Comprehensive Needs Assessment 2018 Ryan White Part A Program Las Vegas TGA
Introduction • Bridget Kelly, Doctoral student, Criminology and Criminal Justice • Cannon Survey Center Manager, Part-time Instructor • Pet, swing dance, and bonsai enthusiast • Interests arising from Ryan White collaboration: – HIV in the South/ in prisons; harm reduction
Background • Work began in May 2018 • Survey instruments were developed collaboratively with the Recipient Office • Both surveys were built in Qualtrics • Consumer Survey was translated into Spanish • Survey team was trained on confidentiality and referrals • Provider Survey Data Collection (optional and anonymous) – June 27 through July 25, 2018 • Consumer Survey Data Collection ($5.00 gift card) – July 2 through August 14, 2018
Presentation Outline • Part One: Provider Survey • Part Two: Consumer Survey
Provider Survey Data Collection • Providers – Self-administered online – Recruited by email, group announcements – 55 survey respondents; 16 agencies invited
Providers: Respondent Profile • 38% case managers/social workers • 20% program managers/supervisors • 1/3 spend over 50% of time with clients • 60% have worked with HIV/AIDS population for 5 years or less • 71% have worked with agency for 5 years or less
Providers: Agency Profile, Type Type of Organization 60.0% 54.7% 50.0% 39.6% 40.0% 30.0% 22.6% 20.8% 20.0% 10.0% 0.0% AIDS service Medical provider Mental health provider Public health clinic organization
Providers: Agency Profile, Funding Funding Streams 100.0% 90.6% 90.0% 80.0% 70.0% 56.6% 60.0% 50.0% 37.7% 40.0% 26.4% 24.5% 30.0% 20.0% 10.0% 0.0% Ryan White Part A Ryan White Part B Federal/State Contributions/Private Revenue (fees) Funding Funding Government Donations
Providers: Agency Profile, Languages • 85% foreign translation services available (typically Spanish, French, Amharic) Translation Services 75.5% 80.0% 64.2% 64.2% 70.0% 60.0% 50.0% 34.0% 40.0% 30.0% 20.0% 10.0% 0.0% Currently have bi- Language line Ensuring translators Translating patient lingual staff on hand are provided by an material into outside company/ lanugages besides organization English
Providers: Agency Profile, Access • 98% near public transportation Agency Hours of Operation 100.0% 100.0% 80.0% 60.0% 40.0% 13.7% 20.0% 5.9% 0.0% Weekday hours Weekday Weekend hours (8am to 5pm) evening hours (After 5pm)
Providers: Capacity Changes in Demand and Funding 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% An increase in demand for services from 76.5% clients? An increase in the number of clients 66.7% seeking services? A decrease in the amount of funding your 21.6% agency receives from any funding stream? A decrease in the amount of funding 17.6% provided from private donations?
Providers: Capacity and Agency Needs Agency Needs to Increase Capacity 62.0% 70.0% 58.0% 60.0% 50.0% 32.0% 40.0% 26.0% 30.0% 20.0% 10.0% 0.0% Funding to expand Funding to develop Increased Training current capacity new capacity partnerships with HIV/AIDS specialty agencies and organizations
Providers: Client Needs Client Needs Ranked by Number of Mentions (Top 5) 30.0% 25.0% 25.0% 20.0% 15.5% 12.9% 15.0% 8.6% 7.8% 10.0% 5.0% 0.0% Housing/ Assistance Mental Health/ Transportation Medical Care Case Management/ to Homeless Behavioral Health/ Coordination/ Substance Abuse Assistance with Services Eligibility
Providers: Ryan White Service Importance Most Important Ryan White Services (Top 5) 80.0% 68.0% 70.0% 62.0% 60.0% 54.0% 60.0% 52.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Early Medical Case Mental Health Emergency Medical Intervention Management Services Financial Transportation Services Assistance
Providers: Agency Barriers Agency Barriers to Service Provision 70.0% 60.0% 60.0% 50.0% 36.0% 40.0% 30.0% 30.0% 30.0% 22.0% 22.0% 20.0% 10.0% 0.0% Clients routinely Agency doesn't Not enough Clients may have Clients don't have Insufficient staff miss provide all the resources at my trouble getting to payment source to provide appointments services a person agency our offices services needs
Providers: Wait Lists for Services • 26% report a wait list for some services, typically – Mental health services (2+ weeks) – Housing (months-year) – Specialty referrals (2-6 months) – Nutrition (3-4 weeks) – Vision/dental (1 month or more)
