Reporting Expenditures by Service Planning Area

County of Los AngelesDepartment of Health ServicesOffice of AIDS Programs and Policy

April 11, 2003

Charles L. HenryDirectorOffice of AIDS Programs and Policy

3

Geographic Estimate of Need Is..One of Multiple Planning

PerspectivesGeographic

Five Supervisorial Districts Eight Service Planning Areas Twenty-six Health Districts

Population(s) ServedPopulation(s) TargetedService Categories

One Frame of Accountability

4

Geographic Estimate of NeedIs Not..Limitation on Client Choice or

PreferenceNet Increase of FundsQuality Assurance of Services

Provided Identification of Behavioral Risk

or Other Target Populations

5

Geographic Estimate of Need Presents Opportunities for..Comparison of Service Sub-

SystemsGuidance for Expansion of

ServicesTargeting Capacity Building

ActivitiesComparison of Estimated Need

and Expenditures

Gunther FreehillDirector, Public AffairsOffice of AIDS Programs and Policy

7

Background

“Divide by Five”Planning Council PrioritiesService ExpansionsCommunity PlanningAIDS Politics

8

March 2002

CARE Act Title I AwardIncrease of $3 MillionIncreased Support for Quality

ManagementIncreased Program SupportIncreased Commission Support

Grant Award Accepted by Board of Supervisors

9

10

Board Request

Domains of Distribution Indicators of NeedAllocation of FundsDistribution of Services

11

Underlying Questions

How is the HIV/AIDS epidemic distributed in Los Angeles County?

Is the epidemic emerging in some areas? Is it receding in others?

Does the distribution of funds match the distribution of need?

Does the distribution of funds make sense?

Is my area getting its fair share?

12

Domains of DistributionZip Code Zones

Zones in Los Angeles County

524Zones > Half of Clients

36 Zones > 200 Clients

15Zones < = Five Clients

286

13

Figure 1: CARE Clients by Health District

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Domains of Distribution

14

Indicators of Need

CARE ClientsAIDS CasesHIV Test Results

15

Figure 2: CARE Clients by Service Planning Area

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

5,500

6,000

SPA 1: Antelope

Valley

SPA 2: SanFernando

Valley

SPA 3: SanGabrielValley

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

18

Figure 5: AIDS Cases by Service Planning Area

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

SPA1:Antelope

Valley

SPA 2: SanFernando

Valley

SPA 3: SanGabrielValley

SPA 4:Metro

SPA 5:West

SPA 6:South

SPA 7: East SPA 8:South Bay

Living Cases

Recent Cases

21

Figure 8: HIV Positive Resultsby Service Planning Area

-

100

200

300

400

500

600

SPA 1: Antelope

Valley

SPA 2: SanFernando

Valley

SPA 3: SanGabrielValley

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

24

Figure 11: Clients, Cases and Results by Service Planning Area

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

SPA 1:Antelope

Valley

SPA 2: SanFernando

Valley

SPA 3: SanGabrielValley

SPA 4:Metro

SPA 5:West

SPA 6:South

SPA 7: East SPA 8:South Bay

CARE Clients

Living Cases

Recent Cases

Positive Tests

26

Estimating Geographic Needfor Care Services

27

Figure 13: Factors Used to Estimate Geographic Need for Care Services

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

SPA 1:Antelope

Valley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4:Metro

SPA 5:West

SPA 6:South

SPA 7: East SPA 8:South Bay

Living Cases

Recent Cases

Poverty

28

Figure 14: Geographic Estimate of Need for Care Services

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

SPA 1:Antelope

Valley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4:Metro

SPA 5:West

SPA 6:South

SPA 7: East SPA 8:South Bay

29

Figure 15: Comparative Distribution of CARE Clients and Geographic Estimate of Need

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

SPA 1: Antelope

Valley

SPA 2: SanFernando

Valley

SPA 3: SanGabrielValley

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

Proportion of CARE Clients

Estimate of Need

30

Estimating Geographic Need for Prevention Services

31

Figure 16: Indicators of Geographic Need for HIV Prevention Services

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

SPA 1:Antelope

Valley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4:Metro

SPA 5:West

SPA 6:South

SPA 7: East SPA 8:South Bay

STD

Recent AIDS Cases

Living AIDS Cases

Substance Use

Counseling & Testing

Poverty

32

Figure 17: Weighted Indicators Determining Geographic Estimate of Need for HIV Prevention

