Integrated Nested Services: Delaware's Experience Treating Minority Substance Abusers at Risk for HIV or HIV Positive

Abstract

Treating minority substance abusers at risk of HIV or HIV positive is a critical public health issue. Delaware has achieved success in treating this population through its integrated nested services approach. Through three Center for Substance Abuse funded projects, Delaware has synthesized a number of evidence-based and best practices from the HIV medical treatment, substance abuse treatment and mental health treatment. Evaluation findings show that Project HOPE and Meeting the Challenges are having a positive impact on clients in a number of areas, including medical compliance, physical health, sobriety, employment/income and living situations. Clearly, this approach benefits all stakeholders, including the State of Delaware, local communities, staff and clients.

Interventions and approaches to integrating HIV and mental health services: a systematic review

“…Integration with primary health care or with other services, was also reported to improve confidentiality that might be breached when someone is seen attending a specialist mental health or HIV facility, reducing stigma and alleviating some of the anxiety among patients seeking care. (Coleman et al 2012, Harris and Williams 1995, Wood 2008, Dillard et al 2010. On the contrary however, it may be more difficult to implement single-site integration in smaller cities or rural areas where there is a lack of resources.…”

“…The involvement of a multidisciplinary team on site also increases the likelihood that the overall needs of a patient with dual or triple-diagnoses are considered within the treatment plan and competing priorities are addressed and minimised, reducing the occurrence of contradictory treatment demands (Dillard et al 2010). From a patient's perspective, this model of integration reduced physical barriers to access, including transportation which often hampers continuous access to care, and other practical challenges facing those with mental or physical impairment (Dillard et al 2010). Integration with primary health care or with other services, was also reported to improve confidentiality that might be breached when someone is seen attending a specialist mental health or HIV facility, reducing stigma and alleviating some of the anxiety among patients seeking care.…”

“…16 were full papers and four were conference abstracts (Namata Mbogga Mukasa et al 2014, Surah 2013, Cohen et al 2011, Vergara-Rodriguez et al 2012. Of these, there were eight descriptive studies (Feingold and Slammon 1993, Dillard et al 2010, Dodds et al 2004, Harris and Williams 1995, Kobayashi and Standridge 2000, Namata Mbogga Mukasa et al 2014, Wood 2008, Jonsson et al 2011, four cohort studies (Farber et al 2014, Nebelkopf and Penagos 2005, Vergara-Rodriguez et al 2012, Esposito-Smythers et al 2014, three retrospective record reviews (Coleman et al 2012, Cohen et al 2011, Feldman et al 2012, two non-randomized intervention studies (Winiarski et al 2005, Surah 2013), one RCT (Tetrault et al 2012), one mixed-methods study (Hyam et al 2012), and one qualitative study (Nakimuli-Mpungu et al 2014). In terms of treatment modalities, 6 out of the 20 studies involved interventions that integrated HIV and mental health services (Farber et al 2014, Feldman et al 2012, Harris and Williams 1995, Hyam et al 2012, Feingold and Slammon 1993, Nakimuli-Mpungu et al 2014.…”

“…In five other studies, the process was part of a larger package of integration with other services, including general primary health care (PHC) (Coleman et al 2012, Winiarski et al 2005 obstetrics and gynaecology (O&G) services (Dodds et al 2004), risk reduction interventions (Namata Mbogga Mukasa et al 2014), TB services (Jonsson et al 2011) and non-communicable disease screening and treatment services (Namata Mbogga Mukasa et al 2014). Three studies involved interventions that integrated HIV, mental health and substance abuse services within a HIV clinic setting (Surah 2013, Vergara-Rodriguez et al 2012, Esposito-Smythers et al 2014 while six others involved integration with primary health care (Cohen et al 2011, Dillard et al 2010, Wood 2008, Hepatitis C treatment (Tetrault et al 2012), risk reduction interventions (Nebelkopf and Penagos 2005) and specialist services (Kobayashi and Standridge 2000) in a single site. Table 2 lists the papers describing this model presented according to treatment modality and setting.…”

“…From a provider's perspective, singlesite integration of services is perceived to enhance communication between providers, and reduce scheduling and coordination time (Coleman et al 2012, Dillard et al 2010. The involvement of a multidisciplinary team on site also increases the likelihood that the overall needs of a patient with dual or triple-diagnoses are considered within the treatment plan and competing priorities are addressed and minimised, reducing the occurrence of contradictory treatment demands (Dillard et al 2010). From a patient's perspective, this model of integration reduced physical barriers to access, including transportation which often hampers continuous access to care, and other practical challenges facing those with mental or physical impairment (Dillard et al 2010).…”