Managing a Title IV Program Challenges

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Managing a Title IV ProgramChallenges
Lessons Learned

• Mary Caffery RN, MSN
• UCSD Mother Child Adolescent HIV Program
• RWCA 2006 Technical Assistance and Training
  Meeting
• August 28, 2006

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UCSD Mother, Child and Adolescent HIV Program
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Challenge Addressing the Multiple Title IV Goals

• Primary and specialty medical care
• Prevent mother to child HIV transmission
• Mental health and psychosocial services
• Logistical support to keep people in care

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Challenge Addressing the Multiple Title IV
Goals

• Outreach and case management to engage and retain
• Access to care and to clinical trials and
  research
• Reach the hardest to reach, poorest of the poor

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High Level Expectations

• Quality, current, state of the art, evidence
  based
• Effective interventions
• Culturally competent
• Consumer involvement
• Efficient, payer of last resort
• Maximize limited resources
• Address unmet need

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Lessons Learned

• Involve the community and team in reaching goals
• (CAB / Network)
• Develop provider and network ownership for
  outcomes
• Work with others
• RWCA Titles
• DHHS, Prevention,
• Mental Health /Substance Abuse Providers
• Community AIDS Service Organizations

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Lessons Learned

• Think strategically
• Assess your organizations strengths/challenges
• Be political look for opportunities
• Share concerns /successes with the right people
• Use your work plan to prioritize

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Challenge Serve our Communities Today in the
Future
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Lessons Learned

• Development of a network is a dynamic process
• Recruitment of a diverse and active community
  planning group is critical
• Anticipate challenges with subcontractors
• Improve contracting expectations and language
• Use competitive bids
• Let go of non-performers

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Challenge It takes a VillageHuman Resources

• Recruitment/retention of high quality personnel
• Career development/ Quality of Work Life
• Ensuring Strong Consumer Involvement
• Assessing, analyzing and addressing barriers
• Developing roles, effective mentoring/supervision
• Conflict resolution
• Burnout / Relapse /Illness

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Lessons Learned

• Assess organizational culture
• Evaluate philosophy of shared expertise, trust
• multidisciplinary vs. interdisciplinary approach
• Plan carefully with the right people
• Develop good supervisors

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Lessons Learned

• Develop good supervisors
• Set expectations and Acknowledge Excellence
• Seek Technical Assistance early
• talk with colleagues identify other supervisors,
  mentors, HRSA, Toolkit, conferences

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Challenge Evolving Data Demands and Systems

• Data / IT
• Confidentiality
• Information security
• Outcomes accountability
• Continuous Quality Improvement Activities
• Evaluation

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Lessons Learned

• Acknowledge costs, time for trial and error,
  training needs
• Locate expertise
• Expect the unexpected
• Share the load
• Develop flexible system
• Maintain back up plan

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ChallengeResource Limitations

• Lessons Learned
• Analyze unit costs
• Encourage staff /CAB to identify
  resources/savings
• Find other funding/revenue recovery
• Discuss program costs/benefits with community
  partners
• Go lean

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Resources

• Title IV Manual Ryan White CARE Act
• Organizations that CARE A Toolkit for Employing
  Consumers in Ryan White CARE Act Programs
  CD-ROM contains materials to help Title IV
  programs develop strategies in employing Ryan
  White CARE Act consumerspeople living with
  HIV/AIDS.
• Cultural Competence Mitigating Health
  Disparities Through Cultural Competence HRSA
  August 2002