SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 2, Issue 2 (January 24, 1997)

Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Introduction

Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.

CCHER's Enhanced Innovative HIV/AIDS Case Management Model for the Haitian Community

The Center for Community Health, Education & Research (CCHER), formerly known as the Haitian AIDS Project, is a community-based health and social services agency serving Boston's Haitian community. CCHER currently provides case management to approximately 77 Haitian adults and children living with HIV/AIDS in Boston and surrounding areas. CCHER's unique case management model was developed to address language and cultural barriers faced by this immigrant population and has allowed HIV-positive Haitian consumers to access needed services and receive a continuum of care.

CCHER's original "Innovative Case Management Program" (ICMP), developed in 1991, was a community- and hospital-based case management program. The ICMP allowed consumers to be followed by the same case manager both in the community, (i.e., consumers accessing services at CCHER or at other service agencies), and at the Boston Medical Center HIV clinic. Furthermore, bilingual/bicultural case managers served as "cultural brokers" to HIV-positive Haitian consumers and their families, acting as trusted confidantes and as mediators between clients and service providers. Additionally, case managers were integrated into hospital clinical teams. With the consumer's consent, case managers took part in case conferences to work with other providers, discussing and resolving problems and creating a culturally appropriate care plan. As a result of this direct partnership, consumers were more at ease discussing sensitive information and personal issues, leading to greater adherence and consumer satisfaction during treatment.

Through the innovative features of the program, CCHER has minimized the involvement of non-clinical staff and reduced the number of missed hospital clinic appointments and duplication of services, thereby minimizing costs. The success of the ICMP has been rooted in the following: 1) continuity of care provided by having the same case manager available at all medical and social service sites, thereby reducing exposure to too many providers and the risk of confusion between patients and providers; 2) strong links between the community and the hospital service delivery system and among individual providers; and 3) interventions, facilitated by bicultural/bilingual staff, that have been culturally and socially relevant to consumers' lives. However, barriers have been encountered, such as: excessive caseloads and tasks of case managers, resulting in limited staff time to devote to risk reduction and psychosocial issues unique to an HIV/AIDS diagnosis; lack of a counseling and educational component in the ICMP; and the fact that many Haitians affected by HIV have been unable to develop coping mechanisms and skills to prevent further transmission of HIV.

Through HRSA/HAB's SPNS grant, CCHER has enhanced its ICMP by developing and implementing a psychosocial counseling curriculum focused on prevention/risk reduction associated with HIV transmission, coping strategies, and concepts of health and illness including the well-being of consumers. The curriculum, which is administered to consumers, is composed of 25 educational modules (topics) related to HIV and other health, emotional, and social needs. This special type of ICMP is called the "Enhanced Innovative Case Management Plan" (EICMP). This EICMP has been created to provide culturally competent education and counseling to help consumers manage any emotional problems they may have and to provide them with the tools to help support their sense of self-worth and autonomy. The program's curriculum was developed through years of preventive thinking and collaboration with clinical providers, members of the CCHER case management team, and others associatedwith providing care and support to members of the Haitian community.

For more information about this project, contact Eustache Jean-Louis, M.D., M.P.H., Executive Director, CCHER, 420 Washington Street, Dorchester, MA 02124, 617.265.0628.

SPNS/Fax is produced by The Measurement Group–PROTOTYPES Evaluation and Dissemination Center (EDC). Editorial comments should be made to The Measurement Group at 5811A Uplander Way, Culver City, California 90230, 310.216.1051, 310.670.7735 (fax).
 

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