theresa l. henry, director of field services program integration the virginia experience virginia...
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Theresa L. Henry, Director of Field Services
Program IntegrationThe Virginia Experience
Virginia Department of HealthDivision of Disease Prevention
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Office of Public Health
Office of Epidemiology
Division of Disease
Prevention
Division of Disease
Surveillance and
Investigation
Division of Environmental Epidemiology
Division of Immunization
Division ofRadiological
Health
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Programs Integrated & Rationale
AIDS Program
Because of transmission mode the then Bureau of STD Control within the Division of Communicable Disease Control was considered to be the best organizational placement for the program.
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Programs Integrated & Rationale
Hepatitis C Program
The Virginia General Assembly appropriated funds to implement a Hepatitis C Awareness and Prevention Program.
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Programs Integrated & Rationale
Hepatitis A and hepatitis B, excluding perinatal, are the responsibility of the Division of Surveillance and Investigation (DSI).
DSI did not have the infrastructure or resources to implement a new program.
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Programs Integrated & Rationale
Perinatal hepatitis B is the responsibility of the Division of Immunization.
The primary goal of this division is reducing morbidity and mortality associated with vaccine-preventable illness.
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Programs Integrated & Rationale
The then Division of HIV/STD
Serviced a population at risk for hepatitis C.
Had sufficient resources to support a new program.
Interested in including viral hepatitis prevention services in clinical and outreach settings.
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Programs Integrated & Rationale
Pharmacy Services
The Bureau of Pharmacy Services was a separate bureau located within the Office of Purchasing and General Services (OPGS).
OPGS primarily performs procurement functions.
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Programs Integrated & Rationale
Analysis of Pharmacy Services’ activity showed that 75% of the medications dispensed were for the Division of HIV/STD.
Placement within the Division of HIV/STD provided an opportunity to capitalize on existing staff expertise in the Division.
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Programs Integrated & Rationale
TB Prevention and Control
The Division of TB Prevention and Control was a separate division within the Office of Epidemiology.
Placement within the Division of HIV, STD, and Pharmacy Services provided an opportunity to establish new teams and capitalize on existing staff expertise.
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Staff Perceptions to the Change
AIDS/HIV Program – New program, no merging of staff
STD staff were more cautious from the standpoint of the challenge associated with a disease that was unknown.
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Staff Perceptions to the Change
Hepatitis C Program - New program, no merging of staff
HIV/STD staff were excited.
Some apprehension from the standpoint of a learning curve with the addition of a “ new” disease.
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Staff Perceptions to the Change
Pharmacy Services – Involved staff merging
Both program area staff were a little cautious at first regarding “fit”.
Pharmacy staff morale improved due to changes in work environment.
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Staff Perceptions to the Change
TB Prevention and Control - Involved staff merging
Resistance and caution from TB staff.
HIV, STD, and Pharmacy Services staff were more accepting.
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Internal Barriers
AIDS Program
Program differences
Pharmacy Services
Organizational structure
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Internal Barriers
TB Prevention and Control
Program differences
Attitudinal
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Addressing Internal Barriers
Pharmacy Services
Met with Human Resources.
TB Prevention and Control
Counseling, some transfers and resignations.
Promote as much consistency across
programs as possible.
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Other Barriers
Non support from CDC after the merger between the Division of TB and the Division of HIV, STD, and Pharmacy Services
Financial assistance
Direct assistance
Strong recommendation to re-establish the TB program as a “unit”.
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Wins - Client level
Delivery of more comprehensive prevention services.
Enhanced coordination of client care and services.
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Wins - Health Department Level
Resource sharing (human, fiscal, data/information)
DIS investigate and follow-up both HIV and STD; collaboration among training staff (HIV, STD, TB).
Enhanced surveillance.
Integration of TB provided additional match for the Ryan White grant which was a significant financial concern.
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Wins - Health Department Level
Greater cross program planning.
Weekly meetings between the Division Director and Program Directors.
Medical Director of TB Program is on the ADAP advisory meeting.
Leaner organizational structure.
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Embarking on Program Integration
A leader who strongly believes in integration.
Clear definition of program integration.
Regular communication across programs.
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Starting Process Again
Hepatitis C Program
Promote viral hepatitis services be the
responsibility of one division.
TB Prevention and Control
More staff involvement in the plan.
Follow the plan.
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Suggestions for CDC
Support project areas that are integrated.
At the CDC level, need to communicate and become more familiar with other division programs.
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Suggestions for CDC
Train public health advisors on STD, TB, HIV, and hepatitis and allow them flexibility to work across program lines.
Allow maximum flexibility on how funding can be used.