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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 – 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. 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: 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 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 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) 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 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 MHHSC PROGRAM MHHSC Cultural Competence HRSA/Lewin Group Report: Critical Areas Focus 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 Protocols Pilot Testing Focus Groups Cultural Competence Inventory/Survey Next phase of analytical framework MHHSC PROGRAM