The QuarterlyThe QuarterlyVolume 1 Issue 4

produces the annual AIDS Walk. And I have served on the Ryan White Planning Council as member, Chair of the Comprehensive Plan Committee and as Vice Chair of the Council.

It is my honor to now serve as Chair of the Council. I ask for your help and your support over the next year to continue the good work we have all banded together to accomplish.

John McMahon Planning Council Chair

The first person I ever knew with HIV/AIDS was a 16 year old son of a friend of mine in San Francisco over 25 years ago. He was taking his homecoming dance date home and was hit by a drunken driver. As part of the emergency room treatment, he received multiple blood transfusions, at least one of which was from tainted blood. This was back before the blood supply was deemed safe.

Over the years, I have met and known countless others who contracted HIV/AIDS, some have lived with it, way too many have died because of it. And because I firmly believe that there, but for the grace of God, go I, my compassion and my passion goes towards working for and with those who are both infected and affected by HIV.

My involvement includes being on the Board of Directors of Hope Care Center, a skilled nursing home in Kansas City solely for people with HIV/AIDS. I sit on the Board of the AIDS Service Foundation, which organizes and

Notes from the Planning Council

After the 4th snowiest winter on record for Kansas City, many residents are ready for the summer. However, there can be health-related risks to the summer heat such as hyperthermia, which is an extreme rise in body temperature.

“Heat-related illnesses are preventable, but we do see them every summer,” said Bill Snook, program manager and coordinator for the Kansas City Metro response to extreme heat. “Knowing that you could be affected by working or exercising outside too long and/or taking medication that can make you more susceptible to the heat is the first step.”

Individuals susceptible to hyperthermia include those using diuretics or alcohol which can dehydrate the body and reduce a person’s ability to sweat and cool down. People who are taking long term tranquilizers such as, phenothaizines, tricyclic antidepressants and monoamine oxidase inhibitors (MAOI’s) are not able to regulate their body temperature effectively.

Stimulants such as methamphetamine or cocaine can also raise the body temperature. Pre-existing health conditions such as obesity, dehydration, hyperthyroidism and cardiac and neurological diseases are at risk from extreme heat conditions.

Ask your medical provider if the medications you are taking or pre-existing medical conditions will make you more affected by high temperatures.

Heat-related illnesses can be life threatening. Seek medical attention immediately if you are others around you show signs of heat exhaustion or stroke.

SIGNS OF HEAT EXHAUSTION AND HEAT STROKE

Watch for these signs of HEAT EXHAUSTION:

1. Cool, moist, pale or flushed skin2. Heavy Sweating3. Headache, nausea, or vomiting4. Dizziness5. Exhaustion6. BODY TEMPERATURE: • Maybenormal • Islikelytoberising

Watch for these signs of HEAT STROKE:1. Hot, red skin2. Changes in consciousness3. Rapid, weak pulse4. Rapid, shallow breathing5. BODY TEMPERATURE: • Canbeveryhigh,sometimesashighas105°F6. If the person was sweating from heavy work or

exercise, skin may be wet; otherwise it will feel dry.

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Beat the Heat

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OnJuly20,2010,theKansasCityRyanWhitePlanningCouncil will be hosting a HIV/AIDS community funding allocation meeting from 1-5 p.m. The planning council must decide how much funding will be used for each of the service priorities, such as primary care services or mental health services.“The funding process has many different parts,” said Samantha Hughes, Planning Council Program Manager. “The advocacy committee of the planning council has asked for the service definitions and the priority and allocation process to be provided in “The Quarterly” to help clients understand how decisions on care are made.”The planning council can only fund service categories that are included in the Ryan White legislation as core medical services or approved by the Secretary of Health and Human Services as support services. The legislative requirement is that at least 75% of funds go to core medical services and no more than 25% to supportive services that contribute to positive medical outcomes for clients. With the federal guidelines in place, the planning council works with the health department’s Communicable Disease Program to determine how many persons living with HIV/AIDS are in the Kansas City area. The result is a snapshot of HIV/AIDS in the community called an epidemiologic profile. The planning council then conducts a needs assessment of populations living with HIV disease and the capacity of the service system to meet those needs though focus groups, surveys, or other methods. The planning council must determine: (1) The number, characteristics, and service needs of

people living with HIV/AIDS (PLWHA) who know their HIV status and are not in care;

(2) The service needs of PLWHA who are in care, including differences in care and needs, particularly for historically underserved populations;

(3) The number and location of agencies providing HIV–related services in the 11 county grant area;

(4) The agency’s capacity and capability to serve PLWHA

(5) The availability of other resources and how Ryan White services need to work with these other services, like substance abuse services and HIV prevention agencies.

