Community Support Services

Behavioral Health Education Services

The Bureau of Community Support Services oversees the Ryan White Part B HIV/AIDS Behavioral Health Education Initiative, which supports community based HIV/AIDS behavioral health education and engagement service programs and an HIV/AIDS behavioral health education training and technical assistance center.

The purpose of the community based HIV/AIDS behavioral health education and engagement service programs is to educate clients about the benefits of engaging in mental health and substance abuse treatment and help address stigma or related anxiety that may impact a client’s willingness to engage in, adhere to, and be retained in their HIV medical and behavioral health care and treatment. Programs will provide behavioral health screenings, referrals, and psychoeducational interventions to PLWH/A. These are short term mechanisms for identifying clients and promoting treatment readiness for linkage to and engagement in behavioral health treatment. Behavioral health educators and peer navigators work together to screen patients for behavioral health needs, conduct individual behavioral health education sessions to destigmatize behavioral health issues, encourage engagement into appropriate treatment, and facilitate expedited referrals to licensed behavioral health professionals.

The purpose of the HIV/AIDS behavioral health education training and technical assistance center is to provide HIV/AIDS focused behavioral health education training and technical assistance services that further advance the capacity of the behavioral health education and engagement service programs funded through this initiative. Services are intended to increase the number of staff who are educated and motivated to perform behavioral health education, screening, engagement, and linkage services to PLWH/A with behavioral health needs.  


John J. Hartigan,  LCSW
Director, Behavioral Health Education Initiative
Bureau of Community Support Services
Division of HIV and Hepatitis Health Care
(518) 486-1323

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Legal and Supportive Services for Individuals and Families Living with HIV

The Bureau of Community Support Services oversees the Legal and Supportive Services for Individuals and Families Living with HIV (LASSIF) Initiative.  Legal service programs are designed to provide comprehensive individual and family legal assistance including legal counsel and guidance in matters such as discrimination, hate crimes, entitlements, housing, health care, finance, and education.  In addition, legal service providers will educate clients and provide active referrals for related services needed for the resolution of a legal issue. Legal services include preparation of wills, health care proxies and living wills.  Family legal services focus on future care and custody, guardianship, standby guardianship, adoption and foster care for dependent children.  Promotion of services is achieved through networking with case management and community-based health and human service providers serving PLWH.  Legal service providers are required to establish collaborative working relationships with supportive service agencies and case management providers to address the issues that may impede individuals and families from completing legal plans.

Supportive services are intended to help families make care and custody decisions and enable the completion of necessary legal guardianship for the dependent children.  Furthermore, supportive services address transition issues faced by new caregivers and children, and seek to stabilize the newly blended family following the death of an HIV-positive parent.  Supportive services are not mental health services as defined by clinical practitioner guidelines.  The short-term supportive services funded by this program may serve as a gateway to access other services for the family, such as mental health, case management and ongoing long-term supportive services.


Deborah Hanna
Director, LASSIF Initiative
Bureau of Community Support Services
Division of HIV and Hepatitis Health Care
(212) 417-4487

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Nutrition Health Education and Food and Meal Services

Bureau of Community Support Services oversees the Nutrition Health Education (NHE) and Food and Meal Services Initiative.  The intent of the initiative is to support nutrition interventions that improve, maintain and/or delay the decline of PLWH/A’s health status.   The initiative has two components; education and food assistance.  NHE empowers clients to learn, practice and apply self-management skills needed to achieve optimal health outcomes.  Self-management skills development includes teaching independent health care behaviors and decision making, while encouraging clients to be responsible for their health care and lifestyle choices. The food assistance services offer nutrient dense, well balanced, and affordable meals tailored to the specific dietary needs of PLWH/A. 

NHE improves health outcomes through the identification of nutritional goals and the development of a plan that supports those goals.  NHE provides PLWH/A with health and nutrition information that supports incorporating healthy food in their diets and changes in lifestyle that lead to improved health outcomes.  Nutrition workshops are facilitated by a culturally-competent community nutrition educator in group or individual settings.  Workshops include relevant information on nutrition for PLWH/A and instruction on food purchase and healthy and safe food preparation.  The community nutrition educator assists clients in developing personalized nutrition plans.   

As part of the NHE and Food and Meal Initiative, providers are charged with fostering collaborations with other providers that benefit clients in meeting both nutrition needs and care and treatment goals.  Leveraging community resources enhances provision of services and supports retention in a continuum of care.

