Cleveland TGA- Ryan White Part A Program EIS Standard of Care

EARLY INTERVENTION SERVICES

Cleveland TGA Definition: Counseling individuals with respect to HIV/AIDS; testing (not funded through Ryan White Part A); referrals; other clinical and diagnostic services regarding HIV/AIDS; periodic medical evaluations for individuals with HIV/AIDS; and providing therapeutic measures.

The entities through which such services may be provided under the grant include public health departments, emergency rooms, substance abuse and mental health treatment programs, detoxification centers, detention facilities, clinics regarding sexually transmitted diseases, homeless shelters, HIV disease counseling and testing sites, health care points of entry specified by eligible areas, federally qualified health centers, and entities described in section 2652(a) that constitute a point of access to services by maintaining referral relationships.

Proposals must include the following components:

A.  Testing (not funded through Ryan White Part A) should detail coordination through other funding sources or agencies

B.  Referral Services

·  Linkage agreements to work with key points of entry

·  Relationship and trust building

·  Assessment of immediate need/attitude/knowledge/behaviors/beliefs regarding care

·  Health Literacy/Health Education (counseling)

·  Access to Linkage and Care

Services should be targeted to the following populations:

·  Newly diagnosed

·  Receiving other HIV/AIDS services but not in primary care

·  Formerly in care – dropped out

·  Never in care

·  Unaware of HIV status

Early Intervention Services (EIS) will lead the efforts of EIIHA (Early Identification of Individuals with HIV/AIDS). All proposals for EIS must address coordination with prevention services, counseling and testing centers, as well as RW Part A providers.

HRSA Definition: Early Intervention Services (EIS) includes counseling individuals with respect to HIV/AIDS; testing (including tests to confirm the presence of the disease, to diagnose the extent of immune deficiency, and to provide information on appropriate therapeutic measures); referrals; other clinical diagnostic services regarding HIV/AIDS; periodic medical evaluations for individuals with HIV/AIDS; and provision of therapeutic measures. Support of Early Intervention Services (EIS) that include identification of individuals at points of entry and access to services and provision of:

·  HIV Testing and Targeted counseling

·  Referral services

·  Linkage to care

·  Health education and literacy training that enable clients to navigate the HIV system of care

All four components to be present, but Part A funds to be used for HIV testing only as necessary to supplement, not supplant, existing funding.

Care and Treatment Goals: The overall goal of Early Intervention Services within the Cleveland TGA is to provide intensive short-term case management services through the Early Identification of Individuals with HIV/AIDS (EIIHA) initiative for newly diagnosed (Unaware) and Out of Care PLWHA (Out of Care as defined by HRSA). The TGA’s target populations are:

·  African American MSM

·  MSM, Ages 45+

·  MSM Youth, 13-24

·  African American and Hispanic Youth, 13-24

·  African American and Hispanic Women

Service Objective:

·  To provide short-term intensive case management services through the EIIHA initiative with the focus on newly diagnosed (Unaware) and Out of Care (OOC) populations

·  Medical care linkage to promote healthy outcomes for PLWHA

·  Support service referrals to ensure clients have access to services that will promote medical adherence

Program Components: All services are provided to link PLWHA newly diagnosed and out of care to medical care and support services through:

·  HIV testing and Targeted counseling

·  Referral services

·  Linkage to care

·  Health education and literacy training that enable clients to navigate the HIV system of care.

Personnel:

Staff Qualification / Expected Practice
Staff providing care and/or counseling services to clients participating in the Early Intervention Services program must be trained to provide these services to newly diagnosed HIV/AIDS clients and to PLWHAs who know their status and are not in care. / Personnel files/resumes/applications for employment reflect requisite experience and education.
Supervision of all staff is evident through documentation of a senior member with experience and skill in the field of targeted counseling.
Agency protocols for supervision of staff is documented and implemented. / Supervision evident in client charts; personnel files indicated supervisor role, to include job description and reflect requisite experience and education.
Agency protocol clearly delineates responsibility of supervisor of EIS staff, to include quarterly report of case records reviewed.
Supervisors must maintain a file on each peer worker supervised and provide documented evidence of supervised sessions on a monthly basis, at a minimum. The file must include:
·  Date, time, and content of supervisory session
·  Results of the case review addressing, at a minimum, completeness and accuracy of records, compliance with Standards and effectiveness of service provided. / Supervisory files indicated documented sessions for each peer worker as indicated.
Agency staff who provide direct care services shall possess a current certification as an HIV prevention counselor, or have advanced training/experience in the area of HIV and/or infectious disease specialty. / Personnel files/resumes/applications for employment reflect requisite experience, education, and certification.

Training:

Training / Expected Practice
Agency staff is trained, certified, and/or licensed to provide early intervention services with documented competency assessments completed annually, or more often as needed. / Personnel files reflect training/certification and/or licensure to provide EIS services to include documented competency assessments completed annually at a minimum.
All newly hired EIS staff have a minimum of ten (10) additional hours of orientation covering target populations and the HIV service delivery system in the Cleveland TGA, including but not limited to:
a.  The full complement of HIV/AIDS services available within the TGA
b.  How to access such services (including how to ensure that particular sub-populations are able to access services, i.e., undocumented individuals)
c.  The Ryan White Part A Standards of Care (Universal and individual Service Category standards)
d.  Education on applications for eligibility under entitlement and benefit programs other than Ryan White services (i.e., Medicaid, Medicare, WIC, OHDAP, SNAP, etc.) / Personnel files reflect completed orientation with additional training as indicated. Personnel files reflect a signed job description.

