mental health, addictions counseling and medical services linkages
DESCRIPTION
Mental Health, Addictions Counseling and Medical Services Linkages. May 29, 2013. For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#. Welcome & Overview, 5 mins Integrating Mental Health, Substance Use and Medical Programs 30 mins - PowerPoint PPT PresentationTRANSCRIPT
Mental Health, Addictions
Counseling and Medical Services
Linkages
May 29, 2013
For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#
2
Welcome & Overview, 5 mins Integrating Mental Health,
Substance Use and Medical Programs 30mins
Panel Discussion on Behavioral Health and Medical Service Integration, 20 mins
Wrap-up & Evaluation, 5 mins
Michael Hagerin+care Campaign ManagerNational Quality CenterNew York, [email protected]
Conversation opportunities throughout webinar
Agenda
3
For more information: www.incarecampaign.org
This Partners in+care webinar is offered as part of the in+care Campaign.
The in+care Campaign is a national effort to improve retention in HIV care.
Webinars are one of many Partners in+care activities designed to engage people living with HIV/AIDS and their allies in the in+care Campaign.
Welcome & Overview
4
This is a “public event.” If you have confidentiality concerns:
Your names appear on-line in the list of webinar registrants -consider just listening to the audio or to viewing the webinar at a later time, after it is posted at www.incarecampaign.org
All webinars are recorded - do not use identifying information when asking questions
Participation Guidelines
For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#
5
Actively participate and write your questions into the chat area during the presentation; we will also have a “pop up” question exercise, and will pause for conversation during the webinar
Do not put us on hold Mute your line if you are not speaking (press *6,
to unmute your line press #6) The slides and recording of this and other
Partners in+care webinars are available for playback and group presentations at www.incarecampaign.org – “Resources” tab
For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#
Participation Guidelines
6
Visit www.incarecampaign.org
Pop-up Question
Yes, we are a one-stop shop. Everything onsite!Yes, we have a formal linkage arrangement with outside providers that is not grant supportedYes, we have a formal linkage arrangement with outside providers that is grant supportedI have no idea…I do not work for an HIV service organization
Service Integration and Linkages
Does your organization offer its patients
access to behavioral health or medical
services?Adam ThompsonPeer ConsultantNational Quality CenterFredricksburg, [email protected]
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the
nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.
WWW.SAMHSA.GOV
Humberto M. Carvalho, MPHProject Officer
Health Systems Branch/Division of Services Improvement
Center for Substance Abuse TreatmentE-mail:
David C. ThompsonTeam Leader-HIV/AIDS ProgramsHealth Systems Branch/Division of
Services ImprovementCenter for Substance Abuse Treatment
E-mail: [email protected]
8
Integrating substance abuse, mental health and HIV services
• Currently funding grants to support substance abuse and mental health services integrated with HIV prevention and treatment services
• Targeted Capacity Expansion Program: Substance Abuse Treatment for Racial/Ethnic Minority Populations at High-Risk for HIV/AIDS – 2012 grant -52 grantees awarded
• Targeted Capacity Expansion: Substance Abuse Treatment for Racial/Ethnic Minority Women at High Risk for HIV/AIDS - 2013 grant
9
New Orleans AIDS Task Force
Juliet Catrett, LCSW-BACSBehavioral Health
SupervisorEmail: [email protected]
Lisa BrelandDirector of Client
ServicesEmail:
Recovery Works ProgramNO/AIDS TASK FORCE
11
Client Demographics:
Gender:Male: 75.5%Female: 20.2%Transgender: 3.8%
Race: Most clients identify as Black/African American
(52.4%) or White (33.2%)Hispanic/Latino: 5.8%
•Mean age was 41.2 years of age with most clients having a high school/GED or lower (62.5%) education level
12
Clients’ Housing and Income
• Mean monthly income: $657.24
• Most clients are unemployed (38%) or disabled or retired (36.5%)
• Most clients live in own apartment (54.8%) or someone else’s apartment/house (23.1%)
13
Significant Changesfrom Intake to 6 Month Follow Up
• ASI Composite Drug Use Score• ASI Composite Alcohol Use Score• Days of illegal drug use• Days of illegal drug use index• Days of drug use, substance of choice• Days of alcohol use to intoxication• Days experiencing alcohol problems• Amount of money spent on alcohol• Drug severity Index Rating (from the SIR)• Alcohol Severity Index Rating (from the SIR)• Males’ mean number of male partners• Percentage of clients using drugs or alcohol before
or during sex
14
Substance Use: Intake to Six Month Follow Up
15
High Risk Sexual Behaviors: Intake to 6 Month Follow Up, Males
16
Outreach
• Our Outreach team is responsible for distributing program pamphlets to other ASOs and residential programs, recruiting clients, and completing follow up GPRAS.
