L A Co mmunity He a lth Pro je c t I mpro ve the he a lth a nd - PowerPoint PPT Presentation

L A Co mmunity He a lth Pro je c t

I mpro ve the he a lth a nd we ll b e ing o f pe o ple a ffe c te d b y drug use in L o s Ang e le s.

Harm Re duc tio n - re duc e ne g a tive c o nse q ue nc e s a sso c ia te d with drug use . Pe e r L e ade rship in planning and se rvic e s F o c us Are as Pre ve ntio n: Ove rdo se , HI V, He patitis C, so ft tissue infe c tio ns Ac c e ss to He althc are : primary, SU tre atme nt, Me ntal He alth Se rvic e s Addre ssing b arrie rs: Ho me le ssne ss, c o rre c tio ns invo lve me nt

Promote Support He a lthy Build Re la tionships Supportive De c isions Communitie s • Cre ate no n- • Pe o ple se t the ir • T rain se rvic e judg me ntal o wn he alth pro vide rs and c o nne c tio ns with g o als – thro ug h o the r pe o ple who use c o llab o ratio n we c o mmunity drug s and the ir assist the m as me mb e rs o n c o mmunitie s. the y mo ve wo rking with to wards the ir pe o ple who use g o als. inje c tio n drug s.

L A Co mmunity He a lth Pro je c t  Annua lly ~8,000 PWI D  77% ho me le ss (98% o utre a c h)  62% o pio ids  55% POC, 45% Ca uc a sia n  90% 30 – 60 YO  75% M, 22% F , 3% T

Co re Princ iple s o f Ha rm Re duc tio n • Clie nt c e nte re d • Building o n c lie nt’ s stre ng ths • Re c o g nize s c o ntinuum o f drug use (no n-disruptive to disruptive ) • Pe o ple o fte n ma ke inc re me nta l c ha ng e s • Re c o g nize s the impo rta nc e o f q ua lity o f life – individua l a nd c o mmunity

Co re Princ iple s o f Ha rm Re duc tio n (c o nt.) • Drug use rs a s prima ry a g e nts in re duc ing ha rms • No n-judg me nta l, no n-c o e rc ive pro visio n o f se rvic e s • I nfo rme d b y so c io e c o no mic / struc tura l fa c to rs, stig ma , & tra uma  c ultura l c o mpe te nc e – pe e rs • “Do e s no t a tte mpt to minimize o r ig no re the re a l a nd tra g ic ha rm a nd da ng e r a sso c ia te d with lic it a nd illic it drug use ”

Ha rm Re duc tio n Prio ritie s I mme dia te he a lth a nd sa fe ty risks (he pa titis, HI V/ AI DS, o ve rdo se - na lo xo ne , supplie s) Sta b iliza tio n & suppo rts (ho using , e c o no mic , c o mmunity) L o ng te rm po sitive c ha ng e s (Re c o ve ry)

Wo rking with pe o ple to re duc e risk HIV ra te a mo ng pe o ple who inje c t drug s in L A is 3%. I nje c tio n drug use c urre ntly a c c o unts fo r mo st HCV tra nsmissio n in the U.S. By 10 ye a r o f inje c tio n HCV ra te = a lmo st 100% 87% ha ve ha d a t le a st o ne o f the fo llo wing SST I : a b sc e ss, c e llulitis, MRSA, Ne c ro tizing F a sc iitis. 20% a t a ny time . L A Co unty ha s the hig he st numb e r o f ove r dose de a ths o f a ny c o unty in Ca lifo rnia . PWID ARE AT E L E VAT E D RISK F OR BOT H ACUT E AND CHRONIC HE AL T H CONDIT IONS. ACCE SS T O URGE NT AND ROUT INE CARE ARE CRIT ICAL L Y NE E DE D F OR T HIS POPUL AT ION.

He a lth risks e xa c e rb a te d b y struc tura l b a rrie rs

Ho me le ssne ss & F o o d I nse c urity  62% o f inje c tio n drug use rs a re ho me le ss rig ht no w b a se d o n c o mmunity sa mple s fro m 2011-13.  13% inc re a se fro m 2001-03 sa mple o f PWI D a t SE Ps.  56% o f L o s Ang e le s PWI D e xpe rie nc e d fo o d inse c urity in the la st mo nth – me dic a ting hung e r

Vio le nc e & T ra uma  Ma jo rity o f ho me le ss pe o ple & PWI D ha ve histo rie s o f e a rly tra uma .  Ho me le ss o ng o ing vio le nc e & tra uma  Ho me le ss PWI D a t e xc ha ng e re po rt hig h ra te s o f vio le nc e

L A Home le ss PWID Viole nc e In the la st 12mo T hre a te d with we a po n 23% Punc he d/ sla ppe d/ kic ke d 21% Vic tim o f stra ng e r a tta c k 19% Ha d b e lo ng ing s sto le n 55% Sa w so me o ne kille d 17% K ne w so me o ne who wa s kille d 42%

Pe o ple use he a lthc a re to re so lve he a lth ne e ds

PWI D E xpe rie nc e & Co nc e rns Just like e ve ryo ne e lse Wa iting is ha rd. Pre se nta tio n: hyg ie ne & c lo thing (to uc h) Co nc e rne d a b o ut pa in (ve ins, a b sc e sse s) Mo re so tha n o the rs: ma na g ing sha me / stig ma **Be ing liste ne d to a nd tre a te d with re spe c t g oe s a long wa y.

