Positive Living Navajo AIDS Network, Inc. Melvin Harrison, Executive Director Marco Arviso, Arizona...
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Transcript of Positive Living Navajo AIDS Network, Inc. Melvin Harrison, Executive Director Marco Arviso, Arizona...
Positive LivingNavajo AIDS Network, Inc.
Melvin Harrison, Executive DirectorMarco Arviso, Arizona Medical Case Manager
Objectives
• Define Medical and Psychosocial case management
• Describe “linkage to care”• List examples of individual, group and
community level interventions.
What is Psychosocial Case Management?
• Early access to and maintenance of comprehensive health care and social services.
• Improved integration of services provided across a variety of settings.
• Prevention of disease transmission and delay of HIV progression.• Increased knowledge of HIV disease.• Greater participation in and optimal use of the health and social
service system.• Reinforcement of positive health behaviors.• Personal empowerment.• An improved quality of life.
What is Medical Case Management?
Medical Case Management (MCM) is traditional case management with the primary purpose of :
1) retaining clients in medical care and2) achieving positive health outcomes for clients
of NAN Inc.
-HIV Medical Case Management GuidelinesDistrict of Columbia 2010
Client Demographics
• Average age: 46 • Age range: 22-74• New Mexico – 18• Arizona – 42 • Average CD4-328.4 • Average Income-
$402.00
•67% have reported substance use in the last year •3 clients looking for suitable housing for winter•1 client self reported as homeless
Active Cases- Enrollment on CM
19961997
19981999
20002001
20022003
20042005
20062007
20082009
20102011
20120
2
4
6
8
10
12
14
16
n=60
Series 1
How does the process of Case Management work?If you know that you are positive and need case management...
If you are recently diagnosed in a clinical
setting…
If you are tested at a mobile unit and are
newly infected...
Contact NAN for Case Management
Linkage to Care:
AssessmentContact NAN Inc. Case Manager and set up an appointment for an intake interview where we will discuss your health concerns and plan your care.
•Health•Financial•Social support•Practical Needs•Education/Employment•Mental Health
•Risk•Substance Abuse•Legal
Working with Primary Care ProvidersThe goal of Medical Case Managers is to provide a client with the skills, information and support to follow mutually agreed upon treatment adherence recommendations of healthcare
professionals to achieve optimal health.
• Taking all medications as prescribed• Making and keeping appointments• Addressing barriers to care and treatment and• Involving the clients belief of Cultural Traditional Medicine where necessary
Team Care Meetings
Meetings with I.H.S. Care team to discuss mutual clients• Evaluation
– CD4– Viral Load– STI– Mental Health– ADAP (AIDS Drug Assistance Program)
• Future appointments• Referrals• Progress notes
Individual Interventions-Care Plans
• Travel Reimbursement • Emergency Financial Request(clients in Crisis)– Wood/coal delivery– Utilities – Housing
• Transitional Housing• Ceremonial Assistance • Social/educational Support • Client/family education/disclosure
Group Interventions•Gathering of Clans• Monthly • Informal • “special guests”
•Healthy Relationships• 5 session cycle• Reducing stress• Disclosure
•Annual Client Summit• Wellness • Updates
•Many Men, Many Voices• Annual• Specifically adapted for PLWHA
Barriers
• Funding– Increased number of clients– Transportation– Housing
• Confidentiality/stigma– Fear of Gov systems
• Substance Abuse