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Asian & Pacific Island Wellness Center

The HOME Project mobile team explicitly targets those homeless individuals who are the most difficult to engage and retain in HIV care.

Name of organization: Asian & Pacific Island Wellness Center, in partnership with the San Francisco Department of Public Health - HIV Health Services and the Tom Waddell Health Center

Project name: HIV Homeless Outreach Mobile Engagement (HOME) Project

Organization Description:
Asian & Pacific Islander Wellness Center (A&PI Wellness Center) is a non-profit, multi-service community-based agency established in 1987 to address the crisis of HIV and AIDS in the Asian community. A&PI Wellness Center operates the HIV Care Program which provides case management, mental health counseling, and substance use counseling for marginal and underserved persons living with HIV from all ethnic and cultural groups. The agency also co-operates the Ryan White-funded Tenderloin Center of Excellence (TACoE) in collaboration with Tom Waddell Health Center and the Harm Reduction Therapy Center.

Organization Description:
Asian & Pacific Islander Wellness Center(A&PI Wellness Center), a non-profit, multi-service community-based agency established in1987 to address the crisis of HIV and AIDS in the Asian community. A&PI Wellness Center operates the HIV Care Program which provides case management, mental health counseling, and substance use counseling for marginal and underserved persons living with HIV from all ethnic and cultural groups. The agency also co-operates the Ryan White-funded Tenderloin Center of Excellence (TACoE) in collaboration with Tom Waddell Health Center and the Harm Reduction Therapy Center.

Goals/objectives:
Key outcomes of the project include:

a) Linking at least 90% of project clients to a patient-centered, culturally competent HIV medical home within one month of engagement in the program;

b) Transitioning at least 65% of project clients to long term and supportive housing over the course of the program;

c) Ensuring that at least 75% of clients with a psychiatric diagnosis will have seen a psychiatrist and will be on a monitored psychotropic regimen within three months of engagement with the multidisciplinary team;

d) Ensuring that at least 50% of chronic substance users will be enrolled in a medical substance
use treatment plan within three months of engagement with the multidisciplinary team.

Catchment Area: City and County of San Francisco

Location: San Francisco, California

Partners and linkages:  San Francisco Department of Public Health, Action Point, Forensic AIDS Project, Tom Waddell Clinic, Housing and Urban Health Clinic, San Francisco General Hospital, South of Market Mental Health, San Francisco Homeless Outreach Team (HOT Team) et. al

Program Intervention/Services:
The mobile team will form intense, one-on-one relationships with their
client population, and will maintain almost daily contact with the individuals they serve. 
Mobile team members will meet homeless individuals directly in the field
regardless of where they are living, and will follow them wherever they go, providing health
monitoring; linkage to needed services; support for attaining stabilization; support with obtaining
housing; and direct assistance in attending medical appointments and taking HIV medications

Program staff:
Homeless Peer Navigator (1.0 FTE)
Medical Social Workers (MSW) (.5FTE)
Program Coordinator (1.0 FTE)
Psychiatric Registered Nurse (PsyRN .20 FTE)
Homeless Outreach Worker (1.0FTE)

Consumer Involvement:
A&PI Wellness has an agency-wide Community Advisory Board and program-specific advisory boards.  Consumer input is solicited for program design, goals and implementation.

Contact Information:
Ben Cabangn, Associate Director of Health Promotion
730 Polk St. 4th fl.
San Francisco, CA 94109
ben@apiwellness.org
(415) 292-3420  x314