughly 50 members including medical
providers behavioral health counselors a nutritionist
pharmd nursing and medical case managers I am one of three community health
workers empowered in the retention of care by navigating HIV consumers through
chronic illness quality health care supportive services as you can see from
our state view this map shows the counties in North Carolina that are
served by the ECU adult specialty care clinic the area we serve is very rural
with some individuals traveling over one hour to appointment as a result
providing services to the rural community presents unique challenges in
reaching our target population over this vast region my esteemed colleague Savi will now
introduce you to legacy community healthcare thank you so much Peter
hi everyone I’m Savi and I work as a CHW at Legacy Community Health in FQHC in
Houston Texas we serve many clients as you can see on the slide both Ryan white
and nan ryan white clients we have over 25 sites across Houston and the
surrounding area though our HIV health care is focused at two of our clinic
sites our area Houston is mostly urban but because it’s so spread out with the
city structure many of our clients travel pretty far distances to get to us
with a mmm sometimes dysfunctional public transportation system or a staff
of over a thousand employees that do many of the services that you see here
on this slide as you can tell we extend far beyond just HIV medical care which
allows our clients to come in for a variety of needs all at once I follow
under the public health department where I’m one of over about ten CHWs but I’m
the only one working solely with clients who are HIV positive and struggling to
stay in medical care and the only one on this project some of our other CHWs work
in outreach education or STD testing which I’ll touch on in a later slide
back to you now Allison thanks so much Peter and Savi for that information
about each of your agencies let’s talk about your CHW program next
Peter Thank You Allison here at East Carolina University community outreach
and support services are the fundamental building blocks of our health care team
approach as you can see by the diagram the client is at the center of numerous
services provided in the Ryan White program I will briefly walk you through
the model and talk about the points of care in our program which is set in
motion with the IV provider scheduled in clinic every client being assigned
we’ll healthcare provider completing the intake process
we’re upon a dedicated medical case manager conducts an assessment to
evaluate barriers to care with behavioral health services which screams
for mental health and substance abuse disorders through the HIV care continuum
is linked with the team medical case manager who is staffed with the provider
in the clinic following the assessment of the patient’s Ryan White eligibility
type of insurance coverage proof of income prescription assistance program
in collaboration with forum D may be required our client is then assigned by
a supervisor based on the agency criteria to the CHW completing the
circle of client care in our multidisciplinary team model the tools
of motivational interviewing trauma-informed care and client
interventions coupled with home visits create a concrete foundation in
assessing stigma ambivalent and social determinants of health for our consumers
the CHW has the capacity to link clients to multiple resources due to the lack of
transportation for example Social Security office Salvation Army social
service food banks optical and dental and other referrals ambulatory services
support specialists advocating through the communication of a client’s
deficient coping skills becomes a buffer for the low literacy level of the
consumers found in some of the rural counties we serve savvy would you please
share legacies model absolutely so in discussing the CHW program at
legacy we are similar to ECU regarding in their model regarding different
positions working together with the client I like to think of it as a bridge
however we’re different from ECU and how we obtain our clients for our program
I take all clients that are referred to me but in addition I also created most
of my caseload by seeking out clients through our electronic medical record
system or our EMR with many departments all potentially working with a client on
multiple health issues so much central things we’ve had to keep in mind our
role distinction and communication as the key to being able to all work
together as you can see from this model on the slide my referrals come from
about five sources as I said initially I was finding my clients through the EMR
by specifically searching for clients that had a large number of no-shows in
the past six months or a year or ones that were in care but struggling to stay
virally suppressed however as the program grew the case managers starting
work started referring clients to me who are having trouble with their funding
sources expiring or they just needed more concentrated time for education or
referrals or assistance things like that so I started to help get these clients
qualified for Ryan White and back in care and then would transition them back
to the case manager I also started receiving referrals from our service
linkage workers who are based out of the case management or Social Services
Department they do home visits and they work with clients who are struggling
today and care similar to me but they’re restricted to working with clients whose
Ryan White is unexpired so they would refer clients to me who are non Ryan
