CultureSpecific Mental Health Intervention The Mental Health HIV Services Collaborative MHHSC Progra

1
Culture-Specific Mental Health InterventionThe
Mental Health HIV Services Collaborative (MHHSC)
Program

• Maria Madison, Abt
• Douglas Fuller, Abt

2
Session Participants

• Maria Madison, Abt
• Vivian Brown, Prototypes
• Eustache Jean Louis Gemima St. Louis Center
  for Community Health, Education Research
• Gabriela Garcia, Abt
• Nelson Jim, Native Circle
• Abdin Noboa-Rios, IQ Solutions
• Douglas Fuller, Abt

3
Presentation Goals

• Describe the MHHSC Program
• Components
• Context
• Relevance
• Convey
• The process of this collaborative.
  utilization-focused evaluation
• Accomplishments to date (products)
• Uses of the outputs of products

4
Substance Abuse Mental Health Services
Administration(SAMHSA)

• Center for Mental Health Services (CMHS)
• Center for Substance Abuse Prevention (CSAP)
• Center for Substance Abuse Treatment (CSAT)

5
SAMHSA HIV/AIDS HISTORY

• Prior to 2001 CSAT funds targeted
  capacity/HIV/AIDS Substance Abuse treatment
  programs for African American, Hispanic/Latino,
  and other racial/ethnic minorities.
• 2001 CMHS funds a similar targeted/expanded
  capacity program for community based
  organizations (CBOs) serving African American,
  Hispanic/Latino, and other racial/ethnic
  minorities.

6
HIV Infection among People with Severe Mental
Illness
Across all published studies, the rate of HIV
infection among psychiatric patients is 10, 25
times higher than that of the general
population. Cournos McKinnon, 1997Krakow et
al., 1998Rosenberg et al., 2001
7
Sexual Risk Behavior Among People With Severe
Mental Illness

COMPARED TO GENERAL POPULATION, PATIENTS HAVE
FEWER EPISODES OF SEX WITH A PARTNER, BUT THEY
HAVE

• ? Number of partners
• ? Number of risky or anonymous partners
• ? Frequency of sex trading
• ? Rates of coerced sex
• McKinnon et.al., 1996, 1999

8
Psychiatric Disorders and Risk for HIV Infection

• Elevated risk for HIV infection in psychiatric
• Patients
• Risk factors
• Alcohol and other drug use
• Unsafe sex
• Environmental circumstances (poverty,
  institutionalization, etc.)
• Substance use is associated with both psychiatric
  symptoms and HIV risk

9
MHHSC Program

• 21 Mental Health Service Sites CBOs
• at least 2 years experience in behavioral health
  care services
• MH Centers, Substance Abuse facilities,
• Primary Health Care /or HIV/AIDS clinics
• Abt Associates, Inc. Coordinating Center

10
MHHSC Program

• Congressional requirement (CBC CHC) provide
  these new HIV/AIDS-related mental health services
  in both traditional and non-traditional settings.
• Funding for mental health treatment services and
  related case management only.
• However, grantees are required to develop
  comprehensive integrated individual treatment
  plans and monitor primary and substance use
  treatment.

11
WHO ARE THE SERVICE SITES?

• New HIV/AIDS-Related Services
• New services (no prior HIV/AIDS-related MH
  services) 5 sites
• Expanded services 16 sites
• Service Delivery Settings
• Traditional (primarily clinic-based) 13 sites
• Non-traditional (e.g., mobile treatment, ) 1
  site
• Both settings 8 sites
• Target Populations
• African American -19 sites
• Hispanic/Latino 14 sites
• Haitian 1 site
• Native American 1 site

12
Demographics Gender
13
Demographics Race / Ethnicity
Hispanic Latino/a 30.65
14
Demographics - Age
15
DSM IV Diagnoses
16
DSM IV Diagnoses Categories
17
MHHSC Program Goals

• Expand
• Effective
• Culturally Competent
• Mental Health Services
• For PLWHIV
• In Minority Communities

18
MHHSC CULTURAL COMPETENCE

• Mission To address cultural competence within
  the MHHSC program as it pertains to client
  services, program development and evaluation.

19
MHHSC Cultural Competence

• Engaging and utilizing key stakeholders
• Local site-specific evaluators
• Local site clinicians
• Program Administrators
• Consumer Networking Committee (CNC)

20
MHHSC Cultural Competence Collaborative Process
Cultural Competence Subcommittee (CCSC)
21
MHHSC Cultural Competence

• Mission To address cultural competence within
  the MHHSC program as it pertains to client
  services, program development and evaluation.

22
MHHSC Cultural Competence

• Goals of evaluation
• Inform program development
• Enhance services to consumers
• Improve organizational and client level outcomes

23
MHHSC Cultural Competence

• Steps in creating evaluation approach
• Identified process and outcome measures of
  interest across the sites
• Reviewed approaches used in site specific
  evaluations
• Determined what was measurable and feasible
• Reviewed and identified measurement approaches

24
MHHSC Cultural Competence

• HRSA/Lewin Group Report
• Critical Areas
• Focus Areas
• Indicators

25
MHHSC Cultural Competence

• Recommendations Phase 1 Analytical Framework
• Domains
• Initial focus areas,
• Questions
• Indicators, and
• Data collection sources

26
MHHSC Cultural Competence

• Next Steps
• Site Visit Protocols
• Pilot Testing
• Focus Groups
• Cultural Competence Inventory/Survey
• Next phase of analytical framework