Getting to Know You: Electronic Health Inventory Update

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“Late July, San Francisco,” Janet Seifert, Art for AIDS 2016

For the past nine months, new clients at AHP have filled out an Electronic Health Inventory (EHI), a detailed survey that ensures that our clients get the health care they need—both from our clinic and from society. The EHI is a detailed survey that asks questions about everything from food insecurity to sleep quality. The questions are personal—“Have you experienced trauma or abuse?” “Do you drink daily?” “Do you use non-prescribed drugs?”—but the prying is not gratuitous. Understanding the whole client helps us provide the best care.

“It’s so useful,” said Bart Shulman, an AHP social worker. “The EHI gives me a quick, detailed picture of what’s going on with a client, allowing me to focus more on the person I’m sitting with.”

AmeriCorps member Ladi Khoddam felt privileged to assist new clients as they filled out the EHI. “I’m not a licensed therapist, but I am a big fan of story telling.” During her year at AHP, Khoddam was a crucial part of the EHI team. “Everyone wants someone to listen,” she recalled. “I tried to create a no-judgment zone and be a friend,” in the 30 to 60 minutes it can take to complete the survey.

“For some people it was an eye opener,” Khoddam added. “It helped them realize, ‘Wow, I’ve been through a lot.’” Khoddam also heard from folks who felt that filling out the EHI helped them organize their thinking before they met with a counselor.

But the EHI survey plays a role outside of the immediacy of a particular session. With nine months of surveys, our EHI results are starting to yield useful data about our client populations as a whole. Crunching the numbers reveals that AHP clients have high rates of post-traumatic stress disorder (PTSD) (67 percent), depression (58 percent), and anxiety (50 percent) when compared to the general population. As if we did not know, these numbers demonstrate in a systematic way that folks who seek out AHP’s counseling services are in distress and need care.

As more and more clients fill out the EHI, AHP will be able to identify if there’s a high rate of any given symptom or experience among particular subgroups of our clients, for example, cisgender gay men, transgender women, HIV-positive people, Asian men, Latino men, or people over the age of 50. EHI data is particularly important for describing the mental health of LGBTQ people, since there is so little data out there about these groups of folks and since so many of our clients are LGBTQ. And it will be able to discern changes over time. Do gay men identify discrimination as an issue less often than they had previously? Do transgender women say they have experienced more instances of violence compared to those who filled out the survey in the prior year?

Future efforts to lobby for LGBTQ health services will be based on data like this, particularly aggregate data that draws conclusions from our whole client base—leaving out individual names and other identifying information—that demonstrates the needs of the communities we serve. The government funds health services based on just this sort of data analysis tracking health needs and trends. Conversely, the lack of LGBTQ data reporting up to now has led to invisibility and the absence of resources for LGBTQ individuals. As Martha Shumway, PhD, an Associate Professor at UCSF and one of the key designers of AHP’s EHI system, noted, “AHP serves populations that people don’t really know about.”

In fact, LGBTQ community data collection is in its infancy. Just this summer, the San Francisco Board of Supervisors unanimously passed an LGBT Data Collection Ordinance that requires five city departments—and contractors like AHP who are DPH-funded to provide health and social services—to collect demographic data on sexual orientation and gender identity. AHP is committed to being a part of that conversation. And, with more than 30 years of experience caring for LGBTQ and HIV-affected folks struggling with mental health and/or substance use issues, we’re one of the most qualified to weigh in.

We’re also committed to a data collection system that encourages a deeper understanding of the human being behind the reported symptoms. “People were very willing to open up,” said Khoddam. “We all have so much more in common than we realize: life is a struggle. That’s something that should unite us. It’s part of our common humanity, and it’s very humbling.”