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

The goals for the third year continue to refine the activities of the second year. Some of these activities – abstracted from Table 3-1 – are as follows.

A key element of the progress of this group of 27 Cooperative Agreement Projects is that working together is a dynamic process. As the work of the Steering Committee, Work Groups, and individual projects progresses, the system is flexible and active so that new issues can be easily addressed as they arise.

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
AIDS Healthcare Foundation (Los Angeles, California)	To increase enrollment in the program to a full complement of 750 patients. To fully develop the management information systems for the capitated care program. To fully integrate the case management approach to providing medical care.	To continue to enroll patients. To sign collaborative agreements with other HIV/AIDS providers to enroll their clients. To sign collaborative agreements with social service providers for case management. To complete the hiring necessary to operate a managed care plan. To explore partnership or affiliation opportunities with established and newly-forming HMOs, PPOs in publicly supported and private insurance markets. To purchase and install practice management software that interfaces with the utilization management software package. To purchase and install medical records software.
Center for Community Health, Education, and Research/Haitian Community AIDS Outreach Project (Dorchester, Massachusetts)	To increase knowledge of how to prevent HIV transmission. To increase compliance with treatment and services. To improve access to health and social services. To increase satisfaction with case management services provided by the Center for Community Health, Education and Research, Inc./Haitian AIDS Project (CCHER/HAP). To understand the effect of participation in the psychosocial educational curriculum on access to and utilization of health and social services.	To continue data collection. To concentrate on implementation on the psychosocial educational curriculum, and collect baseline and monitoring information on all clients. To train CCHER/HAP staff in data collection procedures, while modifying existing management information system components and monitoring data collection efforts. To learn new statistical techniques in anticipation of Year III evaluation activities. To develop Pre- and Post-Test Questionnaires to evaluate the impact of counseling on clients.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
Center for Women Policy Studies (Washington, District of Columbia)	To increase the role of women with HIV/AIDS in program planning and implementation. To conduct a roundtable discussion with providers and women in the rural areas of the EMA and suburban Virginia to identify the policy issues and needs of women in these areas. To continue to conduct detailed assessment on service organizations and agencies to evaluate reductions in barriers (pre- and post-project component implementation). To develop and facilitate training of service providers/agencies and consumers. To convene a policy information sharing meeting with women with HIV to examine issues of representation and inclusion in policy making bodies such as Ryan White CARE Act Title I Planning Council and DC CARE Consortium. To offer information sharing meeting for service providers and women with HIV/AIDS on a broad range of issues. To outline a plan for disseminating a detailed protocol of all procedures, developing a "how to" training manual, and developing multi-media packages for other provider networks.	To convene a community forum of local service providers to review focus group report and in-depth interview findings to address issues of access to and quality of local services. To conduct information sharing meetings on a wide range of policy issues including: Ryan White Services and immigration issues and welfare reform, specifically social security and Medicaid; Housing; Young Women and AIDS; Domestic Violence; and Employment and Job Opportunities. To adapt the Collaborative’s newsletter Woman CARE News to meet the information needs of Latinas and their providers, including adapting the newsletter, policy briefs and information guides in Spanish. To sponsor a two-day advocacy training for women with HIV/AIDS, "Fighting for Our Lives." To issue a report based on the in-depth interview findings to be disseminated to local service providers and women with HIV/AIDS. To conduct a steering committee meeting with technical advisors that will provide updates on medical, psychosocial information as well as upcoming local policy initiatives. To sponsor a cadre retreat for program planning for Year 4.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
East Boston Neighborhood Health Center (East Boston, Massachusetts)	To further develop and evaluate our outreach activities. To further expand patient services. To continue managed care training of staff. To expand patient database to include quality of life, patient satisfaction, inpatient care and outside service utilization. To further expand and analyze monthly resource utilization reports. To further expand process evaluation through case reviews. To further expand membership and functioning of the Consumer Advisory Board. To actively disseminate our model of care and preliminary findings.	To expand the project’s Mobile Unit to new sites. To develop and implement an evaluation tool for the Mobile Unit. To pilot Cooperative Health Care Clinics. To develop and implement patient support groups. To organize and implement patient focus groups. To expand quarterly chart reviews to include quality improvement assessment. To implement quality of life and patient satisfactions surveys. To develop systems to capture monthly outside service utilization. To develop systems to retrieve data from health center’s inpatient database. To streamline process of capturing non-billable service utilization. To document case reviews and action plans for dissemination. To finalize standards of care for medical management of HIV infected patients. To present the program’s model of care and findings at national conferences and local arenas.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
