1 KTE Day 2014. Housekeeping Welcome & important details. 2.

1KTE Day 2014

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HousekeepingWelcome & important details.

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Goals of the Day

• Provide an overview of the program activity data reported during the 2013/2014 fiscal year.

• Discuss the findings and trends, and the implications for our work in responding to HIV in the province of Ontario.

• Build on successful and/or innovative practices to strengthen outcomes for community-based organizations.

• Strengthen partnerships and networking opportunities for community-based organizations.

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Agenda

8:00am Registration and Breakfast

9:00am Traditional Opening, Welcome, and Agenda Review

9:15am Introductions/ Arrival Exercise

9:30am View From the Front Lines 2014 Overview & Short-term Outcome #3 Table Discussion

10:25am View From the Front Lines 2014 Short-term Outcome #1

10:35am BREAK

10:55am Table Discussion – Short-term Outcome #1

11:15am View From the Front Lines 2014 Short-term Outcome #2 Table Discussion

11:45am View From the Front Lines 2014 Short-term Outcome #4 Table Discussion

12:15pm LUNCH

1:15pm Report Back from Table Discussions

1:30pm OCHART – Towards a Better Tomorrow Table Discussion

2:35pm BREAK

2:50pm OCHART – Towards a Better Tomorrow (cont’d)

3:15pm Video Presentation – Showcasing Innovative Practices

3:45pm Next Steps, Evaluation & Wrap-up

4:00pm ADJOURN

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Arrival Exercise

Self-introduction with colleagues at the same table: Name Position Agency How long at the agency One personal thing that is energizing your life right now

that you’re comfortable sharing

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Welcome to OCHART KTE Day >

The Purposes of OCHART Reporting

Accountability

The reports allow the programs,

the AIDS Bureau and the Public

Health Agency of Canada to

check actual activity against

program plans and logic models.

They also provide information on

how resources were used.

Planning

The reports may identify trends

that can be used to adjust

services or develop new

services locally and

provincially.

Quality

Improvement/

Evaluation

The reports may provide

information that programs

can use to strengthen their

services.

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Synthesized Logic Model

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View from the Front Lines 2014

• Brief Epi Update• Outcomes:

– Outcome 3: Individual, Organizationaland Community Capacity

– Outcome 4: Coordination and Collaboration– Outcome 1: Knowledge and Awareness– Outcome 2: Access to Services

• A Regional Snapshot• Hepatitis C Services

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HIV: Where Are We Now?

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HIV in Ontario in 2013

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Priority Populations

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Gay Men Account for Larger % of New Diagnoses

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Risk Factor by Sex

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Risk Factor by Sex

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New Diagnoses Increas ing in Men and Women Age 45 and Older and in Men Ages 25 to 34

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HIV Still Concentrated in Whites & Blacks

• In terms of ethnicity, between 2009-2013:– Most people diagnosed with HIV

were: white (52%), Black (25. – New HIV diagnoses in

men follow the same pattern: mainlywhite followed by Black.

– The distribution of new HIV diagnosesamong females is different: most areBlack (61%) followed by white (25%).

– 3% of new HIV diagnoses between 2009 and 2013 were in people who self-identified as being Indigenous (2% among males, and 4% among females).

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Regional Snapshot

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Who We Are and What We Do

• 89 funded HIV programs – up from 87 in 2012/13• Provided by 73 organizations

– 59 local or regionalprograms

– 14 provincial programs• 4 provide client services • 10 provide capacity building

services to support community-based organizations

• For the first time - 20 Hepatitis C Teams

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Government Funding Up ButFundraising Down

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Building Our Sector

Organizational Capacity– Strong commitment to

program monitoring andevaluation

– Strong commitment totraining

• Focus on addictions,harm reduction andsubstance use, and leadershipskills

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Outcome 3: Slides 28-37Increased individual, organizational and community capacity

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Who Makes the Programs Work?

