OVERVIEW - HIV HEALTH SERVICES PERFORMANCE OBJECTIVES FY

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2 Performance FY 07-8 HIV Health Services OVERVIEW - HIV HEALTH SERVICES PERFORMANCE OBJECTIVES FY 07-8 Measuring client improvement and successful completion of target objectives is an important part of DPH contracting. The HIV Health Services (HHS) and Development and Technical Assistance (CDTA) sections have been working this past year to create a group of performance objectives that are standardized across most service categories. Our goal was to build from current objectives, and create meaningful, measurable, demonstrable objectives that will accurately reflect the good work that you provide to your clients, and will lead to a clearly understood and interpreted review of performance in meeting objectives. These performance objectives are effective on the first date of the contract year for For example, contracts with Ryan White funding are required to begin using the new objectives on March, 07, and contracts with General Fund dollars are required to begin using the new objectives on July, 07. s that contain more than one source of funding are required to begin using the new objectives on whichever funding cycle is earliest: in most cases this will be March, 07. If you are unsure as to when the new objectives are effective for your program please call the CDTA Program Manager assigned to your contract. Not all objectives apply to all programs. Providers should review this document carefully to determine the objectives that are applicable to the funded program(s). ors are responsible for compliance with all applicable items in the Performance and the Declaration of Compliance. All DPH Performance may be located at: under the link " Development Documents" i.

3 3 4 HIV Health Services Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 70% of HIV+ clients (primary care documented in ARIES) will have had two or more medical visits during the year (one in the first half and the other in last half of the year). 85% of clients with HIV (Primary Care documented in ARIES) who received primary care services will have been prescribed ART. Enrolled 6 months Enrolled 6 months ARIES (or other HHS apprvd database) report of documentation required in client database ARIES report of documentation required in client database TES. % may vary; program s CDTA Program Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BOCC. Evaluate & is "Medical Visit Indicator" in ARIES/HRSA HIV/AIDS Bureau (HAB) Quality Mngmt (QM) Report TE: Objective not applicable to DPH-JHS- HIV-IS, City Clinic, and HIVE. % may vary; program s CDTA Program Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BOCC.. Evaluation & is "Medications" checkbox in STAR Report. TE: UC PHAST Program goal is 55% 5 90% of clients with HIV who received primary care services (documented in ARIES) will have had at least one viral load test. Enrolled 6 months ARIES report of documentation required in client database. % may vary; program s CDTA Program Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BOCC.. Evaluation & is "Viral Load Test Table" filtered by primary care services in ARIES STAR Report created 3/8/8, revised 7/6/8 3

4 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES 6 70%, of clients (Primary Care documented in ARIES) will have a viral load < 00 copies/ml which will indicate viral suppression and treatment adherence. 3 Enrolled 6 months ARIES report of documentation required in client database. % may vary; program s CDTA Program Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BOCC.. For Medical Case Management rate is 75% of clients on HAART. 3. Evaluation & ment is the "Cross Tab Wizard" Report TE: UC PHAST Program goal is 50% 7 80% of clients with HIV (Primary Care documented in ARIES) and a CD4 T-cell count 00 cells/mm3 will be prescribed PCP prophylaxis. All Primary Care with T-cell Counts below the threshold ARIES report of documentation required in client database. Evaluate & is "Fix-It PCP Prophylaxes " Report TE: Objective not applicable to DPH-JHS- HIV-IS, City Clinic, and BAPAC-HIVE; UC PHAST Prog goal is 75% 8 70% of clients with HIV who received primary care services (documented in ARIES) will be tested for syphilis, with results documented. Enrolled 6 months ARIES report of documentation required in client database. % may vary; program s CDTA Program Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BOCC.. Evaluate & is "STI / Hepatitis checkbox" in the STAR Report created 3/8/8, revised 7/6/8 4

5 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES 9 60% of clients with HIV who received primary care services (documented in ARIES) will have been screened for Hepatitis C. Enrolled 6 mos., except those who previously tested HepC+ ARIES report of documentation required in client database. % may vary; program s CDTA Program Manager to discuss with HHS; if lower % approved, separate agreement signed; shared with HHS & BOCC.. Evaluation & ment is "Hep C Screen since HIV Dx Indicator" in ARIES RSR. Values of "Hep C Screen since HIV Dx Indicator" for Yes & Not Medically Indicated qualify as screening & should be added to calculate 60% compliance 0 80% of clients identified as out of care will be linked to primary care (documented in ARIES) as measured by attendance at a medical appointment 30 days of being identified as out of care. All clients who are out of care ARIES - Programs will provide a list of out of care clients. % may vary; program s CDTA Program Manager to discuss with HHS; if lower % approved; separate agreement signed; shared with HHS & BOCC. Out of Care = any client that hasn't had primary care appt. 3 or more mos. apart Also applies to SEHC 90% of clients will be assessed for mental health and substance use treatment needs 30 days of program enrollment. All New Also applies to SEHC created 3/8/8, revised 7/6/8 5