Pe e r Re so urc e s: Vide o s

Pe o ple wa nt & ne e d he a lthc a re Stre ng ths to b uild o n:  Alre a dy a c c e ssing pub lic he a lth pro g ra m - c o ming to e xc ha ng e , pa rtic ipa ting in tra ining s  Asking fo r me dic a l he lp  Our e xpe rie nc e , a nd lit b a c ks up the y a re like ly to c o mply with me dic a l instruc tio ns

Pilo t - a n inte rve ntio n to minimize / re c o g nize / re so lve / de fl e c t the struc tura l b a rrie rs to he lp PWI Ds e sta b lish a me dic a l ho me .

Pilo t F e a ture s – Big Pic ture  Se lf ide ntifie d he a lth g o a ls  Addre ss initia l o b sta c le s & ma ke g a me pla n (I D, c lo thing )  T ro ub le sho o t b a rrie rs during pro c e ss (lite ra c y, a nxie ty)  E va lua te e xpe rie nc e & re vise g o a ls & g a me pla n  He a lth E duc a tio n – OD/ SST I  Suppo rt Me dic a l Ho me s – c linic e ng a g e me nt & tra ining

Pilo t F e a ture s – Mo re  Co nta c t: suppo rt me e ting s + e xc ha ng e visits  T ra nspo rt, a c c o mpa ny & suppo rt during c linic visits  I nc e ntive s to re info rc e he a lth g o a ls  Purc ha se supplie s a s ne e de d – te nts, c lo the s, fo o d  E xplic it c o nve rsa tio ns a b o ut wha t to e xpe c t fro m pro vide r visits

Pa rtic ipa nts 80% ho me le ss 85% uninsure d 15% insure d b ut no t using c a re (a uto -e nro lle d) 80% Ca uc a sia n 15% Afric a n Ame ric a n 5% API 80% Ma le 20% F e ma le

Pa rtic ipa nts 1 re c e nt HI V+ dia g no sis 14% se x wo rke rs 36% re po rt e xpe rie nc ing vio le nc e in the pa st 1 c urre ntly in DV situa tio n - no t re a dy to le a ve

During pilo t 30% re q ue ste d he lp with drug c e ssa tio n – 75% he ro in, 25% me th Re ne we d c o nne c tio ns: 3 ho me le ss me n re c o nne c te d with fa mily  I nvita tio n ho me  F a c e b o o k  fa mily visit & dinne r *

Clinic suppo rt ma ke s a ll the diffe re nc e  Sma ll a c tio ns tha t de mo nstra te c o nne c tio n a nd c a ring ma de a hug e impa c t (b ike , hug , sc re e ning )  E ng a g e d le a de rship & sta ff – me dic a l a nd no n-me dic a l  Surve y & tra ining : I nte re st in se rving po pula tio n – a sking fo r mo re to o ls to do so

During pilo t – b a rrie rs still the re Struc tura l pro b le m - po o r a c c e ss to sub sta nc e use tre a tme nt I nc a rc e ra tio n & Po lic ing  20% a rre ste d  wa ve s o f inc re a se d po lic ing o f ho me le ss in Ho llywo o d 20% re po rt vio le nc e during pilo t time 20% ro b b e d 40% displa c e d fro m sa fe c a mpg ro und/ ho me le ss e nc a mpme nt

Pe e r I nvo lve me nt & ma te ria ls  F o c us a nd suppo rt g ro up to e xa mine he a lth a nd o the r issue s  I nfo rma tio na l pa mphle t fo r a t pe o ple who inje c t drug s inte re ste d in re c e iving he a lth c a re se rvic e s  Re fle c ts prio ritie s a nd e xpe rie nc e s o f g ro up  Use s la ng ua g e use d b y the g ro up to de sc rib e the ir e xpe rie nc e  F ilm b a se d o n e xpe rie nc e s o f g ro up, the ir a dvic e a nd g uida nc e fo r o the rs  Pe e rs na rra te a nd a ppe a r in the vide o  Se t in a re a l he a lth c e nte r a nd lite ra lly wa lks pe o ple thro ug h the e ntire e nro llme nt thro ug h pro vide r e xa m pro c e ss  Re a l he a lth c a re pro vide rs inte rvie we d o n c a me ra to ta lk a b o ut the ir e xpe rie nc e s wo rking with this g ro up a nd e xpla ining wha t the y b ring to a ne w pa tie nt e nc o unte r with so me o ne who is a n a c tive sub sta nc e use r

Pe e r Re so urc e s: Vide o s http:/ / c hpla .o rg / vide o s-he a lthc a re -fo r-pe o ple -who -use -drug s/

Pe e r Re so urc e s: Pa mphle ts

Ho w yo u c a re ma tte rs.

Re c o mme nda tio ns T ra in a ll sta ff – a sk the m wha t the y ne e d  Mo tiva tio na l inte rvie wing - fo c us o n b rie f inte rve ntio ns  Wo rking with ho me le ss pa tie nts  T ra uma info rme d c a re E xpa nd pra c tic e to inc lude MAT , c o pre sc riptio n o f na lo xo ne a nd o the r re c o mme nde d pra c tic e s Re c o g nize a nd re spo nd to ne e ds o f the po pula tio n – a sk the m wha t the y ne e d  Suppo rt, he lp with ho using , pla c e to sho we r, c le a n c lo the s, tra nspo rta tio n  Dro p in & nig ht ho urs  o utre a c h prima ry a nd o the r he a lth c a re se rvic e s – no t just re fe rra l

Build T rust  Yo u wo n’ t g e t e ve rything do ne the first visit – yo u ne e d to b uild a re la tio nship  Pa rtne r with a n o rg a niza tio n who kno ws yo ur a re a a nd this po pula tio n

Pro vide re so urc e s: “Me dic ine a nd drug use : Wha t c a n a prima ry c a re pro vide r do ? ” http:/ / c hpla .o rg / vide o s- he a lthc a re -fo r-pe o ple -who - use -drug s/