| HIV treatment adherence, measuring severity of client needs, addressing inequities among children |
Project implementation leads to better health for vulnerable populations
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Every team has been there-you have a goal and have put together a plan to achieve it. But there's a nagging voice whispering, "Are we missing anything? Is there a better way of doing this? Are there tools out there I can use?" Implementing a project--putting it into effect--is made up of many small decisions which together can spell success or failure. Our team at the Center for Advancing Health Policy and Practice (CAHPP) at Boston University School of Public Health collaborates with organizations to build and strengthen their structural capacity, operate more effective and efficient clinical programs, and improve health care access and service delivery. We have years of experience helping local health departments, community health centers, primary care clinics, community-based organizations, and social services provider agencies implement successful projects that improve the health and well-being of the people they serve.
Here are three examples from the past and present. |
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Building on what works to improve health outcomes for people living with HIV
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As part of the
Dissemination of Evidence-Informed Interventions to Improve Health Outcomes along the HIV Care Continuum Initiative, CAHPP has teamed with AIDS United to disseminate and study the implementation of four evidence-informed interventions to improve access to HIV care. Through this partnership, CAHPP and AIDS United work with twelve grantee organizations nationwide as they implement one of four interventions focused on linking and retaining HIV-positive individuals in care, specifically women of color, people who use opioids, or those who are transitioning back into the community from jail. The interventions are based on past initiatives funded under the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau, and Special Projects of National Significance (SPNS). The initiative led by CAHPP and AIDS United represents the first attempt to bring innovative SPNS-supported interventions to scale across the field.
As the Dissemination and Evaluation Center (DEC) for the initiative, CAHPP is using an Implementation Science approach to study barriers and facilitators to implementation. Over three years, CAHPP will use site visits, monthly calls, audio recordings, and site staff interviews to better understand various implementation outcomes such as feasibility of the intervention, fidelity to the intervention manual and materials, cost, and integration of the intervention into other ongoing efforts to improve outcomes along the HIV Care Continuum. Lessons learned from implementation research will be used to guide future replication of the interventions.
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CAHPP team works with state agencies to implement acuity tool that assesses needs of people living with HIV
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In 2014, the Massachusetts Department of Public Health (MDPH) and Boston Public Health Commission (BPHC) launched a project to develop an acuity tool to assess the severity of needs of clients living with HIV. The CAHPP team worked with MDPH and BPHC staff to create an acuity tool that assesses client needs in 13 areas of functioning and four categories of severity, ranging from self-management (the lowest level of acuity) to intensive (the highest level of acuity). The CAHPP team conducted a pilot test of the tool with medical case management providers in 38 agencies across MA and NH. It evaluated the tool's effectiveness by comparing acuity scores obtained by medical case managers and those obtained by BUSPH reviewers. It also conducted focus group interviews with medical case management supervisors and direct care staff who had used the tool to better understand its strengths and limitations. The validation process indicated a fair level of agreement between reviewer and MCM scores, and MCM staff generally agreed that the tool was comprehensive and helped them focus on clients' needs.
According to MDPH Office of HIV/AIDS (MDPH/OHA) staff, the report on the pilot project was helpful in obtaining provider voices about the tool and incorporating modifications to the tool and its use in the field. It provided MDPH/OHA with the credibility and information to talk with providers about necessary modifications and finalize the tool for dissemination in HIV case management programs. The MDPH Office of HIV/AIDS has required the use of the acuity tool in funded case management programs throughout Massachusetts. It has also led to a change in policy: clients with a low acuity score are no longer required to have an individual service plan.
The tool has also been used to assess the acuity of patients in several other organizations throughout the country.
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Helping Title V programs leverage federal and state policies and practices to address health inequities among children with special health care needs
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Navigating the complex federal and state policy landscape is one of many activities Title V staff and child health advocates take on as they work to improve the health of children in their state. The main focus of the
Catalyst Center, a project within CAHPP since 2005, is researching state and federal policies and practices that work to improve the financing of care for children and youth with special health care needs (CYSHCN). To address the inequities that exist among CYSHCN based on race, ethnicity, income, immigration states, language, and level of functional difficulty, Catalyst Center staff created
Health Care Coverage and Financing for Children with Special Health Care Needs: A Tutorial to Address Inequities. The tutorial helps Title V staff and other stakeholders learn about federal and state policies. To help with implementation, the tutorial includes examples of programs, partnerships, and practices some states have used to promote health financing equity for CYSHCN.
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Reducing Health Inequities: Advancing Meaningful Change
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Wednesday, February 1, 2017
9 a.m. to 4:30 p.m.
Instructional Building
72 East Concord Street (Hiebert Lounge)
Boston, MA
Live streaming available during event
Sandro Galea, Dean and Robert A. Knox Professor, Boston University School of Public Health, and Sara Bachman, Interim Director, Center for Innovation in Social Work and Health, Boston University School of Social Work and Director of CAHPP, will host this day-long symposium. Through presentations and panel discussions, speakers from academic institutions, government agencies, and health care organizations will explore why interventions are often insufficient and how public health can take a leadership role in mitigating social determinants of health including race, class, disability, and gender.
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