Topic Areas:
Policy Level Intervention
Community Level Intervention
Program and Institutional Level Intervention
Provider Level Intervention
Client Level Intervention
Policy recommendations to enhance the HIV community planning and resource allocation process to meet health care needs of active substance users
DHP completed two studies, commissioned by HRSA, on the HIV community planning process for active substance users. The first report, completed in September 1999, was used to inform the Ryan White CARE Act reauthorization. The second, follow-up study further investigated the community planning process for substance users and resulted in the development of recommendations and training modules to address community HIV planners' gaps in knowledge about substance use and the needs of substance users.
Expanded Syringe Access Demonstration Program Implementation Monitoring and Advocacy
The Division of Health Policy teamed up with the Legal Action Center (LAC) to provide policy analysis, implementation monitoring, and advocacy on New York State's recently-enacted Expanded Syringe Access Demonstration Program (ESAP). After one year of monitoring, DHP and LAC identified key implementation issues, including barriers to pharmacy and healthcare provider participation, and safe syringe disposal, and developed policy recommendations to maximize the potential to expand injection drug users' access to sterile syringes and safe disposal options.
The New York Forum for Child Health
The New York Forum for Child Health was a multidisciplinary, stakeholder body dedicated to enhancing the health of all children in New York State by improving access to health insurance and quality health care services. The Forum had three core functions:
- First, the Forum was a source of information, including primary and secondary research and policy analysis;
- Second, the Forum had a convening function, based on the belief that children's health will be improved by bringing key stakeholders together to identify critical implementation issues for major policy initiatives and develop recommendations for improvements; and
- Third, the Forum aggressively advocated for evidence-based reforms in child health.
With approximately 50 invited members from the public and private sectors, including clinicians, researchers, advocates, health plan administrators, community organizations, and government officials, the Forum was created in 1997 by The New York Academy of Medicine with support from the Foundation for Child Development and other philanthropic sources. The strategy that drove all Forum activities was a belief that children's health will be improved by bringing key stakeholders together to identify critical implementation issues for major policy initiatives, and by developing recommendations for improving children's access to quality services.
Welfare Reform and the Perinatal Health of Immigrants - In collaboration with SUNY Downstate Health Science Center, the University of California at San Francisco, and the University of Miami, this four year multi-state study aimed to assess the relationship between federal welfare reform, the differing means by which it was applied in four states, and the maternal/newborn health of Latino immigrants in California, Florida, New York and Texas. The Forum sought to identify barriers to public health insurance and health care for Latina immigrants and their children, and to present the descriptive characteristics of women facing those barriers from the subset of the client-level interviews that were conducted as a part of the larger study.
Access to and Use of Health Services in Mixed Status Latino Families - In collaboration with the University of California at San Francisco, this 3-year prospective cohort study of Latino families in the San Francisco Bay Area built on the large cohort of Latina women and newborns who were recruited for the SUNY parent study, and followed the California women in the parent study for 3 years post-partum. In this study, we sought to measure the relationship between access to and use of health services in Latino families and to determine whether access and use varied by immigration status; to compare access and use of health services between Latino children and their parents; and to compare access and use between US-and foreign-born Latino children and adults.
Health Access for NYC Children in Immigrant Families -This project was a qualitative study of children's health care experiences in immigrant families in three immigrant communities in New York City. In-depth interviews were conducted with parents about their children's recent healthcare experiences and access to public health insurance programs. Findings from the SUNY study suggest the importance of in-depth qualitative research on access to coverage and care among children in immigrant families. The study was undertaken in collaboration with the New York Immigration Coalition.
Learning from Immigrants’ Experiences with NYC’s Disaster Relief Medicaid - As a result of New York City’s Disaster Relief Medicaid (“DRM”) program and the large number of immigrants who enrolled in DRM, we had the unique opportunity to learn about both the successes of the DRM enrollment process and the difficulties in the transition to permanent public coverage. Focus groups were conducted at a community-based health center to identify reasons why eligible Latino immigrants enrolled in DRM but did not transition to Medicaid/FHP.
