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Home My WebLink AboutIR 7814 INFORMAL REPORT TO CITY COUNCIL MEMBERS No.- 7814 March 29, 1994 To the Mayor and Members of the City Council �TExPy. Subject: HEALTH DEPARTMENT HIV/STD RESTRUCTURING PLAN '3 Introduction For the past several years, the national and statewide trend within state and local health departments has been the consolidation of Sexually Transmitted Diseases(STD)and HIV program activities, particularly those components which address disease intervention. In recognition of proven linkages between STD and HIV and their common high risk populations, these program consolidations are aimed at maximizing available resources by minimizing duplicative efforts performed by distinct units. Several states, including Texas, are in the process of consolidating STD and HIV state agency bureaus. At the local level, Houston and San Antonio have also adopted this organizational strategy. Fort Worth/Tarrant County Health Department Existing Organization Structure The Fort Worth/Tarrant County Health Department currently compartmentalizes STD and HIV program activities structurally,while relying heavily on cooperation and collaboration between the two distinct units to perform activities which frequently overlap. Both units,for example,provide HIV testing and counseling services. Additionally, all STD and HIV partner notifications must oo be performed by STD Disease Intervention Specialists (currently, HrV staff are not trained to perform partner notifications). Detailed below is a current breakout of activities by section: STD HIV STD Clinic HIV Preventive Medicine Clinic STD Contact Investigation HIV Testing and Counseling HIV Testing and Counseling HIV Education STD/HIV Partner Notification The department's current fragmented approach to reaching common high risk populations to provide education, counseling, testing, and referrals for clinical services is typified by our efforts within Tarrant County correctional facilities. Both STD and HIV staff visit specific correctional facilities, at separate times, to perform education and testing services for Syphilis and HIV. In an effort to address inefficiencies such as these and maximize existing resources, a restructuring plan was developed. Existing.Staffing As detailed above, the existing non-clinical HIV unit currently performs HIV counseling, testing, and education activities aimed at high risk populations. All staff members are assigned to allocate approximately 50% of their time to HIV counseling and testing activities and 50% to HIV educational activities. Under the existing organizational structure, one program coordinator position,funded through the Tarrant County general fund,is responsible for both HIV clinical and non-clinical activities. ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 7814 Mamh 29, 1994 F, To the Mayor and Members of the City Council Page 2 of 4 Subject: Health Department MV/STD Restructuring Plan rxA HIV Non-Clinical Staff 5 Epidemiology Specialists - TDH grant contract funded, County employees 1 Clerk - TDH grant contract funded, County employee 1 Public Health Aide - TDH grant contract funded, County employee 1 Epidemiology Specialist - City of Fort Worth General Fund supported STD non-clinical staff perform STD contact investigation,STD/HIV partner notification,and HIV counseling and testing activities. One field supervisor (funded by the Centers for Disease Control and Prevention [CDC]) is responsible for unit activities. STD Non-Clinical Staff 6 Epidemiology Specialists - TDH grant contract funded, City employees 2 Clerks - One TDH assignee, One TDH grant contract funded, City employees Restructuring Plan Goals During the developmental stages of the restructuring plan, a series of goals was established and prioritized by departmental management which would be addressed by the final plan: GOAL 1: Enhance efficiency in providing STD/HIV disease intervention services to shared target populations. GOAL 2: Enhance and consolidate coordination of STD and HIV clinical activities. GOAL 3: Improve linkage between management objectives and HIV counseling, testing, and education activities. Rationale for Goal 1 has been explained. Enhanced coordination of STD and HIV clinical activities, Goal 2, has been a long-term objective of the Health Department for the past two years. Funding for a single clinic coordinator position to provide fiscal, quality assurance, and other administrative oversight to both clinics has been pursued but is unavailable. Goal 3 addresses another long-term issue. Due to high turnover and increasingly complex clinical administrative responsibilities associated with the HIV Program Coordinator position, adequate staff supervision to provide a strong link between management and the HIV testing, counseling, and education unit has not been possible. In addition,some members of the HIV non-clinical staff have continuously demonstrated resistance to supervisory and management input and directives. - ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 7A14 Mamh 29, I994 �, DoE iop" To the Mayor and Members of the City Council Page 3 of 4 Z5 4 Subject:C� Health Department H1V/STD Restructuring Plan 1873 Original Restructuring Plan To enable achievement of established goals, a plan to consolidate HIV and STD non-clinical staff and activities, mirroring national and state trends, was developed. Step 1 was the creation of a single STD/HIV disease intervention unit, supervised by the CDC- funded disease intervention supervisor, to provide STD contact investigation, STD/HIV partner notification, and HIV counseling and testing services. This unit would be comprised of the six existing STD Epidemiology Specialists plus three Epidemiology Specialists who would be transferred from the existing HIV non-clinical unit. All nine staff members would be cross-trained in both areas and would become state certified disease intervention specialists. Step 2 assigned the remaining three HIV Epidemiology Specialists and one temporary Public Health Aide to the department's existing Health Education unit within the Public Health Promotion Division to perform HIV education services. One reason for the separation of existing HIV non-clinical staff members was to avoid an unreasonable span of control with the single supervisor assigned to the newly-formed STD/HIV disease intervention unit. Without additional funds to create a second supervisor position, increasing the disease intervention supervisor's field staff from six to nine was the maximum believed feasible,particularly in light of personnel issues which warranted Goal 3. Additionally, the HIV education component could utilize,and benefit from,the resources available as part of the department's Health Education unit. Step 3 was designed to address clinical needs. The existing HIV Program Coordinator position (County)would be reclassified as a clinic coordinator to oversee both STD and H11-V clinic functions as described in Goal 2. No reduction in services was anticipated with this proposed restructuring, and presumably an increase would occur through streamlining functions and augmentation of staff through cross- training. The number of FTE's performing HIV activities would be uncha nged. The existing structure assigns six HIV Epidemiology Specialists to perform counseling and testing 60% of the time and HIV education 50% of the time (3 FTE's for each activity). The restructuring assigns three HIV Epidemiology Specialists to cross-train and integrate activities with six additional Epidemiology Specialists and three Epidemiology Specialists to perform HIV education on a full- time basis. Revised Restructuring Plan Following a public hearing in January 1994 and discussions with departmental management staff and HIV unit staff members, the County Commissioners Court agreed to fund a disease intervention supervisor position to allow total integration of STD/HIV non-clinical units. ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 7814 March 29, 1994 Page 4 of 4 Members of the City Council To the Mayor and tip 0 Subject: Health Department HIV/STD Restructuring Plan The revised plan will incorporate all facets of the original plan, with the exception of the separation of HIV counseling and testing activities from HIV education activities. As a result,the combined staff of 12 Epidemiology Specialists will be divided into two teams, each reporting to a disease intervention supervisor, and cross-trained in both areas. Clinical staff will report to the STD/HIV Clinical Programs Coordinator (County). STD/HIV Clinical Programs STD/HIV Disease Intervention STD Clinic STD Contact Investigation HIV Preventive Medicine Clinic STD/HIV Partner Notification HIV Testing and Counseling HIV Education The Health Department plans to implement this restructuring as soon as the second supervisory position is filled. Recruitment is currently underway. For additional information, please contact Assistant City Manager lAbby Watson. Bo e rell rr City ity Manager BT:l L ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS