Analysis of Integrated HIV Housing and Care Services. Analysis of Integrated HIV Housing and Care Services Florida Ihhp Project Site Visit: River Region Human Services Ihhp Grantee Discussion Guide

Thank you for agreeing to participate in this discussion. My name is Meg Hargreaves and I work for Mathematica Policy Research, an independent research firm. As you know, Mathematica Policy Research and Cloudburst are conducting a study for the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) about housing and care services for people living with HIV. The study has two components: (1) a quantitative analysis of national HIV housing assistance data and (2) a qualitative study of Integrated HIV/AIDS Housing Plan (IHHP) projects funded by the U.S. Department of Housing and Urban Development (HUD). Findings from this study will inform Federal policymakers about innovative program integration models that address both housing and health.

The information we are gathering from the IHHP projects will be summarized in a final report for ASPE describing the IHHP programs and their local contexts. While our report will describe the experiences and viewpoints expressed by local program staff and partners, we will not quote any individuals by name. Your participation is entirely voluntary; if you decide not to participate in this interview, your grant will not be affected. With your permission, I would like to tape record this discussion to as a back-up for my notes. Recordings will be retained throughout the remainder of the project and then destroyed after the final report is complete. Do you have any objections?

We have scheduled up to 90 minutes for our discussion today, though we may not use the entire time. Do you have any questions before we start?

1. To start the discussion, please state your job title and briefly describe your role at River Region Human Services and on the Forging Useful Systems to Empower Project (FUSE) project (i.e., IHHP project).
2. How much of your time is currently spent working on the IHHP project?   
3. How long have you worked for River Region Human Services?

I have a few background questions for you about the River Region Human Services and the SPNS grant.

1. Please describe the overall size, scope, and mission of River Region Human Services? 
2. How long has River Region Human Services provided HIV housing services? What types of services are currently provided, to whom, and in what locations?
3. What motivated your agency’s decision to apply for the IHHP SPNS grant?
4. What does the agency hope to accomplish through this grant? 
5. When did the agency receive the grant award and for how much funding?
6. How is the funding being used – to start a new program, modify an existing program, or expand existing services to a new area or population?  Please explain.
7. What is the IHHP program’s current budget?
8. In addition to the IHHP grant, what funding, if any, comes from other sources (HOPWA, other HUD sources, Ryan White HIV/AIDS Program Part A or B, and other sources)?
9. When did River Region Human Services start serving IHHP clients? 
10. How many are currently being served? 
11. In what locations are clients being served?

FOLLOW UP:

• Describe the project’s demographic characteristics of the program’s clients, for example age, gender, language(s) spoken, race/ethnicity, income, housing status, and HIV status.

We are interested in understanding how the IHHP program is staffed.

1. How many staff work in the program, and in what positions/roles?

   [Note: program staff may include: a housing program manager, director, or coordinator; a housing planner or specialist; a direct service supervisor; service coordinator, or social worker; an outreach or intake worker; a program data manager; a mental health or substance abuse treatment counselor; a clinical care physician, nurse, or physician assistant; and/or others.]

2. What percent of their time is spent on the IHHP program?

   PROBES:

   • Does the program use a team-based approach, where clients are assigned to specific teams, or are clients assigned to certain staff?
   • If team-based, what are the team’s responsibilities? Are teams multidisciplinary or interdisciplinary? Who is included on the team?
   • Are teams composed of members from other organizations? If so, what organizations?
3. What is the average number of clients served by each staff?
4. What program-specific trainings have staff members received?

   FOLLOW UP:

   • What topics are covered? 
   • What is the duration and frequency of training?
   • Describe any HIV/AIDS competency training provided.
   • Describe any cultural competency training provided.

Now, I would like to ask about the program’s outreach process.

1. Who handles the program’s client outreach activities?
2. How are potential clients made aware of the IHHP program and its services?
3. Is outreach tailored for different locations or client groups? If so, please explain.

Let’s discuss the program’s intake, enrollment, and care planning processes.

1. Please describe the intake and enrollment process. Who handles the process?
2. How do staff members determine whether an individual is eligible to enroll in the program?
3. Please describe the client assessment and care planning process. Who handles the process?

