MINNESOTA STATE REPORT

1. MINNESOTA STATE REPORT By Candy Hadsall RVIPP Regional Meeting February 3 - 4, 2010 Chicago

2. Overview • MDH Activities other than MIPP • MIPP • Funding • New contractors • 2010 activities • Community Organizing & MDH • EPT in MN • Awareness, education and support • Successes and lessons learned • Ongoing activities

3. MDH Activities • Surveillance developing system to increase proportion of lab-reported cases that have matching provider reports; using MEDSS for automated reminders to providers with electronic reporting • Prevention and testing programs distributed condoms using unspent funds (including female condoms) • 3rd Annual Hepatitis Symposium Aug 11-12 • All funding raised outside MDH (Amer Liver Fdn)

4. MDH Activities (cont) • Syphilis Elimination • Funded again in 2010 due to increase # in 2009 • No longer have SE coordinator • Will do training for providers • $ to Red Door to continue past SE activities: testing in MSM venues, treatment centers, Pride, in clinic; online outreach to MSM sites to connect to clinic; promote inSpot • Media campaign

5. Minnesota IPP 2010-2013 • Change in funding based on: local data, new CDC requirements, changes in CDC requirements, need to identify providers according to state policies (new RFP) • Formula (goal by 2014) • 60% to address disparities in CT rates (urban area) • 30% to address CT increases in Greater MN • 10% to targeted GC screening (urban area)

6. Eligibility Criteria • Had ability to submit data electronically • Had to have contract with lab to provide NAAT • Had to agree to increase current screening levels • Geographic location = in or near zip codes with highest rates of CT and GC • Patient population: high number of pts served reported living in high rate zip codes; high number of ages 15-25 yrs old, especially females; high % of uninsured; high number of African American pts • Had to provide data on above plus: • Rates of CT and GC by female and male • Screening coverage

7. Outcome • Received 10 proposals, funded 5 programs in urban area (10% GC, 60% disparities) • Sole source contract with PPMNS for CT screening and treatment in Greater MN (30%)

8. 2010-2013 MIPP Contractors • Hennepin Co. Public Health Clinic (Red Door) • Health Start (in all 10 public high schools in St. Paul) MIPP funds screening and tx in 5 schools w/highest rates • St. Paul-Ramsey County Department of Public Health (Title X FP & STD clinics) • Teen Age Medical Services • Includes street outreach to African American males • Planned Parenthood Minnesota, North Dakota, South Dakota (16 Title X sites in Greater MN)

9. CSPS and IPP Objectives/Activities • Laboratory meetings • With contracting labs, to tell them about IPP and their role in CT epidemic and PH • With MDH lab administration to assess feasibility of resuming dx testing • Timeliness to treatment • Get more data! • Conduct site visits to discuss findings • Provide TA/capacity bldg as needed to address contributing factors and possible solutions

10. CSPS, IPP Activities (cont) • Continue with EPT: raise awareness, pilot study, survey of provider practices. (will share Lessons Learned) • Leveraging resources: • Capacity building to 5 entities: contractors, other clinics, hospitals, managed care, etc. as need is identified. Purpose: to improve CT screening and treatment services, raise awareness about CT & GC disparities • Organization of statewide stakeholder action group and development of strategy/plan • Summit on CT to be held in July 2010 • NCC proposal to fund Summit

11. Community Engagement

12. Statewide Partnership Group • Need for “aggressive education”, i.e., advocacy • Need to raise awareness about CT epidemic in MN; also disparities w/GC • Need to bring people together to discuss variety of subjects • More and better screening – more $ • Treatment issues – Payment for partner tx, GC tx options diminishing • Confidentiality – EOBs, minor consent • Education, awareness – need for CSE • Teens, parents

13. Purpose • Educate them about problem and ask them to educate others. • Ask for their ideas, solutions that apply in many areas (a “plan”) • Get specific suggestions about MDH’s role and activities (part of “plan”) • Ask how they are willing to help (they may be able to do things we can’t = ask for $, CSE) • Encourage them to take action in their own organizations.

14. Composition of Partnership • 20 individuals, active members, • Composed of core leaders in community w/power to make decisions • Who have time, energy & passion for the issue, • Possess a “can-do” attitude, and • Represent a diverse cross-section from many sectors of the community.

15. Community Organizing • The only people who can deal with a problem are the people who are most affected by the problem. • Basic tenets: • People identify their own problems • People determine their own solutions to the problems • People undertake the implementation of their solutions • Aim is to empower people = we can never do something for another person; that person must do it for themselves. Leaders support them in this process.

16. Community Organizers: • See health and social problems as deeply grounded in broader social context • Recognize individual responsibility for health problems is limited: focus of interventions should be at community and policy levels in addition to at the level of the individual. • See diversity and multiculturalism not as problem but as rich resource

17. How Community Organizing Applies to MDH • We want to meet our mission • Problem: epidemic of chlamydia in young people with numbers increasing each year; current strategies aren’t working • Problem is complex health and social issue • Need new energy, innovative ideas, more effective strategies that really address the needs of the various communities involved • MDH needs assistance and input from various groups in state that are affected

18. Community Organizing and Public Health • “..is as much about facilitating a process whereby communities use their voice to define and make their health concerns known as it is about providing prevention and treatment”. (Wallack 1993”) • “…a process through which communities are helped to identify common problems or goals, mobilize resources, and develop and implement strategies to achieve goals collectively set”. (Community Organizing and Community Building for Health”, Meredith Minkler, editor)

19. 'If you want to go quickly, go alone. If you want to go farther, go together.”African proverb

20. “Take Away” Ideas from EPT in Minnesota

21. Lessons Learned • Licensing Boards (state agencies): MD, RN/NP, pharmacy, PA • Cannot take positions of support • Can say will not take action against professionals operating within standards of care (EPT now standard of care) • Professional associations - Can take positions of support – best in writing • MDs: State medical association • State public health association • Pharmacists: state pharmacy association • PAs: state association • RN/NPs: state nursing association and advanced practice RN groups

22. Raise Awareness of EPT • Universities: Faculty and students at schools of medicine, pharmacy (including student fraternity Kappa Psi), nursing, physician assistants • MDs: Symposia w/Dr. Golden; guidance on MDH website; letter of support from Public Health committee of MMA; article published in MMA journal Nov 2009 • Pharmacists: Table at state conference, spoke at fall symposium, articles in newsletter of state Bd of Pharmacy, MPhA; article published in journal (Jan. 2010) • PAs: Article in newsletter; will speak at state conference March ’10 • RN/NPs: Exploring speaking at state conference

23. EPT Activities in Process • Pilot Study – April 2010- April 2011 • Clinics asked to participate: ½ to hand out Rx, ½ to hand out medications, incl info • Student will do f/up interviews, ask patients to report how many partners received meds, did they take it • Outcomes: • Did pts give meds/Rx to partners? All partners? Why or why not? • More likely to take medication if med was provided vs. Rx? • How many partners took meds? • Have sex after given treatment? • Ask clinics to evaluate their participation and outcomes in various ways (simple report to student)

24. EPT Activities in Process (cont) • Survey of providers – Did pilot 10 months ago, now doing bigger sample. Purpose: was to get baseline. Has been delayed – what will it show? • Goals: • Who was already using EPT? • Who is planning to implement it? • If not going to implement, why not?

25. Candy Hadsall, RN, MASTD Clinical ConsultantMinnesota Department of Health651-201-4015Candy.Hadsall@state.mn.us