6 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES 80% of individualized service plans will be developed 90 days of initial client intake. All -include acuity scale, harm reduction & tx plan. Comprehensive individualized plan includes Mental Health & Substance Use assessment. Tx plan signed by client and clinician Also applies to SEHC 3 80% of individualized service plans will be updated at least every 6 mos. All -include acuity scale, harm reduction & tx plan. Comprehensive individualized plan includes Mental Heath & Substance Use assessment Also applies to SEHC 4 90% of residents will be adherent to their treatment regimen. All Residents Medication logs. % may vary; program s CDTA Program Manager to discuss with HHS. If lower % is approved, separate agreement signed, shared with HHS & BOCC 5 No more than 0% of unduplicated mental health clients will be lost to follow-up. All New Receiving Services 6 Months. Lost to follow-up = one who assigned clinician has been unable to contact or locate after several attempts (does not include clients who declines services in favor of others, relocate outside service area, or are deceased) Also applies to SEHC created 3/8/8, revised 7/6/8 6

7 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 90% of residents will have an "End of Life Plan" and documentation will exist prominently in resident's chart. All Program TES Applicable to Maitri AIDS Hospice 7 90% of applicable resident records will contain documentation that referral has been made to the Alliance Health Project Dementia Team for evaluation. Patients with Dementia Symptoms Applicable to Maitri AIDS Hospice. symptoms that impact physical or mental health, or pose a risk of falls or elopement 8 70% of clients will experience a stabilization or decrease in pain resulting from implementation of the pain management plan. All Receiving Pain Meds, client self report Applicable only to Maitri AIDS Hospice and DPH Health at Home. % may vary; program s CDTA Program Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BOCC. Pain is assessed at entry to the program and at least every 60 days TE: Health at Home Goal is 50%. created 3/8/8, revised 7/6/8 7

8 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 80%¹ of clients who agree to obtain medical care will receive a primary care evaluation visit within 4 weeks of testing positive or being identified as "out-of-care".² HIV+ Out-of-Care MNHC Data and ARIES - Program provides list of clients out of care TES Applicable to MNHC HIV Treatment,, Linkage Program; and DPH SEHC Bridge Project. % may vary; program s CDTA Program Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BOCC. A client identified as "out of care" is one who hasn't had at least primary care appts 3 mos. apart. TE: MNHC Goal is 75%. 0 80% of clients who do not agree to obtain medical care will receive a follow-up contact within one week; if the client allows, follow-up will continue on a monthly basis until the client engages in medical care. HIV+ Out-of-Care who've not yet Agreed to Receive MNHC Charts and Data, and ARIES Applicable to MNHC HIV Treatment, and Linkage Program and DPH SEHC Bridge Project 60% of clients that receive a primary care appt will remain engaged in primary care and will return for at least one follow-up primary care appointment. HIV+ Receiving Primary Care at MNHC MNHC Charts and Data, and ARIES Applicable to MNHC HIV Treatment, and Linkage Program and DPH SEHC Bridge Project created 3/8/8, revised 7/6/8 8

9 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 50% of clients accessing HIV Testing for whom a referral for medical, mental hlth, or substance abuse counseling services is indicated, and who are willing to accept the referral, will have accessed the service. 75% of HIV+ clients diagnosed with diabetes will achieve blood sugar control of 9 on the Hemoglobin AC blood test (HgbAC 9). Program that Obtain an HIV Test HIV+ with Diabetes Tracking Sheet or Summary of MNHC Follow-Up Notes Agency Report from Internal Database of AC blood test TES Applicable to MNHC HIV Treatment, and Linkage Program. Applicable to MNHC and UC 360 Positive Care Center Nutrition Services 4 90% of clients will develop an individual plan to access entitlement programs and other available resources. All Program Applicable to PRC Prog & AF Services TE: HRSA Categories are Non Medical Case Management & Referral for Healthcare and Supportive Services created 3/8/8, revised 7/6/8 9

10 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES 5 60% of clients who complete the Satisfaction Survey will report a decreased level of stress since attending/participating in the program. Completing Annual Survey Agency Report on Responses of Decreased I Feel Less Stress Now Applicable to Shanti Emotional and Practical Support Prog and UC 360 Positive Care African American HIV Men's Support Group (objective is in addition to other unique objectives for each prog) 6 95% of clients will exhibit an improvement of the dental condition due to the dental disease being managed. All Receiving Dental Procedure & Completing a Tx Plan Randomly Audited Records (paper or electronic) Applies to UOP Dental & DPH HIV Dental. Sample size = 0 or 0% of annual UDC, whichever is smaller; list of random clients created via ARIES or other process; clients tracked by anonymous, unique ID; report on meeting goal for each client 7 80% of clients surveyed will report Ease of Scheduling My Appointment as rating 3, or as scored Good or "Excellent". All Receiving Dental Procedure & Completing a Tx Plan Randomly Audited Records (paper or electronic) Applies to UOP Dental & DPH HIV Dental. Sample size = 0 or 0% of annual UDC, whichever is smaller; list of random clients created via ARIES or other process; clients tracked by anonymous, unique ID; report on meeting goal for each client created 3/8/8, revised 7/6/8 0

