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Slide Set H: PCSI: An NCHHSTP Green Paper

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	Program Collaboration and Service Integration: An NCHHSTP Green paper    Kevin Fenton, M.D., Ph.D., F.F.P.H.  Director   National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention   Centers for Disease Control and Prevention    August 21, 2007
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Program Collaboration and Service Integration, an NCHHSTP Green paper
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	Overview    Background on Green Paper  Levels of integration
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Overview
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	Program Collaboration and Service Integration: Enhancing the prevention and control of HIV/AIDS, Viral Hepatitis, STD and TB in the United States    NCHHSTP green paper, July 2007  Green paper: a discussion document intended to stimulate debate and launch a process of consultation    Paper describes how NCHHSTP will work with partners to advance PCSI strategic priority
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Program Collaboration and Service Integration: Enhancing the prevention and control of HIV/AIDS, Viral Hepatitis, STD and TB in the United States
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	Program Collaboration and Service Integration Drivers, Opportunities, and Motivators    Overlapping determinants, programmatic responses, interventions for HIV, Hepatitis, STD, TB prevention  Moving towards a more holistic model of prevention services  Need to accelerate reductions in health disparities  Desire to improve delivery of prevention services to clients  Advances in diagnostic technology and treatment   More efficient use federal resources
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Program Collaboration and Service Integration Drivers, Opportunities, and Motivators
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	Program Collaboration and Service Integration Conceptualizing a national strategy    Where are we now?  What do we want to achieve?  Can we articulate a shared vision for PCSI?  How do we get there?  Develop an agreed typology for PCSI  Determine current distribution of integrated services  Clarify roles, responsibilities and governance  Establish training, policies, guidelines for transformation  Monitor and evaluate progress towards implementation  Measure and reward performance
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Program Collaboration and Service Integration - Conceptualizing a national strategy
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	Program Collaboration and Service Integration Where are we now?    Limited integration of services  Marked variations across the United States  Numerous models of best and promising practice  Numerous barriers to integration  Programs have concerns about implementing  Unclear support and incentives for integration  No national leadership on PCSI
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Program Collaboration and Service Integration - Where are we now?
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	Program Collaboration and Service Integration Where do we want to be?    Goal:   Provide prevention services that are holistic, science based, comprehensive, and high quality to appropriate populations at every interaction with the health care system.    Vision:    Remove barriers to and facilitate adoption of service delivery integration at the client level by aligning NCHHSTP activities, systems, and policies with this goal.
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Program Collaboration and Service Integration - Where do we want to be?
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	Program Collaboration and Service Integration A typology for integrated HIV, Hepatitis, STD and TB preventive services    Comprehensive integration  Service integration across systems of care (CDC or other) based on risk assessment    Expanded Integration  Service integration across programs funded by CDC based on risk assessment    Limited integration  HIV testing  Some integration of health information    No Integration
Slide 8
Program Collaboration and Service Integration - A typology for integrated HIV, Hepatitis, STD and TB preventive services
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	Program Collaboration and Service Integration Level 1 (Limited) Integrated Services    Definition:  Basic core of integrated services with HIV testing being the basic intervention (independent of risk, age, behavior)     Services  Routine HIV testing in line with 2006 CDC revised recommendations  Health information on HIV, STD, viral hepatitis, and TB  Documented and tracked referrals to Level 2, 3, or specialist services available on request or as indicated  HIV+ linked to care
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Program Collaboration and Service Integration - Level 1 (Limited) Integrated Services
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	Program Collaboration and Service Integration Level 2 (Expanded) Integrated Services    All onsite services from Level 1   Chlamydia screening and treatment for women <25  Gonorrhea screening  Syphilis testing  Treatment for CT, GC, syphilis  Hepatitis A/B vaccine  Hepatitis C risk assessment  Expedited partner therapy, partner notification or Partner Counseling Referral Services  Pregnancy testing as indicated  Screening for TB exposure/risk  Condoms available  Documented and tracked referrals to Level 3 or specialists
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Program Collaboration and Service Integration - Level 2 (Expanded) Integrated Services
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	Program Collaboration and Service Integration Level 3 (Comprehensive) Integrated Services    All onsite services from Level 2  Comprehensive sexual and reproductive health risk assessment, drug use, mental health, intimate partner violence risk assessment  Comprehensive HIV, Hepatitis A/B and Hepatitis C, STD, TB screening, diagnosis and treatment  Comprehensive health services, including pregnancy testing and contraceptive services  Health education and targeted risk reduction  Referral to specialist as needed
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Program Collaboration and Service Integration - Level 3 (Comprehensive) Integrated Services
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	Program Collaboration and Service Integration Roles and responsibilities    CDC’s responsibilities  Support greater coordination and communication among programs  Encourage more joint site visits  Provide national guidance and recommendations on standards for PCSI and performance indicators  Conduct periodic assessments of coverage and quality of integrated services  Collate national monitoring and evaluation data on PCSI implementation from grantees  Support training, policy, and guideline development  In consultation with partners, explore funding opportunities
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Program Collaboration and Service Integration - Roles and responsibilities
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	PProgram Collaboration and Service Integration Roles and responsibilities    Grantees, other stakeholders and partners  Design, implement, monitor and evaluate integrated services  Assess quality of services  Develop systems to collect, report, and analyze key integration performance indicators  Support training, policy and guideline development  Identify local funding opportunities to support integration of prevention services
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Program Collaboration and Service Integration - Roles and responsibilities
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	Program Collaboration and Service Integration Training, policies, guidelines for transformation    NCHHSTP acknowledges that successful implementation of PCSI will require ongoing training and support for prevention workers in a variety of health care settings over sustained periods.     In addition to providing clear recommendations and expectations for PCSI, NCHHSTP is committed to supporting state and local programs in PCSI through:  Work with Prevention Training Centers   Using new technologies (e.g. Internet, blogs, listserves)   Partnering with professional agencies ��   Producing integrated guidelines   Supporting ongoing dialogue and information exchange   Share progress data on PCSI implementation   Change NCHHSTP grants and cooperative agreements
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Program Collaboration and Service Integration - Training, policies, guidelines for transformation
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	Program Collaboration and Service Integration Monitoring and evaluating progress    CDC ensures the quality of its programs and projects through regular monitoring, evaluation, audit and other oversight activities.     Both monitoring and evaluation are key components to the successful implementation of PCSI across existing prevention services.    Monitoring and evaluation consists of process measures and performance indicators.
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Program Collaboration and Service Integration - Monitoring and evaluating progress
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	Program Collaboration and Service Integration Measuring and rewarding performance    Performance indicators help to demonstrate the degree to which program objectives have been achieved.     They allow a comparison of what is happening with what was planned, and provide insight into what should be done to tell whether an activity is on schedule and implemented as planned.     What potential performance indicators may be used alongside the PCSI Levels of Integration framework?
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Program Collaboration and Service Integration - Measuring and rewarding performance
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	Summary    Where are we now?  What do we want to achieve?  Can we articulate a shared vision for PCSI?  How do we get there?  Develop an agreed typology for PCSI  Determine current distribution of integrated services  Clarify roles, responsibilities and governance  Establish training, policies, guidelines for transformation  Monitor and evaluate progress towards implementation  Measure and reward performance
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Summary
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