Our completion rate for follow up GPRAS was 89.2%
17
Agencies Contacted through Outreach Program
18
Informational Materials Distributed to Agencies
19
Number of Potential Clients Referred to Program
20
Clients Enrolled in Recovery Works
AIDS ALABAMA
Dr. Joseph E. Schumacher
Evaluator for the AIDS Alabama LIBCAP Program.
Professor of Medicine, Clinical Psychologist, and Behavioral Scientist in
the Division of Preventive Medicine at The University of Alabama at Birmingham.
Email: [email protected]
Mitchell TraverLiving In Balance Chemical
Addiction Program CoordinatorAIDS Alabama
Email: [email protected]
LIBCAPLiving in Balance Chemical
Addiction ProgramElaine Cottle
Mitchell TarverDr. Joseph E. Schumacher
The LIBCAP Team from AIDS Alabama
This project was sponsored by a grant to ADIS Alabama from the Substance Abuse and Mental Health Services Administration (SAMHSA)
of the Department of Health and Human Services (DHHS).
23
AIDS Alabama
• Incorporated as a nonprofit in 1986 with the mission of serving persons with HIV.
• AIDS Alabama is the largest HIV/AIDS service provider in the state
• HIV testing, prevention, and housing (170,000 nights of housing to 750 HIV-positive individuals and their families)
• Only agency in the state with substance abuse and mental health programs for PLWHA.
24
LIBCAP: The Story
• Elaine and Dr. Schumacher meet
• Evidence-based treatment
• Needs assessment and training plan
• SAMHSA HIV capacity expansion grant in 2009
• Last year of LIBCAP grant
• Sustainability
25
LIBCAP
• Substance abuse treatment, housing, vocational development, case management, and aftercare program.
• Problems related to drug and alcohol addiction and homelessness among persons living with HIV and AIDS.
• Four housing-based treatment phases: The Rectory, Next Step, and Re-Entry.
• Living in Balance: Moving from a Life of Addiction to a Life of Recovery (Hoffman, Landry, and Caudill, 2003)
26
Living in Balance
• Listed in NREPP and published by the Hazelden Foundation
• 33 scripted sessions of didactic, experiential, and psycho-education strategies focusing on drug education, relapse prevention, and HIV/STD prevention
• Each session contains similar elements including visualization/relaxation exercises, group exercises, written/oral exercises, role-play activities, and homework assignments.
