Amsterdam 2015
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| Abstract #2215 - Poster 2 | ||||
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Session: 59.8: Poster 2 (Poster) on Tuesday in Chaired by Authors: Presenting Author: Dr. Francine Cournos - Mailman School of Public Health, United States |
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| Additional Authors: | ||||
| Aim: We are seeking to help clinical programs assess their readiness to provide mental health services in HIV primary care. | ||||
| Method / Issue: Mental illnesses, especially depression and substance use disorders, have been identified as common comorbidities among people living with HIV (PLWH) that contribute to morbidity and mortality and interfere with the continuum of HIV care and treatment (testing/diagnosis, linkage and retention of PLWH in quality care, and attainment and maintenance of viral suppression). For PLWH with mental illness, retention in HIV care and achieving viral suppression have been found to be significantly poorer than for PLWH without mental illness. In addition, as with untreated HIV, living with untreated mental illness is itself also associated with greater morbidity and mortality. Screening for common mental illnesses followed by appropriate diagnosis and treatment is less than optimal among HIV care clinics in the United States (U.S.) and is increasingly being done by health care providers who are not mental health experts. Project: A committee of mental health professionals within the AIDS Education and Training Center Program (a U.S. government funded program that provides health care providers with needed education, technical assistance, and capacity building resources in providing quality health care services to PLWH and those at-risk) identified the need for an assessment tool to be used by clinical HIV primary care and specialty care teams to include or improve their clinical program screening for mental illness (testing), conduct more definitive diagnostic assessments for those screening positive (diagnosing), treating those with mental illness diagnoses (linkage and treatment), and following-up with them over time (retention in care). In this way, medical and mental health care become integrated, and the health care team works together to provide ongoing medical and mental health care to PLWH. An assessment tool was developed that includes 41 different assessment questions divided into 6 categories: staff/clinical team readiness, assessment readiness, capacity readiness, community readiness, support readiness, and continuous quality improvement readiness. | ||||
| Results / Comments: Lessons learned: In the U.S., there is a range of health care insurance coverage options for PLWH (private insurance, state/federal government insurance, managed-care, AIDS Drug Assistance Program, in-network and out-of-network provider coverage, for example), and these options vary between states. Thus it is difficult to suggest a single “best practice” mental health care integration approach because of individual differences between patient insurance types as well as differences between clinical sites and populations. For example, rural clinics have fewer mental health care providers available to them, whereas many metropolitan cities have more providers but larger volumes of patients. In another example, adolescent populations are more difficult to engage in mental health care services then are adult populations. | ||||
| Discussion: The Mental Health/Substance Use Readiness Assessment tool promotes a flexible approach to integrated care and includes additional support tools to assist clinical teams in integrating quality mental health services into primary HIV care services using evidence-based best-practice constructs. After this tool is presented, audience feedback will be solicited. | ||||
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