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Trends in the HIV Workforce

• The number of paid staff has increased steadily over the past few years – from 378 in 2007 to 445 in 2013

• The number of both education and IDU peers is down slightly

• The commitment to GIPA/MIPA is strong:– 77 of 89 programs involved members of target population –

although fewer as paid staff

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Trends in Volunteer Services

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Trends in IDU Peer Activities

• IDU outreach programs reported fewer active peers and a drop of about 40% in the number of new peers

• However, the smaller number of IDU peers:– were involved in >50% more

informal interactions– distributed 65% more materials– engaged in 30% more community

development activities– were more involved in formal

program delivery– provided about 120% more practical

assistance services

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Trends in Training

• Programs invest mainly in:

• Skills building– Addictions, harm

reduction, substance use

• Administrative training• Other skills including:

– Health and safety– Stress reduction– Research interviewing– Gender identity– Clear communications

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Trends in Provincial Capacity Bui lding Programs

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Trends in Provincial Capacity Building Programs

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Chal lenges Fac ing Prov inc ia l Capac i ty Bui ld ing Programs

• Costs of training• Time constraints• The impact of staff turnover (e.g. having to

train new people, not being ableto offer advanced programs

• Keeping training relevant- Developing new programs

- Surveying agencies As we invest in training and building the capacity of our peers, we also face the problem of turnover. When people’s life situations change, their engagement and commitment changes. The positive is that our peers have the capacity to move on to better opportunities, the negative is that we lose the peer we have invested in and have to start the process once again.

“[Our organisation] completed a series of site visits to agencies. These visits have provided insight into issues that agencies face at a local level.”

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Table Discussions – Outcome 3Increasing Capacity

1. How has your partnership work been informed or shaped by the evaluations you do? Are there key learnings that you would like to share?

2. When it comes to identifying a need to increase capacity within your organization, what do you do? What is the top need that you have identified and how have or will you address it?

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Outcome 4:Increased coordination and collaboration

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Trends in Community Development

ACAP & COMMUNITY DEVELOPMENT

ACAP funds just under 20% of community development meetings and the focus of those is similar to the focus of meetings funded by other sources.

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Education Outreach Community Development

ACAP & COMMUNITY DEVELOPMENT

ACAP funds just under 20% of community development meetings and the focus of those is similar to the focus of meetings funded by other sources.

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IDU OutreachCommunity Development

Provincial Capacity Building Community Development

The Benefits of Community Development

• “Having [our organization] representation on boards, working groups, and committees allows us to bring forward issues and perspectives that may not otherwise get addressed. For example, we have been able to challenge viewpoints of individuals and organizations, allowing them to rethink their approach to issues.”

• “At times, attendance at [our] working group and network meetings has been inconsistent. To address this, [our organization] is developing MOUs with participating agencies and improving meeting planning processes to ensure that important Alliance meeting and working group meetings are planned/booked for the entire year to ensure greater communication and participation.”

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Capacity Building

• Organizational Capacity– More strategic partnerships

(e.g. mental health,sex workers, long-termcare, geriatrics)

– New ways of delivering services – Challenges: stigma, lack of resources, time available for training,

staff turnover

Based on mental health support needs identified by some clients, we have entered into a new strategic partnership with CMHA in our region to increase our capacity to support mental health issues and to increase CMHA’s capacity to address HIV and sexuality issues in their programming.

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Table Discussions – Outcome 4Community Col laborat ion

1. How do you strengthen and maintain your partnerships over time? What key ideas or suggestions do you have about specific mechanisms to support that?

2. In what ways is information from frontline workers gathered and used to shape community collaborations? What have been some of the successes?

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Outcome 1:

Increased knowledge and awareness

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Who Does Education?

• General education workers• Population-specific workers:

– Gay Men’s Sexual Health Alliance (GMSH)– African, Caribbean and Black strategy workers– The Women & HIV/AIDS Initiative (WHAI)

• Other organizations that serve specific populations:– Indigenous-focused organizations– IDU outreach workers

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Highlights – Knowledge & Awareness

• Education work is shifting:– Fewer presentations/participants – but more ACAP funded

presentations– More presentations

by strategy workersand fewer by general education workers

– Fewer presentations to practitioners/ professionals and more to members of target populations

– More involvement of faith organizations and other partner agencies

“There has been increasing interest in topic-specific workshops such as trans training and harm reduction.”

“[We] organized a public form which included a workshop addressing violence against transwomen, 2-spirited people, LGBTW and sex working women. This even strengthened connections and partnerships with Indigenous, Trans, and Two-Spirited communities.”

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Trends in Education Presentations

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Who are We Talking to?

