Background: The United States' HIV medical and social service systems remain "a fragile edifice with disparate parts" (Sherer, 2013, p. 133). While the Affordable Care Act (ACA) offers several opportunities, considerable uncertainty remains concerning its influence on HIV-affected populations, who face persistent socioeconomic service barriers. Since the early AIDS crisis, nonprofit HIV/AIDS service organizations ("ASOs") � have provided a critical link between healthcare providers and consumers. This qualitative case study examined the systemic change experiences of a nonprofit ASO, with specific attention to technological considerations, members' identification with HIV-affected consumers, and perceptions of the organization's ' history and service values. Methodology: This study aimed to examine an HIV/AIDS service organization's systemic change experiences via the perspectives of its members. Four central questions guided the investigation: 1) How do members of an HIV/AIDS service organization (i.e., Board, leadership, and staff) experience systemic change in the current policy environment? 2) What technological changes do members of the organization consider (i.e., interventions selected to carry out its mission) as they develop a strategic response to Affordable Care Act legislation? 3) To what extent does ASO members' knowledge of and/or identification with HIV-affected constituencies (e.g., gay/bisexual men, injection drug users, communities of color) influence the organization's systemic change process? 4) To what extent does ASO members' understanding of the organization's history and service values influence the organization's systemic change process? Data collection coincided with strategic plan implementation in 2013-2014 and included analysis of 40 documents, observation of 10 implementation meetings, and semi-structured interviews with 20 Board and staff members. This study was determined to be exempt by the university's Institutional Review Board. Results: Findings revealed ten unique themes. Members recognized an opportunity to reckon with external factors, including uncertain policy shifts and changing public perceptions. The rationale for change included both survival and positioning the organization as a sector leader and service destination. Technological considerations included defining measurable outcomes, identifying expansion opportunities, and addressing barriers to growth. Members described personal, longstanding familiarity with consumers, especially concerning stigma and marginalization. Consumers' needs were characterized as both medically and psychosocially complex. Defining organizational characteristics included nonjudgmental services tailored to consumers' needs and identities and longevity of operations. Perspectives on workplace culture were less settled concerning staff and leadership relationships, professionalism, and accountabilities. Appraisals of how to proceed included competing desires for quick, decisive action and cautious, collaborative deliberation. While most members expressed enthusiasm for the changes, some indicated waning confidence in leaders' decisions and communication, and staff departures sharply increased as the study concluded. Significance: This study is timely and relevant for understanding how changes in the U.S. health and human service system influence services targeting historically marginalized populations. Research and practice implications include the influence of shared historical trauma in organizational development and conceptually reframing community-level HIV suppression efforts around contributing social service factors. Social workers in this study demonstrated a continuing role for the profession in HIV services, including organizational leadership, policy advocacy, program supervision, and direct services to consumers.
University of Minnesota Ph.D. dissertation. July 2015. Major: Social Work. Advisor: Jean Quam. 1 computer file (PDF); xi, 231 pages.
Systemic Change in a Community-Based HIV/AIDS Organization: A Case Study Examining the Response to Affordable Care Act Reforms.
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