A Second Year Summary Report: 27 Innovative Models of HIV Care Cooperative Agreements

Table 2-1 highlights achievements of the 27 projects and the Evaluation and Dissemination Center made during the second year. Following this summary of individual program activities, the achievements of the Steering Committee as a whole are described.

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
AIDS Healthcare Foundation (Los Angeles, California)	Studied ways of providing high quality, comprehensive HIV/AIDS care under a capitated reimbursement system to publicly-supported AIDS patients in Los Angeles County. Implemented a plan to improve the way health care services are provided using an interdisciplinary case management approach. Developed an approach to better coordinate the delivery of medical and social services, increase efficiency, reduce overall costs, and improve the quality of care.	Executed a "fully-at-risk" capitated care contract with the California Department of Health Services to provide a continuum of medical services at five hospital-based clinics. Enrolled first patients in the "Positive Healthcare" program on April 1, 1995. Enrolled more than 250 members. Purchased and installed a sophisticated utilization management software package. Established a Quality Improvement Council. Signed collaborative agreements with a large, independent hospital-based HIV/AIDS provider and a case management organization.
Center for Community Health, Education, and Research/Haitian Community AIDS Outreach Project (Dorchester, Massachusetts)	Enrolled Haitian clients into case management and other HIV-related services. Enrolled Haitians with HIV into the psychosocial intervention. Developed a psychosocial education curriculum to reduce barriers. Established methods to deliver the psychosocial intervention. Developed instruments and evaluated several aspects of the project. Quantified and developed measures for evaluation criteria. Established database on 46 clients’ characteristics.	Enrolled more than 90 clients into case management services for the year, with an active case load of 72 HIV clients. Enrolled 46 Haitian clients, 58% (14 males and 13 females) have completed this phase of the intervention. Administered more than 25 topics and conducted more than 400 psychosocial sessions. More than 10 sessions or encounters are registered per individual client to complete the psychosocial intervention. Evaluated the process of developing a psychosocial curriculum for Haitians with HIV. Evaluated the interaction between the HIV consumers and providers during psychosocial sessions. Evaluated aggregated intermediate outcomes on 20 clients before entering phase IV. Established all necessary logistics to enter phase IV.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
Center for Women Policy Studies (District of Columbia)	Established a policy cadre, which consists of women living with HIV/AIDS to plan program activities and advocacy strategies. Sponsored information sharing meetings and policy seminars for local service providers and HIV-positive women on a broad range of policy issues based on the work of the cadre. Convened working groups on specific policy issues (case management, Medicaid, drug assistance programs) as identified by women with HIV/AIDS. Assessed organizational barriers within the HIV/AIDS care system and developed training to reduce these barriers. Conducted qualitative research with women to better understand the needs of women. Published WomanCare NEWS, a quarterly newsletter for women living with HIV/AIDS and their advocates. Identified, documented and disseminated information regarding existing community resources and information guides to local service providers and women. Provided on a bi-monthly basis up-to-date data and research to HIV infected women, Ryan White CARE Act funded agencies, and other HIV service providers. Increased membership in the Collaborative. Developed process evaluation tools—particularly focusing on methodology that captures the process of development of the cadre of women with HIV/AIDS.	Expanded the involvement of Latinas with HIV/AIDS, their providers, and advocates in the Collaborative to assist in the planning of policy and infrastructure advocacy activities. Collaborated on a Latinas with HIV/AIDS support group providing training and skills building, and convened a roundtable of providers. Expanded the involvement of the cadre; a total of 18 women met on a quarterly basis to assist in program planning. Convened two policy seminars including Case Management: Meeting the Needs of Women with HIV/AIDS and Meeting the Needs of Women with HIV/AIDS: Ex-Offenders. Convened a SPEAK OUT on the issue of domestic violence in the lives of women with AIDS and to recommend program activities to address their specific needs. Conducted information-sharing meetings on various program and policy issues including Medical Manifestation of HIV/AIDS, AIDS Drug Assistance Programs, and Protease Inhibitors. Conducted focus groups of women living with AIDS to address the changing needs of women. Conducted over 50 needs assessments of organizations to identify barriers to services and provided training to local service providers addressing case management services. Wrote, published, and broadly disseminated local policy briefs that directly/indirectly impact services to women with HIV. Developed an evaluation model to implement information sharing meetings. Conducted 36 in-depth interviews with a diverse group of women with HIV.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
East Boston Neighborhood Health Center (East Boston, Massachusetts)	Further developed Mobile HIV Testing and Counseling Unit. Further developed HIV Services’ model of care and the multidisciplinary team of providers. Developed systems to better manage patients’ care. Expanded outpatient and inpatient services. Expanded membership and functioning of the Consumer Advisory Board. Expanded patient database to include quarterly updates. Implemented system to capture outpatient service utilization and costs. Prepared monthly summaries of resource use stratified by disease stage.	Piloted Mobile Unit at East Boston Court and at a large methadone maintenance facility. Opened an Anonymous HIV counseling and Testing Clinic at Logan International Health Center. Developed a framework for HIV Services’ model of care, including role definitions. Streamlined patient intake process. Improved the functioning of the weekly team meeting. Expanded the multidisciplinary team to include a home care nurse, a bilingual social worker, a consulting bilingual bicultural substance abuse counselor, and pastoral care interns. Performed a qualitative evaluation of provider satisfaction with new team model. Organized and attended a team development retreat; implemented retreat objectives. Implemented viral load testing as standard of care. Expanded home care to include hospice services. Implemented weekly process evaluation through case reviews with the goal of identifying utilization problems and needed services/systems to better manage patients’ care and to train staff. Developed managed care inpatient units at Boston Medical Center and Massachusetts General Hospital. Developed contractual relationships with chronic care facilities. Implemented quarterly chart reviews to update patient database. Drafted standards of care for the medical management of HIV infected patients.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
Emory University (Atlanta, Georgia)	A clinical instructor/nurse practitioner was hired and the preceptor model "B" was defined as a consultation/training model. The "B" model was defined and the curriculum was developed based on chart review analysis. The curriculum was implemented in June 1996. Centralized "A" HIV training SPNS II workshops that were implemented Spring and Summer of 1996. Qualitative evaluation measures were planned and implemented to capture the outcomes of the project on corrections infrastructure. Both "A" and "B" trainings were planned to meet the needs of health care personnel in dealing with new and evolving clinical content and standards of care for HIV early intervention and antiretroviral drugs.	A project timeline was developed for the three year project, "A" training, and "B" training. Initial visits were taken to eight "B" treatment sites in February and March 1996, the curriculum was defined, and the HIV training was implemented in those eight treatment sites beginning in June of 1996. A crate of HIV educational resources, textbooks, and clinical protocols was distributed to the preceptor of each of the eight treatment sites. A total of 12 model "A" workshops were held in year one and two, reaching a total of 96 participants. New and evolving clinical content and standards of care for HIV early intervention and antiretroviral drugs had implications for all health personnel. Plans for a workshop for physician attendees were modified to include increasing numbers of all health personnel. Specific measures were implemented to increase the attendance at the "A" trainings; learning needs assessments and flyers about future "A" trainings were mailed to all 700 Department of Corrections and contract employees in August and September of 1996. Needs assessments were conducted for both the "A" and "B" models, and their results were analyzed. Evaluation measures for "A" and "B" trainings were implemented, including pre- and post-testing of content for both "A" and "B" trainings, and a qualitative journal to capture the infrastructure changes and outcomes in the preceptor model was implemented for the "B" trainings. Monthly meetings of the project planning group consisting of representatives from Emory, Georgia Department of Corrections, and EMSTAR research continued. These sessions served to plan and implement project activities and progress to analyze progress and barriers. An ad-hoc group of Emory personnel met to plan project activities, prepare for a project site visit, and, later, to plan project transition after resignation of the project director in August 1996.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
The Fortune Society (New York, New York)	Continued to provide vital services unavailable from other sources to clients admitted to the project. Further improved the project’s ability to offer assistance to inmates to meet the HIV-related and other essential needs they have upon their release from jail/prison. Provided intensive case management, counseling and supportive services specially designed to help Latinos and Latinas overcome the linguistic and cultural barriers that inhibit them from accessing needed services. Significantly widened the project’s referral system and outreach efforts to include more correctional facilities in diverse parts of New York State and other jurisdictions.	Continued to attend parole revocation hearings with great success in advocating for alternatives to re-incarceration and in obtaining "revoke and restore" dispositions for project clients detained by order of the Board of Parole. Established new (and maintained current) strong working relationships with Correctional Facility staff, including Institutional Parole Officers, Correctional Counselors, and facility and private discharge planning coordinators. Maintained a comprehensive database to track project services and client demographics. Created an ongoing weekly support group for Latinos and Latinas conducted in Spanish to supplement two other weekly HIV ex-offender support groups. Established a special working relationship with New York State’s Willard Drug Treatment Campus, an alternative to lengthier state incarceration, accepting all HIV-positive inmates for discharge planning, case management and referrals. Published a special edition of the 20,000-circulation quarterly paper Fortune News devoted to HIV and AIDS issues for ex-offenders with articles written by project staff.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