Emory University (Atlanta, Georgia)	To continue planned preceptor model "B" consultation/training in eight treatment sites. To implement at least one per quarter centralized "A" HIV training workshops in the Fall 1996 and Spring 1997. "A" and "B" trainings will be completed in April-May 1997. To utilize qualitative and quantitative evaluation measures to capture the outcomes of the project. To develop and implement "A" and "B" training strategies to meet the learning needs of health care personnel about new and evolving clinical content and standards of care for HIV early intervention and antiretroviral drugs. To plan dissemination activities to present project outcomes to the professional HIV and corrections communities.	To maintain project timeline for the three year project, "A" training, and "B" training. To continue visits to eight "B" treatment sites, implementing the defined curriculum, and the interactive HIV trainings. To invite participation of expert clinical consultants to accompany the training preceptor for selected content in all eight "B" treatment sites. To add to the existing crate of HIV educational resources and clinical protocols disseminated to the preceptor of each of the eight treatment sites as new materials become available. To plan both "A" and "B" curricula based on the results of learning needs assessments. To assess the effect of the specific measures that were implemented to increase the attendance at the "A" trainings. Learning needs assessments and flyers about future "A" trainings were mailed to all Department of Corrections and contract employees in August and September of 1996 and assistance with travel reimbursement was offered. To implement strategies to increase attendance, i.e., time of day, location, communicate details about agenda to each potential participant, and repeat of workshops in regional sites. To continue evaluation measures for "A" and "B" trainings. A pre- and post-test of content is used for both "A" and "B" trainings and a qualitative journal to capture the outcomes in the "B" trainings. To hire a half-time administrative assistant to manage forms and educational resource materials. Monthly or bi-monthly meetings of the project planning group consisting of representatives from Emory, Georgia Department of Corrections, and EMSTAR research will continue to plan and implement project activities and progress and to analyze progress and barriers. To convene an ad-hoc group of Emory personnel as necessary to meet specific interim goals. To respond to calls for abstracts from appropriate professional journals and groups for presentation of Emory project data to the professional community.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
The Fortune Society (New York, New York)	To further refine discharge planning services that provide HIV-positive Latino and Latina prisoners with a humane and smooth transition from prison to the outside community. To continue to meet the basic post-release needs of HIV-positive Latino and Latina ex-offenders by making and following-up on necessary referrals, establishing open communication between clients and parole officers and helping clients be successful in meeting parole mandates, encouraging participation in the wide range of inter-unit and agency-wide program services offered by The Fortune Society including peer support groups, education and career development, and providing counseling, intensive case management and crisis intervention services for program clients. To further increase the growing number of New York’s 70+ correctional facilities from which program clients are drawn.	To continue to identify and provide services and concrete referrals for HIV-positive Latino and Latina prisoners who are within six months of release or are participating in work release programs offered by the Department of Correctional Services. To continue to obtain and assist in preparing necessary forms and applications before each participant’s release to avoid unnecessary delays in processing medical, housing, entitlement or other applications upon release. To continue to provide quality post-release services that empower clients to advocate for themselves in order to set and meet goals, seek out opportunities, obtain satisfactory medical and other services outside the program, and enjoy the strong sense of community that program participants share at The Fortune Society through participation in social events, support groups and interaction with staff, volunteers and other clients. To further enhance staff knowledge and utilization of public and private resources available to clients to meet their needs prior to and after release from correctional facilities. To share program knowledge and referral resources with other community-based organizations and interested parties in order to increase availability of discharge planning and post-release services for HIV-positive inmates in correctional facilities.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
Health Initiatives for Youth (San Francisco, California)	To increase health and social service providers’ knowledge and skills in working with youth and HIV issues. To enhance a youth-sensitive system of health care by encouraging collaboration and coordination of services among youth-serving providers. To develop and implement experiential trainings on a wide range of topics related to youth and HIV. To provide technical assistance and expert consultation to agencies and individuals on youth and HIV topics. To develop and disseminate informational resources related to youth and HIV, including a quarterly newsletter, a directory of youth services, and customized information packets.	To disseminate the findings of the baseline needs assessment through a series of networking luncheons attended by health and social service providers. To offer the standardized cross-agency training Youth and the HIV Antibody Test, Advanced Counseling Skills, and HIV Prevention: From Framework to the Field. To offer customized trainings units and in-service presentations to agencies on specific topics related to working with youth and HIV issues. To coordinate 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. To produce four issues of the newsletter Bridges and distribute it locally and nationally. To disseminate customized youth and HIV information packets including articles, abstracts, statistics and referral lists. To produce and distribute an updated version of the Adolescent Provider Guide, a listing of youth and health services in San Francisco.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
