Collaborative HIV Care at Lawndale Christian Health Center

1. Working Together: A Collaborative Approach to HIV CareLawndale Christian Health Center John Ryan Clinic (Amelia Campos RN, Ron Chacko,MD, Ana Figueroa, Truly Gannon RD, Pastor Linda Johnson, Marissa NillPharmD, Nikiya Pruitt, and Karla Torres PsyD)

2. Key objectives • To share a model of multidisciplinary team care for HIV infected individuals • To share reflections on caring for individuals affected by HIV as individuals and a team • To encourage dialog on how Christians and Christian agencies can more effectively address the HIV epidemic in our neighborhoods

3. “ Medicine as ministry is the work of caring for and promoting the healing of the sick and the suffering.” - Margaret Mohrmann, MD Medicine as Ministry

4. HIV incidence in our communities…

5. People living with HIV/AIDS

6. Lawndale’s John Ryan Clinic • First HIV patients seen at Lawndale- 1992 after patients from TB clinic diagnosed • Recipient of Ryan White part A,B and C grants • 182 patients actively managed for HIV services at Lawndale

7. Clinical services • Primary care and HIV management • Behavioral health/substance abuse • Adherence and medication management • Nutrition evaluation and counseling • Referrals for dentistry and specialty care

8. Case management services • Monthly face-to-face or phone encounters with our patients • Support groups • General HIV support groups in English and Spanish • Women living with HIV/AIDS • Young men living with HIV/AIDS (16-25yo) • Substance abuse/ sobriety

9. Outreach Services • Free rapid HIV and pregnancy testing on-site • Community outreach events • Health education services at Farragut High School

10. Immune reconstitution Dualism (philosophy of mind) From Wikipedia, the free encyclopedia René Descartes's illustration of dualism. Inputs are passed on by the sensory organs to the epiphysis in the brain and from there to the immaterial spirit. In philosophy of mind, dualism is the assumption that mental phenomena are, in some respects, non-physical,[1] or that the mind and body are not identical.[2] Thus, it encompasses a set of views about the relationship between mind and matter, and is contrasted with other positions, such as physicalism, in the mind–body problem.[1][2] Aristotle shared Plato's view of multiple souls, (ψυχήpsychí) and further elaborated a hierarchical arrangement, corresponding to the distinctive functions of plants, animals and people: a nutritive soul of growth and metabolism, that all three share, a perceptive soul of pain, pleasure and desire, that only animals and people share, and the faculty of reason, that is unique to people only. In this view, a soul is the hylomorphic form of a viable organism, wherein each level of the hierarchy formally supervenes upon the substance of the preceding level. Thus, for Aristotle, all three souls perish when the living organism dies.[3][4] For Plato however, the soul was not dependent on the physical body, he believed in metempsychosis, the migration of the soul to a new physical body.[5] Dualism is closely associated with the philosophy of René Descartes (1641), which holds that the mind is a nonphysical substance. Descartes clearly identified the mind with consciousness and self-awareness and distinguished this from the brain as the seat of intelligence.[6] Hence, he was the first to formulate the mind–body problem in the form in which it exists today.[7] Dualism is contrasted with various kinds of monism, including phenomenalism. Substance dualism is contrasted with all forms of materialism, but property dualism may be considered a form of emergent materialism or non-reductive physicalism in some sense. This article discusses the various forms of dualism and the arguments which have been made both for and against this thesis. loneliness disclosure purpose connection support stigma hope addiction depression coherence relationships Identity sex anxiety Illness Antiretroviral therapy agency adherence trauma secrets • Inflammation incarceration love blessing faith homelessness family

11. Multidisciplinary clinic (2 half-sessions/wk) • Patients receive behavioral health, medication management and nutrition services integrated into their HIV primary care experience • Patients who are stable, or otherwise unable to come to multidisciplinary clinic are seen during provider’s other clinic sessions

12. Collaboration- multidisciplinary meetings • Weekly • Clinical team and case management meet 1h to review patients to be seen during week to come • Monthly • Time to pray for patients and team • Team discussion on 3-4 complicated cases, review strengths, barriers to care and issues, develop a team-based plan • Quarterly • Discussion of program and team issues

13. “The woman with the hemorrhage was healed before Jesus knew who she was, but he would not have it remain so. He would be not be a party to magical, faceless healing. So it must be with us. “Who is this?” is always the question that must be asked by us if we are to evoke and enable the sort of healing love that God has manifested to us in Jesus” -Margaret Mohrmann, MD Medicine as Ministry

14. Immune reconstitution Dualism (philosophy of mind) From Wikipedia, the free encyclopedia René Descartes's illustration of dualism. Inputs are passed on by the sensory organs to the epiphysis in the brain and from there to the immaterial spirit. In philosophy of mind, dualism is the assumption that mental phenomena are, in some respects, non-physical,[1] or that the mind and body are not identical.[2] Thus, it encompasses a set of views about the relationship between mind and matter, and is contrasted with other positions, such as physicalism, in the mind–body problem.[1][2] Aristotle shared Plato's view of multiple souls, (ψυχήpsychí) and further elaborated a hierarchical arrangement, corresponding to the distinctive functions of plants, animals and people: a nutritive soul of growth and metabolism, that all three share, a perceptive soul of pain, pleasure and desire, that only animals and people share, and the faculty of reason, that is unique to people only. In this view, a soul is the hylomorphic form of a viable organism, wherein each level of the hierarchy formally supervenes upon the substance of the preceding level. Thus, for Aristotle, all three souls perish when the living organism dies.[3][4] For Plato however, the soul was not dependent on the physical body, he believed in metempsychosis, the migration of the soul to a new physical body.[5] Dualism is closely associated with the philosophy of René Descartes (1641), which holds that the mind is a nonphysical substance. Descartes clearly identified the mind with consciousness and self-awareness and distinguished this from the brain as the seat of intelligence.[6] Hence, he was the first to formulate the mind–body problem in the form in which it exists today.[7] Dualism is contrasted with various kinds of monism, including phenomenalism. Substance dualism is contrasted with all forms of materialism, but property dualism may be considered a form of emergent materialism or non-reductive physicalism in some sense. This article discusses the various forms of dualism and the arguments which have been made both for and against this thesis. loneliness disclosure purpose connection support stigma hope addiction depression coherence relationships Identity sex anxiety Illness Antiretroviral therapy agency adherence trauma secrets • Inflammation incarceration love blessing faith homelessness family

15. “The stories are hard but they are hard because there is nothing harder or less sentimental than Christian realism” -Flannery O’ Connor