1. Dissemination of Evidence-Based Treatments from Clinical Treatment Providers Bethesda, MD October 20, 2009 Susan M. Gordon, Ph.D. Myriah Jackson, B.A. Dissemination of Project WORTH in a Residential Treatment Program for Women and Children

2. Acknowledgements Center for Substance Abuse Treatment HIV/TCE TI019726 NIDA CTN U10 DA013043 Seabrook House Myriah Jackson, HIV counselor

3. MatriArk Family Program Residential treatment program for women & children Southern New Jersey 48 women and 80 children (birth – 12 yrs) Programs: 28-day program 1 – 6 month program 6 – 12 month program 1993 - 2009

4. Demographics Average 30 years of age (18 – 47) 60% never married 90% birth to one or more children Race/Ethnicity 60% White 28% African-American 12% Hispanic Drug Dependencies 45% Cocaine 45% Heroin/opioids 15% Alcohol 12% Cannabis 10% Sedatives 40% Nicotine

5. Sexual Risk Behaviors & MAFC Intervention In the year prior to admission: 93% sexual activity with males 80% sex without barrier protection 75% sex while high or partner was high 40% 2 or more sex partners MAFC Intervention: Offsite HIV screening Monthly HIV educational sessions

6. CSAT TCE/HIV Grant 1.On-site rapid HIV screening/counseling for residents and visitors 2.Medical Case Management for all residents & children 3.Project WORTH – safer sex education program for residents

7. Project Women On the Road To Health (AKA CTN 0019) Safer sex skill development psycho-educational group to reduce HIV/STI transmission Focus: –Barriers to safer sex practices –Assertiveness training –Problem solving –Communication skills –Methods to protect self from partner abuse 5 - 90-minute sessions Trained facilitator Manual Visual presentations Group experiential exercises & discussions Practice using male & female condoms on inanimate models

8. Implementation Steps 1. 2-day Training 2.Goals: 1.3 - 5 sessions in first month of treatment 2.Review sessions for residents in treatment for 4 or more months 3.Modifications 1.Open enrollment 2.Individual session with new residents prior to admission to group 3.Boaster sessions for women in treatment more than 6 months

9. Challenges Open Enrollment –Maintain group cohesion –New members at Sessions 3 – 5 –Individual sessions Identify residents eligible for review sessions before they discharge How to keep curriculum interesting for the review group

10. Attendance – Initial Sessions 150 eligible residents: M = 3.5 +2 sessions 72% received 3+ sessions 13% received NO sessions

11. Satisfaction

12. Behavior Changes During the past 12/3 months did you have sex without using any kind of condom, dental dam or other barrier? 13 participants who completed Admission & Follow-up GAIN Risk Assessment and were sexually active at both points. X 2 (1, N=13) = 4.0, p <.05 McNemar Test