Building Client Rapport and Trust - NASTAD Heal… · 7 Presentation title His Health •We recognize how stigma, discrimination, and medical mistrust act as tremendous barriers to

Building Client

Rapport and Trust:

Leveraging Linkage to Care to Bridge the Patient Provider Gap

June 28, 2016

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His Health, Too

Presenter

Terrell Parker, BA, Program Manager,Brothers United

His Health

Presentation title

Agenda

1. His Health Background

2. Brief overview of The Damien Center/Brothers United Linkage to Care (L2C) Program

3. Discuss peer-professional model and its role on building client trust

4. How to understand when trust is gained

5. Question and Answer

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His Health

Background

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Presentation titleHis Health

• His Health is a united community of advocates and healthcare providers passionately committed to raising the standard of care for black gay men.

• We believe that shifting the HIV epidemic among black gay men is a shared responsibility for patients, providers, and administrators operating at every level of our nation’s health care systems.

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His Heath will launch in the summer of 2016

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Presentation titleHis Health

• We recognize how stigma, discrimination, and medical mistrust act as tremendous barriers to good health for many black gay men.

• To restore trust, we must break down silos and foster better communication between black gay men and care practitioners.

• To grow strong, we must work together.

The Damien Center / Brothers United

Linkage to Care (L2C) Program Overview

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• L2C provides individualized, long-term, one-on-one support for central Indiana’s highest needs clients living with HIV

• 3.5 year research project supported by John’s Hopkins University

• Began in 2013 through joint funding from AIDS United and The Health Foundation of Indianapolis, Indiana AIDS Fund

• Partnership with Brothers United, Women in Motion, and Indiana Latino Institute

• Re-engaged 187 people in HIV medical care and supportive services

• Average health status of clients at enrollment:

• 216 cells/µL CD4 Count and 52,000 RNA copies/mL Viral Load

• Average current health status of clients:

• 528 cells/µL CD4 Count and 10 RNA copies/mL Viral Load

L2C Overview

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L2C Overview

100% 100%91% 91%

70.60%82%

66%

37% 33%25%

0%

20%

40%

60%

80%

100%

120%

ENROLLED LINKED TO CARE RETAINED IN CARE PRESCRIBED HAART SUPPRESSED VIRALLOAD

Damien L2C/National HIV Treatment Cascade

Damien L2C Treatment Cascade National HIV Treatment Cascade

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Male60%

Female23%

MtF10%

Other7%

Sex

L2C Demographics

18-193%

20-2424%

25-2920%

30-3025%

40-4917%

50+11%

Age

Black49%

White31%

Hispanic12%

Multi-Racial

7%

Other1% Race

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L2C Demographics

Less than High

School

High School

Diploma or GED

Some College or Technical

School

College or Higher

Education

Education

$0-4,999

$5,000-9,999

$10,000-14,999

$15,000-19,999

$20,000-29,999 $30,000-

39,000

Income

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1How Building Client Rapport

Leads to Success in Linkage :

The Power/Challenge of the Peer Professional Model

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Challenges

Ways to Address Challenges

Agencies competing for same funding sources and client base

Meet with management and staff, local and state health departments

Community may be unfamiliar with Linkage to Care –

How does it differ from EIS? Care Coordination?

Provide clear explanation of program goals

Identify commonalities – what shared goals exist?

HIPPA concerns

Be prepared to address patient safety concerns

• Partnership amongst The Damien Center, Brothers United, Women in Motion, and the Indiana Latino Institute

• Specifics focus on populations with low linkage to care rates/ low viral suppression rates

• Black Gay/Bi-Sexual Men & Transwomen (BU)

• Black Women (WIM)

• Latino Community (ILI)

• Teens (Damien Center)

Linkage to Care Specialists must reflect the communities they serve…..

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• Are they truly reflective of the community they serve or what you think is acceptable?

• Black MSM

• 24 Years Old

• Bachelors Degree – English & Sociology

• Fully-Integrated into the LGBT community

• Strong communication skills

• Positive reputation within the community

• Care and compassion for others

What to look for in a Linkage Specialist?

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• Challenges








HIPPA concerns


Knowledge and understanding of unique community challenges• Ballroom Culture • Pageantry • New Trends –i.e. Meth Use

Relatability• Shared lived experiences –Not having to repeat every story • Understanding of stigma/trauma specific to this community • Lingo/Language (on tour, date popping, etc.)

Access to the Community low linkage to care rates/ low viral suppression rates

Benefits of a peer-professional model

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Challenges








HIPPA concerns


Challenges of the peer-professional model

Challenges Solutions

Limited experience / knowledge of HIVand systems of care

Extensive trainings on HIV, insurance, housing,

Professional Boundaries /Ethical Dilemmas Trainings on ethics, role plays to help inforce training

Living and working in the community Set clear expectations up front –What is allowed? What is not allowed?

Lack of emotional intelligence Training on reflective listening, motivational interviewing, role plays

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• What boundaries must be set with clients?

