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Culture-Specific Mental Health
Intervention
The Mental Health HIV Services
Collaborative (MHHSC) Program
Maria Madison, Abt
Douglas Fuller, Abt
MHHSC PROGRAM
Session Participants
 Maria Madison, Abt
 Vivian Brown, Prototypes
 Eustache Jean Louis & Gemima St. Louis –
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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
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Components
Context
Relevance
Convey:
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The process of this collaborative. utilizationfocused 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
12
10
10
8
6
4
2
0.4
0
Psychiatric
General
MHHSC PROGRAM
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
MHHSC PROGRAM
Psychiatric Disorders and Risk for
HIV Infection
Elevated risk for HIV infection in psychiatric
Patients
Risk factors:
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Alcohol and other drug use
Unsafe sex
Environmental circumstances (poverty, institutionalization, etc.)
Substance use is associated with both psychiatric symptoms and
HIV risk
MHHSC PROGRAM
MHHSC Program
21 Mental Health Service Sites – CBOs
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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
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New services (no prior HIV/AIDS-related MH services)– 5 sites
Expanded services – 16 sites
Service Delivery Settings
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Traditional (primarily clinic-based) – 13 sites
Non-traditional (e.g., mobile treatment, ) – 1 site
Both settings – 8 sites
Target Populations
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African American -19 sites
Hispanic/Latino – 14 sites
Haitian – 1 site
Native American – 1 site
MHHSC PROGRAM
Demographics – Gender
70.00%
60.00%
61.90%
50.00%
40.00%
37.10%
30.00%
20.00%
10.00%
0.90%
0.00%
Male
Female
Other
MHHSC PROGRAM
Demographics – Race / Ethnicity
Hispanic Latino/a = 30.65%
Other Race
30%
African American/
Black
50%
White
17%
Pacific Islander
0%
Native American
3%
Asian
0%
MHHSC PROGRAM
Demographics - Age
Age Category
Percent
Less 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
60%
50.51%
50%
40%
30%
27.21%
20%
16.89%
10%
5.39%
0%
Single Dx
Dual Dx
Triple Dx
More than 3 Dx
MHHSC PROGRAM
DSM IV Diagnoses Categories
45.71%
48%
42%
36%
30%
24.33%
24%
18%
12%
13.88%
9.44%
6.63%
6%
Adjustment
Disorder
Anxiety
Disorder
Bipolar
Disorder
Depressive
Disorder
Other
Including 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 evaluators
 Local site clinicians
 Program Administrators
 Consumer Networking Committee (CNC)
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MHHSC PROGRAM
MHHSC Cultural Competence
Collaborative Process
Cultural Competence
Subcommittee
(CCSC)
Identification of Relevant
Issues and Strategies
For Addressing Issues
Rollout to Sites
Recommendations
Submission to
Subcommittees and
CNC
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 development
 Enhance services to consumers
 Improve organizational and client level
outcomes
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MHHSC PROGRAM
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
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MHHSC PROGRAM
MHHSC Cultural Competence
HRSA/Lewin Group Report:
Critical Areas
 Focus Areas
 Indicators
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MHHSC PROGRAM
MHHSC Cultural Competence
Recommendations – Phase 1 Analytical
Framework:
Domains
 Initial focus areas,
 Questions
 Indicators, and
 Data collection sources
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MHHSC PROGRAM
MHHSC Cultural Competence
Next Steps:
Site Visit Protocols
 Pilot Testing
 Focus Groups
 Cultural Competence Inventory/Survey
 Next phase of analytical framework
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MHHSC PROGRAM