expanded and enhanced treatment services in a los angeles otp
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Expanded and Enhanced Treatment Services in a Los Angeles OTP. Funded by The Center for Substance Abuse Treatment Targeted Capacity Expansion for Substance Abuse Treatment and HIV/AIDS Services (TCE/HIV) 1H79 TI12619 6H79 TI15867 The Matrix Institute Project Director: Michael McCann. - PowerPoint PPT PresentationTRANSCRIPT
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Expanded and Enhanced Treatment Services in a Los Angeles OTP
Funded by The Center for Substance Abuse Treatment
Targeted Capacity Expansion for Substance Abuse Treatment and HIV/AIDS Services (TCE/HIV)
1H79 TI126196H79 TI15867
The Matrix InstituteProject Director: Michael McCann
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Integrating HIV and HCV Groups into an OTP Setting
Dan George
Matrix Institute on Addictions
Los Angeles, CA
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This Section Will Focus on:
The Implementation of Manualized, Gender-specific HIV Groups
The Creation of a HCV Education Group
The Nuances of Group Implementation and Their Resulting Impact on Program Services
And………………………………………….
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………….. Pamela Lee Anderson?
TO BE CONTINUED……………….
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HIV and HCV- Affecting Our Population
HIV & IDUhigh risk needle-sharing practicesNew AIDS cases reported in 2000, 28%
IDU associated (CDC)
HIV & Crack usehigh risk sexual behaviorsstronger association in women than men
(Edlin,et al. 1994)
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HIV and HCV- Affecting Our Population
Hepatitis C3.9 – 5 million Americans infected (CDC)Approx. 60% of infections due to needle-
sharing70-96% long-term IDUs have been
exposed (Hepatitis Association)
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HIV Groups-Why Gender Specific
Analysis of Studies Evaluating HIV education within SAT programs (Prendergast et al, 2001)
Reviewed 18 StudiesRanged in lengthRanged in type of intervention
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Important Variables
Intensity of interventionEducation only vs skills acquisition (role-
play)
Use of peer group discussion
Separate sex sessions
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HIV/AIDS Prevention for Women in Drug Treatment
NIDA Sponsored
Principal Investigator: Rita Strombeck, PhD.
GOAL: Develop and Evaluate educational program targeting women in drug tx.
“Women Talking”
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Women Talking
Adaptation of AIDS Risk Reduction Model3 stages: recognition of risk commitment to reducing riskCommitment to seeking resolution
Video and group discussions4 X 2-hour sessions
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Educational Topics
Recognition of Risks
Commitment to Change
Sex Behaviors
Drug injection Behavior
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Abbreviated Study Design
2 Sites- LA & Chicago83 Women intervention group83 Women control group
Experimental GroupBaseline interview Intervention (4 –sessions)1-month post interview3- month post interview
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Abbreviated Study Design
Control GroupBaseline interviewNO INTERVENTION1-month post interview3- month post interview
Each participant received $25 gift certificate per interview
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Study Results:
Tx Grp Participants demonstrated: Increase in HIV Knowledge/ Risk
Recognition
Increase in Personal Susceptibility
Increase in Commitment/ Motivation of Behavior Change
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Project Effect on OTP Program Services
“Women Talking” incorporated into “in-house” Women’s HIV group
“Women Talking” used as educational component of group
Modified Women’s group includes the following additional teaching strategies: Role-playing for negotiating safer sex behavior Personalized risk assessments
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Time Out! for Men
Time Out! for Men module created in 1996
Based off the “Time Out! For Me” women’s psychoeducational workshop (Bartholomew, Chatham &
Simpson, 1991).
Time Out! for Me evaluated in methadone maintenance programs Increased knowledge & self-esteem
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Time Out! For Men
8 X 2-hour sessions
Adapted into TCE program 90 minute sessions
Required participation for new enrollees
Volunteer participation for ongoing clients
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Men’s Group Objectives
Improve communication skills
Improve relationships
Challenge gender-role stereotypes
Increase knowledge on Men’s Health
Increase knowledge on HIV & STI’s
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Men’s HIV Group
General response is positive
Increase in knowledge (pre/post snapshot)
Expression of “openness” in group
Provide incentives: coffee and donutsCertificates upon completion
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Men’s HIV Group- Nuances
Difficulty with retention
8- sessions may be too longReduce to four sessions Incorporate HCV groupMandatory for all new TCE program admits
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Hepatitis C Education Group
TCE funding- antibody test 94% +
Created due to a general lapse in knowledge among patients.
Many misunderstandings and myths
“Pamela Lee Anderson”- Mainstream myths
Create an education group curriculum to disseminate info in a quick/efficient manner
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HCV Group Topics
Disease Overview (hx, statistics)
Symptoms
Modes of Transmission
Tx Options Combotherapy (pegylated interferon & ribavirin)
Healthcare maintenance and MD follow-up
Positives of Methadone Maintenance
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HCV Curriculum- Learner Domains
Cognitive Learner objective: increase knowledge of
transmission, symptoms, tx options Evaluative criteria: pre/ post test scores
Affective Learner Objective: increase perceived risk and
perceived “controllability” Evaluative Criteria: pre/ post test, observation
during discussions
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Learner Domains
BehavioralLearner Objective: increase MD
evaluation follow-up and reduce needle-sharing
Evaluative criteria: MD follow-up rates and reported needle-sharing practices (post 6-months)
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Process Evaluation & Effect on Program Services
Integration of 1X HCV group within HIV specific series
Add/ Use role-playing communication strategies re: MD
Lack staffing to conduct HCV follow-up interviews for evaluation
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Expanding Program Services
Maintained/ Established strong HIV/HCV testing and counseling services In-house HIV testing/ counseling by County
(rapid testing now offered)Valley Community Clinic Mobile Unit (HCV/
STD testing/ counseling)