El Paso HRSASPNS USMexico Border Health Initiative

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El Paso HRSA/SPNSUS/Mexico Border Health
Initiative

• Grantees Meeting
• January 2003
• Centro de Salud Familiar La Fe
• CARE Center
• Community Advocacy, Resources, and Education

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Challenges and Lessons Learned

• Staffing
• Leadership and team work
• Increased demand for medical services
• Orientation of services and education to clients

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Staffing

• Turn over rate among bilingual health
  professionals in the past has been high.
• Presently, the existing staff is supportive and
  committed to overall project.
• Increased communication with Administration has
  resulted in increased support.

4
Leadership

• Staff meetings utilized to communicate to staff
  about program goals and objectives.
• Staff participation to establish personal
  /professional growth and development.

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Clinical Services

• La Fe CARE Center provides care to a medically
  underserved population and receives funding form
  TDH RWII, which enables FNP-c to provide clinical
  services on a full time basis in collaboration
  with a part time physician.
• - Clinical services were increased from 8 days
  per month to 16 days per month effective
  August 1st.
• Walk-in clinic hours were implemented to an
  additional 2 half days a week.

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Summary of Care ManagementInterventions

• Follow up on all missed laboratory and follow up
  appointments by RN.
• 2 phone calls on different days.
• Mail post card reminder to home address.
• Chart Review by RN of all medical records prior
  to office visit.
• Transfer of recent labs to care flow summary
  sheet.
• Review immunization record.
• Identify referrals needed or pending reports.

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Cont Care Management Interventions

• Education provided by RN to all new clients.
  Information packet given to the client which
  includes
• HIV Life Cycle Replication
• Understanding of T Cell Counts and Viral Load
• Risk Factors, Risk Reduction
• Importance of keeping appointments
• Clinic hours and after hours on call service.
• HIV/AIDS services provided at La Fe.

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Medication Adherence

• Medication adherence classes have been
  established and will be offered twice a month by
  Dr. Jaime Anaya, Pharm D.
• English/Spanish classes provided to accommodate
  language preference by clients.
• Dinner provided during class as an incentive.

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Mental Health

• Mental health services have been contracted from
  Family Services of El Paso.
• Rosa Luna, LMSW-ACP provides 12 hours per week of
  diagnostic services at CARE.
• Patients needing further evaluation or treatment
  are currently referred to FSEP or other local
  providers.

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Mental Health Assessments

• On multi-site evaluation instruments, 34 of
  patients have identified mental health concerns
  as a presenting issue.
• To date, 112 mental health assessment have been
  completed, and 41 patients (36) have accepted
  referral for mental health services.
• The following data are from a review of 88
  patient charts.

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DSM-IV Axis I Diagnoses

• Diagnoses Deferred 40
• Mood Disorders 28
• Relational Problems 11
• Anxiety Disorders 6
• Identity Problems 3
• Substance Abuse (Cocaine) 1
• No Diagnosis 1

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Most Frequent Psychosocial Stressors Noted on
Axis IV

• Insufficient Social Support 55
• Severe Poverty 22
• Interpersonal Conflict 11
• Recent Job Loss 8
• Recent Changes in Health Status 7
• Severe Illness of Significant Other 7
• Underemployment 6

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DSM-IV Axis X Global Assessment of Functioning

• Mean of patients not referred for further
  services 65
• Some mild symptoms OR some difficulty in social,
  occupational, or school functioning, but
  generally functioning pretty well, has some
  meaningful interpersonal relationships (DSM-IV)
• Mean of patients referred for further services
  57
• Moderate symptoms OR moderate difficulty in
  social, occupational, or school functioning
  (DSM-IV)

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Depressive Symptoms

• Non-referred patients scored in the minimally
  depressed range.
• Referred patients scored in the moderate
  depression range.

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Risk Factors

• The risk composite was formed from all items on
  the multi-site Risk Factors Survey, with the
  exception of the hemophilia question.

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Need for Additional Services

• On site treatment could increase follow-through
  with referrals.
• Further services could include neuropsychological
  screening, crisis intervention, support groups,
  family/couples counseling surrounding disclosure
  issues, etc.

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Adherence

• Adherence estimates are from self-reported
  patient recall over the past three days. The
  index divides doses missed by doses prescribed.

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Evaluation Challenges

• Computer network issues have impeded data entry
  and e-mail communication.
• The computer network is now fully functional.
• Recruitment of patients has been challenging.
• We will regularly update a list of patients we
  need to see, and care managers will be alert for
  them in the clinic.
• Integration of clinical and evaluation data could
  be improved.
• A UTEP research assistant will begin assisting
  with entry of clinical data in a format that can
  be easily integrated with evaluation data.

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Programmatic Challenges for the New Year

• Recruit a qualified bilingual registered
  dietician.
• Explore funding sources to continue food pantry
  services for clients.
• Increase awareness of services and provide
  education to all established clients.
• Continue good communication skills and team work
  approach among staff.
• Continue multidisciplinary approach to
  comprehensive plan of care.

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