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The Role of Strategy Workers

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The Focus of Strategy Workers Presentations

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Education for People Living with HIV

• In 2013-14:– 418 presentations to

people living with HIV –up 38% from 2012-13

– Most were given bygeneral education workersfollowed by ACB workers andGMSH workers

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Regional Trends in Education

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Outreach Activities

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Highlights – Education & Awareness

• Outreach work is shifting:– More brief outreach contacts with people who use drugs, youth at

risk, Indigenous people – less with gay men and ACB communities– Significant increase in ACAP-funded brief outreach– More significant

outreach through faithorganizations and clinics,less in community publicspaces, correctional facilities,bars or shelters

– Social media: increase in Facebook and blogs (ACAP-funded) and less time in chat sites

“Online outreach with gay, bi and other MSM has shifted a bit in terms of content and topics discussed. A lot of discussion is being generated through changes in profile information presented. For instance, we have been promoting men’s groups a lot more online and this generates a great response that stimulates discussions around relationships, body image and social isolation. There has been a lot more interaction with men that identify as married.”

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Trends in Outreach

• Brief outreach– 137,923 contacts

– similar to last year– More ACAP-funded

outreach– Gay men and other

MSM still main target but only 30% of contacts compared to 46% in 2012-13

– 11% more contacts with people who use drugs – mainly due to one organization

Significant face-to-face outreach contacts require a two-way, in-person interaction between agency staff/volunteers and a member of the target population. Brief contact does not involve a two-way interaction but may include people taking material like a pamphlet at even booths.

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Trends in Outreach

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Trends in Outreach

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Trends in Social Media

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IDU Outreach Activities

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Highlights - IDU Outreach

• IDU Outreach Shifting– Changes in drug use patterns– Fewer outreach and

more in-service contacts– More outreach in drop-in centres, partner agencies and shelters– More harm reduction supplies distributed– More practical assistance

“During this reporting period staff has seen a shift in age demographics, we are now seeing younger clients accessing services.”

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Trends in IDU Outreach

• IN 2013-14:– Outreach contacts were down and

more contacts were made through drop-in centres and partner agencies

– In-servicecontacts wereup

– Two regions – Central Eastand Southwestreported morethan double thenumber ofin-servicecontacts

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• More use of crystal meth, heroin, fentanyl• 5 agencies reported – “we are now seeing younger clients accessing services”• More demand for shorter needles and pipes – “syringe distribution

is up 33% from last reporting period• More demand for practical assistance• Stronger partnerships with police, municipalities, other harm reduction services

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Regional Trends in IDU Outreach

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Table Discussions – Outcome 1Increasing Knowledge and Awareness

1. The average ratio of participants to presentations is declining over time, as is the average number of presentations. Is this trend applicable to your agency/program? What do you think it is telling us?

2. Aside from the “traditional” methods of education currently recorded in OCHART, which other methods do you use to deliver education? How have they worked for you? The traditional methods are presentations, education during outreach and 1-on-1 education sessions.

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Outcome 2:Increased access to services

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Highlights – Support Services

• An average of 13,412 people used support services in each half of the year

• Two-thirds maleand one-thirdfemale

• 25% increase inclients age 55+

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Who is Using Support Services

• By the numbers– 13,412 – average # of people

using support services in eachhalf of the year

– 10,990 - # of ongoing or returningclients

– 2,593 - # of new clients– 66% - new clients who are male– 30% - new clients who are female– 1% - clients who are trans

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The Age Picture

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More on the Age Picture

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Services Used

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Regional Trends in Support Services

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Do Women Use Different Services than Men?

• Women and men use the same key services – practical assistance, food programs, case management

• However …– Women are more likely to use interpretation and settlement

services

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Trans Clients Use Different Services

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Do People at Risk Use the Same Support Services as People Living with HIV?

• People at risk:– are younger than

people with HIV – More likely to use

counselling, referrals and support groups

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ACAP and Support Services

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Support Groups

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Number of Deaths Down

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Trends in Support Services

• Challenges:– More clients facing poverty– More clients with complex

medical conditions related to aging and mental health

– More newcomers who do not have status

– More women and more pregnant women with HIV seeking support

• Successes– More strategic partnerships

“"At this time we are working with the medical service providers to ensure medical and treatment access for all individuals. As an agency we have developed a relationship with a community doctor that will help with accessing medical and HIV treatment for clients."

"Clients are reminded of their appointments and offered transportation. Clients have also been offered Directly Observed Treatment through our office staff as a few of the clients who are not consistently taking their medication are accessing our office regularly. So far this program has been a success."