11 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 80% of clients surveyed will report How My Proposed Treatment was Explained to Me as rating 3, or as scored Good or "Excellent". 80% of clients completing a survey will show an improvement in oral health through an improvement in overall quality of life as rating 3, or as scored Good or "Excellent". All Receiving Dental Procedure & Completing a Tx Plan All Receiving Dental Procedure & Completing a Tx Plan Randomly Audited Records (paper or electronic) Randomly Audited Records (paper or electronic) TES Applies to UOP Dental & DPH HIV Dental. Sample size = 0 or 0% of annual UDC, whichever is smaller; list of random clients created via ARIES or other process; clients tracked by anonymous, unique ID; report on meeting goal for each client Applicable to DPH HIV Dental Program. Sample size = 0 or 0% of annual UDC, whichever is smaller; list of random clients created via ARIES or other process; clients tracked by anonymous, unique ID; report on meeting goal for each client 30 80% of clients completing a survey will show an improvement in oral health through a reduction or elimination of pain/discomfort as rating 3, or as scored Good or "Excellent". All Receiving Dental Procedure & Completing a Tx Plan Randomly Audited Records (paper or electronic) Applies to UOP Dental & DPH HIV Dental. Sample size = 0 or 0% of annual UDC, whichever is smaller; list of random clients created via ARIES or other process; clients tracked by anonymous, unique ID; report on meeting goal for each client created 3/8/8, revised 7/6/8

12 Performance FY UNIQUE PROGRAM OBJECTIVES Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 95% of valid client requests for Emergency Assistance payments to 3rd party vendors will be processed within 0 business days after completion of client file documentation. 95% of valid client requests for Eviction Prevention payments to 3rd party vendors will be processed within 5 business days after completion of client file documentation. AEF services will prevent eviction of at least 40 clients. All All All Agency Report via internal monthly and quarterly reports TES Applicable to AIDS Emergency Fund Applicable to AIDS Emergency Fund Applicable to AIDS Emergency Fund 35 AEF services will enable at least 40 clients to move into permanent affordable or subsidized housing. All Agency Report via internal monthly and quarterly reports Applicable to AIDS Emergency Fund 36 ALRP will provide at minimum 8 legal trainings or seminars to probono attorneys. Pro-bono Attorneys Training Logs Applicable to ALRP HIV Legal Services: Advocacy Program created 3/8/8, revised 7/6/8

13 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES 37 ALRP will maintain a baseline of 380 active Panel Attorneys by recruiting 5% of its baseline to address attrition and expand its capacity in areas of law with the greatest client demand for services. Panel Attorneys Agency Report Applicable to ALRP HIV Legal Services: Advocacy Program 38 ALRP will conduct 4 outreach presentations to community based organizations and client groups on rights of people with HIV/AIDS. Community and Groups Tracking Files Applicable to ALRP HIV Legal Services: Advocacy Program 39 90% of cases in which there is no legal remedy will be referred for a nd opinion and/or to an appropriate HIV/AIDS provider, or to another system of care to support the client through resolution of the issue. Cases in which ALRP Determines No Legal Remedy Applicable to ALRP HIV Legal Services: Advocacy Program 40 85% of closed cases will be successfully resolved. All Closed Cases Agency Report on Review of 00 Cases from Tracking Logs and Database Applicable to ALRP HIV Legal Services: Advocacy Program. Successful resolution defined as drafting client's legal documents, resolving dispute, or exhausting reasonable legal avenues created 3/8/8, revised 7/6/8 3

14 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES 4 HCAP attorney participates in 6 continuing education training sessions related to active listening, mediation of consumer grievances, harm reduction, working with individuals with mental hlth issues, and other topics as needed. HCAP Attorney N/A for Training Logs Applicable to ALRP HIV Consumer Advocacy Project (HCAP) 4 HCAP Attorney conducts consumer outreach presentations and outreach presentations to HIV/AIDS service providers. HIV Consumers and Providers Logs Applicable to ALRP HIV Consumer Advocacy Project (HCAP) % of HIV consumers served will be residents of ; 5% may be residents of San Mateo and/or Marin. 80% of provider attendees of ALRP HCAP outreach presentations will report that presentation was relevant & useful to work with clients. HIV Consumers of Local EMA Attendees at presentation Program Database Agency Attendance Lists and Survey Results Applicable to ALRP HIV Consumer Advocacy Project (HCAP) Applicable to ALRP HIV Consumer Advocacy Project (HCAP) created 3/8/8, revised 7/6/8 4

15 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES 45 85% of respondents to the survey will report they were "satisfied with the service received from the HCAP Attorney". Consumer Respondents of Survey Agency Summary Report of Annual Survey Applicable to ALRP HIV Consumer Advocacy Project (HCAP) 46 < 0% of residents will need to be transferred to a higher level of care in order to meet their needs. All Applicable to Catholic Charities Peter Claver and Leland Houses; and Dolores Street Services % of clients with HIV who received primary care services (documented in ARIES) will have had one viral load test. The Youth Advocate will provide 90% Aftercare Program clients in scattered site housing with home visits, and/or practical support visits (going to appts, etc.) per month. Enrolled 6 months Receiving HIV Specialty Svcs 60 Days ARIES report of documentation required in database of client records Applicable to Larkin St Youth Services Applicable to Larkin St Youth Services 49 80% of LSYS HIV+ youth who age out of services (5 yr) will be linked to adult HIV care. HIV+ Youth that Age Out Applicable to Larkin St Youth Services created 3/8/8, revised 7/6/8 5

