Native American Health Center Holistic Native Network

1
Native American Health Center Holistic Native
Network

• AI/AN SPNS Initiative
• Presentation by Maritza Penagos

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Native American Health Center

• A CBO founded in 1972
• Provides a full range of primary medical, dental,
  substance abuse, mental health and HIV/AIDS care.
• One of the largest urban Indian clinics in the
  nation
• We have clinics in Oakland, Sacramento, Alameda
  and San Francisco
• HIV Services located in SF clinic

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Holistic Native Network

• Aims to provide holistic case management for HIV
  positive clients
• Link mental health, substance abuse services,
  primary medical care and practical support
• Goal is to provide integrated health care

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Holistic Native Network

• Primary Medical Care
• Case Management
• Substance Abuse Services
• Mental Health Services
• Peer Advocacy
• Treatment Adherence
• Prevention w/Positives
• HIV CTR

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HIV Counseling, Testing Referral

• 246 increase in testing in last 4 years
• 45 of individuals receiving HIV tests at NAHC
  were AI/AN
• 50 of all tests that were confirmed to be
  positive were AI/AN individuals
• Risk Factors for individuals testing positive at
  NAHC MSM, MSM/IDU, IDU

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Rapid Testing vs. Orasure 2005

• Rapid Testing
• 501 tests
• 4 positives
• 141 High Risk Negatives
• .79 prevalence

• Orasure
• 19 tests
• 2 positives
• 9 high risk
• 10.52 prevalence

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Barriers Successes to Testing

• 55 of the individuals presenting for testing are
  non-Native
• Many staff are cross trained to support our
  drop-in basis testing
• Individuals are coming to us for testing b/c
  theyre being turned away from other agencies for
  not fitting target population characteristics
  during pre-screens

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Linking testing to treatment

• Informed Consent process describes linkages
• When infection is preliminary reactive and
  confirmed, individual is asked if theyd like to
  meet case manager or provider
• Consent to contact during informed consent,
  preliminary reactive and confirmatory stages
• Fiscal year 2005-06
• 4 of the 6 new positives linked to the Ryan White
  Case Management referral.
• 2 enrolled into SPNS

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SPNS Initiative

• 55 clients enrolled
• 48 describe active substance abuse
• 44 have CDC defined AIDS
• 55 fit HUDs homelessness definition
• 56 identify as AI/AN 37 as multi-racial AI/AN

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Utilization of Services

• HIV CTR, case management, treatment adherence and
  peer advocacy are all components of the
  intervention that are highly utilized
• Service utilization of cultural wellness
  activities and alternative therapies has been
  surprisingly low
• Do people underutilize cultural wellness
  activities because of substance abuse?

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SPNS initiative

• data collected includes demographic information
  and a Quality of Life survey at baseline, 3
  months, and 1 year.
• Important change has been observed through the
  Quality of Life survey.

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Past 4 weeks have you been happy?
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Problems interfering with normal social
activities?
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Quality of Life

• This amount of change over a short time span of
  three months indicates positive change,
  suggesting that holistic case management is
  working to improve the lives and sense of
  well-being of our HIV positive clients.

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Lessons Learned

• High acuity level of population being served
  means 2 case managers are needednurse and
  substance abuse case manager
• Substance abuse services have to be well
  integrated
• Harm reduction is vital
• Need to have more linkage and steps between
  assessment of substance abuse and referral to
  recovery program

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Lessons Learned

• Medical model can be implemented in a culturally
  competent manner
• Coordination amongst various departments,
  agencies and funding mandates takes a lot of
  administrative time
• Funding mandates often dictate service planning

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Acknowledgement

• This work was supported by Health Resources and
  Services Administration (HRSA) Special Projects
  of National Significance (SPNS) Program grant H97
  HA 00251 (Holistic Native Network) Center for
  Mental Health Services grant SM 53893 (Native
  Circle) Centers for Disease Control and
  Prevention grant PA 04064 (Circle of Healing)
  Ryan White C.A.R.E. act Title III (San Francisco
  Community Clinic Consortium) San Francisco HIV
  Health Services General Funds grant (Native
  American Center of Excellence).