eSolutions: August 2015
eSolutions: August 2015
Feature article: From Referral to Recovery: Connecting HIV and Behavioral Health Care
Grantee Feature: Making Care Convenient: DACCO
Quick Tips: 4 Steps to Adding a Partner in HIV Care
Featured resource: National HIV/AIDS Strategy for the United States: Updated to 2020
Jake Bowling, Director of Practice Improvement, National Council for Behavioral Health and Task Lead, SAMHSA Minority AIDS Initiative Community of Care (MAI-CoC) Pilot
Mental illnesses and addictions disproportionately affect people living with HIV. Of the 420,000 people diagnosed with HIV/AIDS in the United States from 2005-2009, nearly a quarter needed treatment for alcohol or illicit drug use in a given year.  At the same time, individuals living with mental health conditions have an HIV prevalence rate four times higher than the general population.
Why is this?
Behavioral health conditions and associated social factors – like poverty, limited education and lack of access to quality health care – often contribute to risky sexual or drug use behaviors that can result in HIV infection.
In addition, the emotional impact of a diagnosis, the cognitive and psychological effects of treatment and medication and social marginalization increases the likelihood of subsequent mental illnesses and addictions. 
On top of all of this, the majority of people who receive services for mental illnesses and addictions, as well as HIV care, receive care that is uncoordinated and provided in multiple locations.
Moving to a New Model of Care
One major challenge (and opportunity) for integrated primary and behavioral health service providers is how to get people into HIV care and keep them engaged. Access to services and continual engagement in HIV treatment is vital to living a healthy life. Unlike diabetes or hypertension, where medications can remain effective after a period of interruption, interrupting an HIV treatment regime can lead to resistant strains of the infection and leave people without other treatment options.  And when people have to navigate multiple health care systems, they face formidable barriers both intrinsic (e.g., stigma, denial) and extrinsic (e.g., access, transportation, financial challenges).
The recently updated National HIV/AIDS Strategy for the United States: Updated to 2020 outlines how to increase access to care and improve health outcomes for those living with HIV. This Strategy echoes the need for care coordination and the development of models of care that treat the whole person in partnership with a team of providers, like nurses, doctors, case managers, social workers. A culturally competent workforce is also necessary for navigating care, and providers can design services so that people can receive them in one place, removing the pressure and confusion of having to navigate multiple care systems. Integrating HIV care with behavioral health services also fulfills the goal of the triple aim – improving health outcomes, lowering costs and improving personal experiences.
To move towards integrated and co-located services, provider organizations first must assess their ability to integrate HIV care – from a financial, clinical and operational perspective. They must consider which integrated care model that could best benefit their clients, a primary care partner in which a relationship may already be in place and the resources required to ensure the continuum of providers are trained to provide culturally competent care.
Who is leading this work?
SAMHSA recognizes the importance of this issue, serving a key role in the National HIV/AIDS Strategy and promoting policies that address the prevalence of co-occurring HIV and behavioral health concerns. Through the SAMHSA-funded Minority AIDS Initiative Continuum of Care grant program, 34 provider organizations are integrating HIV prevention and medical care into mental health and addiction treatment programs for racial and ethnic minority populations. These organizations aim to improve health outcomes by increasing HIV testing and awareness, providing linkage and retention to HIV medical care and engagement in behavioral health care.
Simply knowing one’s HIV status can reduce risky behavior and helps reduce HIV transmission. But too often, the biggest obstacle is linking a person to care. Providers can do more than just make the connection or referral; they can offer the integrated services necessary to improve health outcomes.
Interested in learning more about integrating HIV care into your practice? The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) offers free telephonic consultations to organizations that want to explore this area.
See the Quick Tips for how to get started.
Three buses, a taxi ride, half the day spent traveling to reach an appointment at a behavioral health center and another day to receive HIV care. year.
The Drug Abuse Comprehensive Coordinating Office (DACCO), a Tampa-based behavioral health organization that provides wrap-around services for adults and youth, recognizes transportation as a key barrier that people face trying to access behavioral health and HIV care. 
DACCO started offering HIV services (e.g., counseling, testing, maternal health) more than 20 years ago, but only recently created the link to medical services onsite. Supported through the Minority AIDS Initiative Continuum of Care (MAI-CoC) grant, DACCO works with a primary care partner, Tampa Family Health, to provide medical services on DACCO’s campus, making the trip to an appointment as simple as a walk down the hall.