16 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 80% of youth housed in Assisted Care receiving nursing care or peer advocacy support through HIV Specialty Services will demonstrate increased medication adherence. 75% of clients receiving money management will maintain stability in housing for 6 mos. 90% of clients will be able to retain housing due to guarantee that rent will be paid. HIV+ Youth Enrolled 6 Months All Program Agency Report from Internal Database; Files (physical or electronic) Program Entry, Updated Quarterly, Reprtd at FY End TES Applicable to Larkin St Youth Services Applicable to Lutheran Social Services Money Management Applicable to Lutheran Social Services Money Management 53 55% of unduplicated clients referred by the DPH will respond to the annual client satisfaction survey. All Program Agency Summary Report of Annual Survey Applicable to Native American Hlth Center Dental Prog (patients referred from DPH dental svcs). This objective is in place of other dentistry services standardized objectives % of those who complete a survey will report that the dental issue they were referred for by DPH was addressed in a satisfactory manner. Surveyed Agency Summary Report of Annual Survey Applicable to Native American Hlth Center Dental Prog (patients referred from DPH dental svcs). This objective is in place of other dentistry services standardized objectives. created 3/8/8, revised 7/6/8 6

17 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES 55 85% of client cases in which claims for benefits have been filed and have been fully adjudicated by program representation will result in a favorable decision or an award. Who Filed Benefits Claims & Which Have Been Fully Adjudicated Annual Agency Self Report to HHS and BOCC Applicable to Positive Resource Center Program. Agency Report includes % of claims awarded at initial, reconsideration, Admin Law Hearing, or Appeals level; decisions at same, and for Continuing Disability Reviews; by proof of awardnotice received from SSA, or documented in SSA or CalMED data 56 30% of clients who develop an Individual Service Plan will receive authorizations to work with a Dept. of Rehab. Vocational Counselor on an Employment Plan. Who Develop an ISP Applicable to Positive Resource Center Employment Services Program 57 70% of clients who develop an Individual Service Plan will enroll in single or multi-session trainings designed to increase capacity to become employed. Who Develop an ISP Applicable to Positive Resource Center Employment Services Program 58 5% of clients who develop an Individual Service Plan will secure a permanent or temporary full-time or part-time job placement. Who Develop an ISP, client self report Applicable to Positive Resource Center Employment Services Program created 3/8/8, revised 7/6/8 7

18 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have The Employment Specialist will track client income and benefits before and after securing a permanent placement to quantify the impact of employment, for 00% of clients securing a permanent placement. POH will provide at least one nutrition education opportunity to all clients in the program. POH will measure engagement rates of clients with 6 months of service. 60% of clients who return the survey will report "program helps maintain or improve my health". 60% of clients who return survey will report "nutrition education increased my knowledge of nutrition in addressing HIV and overall health". Who Secure a Permanent Placement All HIV+ All HIV+ HIV+ Completing Annual Survey HIV+ Completing Annual Survey Agency Database Records Survey Results Survey Results TES Applicable to Positive Resource Center Employment Services Program Applicable to Project Open Hand Applicable to Project Open Hand Applicable to Project Open Hand Applicable to Project Open Hand created 3/8/8, revised 7/6/8 8

19 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 75% of clients served with a comprehensive evaluation will demonstrate receipt of, or will be in process of receiving eligible benefits. 90% of clients referred for services will be evaluated for psychosocial services, long range plans, and end of life decisions. 70% of active clients will maintain or improve function in ambulation, bathing, dressing, grooming, and transferring. 90% of clients in the Treatment Adherence Program will demonstrate adherence to the medication regimen prescribed. Receiving Comp Evaluation All All Program All clients of Treatment Adherence Program, client self report, or client self report Records-all Rx Meds Taken Documented TES Applicable to AF Non Medical Case Management & Services Applicable to DPH Health at Home Program Applicable to DPH Health at Home Program Applicable to DPH Health at Home Program 68 00% of clients exhibiting signs and symptoms of substance abuse or mental illness will be referred to a provider best suited to their needs. All Program Applicable to DPH Health at Home Program created 3/8/8, revised 7/6/8 9

20 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have Lab staff will conduct initial screening and complete confirmatory HIV test of specimens 5 working days. Tests Performed achievement utilizing lab database TES Applicable to DPH Microbiology Lab. Lab performs confirmatory testing on all preliminary positive test results 70 95% of HIV Viral Load specimens are processed, tested, and results are reviewed and reported by Sr. Microbiologist 7 business days from specimen collection date. Tests Performed Testing Accuracy per Nat'l Proficiency Testing Program Scoring 80% Applicable to DPH Microbiology Lab 7 70% of clients with HIV (Primary Care documented in ARIES) will have had two or more medical visits at least 3 months apart. Enrolled 6 months ARIES report of documentation required in client database Applicable to DPH Multi-Diagnosis Castro-Mission HC 7 85% of clients with HIV who received primary care services (documented in ARIES) will have had at least one viral load test. Enrolled 6 months ARIES report of documentation required in client database Applicable to DPH Multi-Diagnosis Castro-Mission HC. Evaluation & is "Viral Load Test Table" filtered by primary care services in ARIES STAR Report created 3/8/8, revised 7/6/8 0

