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Program Collaboration and Service Integration (PCSI) at NCHHSTP

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
PDF File or PPT File


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
Slide 2

Office of Public Health
PDF File or PPT File


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.
Slide 3
Programs Integrated & Rationale - AIDS Program
PDF File or PPT File


Programs Integrated & Rationale

Hepatitis C Program
- The Virginia General Assembly appropriated funds to implement a Hepatitis C Awareness and Prevention Program.
Slide 4
Programs Integrated & Rationale - Hepatitis Program
PDF File or PPT File


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.
Slide 5
Programs Integrated & Rationale
PDF File or PPT File


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.
Slide 6
Programs Integrated & Rationale
PDF File or PPT File


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.
Slide 7
Programs Integrated & Rationale - The then Division of HIV/STD
PDF File or PPT File


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.
Slide 8
Programs Integrated & Rationale - Pharmacy Services
PDF File or PPT File


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.
Slide 9
Programs Integrated & Rationale
PDF File or PPT File


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
PDF File or PPT File


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.
Slide 11
Staff Perceptions to the Change - AIDS/HIV Program - New program, no merging of staff
PDF File or PPT File


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.
Slide 12
Staff Perceptions to the Change - Hepatitis C Program - New program, no merging of staff
PDF File or PPT File


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.
Slide 13
Staff Perceptions to the Change - Pharmacy Services - Involved staff merging
PDF File or PPT File


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.
Slide 14
Staff Perceptions to the Change - TB Prevention and Control - Involved staff merging
PDF File or PPT File


Internal Barriers

AIDS Program
- Program differences 

Pharmacy Services
- Organizational structure
Slide 15
Internal Barriers - AIDS Program - Pharmacy Services
PDF File or PPT File


Internal Barriers

TB Prevention and Control
- Program differences 
- Attitudinal
Slide 16
Internal Barriers - TB Prevention and Control
PDF File or PPT File


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.
Slide 17
Addressing Internal Barriers
PDF File or PPT File


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”.
Slide 18
Other Barriers
PDF File or PPT File


Wins - Client level

Delivery of more comprehensive prevention services. 

Enhanced coordination of client care and services.
Slide 19
Wins - Client level
PDF File or PPT File


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.
Slide 20
Wins - Health Department Level
PDF File or PPT File


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.
Slide 21
Wins - Health Department Level
PDF File or PPT File


Embarking on Program Integration

A leader who strongly believes in integration.

Clear definition of program integration.

Regular communication across programs
Slide 22
Embarking on Program Integration
PDF File or PPT File


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.
Slide 23
Starting Process Again
PDF File or PPT File


Suggestions for CDC

Support project areas that are integrated.

At the CDC level, need to communicate and become more familiar with other division programs.
Slide 24
Suggestions for CDC
PDF File or PPT File


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
PDF File or PPT File

 

 
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