reporting expenditures by service planning area county of los angeles department of health services...
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Reporting Expenditures by Service Planning Area
County of Los AngelesDepartment of Health ServicesOffice of AIDS Programs and Policy
April 11, 2003
Charles L. HenryDirectorOffice of AIDS Programs and Policy
3
Geographic Estimate of Need Is..One of Multiple Planning
PerspectivesGeographic
Five Supervisorial Districts Eight Service Planning Areas Twenty-six Health Districts
Population(s) ServedPopulation(s) TargetedService Categories
One Frame of Accountability
4
Geographic Estimate of NeedIs Not..Limitation on Client Choice or
PreferenceNet Increase of FundsQuality Assurance of Services
Provided Identification of Behavioral Risk
or Other Target Populations
5
Geographic Estimate of Need Presents Opportunities for..Comparison of Service Sub-
SystemsGuidance for Expansion of
ServicesTargeting Capacity Building
ActivitiesComparison of Estimated Need
and Expenditures
Gunther FreehillDirector, Public AffairsOffice of AIDS Programs and Policy
7
Background
“Divide by Five”Planning Council PrioritiesService ExpansionsCommunity PlanningAIDS Politics
8
March 2002
CARE Act Title I AwardIncrease of $3 MillionIncreased Support for Quality
ManagementIncreased Program SupportIncreased Commission Support
Grant Award Accepted by Board of Supervisors
9
10
Board Request
Domains of Distribution Indicators of NeedAllocation of FundsDistribution of Services
11
Underlying Questions
How is the HIV/AIDS epidemic distributed in Los Angeles County?
Is the epidemic emerging in some areas? Is it receding in others?
Does the distribution of funds match the distribution of need?
Does the distribution of funds make sense?
Is my area getting its fair share?
12
Domains of DistributionZip Code Zones
Zones in Los Angeles County
524Zones > Half of Clients
36 Zones > 200 Clients
15Zones < = Five Clients
286
13
Figure 1: CARE Clients by Health District
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Domains of Distribution
14
Indicators of Need
CARE ClientsAIDS CasesHIV Test Results
15
Figure 2: CARE Clients by Service Planning Area
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
5,500
6,000
SPA 1: Antelope
Valley
SPA 2: SanFernando
Valley
SPA 3: SanGabrielValley
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
18
Figure 5: AIDS Cases by Service Planning Area
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
SPA1:Antelope
Valley
SPA 2: SanFernando
Valley
SPA 3: SanGabrielValley
SPA 4:Metro
SPA 5:West
SPA 6:South
SPA 7: East SPA 8:South Bay
Living Cases
Recent Cases
21
Figure 8: HIV Positive Resultsby Service Planning Area
-
100
200
300
400
500
600
SPA 1: Antelope
Valley
SPA 2: SanFernando
Valley
SPA 3: SanGabrielValley
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
24
Figure 11: Clients, Cases and Results by Service Planning Area
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
SPA 1:Antelope
Valley
SPA 2: SanFernando
Valley
SPA 3: SanGabrielValley
SPA 4:Metro
SPA 5:West
SPA 6:South
SPA 7: East SPA 8:South Bay
CARE Clients
Living Cases
Recent Cases
Positive Tests
26
Estimating Geographic Needfor Care Services
27
Figure 13: Factors Used to Estimate Geographic Need for Care Services
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
SPA 1:Antelope
Valley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4:Metro
SPA 5:West
SPA 6:South
SPA 7: East SPA 8:South Bay
Living Cases
Recent Cases
Poverty
28
Figure 14: Geographic Estimate of Need for Care Services
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
SPA 1:Antelope
Valley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4:Metro
SPA 5:West
SPA 6:South
SPA 7: East SPA 8:South Bay
29
Figure 15: Comparative Distribution of CARE Clients and Geographic Estimate of Need
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
SPA 1: Antelope
Valley
SPA 2: SanFernando
Valley
SPA 3: SanGabrielValley
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
Proportion of CARE Clients
Estimate of Need
30
Estimating Geographic Need for Prevention Services
31
Figure 16: Indicators of Geographic Need for HIV Prevention Services
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
SPA 1:Antelope
Valley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4:Metro
SPA 5:West
SPA 6:South
SPA 7: East SPA 8:South Bay
STD
Recent AIDS Cases
Living AIDS Cases
Substance Use
Counseling & Testing
Poverty
32
Figure 17: Weighted Indicators Determining Geographic Estimate of Need for HIV Prevention
Services STD23%
Recent AIDS Cases11%
Living AIDS Cases22%
Substance Use11%
Poverty22%
Counselingand Testing
11%
33
Figure 18: Geographic Estimate of Needfor HIV Prevention Services
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
SPA 1:Antelope
Valley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4:Metro
SPA 5:West
SPA 6:South
SPA 7: East SPA 8:South Bay
34
Figure 19: Comparison of Geographic Estimate of Need
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
SPA 1: Antelope
Valley
SPA 2: San
FernandoValley
SPA 3: San
GabrielValley
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
Estimate of Need (Care)
Estimate of Need (HIV Prevention)
35
Allocations of Funds and Estimates of Need
36
Figure 20: CARE Act Titles I and II, Estimate of Need
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
SPA 1: Antelope
Valley
SPA 2: San
Fernando
SPA 3: San
Gabriel
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
