Positive Living
Navajo AIDS Network, Inc.
Melvin Harrison, Executive Director
Marco Arviso, Arizona Medical Case Manager
Objectives
• Define Medical and Psychosocial case
management
• Describe “linkage to care”
• List examples of individual, group and
community level interventions.
What is Psychosocial Case Management?
• Early access to and maintenance of comprehensive health
care and social services.
• Improved integration of services provided across a variety
of settings.
• Prevention of disease transmission and delay of HIV
progression.
• Increased knowledge of HIV disease.
• Greater participation in and optimal use of the health and
social service system.
• Reinforcement of positive health behaviors.
• Personal empowerment.
• An improved quality of life.
What is Medical Case Management?
Medical Case Management (MCM) is traditional
case management with the primary purpose of :
1) retaining clients in medical care and
2) achieving positive health outcomes for clients
of NAN Inc.
-HIV Medical Case Management Guidelines
District of Columbia 2010
Client Demographics
•
•
•
•
•
•
Average age: 46
Age range: 22-74
New Mexico – 18
Arizona – 42
Average CD4-328.4
Average Income$402.00
•67% have reported
substance use in the last
year
•3 clients looking for
suitable housing for
winter
•1 client self reported as
homeless
60 clients
2.5 hours
Phoenix, AZ
Pittsburgh, PA
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
Active Cases- Enrollment on CM
n=60
16
14
12
10
8
6
Series 1
4
2
0
AZ Active Cases 2012Gender
Transgender
M-F, 5
n=60
Female, 10
Male, 45
Active CasesStatus
n=60
unknown
3%
HIV
50%
AIDS
47%
Active Client- Risk
Risk
1% 2%
10%
MSM
Hetero
Unk
32%
55%
IDU
MSM/IDU
Linkage to Care:
How does the process of Case Management work?
If you know that you
are positive and need
case management...
If you are tested at a
mobile unit and are
newly infected...
Contact NAN for Case Management
If you are recently
diagnosed in a clinical
setting…
Assessment
Contact NAN Inc. Case Manager and set up an
appointment for an intake interview where we
will discuss your health concerns and plan
your care.
•Health
•Financial
•Social support
•Practical Needs
•Education/Employment
•Mental Health
•Risk
•Substance Abuse
•Legal
Working with Primary Care Providers
The goal of Medical Case Managers is to provide a client with
the skills, information and support to follow mutually agreed
upon treatment adherence recommendations of healthcare
professionals to achieve optimal health.
• Taking all medications as prescribed
• Making and keeping appointments
• Addressing barriers to care and treatment and
• Involving the clients belief of Cultural Traditional
Medicine where necessary
Team Care Meetings
Meetings with I.H.S. Care team to discuss mutual clients
• Evaluation
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–
–
–
–
CD4
Viral Load
STI
Mental Health
ADAP (AIDS Drug Assistance Program)
• Future appointments
• Referrals
• Progress notes
Individual Interventions-Care Plans
• Travel Reimbursement
• Emergency Financial Request(clients in Crisis)
– Wood/coal delivery
– Utilities
– Housing
•
•
•
•
Transitional Housing
Ceremonial Assistance
Social/educational Support
Client/family education/disclosure
Group Interventions
•Gathering of Clans
•Monthly
•Informal
•“special guests”
•Healthy Relationships
•5 session cycle
•Reducing stress
•Disclosure
•Annual Client Summit
•Wellness
•Updates
•Many Men, Many Voices
•Annual
•Specifically adapted for PLWHA
Barriers
• Funding
– Increased number of clients
– Transportation
– Housing
• Confidentiality/stigma
– Fear of Gov systems
• Substance Abuse
Solutions
• Anti stigma approach to media
• Substance Abuse facility addressing MSM/T
unique needs
Questions
Thank you