21 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES 73 70% of clients on HAART (Primary Care documented in ARIES) will have a viral load 00 copies/ml which will indicate viral suppression and successful treatment adherence. Enrolled 6 months ARIES report of documentation required in client database Applicable to DPH Multi-Diagnosis Castro-Mission HC. Evaluation & ment is "Viral Load Values Table" filtered by primary care services in QM HAB Report TE: UC PHAST Program goal is 50% 74 90% of clients will be assessed for mental health and substance use treatment needs 30 days of program enrollment. All New Applicable to DPH Multi-Diagnosis Castro-Mission HC 75 90% of clients assessed as eligible for SSI Disability will have the SSI evaluation written within weeks of the initial assessment. Eligible for SSI Disability Benefits List of SSI Disability eligible clients & monthly stat form Applicable to DPH South Van Ness Adult Behavioral Health Services 76 Food Bank will maintain an average product nutrition rating of.5 on a scale of 0-3 based on nutrient content provided by Nutrition Facts Label. Inventory Available to Agencies Funded by HHS nutrition evaluation tool: CHEW (Choosing Healthy Eating Well) Applicable to Food Bank created 3/8/8, revised 7/6/8

22 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 75% of the HHS funded agencies will report that food received helps their clients meet nutritional needs in response to a provider satisfaction survey. The AIDS/HIV Nightline will conduct outreach to 5 San Francisco service agencies doing HIV/AIDS work. The AIDS/HIV Nightline will exhibit at or participate in two community events. HHS-funded Service Providers Receiving FB Food Not Applicable Not Applicable Agency Summary Report of Provider Satisfaction Survey documentation, i.e., sign-in sheets, confirmatory letters from CBO, demonstration of participation documentation, i.e., sign-in sheets, confirmatory letters from CBO, demonstration of participation TES Applicable to Food Bank Applicable to Suicide Prevention Nightline (in BHS ) Applicable to Suicide Prevention Nightline (in BHS ) 80 The AIDS/HIV Nightline will respond to,05 calls from PLWH/A Not Applicable Call Logs Applicable to Suicide Prevention Nightline (in BHS ) created 3/8/8, revised 7/6/8

23 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have The AIDS/HIV Nightline will complete volunteer training classes assuring each new volunteer receives 60 hours of training. 75% of new clients seeking practical and/or emotional support are matched to staff or a volunteer within 5 business days. 70% of clients will report a decreased level of isolation since being connected with program staff or volunteers. 60% of clients will report an increased level of self sufficiency since being connected with program staff or volunteers. 60% of clients will report a decreased level of stress since engaging with the program. New Volunteers New Completing Annual Survey Completing Annual Survey Completing Annual Survey Training Attendance Logs Responses of "Decreased - I feel less isolated now" Responses of "Increased - I feel more self-sufficient now" Responses of Decreased I feel less stress now TES Applicable to Suicide Prevention Nightline (in BHS ) Applicable to Shanti Emotional and Practical Support Applicable to Shanti Emotional and Practical Support Applicable to Shanti Emotional and Practical Support Applicable to Shanti Emotional and Practical Support: Senior Survivor Support Program created 3/8/8, revised 7/6/8 3

24 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 70% of clients will report a decreased level of isolation since being connected with the program. 60% of clients will report an increased sense of community since being connected with the program. Program will generate and review a list of clients not engaged in Primary Care and will follow-up with the identified clients on a quarterly basis. The Director reviews timelines in the Comprehensive Plan to ensure topics for discussion are included on appropriate meeting agendas in a timely manner. Completing Annual Survey Completing Annual Survey All not Engaged in Primary Care Not Applicable Responses of Decreased-I feel less isolated now Responses of Increased-I feel more connected to community now ARIES Report Steering Committee Retreat Calendar TES Applicable to Shanti Emotional and Practical Support: Senior Survivor Support Program Applicable to Shanti Emotional and Practical Support: Senior Survivor Support Program Applicable to Shanti Medical Case Management Program. Prog must retain all generated quarterly ARIES reports for review by BOCC. TE: Case Manager coordinates with RN(subcontractor) quarterly for follow up by the Peer Advocate. Applicable to Shanti Planning Council Support created 3/8/8, revised 7/6/8 4