Health Initiatives for Youth (San Francisco, California)	Disseminated the results of the baseline needs assessment of providers and youth in five Bay Area counties. Distributed informational resources including the quarterly newsletter Bridges, the Adolescent Providers Guide, and customized information packets. Continued to develop and augment a youth health resource library featuring books, journals, magazines, epidemiological reports, videos, and directories. Provided a wide range of standardized and customized trainings on youth and HIV topics. Provided technical assistance and expert consultation on youth and HIV topics.	Held a series of networking luncheons in each of five target counties to disseminate the findings of the baseline needs assessment as well as encourage collaboration and coordination of services among providers. Coordinated a "youth track" at the 1996 National AIDS Update Conference featuring a wide range of youth-themed workshops, an intensive training, a plenary speaker, and youth-related art, video and theater. Provided the standardized cross-agency trainings Youth and the HIV Antibody Test, Advanced Counseling Skills, and HIV Prevention: From Framework to the Field. Provided customized trainings and in-service presentations to agencies on specific topics related to working with youth and HIV issues. Produced four issues of the newsletter Bridges and distributed them to health and social service providers, youth advocates and policy makers locally and nationally. Disseminated customized information packets about youth and HIV topics including articles, abstracts, statistics, and referral lists. Disseminated the findings of the baseline needs assessment and information about project youth and HIV trainings at the International Conference on AIDS in Vancouver, British Columbia. Produced and distributed an updated version of the Adolescent Provider Guide, a listing of youth and health services in San Francisco.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
Hektoen Institute for Medical Research/Cook County HIV Primary Care Center (Chicago, Illinois)	Developed a Maternal and Child Health/HIV Advisory Council of providers, advocates, community agencies, and consumers. Developed a county-wide implementation committee to assist in developing policies and protocols for use of zidovudine to reduce perinatal HIV transmission. Conducted outreach to every maternity hospital and its obstetrics staff in Cook County. Conducted a needs assessment of practices and knowledge about HIV among Cook County Maternal and Child Health providers. Developed a Policy Statement about counseling and testing by consent and administration of zidovudine during pregnancy. Developed a Community Advocacy Network for the Maternal and Child Health/HIV Integration Project composed of women with HIV.	Trained Chicago Department of Health Maternal and Child Health clinic staff in HIV education and early identification practices. Facilitated the adoption of policies and protocols for HIV counseling and testing by consent for pregnant women by the Chicago Department of Health, and several large hospitals and perinatal networks. Developed a manual for providers about counseling and testing by consent, guidelines for use of zidovudine to reduce perinatal transmission, general OB care of pregnant women with HIV, and general care for the infant of an HIV-positive mother. Provided training regarding counseling, testing by consent, and perinatal transmission reduction for providers.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
Indiana Community AIDS Action Network (Indianapolis, Indiana)	Strengthened and expanded Indiana’s HIV grass roots advocacy network through coordinated coalition-building activities. Developed an education and training program to address increased complaints of HIV discrimination in correctional settings. Provided training and technical assistance to promote development of the Indiana Community AIDS Action Network’s (ICAAN) legal advocacy model in other jurisdictions. Organized a statewide coalition of HIV-impacted individuals and AIDS service organizations to address shortfalls in funding for HIV prevention, care, housing, and support services in Indiana. Assisted in the development of strategies to strengthen linkages between HIV/AIDS organizations and health and human services organizations serving children, seniors, minority, disabled, homeless, migrant, and indigent populations throughout Indiana. Participated in the development of a statewide plan to address Indiana’s HIV service delivery needs through the year 2000. Secured funding through Ryan White CARE Act Title II, private foundations and private donations to continue program services beyond the SPNS Program grant.	Provided HIV legal education and training at the annual, statewide conference of the Indiana Sheriff’s Association and the Indiana Association of Chiefs of Police. Conducted a two-day, statewide HIV advocacy education and training conference for over 100 consumers and consumer advocates. Organized forty consumers and family members from across Indiana to participate in a national, three-day HIV advocacy training program in Washington, DC. Held Indiana’s first HIV Issues Day at the Indiana General Assembly where over forty consumers discussed HIV-related community needs with their state legislators. Filed suit in a major right to privacy claim against a municipality and its police department. Presented ICAAN’s legal advocacy model at the 1996 National AIDS Update Conference, the XI International Conference on AIDS and the 1996 National HIV/AIDS Skills Building Conference. Provided leadership in the development of cost-effective solutions to address serious shortfalls in funding which have prevented Indiana’s AIDS Drug Assistance Program from adding protease inhibitors to its drug formulary.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
Interamerican College of Physicians and Surgeons (New York, New York)	Completed training of 55 physicians in HIV risk-assessment, counseling, testing, treatment of seropositive patients and referral services. Increased HIV risk-assessment, testing, and treatment of positive patients in the majority of the physicians’ practices in the program.	Achieved more frequent screenings in the practices of 90% of trainees. Demonstrated an increase of time invested in pre- and post-test counseling in over 85% of program physicians. Since the start of the program, "over 65% of physicians have tested patients in their practices," the majority of whom had not been regularly testing patients for HIV-infection. Over half of the program physicians have decided to treat HIV-seropositive patients or are currently managing HIV-positive patients in their practices.
Johns Hopkins University School of Medicine (Baltimore, Maryland)	Facilitated extensive communication between the Johns Hopkins Health Systems, the Hopkins HIV Care Program, the Maryland Medicaid Program, and HMOs. Implemented internal audits to determine the efficiency of clinic use, length of stay, use of the chronic care facility, subspecialty consultations, cost of drugs, etc. Analyzed the impact of this type of program on other aspects of the mission of an academic center including teaching and research.	Had a capitation rate defined by Medicaid. Used a database to assure patient financial security with Medicaid rate. Obtained positive response by two HMOs in central Maryland that are now in negotiations. Defined eligibility criteria, services to be offered, and quality assurance systems. Recruited two new physicians.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
Larkin Street Services (San Francisco, California)	Capital Development Activities Acquired building for the program’s future Assisted Care Facility. Program and Evaluation Activities Provided services for youth living with symptomatic HIV or AIDS with a coordinated service delivery model. Completed a general design for an evaluation plan for the program and implemented the evaluation.	Capital Development Activities Completed final schematic architectural drawings for the facility. Submitted final schematic drawing for building permits to the city of San Francisco. Selected a general contractor who will oversee construction of the facility. Program and Evaluation Activities Provided case management, emergency housing, medical services and psychosocial support to 22 youth with symptomatic HIV disease or AIDS. Conducted four focus groups with staff and clients to secure appropriateness of design and program model. Held two neighborhood community meetings to ensure support of the program. Completed evaluation design and piloted the evaluation assessment instrument. Implemented evaluation and began data collection. Began viral load testing on all SPNS Program clients.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
Michigan Protection and Advocacy Service (Lansing, Michigan)	Developed and disseminated Community Advocate Training educational materials. Established contacts with African American, gay and lesbian, and rural communities throughout Michigan. Provided legal representation to clients in cases having impact on larger populations of persons with HIV.	Held nine additional Community Advocate trainings (10 in 1994-95) in both rural and urban areas of Michigan, providing training to an additional 200 participants (150 participants in 1994-95). Sponsored conference to train private attorneys regarding HIV/AIDS legal issues. Held focus groups with service providers and potential training participants to determine effectiveness of outreach efforts. Collected demographic and training evaluation data from training participants. Represented clients in cases involving housing discrimination and reasonable accommodations.
Missouri Department of Health (Jefferson City, Missouri)	Developed a cooperative agreement between the Missouri Department of Health (DOH) and the Missouri Department of Mental Health (DMH). Established a Core Implementation Team (CIT) in St. Louis to plan training and develop an integrated model of care. Provided services to poly-diagnosed persons living with HIV/AIDS in Kansas City.	Developed and implemented a memorandum of agreement between the Missouri Department of Health (DOH) and the Missouri Department of Mental Health (DMH). Developed, distributed, and evaluated a needs assessment in St. Louis. Planned and implemented a comprehensive multi-disciplinary training for 163 service providers in St. Louis. Developed an implementation model in St. Louis through a collaborative effort with the St. Louis (CIT). Conducted follow-up interviews with participants in the Kansas City training. Planned and implemented a comprehensive multi-disciplinary training for 80 DMH service providers.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