Funding
Estimate of Need
37
Figure 21: Distribution of Medical Services, Title I by SPA of Service Delivery Site
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
SPA 1: Antelope
Valley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
Clients Contracted
Units Contracted
Funding
Estimate of Need
38
Figure 22: Distribution of Medical ServicesTitle I, Title III, EIP by SPA of Service Delivery Site
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
SPA 1: Antelope
Valley
SPA 2: San
Fernando
SPA 3: San
Gabriel
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
Funding (Title I, III, EIP)
Estimate of Need
39
Figure 23: Distribution of Case Management Services by SPA of Service Delivery Site
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
SPA 1: Antelope
Valley
SPA 2: San
Fernando
SPA 3: San
Gabriel
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
Clients Contracted
Units Contracted
Funding
Estimate of Need
41
Figure 25: Distribution of Mental Health Services by SPA of Service Delivery Site
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
SPA 1: Antelope
Valley
SPA 2: San
Fernando
SPA 3: San
Gabriel
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
Clients Contracted
Units Contracted
Funding
Estimate of Need
42
Figure 26: Distribution of Substance Abuse Services by SPA of Service Delivery Site
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
SPA 1: Antelope
Valley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
Units Contracted
Funding
Estimate of Need
43
Figure 27: Distribution of Residential Services by SPA of Service Delivery Site
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
SPA 1: Antelope
Valley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East SPA 8: South Bay
Units Contracted
Funding
Estimate of Need
44
Figure 28: Distribution of Dental Services by SPA of Service Delivery Site
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
SPA 1: Antelope
Valley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
Clients Contracted
Units Contracted
Funding
Estimate of Need
45
Challenges to Meeting Geographic Estimate of NeedEstablished Service Delivery
Systems“Land Locked” Services
ResidentialSubstance AbusePublic Health Facilities
Diseconomies of ScaleLack of Provider CapacityClient Choice
46
Programmatic Recommendations
Increase Outpatient Medical ServicesExpansion Service SitesAugment Existing ServicesRe-Design Specialty Consultations
47
Figure 29: Distribution of Medical Services Title I, III, EIP, Specialty by SPA of Service Delivery
Site
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
SPA 1: Antelope
Valley
SPA 2: San
Fernando
SPA 3: San
Gabriel
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
Funding (Title I, III,EIP, Specialty)Estimate of Need
48
Figure 30: Distribution of Medical Services Title I, Title III, EIP, Specialty, Augmentations by
SPA of Service Delivery Site
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
SPA 1: Antelope
Valley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4: Metro
SPA 5: West
SPA 6: South
SPA 7: East
SPA 8: South Bay
Funding (Title I, III, EIP,Specialty, Augmentation)
Estimate of Need
49
Programmatic Recommendations
Increase Translation & Interpretation
Increase Child Care Increase Peer Support Services Increase Substance Abuse
Services
50
Administrative Recommendations
Conduct Rate ReviewsConduct Fiscal Reviews Increase Efficiency in
Contracting Increase MonitoringEnhance Community Planning
51
Board Response
Distribution of ReportReview and Comment by
Commission on HIV Health Services
Request Report on Expenditures by Service Planning Area
52
Year 13 CARE Services
53
CARE Services Year 12, Year 13 and Geographic Estimate of Need
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
SPA 1: AntelopeValley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4: Metro SPA 5: West SPA 6: South SPA 7: East SPA 8: SouthBay
Funding (2002)
Funding (2003)
Estimate of Need
54
Distribution of Medical Services
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
SPA 1: AntelopeValley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4: Metro SPA 5: West SPA 6: South SPA 7: East SPA 8: South Bay
Funding 2002
Funding 2003
Estimate of Need
55
Distribution of Medical Services, Title III, and EIP
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
SPA 1: Antelope Valley
SPA 2: SanFernando
SPA 3: SanGabriel
SPA 4: Metro SPA 5: West SPA 6: South SPA 7: East SPA 8: SouthBay
2002 Medical, III, EIP
2003 Medical, III, EIP
Estimate of Need
56
Re-Solicitation of Services 2003
Child CareTranslation and InterpretationLegal Services, Permanency
PlanningHIV Peer SupportFood
57
Re-Solicitation of Services 2004
Outpatient Medical Services *Substance Abuse Services *Treatment Education and
AdherenceOral HealthResidential Services *HIV Prevention
* Pending Rate Review
58
Re-Solicitation of Services 2005
Mental HealthCase ManagementTraining
59
Questions and Discussion
Mario J. PérezDirector, Prevention Services Division
Robert C. Fish, Ph.D.Director, Care Services Division
Office of AIDS Programs and Policy
61
Expenditures of Funds by Service Planning AreaCost Allocation BasesReports to the Board of
SupervisorsTerms of Reports Summary Reports
62
Cost Allocation Bases
Varies Among Service Categories
Consistent Within Service Category
63
Direct Service Hours
Time spent on the provision of services attributable to a specific client, group, couple or family.
