Evidence Strategies and Practical tools for inclusion of social and structural interventions such as housing, employment, and food security in plans to end the epidemic
Policy, Program, Intervention or other types of research evaluation
Issues : It is well known that the structural determinants of health, such as housing and employment (conditions) shape the physical and mental well-being of individuals living with HIV. Addressing the social determinants of health is key to END the EPIDEMIC. However, few homegrown, culturally appropriate structural interventions exist. We discuss the issue and describe Project CORE.
In the context of employment, the U.S. Equal Employment Opportunity Commission reports that persons living with HIV experience problems with stamina, increased restroom use, vision/difficulty seeing, or cognitive impairment/unable to concentrate. There is a need to change employment conditions as well as ensure individuals living with HIV know their employment rights.Housing is another social determinant of health, in that research indicates that stable housing enhances individuals mental health and increases medication adherence. Despite such findings, many organizations often do not have the resources to change the structures that directly impact individuals living with HIV. This also requires coordination and enhancement of services that might be outside of the traditional scope of HIV service organizations. Thus, intervening on and understanding as well as evaluating the role of social determinants of health might not often be a priority. This abstract describes a unique collaboration between community-based organizations and a university to develop and evaluate a multi-level intervention, Project CORE that coordinates housing and employment services.
Description : Project CORE is a collaboration between Avenue 360 Health and Wellness, AIDS Foundation Houston, Inc. and the University of Houston Graduate College of Social Work, designed to coordinate housing, employment services, and HIV care to increase employment/income outcomes of persons living with HIV who are currently receiving services through HOPWA and/or RWHAP. The purpose of this presentation will be to describe the framework, the Clinical-Community Population Health Intervention (CCPH) model, and the model for Project CORE. The CCPH model is a multipronged approach which includes 1) Inquiry: data collection and partnership formation with community organizations, 2) Assessment: prioritization of health issues and comprehensive strategy development; 3) Action: environmental and policy change with coordinated clinical and community prevention activity leading to improved patient outcomes and cost savings. AVENUE 360 and AFH provide outreach services to HOPWA-eligible individuals to access employment services and provide intensive employment support while making certain individuals overcome exiting and/or potential barriers they face when returning to the workforce. As part of the intervention, employment services are provided in order to enhance current case management strategies designed to connect individuals to employment or to improve a person’s income through employment. Such services include resume building, job search assistance, and resource rooms with internet and commonly used software packets for resume writing, job training, accessibility services. The employment services are based on the Department of Labor’s “Getting to Work” initiative; which enhances the program’s employment and fiscal will management focus by: 1) Increasing the client’s value of work, 2) Implementing employment services via trained service providers and 3) Increasing and maintaining strong partner collaborations with outside employment service providers. Coordination among housing and employment sectors of the organizations are optimized through data sharing, communication, and collective case planning.
Lessons learned : Clinical-Community Population Health Intervention model helps Community Health Centers bridge the gap between health services and community prevention
Changing structures within and between agencies and partners has the potential to have a lasting impact
Documenting the process by which novel interventions are developed is imperative for evidence-based practice and adaptability
Recommendations : Develop interdisciplinary partnerships to coordinate different aspects of care and to evaluate the process and outcomes of the intervention
Capitalize on the strengths of all partners to coordinate all aspects of care
Document novel approaches to changing social and structural determinants of health