Mental Health, Addictions

Counseling and Medical Services

Linkages

May 29, 2013

For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#

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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, NYmichael@nationalqualitycenter.org

Conversation opportunities throughout webinar

Agenda

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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

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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#

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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

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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, VAadamtthompson@gmail.com

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:

humberto.carvalho@samhsa.hhs.gov

 David C. ThompsonTeam Leader-HIV/AIDS ProgramsHealth Systems Branch/Division of

Services ImprovementCenter for Substance Abuse Treatment

E-mail: david.thompson@samhsa.hhs.gov

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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-BACSBehavioral Health

SupervisorEmail: julietc@noaidstf.org

Lisa BrelandDirector of Client

ServicesEmail:

lisab@noaidstf.org

Recovery Works ProgramNO/AIDS TASK FORCE

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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 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

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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

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: jschumacher@uabmc.edu

Mitchell TraverLiving In Balance Chemical

Addiction Program CoordinatorAIDS Alabama

Email: mitchell.tarver@aidsalabama.org 

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).

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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

• 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)

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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%

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  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

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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

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  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

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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

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Integrating Behavioral Health and Medical ServicesPanel DiscussionDavid Thompson

SAMHSA david.thompson@samhsa.hhs.gov

Adam ThompsonNQCadamtthompson@gmail.com

Joseph Schumaker, MDAIDS Alabamajschumacher@uabmc.edu

Juliet Catrett, LCSW-BACSNO AIDS Task Forcejulietc@noaidstf.org

Lisa BrelandNO AIDS Task Forcelisab@noaidstf.org

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