1. MHHSC PROGRAM Culture-Specific Mental Health Intervention The Mental Health HIV Services Collaborative (MHHSC) Program Maria Madison, Abt Douglas Fuller, Abt

2. 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

3. 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

4. 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)

5. 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.

6. 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

7. MHHSC PROGRAM Number of partners Number of risky or anonymous partners Frequency of sex trading Rates of coerced sex McKinnon et.al., 1996, 1999 COMPARED TO GENERAL POPULATION, PATIENTS HAVE FEWER EPISODES OF SEX WITH A PARTNER, BUT THEY HAVE: Sexual Risk Behavior Among People With Severe Mental Illness:

8. 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

9. 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

10. 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.

11. 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

12. MHHSC PROGRAM Demographics – Gender

13. MHHSC PROGRAM Hispanic Latino/a = 30.65% Demographics – Race / Ethnicity

14. MHHSC PROGRAM Demographics - Age Age CategoryPercent Less than 20 years1.72% 20 – 24 years4.68% 25 – 29 years7.41% 30 – 34 years10.76% 35 – 40 years20.83% 40 – 44 years22.78% 45 – 50 years14.51% 50 – 54 years8.74% 55 years and older6.01%

15. MHHSC PROGRAM DSM IV Diagnoses

16. MHHSC PROGRAM DSM IV Diagnoses Categories

17. MHHSC PROGRAM MHHSC Program Goals Expand Effective Culturally Competent Mental Health Services For PLWHIV In Minority Communities

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

19. MHHSC PROGRAM MHHSC Cultural Competence Engaging and utilizing key stakeholders: Local site-specific evaluators Local site clinicians Program Administrators Consumer Networking Committee (CNC)

20. MHHSC PROGRAM MHHSC Cultural Competence Collaborative Process Cultural Competence Subcommittee (CCSC) Identification of Relevant Issues and Strategies For Addressing Issues Recommendations Submission to Subcommittees and CNC Rollout to Sites

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

22. MHHSC PROGRAM MHHSC Cultural Competence Goals of evaluation: Inform program development Enhance services to consumers Improve organizational and client level outcomes

23. 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

24. MHHSC PROGRAM MHHSC Cultural Competence HRSA/Lewin Group Report: Critical Areas Focus Areas Indicators

25. MHHSC PROGRAM MHHSC Cultural Competence Recommendations – Phase 1 Analytical Framework: Domains Initial focus areas, Questions Indicators, and Data collection sources

26. MHHSC PROGRAM MHHSC Cultural Competence Next Steps: Site Visit Protocols Pilot Testing Focus Groups Cultural Competence Inventory/Survey Next phase of analytical framework