Services STD23%

Recent AIDS Cases11%

Living AIDS Cases22%

Substance Use11%

Poverty22%

Counselingand Testing

11%

33

Figure 18: Geographic Estimate of Needfor HIV Prevention Services

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

SPA 1:Antelope

Valley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4:Metro

SPA 5:West

SPA 6:South

SPA 7: East SPA 8:South Bay

34

Figure 19: Comparison of Geographic Estimate of Need

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

SPA 1: Antelope

Valley

SPA 2: San

FernandoValley

SPA 3: San

GabrielValley

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

Estimate of Need (Care)

Estimate of Need (HIV Prevention)

35

Allocations of Funds and Estimates of Need

36

Figure 20: CARE Act Titles I and II, Estimate of Need

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

SPA 1: Antelope

Valley

SPA 2: San

Fernando

SPA 3: San

Gabriel

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

Funding

Estimate of Need

37

Figure 21: Distribution of Medical Services, Title I by SPA of Service Delivery Site

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

SPA 1: Antelope

Valley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

Clients Contracted

Units Contracted

Funding

Estimate of Need

38

Figure 22: Distribution of Medical ServicesTitle I, Title III, EIP by SPA of Service Delivery Site

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

SPA 1: Antelope

Valley

SPA 2: San

Fernando

SPA 3: San

Gabriel

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

Funding (Title I, III, EIP)

Estimate of Need

39

Figure 23: Distribution of Case Management Services by SPA of Service Delivery Site

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

SPA 1: Antelope

Valley

SPA 2: San

Fernando

SPA 3: San

Gabriel

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

Clients Contracted

Units Contracted

Funding

Estimate of Need

41

Figure 25: Distribution of Mental Health Services by SPA of Service Delivery Site

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

SPA 1: Antelope

Valley

SPA 2: San

Fernando

SPA 3: San

Gabriel

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

Clients Contracted

Units Contracted

Funding

Estimate of Need

42

Figure 26: Distribution of Substance Abuse Services by SPA of Service Delivery Site

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

SPA 1: Antelope

Valley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

Units Contracted

Funding

Estimate of Need

43

Figure 27: Distribution of Residential Services by SPA of Service Delivery Site

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

SPA 1: Antelope

Valley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East SPA 8: South Bay

Units Contracted

Funding

Estimate of Need

44

Figure 28: Distribution of Dental Services by SPA of Service Delivery Site

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

SPA 1: Antelope

Valley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

Clients Contracted

Units Contracted

Funding

Estimate of Need

45

Challenges to Meeting Geographic Estimate of NeedEstablished Service Delivery

Systems“Land Locked” Services

ResidentialSubstance AbusePublic Health Facilities

Diseconomies of ScaleLack of Provider CapacityClient Choice

46

Programmatic Recommendations

Increase Outpatient Medical ServicesExpansion Service SitesAugment Existing ServicesRe-Design Specialty Consultations

47

Figure 29: Distribution of Medical Services Title I, III, EIP, Specialty by SPA of Service Delivery

Site

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

SPA 1: Antelope

Valley

SPA 2: San

Fernando

SPA 3: San

Gabriel

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

Funding (Title I, III,EIP, Specialty)Estimate of Need

48

Figure 30: Distribution of Medical Services Title I, Title III, EIP, Specialty, Augmentations by

SPA of Service Delivery Site

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

SPA 1: Antelope

Valley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4: Metro

SPA 5: West

SPA 6: South

SPA 7: East

SPA 8: South Bay

Funding (Title I, III, EIP,Specialty, Augmentation)

Estimate of Need

49

Programmatic Recommendations

Increase Translation & Interpretation

Increase Child Care Increase Peer Support Services Increase Substance Abuse

Services

50

Administrative Recommendations

Conduct Rate ReviewsConduct Fiscal Reviews Increase Efficiency in

Contracting Increase MonitoringEnhance Community Planning

51

Board Response

Distribution of ReportReview and Comment by

Commission on HIV Health Services

Request Report on Expenditures by Service Planning Area

52

Year 13 CARE Services

53

CARE Services Year 12, Year 13 and Geographic Estimate of Need

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

SPA 1: AntelopeValley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4: Metro SPA 5: West SPA 6: South SPA 7: East SPA 8: SouthBay

Funding (2002)

Funding (2003)

Estimate of Need

54

Distribution of Medical Services

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

SPA 1: AntelopeValley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4: Metro SPA 5: West SPA 6: South SPA 7: East SPA 8: South Bay