25 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have The Director coordinates various presentations to the Planning Council to ensure the materials and information reviewed fulfill all legislative requirements and council directives. All new Planning Council members are provided Orientation Training at the beginning of their terms. 3 additional skills-development trainings are provided to new and continuing members in subjects which may include, but are not limited to: The Planning Council Director participates in the evaluation of success in meeting goals of the Comprehensive Plan and provides a written report to Plan Council members each year. Not Applicable HIV Community Planning Council Members HIV Community Planning Council Members Presentation Summary during Prioritization and Allocations process Program Documentation - Training Logs Program Report to Council TES Applicable to Shanti Planning Council Support Applicable to Shanti Planning Council Support. Robert's Rules of Order, Rules of Respective Engagement, Privacy Rights, Cultural Humility, Chairing/Leading Meetings, other trainings identified by the PC Director.. No site visit required; PC Director prepares written report for HHS Applicable to Shanti Planning Council Support. No site visit required; PC Director prepares written report for HHS created 3/8/8, revised 7/6/8 5

26 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have All Planning Council members receive ongoing core competency training in areas identified by the Training Needs Analysis to be conducted and updated by the Training and Evaluation Coordinator. HIV Community Planning Council Members Program Documentation - Training Logs Calendar TES Applicable to Shanti Planning Council Support 94 80% of treatment of care plans will be developed 90 days of client being assigned to a provider. As Defined by Agency Protocol Records, Call Logs Applicable to UC AHP Considering Work Program 95 No more than 0% of UDC will be lost to follow-up within the contract year. As Defined by Agency Protocol Records, Call Logs Applicable to UC AHP Considering Work Program (Note: lost to follow-up defined as one who assigned clinician has been unable to contact or locate after several attempts; does not include clients who decline svcs in favor of others, relocate outside service area or are deceased.) 96 90% of neuropsychological testing findings will be reported to referring provider weeks from completion of neuropsychological testing. As Defined by Agency Protocol Records, Call Logs Applicable to UC AHP Outpatient Mental Health Program created 3/8/8, revised 7/6/8 6

27 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 80% of treatment plans will be developed 90 days of client being assigned to a provider 80% of treatment plans will be reviewed and updated for clients still engaged in care for more than one year. As Defined by Agency Protocol As Defined by Agency Protocol Records, Call Logs Records, Call Logs TES Applicable to UC AHP Outpatient Mental Health Program Applicable to UC AHP Outpatient Mental Health Program 99 No more than 0% of unduplicated mental health clients will be lost to follow-up within the contract year As Defined by Agency Protocol Records, Call Logs Applicable to UC AHP Outpatient Mental Health Program (Note: lost to follow-up defined as one who assigned clinician has been unable to contact or locate after several attempts; does not include clients who decline svcs in favor of others, relocate outside service area or are deceased.) 00 60% of clients who complete a preand post-test OQ-45. Outcome Questionnaire, and who identify problem areas on the pre-test, will improve in one of these areas on the post-test. As Defined by Agency Protocol Records, Call Logs Applicable to UC AHP Outpatient Mental Health Program created 3/8/8, revised 7/6/8 7

28 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES % of clients will report the services received: a. "Helped a great deal" or "Helped somewhat" to deal more effectively with their concerns or problems. b. "Helped very much" or "Helped somewhat" to protect themselves from HIV infection. c. "Helped very much" or "Helped somewhat" to talk to their partners about their HIV infection status. 90% of clients completing 3 months will have received basic HIV disease education from a Nurse Practitioner or RN. who complete a Satisfaction Survey Completing 3 mos. of Service Records, Call Logs Applicable to UC AHP Outpatient Mental Health Program Applicable to UC/DSAAM W % of clients with inconsistent or no primary care will have met with a primary care provider at least once 3 mos. of initiating substance abuse treatment. Referred with Inconsistent or No Primary Care Applicable to UC/DSAAM W93. created 3/8/8, revised 7/6/8 8

29 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 70% of clients identified as needing a mental health assessment will have completed a psychiatric evaluation 6 mos. of initiating substance abuse treatment. 60% of clients will report increased level of understanding HIV treatments and importance of remaining engaged in medical care. A system will be developed to track clients on a wait list for duration on list, primary care status, and linkage to primary care 90% of clients will be assessed for mental health and substance use treatment needs 30 days of program enrolment. Needing Mental Health Assessments Completing Annual Survey on the Wait List All responses: Increased Understanding" of HIV Care and Tx, & "It's Important to see Dr. regularly" data upon request, tabulated on Excel Spreadsheet ARIES report of documentation required in client records database TES Applicable to UC/DSAAM W93. Applicable to UC 360 Positive Care Center African American HIV Men's Support Group Applicable to Westside HIV Home Based Case Management Program Applicable to Westside HIV Home Based Case Management Program created 3/8/8, revised 7/6/8 9

30 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 80% of individualized service plans will be developed 90 days of initial client intake. 80% of individualized service plans will be updated every 6 months 60% of HIV+ clients (primary care documented in ARIES) will have had two or more medical visits during the year (one in the first half and the other in last half of the year). 70% of clients on the wait list that were referred for primary care will be linked to a provider All New All Enrolled 6 months on the Wait List ARIES report of documentation required in client records database ARIES report of documentation required in client records database ARIES report of documentation required in client records database ARIES report of documentation required in client records database TES Applicable to Westside HIV Home Based Case Management Program Applicable to Westside HIV Home Based Case Management Program Applicable to Westside HIV Home Based Case Management Program. Evaluate & via "Medical Visit Indicator" in ARIES/HRSA HIV/AIDS Bureau (HAB) Quality Mngmt (QM) Report. Applicable to Westside HIV Home Based Case Management Program created 3/8/8, revised 7/6/8 30