White I could then get them into the clinics get them back on their funding
source and then work with the service linkage worker if they still needed a
home visit another one on this slide that you’ll see is M Society this is
another one of my referral sources there a men’s empowerment group that operates
out of a community center that’s based within legacy I mean it’s where my
office is they will sometimes have clients come in for events or STD
testing who they’ll group conversate and identify as being out of care and
wanting to be linked back in and they’ll transfer them to me as clients lastly as
I mentioned we have a lot of CHWs in our departments some of them do STD testing
and they’ll occasionally also identify clients who maybe are coming in for
syphilis testing and then through the conversation to find out they’re out of
care for HIV care and want to get back in so again they’ll just connect them to
me so I’m working with clients that are not newly diagnosed they’re ones that
just for some reason or another are out of care through these five systems I’ve
really been able to build up my caseload and I now have over 100 clients back to
you Allison thanks again Peter and Savi now that we’ve heard a little about your
organization and the CHW programs that your organization’s are implementing
let’s spend some time hearing about what you do on a daily basis as a CHW Peter
here we go Allison our team model promotes a weekly huddle with the team
supervisor and all the CHWs we then case conference our client barriers while
addressing definitive alternative resolutions the bedrock of our outreach
begins with assessing our client on their turf and in their space having the
flexibility of meeting clients say in a library in a park a local eatery the
conference room could be in a library it may be here at the clinic we can also go
to the residence home for that home visit but ultimately we’re looking for a
safe space to have that truly one-on-one courageous conversation every client is
simply not always transparent in a clinical setting where this pragmatic
procedure has proven to architect this consumer relationship with our
independent client as well as strengthen community partnerships through
motivational interviewing tech weeks including coaching emotional
support and trauma-informed care the CHW analyzes the client chronic illness
knowledgebase and will administer educational modules such as HIV
one-on-one helping the client to communicate with the health care
provider we have a module to help understanding what is the cd4 count the
viral load opportunistic infections sexually transmitted infections we have
a course on understanding HIV medication and the importance of adherence we teach
our customers goal-setting and lastly we have an educational module for social
support and disclosure where they are applicable for the consumer
interventions the CHW is routinely assess our clients based on a three to
six month benchmark window with the supervisor for the transition of a
modified intensity level where a client is either self-managed moderate or at an
intensive level the adult specialty care houses three dedicated CHWs all
supporting HIV whereby the supportive services and special projects range from
transportation services via Medicaid gas vouchers bus passes taxi cabs as well as
having a clinic band for scheduled provider visits and to our food pantry
managing over roughly 55 appointments ridership transactions that are
coordinated monthly in conjunction with various provider appointments as the
adult specialty care clinic caseload dictate another designated CHW
coordinates target housing as the adult specialty care operates as a referral
agent and facilitates quality improvement consumer training as a
special project in addition to each one of us executing a calibrated caseload in
which the individual client service is documented through the electronic
medical record as well as the care where system our adult specialty care has a
life skill support group which meets every second Wednesday of the month at
our clinic with the with the consumer input and education via Lunch and Learn
campaigns which strengthen the fabric of people living with HIV in the rural
communities that we serve we have created a life skills support dot or
website to educate and inform consumers by providing more visibility of services
offered in our region 10 network as a CHW our consumer is passionately
empowered for the self-management and self-advocacy in maintaining quality
health care outcomes for the HIV chronic illness disease spectrum I’d like to now
turn it over to Savi to share her experiences at Legacy thank you Peter
as Peter was kind of saying at the end my role and I think Peter would agree
completely with this is that as a CHW our role is to support clients and get
them back to a place where they’re able to advocate for their own needs
unlike ACU though we don’t do this through Huddle’s we don’t do Huddle’s we
work I work specifically with providers and case managers when needed at the
clinic or with clients at the clinic I also operate out of our drop-in center
as I mentioned but much of my time is spent building rapport
with clients over the phone before they ever even come back into the clinic so I
don’t do have visits or community visits currently but it’s something we’re
moving towards in our department once we can get the protocol down much of what I
do is connecting clients with the right resources of the right folks to connect
with as Peter mentioned they have a transportation band we don’t have that
but we can provide bus passes for our clients we also don’t do housing out of