New York State Department of Health/Health Research (Albany, New York)	Developed systems and methodologies for use in the collection and analysis of site-specific HIV/AIDS cost and utilization data. Developed guidelines for provider capacity for the delivery of primary care services to adults with HIV/AIDS based on stage-specific data from a national study and on estimates of the distribution of persons with HIV/AIDS receiving primary care services in New York. Awarded grants to provider and health service research groups throughout the state for planning activities associated with the development of program models that will be used in fashioning HIV Special Needs Plans.	Developed and implemented a survey to record the experiences of persons with HIV/AIDS as they transition to Medicaid Managed Care. Examined Medicaid fee-for-service data for establishing baselines for pre-managed care consumer behavior. Developed a relational database that represents several existing Medicaid databases. Initiated the development of a clinical quality of care database.
Outreach, Inc. (Atlanta, Georgia)	Selected site for the creation and implementation of satellite location, "Safe Place." Implemented satellite facility to provide full range of services to substance-abusing, HIV-positive adults.	Continued renovation of satellite facility. Hired staff for the satellite facility. Opened facility for "Safe Place" to provide services to substance-abusing, HIV-positive adults, including: HIV testing, van transportation to medical treatment, crisis intervention services, home visits and follow-up care, group support sessions, peer counselor interactions, and substance abuse counseling.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
PROTOTYPES (Culver City, California)	Expanded WomensLink model substantially since initial implementation. Added transportation unit (Project Access). Added new linkages and services. Continued effectiveness of data collection. Outgrew original physical space, and looking for expanded quarters. Expanded linkages with medical services that are quite effective.	Enrolled 222 women since October 1994. Referred 40.4% into medical outpatient services. Referred 23.4% into substance abuse services. Helped 33.3% receive housing services through HOPWA. Continued significant reduction in structural barriers (e.g., knowing where services are, etc.). Served 38.2% African American, 27.7% Latina, 32.3% Caucasian, and 1.8% women with other ethnicities. Continued follow-ups on a significant number of women originally enrolled. (Follow-ups began in Month 13). Began a specialized program by the Physician Assistant regarding medication regimes and protease inhibitors.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
SUNY Health Science Center at Brooklyn (Brooklyn, New York)	Continued assessment of counseling and testing systems and availability of integrated gynecological/HIV-related care, and perinatal zidovudine treatment at three targeted hospitals. Continued restructuring of counseling and testing systems for prenatal service patients and implementation of procedures for ensuring access to perinatal zidovudine protocol, based on assessment of each site. Expanded/enhanced access to integrated gynecological/HIV-related services in locations where women are already or are likely to receive care. Developed curriculum of abbreviated counseling protocol. Trained private providers and their staffs in providing counseling as routine part of prenatal care. Established systems at three hospitals to implement new NYS regulations and trained staff to comply.	Improved HIV counseling and test rates to the high 80s and low 90s percentiles among prenatal service patients at all three sites due to staff in-service, changed patient flow, clinician involvement in counseling process and encouragement to test, and routinization of HIV counseling and testing as part of prenatal care. Expanded outreach efforts to recruit women into co-located HIV primary and gynecological care and/or substance abuse treatment and HIV pediatric care. Increased patient enrollment in clinical care at these sites. Implemented new regulations re: unblinding of neonatal heelstick results. 95% of women consenting to unblinding at one site. Decreased the number of HIV-positive infants born at the three hospitals due to pregnant women electing to participate in ZDV protocol.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
The Measurement Group – PROTOTYPES Evaluation and Dissemination Center (Culver City, California)	Developed and maintained an overall management strategy for facilitating the activities of the Cooperative Agreement Steering Committee. Developed and maintained a cross-cutting evaluation strategy for the Work Groups and the Cooperative Agreement Steering Committee. Provided technical support on evaluation to individual grantees and the Cooperative Agreement Steering Committee. Planned evaluation technical assistance activities for the cooperative agreement projects.	Coordinated and managed four Steering Committee meetings. Provided management assistance to the Steering Committee and HRSA on overall direction and operations. Developed and refined several dozen evaluation modules and an evaluation plan. Provided individual technical assistance on evaluation to cooperative agreement projects. Advised HRSA on local evaluation issues related to the 27 cooperative agreement projects. Coordinated presentations on behalf of the Steering Committee for the International AIDS Conference in Vancouver and the National Meeting of the American Psychological Association in Toronto. The Evaluation and Dissemination Center also prepared and submitted several additional presentations on behalf of the Steering Committee for consideration at future conferences. Developed several mechanisms for disseminating information from the cooperative agreement projects, including the SPNS/Fax electronic report series, a World Wide Web site on the Internet, and a fax-on-demand system.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
University of Colorado Health Sciences Center (Denver, Colorado)	Initiated and completed training programs utilizing three study methods. Initiated the research phase of the project, including follow-up. Initiated selection and evaluation of a comparison group of randomly selected rural health care providers.	Trained approximately 50 HIV/AIDS educators from participating states to provide the training programs. Enrolled 508 rural health care providers in the self-study method. Provided teleconference presentations to 344 rural health care providers. Provided rural outreach presentations to 717 rural health care providers. Collected follow-up information on 144 study participants. Collected evaluation information on 22 comparison group members.
University of Mississippi Medical Center (Jackson, Mississippi)	Reached agreement with Federal Health Clinics to participate in training project. Established Instructor/Student Learning Centers. Recruited and trained key project staff. Identified baseline evaluation criteria. Completed distance learning and clinical preceptorship for the initial clinics.	Fulfilled subcontracts between the training project and 11 Federal Health Clinics. Purchased and installed all hardware essential to creating PC-based linkages between the project and the offsite student centers. Held full day in-service training for all clinic-based coordinators on the technical requirements of the project. Purchased and installed all software to support the tracking of patient encounter data at the offsite locations.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
University of Nevada School of Medicine (Reno, Nevada)	Refined clinic procedures including increased frequency and duration of visits for some patients, improved feedback to clients through personal contact and written reports, and tested the accuracy and importance of selected measurements. Completed, presented, and published initial statistical analysis of baseline information as an abstract. Revised the medical outcome modules for fax-in data system and currently field testing in the clinic. Expanded outreach to agencies to broaden client base for recruitment and service.	Conducted focus groups to assess client satisfaction and solicit input for program change to improve follow-up for enrolled patients and enhance recruitment. Finalized and distributed brochure along with posters for recruitment. Identified and established links with other HIV nutrition projects and providers to share information and educational materials. Review by physicians and nurses from the Early Intervention Clinic of the medical outcomes fax-in draft for ease of use and completeness. Presented three abstracts at the International AIDS Conference in Vancouver in July 1996 and another at the annual meeting of the American Dietetic Association in October 1996 that was published in the conference proceedings.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
University of Texas Health Science Center at San Antonio (San Antonio, Texas)	Assessed types and levels of service needs for women, children, and families living with HIV/AIDS in South Texas. Expanded organizational assessment to include other organizations in the South Texas HIV/AIDS health delivery system. Cross-trained project staff and provided professional training for addressing needs of women, children, and families living with HIV/AIDS. Developed initial curricula to satisfy training needs for Child Protective workers, foster parents, and volunteers working in urban and rural areas. Implemented evaluation modules at the different sites (San Antonio, Corpus Christi and the Lower Rio Grande Valley) as part of a comprehensive evaluation for the project. Disseminated findings at the local and state levels.	Continued to develop and expand the Family Preservation Council (FPC) agencies’ capacity and family-centered models of care. Finalized the analysis of the baseline data for the psychological functioning of HIV-positive and affected children and families. Implemented short-term measures of family and children’s progress/adaptation. Repeated assessment of the functioning of a sub-sample of infected and affected children. Completed the second level of organizational assessments. Completed the analysis of the "Key Informant Questionnaires," Attitudes and Infrastructure modules collected from the SALUD collaborating agencies. Conducted 78 trainings from June 1, 1995 through May 31, 1996. During these trainings, 2,570 individuals received information relevant to women, children, and families living with HIV/AIDS. Fifty percent of the trainings included direct service providers. Participated as speakers in numerous conferences. SALUD was featured in national and state level publications and is in the process of developing position papers. Completed the first phase of modules implementation to describe family characteristics and baseline women and family needs, quality of life, and services provided.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
University of Vermont & State Agricultural College (Burlington, Vermont)	Developed and implemented clinic sites I, II, and III. Developed computerized data collection tool. Provided state-of-the-art health care in a rural setting to 65 patients with HIV/AIDS. Started primary care provider education.	Hired and trained nurse practitioners at clinic sites I, II, and III. Developed data collection tools and computer software. Developed Psychosocial Resource directory for clinic site I. Infectious Disease Physician specialists traveled to clinic sites I, II, and III. Successfully submitted a first year data abstract to the Third National Meeting on Retrovirus (January 1996) and the 11^th International AIDS Conference (July 1996).

