Early Intervention Services

Service Standard

Early Intervention Services Standards Print version

Subcategories	Service Units
Early Intervention Service	Per encounter with client previously unlinked to care

Health Resources & Services Administration (HRSA) Description:

Support of Early Intervention Services (EIS) that include identification of individuals at points of entry and access to services and must include the following four components:

Targeted HIV testing to help the unaware learn of their HIV status and receive referral to HIV care and treatment services if found to be HIV-infected;
- Recipients must coordinate these testing services with other HIV prevention and testing programs to avoid duplication of efforts;
- HIV testing paid for by EIS cannot supplant testing efforts paid for by other sources;
Referral services to improve HIV care and treatment services at key points of entry;
Access and linkage to HIV care and treatment services such as HIV Outpatient/Ambulatory Health Services, Medical Case Management, and Substance Abuse Care; and
Outreach Services and Health Education/Risk Reduction related to HIV diagnosis.

Program Guidance:

The elements of EIS often overlap with other service category descriptions; however, EIS is the combination of such services rather than a stand-alone service. RWHAP Part recipients should be aware of programmatic expectations that stipulate the allocation of funds into specific service categories.

Language assistance must be provided to individuals who have limited English proficiency and/or other communication needs at no cost to them in order to facilitate timely access to all health care and services.

Subrecipients must provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area to inform all individuals of the availability of language assistance services.

All AAs and subrecipients must establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organizations’ planning and operations.

Limitations:

Ryan White HIV/AIDS Program (RWHAP) Part B funds are used for HIV testing only where existing federal, state, and local funds are not adequate and RWHAP funds will supplement, not supplant, existing funds for testing.

Services:

EIS services are limited to counseling and HIV testing, referral to appropriate services based on HIV status, linkage to care, and education and health literacy training for clients to help them navigate the HIV care system. EIS services require coordination with providers of prevention services and should be provided at specific points of entry.

Counseling, testing, and referral activities are designed to bring individuals with HIV into Outpatient/Ambulatory Health Services (OAHS). The goal of EIS is to decrease the number of underserved individuals with HIV by increasing access to care. EIS also provides the added benefit of educating and motivating clients on the importance and benefits of getting into care. Individuals found not to have HIV should be referred to appropriate prevention services.

Telehealth and Telemedicine is an alternative modality to provide most Ryan White Part B and State Services funded services. For the Ryan White Part B/SS funded providers and Administrative Agencies, telehealth and telemedicine services are to be provided in real-time via audio and video communication technology which can include videoconferencing software.

DSHS HIV Care Services requires that for Ryan White Part B or SS funded services providers must use features to protect ePHI transmission between client and providers. RW Providers must use a telehealth vendor that provides assurances to protect ePHI that includes the vendor signing a business associate agreement (BAA). Ryan White Providers using telehealth must also follow DSHS HIV Care Services guidelines for telehealth and telemedicine outlined in DSHS Telemedicine Guidance.

Service Standard and Measure

The following Standards and Measures are guides to improving healthcare outcomes for people living with HIV throughout the State of Texas within the Ryan White Part B and State Services Program.

