Darryl ODonnell Manager, HIV and Sexually Transmissible Infections Unit

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HIV AND DISABILITY FUNDING, POLICY AND
SOME LESSONS LEARNED
Darryl ODonnellManager, HIV and Sexually
Transmissible Infections Unit AIDS/Infectious
Diseases Branch 19 February 2007
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Overview

• Role of NSW Department of Health
• Funding arrangements
• Strategic directions
• Review of HIV/AIDS Supported Accommodation
  Services
• Lessons learned / next steps

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Role of the NSW Department of Health

• Strategic directions - treatment and care, health
  promotion, surveillance
• Policy and legislative frameworks consistent with
  national strategy
• Funding
• Program monitoring and accountability
• Workforce infrastructure
• Research and surveillance.

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Funding

• Devolved program
• Significant investment (and return on investment)
• Dedicated funding program (silo) AIDS Program
• contribution towards the costs of
• HIV/AIDS and STI prevention, care and support and
  hepatitis C prevention
• Dedicated funding costs and benefits
• Context increased prevalence no growth
• Significant NGO (community-based) program
• AHS program clinical, health promotion, NSP and
  surveillance

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Planning Directions

• NSW HIV/AIDS Strategy 2006-2009
• Strategy and Environmental Scan
  www.health.nsw.gov.au/living/aids.html
• NSW Sexually Transmissible Infections Strategy
  2006-2009
• NSW Hepatitis C Strategy 2006-2009
• NSW HIV/AIDS, STI and Hepatitis C Strategies
  Implementation Plan for Aboriginal People
  2006-2009

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Priority Populations

• Gay men and other homosexually active men
• People living with HIV/AIDS
• People from priority culturally and
  linguistically diverse backgrounds
• Aboriginal people
• People who inject drugs
• Sex workers
• In addition to these populations, there are also
  populations whose HIV prevention, treatment, care
  and support needs warrant specific attention.
  These include HIV-negative individuals in
  sero-discordant relationships (relationships with
  HIV-positive people), people in correctional
  facilities, people with an intellectual
  disability, and people with a mental illness.

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Principles (selected)

• Partnership and joint action
• Involvement of affected communities
• Providing an enabling environment
• Redressing health inequities
• Population health approach
• Balanced with individual service delivery
• Principles speak to a value base underpinning the
  Program

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Principles (selected, in detail)

• All individuals have the right to information,
  education and skill development that enables them
  to protect themselves and others from HIV
  infection and to avoid being involved in HIV
  transmission. the diversity of the target
  audience should be considered particularly in
  relation to cultural and linguistic diversity,
  sexuality, and learning needs and catered for.
• HIV health promotion materials should be
  designed to maximise audience reach and impact.
  Images and language should be culturally
  appropriate to the target audience, and can
  include sexually explicit materials where this is
  necessary to convey educational messages. Such
  tailoring enhances the ability of social
  marketing and health education to communicate
  with the target audience.
• Safe Sex low literacy resource (SWAHS)

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Expectations of HIV/AIDS services

• Recognition of learning needs and potentially
  increased vulnerability of people with
  disabilities to HIV infection, as a result of
  their disability.
• Recognition of the treatment, care and support
  needs of people with HIV, including those with
  pre-existing disability and HIV-related
  disability.
• Operation and utilisation of Family Planning NSW
  as a dedicated HIV and intellectual disability
  reference service.
• Expectation that all services are able to
  recognise and manage interface with disability
  sector.
• Expectation that HIV-related responsibilities are
  not seen to be absolved in the presence of
  disability.
• Expectation that disability-related needs are not
  seen to be absolved in the presence of HIV.

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Family Planning NSW

• Family Planning NSW funded as a state-wide
  reference point for HIV/AIDS and intellectual
  disability issues
• Support for intellectual disability sector to
  undertake HIV prevention
• Support for HIV sector in working with people
  with an intellectual disability.
• Funding includes developing the capacity of
  disability organisations to respond to the HIV
  and sexual health needs of people with
  disabilities through
• Training sessions for the Sex Safe and Fun
  resource
• Dissemination and evaluation of the resource
•  

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Family Planning NSW (contd)

• NSW HIV/AIDS Strategy 2006-2009 Action Plan
• Objective
• Increase HIV knowledge and skills among people
  with an intellectual disability and people with a
  mental illness.
• Strategies
• Develop model health promotion programs
  addressing HIV and sexual health issues for
  people with an intellectual disability.
• Build the capacity of HIV, sexual health,
  disability and mental health services to address
  the HIV health promotion needs of people with an
  intellectual disability and mental illness.
• Lead agency Family Planning NSW

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Priorities Treatment, Care and Support

• Matching funding and service models to need
• Coordination, partnership and service linkages
• Social housing and supported accommodation
• Oral health
• Health and wellbeing
• Individuals with complex needs
• Collection and monitoring of utilisation data
• Treatments and monitoring and
• General practitioners.