The food and meal services component is comprised of:

  • Home-Delivered Meals (hot and/or frozen) to maintain or improve the health and well-being of home restricted individuals with HIV/AIDS.  Meals and snacks are tailored to the dietary needs of the client. For PLWH/A who lack the ability to shop for and prepare food, home-delivered meals fulfill a critical need, often allowing them to remain in their home.
  • Congregate Meals are served in community locations.  Many individuals using the congregate meal programs are indigent, homeless, or in marginal housing which lack kitchen facilities and food preparation equipment. 
  • Food Pantry Bags and Food Vouchers allow PLWH/A with limited financial resources access to nutritious food.  Clients who receive pantry bags and/or vouchers also receive education on preparing meals and making informed food choices.


Maryland M. Toney, MS
Director, Nutrition Initiative
Bureau of Community Support Services
Division of HIV and Hepatitis Health Care
(212) 417-4481

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Supportive Services

The Bureau of Community Support Services oversees the Ryan White Part B HIV/AIDS Supportive Services Initiative. Supportive Services have a crucial role in facilitating access to and retention in care and treatment for PLWHIV/A.  The intent of this initiative is to diminish barriers to care and ultimately improve medical outcomes.

The Supportive Services Initiative provides funding throughout New York State for:

Case Management

Case Management is a proactive, multi-step process of coordinating medical and psychosocial services  and facilitating client access to, and retention and participation in HIV medical care and treatment.   This is accomplished by attending to the client's needs for concrete services such as health care, entitlements, housing, and nutrition, as well as developing the relationships necessary to assist the client with other issues including substance use, mental health, and domestic violence.

This model is responsive to the immediate needs of a person living with HIV/AIDS and is designed to serve persons with discrete or acute needs that can be addressed in the short term or those with more long-term, complex psychosocial and/or health related needs.  Case management services are tailored to the level of need presented; both client and case manager agree to the intensity of service and level of contact. Services are also appropriate for those individuals who become stable but still require a maintenance level for periodic support.

Central to this model of case management is service planning, performed in conjunction with an initial comprehensive assessment and subsequent reassessments of the psychosocial and health care needs of the client and his/her family or close support system. Clients engaged in case management will receive follow-up provided in the community and, in most programs, home visitation.

Universal standards were developed through a collaborative process to define case management, describe updated models of case management services, and clarify service expectations and program requirements. AIDS Institute Standards for HIV/AIDS Case Management are available online.

Health Education/Risk Reduction 

Health Education/Risk Reduction include individual or group level activities that provide health education and consumer support to increase optimal consumer health, while decreasing the risk of transmission of HIV.  Education and risk reduction services should be structured to enhance the knowledge base, health literacy, and self-efficacy of HIV- infected persons in accessing and maintaining HIV medical services and staying healthy.

Funded Agencies provide education services in any of the following three categories based on need:

  • Advanced Health Education/Risk Reduction:  Individual or group level activities that identify methods and activities to achieve specific goals and objectives in order to increase consumer health while decreasing risk of transmission.
  • General Health Education/Risk Reduction:  Individual or group level activities that provide general HIV/AIDS information and risk reduction activities, while motivating consumers to initiate/maintain behavioral change independently. 
  • Peer Education:  Individual or group level activities that provide general health information, education and risk reduction support to participants. 

Linguistic Services

Linguistic Services include medical interpretation/ translation services provided by qualified interpreters to HIV-positive individuals (including those who are deaf/hard of hearing and non-English speaking individuals) for the purpose of ensuring communication between client and providers while accessing medical and Ryan White fundable support services that have a direct impact on primary medical care. 

Medical Transportation

Medical Transportation includes the direct or indirect provision of conveyance services for HIV infected individuals that facilitate access to and retention in medical services and Ryan White fundable support services associated with improving the individual’s HIV clinical status. The goal of medical transportation is to ensure that transportation does not pose a barrier to the receipt of medical and support services. Medical transportation services are not intended to support emergency ambulance services or supplant services that are currently provided by Medicaid or other transportation programs.

Psychosocial Support 

Psychosocial Support is the provision of support and counseling activities to individuals or groups with the purpose of improving medical outcomes. Counseling is a short term focused process of assisting HIV infected individuals who are fundamentally psychologically healthy resolve situational issues.

Treatment Education

Treatment Education is the provision of short-term individual and/or group level activities designed to provide HIV/AIDS treatment information, adherence counseling, monitoring, and other strategies to support client readiness to begin anti-retroviral (ARV) treatment; or maintain maximal adherence to prescribed HIV/AIDS treatment. The goal of treatment education is to provide the HIV infected individual the skills that will enable him/her to self-manage HIV/AIDS related care. Self-management skill development encourages the HIV infected individual to work in partnership with the medical provider, assume responsibility for their behavior, make positive changes to their environment and improve overall planning of their health care.


Mark Perez, Director, Supportive Services Initiative
Bureau of Community Support Services
Division of HIV and Hepatitis Health Care
(212) 417-4480

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