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H H S Department of Health and Human Services
Health Resources and Services Administration
HIV/AIDS Programs

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Severity of Need (SON) Index

The Severity of Need (SON) Index is a methodology under development by the Health Resources and Services Administration’s (HRSA’s) HIV/AIDS Bureau (HAB) to improve the way Ryan White HIV/AIDS funds are distributed to cities (under Part A) and States (Part B). The goal is to distribute scarce Ryan White funds across communities on the basis of a quantified formula that provides a better measure of severity of need.

A sea of data exist for crafting an Index, ranging from fairly concrete data on the number of AIDS cases to other important but difficult-to-measure factors, like how many potential Ryan White clients are getting care from Medicaid. HRSA efforts to improve the use of information in measuring severity of need have been underway for a number of years—increasingly so since 2004 in the wake of an IOM study calling for an enhanced measure of severe need. Efforts have also been driven by legislative fiat and special studies. The anticipated SON will use data measures comparable across jurisdictions and be relevant on quantitative measures established from existing data sources. As such data will not come from grantees, there will be less burden for such reporting.

These Web pages are to keep the Ryan White Community and others informed about ongoing HRSA/HAB efforts to develop a SON Index through the multi-advisory body SON Collaboration, formed in 2005. This site presents the committee process and the deliberations that involved a thorough examination of 56+ quantifiable variables and whether to include or exclude them in the draft Index based upon such factors as the availability and quality of data. Also on this site are ongoing activities and opportunities for input as the Index is further refined and finalized for use in future Ryan White Part A and B funding decisions.

SON Activities to Date, As of Fall 2007

  • Created SON Collaboration input process
  • Garnered broad input from experts, federal staff, grantees, consumers and others
  • Examined existing research and data to explore features of a defensible SON Index
  • Developed a draft SON Index
  • Engaged an objective and expert contractor to conduct future SON Index investigations
  • Assured that the proposed SON Index does not provide incentives for jurisdictions to reduce local resource contributions to HIV/AIDS care
  • Tested the allocation impact of the draft SON Index by collecting and applying current epidemiologic data measured for all jurisdictions
  • Allowed time and opportunities for community input on the draft SON Index.
Severity of Need is...

"the degree to which providing primary medical care to people with HIV disease in any given area is more complicated and costly than in other areas, based on a combination of the adverse health and socio-economic circumstances of the populations to be served.”

Source: HRSA/HAB, Needs Assessment Guide, 2002