HIV & Social Work Across Three Regions

Presented through telehealth April 24, 2012

HIV and Social Work in the RQHR

Heather Temple, BSW/RSWPopulation & Public Health Services- Provincial HIV

Strategy Social Worker 766-7629

Nanette Durand-Ray MSW/RSW & Nancy Wagar, BSW/RSW

Infectious Diseases Clinic- Clinical Social Workers 766-3994

• Since the first documentation of HIV Cases at PPHS (~1986), we have approximately 500 cases on file

• No concrete way to determine exact numbers of cases in RQHR due to unknown deaths, clients lost to follow-up, and movement in/out of province

RQHR STATISTICS

0

10

20

30

40

50

60

Year of Diagnosis

Num

ber

of C

ases

0.0

5.0

10.0

15.0

20.0

25.0

Rate

per

100

,000

Cases 12 19 15 22 36 56 48 39

Rate 4.9 7.7 6.1 9.0 14.6 22.2 18.9 14.6

2003 2004 2005 2006 2007 2008 2009 2010

RQHR HIV RATES

Ministry of Health

• RQHR HIV mother-to-child transmission rate 7% (4/58) January ‘96 & December ’10

• Of the 4 positive infants, none of the mothers received ART

• We currently have 5 pregnant women engaged in care

RQHR PERINATAL STATISTICS- 2010

• IDU remains the major risk exposure

- 77% in 2009 (154/200). Of these:• 84% were of Aboriginal origin • 47% of those who identified IDU as the primary risk

were female- More than 1/3 (34%) were between

the ages of 15-29

• MSM risk remains <10%

Source: HIV and AIDS in Saskatchewan 2009, Annual Report

RISK FACTORS

• Provides medical care, support, and education for people and families living with HIV/AIDS

• Unit 4E in the Regina General Hospital

• Regular clinic visits scheduled for clients (out-patients) every 3-4 months, as needed

• Clinic hours are M-F, 8:00-4:00pm

• Phone: 766-3915

INFECTIOUS DISEASES CLINIC - RGH

• Specialists/Physicians: Dr. Karunakaran and Dr. Wong

• Clinic Nurse: Debbie Rodger

• Social Worker: Nancy Wagar- part time position. (Returning from maternity leave where she was covered by Nanette Durand-Ray)

• Dietician: Karen Karst- every 2nd Tuesday starting in May

• Pharmacist: Mike Stuber- part time (back up to Linda Sulz)

INFECTIOUS DISEASES CLINIC TEAM

• Primary SW focus on unit is HIV specific, but role includes other ID patient concerns as well

• Remains within hospital setting (SWADD)

• Initial Psycho-social assessments for new patients

• Long –term supportive counseling

• Provides HIV education

• Explores support systems

• Assists with financial challenges and form completion (Drug Coverage, employment/ disability benefits, transportation)

• Provides community referrals

• Liases with in-patient hospital units re: counseling, d/c plans

• Generates homecare referrals

• Involved in new interdisciplinary/interagency Case Management team

ID SOCIAL WORKER’S ROLE

• Constant challenges with drug coverage (special support programs, immigration)

• Completing medical reports to maximize benefits (Disability/SAID, EI, CPP)

• Patients wanting Ensure (currently not covered- incl. in Special Diet supplement)

• Formula coverage for babies (to be paid for by CTB)

• Clinic attendance/tracking transient populations

• Lack of patients with GP’s

• Increased follow-up with patients in more complex situations (no longer just checking in)

ID CLINIC SW CHALLENGES

• The “HIV Team” is housed within the Communicable Diseases and Sexual Health Programs Department at PPHS, 2110 Hamilton Street

• 3 Public Health Nurses:- Michelle Bilan (0.8)- Laurel Stang and Rachel Faye (FT)- 766-7625

• Social Worker:- Heather Temple (TFT)- 766-7629

PUBLIC HEALTH: COMMUNICABLE DISEASES AND SEXUAL HEALTH PROGRAMS: HIV TEAM

• Receive all HIV+ labs within the region

• Assist Dr’s with providing new diagnosis’ if needed, or providing diagnosis

• Assist Dr’s with new HIV+ clients with completion of mandatory provincial/federal reporting requirements

• Locate and counsel new and known cases and contacts, provide referrals to/engagement with ID and other agencies