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Table Discussions – Outcome 2Increasing Access to Services

1. Issues associated with poverty, aging, and mental health have been reported as an increasing trend amongst people who access support services. How are you building a broader service or referral network to respond to these issues?

2. What do you feel is most important to know about the support services programs that you provide? Is there anything beyond what is reported in OCHART that would support your response to shifts and changes?

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Lunchtime!

80KTE Day 2014

Table Discussions

Report Back

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How has your partnership work been informed or shaped by the evaluations you do? Are there key learnings that you would like to share?

Highlighted the need for peer involvement & supervision

Helped shape existing programs/services and the creation of new programs/services (e.g., changing hours for services for harm reduction outreach, mobile, offered

new testing clinic in partnership with local testing clinic)

Table Discussions - Outcome 3Increasing Capacity

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How has your partnership work been informed or shaped by the evaluations you do? Are there key learnings that you would like to share?

Helped identify need for new partnerships , who to partner with and how to improve the partnership (i.e., need for shared values, active participation from all partners, patience and

taking the time to collaborate well)

Pointed to the importance of formalizing partnerships (e.g., MOU, TOR, clear roles and responsibilities)


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When it comes to identifying a need to increase capacity within your organization, what do you do? What is the top need that you have identified and how have or will you address it?

Human resources needs must be met in order to address capacity issues (i.e., staff retention, training, mental health training)

Agencies need support: To use new technologies for service delivery and data

collection To deliver specific interventions that target priority populations Supervise volunteers


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When it comes to identifying a need to increase capacity within your organization, what do you do? What is the top need that you have identified and how have or will you address it?

How to address:

Agencies can share resources to train staff together and provide

services to client with complex needs

Use OAN Skills Building Program to address issues

Look at existing resources and opportunities for reallocation

Look at expertise available in partner agencies

Utilize expertise from students and other volunteers that you need


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Table Discussions - Outcome 4 Community Col laborat ion

How do you strengthen and maintain your partnerships over time? What key ideas or suggestions do you have about specific mechanisms to support that?

Develop and regularly update formal agreements (e.g., MOU, TOR, clear roles, scope, common goals, expectations, formal process of working together – referral process, etc.)

Involve knowledge/subject experts and share resources to reduce costs and avoid duplication of programming

Find common issues and make them common goals

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Table Discussions - Outcome 4 Community Col laborat ion

How do you strengthen and maintain your partnerships over time? What key ideas or suggestions do you have about specific mechanisms to support that?

Provide ways to regularly meet with partners but ensure each meeting has a clear goal and expected outcomes

Provide regular updates to partners (including when changes occur at your agency, institutional memory – organization-based)

Acknowledge that partnerships change over time

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Table Discussions - Outcome 1 Increasing Knowledge and Awareness

The average ratio of participants to presentations is declining over time, as is the average number of presentations. Is this trend applicable to your agency/program? What do you think it is telling us?

There is a disconnect between school administration curriculum taught and what students want/need; We know what needs to be taught but it is difficult to get in to those sites and provide the education

Staff turnover affects numbers, may be circumstance not trend

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Increased efforts to use social media to reach stigmatized / vulnerable and hard-to-reach populations; since they don’t tend to get together

Questioning the impact of more traditional methods

Education is client specific, tailored to needs, targeted to priority populations, therefore fewer sessions held (e.g., with massage parlours)

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HIV is losing its importance – there is less interest from the community

May be reaching saturation in smaller communities

Less interest to attend because information is available online

OCHART data entry issues – all agency data is not being reported to the person inputting OCHART data

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Aside from the “traditional” methods of education currently recorded in OCHART, which other methods do you use to deliver education? How have they worked for you?

One-on-one education is shifting to virtual space, social media, smart phone apps, texts, other new technologies used

One-on-education at places where people congregate (outdoor trails, etc.) and non-HIV specific social events

Integrate education into health/wellness /social groups (recorded in support) and practical skills training (e.g., cooking skills)

Integrate HIV messages into leadership and coaching programs

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Issues associated with poverty, aging, and mental health have been reported as an increasing trend amongst people who access support services. How are you building a broader service or referral network to respond to these issues?

Developing partnerships with non-HIV groups housing first faith communities CMHA cross-sectorial partnerships food banks neighbourhood resource centre EMS local farmers, etc.