After the needs assessment, the next step is priority setting. The planning council makes these decisions about priorities for funding based on many factors:

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Setting the funding levels for your careHeat prevention tips

Drink Plenty of FluidsDuring hot weather you will need to increase your fluid intake. Don’t wait until you’re thirsty to drink. Warning: If your doctor generally limits the amount of fluid you drink or has you on water pills, ask how much you should drink while the weather is hot.

Don’t drink liquids that contain alcohol, or large amounts of sugar—these actually cause you to lose more body fluid. Also avoid very cold drinks, because they can cause stomach cramps.

Wear Appropriate Clothing and SunscreenChoose lightweight, light-colored, loose-fitting clothing. Sunburn affects your body’s ability to cool itself and causes a loss of body fluids. Protect yourself from the sun by wearing a wide-brimmed hat, sunglasses, and use sunscreen30minutespriortogoingout.

Schedule Outdoor Activities CarefullyIf you must be outdoors, try to limit your outdoor activity to morning and evening hours. Try to rest often in shady areas so that your body’s thermostat will have a chance to recover.

Stay Cool IndoorsStay indoors and, if at all possible, stay in an air-conditioned place.

Adjust to the EnvironmentBe aware that any sudden change in temperature, such as an early summer heat wave, will be stressful to your body. If you are not accustomed to working or exercising in a hot environment, start slowly and pick up the pace gradually.

Do Not Leave Children in CarsNever leave infants, children or pets in a parked car, even if the windows are cracked open.

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(1) Needs assessment;(2) Data on the most successful and economical ways

of providing services; (3) Actual cost and utilization data provided by the

grantee; (4) Priorities of people living with HIV who will use

services; (5) Ensure Part A funds work well with other services

like HIV prevention and substance abuse; (6) Funds from other funding sources. The final step called allocation which sets the funding levels for the chosen service categories will be held July20,2010.Ifyouwouldliketoparticipateintheallocationprocess,plantoattendtheJuly20thmeetingat the City of Kansas City, Mo., Health Department at 2400TroostAve,KansasCity,Missouri64108.Ifyouneed transportation to the meeting, contact Samantha Hughes at 513-6331. Below is a list of the service categories that the planning council can choose to allocate funding to in June. After the planning council decides which service categories to fund, the Health Department will submit a grant application to the Health Resources Services Administration to request funding.

SERVICE CATEGORY DEFINITIONSCore Services Service categories:a. Outpatient/Ambulatory - medical care (health services) is the provision of professional diagnostic and therapeutic services rendered by a physician, physician’s assistant, clinical nurse specialist, or nurse practitioner in an outpatient setting. Settings include clinics, medical offices, and mobile vans where clients generally do not stay overnight. Emergency room services are not outpatient settings. Services includes diagnostic testing, early intervention and risk assessment, preventive care and screening, practitioner examination, medical history taking, diagnosis and treatment of common physical and mental conditions, prescribing and managing medication therapy, education and counseling on health issues, well-baby care, continuing care and management of chronic conditions, and referral to and provision of specialty care (includes all medical subspecialties). Primary medical care for the treatment of HIV infection includes the provision of care that is consistent with the Public Health Service’s guidelines. Such care must include access to antiretroviral and other drug therapies, including prophylaxis and treatment of opportunistic infections and combination antiretroviral therapies. NOTE: Early Intervention Services provided by Ryan White Part C and Part D Programs should be included here under Outpatient/ Ambulatory medical care.

b. AIDS Drug Assistance Program (ADAP treatments) is a State-administered program authorized under Part B of the Ryan White Program that provides FDA-approved

medications to low-income individuals with HIV disease who have limited or no coverage from private insurance, Medicaid, or Medicare.