Standard	Measure
HIV Testing: Agencies providing HIV testing will ensure the following: Staff will be familiar with the DSHS HIV/STD Policy 2013.02; At a minimum, ensure that HIV testing is performed through the use of blood samples (either finger stick or venipuncture); Maintain records of number of HIV tests conducted in each measurement year; and Maintain records of test results with documentation that indicates whether the client was informed of their status. RWHAP Part B and State Services funds may be used to purchase CLIA-approved in-home testing kits.	Percentage of HIV positive tests in the measurement year. (HRSA HAB Measure) Percentage of individuals who test positive for HIV who are given their HIV-antibody test results in the measurement year. (HRSA HAB Measure) Percentage of agencies that have documented evidence of CLIA- approved testing kits purchased and logs to track use of these testing kits.
Results Counseling: Results counseling will be offered to all clients regardless of the result of the HIV test performed. Results counseling will include discussion of healthy behavior promotion education and general health education provided to the client. Results counseling for people living with HIV will include: Health education regarding HIV Healthy behavior promotion Maintenance of immune system Disclosure to partners and support systems Importance of accessing medical care and medications. Results counseling for HIV-negative individuals will include: Health education Healthy prevention promotion Referral to HIV prevention services	Percentage of clients offered results counseling as documented in the primary client record.
Linkage to Care: Clients testing positive for HIV through preliminary testing will be linked to and assisted in scheduling an appointment with a medical provider of the client’s choosing. Successful linkage to outpatient/ambulatory health services is measured as attendance to the actual medical appointment with a prescribing provider.	Percentage of clients who tested positive who were linked to outpatient/ambulatory health services in the measurement year. Percentage of people living with HIV, regardless of age, who attended a routine HIV medical care visit within 1 month of HIV diagnosis. (HRSA HAB Measure) Percentage of people living with HIV, who were experiencing homelessness or were unstably housed in the measurement period, who attended a routine HIV medical care visit within three (3) months of HIV diagnosis. (HRSA HAB Measure)
EIS Care Planning: Persons living with HIV will have care plans developed during the time they are receiving services through EIS programs. Care plans will include: Problem Statement (Need) Goal(s) – suggest no more than 3 goals Intervention Task(s) Referral(s) Service Deliveries Individuals responsible for the activity (EIS staff, client, family) Anticipated time for each task The care plan is updated with outcomes and revised or amended in response to changes in the client’s life circumstances or goals. As EIS programs are centered to assist clients in engaging in medical care rapidly after testing positive, care plans should be updated at least monthly, or more often as goals are achieved.	Percentage of clients accessing EIS services that have a care plan developed as documented in the primary client record. Percentage of clients accessing EIS services that have a care plan updated and/or revised as documented in the primary client record.
Progress Notes: Progress notes will be maintained in each client’s primary record with documentation of the assistance the EIS staff provided to the client to help achieve the goal of a successful linkage to OAHS services.	Percentage of clients accessing EIS services that have documented progress notes showing assistance provided to the client in the primary client record.
Referrals and Follow-up: EIS staff will assist the clients with referrals to necessary services to achieve successful linkage to care. Referrals will be documented in the client’s primary record and, at a minimum, should include referrals for services such as: OAHS MCM Medical transportation, as applicable Mental Health, as applicable Substance Use Treatment, as applicable Any additional services necessary to help clients engage in their medical care All referrals made will have documentation of follow-up to the referral in the client’s primary record. Follow-up documentation should include the result of the referral made (successful or otherwise) and any additional assistance the EIS staff offered to the client.	Percentage of clients accessing EIS services with documented referrals in the primary client record initiated in a timely manner with client agreed participation upon identification of client needs. Percentage of clients with documented referrals declined by the client in the primary client record. Percentage of clients accessing EIS services that have documentation of follow-up to the referral including appointment attended and the result of the referral in the primary client record.
Transition/Case Closure: Clients who are successfully linked to active MCM services and/or OAHS must have their cases closed with a case closure summary narrative documented on the criteria and protocol outlined below. Common reasons for case closure, as applicable, include: Client is referred and successfully linked to MCM services; Client relocates outside of the service area; Client chooses to terminate services; Client is lost to care or does not engage in services; Client incarceration is greater than six (6) months in a correctional facility; Client death. Transition criteria: Client has completed EIS goals and has been successfully linked to MCM services Client is no longer in need of EIS services (client declines EIS assistance). Client is considered non-adherent with care if three (3) attempts to contact client (via phone, text, home visit, e-mail, and/or written correspondence) are unsuccessful and the client has been given 30 days from initial contact to respond* Case closure proceedings should be initiated by the agency 30 days following the 3rd attempt. Make sure appropriate Releases of Information and consents are signed by the client and meet requirements of Texas Medical Record Privacy Act HB 300 regarding electronic dissemination of protected health information (PHI). Staff should utilize multiple methods of contact (phone, text, e-mail, certified letter) when trying to re-engage a client, as appropriate. Agencies must ensure that they have releases of information and consent forms that meet the requirements of Texas Medical Record Privacy Act HB 300 regarding the electronic dissemination of PHI.	Percentage of EIS clients with closed cases that include documentation stating the reason for closure and a closure summary (brief narrative in progress notes and formal case closure/graduation summary) in the primary client record system. Percentage of closed cases with documentation of supervisor signature/approval on closure summary (electronic review is acceptable).

Standard

Measure

HIV Testing: Agencies providing HIV testing will ensure the following:

Staff will be familiar with the DSHS HIV/STD Policy 2013.02;
At a minimum, ensure that HIV testing is performed through the use of blood samples (either finger stick or venipuncture);
Maintain records of number of HIV tests conducted in each measurement year; and
Maintain records of test results with documentation that indicates whether the client was informed of their status.

RWHAP Part B and State Services funds may be used to purchase CLIA-approved in-home testing kits.

Percentage of HIV positive tests in the measurement year. (HRSA HAB Measure)

Percentage of individuals who test positive for HIV who are given their HIV-antibody test results in the measurement year. (HRSA HAB Measure)

Percentage of agencies that have documented evidence of CLIA- approved testing kits purchased and logs to track use of these testing kits.

Results Counseling: Results counseling will be offered to all clients regardless of the result of the HIV test performed.

Results counseling will include discussion of healthy behavior promotion education and general health education provided to the client.