4. What issues or topics are included in the client assessment and care plan development?

   • Housing stability barriers
   • Other basic needs, including food insecurity
   • Employment, income, or self-sufficiency barriers
   • Health insurance issues
   • Behavioral health issues
   • Mental health status
   • HIV transmission risks
   • Barriers to accessing and staying in HIV clinical care
   • Anti-retroviral therapy medication adherence issues
   • Other? Please specify.

5. What formal assessment and care planning tools (if any) are used? Please describe.

   [INTERVIEWER SHOULD ASK FOR A COPY OF THE TOOL(S), IF APPLICABLE]

6. What program requirements or rules are clients expected to follow? Please explain.

7. From your observation, what are the clients’ greatest service needs?

   Do the needs of people living with HIV/AIDS differ from other clients you serve? Please explain.

8. How does the program address those needs?

Let’s discuss the program’s services and the integration of housing and HIV care.

1. Who provides direct services to the program’s clients? 

2. What direct services are provided to program clients?

   • Housing Assistance. Are you moving clients from tenant-based rental assistance to public housing choice vouchers? Why?
   • Employment or Other Income Assistance. What assistance do clients receive accessing economic or employment assistance (SNAP, Medicaid, SSI/SSDI, TANF, RWHAP, other public assistance, or other resources)?
   • Medical Assistance. Does the program provide direct medical care and/or link clients to medical, mental health, and/or substance abuse treatment services provided elsewhere?
   • Medical Case Management: Is this service provided on-site or through an outside provider?
   • Other Direct Services: Please describe.
3. Are program clients referred to other organizations to obtain services?  If so, what are those services?
4. How are the program’s services modified or customized, if at all, to meet the needs of people living with HIV/AIDS?

1. 1. How is housing assistance coordinated with medical care through the program? 

2. 2. Does the program have any formal or informal arrangements with health care providers to coordinate housing assistance and medical care?

   FOLLOW UP:

   • Does your program work with specific clinics and health centers, or providers to link and retain clients in HIV care?
   • Are particular referral processes used to help clients access services from other providers? Please provide an example of how clients are linked to appropriate health care services.
   • How do providers share client information or coordinate services to make referrals, or to ensure proper HIV care for program clients?
   • How frequently does the program attempt to communicate with health centers and/or providers regarding program clients?
   • In the program’s efforts to link clients to healthcare services, have staff members developed shared goals and/or protocols with outside clinics and health centers?
   • To facilitate partnerships with outside agencies has the program changed the way that clients are linked to healthcare services?

We are interested in understanding better your process for data collection.

1. Who handles the program’s data management duties? 

2. Please describe how the program collects and tracks client-level demographic, service use, and program outcome data, including HIV/AIDS status.

   FOLLOW UP:

   • What data elements are collected, how frequently, using what data forms?
   • Do the data elements include health outcomes? If so, what health outcomes are reported?
   • In what data systems are the data stored and accessed?
   • In your application, you mentioned that you use the HMIS and CAREWare to maximize service coordination and minimize duplication of services and data entries. Do you currently utilize HMIS and CAREWare? Has it been modified or customized your program?
   • What other data information systems do you use, if any, and how are they coordinated with HMIS and CAREWare?
   • How would you describe the quality of the data, particularly, the data on clients’ service use or outcomes?
   • Is the HIV/AIDS status data based on self-report, staff report, or a combination?

   Now, I would like to talk about the ways that the program makes use of client-level data.

3. How does the program use client-level demographic, service use, and/or outcome data in service planning, program monitoring, evaluation, or quality improvement? Please explain and provide examples.

   INDICATOR PROBES:

   • Client Characteristics. Age, gender, race/ethnicity, other demographics, chronic homelessness, prior living situations.
   • Client Service Needs. Basic income needs, housing, employment, food, mental health, substance use, access to insurance and to a primary care provider.
   • Housing Service Utilization and Outcomes.  Avoidance of homelessness, use of transitional housing, housing stability and permanency.
   • HIV Medical Care Utilization and Outcomes. Health insurance status, designated primary care provider, ongoing engagement in care, ART medication adherence, suppression of viral load.
4. Can your program’s information system(s) be used to generate planning reports? If so, please describe the reports.
5. Has the program’s data system been used to tabulate outcomes by demographic characteristics and/or HIV/AIDS status? If so, how often have reports been generated and used?

6. In general, are there efforts to share aggregate and client-level data with partner agencies? If so, who are these partner agencies, what information is shared, how often, and for what reasons?

