The status of the 11 objectives that were delineated in the June 2000 grant application is summarized below:
objective 1: Create and maintain a citywide multi-disciplinary, collaborative network to provide permanency planning services to 300 children and their families.
result: 16 families with 38 children were enrolled during the fiscal year. At least 1 service was provided to 81 families. To date, a cumulative total of 202 children have received services during the 5 years of the project.
objective 2: Establish and maintain collaborative agreements with at least 10 agencies that provide direct services to families affected by HIV.
result: Agreements were renegotiated or negotiated with 12 agencies.
objective 3: Provide comprehensive legal services to 65 families affected by HIV.
result: The UDC School of Law provided permanency planning services to 47 families.
objective 4: Provide therapeutic mental health groups to 100 children, youth and adults affected by HIV.
result: 44 clients participated in 10 groups for children and youth offered by Pediatric Care, Inc.
objective 5: Provide short-term art therapy and counseling to 75 children, youth, adults and families affected by HIV.
result: The mental health subcontractor, Pediatric Care, Inc, provided Therapy to 27 clients.
objective 6: Provide kinship care support to 25 families caring for children affected by HIV.
result: Sasha Bruce Youthwork provided services to 29 families.
objective 7: Provide training to 35 family-based foster care providers and care givers.
result: 28 persons participated in 1 of 4 Caring in the Community training sessions presented by Children's National Medical Center staff, however, the total attendance included staff and volunteers from other agencies.
objective 8: Provide training to 20 parents and caregivers caring for children affected by HIV to enhance their parenting skills.
result: Sasha Bruce conducted a retreat for 14 parents and caregivers.
objective 9: Support the development, enactment, and implementation of a standby guardianship law.
result: A bill to establish standby guardianship was introduced in the city council with strong support. A public hearing was held. Passage is expected in 2002.
objective 10: Determine the HIV-related experiences and needs of the 8 Healthy Families/Thriving Communities Collaboratives and to develop strategies for enhancing the project's relationship with these organizations.
result: A needs assessment study was commissioned and completed. The results were presented to and discussed with staff and subcontractors. Strategies have yet to be fully developed
objective 11: Educate and inform policy-makers and service providers about the life planning needs of HIV-affected children and families through the collection of project data and the analysis and dissemination of findings.
result: The project staff collected and submitted to the AIA Resource Center the required project data. They also collect client socio-demographic, utilization, satisfaction and goal attainment data. These and other data are compiled in final and annual reports that are made available to various stakeholders. Project and subcontractor staff present findings at professional meetings. Testimony at a public legislative hearing on the standby guardianship bill also aimed to educate policy makers about life planning needs, opportunities and resources.
In summary, it may be concluded that 3 (2, 6, and 11) of the
11 objectives were exceeded within the designated time period.
2 objectives
(9 and 10) are expected to be completed in year 6. With the exception
of kinship care case management, service utilization objectives
were not achieved. Enrollment of new families has not been sufficient
to meet overall service projections.
These results were presented to and discussed by project staff and contractors January 25, 2001. Several participants pointed out that the year 5 projection for total clients (300) was not realistic given the numbers served during years 1 through 5 (202). The CCW executive director raised questions about the number of HIV affected children and families in the District: What is the size of the target population and what proportion of affected children are we serving?
Although the project continues to use the Michaels and Levine projection of 10002000 children being orphaned in the District by 2000 as the best information currently available,9 the total size of the population of HIV affected children and adolescents is difficult to estimate. The Levine projection applies to persons whose mothers have died as a result of AIDS since the beginning of the epidemic and includes adult children. The number of currently infected mothers (and fathers) is of course much greater. Insofar as it is estimated that 1/410 to 1/3 of persons with HIV may be unaware of their serostatus and another 22% receive care only intermittently, children of parents in these 2 categories are not accessible for case finding in the HIV services system.11
As demonstrated by the memoranda of understanding currently in place, Family Ties Project has established relationships with the major HIV service providers in the District. Considerable effort in terms of trainings and case conferences in applied to maintaining those reciprocal relationships.
As new treatments became available, survival periods have been extended and mortality has declined, fewer clients are presenting for permanency planning services. It is the impression of several team members that although their clients are surviving for longer periods, when the benefits of treatment have been maximized, a patient's deterioration is often rapid. The life planning specialist observed that although case managers may be aware of the resources for permanency planning and agree with the need for clients to engage in life planning, they might not know how to initiate discussions of life planning with clients. The life planning specialist is in the process of designing methods to enhance skills in this area.
She also reported that she had recently started to locate case management providers for clients who self refer to the project and do not have a case manager. She uses her knowledge of the services system to make the necessary contacts, referrals and follow up to ensure that clients requesting life planning services are linked with case management. It was agreed that this was a necessary adaptation to a service delivery system fraught with coordination and management problems.
Pediatric Care, Inc. managers indicated that increased resources to support a full time group worker could be expected to result in greater availability and utilization of support group and therapy services. With this exception, team members appear to believe the lower than projected enrollment and utilization is not due to insufficient project resources to serve clients.
Regarding the number of clients receiving legal services, it was noted that 60% of the clients enrolled during the project year had yet to be seen by September 30, 2001. However, the attorney believed there was more rapid movement on custody issues than in previous years. It was suggested that staff examine the project data to determine factors related to clients not
yet having seen an attorney. For example, are there clients who explicitly
refuse legal services or have they received legal services elsewhere?
Those present at the meeting suggested the annual service objectives be revised to reflect realistic expectations on the number of clients. They are optimistic that passage of standby guardianship legislation will present an opportunity for a public education campaign on life planning for children, which will result in increased demand for services.
Based on the data reviewed and summarized for this report, the findings from the case studies and team discussion, the project evaluation consultant submitted a recommendations memorandum (March 2002) to the project director.