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Introducing the Linkages to Care Program

May/June 2005

Pamela Morse
It is estimated that 300,000 people in the U.S. who know they are HIV positive are not accessing medical care. The inability to access medical care is influenced by many factors, including feeling healthy, fear and denial, lack of money and/or transportation, language barriers and misinformation. However, with appropriate medical care, we know that the quality of life for these individuals can increase. With ongoing preventative medical care, individuals can experience less infection, increased knowledge of HIV/AIDS, increased knowledge of harm reduction techniques and an increased ability to connect with other community resources.

Currently, the continuum of care relies on case managers to work with clients on the barriers to medical compliance. However, traditional case management is designed to assess a client's needs and coordinate, evaluate and monitor a package of multiple services to meet the total of those needs. It is not a service provided with the specific goal of linkage to medical care. In addition, traditional case management is accessed in conjunction with medical care services. If people are not accessing medical care, how can they effectively access case management?

The Antiretroviral Treatment and Access Study (ARTAS) was designed to bridge that gap. The study assessed the efficacy of a brief intervention, using Strengths-Based Case Management to engage newly diagnosed folks into medical care. Due to the positive results of this study, the CDC has awarded a grant to ASP, subcontracted with Our Common Welfare, to conduct the program evaluation portion of the project, The Linkages to Care Program: ARTAS 2.

The Linkages to Care Program will recruit participants from AIDS Survival Project's and Our Common Welfare's counseling and testing programs, as well as other community counseling and testing sites. Participant eligibility is:


  • 18+ years old

  • HIV-positive diagnosis within the last six months

  • no previous medical care for HIV/AIDS, and

  • income less than 200% of the Federal Poverty Level

Participants will be assigned a care coordinator (typically referred to as a case manager) who will provide a five-session intervention, grounded in the Strengths-Based Case Management (SBCM) model. The end goal is to successfully link participants to medical care.

The SBCM approach was developed at the University of Kansas School of Social Welfare in the early 1980s. It has been used primarily in the field of substance abuse and is now being translated to work within the field of HIV/AIDS. SBCM has been shown to increase the commitment that clients experience in the process of accessing services, teaching self-advocacy and reducing feelings of denial and resistance. During interactions, the care coordinator does not focus on what the client has done wrong in the past but focuses on the client's strengths instead. This teaches clients to recognize the motivation and personal strengths they possess that have led them to being successful in the past. For example, we may ask, "Is there a time in your past that you remember as being really challenging? How did you handle that? What strengths do you see that you used during that time?" We then use these identified strengths to set goals for the future.

At the core, SBCM is completely client-driven. All goals, meeting places and meeting times are set by the client. The care coordinator is then able to transform from a role of teacher/instructor to that of a guide. As a guide, the care coordinator must have a deep understanding of community resources. We are challenged, at every turn, to look at our community as a sea of resources, not as barriers. This is best evidenced in the intensive outreach prescribed as the first steps to participating in SBCM. A phone number and piece of paper will not suffice. Care coordinators make personal contacts and/or gain in-depth knowledge of each site a participant may be referred to prior to the referral. This is extremely important in meeting the goal of linkage to medical care. Entering medical care for HIV is a difficult process for many. Through SBCM, we hope to support folks through the initial process and create a lasting commitment to medical care.

The overarching benefit of using this model is that it does not demand that clients conform to what the community or society deems as right and wrong behavior. Because it is wholly client-driven, each interaction stems from what the client brings into the room. We are then able to celebrate cultural differences and identify the unique strengths as seen through the eyes of each individual.

While this approach to providing services may seem intuitive in many respects, it is very different from what many HIV-positive folks experience when navigating the system here in Atlanta. It is a process that has been shown to change people and create a new, positive path in their lives. In meeting our goal of connecting newly diagnosed people with medical care, we also hope that through solely focusing on peoples' strengths, participants are able to find the unique capabilities, innate strength and self-esteem that may have been disguised for many years. It is our expectation that the Linkages to Care Program will build upon the past success of SBCM, and continue to provide services that exemplify support, self-determination and individuality.

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This article was provided by AIDS Survival Project. It is a part of the publication Survival News.
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