Relevant publications include:
- Challenges Associated with Applying for Health Insurance Among Latina Mothers in California, Florida, and New York, (December 2002).
- Welfare Reform and the Perinatal Health and Health Care Use of Latino Women in California, New York City and Texas, American Journal of Public Health, (November 2001).
- Welfare Reform and the Perinatal Health of Immigrants: Executive Summary, First Year Case Study Findings and Analysis from California, Florida, New York and Texas, (PDF, July 1999).
Today's heightened concern about children's mental health provides a window of opportunity to improve the infrastructure for mental health services in New York. In 2003, the Forum established a Task Force to identify those interventions that would allow pediatricians and other primary care providers to better meet the mental health needs of children and adolescents. Pediatricians are the de facto mental health service for most children in need of such care. Approximately 80% of children with emotional or behavioral problems are treated only by pediatricians. As a first step in this project, NYAM and the American Academy of Pediatrics, District II, Chapter 2, conducted a needs assessment of all pediatricians in New York State, New Jersey and Connecticut regarding their post-September 11th needs. NYAM also conducted a survey of parents following September 11th, which showed high levels of unmet need for counseling among children in NYC.
Relevant publications include:
- Post-Traumatic Stress Reactions in New York City Children After September 11th Terrorist Attacks.
- Use of and Need for Counseling Services by Children in New York City Following the September 11th Attacks on the World Trade Center .
- Determinants of Counseling for Children in Manhattan after the September 11th Attacks. (2002)
Recognizing that mental health issues make up a significant proportion of the work load of pediatricians, and that pediatricians lack access to consultation on an as-needed basis with mental health specialists, in 2005, the Forum began designing a mental health telephone consultation service for primary care providers, the New York State Child Psychiatry Access Project (NYS-CPAP). The CPAP model rests on the simple conclusion that there are not enough mental health specialists to manage all of the emotional, behavioral and developmental problems among children statewide, and that pediatricians and other primary care providers cannot do it, and in many instances, will not do it, without additional training, support, and "back-up" from mental health providers. The CPAP will provide that training, support and back-up for participating primary care providers.
Increasing Access to Medicaid and CHP
Increasing children's access to publicly subsidized health insurance coverage was a major focus for the Forum's activities, meetings and products. Relevant reports include:
- Barriers to Enrollment in Child Health Insurance Programs (2003).
- Strategies to Increase Enrollment on Children's Health Insurance Program (PDF, 1999)
- Voices for Children's Health in Hew York State (PDF,1999)
- The Revolving Door of Recertification (PDF, 1999)
Barriers to Enrollment in State-Supported Child Health Insurance Programs - New York State has initiated a massive outreach program to find families with children eligible for Medicaid or the State's Child Health Insurance Program (CHP) and assist them in enrolling in the programs. The State has also taken steps to streamline and simplify the enrollment process. In collaboration with the New York office of the Children's Defense Fund, this study followed a cohort of families to determine the proportion of children who successfully enroll in Medicaid and CHP, the time it takes to enroll and the reasons for non-enrollment.
Improving the Benefits Package for Child Health Plus
The Child Health Plus benefits package has undergone rapid expansion, and too often, language has been imported directly from standard adult commercial insurance plans. In many cases, this language does not adequately reflect children's needs. The 1998 New York child health insurance expansion included additional benefits for Child Health Plus, but left to the Department of Health the task of defining the scope and level of the benefit. To assist with this process, the Forum undertook a line-by-line review of the benefits package, and submitted a series of recommendations for changes to the Department. The Department has accepted some recommendations, rejected others and is giving further consideration to others. The Forum sought to create a more child-centered standard of care and benefits package for Child Health Plus through administrative, regulatory and statutory change.
Children with Special Health Care Needs
In New York and nationwide, health services for children are generally characterized by fragmentation, not organization. Public funding streams are defined by population-based programming, while the market-driven private sector is defined by medical care for individuals. Today, in New York State, relevant insurance and health care programs for children with special health care needs include Medicaid, Child Health Plus, the Physically Handicapped Children's Program, the Early Intervention Program, which covers children up to three years of age, and the Three to Five Program, for children three years of age to five years of age. Once a child is in school, the school district provides some services not currently included in the CHP benefits package.
