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Slide Set F: Program Integration: The Houston Experience

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 Program Collaboration & Service Integration
The Houston Experience

Marlene McNeese-Ward
Bureau of HIV/STD and Viral Hepatitis Prevention
Slide 1

Program Collaboration & Service Integration - The Houston Experience
PDF File or PPT File


A Historical Look

HDHHS historically received funding through the TDH for STD and HIV activities

STD interventions were co-located with clinical services as a stand alone program within HDHHS

1989 - CDC directly funded HIV Prevention to Houston and the City established the Bureau of HIV Prevention

1994 - Name change to the Bureau of HIV/STD Prevention

2003 - Beginning of annual budget rescissions from CDC

2006 - Bureau underwent massive reorganization

2007 - Name change to the Bureau of HIV/STD and Viral Hepatitis Prevention
Slide 2

A Historical Look
PDF File or PPT File


Why Integration?

Declining resources forced a need to look at feasibility of integrating core prevention services; looking for enhanced efficiencies and effectiveness

Repetitive processes for CBO and client services led to realigning staff by job function rather than by silo programs

HDHHS resources were fragmented and often unaware of related activities targeting the same populations

Persons engaging in unprotected sex are at risk of acquiring multiple infections
Slide 3
Why Integration?
PDF File or PPT File


HDHHS Disease Prevention and Control Division

Dr. Catherine Troisi
Assistant Director

Chief Physician, Communicable Diseases
Dr. Juanetta Irby

Health Promotion and Education
Dr. Patsy Cano
Bureau Chief

HIV/STD and Viral Hepatitis Prevention
Marlene McNeese-Ward
Bureau Chief

Jail Health
Manuel Perez
Bureau Chief

Tuberculosis Prevention and Control
Dr. Mitchel Abramsky
Bureau Chief
Slide 4
HDHHS Disease Prevention and Control Division
PDF File or PPT File


Five Functional Units

Bureau of HIV/STD and Viral Hepatitis Prevention
- Programmatic Monitoring of Subcontractors
- Capacity Building, Evaluation, and Planning
- Internal and External Fiscal and Budgetary Reporting
- Administrative Support
- Public Health Follow Up
Slide 5
Five Functional Units
PDF File or PPT File


Integration Activities
Partner Counseling Referral Services (PCRS) completed by all CBO staff and HDHHS DIS for HIV and syphilis

HDHHS DIS housed within high volume/high morbidity community and provider sites 

Web-Based Self Interview
- allows for an alternate option to provide information on sex partners or associates who may have been exposed to HIV or a STD http://penshouston.org

TB DOT workers trained to conduct HIV rapid testing on field and clinic patients and contacts

HIV CBO contractors screen and vaccinate for multiple diseases

HDHHS family planning nurses assist with provider education during syphilis outbreak responses

Enhanced Syringe Access Program (ESAP)
- structural intervention, establishes a network of pharmacies that agree to sell syringes without a prescription
- HIV CBOs provide education through recruitment efforts & billboard campaign
Slide 6
Integration Activities
PDF File or PPT File


Barriers-Internal and External

Staff concerns around learning another discipline/new skill sets; time taken away from core responsibilities

Cultural differences; i.e. confidentiality, sense of urgency, competing priorities

Intervention methodologies-Tailoring approaches or developing new ones to address co-morbidities

Lack of project officer coordination; conflicting messages

Funding stream restrictions

Inconsistent and/or repetitive reporting requirements

Conflicting program guidance across disciplines

Surveillance database systems that do not “talk” to one another
Slide 7
Barriers-Internal and External
PDF File or PPT File


Wins
        
Enhanced program planning with multi-disciplinary input; development of a holistic prevention plan

Client interaction with one staff person versus two or three

One stop screening for multiple diseases

Increased sharing of information with monthly bureau-wide meetings

Increased understanding of various job functions 

Department move to co-locate staff closer together

One training/capacity building unit serving all HIV/STD/Hepatitis/TB staff, CBOs, community task forces and planning groups

More efficient CBO monitoring
Slide 8
Wins
PDF File or PPT File


Recommendations for Programs

Have a change management plan in place prior to implementation-prepare for contingencies

Research similar program models

Consult with key stakeholders; staff, CBOs, legal, Human Resources, etc.

MOUs can serve to strengthen collaborative relationships

Strive for transparency in developing new processes

Collaboration is okay if integration does not occur
Slide 9
Recommendations for Programs
PDF File or PPT File


Recommendations for CDC
        
CDC must send the same clear message from all Divisions within NCHHSTP

Messages must clarify the goal of PCSI-seamless client level services

Continued cross discipline program announcements, i.e. PS07-768

Integration or consistency in program guidance and terminology; OI, IP

Disseminate best practice models

CDC must lead by example
Slide 10
Recommendations for CDC
PDF File or PPT File


Contact Information

Marlene McNeese-Ward
Bureau Chief
Bureau of HIV/STD and Viral Hepatitis Prevention
Disease Prevention and Control Division
Houston Department of Health and Human Services
8000 N. Stadium Drive, 5th Floor
Houston, Texas 77054
713-794-9307-Office
713-794-9331-Fax
marlene.mcneese-ward@cityofhouston.net
Slide 11
Contact Information
PDF File or PPT File

 

 
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