HIV, Housing & Employment Project Intervention Tools

The Safe & Sound Return Partnership (SSRP) is a three-pronged intervention that works at the client, provider, and system levels to rapidly connect PLWH recently released from Cook County Jail and Illinois state prisons to medical, housing, and employment services using a Peer Community Re-engagement Specialist model.

AIDS Foundation of Chicago (AFC), Chicago, IL

Client Stories

Resources

• Implementation Manual: Safe and Sound Return Partnership Implementation Guide (PDF)
• One Pager: Safe & Sound Return Partnership Overview (PDF)
• Tip Sheet: AIDS Foundation of Chicago (AFC): Re-entry Challenges (PDF)
• Poster: Safe & Sound Return Partnership, AIDS Foundation of Chicago (PDF)

National Ryan White Conference 2020 Presentations and Posters

• PLWHA recently released from incarceration: Barriers to HIV medical care (Poster)
• Social Isolation Among Unstably Housed PLWHA Returning from Incarceration (Poster)
• Expected Stigma and Self-stigma among Persons Living with HIV/AIDS Recently Released from Incarceration  (Poster)
• Transitioning from Jail or Prison to Trauma-Informed HIV Community Services (Poster)
• SPNS Project Institute: Addressing barriers to care for PWH experiencing homelessness and un/underemployment (Presentation)

Through Project CORE (Coordination of Resources and Employment Services) Avenue 360 Health & Wellness offers a medical home for patients and AIDS Foundation Houston coordinates employment training and resources. These agencies believe that coordination is the key to breaking down barriers to health care in their community.

Avenue 360 Health & Wellness, and AIDS Foundation Houston, Houston, TX

Resources

Project CORE is featured in the RWHAP Best Practices Compilation

• Implementation Manual: Project CORE: Coordination of Resources & Employment -- A Structural Intervention (PDF)
• One Pager: Project CORE - Improving HIV Health Outcomes through the Coordination of Supportive Employment and Housing Services (PDF)
• Tip Sheet: Project CORE - Client Engagement (PDF)
• Poster: Project CORE on Coordination of Resources and Employment Services (PDF)

National Ryan White Conference 2020 Presentations and Posters

• Project CORE: A Coordinated Housing, Employment, and HIV Care Intervention (Presentation)
• Systems Models Providing Care and Treatment to People with HIV Experiencing Homelessness and Under/Unemployment (Presentation)
• The Importance of Collaboration to End the Epidemic (Poster)

The CASE Management Initiative (CAre, houSing, and Employment) comprises coordination of client services for six months and transitioning clients to the jurisdiction's case management system after completion of the program. Acuity scores determine clients’ case management paths.

Bexar County Hospital District, San Antonio, TX

Resources 

• Implementation Manual: CASE Management Initiative Program Manual (PDF)
• One Pager: UHS Bexar County - Improving HIV Health Outcomes through the Coordination of Supportive Employment and Housing Services (PDF)
• Tip Sheet: Re-entry Challenges (PDF)
• Case Study: Immigration Case Study (PDF)
• Poster: Improving Health Outcomes Through the Coordination of Supportive Employment & Housing Services (PDF)

National Ryan White Conference 2020 Presentations and Posters

• Improving HIV Health Outcomes through the Coordination of Supportive Employment and Housing Services (Presentation)

Short-term intensive case management services to link clients to housing, employment, and health care services provided by a team comprised of a Peer Care Navigator, Housing Navigator, and an Employment Navigator.

City of Pasadena, Pasadena, CA

Client Stories

Resources

• Implementation Manual: Operation Link Intervention Manual (PDF)
• One Pager: City of Pasadena Coordination of Supportive Employment and Housing Services (PDF)
• Tip Sheet: City of Pasadena Operation Link Housing Subsidies (PDF)
• Poster: City of Pasadena Operation Link (PDF)

National Ryan White Conference 2020 Presentations and Posters

• Leveraging HRSA and HUD Funding to Improve Outcomes for People Who Are Unstably Housed (Presentation)

Smart Care Management data-driven/IT model (e.g., patient portal, real-time dashboard for agencies) to enhance utilization of existing health, housing, and employment services.

City of Paterson, Paterson, NJ

Resources

This intervention is featured in the RWHAP Best Practices Compilation

• Intervention Manual: City of Paterson Intervention Manual (PDF)
• One Pager: City of Paterson Coordination of Supportive Employment and Housing Services (PDF)
• Poster: City of Paterson Coordination of Supportive Employment and Housing Services (PDF)

National Ryan White Conference 2020 Presentations and Posters

• Housing, Employment, and Quality Improvement for Incarcerated Populations: Paterson, N.J., and Puerto Rico (Presentation)

Coordination of health care with housing and employment services through regular meetings, formal agreements, and a Linkage Coordinator.

Family Health Centers of San Diego, San Diego, CA

Resources

• Implementation Manual: The San Diego Coordinated Services Integration Intervention (PDF)
• One Pager: FHCSD - Coordination of Supportive Employment and Housing Services (PDF)
• Tip Sheet: FHCSD Housing Strategy Case Study (PDF)
• Poster: FHS of San Diego - Coordinated Services Intervention (PDF)

National Ryan White Conference 2020 Presentations and Posters

• Leveraging Partnerships to Increase Housing and Employment for People with HIV Experiencing Homelessness and Under/Unemployment (Presentation)

Partnership between employment services and Ryan White HIV/AIDS Program providers to foster case coordination among medical care and social service providers, including a screening and referral system for housing and employment needs and services individualized for specific patient needs. 