c. AIDS Pharmaceutical Assistance (local) includes local pharmacy assistance programs implemented by Part A or Part B Grantees to provide HIV/AIDS medications to clients. This assistance can be funded with Part A grant funds and/or Part B base award funds. Local pharmacy assistance programs are not funded with ADAP earmark funding.

d. Oral health care - includes diagnostic, preventive, and therapeutic services provided by general dental practitioners, dental specialists, dental hygienists and auxiliaries, and other trained primary care providers.

e. Early intervention services (EIS) include counseling individuals with respect to HIV/AIDS; testing (including tests to confirm the presence of the disease, tests to diagnose to extent of immune deficiency, tests to provide information on appropriate therapeutic measures); referrals; other clinical and diagnostic services regarding HIV/AIDS; periodic medical evaluations for individuals with HIV/AIDS; and providing therapeutic measures. NOTE: EIS provided by Ryan White Part C and Part D Programs should NOT be reported here. Part C and Part D EIS should be included under Outpatient/ Ambulatory medical care.

f. Health Insurance Premium & Cost Sharing Assistance is the provision of financial assistance for eligible individuals living with HIV to maintain a continuity of health insurance or to receive medical benefits under a health insurance program. Depending upon funding availability, this includes premium payments, risk pools, co-payments, and deductibles.

g. Home Health Care - includes the provision of services in the home by licensed health care workers such as nurses and the administration of intravenous and aerosolized treatment, parenteral feeding, diagnostic testing, and other medical therapies.

h. Home and Community-based Health Services include skilled health services furnished to the individual in the individual’s home based on a written plan of care established by a case management team that includes appropriate health care professionals. Services include durable medical equipment; home health aide services and personal care services in the home; day treatment or other partial hospitalization services; home intravenous and aerosolized drug therapy (including prescription drugs administered as part of such therapy); routine diagnostics testing administered in the home; and appropriate mental health, developmental, and rehabilitation services. Inpatient hospitals services, nursing home and other long term care facilities are NOT included.

i. Hospice services include room, board, nursing care, counseling, physician services, and palliative therapeutics provided to clients in the terminal stages of illness in a

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residential setting, including a non-acute-care section of a hospital that has been designated and staffed to provide hospice services for terminal clients.

j. Mental health services - Individual, family, and group interventions that ensure a continuum of care through outpatient evaluation, assessment and access to professional but enhanced by case management, peer advocates, and psychosocial support programs. Mental health professional (licensed or authorized within the state) may be a psychiatrist, nurse practitioner, licensed clinical social worker, (LCSW), psychologist (PHD), therapist, professional counselor (LPC), and/or clinical nurse specialist.

k. Medical nutrition therapy - is provided by a licensed registered dietitian outside of a primary care visit and includes the provision of nutritional supplements. Medical nutrition therapy provided by someone other than a licensed/registered dietitian should be recorded under psychosocial support services.

l. Medical Case management services (including treatment adherence) - are a range of client-centered services that link clients with health care, psychosocial, and other services. The coordination and follow-up of medical treatments is a component of medical case management. These services ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care, through ongoing assessment of the client’s and other key family members’ needs and personal support systems. Medical case management includes the provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments. Key activities include (1) initial assessment of service needs; (2) development of a comprehensive, individualized service plan; (3) coordination of services required to implement the plan; (4) client monitoring to assess the efficacy of the plan; and (5) periodic re-evaluation and adaptation of the plan as necessary over the life of the client. It includes client-specific advocacy and/or review of utilization of services. This includes all types of case management including face-to-face, phone contact, and any other forms of communication.

m. Substance abuse services outpatient Individual, family, and group interventions that ensure a continuum of care through evaluation, assessment, harm reduction model and support access to community treatment and after care. Service is conducted by a licensed professional but enhanced by case management, peer advocates and psychosocial support programs.

