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Slide Set G: Program Integration: The New York Experience

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Integration of HIV/AIDS, STD, TB and Viral HepatitisNew York State’s Experience Guthrie S. Birkhead, M.D., M.P.H. Director, AIDS Institute Director, Center for Community Health NYS Department of Health External Consultation: Program Collaboration and Service Integration Atlanta, GA August 21-22, 2007
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Integration of HIV/AIDS, STD, TB and Viral Hepatitis New York State's Experience
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Why Integration? An effective way to plan programs and services from the perspectives of: - Common risk factors; - Same people being served; - Same providers in the community. Recognize multi-factorial nature of disease causation and risk Make most efficient use of scarce resources
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Why Integration?
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NYS DOH Org Chart with the Center for Community Health, AIDS Institute, Wadsworth Center for Laboratories and Research, and Office of Science and Public Health circled.
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NYS DOH Org Chart
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NYS Organizational Matrix For HIV/STD/TB/Hepatitis AIDS Institute - HIV Health Care - HIV Prevention - Medical Director Public Health Laboratory Center for Community Health - Epidemiology - HIV/AIDS Epi - STD Control - Com Dis Control Immunization Prg - Family Health B of Women’s Health
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NYS Organizational Matrix
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Important Related Offices for Integration Department of Health - Medicaid - Managed Care - Science and Public Health - Hospital regulation Other State Agencies - Correction - Alcoholism and Substance Abuse Services - Mental Health - Parole Other Pubic hospital system
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Important Related Offices for Integration
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Evolution of Program Integration, New York State Mid -1980s – AIDS Institute formed - AIDS Surveillance/Epi => Epi Division - Enhanced Medicaid $$ => AIDS Institute Early 1990s – Address heavy impact of IDU on HIV - HIV testing/care collocated with substance abuse treatment services => AIDS Institute/OASAS Mid -1990s – Provide partner notification - HIV partner notification program => STD program Late 1990s / Early 2000s – Hepatitis Work Group - Hep vaccine – Immunization Program + STD + HIV/IDU prgs. - Hep surveillance => Epi division - Hep C coordinator moved Epi => AIDS Inst
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Evolution of Program Integration, New York State
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Multiple Approaches to Program Integration Structural - Pros: Better align major players - Cons: can’t be relied on to address all integration issues; reorganization can lead to confusion Collaborative (cross functional) - Pros: Flexible, rapid implementation - Cons: not sustainable if not institutionalized Both approaches are needed.
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Multiple Approaches to Program Integration
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Avoid Over-Reorganization '...every time we were beginning to form up into teams we would be reorganized...I was to learn later in life that we tend to meet any new situation by reorganizing; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency and demoralization.' -Petronius Arbiter, 210 B.C.
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Avoid Over-Reorganization
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NYS Approach to Integration Active involvement of providers, consumers; Leverage multiple funding streams; existing programs; Mobilization of other state agencies, systems; Open lines of communication; - Joint development of messages and materials; - Collaboration on funding proposals; - Link prevention and care. Utilize cross functional teams frequently
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NYS Approach to Integration
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Integration Example: Hepatitis Focus on hepatitis began without new resources Establish widely representative working group meets quarterly Joint development of strategic plan Given lack of dedicated funding, program components were located where resources exist: - Surveillance – with communicable disease - Vaccination – piggy-back on existing service settings - STD - Link to health care settings – AIDS healthcare program
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Integration Example: Hepatitis
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Hepatitis Integration 2006 Table: Collaborative Hepatitis/Hepatitis Integration Program Initiatives of the New York State Department of Health: 2006 Highlights
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Hepatitis Integration 2006
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Hepatitis Integration Successes Hepatitis Integration Project (CDC funded) - Builds on co-located HIV Testing/Primary Care in Substance Use Treatment and harm reduction settings National Hepatitis Training Center Hepatitis A and B Vaccination - STD, state corrections, harm reduction sites Hepatitis C surveillance and follow up: Communicable Disease Hepatitis C Coordinator – AIDS Institute
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Hepatitis Integration Successes
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Targeting High-Risk Adults for Hepatitis A and B Flow chart illustrating the process for targeting High-Risk Adults for Hepatitis A and B, including NYSDOH, Local Health Departments, Other Local Agencies and Organizations, Risk Populations
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Targeting High-Risk Adults for Hepatitis A and B
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Hepatitis Integration Status Collaborative approach is successful in the absence of dedicated funds Takes advantage of expertise and populations served by various existing units Structural changes (move Hep C coordinator to AIDS Institute) included Remain open to reorganization in the future as resources become available.
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Hepatitis Integration Status
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Impediments to Integration Different philosophies; Organizational separation; Limitations of categorical grants; Competition for financial resources; History of poor relationships; Personality conflicts.
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Impediments to Integration
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Facilitators of Integration Communication Leadership; Realization of shared goals; Plan from perspective of the “customer”: patients, clients, providers; Identify needed components and build on the different strengths of programs; Realize economies of collaboration; Organizational connections.
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Facilitators of Integration
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CDC’s Role Recognize the need for flexibility to meet local needs; Recognize and promote “Models that work”/“Best Practices”; Foster interaction among Project Officers in different program areas; Consider cross-training, joint site visits; Convene joint national conferences or overlap at same locale;
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CDC's Role
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CDC’s Role Coordinate with other federal agencies, e.g. substance use; Build in integrative goals into cooperative agreements; Give data standards and provide flexibility for providing equivalent data; Be consistent in definitions/data elements (age, race, etc.); Request adequate and stable resources.
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CDC's Role
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Summary Integration must be a broad, organizing principle, even beyond these 4 programs; Although structural integration may be desirable, collaborative integration must also be practiced. Integration must be an organizational priority backed by leadership; Integration can’t overcome inadequate funding.
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Summary
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Cartoon: Welcome to New York (Just Kidding)
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End
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