Fenway Health, Boston, MA

Resources 

No Wrong Door is featured in the RWHAP Best Practices Compilation

• Implementation Manual: No Wrong Door for High-Acuity Care: A Federally-Qualified Health Center and AIDS Services Organization take the next steps by integrating employment services and intentionally coordinating care (PDF)
• One Pager: Fenway Health - Coordination of Supportive Employment and Housing Services (PDF)
• Tip Sheet: Fenway Health - Employment Strategies (PDF)
• Poster: Fenway Health Housing & Employment Project (PDF)
• Spotlight: Integrating HIV Care, Housing, and Employment Support in a FQHC: A No Wrong Door Approach (PDF)

National Ryan White Conference 2020 Presentations and Posters

• Leveraging HRSA and HUD Funding to Improve Outcomes for People Who Are Unstably Housed (Presentation)
• Poster: Integrating Employment Services Into HIV Care Model Through Partnership With Department of Labor Funded Site (Poster)

Project HEALTH (Housing & Employment Access Lead to Health) uses care coordination to link clients to services by assessing client needs, barriers, and stages of change, guided by electronic health records and a modified stages of change tool used to assess housing & employment stages of change.

GMHC, New York, NY

Resources 

• Implementation Manual: GMHC Project HEALTH – Housing and Employment Access Lead to Health (PDF)
• One Pager: GMHC Project Health - Coordination of Supportive Employment and Housing Services (PDF)
• Tip Sheet: GMHC Project HEALTH - Employment Strategies (PDF)
• Poster: GMHC Project HEALTH (Housing and Employment Access Lead to Health) (PDF)

National Ryan White Conference 2020 Presentations and Posters

• Systems Models Providing Care and Treatment to People with HIV Experiencing Homelessness and Under/Unemployment (Presentation)
• Adapting the URICA Assessment for Use With PLWH Experiencing Homelessness and Unemployment (Poster)
• Obtaining Clinical Outcome Data for HIV Care Organizations without a Clinical Service Component (Presentation)
• Leveraging EHRs to Collect and Integrate Outcomes-Based Data in Care (Presentation)

KC Life 360’s same-day intake, informed consent, and one-on-one with an Employment Career Specialist generates awareness of services and benefits across provider networks.

Kansas City, MO Health Department, Kansas City, MO

Client Stories

Resources

KC Life 360 is featured in the RWHAP Best Practices Compilation

• Manual: KC Life 360 Intervention Manual (PDF)
• One Pager: Kansas City, MO Coordination of Supportive Employment and Housing Services (PDF)
• Tip Sheet: Client Engagement, Kansas City, MO Coordination of Supportive Employment and Housing Services (PDF)
• Poster: Kansas City, MO Coordination of Supportive Employment and Housing Services (PDF)
• Spotlight: Bike Exchange (PDF)
• Slides: KC Life 360 Presentation
• Project Website: KC Life 360 at UMKC

National Ryan White Conference 2020 Presentations and Posters

• Housing and Employment Success Stories: Innovative System Service Delivery Supporting the HIV Care Continuum (Presentation)
• Collaborating with Local Coordinated Entry to Ensure Access to Housing for Persons with HIV (Presentation)

H.O.M.E.S. (Housing Opportunities, Medical, & Employment Services) is a housing-first model to help people with HIV address their housing instability while working towards obtaining employment and maintaining consistent medical care. Every patient completes an individual service plan, developed in partnership with their case manager.

Positive Impact Health Centers, Atlanta, GA

Client Stories

Resources 

• Implementation Manual: Housing Opportunities Medical Employment Services (HOMES) Program Manual (PDF)
• One Pager: Positive Impact Health Centers - Coordination of Supportive Employment and Housing Services (PDF)
• Tip Sheet: Positive Impact Health Centers - Client Engagement (PDF)
• Poster: Positive Impact Health Centers - H.O.M.E.S. (PDF)

RW2020 Presentations and Posters

• Systems Models Providing Care and Treatment to People with HIV Experiencing Homelessness and Under/Unemployment (PDF)

Clients are enrolled into a low barrier program that provides immediate and critical housing crisis intervention, including in-housing employment services and ongoing intervention services to secure permanent housing and maintain access to HIV primary care. 

PRC, San Francisco, CA

Resources

• Implementation Manual: PRC Housing Planning Program Manual (PDF)
• One Pager: PRC - Coordination of Supportive Employment and Housing Services (PDF)
• Tip Sheet: PRC - Housing Case Study (PDF)
• Poster: PRC - Integrated Health Analysis (PDF)

National Ryan White Conference 2020 Presentations and Posters

• Improving HIV Health Outcomes through the Coordination of Supportive Employment and Housing Services (Presentation)

Project HERO (Housing and Employment Resources for Improving HIV Outcomes) provides housing and employment services including a Job Club, to provide a supportive environment and training for participants. 

Yale School of Medicine, Liberty Community Services, New Haven, CT

Client Stories

Resources 

Project HERO is featured in the RWHAP Best Practices Compilation 

• Implementation Manual: Project HERO (Housing and Employment Resources for Improving HIV Outcomes) (PDF)
• One Pager: Yale Project HERO - Coordination of Supportive Employment and Housing Services (PDF)
• Tip Sheet: Yale/Liberty - POWER (Pursuing Opportunities With Employment & Resources) (PDF)
• Poster: Yale School of Medicine/Liberty Community Services - POWER (PDF) 

National Ryan White Conference 2020 Presentations and Posters

• Leveraging Partnerships to Increase Housing and Employment for People with HIV Experiencing Homelessness and Under/Unemployment (Presentation)
• Work is Everyone’s Business: Strategies to Facilitate Movement on the Employment Spectrum for PWH (Presentation)