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Issues associated with poverty, aging, and mental health have been reported as an increasing trend amongst people who access support services. How are you building a broader service or referral network to respond to these issues?

One central, coordinated intake and then discuss with partners how best to meet needs (integrated model of care)

Bringing services to people’s homes

Need for more funding, new sources through broader health organizations (LHINS)

OCHART – Towards a Better Tomorrow

OCHART – what it is

• OCHART is a joint reporting tool for organizations funded by the AIDS Bureau and PHAC (reduces burden)

• OCHART was developed and housed at OHTN and is 10 years old

OCHART captures:

1. Quantitative (output level) deliverables (# of people reached, # sessions delivered etc.)

2. Narrative, reflecting changes and trends in demands for service and service delivery

3. Qualitative and quantitative information indicating progress towards completion of work plans

OCHART – A Brief History…

OHTN hosts the web-based tool, provides administrative, technical and analytical support for OCHART, incl responding to data requests and producing the View From the Front Lines

In 2005, AIDS Bureau & PHAC introduced a joint web-based reporting tool in consultation with funded agencies: the Ontario Community HIV/AIDS Reporting Tool (OCHART)

Need identified in strategies

Agency consultation and review – process included direct agency involvement/feedback

Data capacity survey and IT assessment of agencies

Contracted with the OHTN

Focus-tested the application

Training and implementation

Working group meets regularly to discuss OCHART, outcomes and necessary refinement

Changes made as required

OCHART – where we are now…

• There are 108 agencies/programs currently using OCHART

• OCHART consists of 16 sections that include 239 questions and 82 comments

• OCHART database houses 758 unique data elements• Recent additions:

– 2013-14 Hepatitis C Teams added– 2014-15 Anonymous Testing sites, HIV clinical services and

OHTN added

• Major changes to content in 2014-15; brought issues to the forefront

OCHART – the key issues…

• Technical issues:– platform is showing its age and could be more user friendly– 10 years = numerous changes to OCHART platform which has

meant ad hoc technical patches– current OCHART platform requires a lot of manual work from a

technical perspective

• Content issues:– questions in OCHART could be revised to better capture the work

of the funded organizations– data collected is primarily output level data. i.e # of presentations,

# participants. It is difficult to analyze the longer term impacts.

• Overarching:– system needs to be updated to reflect the priorities of the new

Provincial HIV strategy to 2020: Changing the Course of the HIV Prevention, Engagement and Care Cascade and does not align well with the PHAC’s Project Measurement Tool (PMT).

OCHART – the next steps

• Over next 18 months, OCHART will go through transition to address both technical and content issues

• There will be opportunities for community input in the review and transition

• Goal – launch the “new OCHART” for 2016-17 reporting• Until then, this will mean careful, supportive and patient

interactions with OCHART…

OCHART – what will not change

• OCHART will continue to be a joint federal/provincial mandatory reporting and accountability tool

• OHTN will continue providing support to OCHART users and providing OCHART data for analysis

• Agencies and programs will continue to have an opportunity to provide input into development of OCHART

• Agencies will still get their data/agency reports

OCHART – what will change

• Will be moved to a new more user friendly platform• Specific sections will be revised to better align with the

provincial strategy to reflect the concept of the HIV Engagement, Prevention and Care Cascade

• Will be revised to better align with PHAC’s PMT tool (ex more narrative – longer term results and impacts)

• Will provide agencies with an opportunity to report on the outcomes of their work

OCHART – what will change

• With input from community, we will develop a set of outcome level indictors that will be reported in OCHART.

Some examples may include: - Number of people connected to HIV care within the

reporting period- New partnerships that allow better access to population

at risk for early diagnosis - Purpose of education presentation (i.e. generate more

referrals to HIV testing in a specific priority population)

Funder requirements - AIDS Bureau

• Critical need to link activities and outcomes with the new Provincial strategy

• The Strategy provides a conceptual framework to respond to HIV in Ontario – the cascade

• We will be using evidence to inform the development of program guidelines, service models, KTE materials, new interventions aimed to minimize people falling out of the spectrum of care/the cascade.

