Transcript Slide 1

Mental Health,
Addictions
Counseling and
Medical Services
Linkages
May 29, 2013
For Audio: Dial-in#: 866.394.2346
Participant Code: 397 154 6368#
Agenda
Michael Hager
in+care Campaign Manager
National Quality Center
New York, NY
[email protected]
 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
Conversation opportunities throughout webinar
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Welcome & Overview
 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.
For more information: www.incarecampaign.org
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Participation Guidelines
 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
For Audio: Dial-in#: 866.394.2346
4
Participant Code: 397 154 6368#
Participation Guidelines
 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
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Participant Code: 397 154 6368#
Service Integration and Linkages
Pop-up Question
Does your organization offer
its patients access to
behavioral health or medical
services?
Yes, we are a one-stop shop. Everything onsite!
Yes, we have a formal linkage arrangement with outside providers that is not grant supported
Yes, we have a formal linkage arrangement with outside providers that is grant supported
I have no idea…
I do not work for an HIV service organization
Visit www.incarecampaign.org
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Adam Thompson
Peer Consultant
National Quality Center
Fredricksburg, VA
[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
David C. Thompson
Team Leader-HIV/AIDS Programs
Health Systems Branch/Division of Services
Improvement
Center for Substance Abuse Treatment
E-mail: [email protected]
Humberto M. Carvalho, MPH
Project Officer
Health Systems Branch/Division of Services
Improvement
Center for Substance Abuse Treatment
E-mail: [email protected]
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
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New Orleans AIDS Task Force
Juliet Catrett, LCSW-BACS
Behavioral Health Supervisor
Email: [email protected]
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Lisa Breland
Director of Client Services
Email: [email protected]
Recovery Works Program
NO/AIDS TASK FORCE
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
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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%)
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Significant Changes
from Intake to 6 Month Follow Up
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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
Substance Use: Intake to Six Month Follow Up
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High Risk Sexual Behaviors: Intake to 6 Month
Follow Up, Males
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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%
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Agencies Contacted through Outreach Program
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Informational Materials Distributed to Agencies
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Number of Potential Clients Referred to Program
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Clients Enrolled in Recovery Works
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AIDS ALABAMA
Dr. Joseph E. Schumacher
Mitchell Traver
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]
Living In Balance Chemical Addiction
Program Coordinator
AIDS Alabama
Email: [email protected]
LIBCAP
Living in Balance Chemical Addiction
Program
Elaine Cottle
Mitchell Tarver
Dr. 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).
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.
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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
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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)
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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.
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Program Evaluation
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Intake rate: 307/405 = 75.8%
Follow-up rate: 219/274 = 79.9%
GPRA outcomes
Site specific assessments
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•
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DSM IV SUD Checklist
Patient Health Questionnaire (PHQ)
Treatment Readiness Ruler (TRR)
HIV Risk Assessment for Positives (HRAP)
Tobacco Use Questionnaire (TUQ)
GPRA Outcomes
GPRA Measure
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% 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%
Table 1. Demographic characteristics by treatment completion status
Total sample
(N=123)
Discharged
(N=83)
Completed
(N=40)
Test statistic
p value
Sex (#, %)
Male
86 (69.1%)
55 (66.3%)
31 (77.5%)
Female
27 (30.9%)
28 (33.7%)
9 (22.5%)
Caucasian
22 (17.8%)
14 (17.1%)
8 (20.0%)
African
American
99 (80.5%)
67 (81.7%)
Age M (SD)
43.3 (8.3)
42.5 (8.8)
χ2=1.671
p=0.196
32 (80.0%)
χ2=.903
p=0.628
44.4 (6.9)
t=-1.51
p=0.253
Race (#, %)
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Table 2. Substance use disorders by treatment completion status
Total sample
(N=123)
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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 3. Psychosocial characteristics by treatment completion status
Total sample
(N=123)
Treatment readiness:
M (SD)
Completed
(N=40)
Test statistic
p value
8.0 (1.9)
7.9 (2.1)
8.3 (1.6)
t=-1.35
p=0.181
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
PHQ-9 depression:
M (SD)
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Discharged
(N=83)
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
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Panel
Discussion
Integrating Behavioral Health and Medical Services
Panel Discussion
David Thompson
SAMHSA
[email protected]
Adam Thompson
NQC
[email protected]
Joseph Schumaker, MD
AIDS Alabama
[email protected]
Juliet Catrett, LCSW-BACS
NO AIDS Task Force
[email protected]
Lisa Breland
NO AIDS Task Force
[email protected]
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Partners in+care Resources
Visit Web / Open the Toolkit
www.incarecampaign.org - “Partners” tab
Sign up for Partners in+care Network
www.incarecampaign.org – “Partners” tab
Join Facebook
Send email to
[email protected] –
“Facebook” in subject line
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Campaign Headquarters:
National Quality Center (NQC)
90 Church Street, 13th floor
New York, NY 10007
Phone 212-417-4730