Reaching The Hard To Reach Jane Fox, MPH & Serena Rajabiun, MA, MPH Boston University
Objectives • List methods to determine who is truly not engaged in HIV primary care; • Identify partnerships to support your efforts in identifying and serving hard to reach clients; and • Discuss internal methods to increase staff customer service skills to support linking and keeping hard to reach clients in HIV care and services
Why? • Recruitment • Enrollment • Follow-up
Who is hard to reach? • People who… – Experience stigma – Are using substances – Have co-occurring mental health issues – Are employed – Have experienced trauma – Undocumented
What to do? • Internal methods • External methods • Using data and data systems • Social media • Tangible reinforcements • Other lessons from SPNS colleagues
Inte rnal methods • Internal methods – Build a list – Educate your agency staff about the intervention and the study (protocol) – Talk with providers – Talk more and continue talking (keeping momentum) – Expand into other departments (ER, behavioral health, etc)
Agency wide buy-in • Agency wide knowledge and buy-in • Using others in your organizational system (ER notifications, other programs/projects who may run into your clients or potential clients) • Referral procedures – Who to call – How to schedule – Flow chart
Build a list Building an out of care list (for clinical sites or have a partnership • with one) – Definition of out of care – Using EMRs, scheduling systems, or CareWare (or equivalent) – Talk to your providers – • “who have you not seen in the past 6 months?” • “who has been loosely engaged in care?” • “who is not virally suppressed but should be?” – Refine your list as you go – Lather, rinse, repeat
External methods External methods • – Meet with current partnership staff (DIS, existing MOU providers, testing agencies) • How does this project fit into existing partnerships? Identify gaps in your partnerships and target those who can fill the • gaps – What services or partners are needed to best meet the needs of your clients? Including locating them? – What do you have to offer partners and what is your ask of them? Not the “usual” folks •
Expand your partners • Get out and build new partnerships – What do you bring to this partnership and what are you looking for in exchange? • Set-up appointments to visit potential partners – Introductions (of you and your project) – Identify your common goal – Communication – referral mechanisms – Other groups/forums
Build a community team • Organize a community forum/partnership meeting – You are not alone in this. – Bring your old and new partners together to meet on a topic or issue – Housing, behavioral health services, transportation, finding clients, etc – Make sure to include the community case managers and link coordinators both RW and not • Nurture these relationships • Continue to expand the group
Customer service • Do your partner agencies need training on customer service? – How can you help build partner capacity? – Can you help with cultural competency capacity building with those partners who need it? – Can you share resources to train partner agency staff with your staff?
Data and data systems • Data & data systems – HMIS • use this system to find out where clients are accessing services and where they are staying – Internal data alerts (ER) – Other data sharing – Jail/prison registries – Contact form (UNC)
Contact form Where can we find you? • – Demographics • The usual + – Aliases – Picture Contact information • – Emergency – Family – Friends – Parole officer – Case manager (RW and others) – Other social service agency staff
Contact form • Where can we find you? – Locations (days and time) • Address(es) • Social service agencies • Job • Hang outs • Churches • Any other regularly visited places – Social media accounts
Social media • Social Media – Facebook – Instagram
Tangible reinforcements • Contact cards • Bracelets • Cell phone minutes • Bus tokens
What else can you do? • Be customer service driven • Get out of the office – feet on the street (if not you, staff can call your cell to let you know they have found someone) • Go to or post intervention staff at a community agency - foods pantries/meals, drop in centers, library, day programs, etc
Lessons from other SPNS sites • Identify your champion(s) • Be responsive – Flexibility (hours of operation/evenings or weekends) – Meeting the person where s/he is – letting clients help prioritize their perceived needs – Offer or assist with transportation • Communication with team members to: – “Tag team” people out of care – Recognize and act on signs of impending crisis
Some folks are just not interested • Attempt to identify the patient’s priorities – What do they need that you can help with? – Is there a carrot? • Free will but keep in contact if allowed
A few resources https://careacttarget.org/ihip/innovative-approaches-engaging-hard-reach-populations • https://careacttarget.org/sites/default/files/file-upload/resources/ihip-opt-Outreach_curriculum_final.pdf • https://careacttarget.org/ihip/innovative-approaches-engaging-hard-reach-populations-living-hivaids-care-training- • manual-0 https://careacttarget.org/sites/default/files/file-upload/resources/MakingtheConnectionSPNS2007.pdf • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974746/ • http://www.unm.edu/~marivera/522%20readings%203/retaining%20clients%20in%20a%20cohort%20study.pdf •
Contact information Jane Fox, MPH janefox@bu.edu 617-638-1937 Serena Rajabiun, MA, MPH rajabiun@bu.edu 617-638-1934
Recommend
More recommend