our case management team but we would refer externally for that besides that
though our more unique part of our organization is how many services are
housed under our umbrella much of my position involves coordinating clients
internal referrals for other services because these are needs that are getting
in the way of their care and their reasons they’re not coming back in so I
had one client who was really struggling with his health and fitness and eating
and that was affecting how he was taking his medication and really being able to
keep himself healthy and I was able to refer him directly to our in-house
nutritionist and we have a gym on-site at his medical visit so that he could do
all of those things in the same place and all of this works together to really
build rapport with clients and help them solve some of their needs education wise
a lot of what I do is unofficial education I have done some more official
education curriculum sessions with clients around medication adherence and
lab results but I think the majority of my time is taught educating clients
about how to get their medication what systems are in place to help them pay
for their medical care and the community resources they can utilize these three
things are some of the main reasons my clients list for why they’re struggling
to stay in care I get a lot of my community information through the Ryan
White Planning Council where I serve on the Quality Improvement Committee here
in Houston differently again from ECU I never have an end date with my clients
and each of them I’m in contact with depending on their need some need weekly
phone calls or more depending on what’s going on in their lives and then some
just need a call every month or two maybe they need a reminder or just to
feel like they’re connected to something so that’s how I’m currently operating
with my caseload that to Alison thanks again for all this great
information before we open for questions and some more discussion I want to allow
Peter and Savi to each share a brief client story with you Peter can you
start us off again absolutely Alison I wanted to share as I
was briefly looking over some of the questions and I didn’t know exactly how
we were going to answer but someone asked is you equal is usual you
incorporated in the client education and this fell at what point and who is
communicating the message and how that message being communicated I did want to
add when we go over HIV 101 and we take the client through the basis we do
educate them about the u equals u campaign so it is done upfront with the
client so that they do understand um a comprehensive understanding of the
chronic illness and that our goal and achieving viral load suppression on six
months and greater your you’re no longer infectious you’re not transferring the
virus to anyone through contact so Thank You Allison for allowing me that moment
I’m very excited to share this success story it begins with a 57 year old
african-american male diagnosed in 2005 with a living in a homeless shelter in
Washington North Carolina while rien gauging in care he consented to our CHW
initiative in November of 2017 the labs at the beginning of 2018 there was a
viral load of about a hundred and fifty nine thousand and the client cd4 count
was four single digits for the barriers of care were no direct telephone
communication unstable housing poured lack of transportation substance use
disorder and non adherence to antiretroviral therapy the behavioral
health services determined that our client was incapable of performing
activities of daily living during february of 2018 our clients mother
informed the CHW that the patient had traveled to a neighboring town away from
where they were and was arrested for vagrancy and was currently out on bond
our clients mother is living in her eighties under the duress with the
hardship of being unable to care for her son under all the challenges housing
assistance for the client was the major priority exploring all of the available
options to case conferencing and teamwork and about March of 2018 our
client was placed in an adult living facility in New Bern North Carolina and
as of May of 2018 our client had achieved viral load suppression and this
client cd4 count had now at least reached into two digits of 27 so you can
understand that his immune system had truly been compromised as a CHW building
the relationship with the client has been extended to close communication
with the mother of allocation for flexible effective boundaries of care
our clients as of a visit this year in January is Bill viral load suppressed
and the cd4 count is now at a hundred and sixty two he’s currently working odd
jobs signing himself in and out of the adult living facility yielding personal
income while gaining weight Maine a healthy relationship with his family
and a very proud mother the relationship building is the very core of what keeps
our client engaged in their care because you have to remember this was a homeless
client no communication with telephone and his mother desperately trying not to
lose her son our client under the guidance of behavioral health services
is pursuing nicotine dependence treatment and if you heard this story
part of the barriers were substance use disorder his follow up provider visit
just this past April last month resulted in sustainable viral load suppression
and a 205 cd4 count at the CHW these social determinants of health were the
insurmountable challenge for our client success in about a year’s time frame
this client turned his situation around into sustaining viral load suppression