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
University of Washington (Seattle, Washington)	Conducted chart reviews in two long term care facilities to identify diagnosis, treatment, referral patterns and psychiatric morbidity in patients, emphasizing delirium. Analyzed data for statewide hospital-based units regarding diagnosis, treatment, referral patterns and psychiatric morbidity of patients, emphasizing delirium. Established baseline needs assessment of providers at the four participating agencies to determine training needs. Performed a total of 775 patient interviews and/or chart reviews at four participating sites. Developed, implemented and evaluated 57 health care provider trainings on neuropsychiatric illnesses associated with HIV/AIDS. Offered bimonthly and as needed family educational support sessions for groups and individuals. Produced and evaluated a training video and study guide for health care providers and families of persons with HIV/AIDS entitled "Unmasking AIDS Related Delirium."	Began production of training video on HIV/AIDS related delirium. Trained 632 health care providers regarding neuropsychiatric illnesses associated with HIV/AIDS. Published a paper in AIDS Patient Care pertaining to the discrepancy between occurrence and health care provider identification of HIV-related delirium. Presented a poster at the International AIDS Conference in Vancouver, BC describing delirium among AIDS patients in a long term care facility. Presented a poster at American Public Health Association in New York that displayed a description of the project and the delirium video. Drafted a second article for publication regarding recognition and medication factors of delirium in AIDS patients. Disseminated a copy of the video to the SPNS Program project management staff and the other 26 SPNS Program HIV Innovative Models of Care projects.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
Visiting Nurse Association of Los Angeles (Los Angeles, California)	Continuity of Care model became operational. Served 168 patients in the second year. Validated the Continuity of Care model to be more cost efficient and more effective in meeting patient needs. Developed preliminary capitation rates.	Demonstrated that Continuity of Care model produced nearly 40% lower costs than traditional home care model. Found that clients in the Continuity of Care model experienced a higher quality of life than clients in traditional home care. Demonstrated that a psychosocial orientation in home care is more efficient and more effective than a pure medical orientation in home care.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
Washington University (St. Louis, Missouri)	Established the Helena Hatch Special Care Center for Women, bringing in multidisciplinary services under one roof. Established a data collection system for tracking women enrolled in the Center. Created a variety of educational and support programs for clients. Established a community advisory board comprised of a mixture of clients and professionals.	Developed referral networks within the community. Increased client enrollment from 25 to 192. Obtained significant representation on the Ryan White Title I Planning Council. Developed a comprehensive, modular protocol for educating clients about disease management. Decreased vertical HIV transmission rate from 44.4% in 1994 to <5% in 1996. Co-sponsored the Midwest HIV Prevention Conference: A Focus on Adolescents and Women. Conducted the first overnight retreat for clients. Initiated a peer outreach/support program. Hired a volunteer and special events coordinator. Secured a resource room and office space adjacent to the clinic. Established outreach into the "bootheel" area of Missouri. Successfully submitted three abstracts to the American Public Health Association 124^th Annual Meeting and one at the National HIV Social Worker Conference held in 1996. Created/initiated comprehensive guidelines for multi-disciplinary follow-up of pregnant clients and their neonates. Established a quarterly client newsletter.

