Immigrants in the CHAIN NYC and Tri-County Cohorts

Service Needs and Utilization

Needs Assessment Meeting March 24, 2010

 CHAIN study participants classified as: born in U.S., born in Puerto Rico, born elsewhere  NYCDOH took the lead in defining a set of service domains, service need, and utilization measures  Minor differences in need definition between Tri-County and NYC  “Need” includes those currently using service “Unmet need” =% without adequate service utilization among those with need for service  Compare 2006-2009 with earlier interview period 2001-2006

Background

Female 20-34yrs old

US n= (527)

PLACE OF BIRTH CHAIN COHORT ENROLLED 2001-2002

New York City PR Other US Tri-County Region PR Other (72) (94) (320) (27) (50) 43% 36% 28% 47% 48% 62% 24% 26% 33% 25% 22% 48%

Risk exposure

MSM Problem Drug Use MSM/ PDU Hetero/ Oth 18% 45 9 29 15% 54 8 22

Demographics

33% 16 4 47 18% 47 5 31 4% 63 7 26 10% 10 2 78

 Who Needs the Service?

All Individuals

 Measure of Adequate Utilization

One or more visits to HIV Primary Care Physician in last six months

Domain: Ambulatory Health Care Service : HIV Primary Care

Need

Always 100%

Adequate Utilization

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2001-2006 2006-2009

NEW YORK CITY

2001-2006 2006-2009

TRI-COUNTY

Trends in HIV Primary Care

US PR Oth

 Who Needs the Service?

1. CD4 count< 200 & not on ARV 2. Not completely adherent to ARV meds or 3. Receiving support services for ARV meds

 Measure of Adequate Utilization

Receiving support services for taking ARV’s from professional providers

Domain: Ambulatory Health Care Service : ARV Treatment Support

Need for Service:

80% US PR Oth 2001-06 2006-09 47% 38% 38% 29% 48% 40%

New York City

70% 60% 50% US PR Oth 2001-06 2006-09 57% 51% 49% 47%

Tri-County

42% 40% 40% 30% 20% 10% 0%

Adequate Utilization:

2001-2006 2006-2009

NEW YORK CITY

2001-2006 2006-2009

TRI-COUNTY

Trends in ARV Treatment Support

US PR Oth

 Who Needs the Service?

1. Self reported poor mental health 2. In last 6 months had an inpatient, emergency room or



mobile unit visit for psychiatric reasons 3. Being homeless or in unstable housing in last 6 months 4. During past year used cocaine, crack or heroin, OR 5. During past 6 months problem drinking Tri-County 100% of PLWHA

 Measure of Adequate Utilization

A case manager did one or more of the following last 6 months: -Developed or revised a plan for dealing with needs, -Made referrals for social services, -Helped filling out forms for benefits or entitlements

Domain: Case Management Service : Social Service C.M.

Need for Service:

90% US PR Oth 2001-06 2006-09 59% 48% 65% 54% 51% 44%

New York City

80% 70% 60% 50% 40% US PR Oth 2001-06 2006-09 100% 100% 100% 100% 100%

Tri-County

100% 30% 20% 10% 0%

Adequate Utilization:

2001-2006 2006-2009

NE W YORK CITY

2001-2006 2006-2009

TRI-COUNTY

Trends in Social Service C.M.

US PR Oth

 Who Needs the Service?

1. No HIV primary care in the last 6 months 2. Stopped going or no visit to provider in last 6 months 3. Missed more than one appointment in last 6 months 4. No CD4 or VL test in the past 6 months, OR 5. Had any of the above problems at prior interviews AND had a case manager helped in getting or referring for medical services in the last 6 months



Tri-County: 100% of PLWHA

 Measure of Adequate Utilization

During the last 6 months a case manager helped in getting or referring for medical services.

Domain: Case Management Service : Medical C.M.

Need for Service:

90% US PR Oth 2001-06 2006-09 69% 54% 51% 47% 58% 47%

New York City

80% 70% 60% 50% US PR Oth 2001-06 2006-09 100% 100% 100% 100% 100% 100%

Tri-County

40% 30% 20% 10% 0%

Adequate Utilization:

2001-2006 2006-2009

NEW YORK CITY

2001-2006 2006-2009

TRI-COUNTY

Trends in Medical C.M.