Results counseling for people living with HIV will include:

Health education regarding HIV
Healthy behavior promotion
Maintenance of immune system
Disclosure to partners and support systems
Importance of accessing medical care and medications.

Results counseling for HIV-negative individuals will include:

Health education
Healthy prevention promotion
Referral to HIV prevention services

Percentage of clients offered results counseling as documented in the primary client record.

Linkage to Care: Clients testing positive for HIV through preliminary testing will be linked to and assisted in scheduling an appointment with a medical provider of the client’s choosing.

Successful linkage to outpatient/ambulatory health services is measured as attendance to the actual medical appointment with a prescribing provider.

Percentage of clients who tested positive who were linked to outpatient/ambulatory health services in the measurement year.

Percentage of people living with HIV, regardless of age, who attended a routine HIV medical care visit within 1 month of HIV diagnosis. (HRSA HAB Measure)

Percentage of people living with HIV, who were experiencing homelessness or were unstably housed in the measurement period, who attended a routine HIV medical care visit within three (3) months of HIV diagnosis. (HRSA HAB Measure)

EIS Care Planning: Persons living with HIV will have care plans developed during the time they are receiving services through EIS programs. Care plans will include:

Problem Statement (Need)
Goal(s) – suggest no more than 3 goals
Intervention
- Task(s)
- Referral(s)
- Service Deliveries
Individuals responsible for the activity (EIS staff, client, family)
Anticipated time for each task

The care plan is updated with outcomes and revised or amended in response to changes in the client’s life circumstances or goals.

As EIS programs are centered to assist clients in engaging in medical care rapidly after testing positive, care plans should be updated at least monthly, or more often as goals are achieved.

Percentage of clients accessing EIS services that have a care plan developed as documented in the primary client record.

Percentage of clients accessing EIS services that have a care plan updated and/or revised as documented in the primary client record.

Progress Notes: Progress notes will be maintained in each client’s primary record with documentation of the assistance the EIS staff provided to the client to help achieve the goal of a successful linkage to OAHS services.

Percentage of clients accessing EIS services that have documented progress notes showing assistance provided to the client in the primary client record.

Referrals and Follow-up: EIS staff will assist the clients with referrals to necessary services to achieve successful linkage to care.

Referrals will be documented in the client’s primary record and, at a minimum, should include referrals for services such as:

OAHS
MCM
Medical transportation, as applicable
Mental Health, as applicable
Substance Use Treatment, as applicable
Any additional services necessary to help clients engage in their medical care

All referrals made will have documentation of follow-up to the referral in the client’s primary record. Follow-up documentation should include the result of the referral made (successful or otherwise) and any additional assistance the EIS staff offered to the client.

Percentage of clients accessing EIS services with documented referrals in the primary client record initiated in a timely manner with client agreed participation upon identification of client needs.

Percentage of clients with documented referrals declined by the client in the primary client record.

Percentage of clients accessing EIS services that have documentation of follow-up to the referral including appointment attended and the result of the referral in the primary client record.

Transition/Case Closure: Clients who are successfully linked to active MCM services and/or OAHS must have their cases closed with a case closure summary narrative documented on the criteria and protocol outlined below.

Common reasons for case closure, as applicable, include:

Client is referred and successfully linked to MCM services;
Client relocates outside of the service area;
Client chooses to terminate services;
Client is lost to care or does not engage in services;
Client incarceration is greater than six (6) months in a correctional facility;
Client death.

Transition criteria:

Client has completed EIS goals and has been successfully linked to MCM services
Client is no longer in need of EIS services (client declines EIS assistance).

Client is considered non-adherent with care if three
(3) attempts to contact client (via phone, text, home visit, e-mail, and/or written correspondence) are unsuccessful and the client has been given 30 days from initial contact to respond* Case closure proceedings should be initiated by the agency 30 days following the 3rd attempt. Make sure appropriate Releases of Information and consents are signed by the client and meet requirements of Texas Medical Record Privacy Act HB 300 regarding electronic dissemination of protected health information (PHI).

Staff should utilize multiple methods of contact (phone, text, e-mail, certified letter) when trying to re-engage a client, as appropriate. Agencies must ensure that they have releases of information and consent forms that meet the requirements of Texas Medical Record Privacy Act HB 300 regarding the electronic dissemination of PHI.

Percentage of EIS clients with closed cases that include documentation stating the reason for closure and a closure summary (brief narrative in progress notes and formal case closure/graduation summary) in the primary client record system.

Percentage of closed cases with documentation of supervisor signature/approval on closure summary (electronic review is acceptable).

Notes:

1. After three unsuccessful attempts are made to contact and re-engage the client, EIS staff should work with their local Disease Intervention Specialist (DIS) workers.