Providers: Suggested Improvements • Support of eligibility processing • Transportation • Agencies/locations that can accommodate the full range of services that clients need • Coordination/communication between agencies • Funding/resources/personnel
Questions
Consumer Survey Data Collection • Consumers – Self-administered online/mail + Interviewer-administered by phone – Recruited by phone, flyers, group announcements – 199 survey respondents; 3,169 contacts attempted up to 3x, 943 received link – Incentive provided - $5 gift card for Smith’s Food & Drug • 171 sent, 28 opted out
Consumers: Respondent Profile • 199 respondents: 76% male, 76% age 45+ • 37.2% White/C, 28.4% Black/AA, 27.3% Hispanic/Latino Race/ethnicity Age 40.0% 37.2% 40.0% 35.4% 35.0% 35.0% 29.7% 28.4% 27.3% 30.0% 30.0% 25.0% 25.0% 20.0% 20.0% 15.9% 15.0% 15.0% 11.3% 7.2% 10.0% 10.0% 4.9% 5.0% 5.0% 0.5% 1.1% 0.5% 0.5% 0.0% 0.0% 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 and American Asian Black/African Hispanic/Latino Native White Multiple Races older Indian/Alaskan American Hawaiian/Pacific Native Islander
Consumers: General Service Needs and Challenges in Managing Health • In your opinion, what is your most important service that helps you manage your HIV status? – Medication/medication assistance – Access to doctors, staff, and medical care • What challenges/concerns did you have in the past 12 months taking care of yourself? – Financial constraints – Struggles with poor health – Inconsistency in medical care – Transportation
Consumers: Changes in Administration of Care In the past year have there been any changes in the way HIV/AIDS care is administered? 70.0% 59.2% 60.0% 50.0% 40.0% 30.0% 16.3% 20.0% 13.6% 10.9% 10.0% 0.0% No changes A little change Some changes A lot of changes
Consumers: Difficulty Obtaining Treatment To what extent have you had difficulty obtaining HIV/AIDS care and treatment that you need? 66.1% 70.0% 60.0% 50.0% 40.0% 30.0% 15.1% 20.0% 10.4% 8.3% 10.0% 0.0% No difficulty A little difficulty Some difficulty A great deal of difficulty
Consumers: Health Information Sources Where do you receive information about your HIV-related health? 76.1% 80.0% 70.0% 60.0% 50.0% 38.6% 40.0% 30.0% 21.8% 18.3% 15.2% 20.0% 12.2% 10.0% 0.0% Clinic visit Service Support group Online (internet, Case manager Other organization Facebook, etc.)
Consumers: Travel Time to Health Provider On average how long does it take you to get from your home to your HIV doctor's office? 40.0% 34.8% 35.0% 30.0% 26.3% 22.2% 25.0% 16.7% 20.0% 15.0% 10.0% 5.0% 0.0% Less than 15 minutes 16 minutes to 30 31 minutes to 45 More than 45 minutes minutes minutes
Consumers: Cultural Competence of Providers Are the services you receive at your HIV doctor's office culturally competent? 80.4% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 8.4% 7.3% 3.9% 10.0% 0.0% Not at all A little Some A great deal
Consumers: Experiences with Stigma • In the past year, have you experienced stigma at your treatment provider(s)? – 92% indicated NO – 8% indicated YES
Consumers: Services Received Services Received in the Past Year (Top 5) 70.0% 60.1% 57.2% 60.0% 47.0% 50.0% 42.6% 35.2% 40.0% 30.0% 20.0% 10.0% 0.0% Health Insurance Oral Health Care Medical Case Food Assistance Mental Health Assistance Management
Consumers: Services Needed, but Not Receiving Services Needed Now, but Not Receiving (Top 5) 45.5% 50.0% 42.2% 45.0% 40.0% 35.0% 29.1% 29.0% 26.4% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Oral Health Food Assistance Medical Emergency Housing Care Transportation Financial Assistance Assistance • Barriers include: Lack of awareness/availability of service, transportation
Consumers: Service Need, Regardless of Current Use Services with Great Deal of Need (Top 5) 65.9% 70.0% 60.0% 54.0% 50.3% 50.0% 42.9% 37.0% 40.0% 30.0% 20.0% 10.0% 0.0% Oral Health Care Health Insurance Food Assistance Medical Housing Assistance Assistance Transportation
Consumers: Additional Services Needed, but Not Receiving • Vision care • Financial assistance • Housing • Specialty care
Conclusions and Recommendations • High need and use: – Oral health care – Transportation – Health insurance assistance • High need (sometimes not receiving): – Food assistance – Housing • To address a common barrier (lack of awareness/help with eligibility): – Medical case management
Questions
Full Report • Available from the Part A Recipient Office
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