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Complex Needs

• The phrase complex needs has been used by
  practitioners to describe individuals with a
  range of co-morbidities or psychosocial needs,
  which may or may not be related to HIV/AIDS.
  These may include mental illness (including
  personality disorders), HIV/AIDS- or
  treatments-related cognitive impairment,
  intellectual disability, and/or multiple
  co-existing health conditions.
• Individuals may be defined as having complex
  needs because they require support from multiple
  service systems have significant health issues,
  including but not limited to co-morbidities
  require intensive support to access health and
  welfare services are vulnerable to crises
  related to mental health or psychosocial issues
  or experience vulnerability in maintaining a
  tenancy, or at times are incarcerated.

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HIV Supported Accommodation

• Annual AIDS Program expenditure on SA 4
  million
• Delivered across a range of NGO and public sector
  agencies
• Review trigger capacity concern (high needs end)
• Review conducted in 2006
• Why is this of interest today?
• Lessons in dis-entangling complex needs all
  HIV supported accommodation clients have complex
  needs but what is the nature of that need and
  what are the service delivery implications of it?
• Lessons in managing the interface between
  HIV/AIDS and disability, and HIV/AIDS and other
  human service systems

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HIV Supported Accommodation (contd)

• Definition
• Is provided through AIDS Program funding when
  HIV/AIDS is the significant factor for the
  inability to live independently and where support
  in daily living is required.
• Varying levels of care for a specific period or
  as an ongoing need may be required. Where
  possible, rehabilitation will be a key goal.
• Support can be provided either within a
  residential facility or through a service
  providing support in the persons home.
• Supported accommodation to maintain independent
  living can be provided through outreach services,
  day-care facilities and other flexible
  arrangements.

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HIV Supported Accommodation (contd)

• Established facilities
• - The Bridge
• - Bobby Goldsmith House
• - Foley House
• - Stanford House
• - The Haven

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HIV Supported Accommodation (contd)

• Flexible models for meeting individual needs.
• In addition to specific facilities
• - outreach services
• - day-care facilities
• - mainstream health/HACC services
• - the purchase of services appropriate to needs
• - involvement of volunteer services.

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Recommendations from the Review of HIV
Supported Accommodation Services
?

• Provide state-wide access
• - by coordinating access through a centralised
  intake system
• Establish priorities for access
• PLWHA with complex needs directly related to HIV
  and which result in an inability to live
  independently.
• PLWHA unable to live independently due to medical
  conditions directly arising from their HIV/AIDS
  diagnosis including people with ADC, PML,
  cognitive impairment that is HIV related and
  physical illness.
• Respite care for PLWH/A and their carers.
• Strengthen case work to
• reduce need for supported accommodation
• reduce re-admissions
• provide better client outcomes

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Recommendations from the Review of HIV
Supported Accommodation Services (contd)

• Strengthen workforce skills
• Match services with needs
• Continue to provide flexible models focusing on
  individual needs
• Establish partnerships with/links to relevant
  services particularly Alcohol and Other Drug, and
  Mental Health
• Overcome barriers to people with HIV/AIDS
  accessing non-HIV services
• Establish service accountabilities in Funding and
  Performance Agreements
• Strengthen facility capacity and appropriateness

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Lessons learnt / observations

• HIV/AIDS remains silo-ed.
• Resistance among some service providers to
  referral to non-HIV specific services.
• Some lack of confidence in capability of non-HIV
  specific services.
• Sometimes significant over-confidence in
  capability to deliver non-HIV related care.
• Varying accounts of experience of access to
  non-HIV specific services some recent past and
  some distant past.
• Absence of a (documented) evidence base to
  support poor access.
• View that poor access is a result of policy
  failure.

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Lessons learnt / observations

• Contention around when HIV/AIDS is the
  significant factor. Identifying the primary
  presenting issue.
• Expectation that AIDS Program funding may be used
  to meet non-HIV related needs. Issues of future
  sufficiency.
• Some evidence of poor client outcomes where
  appropriate referral is resisted.
• Significant frustration around client dumping.
• Consequent role-creep as services respond to
  evident need.
• Significant structural / other barriers to
  effective case work and management.
• Complex needs as a diagnosis which can obscure
  effective identification / communication of
  identified functional and service needs.

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Key new initiatives

• Establishment of centralised intake system.
• Referral data collection (cross-agency).
• Review of case work and management.
• Strengthening early intervention capacity.
• Standardising performance expectations and data
  collection.
• 12 months Review of intake system.
• 12 months Review of referral data (agency-lead).