Description of Service (HRSA Program Monitoring Standards):

STANDARD / PERFORMANCE MEASURE/METHOD / MONITORING STANDARDS / LIMITATIONS
Support of Early Intervention Services (EIS) that include identification of individuals at points of entry and access to services and provision of:
·  HIV testing and Targeted counseling
·  Referral services
·  Linkage to care
·  Health education and literacy training that enable clients to navigate the HIV system of care
All four (4) components to be present, but Part A funds to be used for HIV testing only as necessary to supplement, not supplant, existing funding. / Documentation that:
1.  Part A funds are used for HIV testing only where existing federal, state, and local funds are not adequate, and Ryan White funds will supplement and not supplant existing funds for testing
2.  Individuals who test positive are referred for and linked to health care and supportive services
3.  Health education and literacy training is provided that enables clients to navigate the HIV system
4.  EIS is provided at or in coordination with documented key points of entry
5.  EIS services are coordinated with HIV prevention efforts and programs / 1.  Establish memoranda of understanding (MOUs) with key points of entry into care to facilitate access to care for those who test positive
2.  Document provision of all four required EIS service components, with Part A or other funding
3.  Document and report on numbers of HI tests and positives, as well as where and when Part A-funded HIV testing occurs
4.  Document that HIV testing activities and methods meet CDC and state requirements
5.  Document the number of referrals for health care and supportive services
6.  Document referrals from key points of entry to EIS programs
7.  Document training and education sessions designed to help individuals navigate and understand the HIV system of care
8.  Establish linkage agreements with testing sites where Part A is not funding testing but is funding referral and access to care and education, system navigation services
9.  Obtain written approval from the grantee to provide EIS services in points of entry not included in original scope of work

QUALITY MANAGEMENT:

Program Outcomes: The goal of EIS is to decrease the number of Unaware and Out of Care individuals with HIV/AIDS by increasing access to care.

Indicators:

·  Number of newly diagnosed (Unaware) brought into care

·  Number of Out of Care (OOC) returned to care

EIS SoC / Outcome Measure / Numerator / Denominator / Data Source / Goal/Benchmark /
STRUCTURE /
Agency staff providing direct care services shall have documented experience and/or certification as appropriate to provide EIS counseling, testing, referral services, and linkages to care. / All agency EIS staff will have documented experience in the field of case management services, to include EIS counseling, health education, referral services, linkages to care, and HIV testing. / All EIS staff providing direct care services to PLWHA in the Cleveland TGA / All EIS staff / Agency Files / 100% of EIS staff will have documented experience and/or certifications to provide EIS services. /
EIS service providers will have MOUs on file with key points of entry into care to facilitate access to care for those who test positive. / EIS providers will maintain working relationships with key points of entry into care (ER, Homeless Shelters, HIV testing sites, etc.) to facilitate access to care for those who test positive. / All EIS providers who have MOUs on file for key points of entry / All EIS providers / Agency Files / 100% of EIS providers will have documented MOUs on file for key points of entry into care to facilitate access to care for those who test positive. /
EIS SoC / Outcome Measure / Numerator / Denominator / Data Source / Goal/Benchmark /
PROCESS /
Agency staff will have documented evidence of orientation training in case management services. / EIS staff will have documented training provided, at a minimum annually, for case management services. / All EIS staff with documented training in case management / All EIS staff / Agency Files / 100% of EIS staff will have documented training provided in case management services, at a minimum annually. /
Supervision of unlicensed EIS staff is documented through client case reviews and kept in secure staff file. / All EIS staff will be supervised and have documentation of such supervision in staff file. / All EIS staff with documented evidence of supervision / All EIS staff / Agency Files / 100% of EIS staff will be supervised and have documentation in staff files of results of each supervised session. /
EIS SoC / Outcome Measure / Numerator / Denominator / Data Source / Goal/Benchmark /
OUTCOME /
EIS Service Provider shall ensure client attends an initial visit with an HIV Specialist. The initial visit must take place within 90 days of identification and must include CD4 count and viral load screening. / Documentation of initial medical visit in client files. / Number of newly enrolled EIS clients with documentation of attendance to initial medical visit / Number of newly enrolled EIS clients / Client Charts
CAREWare / 75% of newly enrolled EIS clients will have documentation of attendance to an initial medical visit in their files. /
EIS Service Provider shall provide client health education concerning the HIV disease process, risk reduction, and maintenance of the immune system. / Documentation of health education and literacy assessment completed in client files. / Number of newly enrolled EIS clients with documentation of health education/literacy assessment completed / Number of newly enrolled EIS clients / Client Charts
CAREWare / 75% of newly enrolled EIS clients will have documentation of health education given regarding HIV disease process, risk reduction, and maintenance of the immune system, to include a health literacy assessment. /
EIS SoC / Outcome Measure / Numerator / Denominator / Data Source / Goal/Benchmark
OUTCOME
EIS Service Providers will ensure linkages to mental health and psychosocial support services to clients demonstrating need for behavioral health services as indicated by the clinician’s assessment of the patient’s needs. / Documentation of mental health, psychosocial support services linkages based on clinician’s assessment. / Number of newly enrolled EIS clients with referrals to mental health and support services / Number of newly enrolled EIS clients / Client charts
CAREWare / 75% of newly enrolled EIS clients will have documentation of mental health and psychosocial support service referrals in client files, where indicated a need.
EIS clients will attend at least one medical visit before transitioning to Medical Case Management Services. / Documentation of transition from EIS to Medical Case Management services. / Number of newly enrolled EIS clients transitioned to Medical Case Management Services / Number of newly enrolled EIS clients with at least one medical visit documented / Client Charts
CAREWare / 75% of EIS clients will be transitioned from EIS to Medical Case Management services after documented evidence of at least one medical care visit in an HIV setting.

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Revised and Approved by QI, August 2013