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Association for Women in Psychology Conference. Presented at the:. “A Model of Integrated Treatment for Women with Co-Occurring Disorders who are at High Risk for HIV”. March 11, 2007 San Francisco, California By Donna L. Caldwell, PhD. Presentation Overview. The participants

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Association for women in psychology conference l.jpg

Association for Women in Psychology Conference

Presented at the:

“A Model of Integrated Treatment for

Women with Co-Occurring Disorders

who are at High Risk for HIV”

March 11, 2007

San Francisco, California

By Donna L. Caldwell, PhD


Presentation overview l.jpg

Presentation Overview

  • The participants

  • The intervention

  • Preliminary outcomes

  • Challenges/Discussion


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On TRaC is a SAMHSA CSAT funded program that provides treatment readiness case management to women, adolescents and men (men with a history of injection drug use).

The program provides expedited access to behavioral health and support services using a multi-disciplinary team approach. The data presented concerning women with co-occurring disorders (n = 54) are a subset of a larger study.


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Fall River Community

2% African American

93% White (Portuguese American 61%)

3% Hispanic

2% Asian

Program Participants

6% African American

78% White (includes significant Portuguese community)

9% Hispanic

6% Biracial

2% Cape Verdean

Participant Demographic Data

Average Age: 34 (range 17-60)Ethnicity:


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<9th grade

7%

>12th grade

9-11th grade

35%

22%

12 or GED

36%

Education Level of Participants

Of the 351 cities and towns in MA ranked by

educational attainment level, Fall River ranks last.


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Fall River Community

37% of Fall River residents live below 200% of federal poverty level.

15% (approx 14,000 people) receive Medicaid benefits

Program Participants

35% report no income

The average income is $665. (Includes only participants with reported income.)

24% report no insurance at referral

69% receive Medicaid benefits at referral

Income Level of Participants


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other

4%

heroin

alcohol

29%

26%

marijuana

13%

crack/cocaine

28%

Primary Drug of Choice


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Fall River Community

Fall River residents are admitted at more than double (218%) the average “crude” rate for MA communities.

Of the Fall River Residents admitted to these programs, injection drug use is reported at more than 4 times the average among admissions from other communities in the state.

Program Participants

37% had been inpatient for substance treatment within 30 days of enrollment

36% reported a history of injection drug use

Drug Treatment


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HIV/AIDS: Fall River ranks among the top ten cities in Massachusetts where HIV infection is linked to injection drug use. Based on the CDC formula, there may be as many as 600 people living with HIV. Approximately one quarter to one third have not been tested. Injection drug users make up 49% of HIV/AIDS cases.

Unique to Fall River is the level of impact on women. With 28% of HIV/AIDS cases occurring among women in Massachusetts, Fall River holds the distinction of 57% women among those infected, almost twice the states experience. Of this 57%, 64% identify their own injecting drug use as the mode of transmission.

Hepatitis C: estimate as many as 2,400 are living with Hepatitis C

Hepatitis B: the area “crude rate” for Acute Hepatitis B is 10.8 per 100,000 persons, while the statewide average is 1.8. This represents a 600% higher than average incidence.


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Mental Health Diagnoses

100%

80%

60%

52%

50%

40%

20%

20%

13%

11%

9%

9%

6%

0%

Substance

Induced

Mood

Disorder

Bipolar

I

Disorder

ADD/

ADHD

Major

Depression

PTSD

Bipolar

II

Disorder

Other

Other

Anxiety

Disorders


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ServicesOutreach and Recruitment:

  • Outreach

  • Brief Intervention

  • Transportation

    Referral Sources:

  • 69% SSTAR Services

    Also:

  • Child welfare

  • Legal system

  • School system

  • Self referral


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ServicesTreatment Readiness Case Management

Intake and Assessment

Treatment Coordination

Benefits Procurement

Motivational Interviewing

Practical/Life Skills

One-on-One Support


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Mental Health and Substance Abuse Treatment

  • Expedited Access to Psychiatric Care and Drug Treatment

  • Medication Management

  • Individual Treatment for Co-occurring Disorders

Currently there is a 3-6 month wait for psychiatric care and several weeks for mental health counseling. These participants gain almost immediate access to these services.


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Supportive Services

  • HIV, Viral Hepatitis and STD Counseling,Testing and ReferralServices

  • Family Planning: Case Finding and Reproductive Health Services

  • Access to Health Care

  • Intensive Outpatient Group

  • Harm Reduction


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100%

80%

60%

44%

40%

31%

30%

28%

24%

15%

20%

11%

11%

4%

2%

0%

Unem-

ployed,

disabled

Full-

time

Part-

time

Unem-

ployed,

looking

Unem-

ployed,

not looking

Program Participant Income

at Enrollment and 6 months


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100%

80%

60%

46%

40%

31%

20%

0%

Intake

6 months

Program Participant Drug Use

at Enrollment and 6 months*

*p=.04


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100%

80%

60%

47%

45%

40%

34%

19%

17%

17%

15%

20%

6%

0%

none

1-10 days

11-20 days

21-30 days

Percent of Participants Reporting Serious Depression at Enrollment and 6 months*

*p=.001


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100%

80%

60%

42%

38%

40%

28%

25%

23%

21%

17%

20%

8%

0%

none

1-10 days

11-20 days

21-30 days

Percent of Participants Reporting Serious Anxiety at Enrollment and 6 months*

*p=.018


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100%

80%

60%

43%

40%

27%

24%

24%

24%

20%

20%

12%

10%

8%

2%

0%

Not at all

slightly

consi-

derably

moder-

ately

extremely

Percent of Participants

Bothered by Psychological Problems

at Enrollment and 6 months*

*p=.05


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Challenges

  • Harm reduction model

  • Length of treatment services

  • Sustainability

    Discussion/Questions


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Participant Satisfaction

“When I first came to OnTrac I was very scattered, scared and still saw my life around using. Almost six months later I see a difference, feel a difference. Looking back I know that a lot of the growth would not have happened without the staff at SSTAR. It definitely helps me.”

“I would recommend the program to anyone. (Staff) treated me like an equal person, never did I feel or was I treated like an addict.”


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