• We anticipate asking questions in the new OCHART from the cascade framework, demonstrating the work is effective in keeping people in care

Funder requirements - Publ ic Health Agency of Canada

• April 2015 – revision of OCHART tool to include some additional questions to ensure alignment with the PMT (i.e. an ACAP narrative section with focus on results)

• Community Action Fund (April 1, 2017) - integrated fund that addresses HIV, hepatitis C and related STBBIs as well as related aspects of health (e.g., mental health, aging) and social determinants of health

• Once details of the fund are finalized we will discuss alignment with OCHART

What is your role today

• Contribute to the development of a New and Better OCHART, which starts NOW…

• First - a short presentation/refresher on the HIV Engagement, Prevention and Care cascade

• Then - two rounds of table discussions focused on the activity data that either could be or is collected, which connects to the cascade

• Results will be summarized and presented back to you after the KTE day

• What you say today will inform the process of developing the new OCHART and will help funders to develop a mechanism that is inclusive and mutually beneficial.

HIV/AIDS Strategy to 2020:

Changing the Course of the HIV Prevention, Engagement and Care Cascade

The New Provincial Strategy

The strategy introduces a three-dimensional approach to HIV response in Ontario. Based on the current epidemiologic data, trends and evidence based practices, the strategy focuses on:

– Delivering services to priority populations

– Addressing biological, individual, social and structural determinants of health

– Changing the course of HIV Engagement, Prevention and Care cascade

Strategically tailor the HIV service response to support key

populations to increase access to HIV and other health and social

services for people at high risk of HIV infection and poorer health outcomes when living with HIV

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Social determinants

of health

Access to prevention and care services

People with HIV/AIDS

Gay & Bi MSM (incl. transmen)

African Caribbean Black communities

Indigenous people

People who use drugs

Women at-risk (incl. transwomen)

St ra teg i c Ap p ro ach #1F o cu s o n p o p u l a t i o n s mo st a f fec ted b y H I V

Engaged in Care

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at-risk of HIV

infection

Linked to care and support

Linked to HIV care

Retained in HIV care

On HIV treatment

Low or undetectable

viral load

Infected with HIV

HIV testing counselling

referral

Diagnosed with HIV

Increased control over health

HIV prevented

Increased control over health

Full opportunity for longevity/quality of life

HIV prevented

St ra teg i c Ap p ro ach #2Ch an g i n g th e co u rse o f th e H I V p reven t i o n ,en g ag emen t an d care cascad e

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100%

52%-60%

43%-52%28%-42%

65%-75%

Note: Data reported as current estimate, but some data comes from Remis (2009, 2011, 2012), PHO Lab (2007-2008) and OCS (2011)

Ontario’s HIV Treatment Cascade

Ontario’s HIV Treatment Cascade

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JurisdictionEstimated % Undetectable

Ontario 28%-42%

B.C. 35%

U.S. 30% (2011)

Australia 62%

UK 58%

Raymond A et al. Large disparities in HIV treatment cascades between eight European and high-income countries: analysis of break points. International Congress of Drug Therapy in HIV Infection, abstract 0-237, Glasgow, 2014.

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• What work do you in Education, Outreach and

Community Development that fits the cascade but is not

currently captured or could be captured differently in

OCHART?

Table discussion – round 1

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Break time!Enjoy…

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• What work do you in Support that fits the cascade but is

not currently captured in OCHART or could be captured

differently in OCHART?

Table discussion – round 2

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Video PresentationsShowcasing Innovative Practices

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Next steps, evaluationand wrap up…

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OCHART: Top 5 To-Do List for Staff Transitions

1. Notify OHTN to cancel old staff member's account

2. Notify OHTN for a new account when new staff are hired

3. Orient new staff around in-house data collection tools and procedures for OCHART

4. Direct new staff to the on-line training on the home page of the OCHART website

5. Connect new staff with OHTN for answers to questions

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Next steps & evaluation

• VFTFL available (English & French) online on OCHART website

www.ochart.ca Reports View From the Front Lines

• Presentations from KTE Day & Supplemental Tables online

www.ochart.ca Reports KTE Day 2013

• Evaluation Survey (short!) – email coming early next week

Please fill this out! It helps us serve you better.

Thanks! We look forward to receiving your feedback.

http://www.ochart.ca/

http://www.ochart.ca/

119KTE Day 2014

Thanks!

1 KTE Day 2014. Housekeeping Welcome & important details. 2.

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Transcript of 1 KTE Day 2014. Housekeeping Welcome & important details. 2.