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 : The Palm Beach County, the Ryan White Part A program provides medical and support services for people living with HIV/AIDS (PLWHA). City of West Palm Beach, serves as the Grantee for the Housing Opportunities for Persons with AIDS (HOPWA) program. The County in partnership with the City has implemented a coordinated approach to reducing new HIV infections, increasing access to care for PLWHA, and reducing HIV-related health disparities. This project has been funded by a HRSA SPNS grant.
The County assures that treatment and support services are targeted to and provided for PLWHA that are homeless or living in unstable housing situations. This is accomplished by addressing the needs homelessness and housing unstable in the local Ryan White A patient population, and by effectively streamlining program planning and evaluation across the HOPWA and Ryan White programs. The project goals include:
(1) Facilitate effective care coordination and service referrals between HOPWA and Ryan White Part A providers
(2) Increase viral suppression by identifying gaps and delays in services for PLWHA
(3) Develop a comprehensive evaluation and monitoring framework that utilizes client-level health outcomes to assess service delivery models and inform funding allocations
(4) Facilitate partnerships with HUD-funded housing programs to create effective and efficient use of housing resources in Palm Beach County
Description : • Data Integration: Ryan White data is housed in an existing database. HOPWA transitioning from paper files to electronic by integrating their data into the database used by Ryan White. This was completed through data uploads, manual data entry, and scanning.
• Service Coordination: Through better service coordination the client’s navigate the systems more efficiently.
• Database Enhancements: Post integration, enhancement are considered to make the system more effective. For example digitizing the HOPWA wait list, adding triggers & alerts for the front end users.
• Monitoring and Evaluation: Data integrity is monitored. Consumer health outcomes are assessed. The strengthening of the homeless and housing network is evaluated through a social network analysis.
Lessons learned : Findings for the following evaluation questions and the five domains will be presented. The presentation will include client flow chart, social networking analysis, health outcome data, impact of database enhancements, shifts in data entry procedures, etc.
(1) What impact does database integration/service coordination have on client health outcomes?
(2) What systems/policy changes have the greatest influence on greater service coordination between the HOPWA and Ryan White programs? Which agencies are most critical in facilitating service integration?
(3) What are the key processes that define the jurisdictional information system? How does the data management system reflect these processes/process rules?
The evaluation design proposes to collect data across five domains:
1. network/organizational relationships
2. systems/policy change
3. best practice diffusion
4. network leadership
5. health outcomes
Recommendations : Next steps will be presented and at a minimum include an overview of the following:
• Ongoing review and identification of system enhancements for database and service coordination to improve health outcomes
• Ongoing assessment of impact of systems/policy changes
• Ongoing system user training
• Ongoing strengthening of network measured through periodic social network analysis using the PARTNER tool.