• Provide pre/post test counselling and testing for HIV in clinic and community

• Specimen collection, immunizations

• Assist in navigation of medical system

PUBLIC HEALTH HIV NURSES

• New temporary position created under provincial HIV strategy- began in March ’11-2014

• Assists PHN’s with Case Management and providing social support to cases and contacts

• Assists PHN’s with locating and completing reporting requirements• Provides transportation to access medical care/resources-facilitate 1st

access to ID Clinic• Provides individual counselling/support, HIV education, promotes harm

reduction strategies • Liaises with acute care units/community agencies to assist with

providing holistic client centered care. Generates referrals and connects clients with community resources

• Home/hospital visiting, meeting clients “where they are at”• Advocates for and assists at risk and vulnerable clients with navigating

health care systems (in hospital and accessing)• Involved in new interdisciplinary/interagency Case Management team

PUBLIC HEALTH/HIV STRATEGY SOCIAL WORK ROLE

• Increasing caseload of clients with multiple complex social needs (addictions, mental health, housing)

• Advocating for clients in ER/acute care settings with concurrent disorders/medical issues

• Assisting clients with obtaining family physicians

• Supporting clients in maintaining health within risky social situations

PH/STRATEGY SW CHALLENGES

• The challenge of meeting clients/patient’s needs (medical and social) is being addressed by the Provincial HIV Strategy implementation

• Funding has been provided for increased support in the community including:

– 1 TFT Social Worker– 3 HIV Community Outreach Workers based at

ANHAN, APSS, and SWAP– 3 Peer to Peer Community Mentors – 1 Acute Care Peer to Peer Coordinator– Housing Coordinator based out of Carmichael

Outreach Centre

CASE MANAGEMENT IN THE RQHR

• Case Management (CM) is a collaborative process in a continuum of care that assesses, plans, implements, coordinates, monitors, and evaluates the options, services and care required by a client

• To date, CM has been provided by the ID Clinic staff and PHN’s. However, due to increasing client complexities in their social circumstances, improved integration and collaboration of care and services for clients provided across a variety of settings is required

CASE MANAGEMENT IN THE RQHR

• HIV Case Management is a process whereby people living with HIV who require short-term or long-term support are better able to achieve positive health and social outcomes and reduce their risk of progression to advanced HIV.

• CM Team will consist of case managers, outreach staff, and as indicated, health care providers from agencies within the RQHR and community-based organizations

CASE MANAGEMENT TEAM IN THE RQHR

• Currently meets on a bi-weekly basis to consult on clients living with HIV, who require support related to the social determinants of health and/or linkage/retention in care.

• HIV Case Management process still in preliminary

stages: – 3 clients formally engaged in HIV Case Management

(have signed consent forms)– Currently exploring alternative avenues to engage

additional clients in CM

CASE MANAGEMENT TEAM

• Native Health Services• Addictions Services• Mental Health Services• Street Project/Needle Exchange• Methadone Clinic• Four Directions• Sexual Health Clinic

RQHR RESOURCES

• AIDS Programs South Saskatchewan (APSS)• All Nations Hope AIDS Network (ANHAN)• Street Workers Advocacy Project (SWAP)• Carmichael Outreach Centre• Regina Food Bank• Income Assistance (MSS & Band Funding)• Parliament Methadone Clinic• Canadian AIDS Treatment Info. Exchange

(CATIE)• Shelters (My Aunt’s Place, Isabelle Johnson,

Souls Harbour/Rescue Mission, Salvation Army…)

COMMUNITY BASED RESOURCES

• Addressing social needs to bring client’s to a stable place where they are able to be active and successful in the management of HIV:

– Basic needs 1st → if cannot be met, reduced ability for change/intervention (Social Determinants of Health)

• Main issues include:– Poverty– Housing/homelessness/transience– Addictions/mental health – Family violence– Intergenerational/interfamilial– Limited rural resources– Acute care admissions (addictions, pain management,

confidentiality, discrimination)– Fear of death/dying/life expectancy

CHALLENGES FOR SW AND CLIENTS IN THE RQHR

• Increasing regional cultural awareness and integration• Increasing departmental collaboration and streamlining of

program access, specific to the HIV population, has resulted in clients receiving more holistic care

