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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