Hektoen Institute for Medical Research/Cook County HIV Primary Care Center (Chicago, Illinois)	To continue to provide education and training for OB/GYN and Family Planning Physicians. To further develop the role of the Maternal and Child Health/HIV Advisory Council. To develop a system of follow-up for pregnant women with HIV. To further develop the Community Advocacy Group.	To provide eight provider training sessions. To finalize a manual for Maternal and Child Health providers. To follow pregnant women with HIV and their infants. To develop and systematize data collection for pregnant women with HIV and their infants. To train the Community Advocacy Group on perinatal transmission reduction, legislative issues, and public speaking. To systematize a program of peer support for pregnant women with HIV. To facilitate the adoption of policies and procedures on counseling and testing by consent in various perinatal centers. To produce a video for training providers. To develop educational materials on counseling and testing for pregnant women to be used by prenatal care providers. To develop and implement interviews with key members of the Maternal and Child Health /HIV Advisory Council.
Indiana Community AIDS Action Network (Indianapolis, Indiana)	Project ended September 30, 1996
Interamerican College of Physicians and Surgeons (New York, New York)	To train 90 physicians in the New York/New Jersey area in HIV risk-assessment, counseling, testing and treatment of HIV-seropositive patients and referral services. To ensure that the majority of participating physicians improve and increase their procedures for HIV risk-assessment, testing and treatment of seropositive patients in their practices.	To complete HIV/AIDS training for 70 physicians in the New York/New Jersey area in a five month time period, using a general protocol with specific modifications for each physician based on his/her experience and needs. To motivate 65% of program physicians to manage HIV-positive patients in their practices.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
Johns Hopkins University School of Medicine (Baltimore, Maryland)	To design a program for HIV care delivery that makes efficient use of resources. To continue to network with SPNS Program groups doing this type of work. To pursue multiple options for care delivery in selected categories based on competitive pricing: pharmacy, home care, and hospice care. To initiate the program including the assessment for cost-effectiveness, quality of life and complications/survival.	To determine rate, possibly stratified by high-risk as defined by CD4 cell count less than 50 or selected diagnoses. To identify a partner HMO. To complete a methodology for cost analysis. To identify a pharmaceutical supplier that will share in financial risk for drugs.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
Larkin Street Services (San Francisco, California)	Capital Development Activities To complete construction of the Assisted Care Facility by June 30, 1997. Program and Evaluation Activities To open the Assisted Care Facility for service which will include moving the Aftercare Program to that site by July 15, 1997. To provide comprehensive services through the Aftercare Program to youth living with symptomatic HIV or AIDS. To continue to collect data once every three months in a sweeps fashion for all SPNS Program clients.	Capital Development Activities To complete construction of the Assisted Living Facility. To obtain RCFCI certification and licensing. To select property manager for the facility. To prepare building for the actual opening of the program, which includes move-in phase. Program and Evaluation Activities To develop intake/selection criteria and complete selection process for program residents. To conduct several focus groups with the youth who will be residents of the facility to ensure that both the programmatic design and objectives meet their needs and the needs of other youth who are potential residents. To develop and complete final staffing plan, and identify candidates and select staff for the facility. To develop and implement program operation plan for the Assisted Care Facility, including relocating our Aftercare program to the facility. To interview and select the health care provider to provide skilled nursing services for the residents at the facility. To continue to provide services to 25 youth living with symptomatic HIV or AIDS through our Aftercare program and upon building opening, transition those youth identified to be residents of the Assisted Care program. To offer all SPNS Program clients combination anti-viral treatments and access to Protease Inhibitors if appropriate. To begin administering our Current and Anticipatory Loss Scale for standardization with 60 HIV-positive youth, including the 25 SPNS clients.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
Michigan Protection and Advocacy Service (Lansing, Michigan)	Project ended September 30, 1996.
Missouri Department of Health (Jefferson City, Missouri)	To organize an outstate (i.e., the outer regions of Missouri state) planning and implementation committee to develop the outstate training and implementation strategy. To collaborate with an evaluation team to produce data collection instruments for national dissemination. To have an integrated care model in St. Louis operational by mid-February. To enhance utilization of the existing implementation model in Kansas City.	To provide comprehensive multi-disciplinary trainings for out-of-state service providers. To develop and implement an integrated care program (a "one stop shop") providing comprehensive services for poly-diagnosed individuals with HIV/AIDS in Missouri. To initiate contracts with St. Louis medical team members and treatment team members’ organizations. To develop a confidentiality agreement between the Missouri Department of Health and the Department of Mental Health. To provide refresher training courses in St. Louis and Kansas City.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