and I can just tell you I am very very pleased for the turnaround and I’m very
very grateful for the work that was placed into this client living with HIV
savvy you have the podium for a legacy CHW success story thank you Peter
so my story is a little bit different because my client is still struggling
with care and his medication he’s about 30 years old and was diagnosed with HIV
at least five years ago I started working with him in February of last
year when he had not been in for a medical appointment with us since 2014
or 2015 when I was finally able to reach him by phone I found out that one of the
reasons he wasn’t in care was because his financial situation had changed he
had started only working barely part-time and was going to school
full-time and so we didn’t really know what
options were available to him he had insurance but was having trouble paying
the bill for it legacy offers financial assistance
programs that help clients pay for their premiums on insurance so I was able to
get him in on that assistance and then to also get him on the Ryan White and a
DAP medication assistance to help with anything that his insurance wouldn’t
cover at this time he no longer has insurance so his Ryan White and his atap
have been vital to pay for his medical visits his labs his medication when I
first started working with him he told me that he can’t swallow pills so I
looked back through all of his medical records and visits and he had never told
his doctor this and directly from his last visit it was reported that he said
excellence and excellent appearance with HIV meds with no issues in understanding
because medication or responding to it so through discussions with him it
turned out that ever since he was a child he hadn’t been able to take pills
and instead he just sucks on them until they dissolve which for some medications
that’s totally fine but his HIV medication was time-release capsules
which means if he was swallowing it he was swallowing incorrect amounts of his
medication it wasn’t dissolving correctly and then wasn’t being absorbed
properly in the body this was also making him very sick and he was vomiting
pretty regularly which then also made it so his medication wasn’t being absorbed
but in his mind he was taking his medication which is why he kept
reporting that what followed for me was work that required hours and hours and
hours of time to assist him so first me I worked with him on some
swallowing techniques to try to see if it was something we could get past when
that didn’t work I was regularly working with his provider and the case manager
to keep them informed and who then tried to work to address medication changes so
we had to get our pharmacy involved to make sure there were liquid versions of
all of his medications and then we had to get medication assistance programs
involved to help him pay for it at the same time he was in school and working
and he kept missing appointments because in his mind he was fine he was taking
his medication so there was this gap further and further when his labs were
being done so when we finally got him back in got
him on liquid meds and got him to do a lab it was clear that the last five
years incorrectly taking his medication was really starting to show in his labs
and to keep in mind when we first worked with him in 2014 his cd4 was only at 296
so his numbers were all ready to begin with very low so for the past year I
think I was trying to figure out how many times I maybe have have spoken to
him I think I’ve spoken to him on the phone at least 50 times he’s been
hospitalized a few times in this past year and so I visited visited him in the
hospital twice in this past year I’ve changed his provider once so that we
could get him on a provider that had a more open schedule for his flexibility
I’ve worked with him to update his Ryan White and his atap as they expiry yearly
I’ve also worked with him to help him disclose to his mother about his
diagnosis because he hadn’t told her yet he switched medications at least three
times in the past year at my best guess I’ve probably spent ten times the amount
of time on his case and I have with any of my other clients and they’re pretty
difficult clients to begin with so while this isn’t the best success story
because he’s still hospitalized he still has trouble with his medications even
his liquid ones because he got pretty used to vomiting and still sometimes
does that and and doesn’t quite understand um he does keep coming back
to us and he’s calling now to cancel any appointments he never no shows he’ll
schedule his hospital discharge directly from the hospital he won’t call ahead to
get a wheelchair if he’s feeling weak that day and so while he’s still
struggling he’s really starting to advocate for himself and so it’s clear
through through this past year working with him that a provider or case manager
don’t necessarily have this kind of time to put in with client and it we would
have maybe had some more success sooner if if this had started sooner but either
way it’s clear not the rapport between the two of us is super important and
it’s got him to really trust the clinic and feel like he can come in and
advocate for himself so my hope is that with more visits we’ll see him doing
better and better and that this program has really been very
important for his life and his health thanks so much for those really valuable
and important stories so we want to thank our partners and colleagues for
their help and support throughout the initiative and also on this webinar
today and starting with our hersa hab project project Officer Brian
Fitzsimmons I want to extend our thanks to the ten
