Case manager-reported utilization of support group, substance use and mental health services among HIV-positive women in New York City

Abstract

A retrospective, longitudinal analysis of case management and medical charts was used to evaluate utilization of support group, mental health, and substance abuse treatment services among HIV-positive women in New York City. Analyses of 4134 case management and supportive service transactions revealed that 70% utilized support groups over the two-year study period. In contrast, only 35% utilized mental health services (therapy) and of those identified as using substances, only 48% utilized substance abuse treatment services. Considering the high prevalence of mental illness (63%, n=29) and substance use (54%, n=25) in the sample, the low utilization rates highlight unmet needs for service. Significant differences were found in utilization of mental health and substance abuse treatment services, with those who received services at a medical model agency (integrated care) being more likely to receive both types of treatment. In contrast, participants attending support groups in non-medical model agencies (77.8%, n=7) were significantly more likely to be retained in group (i.e., attend 11 or more sessions) than those at medical model agencies (39.1%, n=9). Based on the higher utilization rates of support groups among seropositive women, perhaps these groups could be a vehicle for establishing rapport between mental health professionals and group members to bridge the utilization gap and reduce the stigma associated with therapy and substance abuse treatment services. These findings both taut the success and highlight weaknesses regarding accessing mental health and substance abuse care, and support group retention. Sharing of information regarding recruitment and retention efforts between agencies of different modalities would be beneficial and also could identify service niches that capitalize on their subsequent strengths.

Improving outcomes at Level I trauma centers

“…32 Studies suggest that certain high-risk groups may be especially reluctant to use support resources, including patients who are older, less educated, or those with mental health or substance abuse issues. 32,30 Specifically, the literature suggests difficulty in engaging trauma patients after discharge. 33 Furthermore, subjects were being enrolled into the evaluation group during the program's initial rollout, potentially not allowing enough time for the program to become firmly established.…”

Longitudinal Associations Between Case Management and Supportive Services Use among Black and Latina HIV-positive Women in New York City

“…Prior analyses on individual supportive service data of this same sample found differences in use levels by service delivery model, mental illness, and substance use status. 13 However, these findings of the aggregate of supportive service data revealed that the differences in use were more related to the case manager relationship and less about moderating institution-level and person-level factors over the 24-month period.…”

“…Lastly, none of the agencies provided standardized mental illness assessments for case managers, although the mental illness prevalence rates (63%) found in our sample are aligned with literature on HIV-positive people. [13][14][15][16][17] …”

Implementing psychosocial programming at a level 1 trauma center: results from a 5-year period

“…This is poignantly true for psychosocial resource programs similar to our own. One reason behind this trend is that many high-risk groups, including those with cancer, HIV, and autoimmune diseases, are reluctant to use such services 35–39. For example, a foremost barrier to attending support groups among these populations is a lack of perceived need 38 39.…”