Direct service hours include Time invested to prepare for a
client, group, couple or family intervention
Intake, assessment, and treatment time
Time invested to document the client, group, couple or family contact
64
Direct Service Hours (Cont.)
Direct service hours does not includeTime invested for trainings
(including certification trainings)Service category specific
meetings or staff meetingsDevelopment of program
associated materials and forms (e.g. curriculums, pamphlets)
All other activities not attributable to a specific client, group, couple, or family
65
Cost Allocation Basis No. 1Unit
Case Management, Medical
Case Management, Psychosocial
Client Advocacy Health Education, Risk
Reduction Home Based Case
Management Legal Services Mental Health,
Counseling Services
Hours of Direct Service Mental Health, Psychiatric
Services Other support: Child Care Other support:
Translation, Interpretation
Partner Counseling & Referral Services
Permanency Planning Prevention for HIV
Positives Psychosocial Support
Services Substance Abuse, Crisis
Counseling Treatment Adherence
66
Cost Allocation Basis No. 1 (Cont.)
Unit Service Certifications and
Recertifications• AIDS Drug
Assistance Program Consultations (by
SPA of referral)• Outpatient Medical,
Specialty Cost of rides (by
SPA of client)• Transportation - Taxi
Doses • Substance Abuse, Methadone Maintenance
67
Cost Allocation Basis No. 1 (Cont.)
Unit Service Interventions
Completed• Perinatal
Demonstration Project
Meals • Food Bank, Home Delivered Meals
Procedures • Oral Health Care Residential Days • Housing Assistance,
Residential Services• Hospice (Residential,
In-home)• Substance Abuse, All
Residential
68
Cost Allocation Basis No. 1 (Cont.)
Unit Service Rides • Transportation - Van Tokens, Monthly
Stickers (Disability Passes)
• Transportation – MTA, Metrolink
Visits • Early Intervention, Bridge
• Nutritional Counseling
• Outpatient Medical
• Substance Abuse, Day Treatment
69
Cost Allocation Basis No. 2
Unit Service Cost for Service
(Each Service x Each Fee)
• HIV/AIDS Counseling and Testing
70
Exercise
180(100%)
54 (30%)
18 (10%)
108 (60%)
TOTAL
450045Group Level Interventions
6330030 + 3Individual Level Interventions
72241830
Outreach (Contacts and Encounters)
TotalSPA 5SPA 4SPA 2
71
Monthly Reports8. Service Planning Areas (SPAs) [Please write the number of units of service delivered in the following SPA(s) this month and year to date]:
SPAThis Month Contract Year-to-Date
Unit =
SPA 1SPA 2SPA 3SPA 4SPA 5SPA 6SPA 7SPA 8
TOTAL
Hours
0108
01854000
180
72
Monitoring Compliance
Include in General Program Management and MonitoringReviewed MonthlyDiscrepancies IdentifiedPlans of Corrective ActionConsidered in Contract
Negotiation
73
Quarterly Expenditure Reports to the Board
Reports Organized by GrantsCARE Act Title ICARE Act Title IICenters for Disease Control and
Prevention (CDC)StateNet County Cost
74
Terms of Reports
First Six Months: Negotiated Deliverables
Second Six Months: Actual Delivery, First Six Months
Final: Actual Delivery, Twelve Months
75
Service Category Summary Reports
Commission on HIV Health Services
Prevention Planning CommitteeAvailable upon request
76
Questions and DiscussionClosing Remarks