Michigan Protection and Advocacy Service

A report of activities funded by the Health Resources and Services Administration Special Projects of National Significance Program

October 1994 – September 1996

Grant # BRU-115-95

A Summary of an Evaluation Report by The Measurement Group

The Measurement Group-PROTOTYPES

Evaluation and Dissemination Center

Acknowledgments

This report could not have been produced without the efforts and cooperation of Jay Kaplan, J.D., and Laura Anderson, J.D., of the Michigan Protection and Advocacy Service, as well as the staff, local network representatives, and consumer representatives who provided information for the qualitative report. This short version of the full report was prepared at The Measurement Group with contributions by Lisa A. Melchior, Ph.D., Jacqueline Gelfand, M.A., George J. Huba, Ph.D., Kiku Annon, M.A. and Ariane Kawata.

This publication is supported by the Grant Number BRU 900113-01-0 from the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program. The publication’s contents are solely the responsibility of the authors and do not necessarily represent the official view of HRSA or HRSA/HAB's Special Projects of National Significance. Printing run of 6/30/97.

Michigan Protection and Advocacy Service

A report of activities funded by the Health Resources and Services Administration Special Projects of National Significance Program

October 1994 – September 1996

Developed for HRSA/HAB's SPNS Cooperative Agreements by The Measurement Group—PROTOTYPES Evaluation and Dissemination Center

Introduction

The Michigan Protection and Advocacy Service (MPAS) is a statewide agency which provides services to residents throughout the state of Michigan. Through its HIV/AIDS Advocacy Program, MPAS advocated for the legal rights of people living with HIV.

This pamphlet on the Michigan Protection and Advocacy Service describes clients seen, services provided, trainings given, and referrals made by MPAS. In addition, it describes information from interviews with staff providing a perspective on the successes and challenges faced by the program.

Background and Funding

On October 1, 1994, the Special Projects of National Significance (SPNS) Program of the Health Resources and Services Administration (HRSA) funded an HIV Innovative Model of Care Initiative consisting of 27 cooperative agreements, HRSA, and an Evaluation and Dissemination Center (EDC). The cooperative agreement funding mechanism was selected to encourage projects to identify shared goals and objectives; to enable projects to share technical expertise; and to establish a cross-cutting evaluation. The Michigan Protection and Advocacy Service was one of two legal advocacy programs funded through this initiative.

Michigan Protection and Advocacy Service

Michigan Protection and Advocacy Services (MPAS) is an agency which provides services to residents throughout the State of Michigan. Its goals for this project were to: 1) train volunteer Community Advocates on legal rights and issues related to people with HIV/AIDS; 2) increase recruitment of private attorneys; and, 3) provide impact litigation. Through its HIV/AIDS Advocacy Program, MPAS advocated for the legal rights of people living with HIV. MPAS expanded the outreach efforts of its HIV/AIDS Advocacy Program by training members of the gay, Latino, and African American communities. The training target populations were chosen because these populations are discriminated against due to race, ethnicity, language, and sexual orientation, in addition to their HIV status.

MPAS staff provided ongoing support, updated information, and technical assistance to the Community Advocates. Community Advocates then provided informal legally-based advocacy services to clients within their own communities, in an environment that was culturally sensitive and accessible to the client.

Community Advocates were trained on issues such as:

Legal protection for people with HIV in the areas of housing, employment, public accommodations, and government services

How to access health care services and health care payment options

Summary of Quantitative Data

Training

MPAS conducted 82 training sessions between October 17, 1994 and July 18, 1996. Training sessions were conducted for a number of reasons, including agency or community outreach, education updates, the teaching of methods and skills, and strengthening client and policy advocacy skills. All sessions were focused on advocacy and education issues.

The most commonly stated training purpose was to provide an education update (93.9%)

Client advocacy (90.2%) and policy advocacy (86.6%) were part of nearly every session

Other common purposes for training included recruitment of volunteers (62.2%) and community outreach (59.8%)

Overall, legal advocacy-ethical issues were the most commonly covered training category. As part of this category, topics covered included ethical/legal issues (96.3%), confidentiality (84.1%), HIV sensitivity (78.0%), and empowerment (75.6%).

