Life Care Services
Life care services is the term the Wisconsin AIDS/HIV Program uses to identify case management and supportive services for persons with HIV disease. Case management is a method of service delivery striving to ensure that clients with complex health and social service needs receive timely, coordinated, and cost effective services. Case management involves the active participation of the case manager and the client (or his or her designated representative). The key role of the case manager is to coordinate or arrange needed services for clients across a range of service providers and settings. Case managers help clients obtain services such as medical, dental and mental health care; financial assistance; legal assistance; practical and emotional support; and housing assistance.
The AIDS/HIV Program intends that life care services be available and reasonably accessible to all Wisconsin residents with HIV infection who request services. To accomplish this, the Division funds an ASO in each of five Department of Health Services (DHS) regions. Designated ASOs must collaborate with local health departments, county human services departments and other community agencies, including minority community-based organizations to plan and coordinate case management and support services within their DHFS region. Designated ASOs may use life care service funds to support and staff a case management program or may subcontract with other community agencies to provide case management and/or related supportive services.
Life care services funds support, in whole or part, over 40 case management staff positions statewide. Currently, case managers assist over 2,000 clients annually. Clients access case management services through referral from a variety of HIV service providers including physicians, counseling and testing sites, and partner counseling and referral staff. Clients may also access case management by contacting an ASO or CBO directly.
Goals for life care services include:
- To provide cost efficient case management services.
- To help clients obtain HIV-related medical care through effective case management.
- To help clients obtain appropriate benefits through effective case management.
- To help clients, their family members and friends obtain supportive services through effective case management.
- To provide quality case management services in a timely manner.
Ryan White Title II funds supplement life care services funds in many areas of the state.
In 1992, the AIDS/HIV Program convened a case management workgroup to develop case management practice standards and forms to formalize the Life Care Services program throughout the state. The Program published Practice Standards and Administrative Guidelines for HIV-related Case Management in January 1993. The Program revised the standardized case management forms in December 1994. The Practice Standards and Administrative Guidelines were further revised in 2003. All agencies funded by the AIDS/HIV Program to provide HIV case management must implement these standards and forms.
Case management is a formal process that includes:
- Service plan development;
- Ongoing monitoring and evaluation;
The AIDS Resource Center of Wisconsin (ARCW) and a private vendor developed a computerized case management system that is consistent with the approved practice standards and forms. The system assists case managers to coordinate client services, and to manage time and record keeping more effectively and efficiently. All designated ASOs are implementing the computerized case management system. The system will also enhance the capacity of ASOs to collect and analyze case management data.
Advances in treatment of HIV disease, including combination therapy, have had a significant impact on HIV case management. Now more than ever, it is crucial that persons with HIV have access to treatment. Case managers continue to play an important role in linking clients to medical care and to programs such as Medical Assistance, the AIDS/HIV Health Insurance Premium Subsidy Program and the AIDS/HIV Drug Assistance Program. Case managers also have a role in helping clients to adhere to their treatment regimens, in part by addressing underlying needs such as housing, transportation and child care. As persons with HIV live longer, healthier lives, issues surrounding prevention of transmission of HIV may resurface. Case managers can assist clients with prevention information, and when appropriate, refer clients to more intensive services through prevention case management. Finally, case managers continue to assist clients who cannot tolerate or do not benefit from new therapies.
The AIDS/HIV Program ASOs, CBOs and the clients they serve must continue to work together to ensure that the life care services case management program continues to effectively address the changing needs of persons living with HIV disease.
For more information about HIV life care services, contact Michael McFadden at 608/266-0682 or the local ASO office.
Authorization for HIV early intervention grants was included in the Wisconsin state fiscal year (SFY) 94/95 biennial budget. Early intervention funds, which are part of the State's life care services appropriation, are awarded to the five regional Wisconsin ASOs. The Wisconsin ASOs have been selected to provide HIV early intervention services because they provide a strong link to life care services, the AIDS Drug Assistance Program, AIDS/HIV Health Insurance Premium Subsidy Program, and other supportive services.
The Wisconsin AIDS/HIV Program recognizes that there are a variety of service delivery models for HIV early intervention programs. These models vary in many ways, including the type and scope of services provided, the target populations served, and the manner in which services are delivered. State general purpose revenue (GPR) funds for early intervention services are limited and are targeted for services which can effectively and efficiently reach those in greatest need. Because not all early intervention services and service delivery models can be funded with GPR funds, grantees are encouraged to seek other sources of funding to increase the capacity and the scope of early intervention services in local communities. This includes collaborating with local community health centers, the Ryan White Title III program, the University of Wisconsin Department of Family Medicine-Family Practice Residency Program, local health departments, and private physicians.
Agencies receiving GPR HIV early intervention funds are expected to integrate and coordinate state funded early intervention services with related HIV programs and resources. Such programs include but are not limited to case management, the Wisconsin HIV Drug Assistance Program, the AIDS/HIV Health Insurance Premium Subsidy program, and partner counseling and referral services. Services are coordinated by the ASOs and provided by local physicians, ASO nurses, and case managers.
The primary objective for state-funded HIV early intervention programs is to ensure early and prompt access to needed HIV-related health services for HIV positive persons. This includes:
- Prompt referral to a primary care physician;
- Providing risk reduction counseling to support HIV-related risk-reducing behaviors, and;
- Providing mental health screening to ensure prompt referral to mental health professionals as indicated.
HIV early intervention funds support the following early intervention services:
1. Primary health care services for HIV positive persons to include:
- Verification/confirmation of HIV status
- Comprehensive history and physical assessment
- Ongoing immune status monitoring
- Referral to primary care physician
- Referral for specialized medical services
2. Risk reduction counseling and education for HIV positive persons
- Referral for substance abuse counseling
- Referral for counseling related to high risk sexual behavior
Mental health screening and/or assessment for HIV positive persons to include:
- Referral for specialized mental health services
- Referral to community mental health services
Agencies receiving state HIV early intervention funds are required to ensure that the following services are provided to all HIV early intervention clients either directly or through subcontracts with health care providers:
- Comprehensive history, physical assessment
- T cell subsets
- Viral load testing
- TB skin test
- Appropriate vaccines
- Lab tests indicated by history and physical
The following areas are priorities for HIV early intervention programs:
- Increased TB screening and follow-up
- Increased STD screening and follow-up
- Increased utilization of partner counseling and referral services
- Integration of early intervention services with prevention case management
For more information about HIV early intervention services available in an area, contact Michael McFadden at 608/266-0682 or the local ASO office.