Unfortunately, providers and families alike report major hardship navigating between and among programs. In addition, questions exist regarding the adequacy of these programs, both in terms of their availability and scope. While individual disabilities may be more or less adequately served, overall there is little coordination among and between the myriad programs serving children with special health care needs. As a consequence, children often go without needed health care services.
To address this problem, the Forum released recommendations for improving the organization of health care services for children with special health care needs in the report, Children with Special Health Care Needs: Next Steps for New York (October 2003). In January 2004, the Forum sponsored a statewide conference on this issue in collaboration with the Children's Aid Society and the American Academy of Pediatrics-District II, with Conference Proceedings published later that year.
Monitoring Child Health - Report Card
The Forum's report card on child health was designed to monitor the impact of the changing health care environment on children's health and access to health care in New York State. The first issue, Child Health 2000: Report Card for New York State, Regions and Counties , links key measures of child health with recent policy changes, such as expansions in health insurance coverage (i.e. New York's Child Health Plus and separate state insurance programs nationwide), Medicaid managed care, and welfare reform. Child Health 2000 has a web-based version that is more expansive than the hard copy, including never-before-published rankings on seven indicators for the 62 counties statewide.
COMMUNITY LEVEL INTERVENTION
Development of Curricula to More Effectively Plan for Health Services Under Ryan White Title I
Building on the two studies mentioned above, DHP developed and piloted two curricula across the country to more effectively conduct health planning under Ryan White Title I. DHP piloted the curricula with five planning councils throughout 2003 in Detroit, Miami, Oakland, Jersey City and New Haven. The curricula are adaptable to various populations and DHP piloted Enhancing the Response of Title I Eligible Metropolitan Areas to Substance Users and Enhancing the Response to Title I Eligible Metropolitan Areas to the Mentally Ill.
Comprehensive Services Plan for Syringe Exchange in New York City
The Division of Health Policy completed a needs assessment, plan, and policy recommendations for syringe exchanges. Private foundations are the primary audience for this plan as funders supportive of this mode of HIV prevention have expressed confusion about how to prioritize the multiple requests they receive for support. The desired outcome of this project was that providers, policy-makers, and funders recognized the opportunity afforded by syringe exchanges to connect active users into the continuum of prevention, care and survival services that they need.
Access to Health and Support Services for Users of Drugs and Alcohol
This recently completed project was a follow-up to the study, Healthcare Accessibility and Acceptability for People who Use Drugs which was a qualitative study of the healthcare attitudes and experiences of substance users. The follow-up was funded to significantly expand the number of people that could be interviewed, so as to get a sense of the prevalence of behaviors and issues identified in the previous project. This study had a broadened focus: it addressed access and use of social and support services, as well as health services, and placed a greater emphasis on people without linkages to care, including homeless and temporarily housed individuals.
Development of Curricula to More Effectively Plan for Health Services Under Ryan White Title I
Building on the two studies mentioned above, DHP developed and piloted two curricula across the country to more effectively conduct health planning under Ryan White Title I. DHP piloted the curricula with five planning councils throughout 2003 in Detroit, Miami, Oakland, Jersey City and New Haven. The curricula are adaptable to various populations and DHP piloted Enhancing the Response of Title I Eligible Metropolitan Areas to Substance Users and Enhancing the Response to Title I Eligible Metropolitan Areas to the Mentally Ill.
World Trade Center Disaster: Impact on Drug Use Patterns
This project sought to assess the impact of the World Trade Center Disaster on drug use patterns among users of illicit drugs over both the short and long term. The specific aims of the project were to:
- describe the subjects' experiences and feelings on and after the day of the attack;
- to determine how it affected them practically and emotionally;
- to assess whether the attack resulted in any changes in drug use; and ,
- to assess access to social, health, and drug treatment services after the attack.
