Care Alliance Health Center Cleveland, Ohio

1
Care Alliance Health CenterCleveland, Ohio

• Enhancing Linkages to HIV Primary Care
• in Jail Settings
• Grantee Meeting
• 10/25/2007 10/26/2007
• Rockville, MD

2
Project Goals and Objectives

• º Increase HIV CT in County and City jails
• -Education sessions with inmates
• -Pre-release HIV counseling testing
• º Provide a comprehensive continuum of medical
  care/early intervention
• services to HIV inmates
• -Client-centered case management of HIV
  inmates
• -Continuous care post release
• -Assess and provide Short-term mental health/SA
  counseling with referral to long term counseling
  (arranged pre-release)

3
Project Goals and Objectivescontd

• Develop data and tracking system to measure
  outcomes
• -Minimum of 2 chart audits per year
• -Use of Chronic Care Model
• º Develop system of service delivery that is
  client-centered and sensitive to
• gender, cultural diversity, and individual
  issues
• -Survey individuals who have received services
• -Administer follow up surveys post
  release
• -Facilitate membership of HIV inmates onto CAB
  following release

4
Increase Screening

• Currently, few inmates in local jails are tested
  for HIV
• Mandated by court
• Seek test while getting other services outside (
  STD)
• Develop system to educate inmates and offer HIV
  screening prior to release to community
• Evaluate effectiveness of screening (utility,
  cost, feasibility and acceptability)

5
Evaluate and Enhance Existing Services for HIV
Inmates

• Develop tracking system for inmates known to HIV
  (either by self report or prior testing)
• Increased coordination of care with outside
  providers via dedicated case manager for jails
• Link to providers prior to release when if not
  in care
• Captive moment to evaluate and possibly start
  therapy
• Coordinated case management and linkage into care
  immediately upon release- leverage existing
  network of Ryan White funded case managers

6
Project Team and Collaborative Partners

• Grantee Care Alliance Health Center
• Evaluation Collaborative Research
• PI Ann Avery, M.D. MetroHealth Medical Center
• Local evaluator Helen Lansche, RN, MSHA
• Jail Program Coordinator
• Interventionist/Research Assistants
• Case Manager Dwayne McCully
• Medical team
• Jacqueline Carroll, Coordinator Clinical
  Services/Infectious Disease
• Dr. Angel Brown, Medical Director
• Cuyahoga County Corrections Center Jail I (59
  pods) and Jail II (26 pods) total bed capacity
  1,749 inmates
• Cleveland House of Corrections 4 pods approx 200
  inmates nightly
• Collaborative partners- network of social service
  agencies, CWRU, MetroHealth Medical Center,
  University / Case Medical Center, HOPWA
  recipients, Cleveland Department of Public Health
  and Cuyahoga County Board of Health

7
Target Population

• Target Provision of HIV counseling testing to
  50 inmates per month
• Provide services to 100 of HIV-positive
  individuals
• Demographics of target population
• 93 males
• 48 black 50 white
• Fastest growing populations are black females and
  white males (crystal meth use)
• Target population includes substance abusers,
  commercial sex workers and other incarcerated
  individuals known to be hard to reach and
  chronically not in care
• Geography
• Cuyahoga County population _at_ 1.4 million
  Clevelands population 500,000 downtown
  population _at_ 8,000
• 33rd largest city in United States dubious
  distinction as nations largest poor city in
  2003, 2005 and 2006
• 26.3 family incomes below poverty levels
• 2nd highest black and Hispanic poverty rates
• 2nd highest economically dependent
• Other relevant information
• 12-19 of incarcerated are HIV
• Ohio anticipates an increase of 17,000 inmates
  (37 increase) over next 10 years

8
Local Evaluation Strategy

• Process evaluation design
• º Educational sessions
• º Number of inmates participating in sessions.
• º Number of inmates receiving HIV CT
• º Number of individuals in care
• º Number of individuals receiving services
• Outcome evaluation design
• º Chart audits
• º Satisfaction survey of participants
• º Annual satisfaction survey
• º Annual needs assessment/ focus groups

9
Local Data Collection

• Data collection
• º Number of educational sessions number of
  participants.
• º Number of inmates consenting to CT, number
  tested, number negative with negative
  results, number HIV, release dates for HIV
• º Number of HIV individuals receiving case
  management, medical and dental services,
  MH/SA counseling, and referrals to other
  services.
• º Compliance with clinical guidelines
• º Maintenance in care
• º Satisfaction with services
• º Needs assessment
• Method of data collection
• º Log maintained by Interventionist/Research
  Assistant
• º Log maintained by CT
• º Minimum of 2 chart audits per year
• º Satisfaction survey upon release and
  annually
• º Focus groups
• Describe who will collect data
• PI Program Coordinator Local Evaluator

10
Outcomes

• º Increase HIV CT in County and City jails
• -Education sessions on risk behaviors leading
  to HIV exposure and infection
• -Pre-release HIV counseling testing
• º Provide a comprehensive continuum of medical
  care/early intervention
• services to HIV inmates
• -Client-centered case management of HIV
  inmates on-site from incarceration to post
  release
• -Continuous care provided on site at Care
  Alliance Health Center
• -Mental health/SA counseling with referral to
  long term counseling
• º Develop data and tracking system to measure
  outcomes
• -Minimum of 2 chart audits per year (100 of
  involved population)
• º Develop system of service delivery that is
  client-centered and
• sensitive to gender, cultural diversity, and
  individual issues
• -Administer satisfaction survey to all
  individuals who received services upon release
  and annually convene annual focus groups
• -Facilitate membership of HIV inmates onto CAB
  following release

11
Expected Challenges Possible Solutions

• Challenges or obstacles
• Lack of collaborative approach to care upon
  release
• Difficulty with transportation
• Difficulty in following complex therapies not
  universally available within jail system
• Threatened (or perceived to be threatened)
  confidentiality of inmates
• while incarcerated
• Possible solutions
• - Jail-based Outreach Educator/Case Manager
• - Collaborative relationship between Case
  Manager and corrections staff
• - Locations of health services readily
  available to community

12
Care Alliance Health CenterContact Information

• Jenice ContrerasDirector of Development
• Care Alliance Health Center
• 1530 St. Clair Avenue
• Cleveland, Ohio 44114
• (p) 216.781.6228  x249
• (f) 216.298.5015
• jcontreras_at_carealliance.org
• www.carealliance.org