Support Services n. Case Management (non-Medical) includes the

provision of advice and assistance in obtaining medical, social, community, legal, financial, and other needed services. Non-medical case management does not involve coordination and follow-up of medical treatments, as medical case management does.

o. Child care services - are the provision of care for the children of clients who are HIV-positive while the clients attend medical or other appointments or Ryan White Program-related meetings, groups, or training. NOTE: This does not include child care while a client is at work.

p. Pediatric developmental assessment and early intervention services are the provision of professional early interventions by physicians, developmental psychologists, educators, and others in the psychosocial and intellectual development of infants and children. These services involve the assessment of an infant’s or child’s developmental status and needs in relation to the involvement with the education system, including early assessment of educational intervention services. It includes comprehensive assessment of infants and children, taking into account the effects of chronic conditions associated with HIV, drug exposure, and other factors. Provision of information about access to Head Start services, appropriate educational settings for HIV-affected clients, and education/assistance to schools should also be reported in this category.

q. Emergency financial assistance - is the provision of short-term payments to agencies or establishment of voucher programs to assist with emergency expenses related to essential utilities, housing, food (including groceries, food vouchers, and food stamps), and medication

when other resources are not available.NOTE: Part A and Part B programs must be allocated, tracked and report these funds under

specific service categories as described under 2.6 in DSS Program Policy Guidance No. 2 (formally PolicyNo.97-02).

r. Food bank/home-delivered meals include the provision of actual food or meals. It

does not include finances to purchase food or meals. The provision of

essential household supplies such as hygiene items and household cleaning supplies should be included in this item. Includes

vouchers to purchase food.

s. Health education/risk reduction is the provision of services that educate clients with HIV about HIV transmission and how to reduce the risk of HIV

transmission. It includes the provision of information; including

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information dissemination about medical and psychosocial support services and counseling to help clients with HIV improve their health status.

t. Housing services are the provision of short-term assistance to support emergency, temporary or transitional housing to enable an individual or family to gain or maintain medical care. Housing-related referral services include assessment, search, placement, advocacy, and the fees associated with them. Eligible housing can include both housing that does not provide direct medical or supportive services and housing that provides some type of medical or supportive services such as residential mental health services, foster care, or assisted living residential services.

u. Legal services are the provision of services to individuals with respect to powers of attorney, do-not-resuscitate orders and interventions necessary to ensure access to eligible benefits, including discrimination or breach of confidentiality litigation as it relates to services eligible for funding under the Ryan White Program. It does not include any legal services that arrange for guardianship or adoption of children after the death of their normal caregiver.

v. Linguistics services include the provision of interpretation and translation services.

w. Medical transportation services - include conveyance services provided, directly or through voucher, to a client so that he or she may access health care services.

x. Outreach services - are programs that have as their principal purpose identification of people with unknown HIV disease or those who know their status so that they may become aware of, and may be enrolled in care and treatment services (i.e., case finding), not HIV counseling and testing nor HIV prevention education. These services may target high-risk communities or individuals. Outreach programs must be planned and delivered in coordination with local HIV prevention outreach programs to avoid duplication of effort; be targeted to populations known through local epidemiologic data to be at disproportionate

risk for HIV infection; be conducted at times and in places where there is a high probability that individuals with HIV infection will be reached; and be designed with quantified program reporting that will accommodate local effectiveness evaluation.

y. Permanency planning - is the provision of services to help clients or families make decisions about placement and care of minor children after the parents/caregivers are deceased or are no longer able to care for them.

z. Psychosocial support services - are the provision of support and counseling activities, child abuse and neglect counseling, HIV support groups, pastoral care, caregiver support, and bereavement counseling. Includes nutrition counseling provided by a non-registered dietitian but excludes the provision of nutritional supplements.

aa. Referral for health care/supportive services - is the act of directing a client to a service in person or through telephone, written, or other type of communication. Referrals may be made within the non-medical case management system by professional case managers, informally through support staff, or as part of an outreach program.

ab. Rehabilitation services - are services provided by a licensed or authorized professional in accordance with an individualized plan of care intended to improve or maintain a client’s quality of life and optimal capacity for self-care. Services include physical and occupational therapy, speech pathology, and low-vision training.

ac. Respite care - is the provision of community or home-based, non-medical assistance designed to relieve the primary caregiver responsible for providing day-to-day care of a client with HIV/AIDS.

ad. Treatment adherence counseling - is the provision of counseling or special programs to ensure readiness for, and adherence to, complex HIV/AIDS treatments by non-medical personnel outside of the medical case management and clinical setting.