Ryan wide provider sites that are working with us on this initiative as
listed here and finally I want to say a special thank you to my group at the
Center for innovation in social work on health Linda who you met briefly at the
beginning of the webinar and my colleagues especially Rachel and Maria
who are working behind the scenes with us today so now we’ll spend some time we have a
good 20 minutes to spend some time on questions and answers as we mentioned
before please try to use the Q&A function to ask questions we’ll answer
as many as we can for those questions that we are not able to answer during
the time we have left we will be making every effort to answer them offline and
sending out a document of questions and answers to all participants of the
webinar today that question and answer document will also be posted on our
website and on target HIV along with the slides in the recording of today’s
webinar so we have quite a few questions that have been answered I’m going to try
to start going through them for Savi and Peter so starting with one that Peter
already addressed we just wanted to give you an opportunity to to answer if you
had any information savvy about whether u equals U is incorporated into client
education and if so what does that look like sure so I think similar to Peter
that’s kind incorporated throughout the whole
process I think it varies depending on the client because some of my clients
are really aware of this information it’s not necessarily the education about
HIV it’s more that they have barriers in their lives that are separate from HIV
so it may be that someone’s really aware of HIV and you equals you and all of
that but maybe they’re having trouble with their housing they don’t have
stable housing and so they’re not taking their medication because they don’t have
a safe place to do it or a safe time um but definitely you equals you is
something that I will always talk with with clients initially to try to kind of
find out what their understanding is on HIV to get a baseline for what education
they may or may not need thanks savy so Mahara asked our program does everything
that you all have mentioned and they’re also a substance abuse treatment center
and many of their hiv-positive clients have substance abuse concerns do either
one of you all refer clients to substance abuse treatment
Alyson I’d like to take that okay well at the clinic we start with our
behavioral health services and once they’ve determined that there is a
substance use issue I personally as a CHW have had a client that I transported
in the clinic van to a substance abuse center on a distance from where we are I
don’t know how familiar everybody is Raleigh is the capital of North Carolina
so we do in fact work with a client to place them in a substance abuse
treatment center if that is the recourse as savy alluded to a lot of times HIV
might be the chronic illness but it’s the barriers that the client is truly
dealing with so the short answer is yes we certainly do um facilitate helping a
client with a substance abuse treatment center and for me what I’ll do is
because I can’t diagnose a substance abuse disorder sometimes I will or some
substance use disorder excuse me I will transfer them also to behavioral health
or a case manager but we do have internal tobacco cessation which is I
can refer them to great thanks so Eli has a question he
Eli says that they work as a CHW for an HIV prevention Research Center at
Children’s Hospital in Philadelphia and they’re new to this line of work and
they’re interested in hearing about what resources you all use to help your
skills in motivational interviewing and resources that you might have find
helpful as a CHW in general I could say that we have an ongoing
in-house training whether it’s through a lunch and learn whether it’s through a
webinar of this type but we have a individual they’re actually part of the
behavioral health staff and we have a monthly training session or meeting for
motivational interviewing that is ongoing for us and we have to attain a
certain level of the technique so for my Center the infrastructure is an ongoing
motivational interviewing training in hell for me externally I’ve done a few
trainings through the CDC they have a motivational interviewing one they have
a testing one at HIV testing one as well so if you look on the CDC’s website for
some of their trainings I believe it travels all around the country and for
motivational interviewing specifically great thanks so ng asked a question
about where along the care continuum do you most frequently encounter stigma
issues and how do you help clients deal with stigma that prevent them from
staying healthy well I would jump right in and I’d say
all along the healthcare continuum stigma stigma is such a sensitive
component of HIV care so you’re constantly educating you’re constantly
um trying to get the client to share anything that might trigger some form of
trauma behind a stigmatized experience that they’re going through so I would
have to say that it’s ongoing fortunately for the clinic that I
support because we do have the flexibility of being of doing home
visits and meeting the client on their turf when you’re in a client base you
have a better assessment if you will of what certain stigmas are so it’s
somewhat easier to build a relationship with the client on based upon seeing
that client in their natural environment so for us I know it’s on going through
the HIV care continuum that one may encounter deal with and process stigma I couldn’t agree more with Peter was everywhere and so I don’t think