• No engagement during personal time

• Strictly professional relationship

• What happens when clients make advances towards you?

Ethical Dilemmas & Boundaries

• Should someone I know personally be a client of mine?

• How do I respond if people ask me do I know this person?

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Motivation Interview & Communication

Communication

• Understanding

• Non-judgmental

• Reflective listening

Motivational interviewing helps you ask the questions that will elicit deeper responses and results from

your clients and patients. Motivational interviewing is a method that works on facilitating and engaging

intrinsic motivation within the client in order to change behavior. MI is a goal-oriented, client-centered

counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.

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Building Trust: One person at a time

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-First Impressions

-Person-Centered

Approach

-Expertise &

Dependability

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Meet Jacob…

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• Challenges








HIPPA concerns


• 23 Years Old

• Black

• Gay

• Male

• Walk-In – “I heard you need help with housing”

• Recently moved to Indianapolis from Chicago – 6 months

• Broke up with his partner, now homeless

• Has not been on medication since moving to Indianapolis

• No medical insurance

• Currently seeking employment

linkage to care rates/ low viral suppression rates

Who is Jacob…. On the Surface?

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Why do first impressions matter?

• Trauma Informed Care: “Trauma informed care is often described as a lens or framework to deliver

medical care. Why? Because practicing trauma informed doesn't mean checking off boxes mindlessly or

screening patients for emotional distress only to meet a requirement. ”

Goals of the Initial Appointment:• Build and bond a rapport with the client –Will the client feel comfortable using my number? • Help the client feel safe “Everything will be okay.”• Get accurate contact information / schedule appointment

Small tips:

No Cell phone / distractionsBreak up the isolation: Don’t sit behind a desk Everyone has something in common, right? Can you find something in common? Music? Food? TV Show? Don’t immediately rush to talk about HIV Is your environment comfortable? Don’t be afraid to be the example

First visits can make or break your working relationship!!

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to Address Challenges







HIPPA concerns


How do you accomplish a successful first visit?

Meet clients where

they areKnow of

community resources to

address COMPOUNDING barriers to care

Ask the right question, in

the right way, at the right

timeFocus on addressing

CLIENT’S top barrier to

care

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Most people just want

to be heard… how

good are your

listening skills?

• Experiments with recreational drugs

• Has engaged in survival sex

• Has a history of mental health challenges

• Aspires to be a writer• Wants to go back to

school • Has a close

relationship with his grandmother

• Loves Beyonce, Rihanna, and Fantasia

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Trust is Earned… You must do the work and stay committed

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Help clients IDENTIFY and PRIORITIZE barriers to care and risks to maintainencein care

If a client’s basic needs aren’t being met,

how do we expect them to successfully

engage and maintain in HIV medical care?

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Barrier Baseline At Case Closure

Lack of transportation 51.01% 15.09%

Forgot to attend appointment(s) 44.97% 24.53%

Inability to pay for treatment (lack of understanding insurance

options)

35.57% 3.77%

Unsure where to access HIV care 32.89% 3.77%

Denial 31.54% 9.43%

Mistrust of the medical system 21.48% 3.77%

Feeling too healthy to seek care 20.13% 1.89%

Understand Client’s Challenges of Engagement

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Once clients feel you are working with them, and see progress… Your trust will grow!!

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• You become crisis manager / the expert on everything –set boundaries

• They begin to get personal…. Sometimes too personal

• They begin to reveal their distrusts of the medical system

• Word of mouth spreads…. Referrals!!!

“I know this really great guy who will remind you about your appointments and even come to your house to pick you up!!”

How do you know when trust is gained?

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How do we leverage this trust?

• Help clients feel more comfortable with a medical provider

• Break down mental health stigma

• Help with Medication Adherence / Helping clients understand medication changes (be there during the first pill)

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• Created 6 month plan of action with client to address initial barriers

• Assisted client in re-engaging in HIV medical care

• Provided transportation and support during medical and supportive service appointments

• Assisted client with job search and resume

• Provided transportation to job interviews

• Helped client apply for HOPWA Assistance

• Helped client reengage in mental health services

• Connected clients to support groups to discuss substance use

Jacob’s Plan??

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• Client re-engaged in medical care and was prescribed HAART within 90 days

• Client gained stable employment within three months

• Client became virally suppressed within 6 months

• Client continued to engage in survival sex until he was arrested for prostitution and feared prosecution because of non disclosure.

• Client’s viral load rose again

• Client gained stable housing after 9 months

• Client reached viral suppression 3 months after his initial viral load spike

Results

NEW SLIDE

Imagery can help bring

your slide to life

Questions?

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Contact info:

Terrell Parker, BA

[email protected]

Omoro Omoighe, Associate Director Health Equity/Healthcare Access, NASTAD

[email protected]

Thank you!

mailto:[email protected]

mailto:[email protected]

Documents

Building Client Rapport and Trust - NASTAD Heal… · 7 Presentation title His Health •We recognize how stigma, discrimination, and medical mistrust act as tremendous barriers to