Table 2-1

Individual Project Achievements in the Second Year

Project	General Program Achievements	Specific Program Achievements
Well-Being Institute (Detroit, Michigan)	Assisted HIV-positive substance-abusing women to enroll in primary care services (including substance abuse treatment, when desired). Assisted HIV-positive substance-abusing women to remain active with their primary care providers. Recruited substance-abusing women each month who are not known to be HIV-positive and provide pre- and post-test counseling and HIV testing services to these women. Ethnographic component made operational, developing ethnographic interview transcripts each month regarding identification and explication of not-yet-understood access barriers to receipt of primary health care for HIV-positive women substance abusers.	Primary care barrier reduction: provided services to 62 women (approximately 30 clients per month with some months serving as many as 40 clients); child care was provided to 16 of the women who had children and who needed child care during health-related service appointments; 47 women were continuously active; and 20 women graduated and became successfully retained in primary care. Provided HIV testing and pre- and post-test counseling services to 26 high-risk active substance-abusing women. One woman was found to be HIV-positive and was connected with support services and primary care services. Completed 22 client interviews, eight staff interviews, and two focus groups, illuminating much supplemental information related to barriers to health care for this population. Established a day treatment program to facilitate locating women for primary care health appointments. Developed a revenue-generating business enterprise (Tier III) for program graduates to participate in what is called "Sisters In Craft." Women make crafts and sell them to make money for themselves to occupy their newly available time now that they are no longer "Sisters In Crack." Awarded a transportation contract to fund transportation for Tiers II and III to supplement WBI’s transportation program for Tier I clients.

The Cooperative Agreement Projects had many different barriers to overcome as they developed, stabilized, delivered, and refined service delivery models. While many of the individual project barriers were related to one another, there were many different combinations experienced by the 27 grantees. Among the factors that differentiated the 27 projects and the barriers they encountered and overcame were the following:

While several projects represented modifications and extensions of ongoing programs, other projects were new and could not make use of existing facilities, staff, or full expertise of how to run the program. Table 2-1 lists a number of general and specific achievements that were made by each of the projects within the first two years of program funding.
At the time the projects began, some of the grantees were able to reassign existing staff from other programs while other grantees were required to hire and train new staff. In several instances, staffing the projects was a rather lengthy process necessitating working within detailed hiring and staffing rules of large institutions. At some projects, the personnel policies of the large institutions required that the project accommodate to the organization.
While some of the projects represented fairly smooth transitions from the other programs of the grantee agencies, other projects represented relatively large discontinuities and experience had to be brought into the project from the outside.
At the time of project implementation, some of the projects had appropriate physical facilities for the grant-supported program while other projects had to undergo relatively extensive processes to obtain appropriate offices and clinics, in some cases obtaining a variety of needed licenses and permits. These barriers continued for several projects as they modified their programs.
For some of the projects, legislative and other institutional changes necessitated shifting program objectives, budgets, staffing, and other needs.

B. Achievements of the Work Groups and the Steering Committee

The Steering Committee held four meetings during the second year (1996). Each of the meetings went for two full days. The meetings were held on January 18-19 in Atlanta, on April 11-12 in the District of Columbia, on June 27-28 in Chicago, and on September 26-27 in Chevy Chase, Maryland. The major achievements of the Steering Committee by meeting during the second year are summarized in Table 2-2.

