MHHSC PROGRAM

Culture-Specific Mental Health Intervention

The Mental Health HIV Services

Collaborative (MHHSC) Program

Maria Madison, AbtDouglas Fuller, Abt

MHHSC PROGRAM

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

MHHSC PROGRAM

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

MHHSC PROGRAM

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)

MHHSC PROGRAM

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.

MHHSC PROGRAM

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, 1997;Krakow et al., 1998;Rosenberg et al., 2001

HIV Prevalence in Psychiatric and General Populations

10

0.4

0

2

4

6

8

10

12

Psychiatric General

MHHSC PROGRAM

Number of partners

Number of risky or anonymous partners

Frequency of sex trading

Rates of coerced sexMcKinnon et.al., 1996, 1999

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

Sexual Risk Behavior Among People With Severe Mental Illness:

MHHSC PROGRAM

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

Psychiatric Disorders and Risk for HIV Infection

MHHSC PROGRAM

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

MHHSC PROGRAM

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.

MHHSC PROGRAM

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

MHHSC PROGRAM

Demographics – Gender

61.90%

37.10%

0.90%0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Male Female Other

MHHSC PROGRAM

Hispanic Latino/a = 30.65%

Demographics – Race / Ethnicity

Native American3%

Asian0%Pacific Islander

0%

White17%

Other Race30%

African American/ Black50%

MHHSC PROGRAM

Demographics - Age

Age Category PercentLess than 20 years 1.72%

20 – 24 years 4.68%

25 – 29 years 7.41%

30 – 34 years 10.76%

35 – 40 years 20.83%

40 – 44 years 22.78%

45 – 50 years 14.51%

50 – 54 years 8.74%

55 years and older 6.01%

MHHSC PROGRAM

DSM IV Diagnoses

27.21%

5.39%

50.51%

16.89%

0%

10%

20%

30%

40%

50%

60%

Single Dx Dual Dx Triple Dx More than 3 Dx

MHHSC PROGRAM

DSM IV Diagnoses Categories

9.44%

13.88%

6.63%

45.71%

24.33%

6%

12%

18%

24%

30%

36%

42%

48%

AdjustmentDisorder

AnxietyDisorder

BipolarDisorder

DepressiveDisorder

OtherIncluding HIV

Dementia

MHHSC PROGRAM

MHHSC Program Goals

Expand

Effective

Culturally Competent

Mental Health Services

For PLWHIV

In Minority Communities

MHHSC PROGRAM

MHHSC CULTURAL COMPETENCE

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

MHHSC PROGRAM

MHHSC Cultural Competence

Engaging and utilizing key stakeholders:Local site-specific evaluatorsLocal site cliniciansProgram AdministratorsConsumer Networking Committee (CNC)

MHHSC PROGRAM

MHHSC Cultural Competence Collaborative Process

Cultural CompetenceSubcommittee

(CCSC)

Identification of RelevantIssues and Strategies

For Addressing Issues

RecommendationsSubmission to

Subcommittees andCNC

Rollout to Sites

MHHSC PROGRAM

MHHSC Cultural Competence

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

MHHSC PROGRAM

MHHSC Cultural Competence

Goals of evaluation: Inform program developmentEnhance services to consumers Improve organizational and client level

outcomes

MHHSC PROGRAM

MHHSC Cultural Competence

Steps in creating evaluation approach: Identified process and outcome

measures of interest across the sitesReviewed approaches used in site

specific evaluationsDetermined what was measurable and

feasible; Reviewed and identified measurement

approaches

MHHSC PROGRAM

MHHSC Cultural Competence

HRSA/Lewin Group Report:Critical AreasFocus Areas Indicators

MHHSC PROGRAM

MHHSC Cultural Competence

Recommendations – Phase 1 Analytical Framework:

Domains Initial focus areas, Questions Indicators, and Data collection sources

MHHSC PROGRAM

MHHSC Cultural Competence

Next Steps:Site Visit ProtocolsPilot TestingFocus Groups Cultural Competence Inventory/Survey Next phase of analytical framework