August 7, 2003 ALLGRANTEE MEETING HRSA SPNS New Mexico Border Health Initiative

1
August 7,
2003ALL-GRANTEE MEETINGHRSA SPNSNew Mexico
Border Health Initiative

• Kari Maier, Project Director
• Veronica Salcido-Harding, Project Coordinator
• Michelle Valverde, Local Evaluator
• Yvonne Roacho, Data Manager
• Jennifer Felderman, Graduate Research Assistant

2
Purpose of Presentation

• Describe the theoretical models
• Identify the units of service
• Outline the research hypotheses
• Provide a preliminary analysis of the evaluation
  data

3
It all begins with case management

• Case management model is based on social work
  practice
• Client-centered approach
• Role of the case manager is to enable the client
  to reach self-determined goals and to facilitate
  client links with the social environment and
  family

4
Next comes outreach

• Social Cognitive Theory (Wulfert and Wan, and
  Bandura)

Perceived Vulnerability
Information
Development and Enhancement of Social and
Self-Regulatory Skills
Safer Behaviors
Self-Efficacy
Peer Group Support
Adapted from Fisher Fisher Model, 2000
5
Health Outreach Workers

• Diffusion Theory
• The process by which an innovation is
  communicated through certain channels over time
  among the members of a social system
• An innovation is an idea, practice, or object
  perceived as new by an individual or other unit
  of adoption (such as the organization)

6
Diffusion Model (Example)

• STOP AIDS PROGRAM mid 1980s San Francisco
• Outreach workers being very similar to their
  target audience
• The small group health educators being respected
  opinion leaders who were perceived as credible
  because of their personal involvement in the
  epidemic
• Use of interpersonal information as peers

7
HOW, Provider, and Client Education

• Principles of Knowles Theory of Andragogy
• 1. Adults need to be involved in the planning
  and evaluation of their instruction.
• 2. Experience (including mistakes) provides the
  basis for learning activities.
• 3. Adults are most interested in learning
  subjects that have immediate relevance.
• 4. Adult learning is problem-centered rather
  than content-oriented.

8
Education Continued

• Principles of Rogers Theory of Experiential
  Learning
• 1. Significant learning takes place when the
  subject matter is relevant to the learners
  personal interests.
• 2. Learning which is threatening to the self is
  more easily assimilated when external threats are
  low.
• 3. Learning proceeds faster when the threat to
  the self is low.
• 4. Self initiated learning is the most lasting
  and pervasive.

9
Units of Services Provided (FY3)

• Outreach 718 contacts, 337 tests
• Goal was 500 and 150 respectively
• Case management 133 clients, 2,813 contacts
• Goal was 100 of clients (133)
• Client education 133 clients (unknown of
  contacts will know for FY4 and beyond)
• Goal was 100 of clients (133)
• Provider education 4 trainings, 77 participants
  (duplicated)
• Goal was 50 participants

10
Research Hypotheses Preliminary Evaluation
Results - Goal 1

• Training for the HOWs will increase/improve
• Their knowledge, skills, and attitudes
• Their ability to reach the target groups
• Contact with the HOW will result in
• Greater awareness of the importance of being
  tested and knowing ones HIV status
• Increased return rates
• Improved attitudes toward entering care (if
  applicable)
• Early enrollment into care (before diagnosis of
  AIDS)

11
Research Hypotheses Preliminary Evaluation
Results - Goal 1

• The training provided to the HOWs will
• Increase their knowledge and skills
• Improve their attitudes toward target groups

12
Goal 1 Continued

• The training will also
• Increase their ability to reach the target
  groups MSM, IDU, women at risk (WAR)

13
Goal 1 Continued

• For the individuals tested, the contact with the
  HOWs will result in a greater awareness of the
  importance of
• Being tested for HIV
• Knowing their HIV status

14
(No Transcript)
15
Goal 1 Continued

• The contact will also result in
• At least a 60 return rate (FY2 FY3)

Note Return rate goal for FY1 was 40
16
Goal 1 Continued

• For the HIV individuals identified through
  outreach, the contact with the HOWs will
• Improve their attitudes toward entering care
• Unable to capture this (1 enrolled immediately 1
  lost to follow-up)
• Result in at least 70 enrolling into care
• 1 out of 2 enrolled (NOTE Individual who
  followed up with the HOW)

17
Goal 1 Continued

• For those who do enroll, the contact will also
• Result in 100 early enrollment into care (before
  AIDS)
• 0 out of 1

18
Research Hypotheses Preliminary Evaluation
Results - Goal 2

• Case management will
• Reduce the barriers to primary care
• Fewer clients were experiencing 15 of the 17 key
  barriers after entering CdV while CM is a likely
  positive contributor it is not possible to
  demonstrate causal link
• Training for providers (Goal 4) and clients (Goal
  3) is targeting several of the problems that
  continued to exist for approximately 1/3 of the
  clients even after they enrolled into care

19
Barriers Before and After Entering Camino de
Vida (n 75)
20
Goal 2 Continued

• Case management will also
• Increase client satisfaction with care
• Increase social support for clients
• Case study of two clients

21
Research Hypotheses Preliminary Evaluation
Results - Goal 3

• Client education (as provided by the Case
  Managers) will
• Increase client knowledge of, skills, and/or
  interest in HIV disease management
• Pilot results 24/27 clients (89) who responded
  had received at least a little HIV/AIDS health
  education from a staff member at CdV (1 of these
  was incomplete)
• Survey will be sent out again this fall

22
Increase in Client Understanding of HIV Disease
Management (n 23)
n 20 only clients taking medications answered
these questions
23
Goal 3 Continued

• Client education (as provided by the Case
  Managers) will also
• Increase utilization of primary care and/or
  adherence to medications
• Will use FY3 and FY5 chart review results

24
Research Hypotheses Preliminary Evaluation
Results - Goal 4

• The education/training delivered to the providers
  will
• Result in an increase in understanding of HIV
  care
• Future follow-up with Hubas Module 55

25
(No Transcript)
26
In Summary

• Outreach
• Continue to increase testing among IDUs and MSM
  (advanced trainings) and focus on PLWAs
• Case Management
• Continue trainings for CMs and focus on enrolling
  new clients and time sequence series
• Client Education
• Provide training for clients, formalize the
  curriculum, and re-administer the questionnaire
• Provider Education
• Continue to target providers and improve the
  evaluation strategy

27
Conclusion

• Thank you!