New York State Department of Health/Health Research (Albany, New York)	To work with HIV Special Needs Plans Planning Grant Awardees in data collection and development of documents that will help guide the state in the design of legal, administrative, and financial aspects of Special Needs Plans (SNPs). To collect and begin initial analyses of cost and utilization data generated as part of the "Provider Cohort" study. To initiate medical record reviews to collect data on disease stage to complement cost and utilization data generated as part of the "Provider Cohort" study. To collect and begin initial analyses of "Client Cohort Data" creating a baseline that defines patient experience as they seek and access care under fee-for-service. To develop and distribute a procurement document for HIV SNPs. To distribute developmental grants to new SNPs for capital acquisition, cash reserves and structural network.	To design and maintain databases as necessary to collect and analyze cost and utilization data. To design and maintain databases as necessary to collect and analyze data collected under the auspices of the "Client Cohort." To use all clinical, cost and utilization data collected to refine and revise managed care capitation payments for persons with HIV/AIDS treated at both "mainstream" and HIV Special Needs Plans. To award 12 HIV SNP licenses by Fall of 1997 with projected voluntary enrollment commencing in the first quarter of 1998. To identify funding to support developmental activities during the transitional time between SNP license awards and actual enrollment activities commence.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
Outreach, Inc. (Atlanta, Georgia)	To develop a system to reduce barriers to medical treatment for clients. To assist persons with active addictions who are HIV-positive to obtain medical and substance abuse treatment and provide practical and emotional follow-up support and care. To reduce barriers to accessing medical care for our target population by training primary care health providers at two major infectious disease clinics.	To create a transportation system. To establish relationships with agencies for substance abusing persons within the community. To place 41 clients in detoxification treatment. To provide a full range of 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.
PROTOTYPES (Culver City, California)	To continue to expand a system of care for women living with HIV/AIDS. To further expand the work with pregnant women living with HIV/AIDS. To begin dissemination of information about the program at conferences. To reduce social barriers (e.g., fear of losing child, difficulty making and keeping appointments) significantly in order to match reduction in structural barriers.	To begin analysis of medical compliance and quality of life issues. To increase trainings to primary care providers. To continue follow-up and begin analyses to assess changes in depression levels, quality of life, etc. To present data at the National Women and HIV Conference in May 1997. To submit papers to other conferences as well.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
SUNY Health Science Center at Brooklyn (Brooklyn, New York)	To increase the availability of and competency in HIV counseling and testing among OB/GYN providers, both in-house and in private practice in Brooklyn. To increase the number of women who receive HIV counseling and testing prenatally in Central Brooklyn. To increase early identification of HIV-positive women during pregnancy and increase availability and use of the perinatal zidovudine protocols. To increase the number of women who receive the HIV primary and gynecological care in a co-located setting, thereby increasing their chances for receiving total care. To decrease perinatal transmission of HIV at the three sites.	To develop training curricula, support materials, and technical assistance in systems’ development and implementation to incorporate HIV counseling and training into routine OB/GYN clinical care. To develop systems at each of the three sites which ensure compliance with the changing NYS regulations, while not straying from programmatic goals. To train private community-based OB/GYN providers in abbreviated HIV counseling and testing for all prenatal patients and to update them on changing NYS regulations. To develop an outreach program, with consumer involvement, to increase prenatal HIV counseling and testing, early identification and referral of HIV-positive women not previously in care, into MAPS’ co-located care services. To continue to decrease the number of HIV exposed and/or infected infants born at the three hospitals.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
The Measurement Group – PROTOTYPES Evaluation and Dissemination Center (Culver City, California)	To continue to develop and maintain the overall management strategy for facilitating the activities of the cooperative agreement projects. To implement and manage a cross-cutting evaluation strategy for the Work Groups, Cooperative Agreement Steering Committee and HRSA. To provide technical support on evaluation and dissemination to individual grantees, the Cooperative Agreement Steering Committee, and HRSA. To develop an overall dissemination strategy for Work Groups, the Cooperative Agreement Steering Committee, and HRSA.	To coordinate and manage four Steering Committee meetings. To provide management assistance to the Steering Committee on its overall direction and operations. To develop several dozen additional evaluation modules and refine an evaluation plan. To implement all evaluation modules and develop a common database for analysis. To conduct preliminary evaluation analyses. To provide individual technical assistance on evaluation to cooperative agreement projects. To prepare summary reports for HRSA and the Steering Committee.
University of Colorado Health Sciences Center (Denver, Colorado)	To complete comparison group recruitment. To complete follow-up portion of research project. To initiate and complete data analysis. To revise educational products based on project experience. To continue training programs with updated materials. To disseminate research results.	To obtain complete evaluation information on 150 comparison group members. To obtain follow-up information on at least 50% of study participants. To revise self-study module and curriculum. To train at least 300 urban and rural health care providers with the updated materials. To present research results and educational products at local, state, regional and national forums.
University of Mississippi Medical Center (Jackson, Mississippi)	To recruit and train ancillary staff necessary to support the project. To collect all pre-intervention evaluation data. To initiate distance learning preceptorship course in each Federal Health Clinic. To initiate the collection of ongoing patient encounter tracking in the clinics.	To travel to all sites and complete software installation and test equipment used to support the implementation of the distance learning. To train/retrain key and ancillary support staff. To implement clinical preceptorship training programs in all clinics. To complete pre-training surveys in all sites. To compile 6-month pre-training patient encounter data for each training group.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