   FOLLOW UP:

   • Are housing indicators and/or outcomes data shared with these partners? Please describe.
   • Are HIV clinical care indictors and/or outcomes data shared with these partners? Please describe.
   • [If reports are generated] Are reports shared with external partners/agencies/providers? If so, which reports are shared and how frequently?
   • How regularly do program staff members have contact with these other agencies about data issues and/or findings?
   • Do these efforts require ongoing cooperation with partner agencies?  For what purpose [PROBES: to prevent duplication efforts and ensure data quality among agencies]?
   • In your efforts to share data, have you developed shared goals and/or protocols with outside partners?
   • To facilitate data partnerships with outside agencies, have you made changes in the way the program collects, uses, and shares data?

We are interested in learning more about how your agency is involved in community planning activities and processes.

1. In what way(s) is the agency involved, if at all, in the following in community/state planning activities?

   • HUD Consolidated Plan and Annual Action Plans
   • HUD Continuum of Care Homeless Assistance Planning
   • Public Housing Agency Plans – 5-Year Plans and Annual Plans
   • RWHAP HIV Planning Council  - Comprehensive Plans and Needs Assessments
   • CDC Prevention Community Planning Group – Comprehensive HIV Prevention Plan
   • State Mental Health Planning Council – Comprehensive Mental Health Services Plan
   • Online planning forums for program clients and other people living with HIV
   • Other HIV housing related community planning activities

   FOLLOW UP:

   • How frequently do you communicate with other agencies, including both federal agencies and non-profit organizations, regarding community planning activities? With which agencies, in particular?
   • Do these efforts require cooperation or coordination with each other? Please explain.
   • Have you and other agencies developed shared goals and/or protocols as part of these planning efforts.
   • To facilitate this collaboration, have you made system-wide changes in the ways in which you are involved in community planning activities?
   • Do you share resources with other organizations in order to facilitate community planning activities?  Please describe.

2. Have you participated in or conducted a community-level needs assessment or census related to stable housing and health outcomes for people living with HIV/AIDS? 

   IF YES:

   • When, and how often, have such community-level needs assessment efforts occurred?
   • Please describe the methods used to assess community-level HIV housing and health care needs.
   • What issues did the most recent community-level needs assessment explore?

   FOLLOW UP:

   • What barriers to stable housing and health outcomes for people living with HIV/AIDS have been identified at the community-level?
   • What strategies, if any, have been implemented to address these housing and health barriers at the community-level?

3. One of the IHHP grant requirements is to develop an integrated housing plan at the community-level. How do you plan to fulfill that requirement?

   FOLLOW UP:

   • What do you want to achieve through this grant to support the comprehensive planning and coordination of local resources for the housing and HIV care of people with HIV?
   • What has been done to develop and implement this community plan? What has been accomplished thus far?
   • When completed, would this new integrated housing plan change what is currently happening at the community-level? If so, how?
   • How do you plan to sustain these changes in community planning and local service integration?
4. Describe any additional policy work your program does to support HIV housing system development and integration.

I’d like to wrap up this discussion by learning more about your program’s successes and challenges.

1. In general, how is IHHP grant program going? What aspects of the program have been the most successful?

2. What challenges, if any, have you encountered in implementing your program?

   FOLLOW UP:

   • Have you implemented any strategies to address these challenges? If so, please describe.
3. What elements of your program do you think are the most important in meeting the needs of people living with HIV/AIDS?

4. Are there innovative features that you feel distinguish the IHHP project from other housing programs targeting people living with HIV/AIDS?

   PROBES:

   • Integrated practices in client outreach, enrollment, services, and linkages to care.
   • Enhanced staff qualifications and training; comprehensive, coordinated care teams.
   • Integration of housing and health care data collection, reporting, and evaluation systems.
   • Local coordination of service providers, streamlined access to housing and health care.
   • Collaborative community needs assessment and planning, local awareness and support.
   • Local and state policy advocacy supporting the integration of HIV housing and health care services.
5. What are some lessons that your program has learned about integrating housing and health care services for people with HIV/AIDS?
6. What programmatic changes would you make, if any, to help the program better serve your clients and to sustain the integration the grant has achieved?

1. Before we end the discussion, is there anything I haven’t asked that you think would be important for me to know in understanding the effectiveness of the IHHP program?

Thank you again for your participation!