Trainers

A total of nine trainers participated in the MPAS’s training sessions. Six of them were male and three were female. They ranged in age from 29 to 44 years of age and represented a diverse group of individuals, which included people of color, and gay, lesbian and bisexual trainers.

Training Participants

In total 236 people received training from MPAS. The majority of the participants attended multiple sessions.

57.6% were female and 39.8% were male

The majority of trainees had some type of college degree

Roughly half of the trainees had an administrative, supervisorial or office support role

Many of the female trainees were case managers

Many of the male trainees were consumers, people who were HIV-positive, or friends and family

Most of the trainees participated in the training sessions for the purpose of training others

Technical Assistance

In addition to providing training and direct services, MPAS offered technical assistance. The majority of recipients were social services providers who requested technical assistance on program development in the areas of legal/ethical/community issues (95.5%), and sensitivity to HIV issues (90.9%). The impact of providing technical assistance increased the recipients’ knowledge of HIV/AIDS and available services. It also allowed for the facilitation of information dissemination.

Direct Services

Forty-seven clients received direct services from MPAS from February 1995 to June 1996. Legal and advocacy services were provided to nearly all of the clients. During these session, the topics that were discussed with clients included:

Basic needs/advocacy (91.5%)

Linkages to other services (31.9%)

Living with HIV (25.5%)

Project staff documented outcomes of the legal services that were provided.

In nearly three-fourths of the cases, documents were signed that led to the discontinuation of services

In some cases, clients were referred out, while in others, clients resolved the problems on their own

None of the cases needed to be resolved through litigation

Summary of Qualitative Data

Structured Staff Interview

Interviews were conducted with staff involved in the MPAS project. Staff had the unique ability to assess the strengths and challenges of the project. Two staff members (an attorney and an advocate) and two Community Advocates (a service provider and a small business owner) were interviewed and asked to rate program elements aimed at reducing discriminatory behaviors which prevent persons with HIV disease from receiving a full range of health and human services. A number of program elements were seen as being the key to success:

Training and education for Community Advocates

Linkages with other health and human service programs

Agency outreach

In addition, staff were asked to rate the importance of their program goals to the success of the MPAS project. Goals seen as important to MPAS’s success included:

Having a committed staff

Having a referral service to other agencies

Having MPAS personnel provide ongoing support, updated information, and technical assistance to Community Advocates

Developing and maintaining relationships with policy makers, providers, and representatives of various HIV impacted populations

Effective Program Strategies

Effective strategies used by MPAS to reduce cultural, linguistic, and/or organizational barriers to care for individuals with HIV were the provision of training to Community Advocates and the recruitment of and training for attorneys. In addition, educating consumers and people who were presenting barriers to people with HIV, such as government workers, proved to be successful.

Most Successful Aspects of the MPAS Program

MPAS was very successful in providing services to the residents of Michigan. One of the reasons this was possible was due to the ability of MPAS to provide training on HIV legal concepts in a comprehensive, yet easy to understand manner. Through successful outreach activities, a number of different, distinct communities increased their awareness of MPAS. Other successes of the program included:

Great opportunities for networking among training participants

Recruitment of 100 lawyers into attorney network

Provision educational materials

Technical Assistance for Consumer Advocates

Ability to have earlier intervention

Referrals

During the last six months of the program, there were continual increases in requests for more training by agencies. One of the staff members provided a consumer-specific training session entitled "Advocacy School." MPAS also became more involved in grass-roots activities in communities related to policy issues such as stand-by guardianships.

Most Challenging Aspects to the MPAS Program

In the beginning of the program, MPAS had difficulty getting the word out to consumers about the trainings that were available. Once it was determined that the barriers included lack of transportation, childcare and food, and it was learned that MPAS provided these services, attendance by consumers rose. Other challenges included:

Involving non-HIV specific programs to sponsor training or identifying people

Public policy issues that affect people with HIV

Self-advocacy and direct advocacy skills

Great distances traveled by MPAS trainers

Difficulty in overcoming myths held by people about HIV

Summary

The Michigan Protection and Advocacy Service Project was successful in advocating for the legal rights of people living with HIV. Trained Community Advocates were integral in increasing the number of referrals made to MPAS. This resulted in an increased awareness among community members about the legal rights of people with HIV.