University of Nevada School of Medicine (Reno, Nevada)	To move the nutrition project into the new clinic site with greater access and responsiveness to prospective and currently enrolled patients. To streamline the necessary measurements found to be most sensitive for predicting and following weight and wasting for increased efficiency and time effectiveness. To increase dissemination of information through submission of abstracts to meetings for both AIDS and nutrition related subjects. To continue and expand data analysis as more information and modules are added including the medical outcome fax-in form for the clinic.	To complete chart review for medical follow-up information on control patients for comparison with enrolled subjects. To offer more educational handouts for general patient use in the clinic as well as for enrolled patients specifically to address issues such as sore mouth, low energy, and decreased intake. To implement and test nutritional supplement use in the enrolled population. To publish a paper on one or more of the baseline findings analyzed to date and begin analysis of change in patients followed for 18 to 24 months. To complete the implementation of the medical outcomes fax-in form for the clinic and proceed with development of fax-in systems for nutritional measures. To focus more closely on the metabolic and laboratory measures to determine their sensitivity, cost effectiveness, and effective use in long term follow-up.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
University of Texas Health Science Center at San Antonio (San Antonio, Texas)	To assess longitudinal impact of the project on the barriers, problems and needs of women, children and families in South Texas. To diagnose how agencies in the catchment area work together and to determine how the delivery of services may be enhanced and effectively service the targeted population. To make comparisons among individuals and families who have been involved in the system for longer and shorter periods of time and determine differences in levels of access to services and degree of barriers to care. To continue cross-training of project staff and implement developed curricula. To develop strategies to continue expanding the capacity of the health and human service delivery systems in South Texas and ensure sustainability of the project’s efforts. To measure and compare consumer access and satisfaction. To disseminate findings and provide policy makers with concrete information to develop more responsive system regulations.	To analyze information obtained and summarize results for individual and family needs assessment project activities. To continue the development of infrastructure and family-centered models of care. To publish an article regarding the model for continuity of care and delivery of services for women, children and families living with HIV/AIDS in South Texas. To document differences in the experience of individuals and families. To conduct training of trainers session utilizing the new curricula developed for the Texas Department of Protective and Regulatory Services. To establish mechanisms to continue training activities with Child Protective workers, foster parents and volunteers working in urban and rural areas. To disseminate project findings through position papers, publications, and conferences. To identify new barriers and problems faced by women, children and families in a changing health and human services environment. To make specific recommendations for community based strategies to reduce previously identified structural barriers to family-centered care.
University of Vermont & State Agricultural College (Burlington, Vermont)	To further implement Clinic II. To establish and open Clinic Site III. To input all data from Years I and II into computer program. To begin Primary Care Provider education in Clinic Sites I and II.	To continue work of Clinic I. To open Clinic II. To open Clinic III and train the nurse practitioner. To enter Year I data into computerized data base. To begin analysis of data.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
University of Washington (Seattle, Washington)	To enhance the delivery of psychiatric services to patients in two residential care facilities and two hospital-based AIDS units. To increase the knowledge and perceived ability of providers at the participating four agencies regarding HIV-associated delirium versus other neuropsychiatric illnesses. To increase the knowledge and perceived ability of families to identify and access treatment for HIV/AIDS associated delirium and other neuropsychiatric illnesses. To produce a training video geared towards educating providers, patients, and families on HIV/AIDS related delirium. To perform psychiatric consultation upon request at four participating agencies for the first six months. To compile evaluation findings and disseminate them to SPNS multi-site evaluation center, and to local, state, and national networks. To publish model and evaluation findings in appropriate professional journals.	To offer admission consultation and psychiatric screening to all patients admitted to the four participating agencies. To provide site specific monthly training sessions for providers on neuropsychiatric illnesses associated with HIV/AIDS with an emphasis on delirium, at the four participating agencies. To provide bi-monthly family educational sessions at each of the four participating agencies for family members of patients with delirium or other neuropsychiatric illnesses. To complete chart and outcome evaluations to determine the effect of the project’s trainings on health care professionals’ knowledge of delirium, their ability to correctly identify, diagnose and treat delirium, and their willingness to advocate for psychiatric consultations. To market and disseminate the "Unmasking AIDS-Related Delirium" video through the University of Washington MedEd Publications. To compose and submit articles pertaining to the process of filming the training video to Innovations magazine. To prepare additional articles for publication.
Visiting Nurse Association of Los Angeles (Los Angeles, California)	To finalize Capitation Development model. To finalize capitation rates for end-stage home care. To evaluate patient satisfaction with service models.	To have a computer-based capitation model in place by September 30, 1997. To have a range of risk adjusted rates for home care for end stage HIV/AIDS patients completed by September 30, 1997. To measure, using a normed scale, the satisfaction with services of clients in both models of care on a bi-monthly basis beginning October 1, 1996.

