SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 1, Issue 15 (November 1, 1996)

This document has been superceded by our Online Knowledge Base on Innovative Models of HIV/AIDS Care. Click here to access the Knowledge Base. Click here to access descriptions of 27 Innovative Models of HIV/AIDS Care and the lessons learned from these projects. SPNS/Fax was written, published, and distributed by fax by The Measurement Group between 1995 and 1998.

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

Introduction

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

Well-Being Institute Addresses Needs of HIV-Infected Women Substance Abusers

The Well-Being Institute's (WBI) Women's Intervention Program is a comprehensive community-based nursing project specially designed for HIV-infected women substance abusers who "fall between the cracks" of the health delivery system in Detroit, Michigan. The table below shows access barriers identified by the women and the programmatic strategies used by staff to overcome these barriers. WBI gives personalized attention to the reasons each woman says she does not access services. Because these women are isolated and hard to find, a day treatment program was developed to bring them to one central place – WBI's nursing program office – from which health care access is facilitated more efficiently.

Health Care Access Barrier How the Women's Intervention Program Addresses the Barrier
No knowledge that service exists; no knowledge of where to get services
  • WBI staff counsel clients on availability of services
  • Staff "Access Team" identifies services needed to meet clients' needs
  • Staff make appointments for clients with appropriate service providers
Services not affordable
  • Staff assists eligible clients to obtain Medicaid and federal/state disability benefits
  • Free medical care is provided via local clinic
  • Free primary nursing care examinations are provided at a local Primary Nursing Clinic
Transportation problems
  • Free van transportation is provided to clients to/from residence and health-care appointments
  • Six free rides per month to/from health-care appointments are provided to program graduates
Fear that HIV status will be discovered
  • Staff accompany clients to medical examinations
  • Staff stress confidentiality to primary care providers
Child care problems
  • Child care is provided during health-related appointments, individual counseling sessions, and group counseling
Fear that service facility will not provide treatment
  • Staff accompany clients to medical examinations
Feeling that service providers do not like HIV-positive clients
  • Staff accompany clients to medical examinations
  • Intensive advocacy with provider organizations

This project has three tiers of service, each designed to engage the woman in taking responsibility for her own health care needs and overcoming barriers to obtaining care.

  • Tier I provides intensive advocacy services within a day treatment program format, four days each week.

  • Tier II is an intensive substance abuse program called the Detroit LIGHThouse, specializing in HIV-related issues.

  • Tier III challenges the women to work together to plan group directed, self-supporting revenue-generating events to sell crafts they have made. Women graduate to Tier III once they are able to make and keep health-related appointments.

All of the 51 women who participated in the Women's Intervention program through 5/30/96 identified at least one major access barrier which has prevented them from receiving HIV-related health care. The women are triply diagnosed (i.e., active substance users, mentally ill, and HIV-positive). Most (59%) report using crack cocaine in the past six months. Another 2% report using heroin only, 11% report using both heroin and crack, and 28% use primarily alcohol and marijuana. 71% score at or above a well established index for depressed affect. The Well-Being Institute has been successful in improving women's sense of global well being (p < .03), which has been demonstrated to be associated with a decrease in drug use and psychological problems. Through program efforts (group and individual counseling using the Personalized Nursing LIGHT Model, lunch, advocacy, transportation, and child care), all clients have been enrolled and retained in primary care.

For more information about this project, contact Geoffrey A.D. Smereck, A.B., J.D., or Marcia Andersen Ph.D., R.N., F.A.A.N., C.S., at the Well-Being Institute, 216 S. State St., Suite 4, Ann Arbor, MI 48104. The Well-Being Institute web site is located at: http://www.pnc-wbi.com.

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

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