1. Refinement of Common Objectives

During the course of the four Steering Committee meetings that occurred this year (1996), individual Work Groups met at least four hours during each session. Discussions revolved around a number of themes. While the themes differed slightly among the Work Groups, the following issues were represented in most groups.

Work Groups determined shared programmatic objectives by a thorough examination of individual project objectives. Common objectives continued to be refined by each Work Group. Some examples of common objectives are as follows. The Capitated Care Work Group developed common methods of calculating costs of services and identified barriers encountered in developing managed care services. The Community Based Organization Work Group examined ways of overcoming barriers to services encountered by traditionally underserved groups. The Comprehensive Care Work Group cataloged methods of the implementation of comprehensive, AIDS care clinics. The Infrastructure-Advocacy Work Group examined ways of enlarging/expanding the capacity and responsiveness of local HIV/AIDS service systems. Since the beginning of project funding, the Infrastructure-Advocacy Work Group has been slightly reconstituted to refine common project goals/objectives and to increase the capacity and size of this work group. The Training Work Group evaluated a number of exercises and techniques that constitute the state-of-the-art in HIV/AIDS training.
Work Groups discussed individual perspectives on effective program elements, and in the process of doing so, developed consensus positions about the importance of many program elements. At the same time, individual project expertise was shared so as to build better programs throughout the cooperative agreements. The degree of sharing was significantly greater during the second year, to a large degree because projects had already developed shared objectives and common vocabularies for addressing common problems.
Work Groups discussed their outcome objectives and the way that these might be assessed within their projects.
As a whole Steering Committee, the deliberations of the Work Groups on the above elements were synthesized and combined to develop overall standards for the cooperative agreement projects.
As important topics have been identified in the standing Work Groups, ad hoc "special topics" Work Groups have been formed. During the second year, three such groups—Services for Women and Women and Children, Reducing Barriers for Disenfranchised and Underserved Populations, and Medical Care Issues—were formed and met to identify common issues.
Based on the experience of the Year 2 special topics Work Groups, the Cooperative Agreement Steering Committee agreed to form more groups in the third year on an ad hoc basis.

2. Sharing Project Expertise, Methods, and Resources

As it evolved during the second year, a significant part of the work of the Steering Committee was to ensure that there were mechanisms for sharing project expertise, methods, and resources. The Steering Committee employed a number of techniques for improving communication, engaging in project cross-training, sharing costs of developing common evaluation methods, and exchanging information needed by several projects. Much of the sharing was facilitated by the Evaluation and Dissemination Center.

The Steering Committee developed a group process mechanism which was described in the first-year report (Figure 2-1). That figure is reprinted in Appendix V of this report. Each of the cooperative agreement projects brings unique expertise, resources, and information to the Steering Committee via participation in the Work Groups and the Steering Committee as a whole. The information brought to this process is shared by these groups to develop common objectives, distribute materials and resources, and conduct cross-cutting evaluation activities. These activities, in turn, contribute to a group feedback process in which these issues are brought back to the individual cooperative agreement projects as well as the larger HIV service community. Finally, the information sharing process serves as a quality improvement mechanism for the participants in the Steering Committee and its Work Groups so that the overall group process is self-monitoring.

Some examples of the ways in which expertise, methods, and resources were shared by the project representatives during the second year include the following:

Five medical projects provided a half-day training session for all projects on state-of-the-art medical management of HIV. This training covered new drug therapies including protease inhibitors, therapies for opportunistic infections, and viral load measurements for all age groups.
A poster session at the April Steering Committee meeting permitted individual projects to share their experiences and techniques during the first 18 months. The session was attended by more than 100 visitors.
As a conclusion to their project period, Jay Kaplan from Michigan Protection and Advocacy Services and Paul Chase from Indiana Community AIDS Action Network shared their experiences at the September Steering Committee meeting.

Time was used at each Steering Committee meeting for individual projects to highlight their progress to date and to share methods with one another. This information sharing occurred formally through discussion in the Work Groups and the Steering Committee as a whole. Informal networking also occurred at Steering Committee meetings as well. Projects that formally presented include: Outreach, Inc.; Emory University; The Measurement Group-PROTOTYPES Evaluation and Dissemination Center; University of Vermont; the Metro DC Collaborative (Center for Women Policy Studies); PROTOTYPES; Cook County Maternal and Child Health/HIV Integration Project; University of Texas Health Science Center at San Antonio; Michigan Protection and Advocacy Service; Indiana Community AIDS Action Network; Visiting Nurse Association; New York State AIDS Institute; and University of Washington.
A formal mechanism was developed both at the Steering Committee meetings and through the Evaluation and Dissemination Center to distribute the more than 200 documents offered by participating projects to one another. These materials ranged from clinical practice manuals to evaluation measures to training exercises to information brochures for service consumers to scientific literature reviews to lists of conferences.
Federal briefings on available resources were given at each Steering Committee meeting. Federal grants management staff also provided presentations on matters of common interest on administering the projects.

The major achievements from the Steering Committee meetings in 1996 are summarized in Table 2-2.

Table 2-2

Major Achievements at Steering Committee Meetings

A. Summary of HRSA SPNS Cooperative Agreement Steering Committee Meeting

January 18-19, 1996

Sheraton Hotel

Atlanta, Georgia

The main activities of these meetings included:

Review of the first year report

Site visit to Outreach, Inc.

Presentation by Emory University

Discussion of a fax-out newsletter

Presentation of data received by The Measurement Group to date

Working group meetings and reports back to the Steering Committee

Review of the First Year Report

There was a discussion on a draft of the first year report that had been sent to the committee for review.

Suggestions for revisions were given, with a final draft mailed to the projects within a few weeks.

Site Visit to Outreach, Inc.

The Steering Committee meeting participants visited the Outreach, Incorporated Safe Place project.

Presentation by Emory University

Emory University gave a presentation on their HIV Training for Georgia’s Correctional Health Care Providers project.

Discussion of a Fax-Out Newsletter

There was a suggestion to create a fax-out SPNS Program newsletter that would highlight individual projects, findings, etc.

Plans were made to put this idea into practice.

Presentation of Data Received by The Measurement Group to Date

A presentation giving an overview of the data that had been submitted to The Measurement Group to date was given.

There was a discussion about the status of data collection at the different projects and about the evaluation process as a whole.

Working Group Meetings and Reports Back to the Steering Committee

Training

Decided that only very general common outcomes would be possible to measure.

Capitated Care

Agreed on a common definition of enrollment.

Discussed changes and modifications to modules.

Policy Advocacy/Infrastructure

Decided to focus on structural change issues that would describe system-level outcomes.

Agreed that they need to look at what will be taking place in the system that will cause changes and look at these as barriers.