Table 3-1

Individual Project Plans for the Third Year

Project	General Programmatic Goals	Specific Programmatic Objectives
Washington University (St. Louis, Missouri)	To continue the implementation of the Special Care Center. To establish a peer education/support program. To facilitate an integrated community outreach program targeting women who are lost to follow-up, are HIV-positive but not yet in care, and/or are at risk for being infected. To develop an effective system for identifying and following women with HIV in the southern Illinois area, using local resources. To build provider capacity in the service area regarding the identification, counseling, and treatment of women with or at risk for HIV infection, with special emphasis on reduction of vertical transmission.	To track all pregnant women enrolled in the Center, and their neonates, using local and national measurements. To create, implement, and evaluate educational programs and tools to assist women in making informed reproductive decisions by providing education to all women of childbearing age who are enrolled in the Center. To support peer outreach workers in assistance with client and community needs. To work with community members in arriving at a community diagnosis and plan for conducting outreach to women with or at risk for HIV. To analyze data collected during the first two years of the program.
Well-Being Institute (Detroit, Michigan)	To assist substance abusing women with HIV to overcome their access barriers and enroll in primary care services (including substance abuse treatment, when desired). To assist substance abusing women with HIV to remain active with their primary care providers. To recruit five substance abusing women per month who are not known to be HIV-positive and provide pre- and post-test counseling services to these women. To develop ethnographic interview transcripts regarding identification and explication of not-yet-understood access barriers to receipt of primary health care for women substance abusers with HIV.	To provide services to 32 women at any one time during the year. To enroll or reactivate all clients in primary care services (including substance abuse treatment if desired). To provide intensive advocacy, nursing, counseling, needs assessments, transportation, and child care to facilitate participation, and retention, in primary health care for HIV disease. To use street outreach to recruit five substance abusing women per month who are severely disaffiliated and who have "fallen between the cracks" of the health delivery system, and provide them with HIV testing and counseling.