27
Program Evaluation
• Intake rate: 307/405 = 75.8%• Follow-up rate: 219/274 = 79.9%• GPRA outcomes• Site specific assessments
• DSM IV SUD Checklist• Patient Health Questionnaire (PHQ)• Treatment Readiness Ruler (TRR)• HIV Risk Assessment for Positives (HRAP)• Tobacco Use Questionnaire (TUQ)
28
GPRA Outcomes
GPRA Measure % at intake % at 6-mos
Rate of Change
Did not use drugs or alcohol
22.8% 68.5% +200%
No past 30 day arrests 93.2% 95.0% +2%
Currently employed 6.4% 26.5% +314%
No health/social conseq’s
18.3% 72.9% +298%
Were socially connected
89.5% 95.9% +7%
Had permanent housing
11.9% 14.6% +23%
29
Total sample(N=123)
Discharged (N=83)
Completed (N=40)
Test statistic p value
Sex (#, %) Male Female
86 (69.1%) 27 (30.9%)
55 (66.3%) 28 (33.7%)
31 (77.5%) 9 (22.5%)
χ2=1.671
p=0.196
Race (#, %) Caucasian African American
22 (17.8%) 99 (80.5%)
14 (17.1%) 67 (81.7%)
8 (20.0%) 32 (80.0%)
χ2=.903
p=0.628
Age M (SD)
43.3 (8.3) 42.5 (8.8) 44.4 (6.9) t=-1.51 p=0.253
Table 1. Demographic characteristics by treatment completion status
30
Total sample (N=123)
Discharged (N=83)
Completed (N=40)
Test statistic p value
Alcohol dependency
49 (39.8%)
38 (45.8%)
11 (27.5%)
χ2=3.872
p=0.049*
Cannabis dependency
32 (26.2%)
26 (31.7%)
6 (15.0%)
χ2=4.150
p=0.016*
Cocaine dependency
114 (92.7%)
76 (91.6%)
38 (95.0%)
χ2=0.50
p=0.479
Amphetamine dependency
4 (3.3%)
3 (3.7%)
1 (2.5%)
χ2=0.119
p=0.73
Opiate dependency
2 (1.6%)
2 (2.4%)
0 (0%)
χ2=1.605
p=0.205
Sedative dependency
3 (2.5%)
2 (2.4%)
1 (2.5%)
χ2=0.0
p=0.984
Poly drug dependency
3 (2.5%)
2 (3%)
1 (3.3%)
χ2=0.006
p=0.937
Nicotine dependency
31 (25.4%)
16 (19.5%)
15 (37.%)
χ2=4.428
p=0.0354*
More than 1 diagnosis
93 (75.6%)
64 (77.1%)
29 (72.5%)
χ2=.307
p=0.579
Table 2. Substance use disorders by treatment completion status
31
Total sample(N=123)
Discharged (N=83)
Completed (N=40)
Test statistic p value
Treatment readiness: M (SD)
8.0 (1.9)
7.9 (2.1)
8.3 (1.6)
t=-1.35
p=0.181
PHQ-9 depression: M (SD)
8.5 (7.1)
8.3 (6.9)
8.8 (7.8)
t= -.355
p=0.723
PHQ-5 anxiety:M (SD)
1.2 (2.0)
1.3 (2.1)
1.0 (1.9)
t=0.595
p=0.553
HIV risk behaviors: M (SD)
1.3 (1.8)
1.29 (1.3)
1.38 (2.5)
t=-.215
p=0.831
Suicidal thoughts(#, % yes)
30 (24.4%)
19 (22.9%)
11 (27.5%)
χ2=4.76
p=0.19
Table 3. Psychosocial characteristics by treatment completion status
32
Lessons Learned
• HIV Specific Treatment: Blessing and a Curse
• Men + Women +LBGT = Drama
• Vocational goals were difficult to meet
• Retention and Completion Challenge
• Good chances of sustainability
Panel Discussion
34
Integrating Behavioral Health and Medical ServicesPanel DiscussionDavid Thompson
SAMHSA [email protected]
Adam [email protected]
Joseph Schumaker, MDAIDS [email protected]
Juliet Catrett, LCSW-BACSNO AIDS Task [email protected]
Lisa BrelandNO AIDS Task [email protected]
35
Campaign Headquarters:National Quality Center (NQC)90 Church Street, 13th floorNew York, NY 10007Phone 212-417-4730
Visit Web / Open the Toolkit www.incarecampaign.org -
“Partners” tab
Sign up for Partners in+care Network
www.incarecampaign.org – “Partners” tab
Join FacebookSend email to
[email protected] – “Facebook” in subject line
Partners in+care Resources