US PR Oth

 Who Needs the Service?

1. Self reported poor mental health 2. In the 6 months had inpatient, emergency room or mobile unit visit for psychiatric reasons, OR 3. In the last 6 months received counseling from a mental health care professional or clinical social worker

 Measure of Adequate Utilization

In the last 6 months received treatment or counseling from a mental health care professional or clinical social worker

Domain: Mental Health Service : Professional Mental Health Services

Need for Service:

90% US PR Oth 2001-06 2006-09 55% 50% 62% 63% 63% 64%

New York City

80% 70% 60% 50% US PR Oth 2001-06 2006-09 57% 54% 67% 60% 48%

Tri-County

50% 40% 30% 20% 10% 0%

Adequate Utilization:

2001-2006 2006-2009

NEW YORK CITY

2001-2006 2006-2009

TRI-COUNTY

Trends in Mental Health Services

US PR Oth

 Who Needs the Service?

1. During past year used cocaine, crack or heroin, 2. During past 6 months heavy or problem drinking OR 3. Reported receiving drug or alcohol treatment was important

 Measure of Adequate Utilization

In last 6 months received any form of alcohol or drug treatment

Service: Alcohol or Drug Treatment

Need for Service: Adequate Utilization:

US PR Oth 2001-06 2006-09 65% 56% 57% 37% 52% 24%

New York City

80% 70% 60% 50% 40% US PR Oth 2001-06 2006-09 65% 56% 57% 52% 37%

Tri-County

24% 30% 20% 10% 0% 2001-2006 2006-2009

NEW YORK CITY

2001-2006 2006-2009

TRI-COUNTY

Trends in Alcohol or Drug Treatment

US PR Oth

 Who Needs the Service?

In last 6 months reported one or more: 1. Report need for transportation assistance 2. Did not get or delayed getting medical care or social services due to lack of transportation

 Measure of Adequate Utilization

In last 6 months, received transportation services.

Service: Transportation

Need for Service:

US PR Oth US PR Oth 2001-06 2006-09 17% 13% 13%

New York City

2001-06 2006-09 33% 25% 37% 27%

Tri-County

11% 18% 7% 15% 16% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Adequate Utilization:

2001-2006 2006-2009 2001-2006

NEW YORK CITY TRI-COUNTY

2006-2009

Trends in Transportation Services

US PR Oth

Service Highest Need Lowest Utilization ARV Treatment Support

NYC Tri-CO

Medical Case Management

NYC Tri-Co

Social Service Case Mgmt

NYC Tri-Co US, OTH US PR, US - PR, US - PR,OTH OTH PR, US US PR, US US

Prof’l Mental Health Services

NYC Tri-CO

Alcohol/Drug Treatment

NYC Tri-Co OTH, PR PR US, PR US, PR PR OTH PR, OTH PR, OTH

Transportation

NYC Tri-Co PR US OTH US

Summary of Differences

Acknowledgements

 A Technical Review Team (TRT) provides oversight for the CHAIN Project. In addition to Peter Messeri, PhD, Angela Aidala, PhD, Maiko Yamagido and Maria Caban, MA of Columbia University’s Mailman School of Public Health, TRT members include, Nina Rothschild, DrPH, Mary Irvine, DrPH, Fabienne Laraque, MD, Yoran Grant, PhD, Daniel Weglein, MD, NYCDOHMH; Julie Lehane, PhD, Tom Petro, Westchester County DOH; Mary Ann Chiasson, DrPH( Chair) and Roberta Scheinmann, MPH, Public Health Solutions.

 This presentation based on analyses of CHAIN cohort service needs and patterns of service utilization prepared by Maiko Yomogida and Peter Messeri.

 Funding for this research was provide by a grant from the NYCDOHMH as part of its Ryan White CARE Act grant, H89 HA 0015, from the US Health Resources and Services Administration (HRSA), HIV/AIDS Bureau with the support of the HIV Health and Human Services Planning Council. Its contents are solely the responsibility of the report authors and do not necessarily represent the official views of the U.S. Health Resources and Services Administration, the City of New York, or Public Health Solutions.