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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 
Slide 1

Integration of HIV/AIDS, STD, TB and Viral Hepatitis New York State's Experience
PDF File or PPT File


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
Slide 2

Why Integration?
PDF File or PPT File


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.
Slide 3
NYS DOH Org Chart
PDF File or PPT File


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
Slide 4
NYS Organizational Matrix
PDF File or PPT File


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
Slide 5
Important Related Offices for Integration
PDF File or PPT File


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
Slide 6
Evolution of Program Integration, New York State
PDF File or PPT File


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.
Slide 7
Multiple Approaches to Program Integration
PDF File or PPT File


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.
Slide 8
Avoid Over-Reorganization
PDF File or PPT File


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
Slide 9
NYS Approach to Integration
PDF File or PPT File


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
Slide 10
Integration Example: Hepatitis
PDF File or PPT File


Hepatitis Integration 2006

Table: Collaborative Hepatitis/Hepatitis Integration Program Initiatives of the New York State Department of Health: 2006 Highlights
Slide 11
Hepatitis Integration 2006
PDF File or PPT File


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
Slide 12
Hepatitis Integration Successes
PDF File or PPT File


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
Slide 13
Targeting High-Risk Adults for Hepatitis A and B
PDF File or PPT File


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.
Slide 14
Hepatitis Integration Status
PDF File or PPT File


Impediments to Integration
Different philosophies;
Organizational separation;
Limitations of categorical grants;
Competition for financial resources;
History of poor relationships;
Personality conflicts.
Slide 15
Impediments to Integration
PDF File or PPT File


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.
Slide 16
Facilitators of Integration
PDF File or PPT File


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;
Slide 17
CDC's Role
PDF File or PPT File


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.
Slide 18
CDC's Role
PDF File or PPT File


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.
Slide 19
Summary
PDF File or PPT File


Cartoon: Welcome to New York (Just Kidding)
Slide 20
End
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