• Increasing numbers of supports available to clients• Increasing awareness of HIV in the greater community and

motivation to make positive changes• Working from client-centered, harm reduction, strength-

based philosophies that intend to meet all clients “where they are at”

• Working towards timely, low-barrier access to and coordination of care and services that provide support for people living with HIV

• Increasingly holistic care and services that are client-driven• Efforts being made to enable culturally safe environments,

focused on needs identified by and with the client

STRENGTHS WITHIN THE RQHR

HIV SOCIAL ISSUES –

THE PRINCE ALBERT PICTURE

Presented by: Barb BowditchCase Manager Prince Albert Positive Care Program

Client Profile - majority Aboriginal

- majority have addiction issues-large number living in First Nation

communities- transient - homeless- Come from within our health region,

other health regions, northern communities and both Provincial Correctional Centre's

My role:- Client centered-support for clients in office, home visits, in hospital and via telephone- outreach support in First Nation Communities- support for HIV+ Inmates in both Provincial Correctional Centers'- support to family members- Housing assessment and intake- discharge planning – Correctional Centers' and hospital.

-assist with disclosure – partners, family members and children

-act as a referral agent – HIV nurse, housing coordinator, addiction services detox, methadone program etc.

- client advocate -confidentiality breach – care

-HIV education – client, family, in community and inmates.

-transportation for clinic appointments, blood work, Saskatoon appointments , Detox and Treatment Centers.

Issues and Challenges:

- disappear after diagnosis-not ready to accept diagnosis- not ready start treatment/compliance- trust issues- isolated communities- transportation – rural and First Nation community-mental health

- addiction

- homelessness

- lost to follow up

- transient population

- large case load

- limited human resources (Positive Care Program)

Strengths:

-Accessibility

- trust

- committed staff and physicians

- transportation

-Nurse Practitioner on site 2 days per week

- Housing Coordinator

-Addiction worker on site 2 afternoons per week

Successes:

-clients stable once housed

-clients seeking addiction services

-One – Stop Shop

- Partnerships

- Outreach

Opportunities for Improvement:

- On-site Mental Health worker

- Pharmacist on site on clinic days

- Increase Positive Care Program staff

- Increase outreach services – assisting communities to deliver care in their community

- Enhance spiritual care provider services – i.e. Elders

-Peer support network

-Support group

• Presented by:

• Shelly Glum, BSW/RSW• Social Worker• Positive Living Program• Saskatoon Health Region

HIV, SOCIAL WORK AND SASKATOON

• Background

• Positive Living Program, May 2011

• Partnership with Mental Health and Addiction Services

• The people we work with, who we see

ROLE

• Partnerships

• WSCC, MHAS, CBO’s, PLP, STC and other SHR programs

• Case Management Services

STRENGTHS

• Mental Health and Addictions

• Housing

• Income Security

• Food Security

• Prisons

• Hospitalizations, palliative care

CHALLENGES

• Prevalence of concurrent disorders regarding mental health

MENTAL HEALTH AND ADDICTIONS

Addition to Maslow’s Hierarchy (for folks who use drugs)

Self-Actualization

Esteem Needs

Sense of Belonging

Safety

Physiological Needs

The Drugs/The Score/The $ for Drugs

• So much more needed than “affordable”

• Supportive, transitional, harm reduction, etc.

• Out of the “core”

HOUSING

• “Not enough money” means so much more

• Social programs do not meet basic needs

INCOME SECURITY

• SAP Shelter amounts: Single $459; Childless Couple $537

• SAP Basic Allowance: $255 + $50 + $20 + $140 = $465

• Working poor

INCOME SECURITY (CONT’D)

• SAP Rates = food bank

• Most money going into shelter

• Special diet allowance goes into shelter, big issue for those experiencing wasting

• Nutrition supplement access

FOOD SECURITY

• Stigma when inside

• Transition to community challenges

• Partnership development needed

PRISONS

• Addiction management

• Transition to Community upon Discharge Challenges

• Assist with discharge planning

• Many people dying but not accessing palliative care

HOSPITALIZATIONS/ PALLIATIVE CARE

• Continue to build partnerships

• Mental health and addictions workers on site (Nine Circles model)

• Support Group

AREAS OF IMPROVEMENT

Questions