A One-Stop Shop
To bring a primary care partner onsite, DACCO approached community health centers that already provided these services, seeking out organizations with common goals and missions. Working with Tampa Family Health to co-locate services eliminated many of the barriers to HIV care that DACCO’s clients faced. Tampa’s public transportation system has long been an obstacle for clients worried not only about cost, but time. And navigating public transportation to different appointments in different locations often meant clients sacrificed one appointment for another. DACCO also realized the stigma related to the name of their HIV care department deterred some clients from returning. To be more inclusive of the care provided and taking into account client feedback, DACCO’s HIV care department has now transitioned to the “health services department.”
Through Project Care, a support group for clients living with HIV and addiction, clients can sign a release of information for case managers to access health information to ensure engagement. While the organizations do not have a synced electronic health record, co-location has made it easy for DACCO staff to request medical records and speak to health center staff to input this information into the electronic health record (EHR).
To receive medical services, medical case managers—funded through this grant— act as liaisons between behavioral health and medical services and as such, can walk a client down the hall to make a referral or appointment. Proximity also makes it easy for case managers to review medical records and follow-up with health center staff.
Through this new one-stop system, DACCO has increased client retention and engagement in treatment. The co-located services have also affected other community services. For example, the embedded medical case managers alleviated pressure on other case management services in the area that they previously relied upon. Often, these were overwhelmed service systems that, in turn, would have long wait times—only further deterring clients from seeking and staying in care.
Nurturing a Partnership
When DACCO began its partnership with Tampa Family Health, it was important for all staff—particularly case managers who are often in the clinic daily—to meet, discuss goals and understand the clinical processes. Their success is based on nurturing these relationships. Staff also meets weekly based on specific grant project to discuss barriers, outcomes and sustainability. Co-located services can only succeed with open lines of communication.
Care Beyond the Campus
As DACCO moves forward in expanding its services, the organization is exploring the possibility of mobilizing services. This will allow DACCO to bring services to rural communities and other areas of the county where transportation continues to be a barrier.
How is your organization integrating HIV care? Let us know, email Integration@theNationalCouncil.org.
How can you integrate HIV services or expand the services you already provide? Here are some tips to help you get started.
- Do your research. Identify community-based organizations that already provide HIV/AIDS services. Identify potential overlaps in services and where organizational goals align.
- Seek new partnerships. Introduce your organization and your services to potential partners. Consider how to present your organization and how to make the case for integrated care. Check out CIHS’ partnership webpage for more resources.
- Prepare your team. With the addition of new services, your team will need to be trained on how the new partnership or services will impact their jobs, and new partners need mechanisms to stay informed. In both cases, communication is key. We’ve outlined a variety of resources on teams and workforce development that share best practices for strengthening your team.
- Expand your expertise. Tap into the resources for providers on AIDS.gov and the AIDSEducating and Training Centers Program to learn ways you can build clinical capacity and expertise.
Get more resources on HIV care on our website.
The White House recently released the National HIV/AIDS Strategy for the United States: Updated to 2020, a five-year plan that details what actions the federal government and other sectors should take to address HIV, according to the latest science.
A roundup of the latest reports, grant opportunities and innovations related to integrated care.
The Association for Behavioral Health and Wellness’ report, Healthcare Integration in the Era of the Affordable Care Act, highlights the opportunities for and capabilities of managed behavioral health care organizations in contributing to integrating primary care and behavioral health.
Learn what steps HHS is taking to combat opioid abuse – including efforts to change opioid prescribing practices, increase the use of naloxone, and expand the use of medication-assisted treatment.
Get the latest information on prevalence of diabetes in the United States, preventative care practices, risk factors, quality of care, and outcomes with the CDC’s 2014 Diabetes Report Card.
Psychosocial Interventions for Mental and Substance Use Disorders, a report from the Institute of Medicine, offers recommendations to ensure that evidence-based, high-quality care is provided to individuals receiving services for mental health and substance use disorders.
Be sure to watch The Next 50 Years, a video from the Surgeon General, to learn what strategies you can take to help end the tobacco epidemic.
In case you missed it: watch the recent webinar from CIHS to learn how health centers can support critical prevention and early intervention for adolescent alcohol use - including how to talk with adolescents about alcohol use and practical strategies to engage adolescents in services. View the recording here.