CBO

Agreed on common outcome measures as well as some common dependent variables.

Agreed on a common definition of enrollment.

Comprehensive Care

Agreed on a definition of enrollment, client level outcomes and most medical terms.

Agreed to share data within the group as much as possible.

B. Summary of HRSA SPNS Cooperative Agreement Steering Committee Meeting

April 11-12, 1996

Dupont Plaza Hotel

Washington, DC

The main activities of these meetings included:

Presentation of the First Year Report to Dr. Sumaya, Dr. O’Neill, and Mr. Mahoney

Poster session

Presentations by the Metro DC Collaborative for Women with HIV (Center for Women Policy Studies) and the University of Vermont projects

Topical work group and special work group meetings and reports back to the Steering Committee

Presentation of the First Year Report to Dr. Sumaya, Dr. O’Neill, and Mr. Mahoney

Trudy Larson presented copies of the first year report to Dr. Sumaya, Dr. O’Neill, and Mr. Mahoney of HRSA.

All of the HRSA representatives addressed the Steering Committee and shared their thoughts on the important work the SPNS Program projects are doing and on issues regarding the future of HRSA.

Poster Session

Cooperative Agreement Projects had the opportunity to present posters on their projects to share information with each other.

More than half of the posters were electronic presentations.

Presentations by the Metro DC Collaborative for Women with HIV and the University of Vermont Projects

Representatives from the Metro DC Collaborative project gave presentations on the wide variety of women’s issues their project deals with.

The project from the University of Vermont Medical Center gave a slide presentation on the history of AIDS in Vermont and providing primary care to HIV and AIDS patients in a rural community.

Working Group and Special Working Group Meetings and Reports Back to the Steering Committee

CBO

Discussed funding and ways to meet new needs and find new resources

Capitated Care

Developed patient satisfaction survey and finalized module packages

Discussed the need for comparison groups to look at cost and utilization

Comprehensive Care

Discussed patient satisfaction survey

Discussed the work being done by the Infrastructure Group but felt it would not work for them due to "behind closed doors" barriers

Policy Advocacy/Infrastructure

Discussed the impact of external forces beyond their control and the need to balance this with infrastructural changes that they can control

Agreed to provide a draft of a report for the June meeting showing an overview of how to decide infrastructural change

Training

Discussed module revisions

Discussed the difficulty in measuring outcomes in education

Special Topics Work Groups

The Medical Care Issues Work Group is a combination of the Capitated Care and Comprehensive Care groups, and they will work together on quality of care issues.

The Service for Women and Women and Children Group’s long term purpose is to build collective strategies and services that all projects can implement, and be a watchdog on issues of care for women and children.

The Reducing Barriers for Disenfranchised and Underserved Populations Work Group had presentations by two guest speakers on issues of access for African Americans, youth, and women.

C. Summary of HRSA SPNS Cooperative Agreement Steering Committee Meeting

June 27-28, 1996

Radisson Suites Hotel

Chicago, Illinois

The main activities of these meetings included:

Summaries of poster presentations for the International AIDS Conference by HRSA/HAB's SPNS grantees

Site visit to the Cook County Hospital project

Presentation by the Medical Management of HIV Panel

Presentation by Project Salud

Working group and special working group meetings and reports back to the Steering Committee

Discussion about forming a coalition to represent the HRSA SPNS Program

Summaries of Poster Presentations for the International AIDS Conference by HRSA/HAB's SPNS Grantees

Eight projects gave summaries of the posters they prepared for the International AIDS Conference.

The poster about the Cooperative Agreement Steering Committee, prepared by The Measurement Group, was reviewed by Steering Committee representatives.

Site visit to the Cook County Hospital project

The participants of the Steering Committee meeting visited Cook County Hospital’s Maternal and Child Health/HIV Integration Project.

The Steering Committee witnessed the graduation of the women with HIV from Cook County’s Community Advocacy Network (CAN) training program.

Presentation by the Medical Management of HIV Panel and Project Salud

The panel discussed medical management of new drug therapies, perinatal transmission and pediatric AIDS.

Project Salud presented a slide show on its work toward improving systems of care for women, children and families dealing with AIDS.

Working Group and Special Working Group Meetings and Reports Back to the Steering Committee

Capitated Care

Discussed pharmacy data and home care issues

Decided to take on an advocacy role for incorporating managed care in Titles I and II

Policy Advocacy/Infrastructure

Reviewed the report on shared barrier strategies and outcomes they plan to have ready by the end of December

Decided they will soon have some good policy recommendations for both state and federal policy makers

CBO

Discussed the qualitative modules and decided they needed revision for service projects

Training

Discussed developing standardized scenarios

Decided to develop a training manual

Comprehensive Care

Discussed implementation issues regarding evaluation and agreed on some common data collection instruments

Discussed the qualitative module

Special Work Groups

The Service for Women and Women and Children Group wants to publish a report on the experiences of women with HIV.

The Medical Services Discussion Group discussed the notion of compliance.

The Reducing Barriers for Disenfranchised and Underserved Populations Group focused on input from consumers on barriers and how agencies can miss them.

Discussion about Forming a Coalition to Represent the HRSA/HAB's SPNS

Discussion of the SPNS Program’s new Part F status

Discussion of forming a coalition to represent the SPNS Program to Titles I-IV, as funding will now come from those Titles

D. Summary of HRSA SPNS Cooperative Agreement Steering Committee Meeting

September 26-27, 1996

Holiday Inn Chevy Chase

Chevy Chase, Maryland

The main activities of these meetings included:

Presentation by the Michigan Protection and Advocacy Services project

Presentation by the Indiana Community AIDS Action Network project

Presentation by the Visiting Nurse Association of Los Angeles project

Presentation by the Training Group on their training manual

Presentation by the New York State AIDS Institute project

Working group and special working group meetings and reports back to the Steering Committee

Presentation by the Michigan Protection and Advocacy Services Project

The project gave a presentation on its work as a private, non-profit advocacy group for people with disabilities, that provides a full continuum of advocacy for people with HIV/AIDS.

This project trains people on HIV legal issues and teaches them to be community advocates, and also provides professional legal advocacy when the community advocates are not enough.

Presentation by the Indiana Community AIDS Action Network Project

The project gave a presentation on its legal services for discrimination cases.

This project has four components: direct legal services, prevention education, coalition building, and public policy advocacy.

Presentation by the Visiting Nurse Association of Los Angeles Project

The project gave a presentation on its work as a capitated care group.

This project developed a homecare/hospice capitation model and compared acute care services to hospice care; hospice care is more cost effective.