31 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 70% of clients on HAART (Primary Care documented in ARIES) will have a viral load 00 copies/ml which will indicate viral suppression and successful treatment adherence. 75% of clients served for 0 days will report improved quality of life since the inception of Attendant Care or Homemaker Services. All clients served for 90 days will demonstrate an improved home environment. All active clients will be assessed for Dementia and other cognitive impairments every 60 days. on HAART Served 0 days Served 90 days with Assessments of Home Environment All Active ARIES report of documentation required in client records database, client self report Home Environment Assessment Tool Psychosocial Benefits, Nursing Assess, Svc Plan, Prog Notes & chart review TES Applicable to Westside HIV Home Based Case Management Program. Evaluate & via "Viral Load Values Table" filtered by primary care services in HAB QM Report Applicable to Westside HIV Home Based Case Management Program. RN/SW observation of client and/or client self report in improvement on ability to maintain independent living Applicable to Westside HIV Home Based Case Management Program. Assess client homes for safety, etc.; problems identified & efforts to improve documented by Social Worker in subsequent assessments Applicable to Westside HIV Home Based Case Management Program created 3/8/8, revised 7/6/8 3

32 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES 8 00% of clients exhibiting signs and symptoms of substance abuse or mental illness will be referred to a provider best suited to their needs. All Program Applicable to Westside HIV Home Based Case Management Program 9 PROGRAM OBJECTIVES TRANSITIONED TO HIV HEALTH SERVCES FROM HOUSING AND URBAN HEALTH The Case Manager will confirm that 00% of clients have an individualized service plan in place within 90 days of service enrollment. All clients Agency or database. year Applicable to Catholic Charities - Peter Claver 90% of clients that remain in the program for 60 days will access primary care services at least once during the contract year. All clients in program 60 days Agency or database, including ARIES. year Applicable to: Rafiki - Brandy Moore Case Management HealthRight360 - Planetree Catholic Charities - Rita/Hazel, Derek Silva 3 00% of new clients will have a individualized service plan in place within 30 days of initial assessment. All clients Agency or database. year Applicable to: Rafiki - Brandy Moore Case Mgmt HealthRight360 - Planetree Catholic Charities - Rita/Hazel, Derek Silva created 3/8/8, revised 7/6/8 3

33 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 80% of individualized service plans will be updated at least every 6 months. All clients housed for 6 months Agency or database. year TES Applicable to: Rafiki - Brandy Moore Transitional Housing and Case Mgmt HealthRight360 - Planetree Catholic Charities - Rita/Hazel, Derek Silva 5 00% of individualized service plans will be updated at least every 3 months, or more frequently as the resident's condition worsens. All clients housed for 3 months Agency or database. year Applicable to Catholic Charities - Peter Claver 6 00% of clients will be assessed for all eligible financial and insurance coverage benefits within 30 days of enrollment in the program. All clients Agency or database. year Applicable to: Rafiki - Brandy Moore Transitional Housing and Case Mgmt HealthRight360 - Planetree Catholic Charities - Rita/Hazel, Derek Silva, Peter Claver 8 00% of clients will be assessed for mental health and substance use treatment needs at least once per year. All clients Agency or database year Applicable to: Rafiki - Brandy Moore Transitional Housing and Case Mgmt HealthRight360 - Planetree Catholic Charities - Rita/Hazel, Derek Silva 9 00% of subsidy recipients will have their eligibility recertified at least annually. All clients Agency or database year Applicable to: AIDS Foundation - Rental Subsidies Catholic Charities - Assisted Housing created 3/8/8, revised 7/6/8 33

34 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have During the fiscal year and as documented in, 00% of new subsidy clients will have a housing plan in place within one month of subsidy receipt. < 0% of residents will need to be transferred to a higher level of care in order to meet their needs (Inversely, 90% will not need a hospital admission). 80% of clients who participate in services will accomplish at least one goal established in their individualized services plan. All new clients All clients All clients Agency or database Agency or database A sample of randomly selected client charts will be available for review during monitoring year year year TES Applicable to: Catholic Charities - Assisted Housing Applicable to Catholic Charities - Peter Claver Applicable to: Rafiki - Brandy Moore Transitional Housing and Case Management HealthRight360 - Planetree Catholic Charities - Rita/Hazel, Derek Silva, Peter Claver (Note: PC goal = 75%) created 3/8/8, revised 7/6/8 34

