Achievements & Lessons Learned-Y: Well-Being Institute

Knowledge Item: CA-Initiative Impact-99Y
Major Achievements and Lessons Learned: 1994-1999

Well-Being Institute

The Well-Being Institute is a comprehensive community-based nursing project reducing access barriers for substance abusing, HIV-positive women who “fall between the cracks” of the health delivery system in Detroit.

In 1999, the Evaluation and Dissemination Center asked each project to state its major achievements and the lessons it had learned from conducting the project. Those stated achievements and lessons learned are reproduced here (with minor editing) as reported to the Evaluation and Dissemination Center. The summary statements given here are those aspects of the program's experiences that the Project Director wished to emphasize.

*Achievement 1*: Recruited 103 women with both HIV and substance abuse, about 70% also having mental illness and assisted them to overcome their access barriers to receipt of primary health care.
Key Elements for Success: Strong community linkages-recruitment; developed linking delivery system. Intensive women-focused, nursing-based, team-oriented interventions.	Factors that Limited Success: Higher incidence of mental illness than expected; strong disaffiliating socio-economic biases in environment.	Factors that Ensured Success: Strong staff experience with mentally ill; strong staff camaraderie; high degree of collaboration with other CBOs and providers at local/State levels. Long history of outreach experience; nursing care delivery system (Hyperlinking).

*Achievement 2:* Identified and built community collaboration linkages.
Key Elements for Success: Staff well-networked at local and State levels with key providers, regional and statewide HIV consortia; staff professional experience in community.	Factors that Limited Success: Various "turf" issues among service providers.	Factors that Ensured Success: Strong staff willingness to collaborate and to "share credit."

*Achievement 3:* Developing a nursing care delivery system we call "Nurse Hyperlinking," which reduces access barriers and facilitates retention in health care, and facilitates linking clients to primary health care.
Key Elements for Success: Strong WBI nurse/staff community contacts.	Factors that Limited Success: Would be stronger with contracts with HIV, mental health, and substance abuse agencies.	Factors that Ensured Success: Strong WBI nurse/staff linkages in key HIV, substance abuse, and mental health agencies.

*Achievement 4:* Developed a well-running transportation system for the client population unique to our city (westside van, eastside van runs)
Key Elements for Success: Well-organized smooth-running scheduling system; reliable staff; staff kind and accommodating to "difficult" client needs.	Factors that Limited Success: Mental illness of clients; sometimes chaotic appointment requests.	Factors that Ensured Success: Strong staff desire to be helpful to clients; good maintenance of vans.

*Achievement 5:* Improved participants' sense of well being significantly.
Key Elements for Success: Personalized Nursing L.I.G.H.T. Model; Intensive women-focused, nursing-based, client driven intervention whose goal is improvement of well being.	Factors that Limited Success: Client poverty, lack of resources, multiplicity of health problems.	Factors that Ensured Success: Strong staff willingness to be helpful to clients; L.I.G.H.T. Model; our Day Treatment Program; re-affiliating clients with family/friends.

1. Lesson Learned: We found we needed our "Day Treatment Program" to keep clients on-site and available for long portions of the day. This facilitated many program success-elements; indeed, other CBOs and case managers would conduct their interventions at our SPNS site.

How related to achievements: Facilitated delivery of intervention to clients with regularity; locating clients made obviously easier; enhanced nurse-client bonding over time, which in-turn strengthened staff ability to assess client needs/change in needs and develop nursing care that improved client well being; assisted in re-affiliating clients with friends/family.

2. Lesson Learned: Specialized HIV-focused transportation is essential for doubly- and triply-diagnosed, low-SES client populations, for them to access primary health care for their HIV disease – at least in cities having: (a) harsh winters, (b) high incidence of violent crime, and (c) poor-coverage public transportation in low-SES neighborhoods.

How related to achievements: Our strong transportation component made it possible for clients to access their HIV-related health care appointments with high adherence; also, boosted client participation in program interventions; strongly boosted client "comradeship" among each other.

3. Lesson Learned: Doubly- and triply-diagnosed women need a minimal sustainable package of services, long term, to sustain the gains make in treatment.

How related to achievements: With SPNS Branch authorization, we created a multi-tiered program which provided a less-comprehensive (and less expensive) set of services to women with extreme need, long term, to sustain the gains made during the full-service period of program for those clients.

4. Lesson Learned: 70% of dually-diagnosed women (HIV and substance abuse) are also mentally ill.

How related to achievements: We, from the outset, had to re-orient our interventions to the much higher-than-expected incidence of mental illness among our clients.

5. Lesson Learned: We found that our next step is to work on improving adherence to treatment recommendations, now that we have gotten women enrolled and retained in primary care.

How related to achievements: We were successful in getting women to their medical appointments; next, we need to work on adherence to treatment recommendations.

Completed By: Geoffrey Smereck, J.D.; Marcia Andersen, R.N., Ph.D.; Elaine Hockman, Ph.D.
Last Updated: July 1999

Project Resource Page

Well-Being Institute

Evaluation Data

Last Updated: August 02, 2001; data through June 15, 1999; analyses conducted January 2000.

Knowledge Base Citation: The Knowledge Base and this Knowledge Item were designed and authored by G. J. Huba, Ph.D.; in collaboration with Lisa A. Melchior, Ph.D.; A. T. Panter, Ph.D.; and the staff of The Measurement Group. Cite this work as "Huba, G. J., Melchior, L. A., and Panter, A. T. (1998 - 2001). The Measurement Group Knowledge Base on HIV/AIDS Care. On the World Wide Web: http://www.TheMeasurementGroup.com."

Questions or Comments: Contact The Measurement Group.

Use of Knowledge Base Information: Acceptable Uses and Limitations.

Collaborators from Participating Projects: Cooperative Agreement Steering Committee 1999.

Participating Projects: This Knowledge Base is based on the service delivery experiences of 27 Cooperative Agreement Projects on Innovative Models of HIV/AIDS Care. These projects and the Evaluation and Dissemination Center which produced this Knowledge Base were funded by the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) as Special Projects of National Significance (SPNS) between 1994 and 1999.

Why This Evaluation was Conducted: Editorial.

More Information: Design of this Knowledge Base.

Recommended Citation Format for Web Materials: American Psychological Association Publication Manual Section, Revised 2001.

Work on the Knowledge Base and the cross-cutting evaluation was supported in part by Grant Number 5 U90 HA 00030-05 from the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau's (HAB) Special Projects of National Significance (SPNS). The contents of this Knowledge Base are solely the responsibility of The Measurement Group and do not necessarily represent the official views of HRSA or HRSA/HAB's Special Projects of National Significance nor may they represent the positions of the individual grantees whose projects are included in the cross-cutting evaluation.