The Center for Community Health promotes the public's health through community partnerships. |
(Heather Baldwin, Mary Caffery, Vivian Reznik, and Karen Lope) Location: UCSD Treatment Center Mary Caffery, RN, MSN Program Coordinator UCSD Mother, Child and Adolescent HIV Program Topic: Models of HIV Services for Families The UCSD Mother, Child and Adolescent HIV Program serves patients with a multidisciplinary approach to care. A range of services are provided such as medical care, neurodevelopment testing, counseling, clinical trials, patient education, and community education. The individuals who access services from the program include families and expecting mothers. There are very few cases in which the father is also being seen. A key to the success of the program is the dedication of the providers and staff to provide high quality pre-natal care (prevention). The goal of the program is to support, protect, and develop the family. The racial/ethnic makeup of the patients is diverse the majority of which are African -Americans and Latinos. Native American and Pacific Islanders compose the smallest portion of clients. The services offered at the UCSD Mother, Child and Adolescent HIV Program are supported through funds from CARE Act Title IV, Comprehensive Family Branch, HIV/AIDS Bureau, and the Health Resources and Services Administration. Additionally clinical care is funded in part by Ryan White Care Act, Medi-Cal, and California Children Services. Services are divided into different areas: health care, teen HIV program, clinical trials, counseling, case management, and education. The first option in helping families is prevention. Prevention with this population is targeted at eliminating transmission of the virus from mother to child. Therefore high quality pre-natal care has been a focus for providers. This year is the five-year anniversary of the program. Individuals who have maintained their participation in the program have not transmitted the virus to their children. Karen Loper, MD, MPH Director of Adolescent Medicine Topic: Ethical issues when providing services to youth As a medical practitioner working with children and adolescent populations many issues related to ethics become apparent such as confidentiality. Some issues related to ethics are:
When making decisions that may effect an individual, the health practitioner must also identify who is the person to best make the decision. Is it the 16year old who is pregnant or her parents? Each state and local area have their own laws, but many other issues are pertinent to the decision making process such as: the status of parents, custody, status of minor, nature and severity of the problem, and the judgement of the care provider. These factors must be taken into consideration when making a medical treatment decision. For example in California a person 12 years of age is able to make decisions about health care services that are related to sexual issues. Some of these decisions may include testing and treatment of STI's and HIV, abortion, contraception, education, and prenatal care. The primary role of the practitioner is to provide information to ease the decision making for the minor. Although some major treatment choices can be determined by a 12 year old many other factors limit confidentiality. These include state laws, the developmental level of the minor, severity of the problem, the wishes of the minor to involve the parents, ability for patient to follow through with care, and the best judgement of the care provider. Three areas that limit the liability for a practitioner to maintain confidentiality are if a patient is suicidal, homicidal, or there are problems with abuse. Under laws in California there is no requirement that a parent must be notified. If any evidence or suspicion of abuse is apparent the provider must report to the appropriate agencies. The care provider has several responsibilities and needs to keep in mind, that the primary responsibility is to youth and secondarily to the parent. Additionally the care provider is responsible to: 1) children of the youth and their partner, 2) public health, 3) adherence to state laws, 4) protection of minor records, and 5) involve parent or guardian in deacons making as much as possible. Heather D.Baldwin, MPH Project Coordinator San Diego Area AIDS Education & Training Center Topic: HIV Clinical Training and Continuing Education for Providers Health Resources and Service Administration provided funding for nationwide centers to educate and train Ryan White Medical Providers. Funding for the San Diego region will continue until August 2000. The program is through AIDS Education and Training Centers (AETC). Five goals of the AETC are to 1) provide clinical training which focus on treatment that is state of the art, 2) develop, organize, and conduct continuing medical education (CME), 3) provide timely information to health care professionals on issues of treatment and care, 4) serve as a resource for health care providers, and 5) collaborate with health related organizations, agencies, and institutions. The main focus is to improve skills and knowledge related to HIV treatment and care. For the AETC at UCSD training is only available for physicians. But many other of the AETC across the country provide clinical training to nurses, nurse practitioners, pharmacist, physician assistants, dentist, and mental health providers. The clinical training is a mix of observation, didactic lectures, hands on clinical practice, and use of standardized patients. The training may vary in length depending on the AETC. Some AETCs also offer a mini residency program, which is 1 day a week for 5 weeks. The development of the training is based on the needs of the local provider. Another incentive for the physician to participate is the ability to obtain CME credit. Some examples of options to obtain CME are 1) monthly case study meetings, 2) audio conferences, 3) telemedicine, 4) medical websites, and 5) academic detailing. The use of the medical website allows the needs of the provider to be tailored. An example of uses in telemedicine includes interactive case studies. Currently there are no translational services available at the San Diego AETC. But there have been exchanges with providers from Mexico and Peru. |