there’s any one place where I find it it more often with clients right absolutely so here’s a question sorry here’s our
question from Amy asking Savi and Peter can you elaborate and talk a little bit
about the benefits and challenges of having sort of a set time limit for your
work with clients or and and not having a set time limit for that work
I can throw one or Peter you go ahead you go first no no having to go right
ahead dear okay because I saw this one and I was like who I want to answer this
so I think the benefit the benefit to this because I don’t have a set time
limit is I’m never rushed with my clients and they feel that so they feel
like they can open up more so I’m able to get I think a lot more information
out of them than potentially a provider or a case manager that’s why I think I
got the information about my clients swallowing pills issue because he felt
rushed in his visit the downside to it sometimes is especially not having an
end date with clients is sometimes they’ll be really successful they’ll be
advocating for themselves they’ll be attending their appointments and then
they’ll fall off again so it does sometimes feel as if my work is never
done which is good and bad I would say Thank You Sammy I wanted to just build
off of what you just stated that even though we have developed a process to
transition a client based upon their own personal and intensive level once we
build that relationship up front we all have a work cellphone and believe me
we’re not going to not assist or not help a client that you’ve developed a
relationship with and they continue to call you oftentimes when we’re in a
season of the Ryan White eligibility renewal it’s probably easier for the
client is going to call me and send or text proof of income pay stubs if you
will before they even send it to the medical case manager who in turn
actually does the processing so the relationships are ongoing so we develop
the process so that we have one in place to transition clients but just like Savi
those relationships continue and the client may call us continually and we’re
certainly either going to refer or simply resolve whatever the issue is so
we’ve developed a process but the relationship is ongoing great Helene is
wondering if you all have any examples of working with clients around dental an
oral health care absolutely.we we work under the umbrella
of East Carolina University so we have a dental school so the arm the
infrastructure of that referral as I stated in my presentation is that we do
help the client with dental as well as optical and any other ambulatory
referrals that they need so yes that is in full effect um we make a referral to
the dental school they set up the appointment with the client and that is
a health area that we do address absolutely legacy as well we have a
dental facility in our clinic and also a vision center I don’t find that I’m
doing very intensive education necessarily on dental just because the
clients typically have a lot of needs and they they typically know if they
have dental issues sometimes but that is something that I’ll refer them to get
them on the wait list for that and I just wanted to add savvy you just made
me realize normally in the provider visit is when the referral will actually
be made like they can mention it to me and I can follow through with it but
normally um that’s actually captured in the provider visit great thanks we’ve
got a couple of questions of around caseload Don is interested in knowing
what that what your average caseload is and holly’s interested in how you savvy
or and also you Peter how do you prioritize your caseloads especially you
savvy since you have a great large number of folks on yours sure I can
start with this one Peter if that’s fine with you so I would say with so I think
I have about 120 clients right now but not all of them are
active so I will mark them as inactive and some as active and that helps me
organize them the ones that I put on inactive or are ones that I have tried
quite a number of ways to reach and I want to keep them there in case some of
those things eventually sink in and they come back in for my active caseload um
it’s organized by when they’re appointment times are or when the I’ve
last called them so there are some that I prioritize higher based on lab results
or upcoming appointment needs and in a kind of varies per client so I guess
that’s not entirely clear but I find that some days I don’t have enough to do
and some days I’m super super busy and so I kind of manage that on a day-by-day
basis and in the future with this kind of programming and client I think this
will be a decent sized caseload for sure Thank You Savi right now I’m working
currently with an active caseload of roughly 40 people as I try to illustrate
in my presentation being one of three CHWs we have special projects and so
there is a balancing act that we do perform daily um I’m a person that goes
by a day planner so based upon the client schedule
provider visit based upon the need for transportation based upon meetings etc
you basically do have to prioritize as savvy as saying daily it’s just a daily
on prioritization some days are certainly more aggressive
than others but um you you have to understand the nature of what you do you
could have your day perfectly planned and all of a sudden you get a phone call
and just like a monkey wrench being thrown into the greatest plan you have
to put out the fire so it does come with the territory of simply prioritizing on
a needs basis but I do try to be proactive I try to have everything in a
day planner including meetings and so you try to