PROGRAM AND INSTITUTIONAL LEVEL INTERVENTION
National Center for Adherence Support Evaluation (CASE)
This national center was funded for five years as of Oct. 1, 1999 by the Health Resources and Services Administration's (HRSA) Special Projects of National Significance (SPNS) program to support 12 funded adherence support evaluation programs by:
- assisting each project to conduct the most meaningful evaluation possible of its own adherence intervention;
- conducting a cross-site evaluation of the adherence interventions of the 12 funded projects; and,
- assisting with effective dissemination of evaluation findings.
For more information, visit the Center's website at http://www.bhives.org, or contact the Center at bhives@nyam.org.
Evaluation of the Treatment Adherence Demonstration Project
This project was an evaluation of eleven New York State-based programs that supported adherence to complex HIV treatment regimens. The main objective of the evaluation was to identify program characteristics that best supported adherence overall, for different populations, and over an extended period of time. Additional objectives included clarification of characteristics of individuals, support systems, and medical regimens associated with different levels of adherence. The evaluation was done in partnership with the New York State Department of Health/AIDS Institute, which received 3 years of funding for it in October 1999, through HRSA's SPNS program. This funding built upon one-year pilot funds provided by HRSA, the Royal S. Marks Fund, and Title I of the Ryan White CARE Act.
Evaluation of the New York State Targeted Provider Education Demonstration (TPED)
This was an evaluation of a three-year program implemented by the New York State Department of Health/AIDS Institute, which provided HIV-related training to health and support service personnel in community-based organizations that serve people of color. The evaluation included process and outcome measures, the latter focused on increased knowledge and increased training capacity among program participants. Funding for the evaluation was received in December 1999.
HIV Ambulatory Care Symposia
Funded by the AIDS Institute, the HIV/AIDS symposia provided a forum for clinical care providers to participate in the identification and development of strategies to improve the quality of ambulatory care for people with HIV. Topics covered in the past included caring for active substance users, the role of the pharmaceutical industry in healthcare institutions, and the provider's role in expanded syringe access.
In 2002-2003, DHP programmed and hosted five HIV Care Symposia designed to improve medical professional's knowledge on emerging topics in HIV care and treatment. An advisory committee assisted in developing topics and identifying speakers. The advisory committee, chaired by Dr. Victoria Sharp, Director of the Samuel's Center for HIV at St. Luke's/Roosevelt Hospital and Dr. Gary Kalkut, Director of Medical Services at Montefiore Medical Center, convened over the course of the year to identify topics and presenters for each of the symposia.
Healthcare Handbook for Drug Users and a Manual for Primary Care Providers
As a follow-up to our study on Accessibility and Acceptability of Healthcare for People that Use Drugs, DHP completed two projects aimed towards improving the interactions between substance users and healthcare providers. The first one, entitled Health Matters: Health Care, Health Problems, and Other Useful Information for People Who Use Drugs and People Who Don't Use Drugs includes information on communicating with providers, basic health related information, and information on resources available to people who use drugs. The second one, entitled Manual for Primary Care Providers: Effectively Caring for Active Substances Users includes information on substance use, addiction, drug treatment, harm reduction, common health problems associated with drug use, HIV/AIDS, pain management, pharmacokinetics, models of accessible care, women and substance use, and the public policy context of drug use.
Healthcare Handbook for Drug Users and a Manual for Primary Care Providers
As a follow-up to our study on Accessibility and Acceptability of Healthcare for People that Use Drugs, DHP completed two projects aimed towards improving the interactions between substance users and healthcare providers. The first one, entitled Health Matters: Health Care, Health Problems, and Other Useful Information for People Who Use Drugs and People Who Don't Use Drugs includes information on communicating with providers, basic health related information, and information on resources available to people who use drugs. The second one, entitled Manual for Primary Care Providers: Effectively Caring for Active Substances Users includes information on substance use, addiction, drug treatment, harm reduction, common health problems associated with drug use, HIV/AIDS, pain management, pharmacokinetics, models of accessible care, women and substance use, and the public policy context of drug use.