35 Performance FY Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have 75% of clients who are discharged from the program will secure housing appropriate to their needs (e.g., independent/unsubsidized, move-in with family or friends, transition to level of care appropriate for their needs, etc.). 75% of all clients referred for primary care, mental health and/or substance use services will be linked to these services. Within six months of initial subsidy receipt and as documented in client files, the program will stabilize the housing situation of a least 80% of program participants. All clients who exit housing; clients who pass away are excluded All clients All new clients Agency or database Agency or database, including ARIES Agency or database year year year TES. Discharge plan indicates what type of housing client will transition to. Applicable to: AF - Rental Subsidies Rafiki - Brandy Moore Transitional Housing and Case Management HealthRight360 - Planetree Catholic Charities - Rita/Hazel, Derek Silva, Assisted Housing Applicable to: Rafiki - Brandy Moore Transitional Housing & Case Mgmt HealthRight360 - Planetree Catholic Charities - Rita/Hazel, Derek Silva )Percentage for Brandy Moore Case Management is 50%. Applicable to: Catholic Charities - Assisted Housing created 3/8/8, revised 7/6/8 35

36 Performance FY 07-8 Note: Please review the "Unique Program" to determine if your program has objectives in addition to, or instead of, those that have TES 38 80% of subsidy recipients who have secured housing will have maintained that housing or moved to a level of care more appropriate to their need. All clients Agency or database year Applicable to: Catholic Charities - Assisted Housing 39 PROGRAM OBJECTIVES FOR A NEW HIV HEALTH SERVCES PROGRAM % of clients that receive an intake will obtain, retain, or increase access to health care coverage. 85% of training participants that complete questionnaires will respond that the training attended was "somewhat informative" or "very informative". All clients that receive an intake respondents to the questionnaire Agency or database Agency or database; participants complete evaluations of sessions year year Applicable to: PRC - Equal Access to Healthcare Program (EAHP) Applicable to: PRC - Equal Access to Healthcare Program (EAHP) 4 PRC will track the presenting issues for each client that receives an intake in order to identify the top five presenting issues; using this information the program will design focused trainings on these issues for the following contract year. N/A Agency or database year Applicable to: PRC - Equal Access to Healthcare Program (EAHP) created 3/8/8, revised 7/6/8 36

37 7-8 HHS Performance Mapping Document Providers with for BOCC Monitoring - Ryan White Cycle (fiscal terms: Part A - Mar thru Feb, Part B - April thru Mar, Part C - May thru April) or Name Program Name Funding Source CMS # Street Address City Zip Program Director Program Contact Standardized Applicable Individualized in addition to or in place of AIDS Legal Referral HIV Legal Services Part A Mission St Ste Bill Hirsh bill@alrp.org N/A Five: Rows 3-40 AIDS Legal Referral HIV Consumer Advocacy Project Part A Mission St Ste Bill Hirsh bill@alrp.org N/A Five: Rows 4-45 Asian/Pacific Islander Wellness (now CHC) API Integrated Case Management Part A Polk St 4th Fl 9409 Ming Ming Kwan Kate Franza mingming@sfcommunityhealth.org kate@sfcommunityhealth.org Medical Case Management N/A Asian/Pacific Islander Wellness (now CHC) API Tenderloin Area CoE Part A Polk St 4th Fl 9409 Ming Ming Kwan Kate Franza mingming@sfcommunityhealth.org kate@sfcommunityhealth.org N/A For APIWC programs above and below this row please conduct one site visit, but produce reports to capture different UOS/UDC and Performance and to meet requirements of federal funder. Asian/Pacific Islander Wellness (now CHC) HIV Early Intervention Services Part C Polk St 4th Fl 9409 Ming Ming Kwan Kate Franza mingming@sfcommunityhealth.org kate@sfcommunityhealth.org N/A Catholic Charities CYO Leland House Attendant Care Part A, B 69 4 Leland Ave 9434 Ellen Hammerle Stephanie Godt ehammerle@catholiccharitiessf.org sgodt@catholiccharitiessf.org Add One: Row 46 Catholic Charities CYO Peter Claver Community Attendant Care Part A, B Golden Gate Ave 945 Ellen Hammerle Tonja Sagun Timothy Evans ehammerle@catholiccharitiessf.org tsagun@catholiccharitiessf.org TiEvans@catholiccharitiessf.org Add One: Row 46 Catholic Charities CYO Hazel Betsey/ Rita dacascia (formerly HUH contract) Part A Eddy St 9405 Ellen Hammerle Timothy Evans ehammerle@catholiccharitiessf.org TiEvans@catholiccharitiessf.org N/A Eight: Rows -4, 6, 8, Catholic Charities CYO Derek Silva (formerly HUH contract ) Part A 76 0 Franklin St 94 Ellen Hammerle Kevin Fauteux ehammerle@catholiccharitiessf.org kfauteux@catholiccharitiessf.org N/A Eight: Rows -4, 6, 8, Community Awareness and Tx A Woman's Pl / HIV Women's Residential Prog Part A Mission St 940 Janet Goy Ivy Ho janet.goy@catsinc.org ivy.ho@catsinc.org Residential Mental Health N/A Dignity Health dba St. Mary's Medical Center Integrated HIV Health Services Part A Stanyan St 947 Leah Kramer leah.kramer@dignityhealth.org Ambulatory Outpt N/A Dolores Street Community Services Richard M. Cohen Residence Part A, B Valencia St 9403 Kevin Cunz kevin@dscs.org Add One: Row HIV HS Objs w Mapping FINAL xlsx created 8/5/7, rev 7/6/8 37