The need for legal advocacy and information on the rights of people with HIV and AIDS in the state of Michigan still exists. Legal advocacy provided by the MPAS program allowed for access to public and disability benefits and medical insurance, and it decreased discrimination in employment and housing for people with HIV. Unfortunately, there is currently no requirement in the state for lawyers to provide pro-bono work. Therefore, it was challenging for MPAS to encourage other lawyers to accept discrimination cases from people with HIV. However, this project was able to add 100 new attorneys to its attorney referral list, thus increasing the project’s referral network.

In looking at the types of services provided by the Community Advocates and by staff and volunteer attorneys, it is clear that a program such as MPAS intervenes in such a way that costly litigation may be avoided. This is evidenced by the fact that none of the cases presented to MPAS were resolved through litigation, but rather through the activities of Community Advocates, appropriate referrals, negotiations, letters, and phone calls.

The great need for legal advocacy among people living with HIV, as evidenced by the staff work overload and the great demand expressed by consumers, demonstrates that without legal services such as those of MPAS, many people with HIV would not be able to receive housing or medical services. Michigan Protection and Advocacy Services upholds the rights of individuals with HIV to receive the basic services which every person has a right to possess.

For Additional Information

The complete report on the Michigan Protection and Advocacy Service Project is available by contacting:

The Measurement Group—PROTOTYPES

Evaluation and Dissemination Center

5811A Uplander Way, Culver City, CA 90230

-or-

The Health Resources and Services Administration,

Special Projects of National Significance Program

5600 Fishers Lane, Parklawn Building, Room 7A-08,

Rockville, MD 20857.

This report is also available on the Internet at The Measurement Group web site (www.TheMeasurementGroup.com). Additional reports and presentations are available.

HRSA/HAB's SPNS Steering

Committee Representatives

1995 – 1996

AIDS Healthcare Foundation (Peter Reis)

Center for Community Health, Education, and Research/Haitian Community AIDS Outreach Project (Eustache Jean-Louis, M.D.)

Center for Women Policy Studies (Leslie R. Wolfe, Ph.D.)

East Boston Neighborhood Health Center (Judith Steinberg, M.D.)

Emory University (Jacqueline Zalumas, Ph.D.)

The Fortune Society (Tracey Gallagher)

Health Initiatives for Youth (Ron Henderson)

Health Resources and Services Administration (Barney Singer, J.D.)

Hektoen Institute for Medical Research/Cook County HIV Primary Care Center

(Mary Driscoll, R.N., M.P.H.)

Indiana Community AIDS Action Network (Paul Chase, J.D.)

Interamerican College of Physicians and Surgeons (George Falus, Ph.D.)

Johns Hopkins University School of Medicine (John G. Bartlett, M.D.)

Larkin Street Services (Anne B. Stanton, M.S.W., C.S.W.)

Michigan Protection and Advocacy Service (Jay Kaplan, J.D.)

Missouri Department of Health (Lawrence P. Thomas, M.S.W.)

New York State Department of Health/Health Research (Humberto Cruz)

Outreach, Inc. (Sandra S. McDonald)

PROTOTYPES (Vivian Brown, Ph.D.)

SUNY–Health Science Center at Brooklyn (Jill Rips, M.A., M.Phil.)

The Measurement Group-PROTOTYPES Evaluation & Dissemination Center

(George Huba, Ph.D.)

University of Colorado Health Sciences Center (Donna Anderson, M.P.H., Ph.D.)

University of Mississippi Medical Center (Harold M. Henderson, M.D.)

University of Nevada School of Medicine (Trudy A. Larson, M.D.)

University of Texas Health Science Center at San Antonio (Victor F. German, M.D., Ph.D.)

University of Vermont & State Agricultural College (Christopher J. Grace, M.D.)

University of Washington (Karina K. Udall, M.D., M.P.H.)

Visiting Nurse Association of Los Angeles (David A. Cherin, M.S.W. Ph.D.)

Washington University (Karen Meredith, M.P.H., R.N.)

Well-Being Institute (Geoffrey Smereck, J.D.)