CIVIC ENGAGEMENT 105SL:

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CIVIC ENGAGEMENT 105SL Client-Based Program
Evaluation on Bienestars Case Management
Group Members Adrienne Quiroz (Community
Partner) Castor Phan (Undergraduate) Monica
Briseno (Undergraduate) Sophia Liu
(Undergraduate)
C, M, S, A
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Literature Review

• Objectives To assess the prevalence of need and
  unmet need for supportive services and the impact
  of case managers on unmet need among HIV-infected
  persons.
• Research design National probability sample.
• Participants A total of 2,832 HIV-Infected
  adults receiving care.
• Measures need and unmet need for benefits
  advocacy, housing, home health, emotional
  counseling, and substance abuse treatment
  services.
• Conclusion Need and unmet need for supportive
  services among HIV-infected persons is high. Case
  management programs appear to lower unmet need
  for supportive services.

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Mission and Agency Description

• Non-profit community service
• Target population Latino, HIV positive
  underrepresented communities.
• Originated as a direct result of neglect and
  non-existent HIV/AIDS services for the Latino
  community.
• Committed to Health and Well-being
• Education, Prevention, Mobilization, Advocacy,
  and Direct Social Support
• Important Services HIV Testing, Food Bank, Peer
  Support, Mental Health, and Housing

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Bienestar Today
Multi-service, multi-center agency, serving Los
Angeles, San Bernardino, and San Diego Counties.
Expanded target population reaching Latino
community and underrepresented communities
Bilingual and bicultural staff and volunteers
that are representative of the communities they
serve. Standard of excellence for peer-driven
services throughout the United States and Latin
America.
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Case Management Program Description

• Case Management (CM) is a psychosocial service
  that links HIV clients to other services
• Case Managers (CMs) identify and assess clients
  with Individual Service Plans (ISPs)
• Begins with CMs and client interview
• Case Manager Case Loads
• Full-time 50 Clients
• Part-time 25 Clients
• Quarter-time 12
• Clients are referred to programs
• Client Qualifications Must be HIV, Resident of
  LA County, not receiving HIV CM, and clients who
  are not adhering to medication

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Bienestar Locations
HOLLYWOOD - METRO AREA CENTER SPA 4
EAST LOS ANGELES CENTER SPA 7
Service Planning Area
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GIS Data

• Medical Services
• SPA 4 - Hollywood

Legend
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Demographics

• Ethnicity/Race Age
• SPA 4 (Metro)

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GIS Data

• Medical Services
• SPA 7 - East LA

Legend
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Demographics

• Ethnicity/Race Age
• SPA 7 (East LA)

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Gender
From 36 Client Files, SPA 4 7
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Distribution of Age
From 36 Client Files, SPA 4 7
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Services
From 36 Client Files, SPA 4 7
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Research Question

• How do funding decisions impact the delivery of
  case management services?

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Methodology

• Qualitative Approach
• Interviews with Four Case Managers
• Total of 4 Interviews
• All phone interviews
• 15 Questions
• 2 CMs responded to
• additional questions

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Interview Questions

• Case Management

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Interview Questions

• Do you find the current tools for case managers
  useful for helping clients? If yes, what are
  they? If no, what would you change or develop?
  How can Bienestar help you make your job easier?
• CM 1 Response Services are not as strong after
  each year because of limited funding
• CM 2 Response Satisfied.
• CM 3 Response No, case managers need more
  private areas for interviews
• CM 4 Response Current tools are adequate

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Interview Questions

• 2. How does case management meet the needs of the
  client?
• CM 1 Response Searching for the right services
• CM 2 Response Programs theyre geared for
  individual needs of client
• CM 3 Response Offering sense of family
• CM 4 Response Individual service plans (ISPs)
  are effective in meeting needs

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Interview Questions

• Funding

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Interview Questions

• 3. How was the news about budget funding
  delivered?
• CM 2 Response News was not delivered directly
  to case management team
• CM 3 Response In person

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Interview Questions

• 4. What is your understanding of the rationale
  for the cuts?
• CM 2 Response Federal affected every agency
  in the county
• CM 3 Response County funding was cut

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Interview Questions

• 5. How did the changes affect your professional
  responsibilities?
• CM 2 Response Not affected
• CM 3 Response Not affected. Changes are
  affecting client services

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Interview Questions

• 6. Whats the biggest thing you notice now that
  the cuts have occurred?
• CM 2 Response Bienestar is uncertain about
  future and job security
• CM 3 Response Less services for clients recently
  diagnosed with HIV/AIDS

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Interview Questions

• 7. Have you noticed any impact on clients after
  these changes?
• CM 2 Response There were no job cuts, so
  clients were not impacted
• CM 3 Response Clients are having difficulty
  getting housing, transportation and
  FoodBank

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Interview Questions

• 8. If it were up to you where do you think
  funding should be concentrated to make Case
  Management more effective?
• CM 2 Response Focus on client services
• CM 3 Response Decrease case load from 50 to
  approximately 35

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Quotes

• I understand that we are moving toward the
  medical model of case management but there are
  still clients who will be accessing services
  independently outside the medical clinic referral
  scene.

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Results and Findings

• Case managers dont have full case loads
• They expressed concern about popular services
  being impacted by funding cuts (e.g. housing,
  foodbank)
• CMs believe they can do the best job they can
  with more funding from government

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Discussion

• Initial expectation case managers had full case
  loads
• Clients would be affected by budget cuts
• From Case Manager 2 3
• Client Surveys
• Lack of participation
• Our change in direction made this data extraneous

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Client Surveys
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Policy Implications

• Local and State Government
• 1. Focus on preventative measures and
  accessibility.
• 2. Local, low or no-cost clinics are the
  backbone of LA Countys healthcare system.
• 3. Match county funds and state funds with
  federal funds.

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Policy Implications

• Agency
• 1. A system of effective communication between
  staff and their supervisors.
• 2. A more clear and complete record of the
  clients profiles and background.
• 3. A database of client information.
• 4. Outreach to women and younger population

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Future Research

• How will Bienestars new medical approach compare
  with its current method?
• How will it affect case managers and clients?
• Further research on effectiveness of case
  management to meet the unmet needs of clients
• Examine what services clients feel need greater
  funding

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Questions?
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