Funding 2002

Funding 2003

Estimate of Need

55

Distribution of Medical Services, Title III, and EIP

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

SPA 1: Antelope Valley

SPA 2: SanFernando

SPA 3: SanGabriel

SPA 4: Metro SPA 5: West SPA 6: South SPA 7: East SPA 8: SouthBay

2002 Medical, III, EIP

2003 Medical, III, EIP

Estimate of Need

56

Re-Solicitation of Services 2003

Child CareTranslation and InterpretationLegal Services, Permanency

PlanningHIV Peer SupportFood

57

Re-Solicitation of Services 2004

Outpatient Medical Services *Substance Abuse Services *Treatment Education and

AdherenceOral HealthResidential Services *HIV Prevention

* Pending Rate Review

58

Re-Solicitation of Services 2005

Mental HealthCase ManagementTraining

59

Questions and Discussion

Mario J. PérezDirector, Prevention Services Division

Robert C. Fish, Ph.D.Director, Care Services Division

Office of AIDS Programs and Policy

61

Expenditures of Funds by Service Planning AreaCost Allocation BasesReports to the Board of

SupervisorsTerms of Reports Summary Reports

62

Cost Allocation Bases

Varies Among Service Categories

Consistent Within Service Category

63

Direct Service Hours

Time spent on the provision of services attributable to a specific client, group, couple or family.

Direct service hours include Time invested to prepare for a

client, group, couple or family intervention

Intake, assessment, and treatment time

Time invested to document the client, group, couple or family contact

64

Direct Service Hours (Cont.)

Direct service hours does not includeTime invested for trainings

(including certification trainings)Service category specific

meetings or staff meetingsDevelopment of program

associated materials and forms (e.g. curriculums, pamphlets)

All other activities not attributable to a specific client, group, couple, or family

65

Cost Allocation Basis No. 1Unit

Case Management, Medical

Case Management, Psychosocial

Client Advocacy Health Education, Risk

Reduction Home Based Case

Management Legal Services Mental Health,

Counseling Services

Hours of Direct Service Mental Health, Psychiatric

Services Other support: Child Care Other support:

Translation, Interpretation

Partner Counseling & Referral Services

Permanency Planning Prevention for HIV

Positives Psychosocial Support

Services Substance Abuse, Crisis

Counseling Treatment Adherence

66

Cost Allocation Basis No. 1 (Cont.)

Unit Service Certifications and

Recertifications• AIDS Drug

Assistance Program Consultations (by

SPA of referral)• Outpatient Medical,

Specialty Cost of rides (by

SPA of client)• Transportation - Taxi

Doses • Substance Abuse, Methadone Maintenance

67

Cost Allocation Basis No. 1 (Cont.)

Unit Service Interventions

Completed• Perinatal

Demonstration Project

Meals • Food Bank, Home Delivered Meals

Procedures • Oral Health Care Residential Days • Housing Assistance,

Residential Services• Hospice (Residential,

In-home)• Substance Abuse, All

Residential

68

Cost Allocation Basis No. 1 (Cont.)

Unit Service Rides • Transportation - Van Tokens, Monthly

Stickers (Disability Passes)

• Transportation – MTA, Metrolink

Visits • Early Intervention, Bridge

• Nutritional Counseling

• Outpatient Medical

• Substance Abuse, Day Treatment

69

Cost Allocation Basis No. 2

Unit Service Cost for Service

(Each Service x Each Fee)

• HIV/AIDS Counseling and Testing

70

Exercise

180(100%)

54 (30%)

18 (10%)

108 (60%)

TOTAL

450045Group Level Interventions

6330030 + 3Individual Level Interventions

72241830

Outreach (Contacts and Encounters)

TotalSPA 5SPA 4SPA 2

71

Monthly Reports8. Service Planning Areas (SPAs) [Please write the number of units of service delivered in the following SPA(s) this month and year to date]:

SPAThis Month Contract Year-to-Date

Unit =

SPA 1SPA 2SPA 3SPA 4SPA 5SPA 6SPA 7SPA 8

TOTAL

Hours

0108

01854000

180

72

Monitoring Compliance

Include in General Program Management and MonitoringReviewed MonthlyDiscrepancies IdentifiedPlans of Corrective ActionConsidered in Contract

Negotiation

73

Quarterly Expenditure Reports to the Board

Reports Organized by GrantsCARE Act Title ICARE Act Title IICenters for Disease Control and

Prevention (CDC)StateNet County Cost

74

Terms of Reports

First Six Months: Negotiated Deliverables

Second Six Months: Actual Delivery, First Six Months

Final: Actual Delivery, Twelve Months

75

Service Category Summary Reports

Commission on HIV Health Services

Prevention Planning CommitteeAvailable upon request

76

Questions and DiscussionClosing Remarks