B. Steering Committee Plans for the Third Year

The Steering Committee intends to hold three meetings during the third year. The meetings are scheduled to be held January 16-17, 1997 in San Francisco, California; May 8-9, 1997 in the District of Columbia; and September 18-19, 1997 in the District of Columbia.

The Steering Committee continues to identify three large-scale objectives for the third year of the project:

to evaluate a set of common objectives among relatively comparable projects and to collect a common data set to make it possible to evaluate the common objectives;

to share expertise among projects through formal and informal presentations; visits to programs during Steering Committee meetings; use of training materials such as exercises, videotapes, and other materials; and discussions in the small Work Groups as well as the Steering Committee as a whole; and

to report and disseminate the experiences of the projects.

These objectives are discussed in more detail below.

1. Evaluation of Common Objectives and Collection of a Common Data Set

During the third year of the cooperative agreements, the Steering Committee intends to facilitate the implementation of methods of data collection and assessment within the member projects so as to evaluate common objectives that have been stated and negotiated during the first year. During the third grant year, the project representatives will collectively undertake the following steps.

Continue to implement core data collection modules within appropriate projects.

Submit data as they are collected to the data repository at the Evaluation and Dissemination Center.

Examine analyses of the common data set that are prepared by the Evaluation and Dissemination Center at the Steering Committee meetings.

Suggest additional data collection modules, analyses, and reports to the Evaluation and Dissemination Center through the Steering Committee meetings.

Conduct cooperative analyses of major data trends.

Disseminate these common evaluation results, as broadly as possible.

2. Sharing Expertise Among Projects

In order to share expertise among the project representatives during the third year, the Steering Committee has made the following suggestions:

At each of the Steering Committee meetings, it is recommended that "local" projects schedule site visits and training sessions. This is a continuation of existing practices that have proven to be very successful.

Each Steering Committee meeting should permit at least a half day for Work Group meetings. Work Groups are strongly encouraged to develop joint projects.

At selected Steering Committee meetings, time for a poster session should be provided so that all projects might highlight some aspect of their work. This suggestion is a follow-up to the successful poster sessions held at the September 1995 and April 1996 Steering Committee meetings. Currently, a poster session has been scheduled for the May 1997 Steering Committee meeting in the District of Columbia.

Request that projects whose funding terminates at the end of Year III to provide training on their findings and expertise to the other projects during this grant year. Seven projects are scheduled to complete their finding cycles this year.

Further develop an active archiving and action learning process so that the results of individual projects continue to inform and enhance the progress of other projects.

3. Reporting-Dissemination Objectives

In order to report on the progress of the individual projects and the overall Steering Committee, the Steering Committee has made the following recommendations:

This report should be prepared for the second year and that similar reports be developed for subsequent years.

Specialized data-based reports should be prepared from the common data set and issued after consideration by the Steering Committee. These data-based reports should be submitted to professional association meetings, scientific journals, and published on the Internet on the EDC web page.

Collective presentations for HRSA/HAB's SPNS Cooperative Agreement Work Groups and Steering Committee should be prepared.

Individual projects should be encouraged to issue reports on the success of their programs as soon as sufficient data are available to support such a conclusion. These reports should be supported by the overall Steering Committee.

The Evaluation and Dissemination Center should continue its series of faxed reports to share the successes of the projects.

The Evaluation and Dissemination Center should continue to maintain an Internet (World Wide Web) site featuring information about the Cooperative Agreement Projects.

The Steering Committee should regularly consider additional reports at each of its meetings during the third project year.

4. Programs and Policy Recommendations

The overall Steering Committee makes the following program and policy recommendations based on their experiences.

Work Groups should prepare special reports that summarize current progress and the policy implications of their work. Currently, reports are being prepared by each of the five standing Work Groups of the Cooperative Agreement Steering Committee with completion expected during the third grant year.

As appropriate, specialized studies among the grantees should be developed. One example of this is a group of six projects and the Evaluation and Dissemination Center who are collaborating on a study of medical treatment adherence with combination therapies including protease inhibitors.

There should be common dissemination of collaborative products including convention presentations, journal articles, and other documents produced by the Steering Committee or its subcommittees.

The Work Groups and the Steering Committee as a whole should consider how their work may inform the larger policy arena and work in a proactive way to ensure that the experience of the group is part of the public debate.

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