Presentation by the Training Group on Their Training Manual

The Training Group gave a presentation on the results of their meeting, held the day before the conference, on developing a training manual.

The group decided on an outline for the manual, which will contain sections on the heart of training underlying the art, the nuts and bolts of training, and curriculum for teaching about HIV/AIDS.

Presentation by the New York State AIDS Institute Project

The project gave a presentation on implementing managed care for HIV services in New York.

This project is working with new legislation for New York to set up 12 capitated care programs (and may include two partial capitated programs).

Topical Work Group and Special Topics Work Group Meetings and Reports Back to the Steering Committee

Training

Discussed training data

Discussed the training manual and their meeting a day early at the January Steering Committee meeting

Comprehensive Care

Decided to produce a collective report

Discussed the protease inhibitor study

Capitated Care

Decided on producing an educational packet on managed care

Discussed the need to educate providers and those living with AIDS about dealing with managed care organizations

Policy Advocacy/Infrastructure

Reviewed their qualitative report on infrastructure and policy change, which is nearing completion

Decided to meet a day early at the January Steering Committee meeting

CBO

Shared experiences

Decided to meet a day early at the January Steering Committee meeting to work on a monograph

Special Topics Work Groups

The Reducing Barriers for Disenfranchised and Underserved Populations Group shared their experiences.

The Services for Women and Women and Children Group will publish a qualitative report on the experiences of women with HIV.

The Medical Services Discussion Group decided to expand the educational packet by the Capitated Care group to include a piece for policymakers.

3. Development of Common Evaluation Methods and Protocols

As a significant part of its activities during the first year, the Steering Committee had adopted a modular evaluation design that was suggested by the Evaluation and Dissemination Center. In the modular evaluation design, standardized short forms of 1-2 pages were developed for a number of different functional evaluation questions. In collaboration between the Evaluation and Dissemination Center and the Steering Committee, more than 70 modules were developed and implemented in the projects.

At each of the Steering Committee meetings during the second year, there was a summary presentation by the Evaluation and Dissemination Center about the data collected by the projects to date. This presentation allowed the representatives of the Cooperative Agreement to review the progress of the group as a whole to date. Data presented formed the basis of new questions and evaluations to be addressed.

4. Development of a Governance Structure and Major Committee Decisions

Significant work was undertaken during the second project year to further elaborate organizational and governance structures for the cooperative agreements. The resulting organizational structure was described previously in Chapter 1 and in Figure 1-1.

5. Dissemination of Results through SPNS/Fax

SPNS/Fax is an electronic report from the HRSA SPNS Cooperative Agreement Projects. The report is distributed every two weeks by facsimile machine. SPNS/Fax is produced and distributed by The Measurement Group—PROTOTYPES Evaluation and Dissemination Center. Each issue of SPNS/Fax highlights findings from the Cooperative Agreement. Topics discussed in SPNS/Fax issues to date (one per issue) include: 1) general information on the SPNS Cooperative Agreements; 2) how the PROTOTYPES WomensLink project cut perceived barriers to services; 3) how the Health Initiatives for Youth program identified needs of high risk and HIV infected youth and their providers; 4) progress during the first year for the HIV Innovative Models of care; 5) information on the Cook County Maternal and Child Health/HIV Integration project; 6) a list of Cooperative Agreement Projects‘ presentations at the XI International Conference on AIDS; 7) information on the New York State projects—New York Department of Health/Health Research and the SUNY Health Science Center at Brooklyn; 8) information on the Mountain-Plains Regional AIDS Education and Training Center SPNS Program project; 9) information on the University of Vermont SPNS project; 10) how the University of Washington project improved health care providers’ understanding of delirium in HIV/AIDS patients; 11) how the Visiting Nurse Association-Los Angeles developed an innovative capitated system of hospice care; 12) how the Michigan Protection and Advocacy Service trained community advocates; 13) how the Indiana Community AIDS Action Network targeted discriminatory barriers faced by people with AIDS; 14) information on the Evaluation and Dissemination Center’s World Wide Web page and Fax-on-Demand system; 15) how the Well-Being Institute addressed the needs of HIV-positive women substance abusers; 16) a list of Cooperative Agreement Projects‘ presentations at the 124th Annual Meeting of the American Public Health Association; 17) information on the invited symposium at the American Psychological Association meeting to discuss cross-site evaluation issues for SPNS Program grantees; and 18) the nutrition intervention provided by the University of Nevada School of Medicine.

6. Dissemination of Information through the Internet

As a way of publicizing the activities of the 27 grantees and the EDC, The Measurement Group has established a World Wide Web site at the address www.TheMeasurementGroup.com/edc.htm. The contents of the web site include descriptions of the grantees, lists of project directors and HRSA staff, various mailing lists, reports of the Cooperative Agreement, and complete information on the cross-cutting strategy for the Cooperative Agreement. A special section of the web page lists the abstracts from the International AIDS Conference in Vancouver in July 1996 which were presented by member projects. There are hotlinks from the titles in the reference list to the actual abstracts as they appeared in the conference program. In addition, the site contains all issues of SPNS/Fax. The issues of SPNS/Fax on the web have enhanced graphics. The web site also features numerous hotlinks from the project descriptions, project directors, and HRSA project officers to additional information sections and email addresses. Additional materials presented by the projects including convention and scientific papers, abstracts, manuals, and brochures will be added to the site as they are developed. Also, the site contains a series of hotlinks to more than 50 national web sites containing HIV/AIDS information. A special feature of the web site is that it includes more than 20 animated slide show presentations on various aspects of the Cooperative Agreements. The web site is updated at least weekly to reflect current information produced by this group of grantees.

7. Dissemination of Information through the Fax-on-Demand System

The Measurement Group has developed a fax-on-demand system that contains much of the same content as the Web site. To access the fax-on-demand system, callers dial 310-216-0702. A computer-controlled voice mail system responds, listing a number of options on obtaining different documents. The system provides numbers for ordering each available document. Callers then select documents by entering the provided order number(s) on their telephone keypad. Once the order numbers for all desired documents are entered, callers key in their fax number. The fax-on-demand system then faxes ordered documents to the caller’s fax machine. Contents include: all editions of SPNS/Fax; the executive summary of the first-year report of the Cooperative Agreement; the abstract of the Cooperative Agreement presentation at the International AIDS Conference in July, 1996; the mailing list of Cooperative Agreement Projects; a listing of the evaluation modules used by the Cooperative Agreement Projects; an organizational chart of the Cooperative Agreement Steering Committee; short abstracts of the Cooperative Agreement Projects; a summary of the Module Evaluation Strategy; and information on the Evaluation and Dissemination Center.

Back to Table of Contents