Reaching The Hard To Reach Jane Fox, MPH & Serena Rajabiun, MA, - - PowerPoint PPT Presentation

Reaching The Hard To Reach

Jane Fox, MPH & Serena Rajabiun, MA, MPH Boston University

Objectives

• List methods to determine who is truly not engaged in HIV

primary care;

• Identify partnerships to support your efforts in identifying

and serving hard to reach clients; and

• Discuss internal methods to increase staff customer service

skills to support linking and keeping hard to reach clients in HIV care and services

Why?

• Recruitment
• Enrollment
• Follow-up

Who is hard to reach?

• People who…

– Experience stigma – Are using substances – Have co-occurring mental health issues – Are employed – Have experienced trauma – Undocumented

What to do?

• Internal methods
• External methods
• Using data and data systems
• Social media
• Tangible reinforcements
• Other lessons from SPNS colleagues

Internal methods

• Internal methods

– Build a list – Educate your agency staff about the intervention and the study (protocol) – Talk with providers – Talk more and continue talking (keeping momentum) – Expand into other departments (ER, behavioral health, etc)

Agency wide buy-in

• Agency wide knowledge and buy-in
• Using others in your organizational system (ER notifications,
• ther programs/projects who may run into your clients or

potential clients)

• Referral procedures

– Who to call – How to schedule – Flow chart

Build a list

• Building an out of care list (for clinical sites or have a partnership

with one) – Definition of out of care – Using EMRs, scheduling systems, or CareWare (or equivalent) – Talk to your providers –

• “who have you not seen in the past 6 months?”
• “who has been loosely engaged in care?”
• “who is not virally suppressed but should be?”

– Refine your list as you go – Lather, rinse, repeat

External methods

• External methods

– Meet with current partnership staff (DIS, existing MOU providers, testing agencies)

• How does this project fit into existing partnerships?
• Identify gaps in your partnerships and target those who can fill the

gaps – What services or partners are needed to best meet the needs of your clients? Including locating them? – What do you have to offer partners and what is your ask of them?

• Not the “usual” folks

Expand your partners

• Get out and build new partnerships

– What do you bring to this partnership and what are you looking for in exchange?

• Set-up appointments to visit potential partners

– Introductions (of you and your project) – Identify your common goal – Communication – referral mechanisms – Other groups/forums

Build a community team

• Organize a community forum/partnership meeting

– You are not alone in this. – Bring your old and new partners together to meet on a topic or issue – Housing, behavioral health services, transportation, finding clients, etc – Make sure to include the community case managers and link coordinators both RW and not

• Nurture these relationships
• Continue to expand the group

Customer service

• Do your partner agencies need training on customer service?

– How can you help build partner capacity? – Can you help with cultural competency capacity building with those partners who need it? – Can you share resources to train partner agency staff with your staff?

Data and data systems

• Data & data systems

– HMIS

• use this system to find out where clients are accessing

services and where they are staying – Internal data alerts (ER) – Other data sharing – Jail/prison registries – Contact form (UNC)

Contact form

• Where can we find you?

– Demographics

• The usual +

– Aliases – Picture

• Contact information

– Emergency – Family – Friends – Parole officer – Case manager (RW and others) – Other social service agency staff

Contact form

• Where can we find you?

– Locations (days and time)

• Address(es)
• Social service agencies
• Job
• Hang outs
• Churches
• Any other regularly visited places

– Social media accounts

Social media

• Social Media

– Facebook – Instagram

Tangible reinforcements

• Contact cards
• Bracelets
• Cell phone minutes
• Bus tokens

What else can you do?

• Be customer service driven
• Get out of the office – feet on the street (if not you, staff can

call your cell to let you know they have found someone)

• Go to or post intervention staff at a community agency -

foods pantries/meals, drop in centers, library, day programs, etc

Lessons from other SPNS sites

• Identify your champion(s)
• Be responsive

– Flexibility (hours of operation/evenings or weekends) – Meeting the person where s/he is – letting clients help prioritize their perceived needs – Offer or assist with transportation

• Communication with team members to:

– “Tag team” people out of care – Recognize and act on signs of impending crisis

Some folks are just not interested

• Attempt to identify the

patient’s priorities

– What do they need that you can help with? – Is there a carrot?

• Free will but keep in

contact if allowed

A few resources

• https://careacttarget.org/ihip/innovative-approaches-engaging-hard-reach-populations
• https://careacttarget.org/sites/default/files/file-upload/resources/ihip-opt-Outreach_curriculum_final.pdf
• https://careacttarget.org/ihip/innovative-approaches-engaging-hard-reach-populations-living-hivaids-care-training-

manual-0

• https://careacttarget.org/sites/default/files/file-upload/resources/MakingtheConnectionSPNS2007.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974746/
• http://www.unm.edu/~marivera/522%20readings%203/retaining%20clients%20in%20a%20cohort%20study.pdf

Contact information

Jane Fox, MPH janefox@bu.edu 617-638-1937 Serena Rajabiun, MA, MPH rajabiun@bu.edu 617-638-1934