Slide Set E: Program Integration: The Virginia Experience

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Program Integration The Virginia Experience Virginia Department of Health Division of Disease Prevention Theresa L. Henry, Director of Field Services

Slide 1
Program Integration – The Virginia Experience
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Office of Public Health Organization Chart Office of Epidemiology Division of Disease Prevention Division of Disease Surveillance and Investigation Division of Environmental Epidemiology Division of Immunization Division of Radiological Health

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Office of Public Health
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Programs Integrated & Rationale AIDS Program - Because of transmission mode the then Bureau of STD Control within the Division of Communicable Disease Control was considered to be the best organizational placement for the program.

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Programs Integrated & Rationale – AIDS Program
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Programs Integrated & Rationale Hepatitis C Program - The Virginia General Assembly appropriated funds to implement a Hepatitis C Awareness and Prevention Program.

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Programs Integrated & Rationale – Hepatitis Program
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Programs Integrated & Rationale Hepatitis A and hepatitis B, excluding perinatal, are the responsibility of the Division of Surveillance and Investigation (DSI). DSI did not have the infrastructure or resources to implement a new program.

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Programs Integrated & Rationale
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Programs Integrated & Rationale Perinatal hepatitis B is the responsibility of the Division of Immunization. The primary goal of this division is reducing morbidity and mortality associated with vaccine-preventable illness.

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Programs Integrated & Rationale
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Programs Integrated & Rationale The then Division of HIV/STD - Serviced a population at risk for hepatitis C. - Had sufficient resources to support a new program. - Interested in including viral hepatitis prevention services in clinical and outreach settings.

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Programs Integrated & Rationale – The then Division of HIV/STD
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Programs Integrated & Rationale Pharmacy Services - The Bureau of Pharmacy Services was a separate bureau located within the Office of Purchasing and General Services (OPGS). - OPGS primarily performs procurement functions.

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Programs Integrated & Rationale – Pharmacy Services
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Programs Integrated & Rationale Analysis of Pharmacy Services’ activity showed that 75% of the medications dispensed were for the Division of HIV/STD. Placement within the Division of HIV/STD provided an opportunity to capitalize on existing staff expertise in the Division.

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Programs Integrated & Rationale
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Programs Integrated & Rationale TB Prevention and Control - The Division of TB Prevention and Control was a separate division within the Office of Epidemiology. - Placement within the Division of HIV, STD, and Pharmacy Services provided an opportunity to establish new teams and capitalize on existing staff expertise.

Slide 10
Programs Integrated & Rationale – TB Prevention and Control
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Staff Perceptions to the Change AIDS/HIV Program – New program, no merging of staff - STD staff were more cautious from the standpoint of the challenge associated with a disease that was unknown.

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Staff Perceptions to the Change – AIDS/HIV Program – New program, no merging of staff
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Staff Perceptions to the Change Hepatitis C Program - New program, no merging of staff - HIV/STD staff were excited. - Some apprehension from the standpoint of a learning curve with the addition of a “ new” disease.

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Staff Perceptions to the Change – Hepatitis C Program – New program, no merging of staff
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Staff Perceptions to the Change Pharmacy Services – Involved staff merging - Both program area staff were a little cautious at first regarding “fit”. - Pharmacy staff morale improved due to changes in work environment.

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Staff Perceptions to the Change – Pharmacy Services – Involved staff merging
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Staff Perceptions to the Change TB Prevention and Control - Involved staff merging - Resistance and caution from TB staff. - HIV, STD, and Pharmacy Services staff were more accepting.

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Staff Perceptions to the Change – TB Prevention and Control – Involved staff merging
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Internal Barriers AIDS Program - Program differences Pharmacy Services - Organizational structure

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Internal Barriers – AIDS Program – Pharmacy Services
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Internal Barriers TB Prevention and Control - Program differences - Attitudinal

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Internal Barriers – TB Prevention and Control
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Addressing Internal Barriers Pharmacy Services - Met with Human Resources. TB Prevention and Control - Counseling, some transfers and resignations. - Promote as much consistency across programs as possible.

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Addressing Internal Barriers
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Other Barriers Non support from CDC after the merger between the Division of TB and the Division of HIV, STD, and Pharmacy Services - Financial assistance - Direct assistance - Strong recommendation to re-establish the TB program as a “unit”.

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Other Barriers
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Wins - Client level Delivery of more comprehensive prevention services. Enhanced coordination of client care and services.

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Wins – Client level
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Wins - Health Department Level Resource sharing (human, fiscal, data/information) - DIS investigate and follow-up both HIV and STD; collaboration among training staff (HIV, STD, TB). - Enhanced surveillance. - Integration of TB provided additional match for the Ryan White grant which was a significant financial concern.

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Wins – Health Department Level
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Wins - Health Department Level Greater cross program planning. - Weekly meetings between the Division Director and Program Directors. - Medical Director of TB Program is on the ADAP advisory meeting. Leaner organizational structure.

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Wins – Health Department Level
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Embarking on Program Integration A leader who strongly believes in integration. Clear definition of program integration. Regular communication across programs

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Embarking on Program Integration
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Starting Process Again Hepatitis C Program - Promote viral hepatitis services be the responsibility of one division. TB Prevention and Control - More staff involvement in the plan. - Follow the plan.

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Starting Process Again
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Suggestions for CDC Support project areas that are integrated. At the CDC level, need to communicate and become more familiar with other division programs.

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Suggestions for CDC
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Suggestions for CDC Train public health advisors on STD, TB, HIV, and hepatitis and allow them flexibility to work across program lines. Allow maximum flexibility on how funding can be used.

Slide 25
Suggestions for CDC
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Page last reviewed: March 5, 2014

Content source: National Center for HIV, Viral Hepatitis, STD, and TB Prevention