really create a balance for yourself so it’s it certainly is the true definition
of multitasking Thanks we have a couple questions from
Derek one is about access to mental health services and he’s describing that
they they have a lot of patients with who need mental health services without
a lot of providers and he’s wondering if what your experiences have been with
mental health care and he’s also wondering about experiences you’ve had
with transportation if you if you’ve had a lot of clients that you think have
taken advantage of transportation services unfairly perhaps savvy I’d like
to jump in on this one go for it when it when it comes to mental health I can
tell you upfront and personal this is framed in the intake process the intake
process is the pretty much the buffer that assesses the arm client barriers to
care and we have the behavioral health services staff do a complete screening
on mental health behavioral health and any kind of substance use and misuse so
those things are captured upfront and personal when it comes to transportation
I can assure you we have a dedicated CHW who coordinates transportation whether a
person is Medicaid eligible or whether or not they would be requiring a gas
voucher or a bus pass as a as Ryan White being a payer of last resort we may have
to result to a taxicab but the moral of the story is we have a dedicated
coordinator who handling that so this CHW would be
red-flagged by any abuse or misgivings of a client taking advantage of our
resources um we do have financial budgets that have to be set and mandated
so we don’t have any issues because we have we have a dedicated CHW who
coordinates and I’m talking about clients that don’t only have a specialty
care appointment with the ID provider but we try to coordinate if that client
also has a primary care appointment or a dental appointment so it’s quite intense
that um we monitor that very closely so we don’t run into any kind of abuse if
that answers your question thanks so much Peter do you want to add anything
we have I think we just have time for one more quick question unless you have
anything to add Savi I know Peter deals with transportation a lot more than I do
we only do bus passes great we have an anonymous question asking if you could
talk just briefly about your no-show rates and how the how your agency in
general sort of addresses no-shows do you offer walk-in clinics what are the
different things you do to address no-show rates
I would love to touch on this one because this is probably my biggest
issue with clients is not only am i dealing with clients that are already
difficult to get in but they regularly do not call to cancel their appointments
so my notion rates are very high I would say something in the range last time I
think I checked it was like 40 or 50 percent of my clients are no showing and
I address that by constant constant reminders of appointments I follow up
with clients after their appointments if they miss I’m going to call the next day
and/or that day to reschedule them so it’s kind of constant attention to
address it we have some walk-in slots and we have some same-day appointments
but those can get pretty difficult specifically for clients who are
returning to care they need a longer appointment slot than just a same-day
appointment so for them sometimes I have to book out pretty far in advance which
requires just more attention so as I touched on in the slides that would
maybe be a client that I would be more regularly keeping in contact with just
so that they attend their appointment but no-shows is also something our
clinic deals with and struggles with sometimes for sure Chevy I would just
add that um we do have a dedicated coordinator that that does call the
client when it comes to a provider that has two go to the hospital for follow-ups we may
have to bump clients from an original appointment on time and date so we
actually do have someone that completely coordinates that whole thing as far as
our caseloads um we have the luxury of being proactive and calling the clients
and getting a confirmation as to whether or not they are going to come so I know
from the personal standpoint of the CHW in my clinic we basically do monitor
that a little more closely based upon our own caseloads because each client
even though they may have a CHW they also have a medical case manager so they
have several people calling them on inclusive of this coordinator that maybe
work in a bump list for providers that have had to change their clinic and
their appointment so we do have a lot of safety nets in place so we do work
diligently on that no-show rate thank you all so much thank you Peter and Savi
thanks to all of you attending apologies for ending the webinar a couple minutes
after three o’clock when you sign out of the webinar you’ll receive an email with
a link to a very short poll we’re really grateful for any feedback you can
provide to us on today’s presentation so thank you in advance for completing
those short questions and as I mentioned earlier this webinar is the third in a
series associated with this initiative so you can visit target HIV or our
project website to learn more and also access the other webinars in the series
and to review related resources we’ll be posting a recording of this webinar as
well as the slides and later on the questions and answers
that you all have asked asked us feel free to contact us if you have more
questions or want more information about the project we’re going to end the
webinar now thank you all again so much and have a great day

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