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HopeDo you sometimes feel that bad news is everywhere? Do you ever hope that thingswill get better? Hope can be a valued part of anyone’s care.

-From Wikipedia

Hope is a belief in a positive outcome related to events and circumstances in one’s life. Hope is the feeling that what is wanted can be had or that events will turn out for the best.

In a religious context, it is not considered as a physical emotion but as a spiritual grace. Hope is distinct from positive thinking, which refers to a therapeutic or systematic process used in psychology for reversing pessimism. The term false hope refers to a hope based entirely around a fantasy or an extremely unlikely outcome.

In Greek mythology, Hope was personified by the Goddess Elpis. When Pandora opened Pandora’s Box, she let out all of the evils unto the world except hoplessness. The Greeks may have believed that to be without hope is one of the most dangerous evils.

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Outstanding - Dynamic - Team Players to be apart of the KC-TGA Planning Council.

If you are interested in being a encouraging and constructive voice in the community for HIV Prevention and Care please contactthePlanningCouncilSupportOfficeat816-513-6331or e-mail Samantha_hughes@kcmo.org for more information.

Wanted

OnApril9,2010,theWhiteHouseOfficeofNationalAIDS Policy (ONAP) released Community Ideas for Improving the Response to the Domestic HIV Epidemic: A report on a national dialogue on HIV/AIDS. The recommendations were compiled after a series of 14 community discussions conducted aroundthenation,speakingwithover4,200peopleandover1,000writtenrecommendations.

Some of the possible interventions that could be part of a national strategy to reduce HIV/AIDS include creating a national awareness campaign, increase and improve testing, while making it routine, increase the number of HIV care providers and HIV/AIDS education and training and provide culturally and linguistically appropriate services and interventions to name a few.

“Many of the recommendations or areas of concern have been raised by members of the Planning Council,” said Travis Barnhart, chair of the Prevention Committee of the Kansas City Ryan White Planning Council. “We need to continue the dialogue here in Kansas City and begin to define strategies and implement policies that will prevent new HIV infections, increase access to care and optimize health outcomes and reduce HIV-related disparities.”

One key consideration and recommendation was to make certain the discussion about public health reform and the proposed legislation included chronic disease management. The Inclusion of chronic disease management in overall healthcare delivery is intended to improve health, lower incidence of co-diseases (such as Hepatitis C) and medical complications.

More information on the results of the national HIV/AIDS community discussions can be found at http://www.whitehouse.gov/sites/default/files/microsites/ONAP_rpt.pdf

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Improving the response to HIV/AIDS

This newsletter is published with funds from the Missouri Department of Health and Senior Services through the HIVCaseManagementContractC309302001

July 2010Planning Council Meeting Schedule

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1 2 3

4 4th of July 5 6 7 3:00PM-5:00PMExecutive Committee

KCHD- Room 1077

8 9 10

11 12 1:00PM-3:00PMAssessment &

ComprehensivePlan Committee

3rd Floor Conference Center

13 1:00PM-3:00PMCommunity Advocacy

Committee3rd Floor Conference Cnt

3:00PM-5:00PMPrevention Council Meeting

KCHD- Lower Level

14 1:00PM-3:00PMFinance Committee

3rd Floor Conference Center

15 16 17

18 19 20 9:00AM-12:00PMPlanning Council Orientation

KCHD

1:00PM-5:00PMPlanning Council Finance

Forum Allocations KCHD- Lower Level

21 22 23 24

25 26 27 28 29 30 31

August 2010Planning Council Meeting Schedule

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1 2 3 43:00 PM-5:00 PM

Executive CommitteeKCHD- Room 1077

5 6 7

8 91:00PM-3:00PMAssessment &

ComprehensivePlan Committee

3rd Floor Conference Center

101:00PM-3:00PM

Community AdvocacyCommittee

3rd Floor Conference Center

3:00PM-5:00PMPrevention Council Meeting

KCHD- Lower Level

111:00PM-3:00PM

Finance Committee3rd Floor

Conference Center

12 13 14

15 16 171:00PM-5:00PM

Planning Council Finance Forum Allocations KCHD- Lower Level

18 19 20 21

22/29 23/30 24/31 25 26 27 28