Program Readiness to Incorporate Comprehensive Mental Health Care in the HIV Primary Care Setting

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1 Program Readiness to Incorporate Comprehensive Mental Health Care in the HIV Primary Care Setting John A. Nelson, PhD, CPNP AETC NRC, Program Director François-Xavier Bagnoud Center Rutgers School of Nursing Newark, NJ

2 About the AETCs The AIDS Education and Training Centers (AETCs), a national network of leading HIV experts, provide locally based, tailored education and technical assistance to healthcare teams and systems to integrate comprehensive care for those living with or affected by HIV. The AETCs transform HIV care by building the capacity to provide accessible, high-quality treatment and services throughout the United States. The AIDS Education and Training Centers are funded by the Health Resources and Services Administration, HIV/AIDS Bureau

3 Mission To improve the quality of life of persons living with or at-risk of HIV through the provision of high-quality professional education and training.

4 Map of the Regional AETCs

5 Target Population HIV/AIDS care providers: Physicians, Physician assistants, Nurses, Advanced practice nurses, Pharmacists, Dentists/Dental professionals Health profession students Other multidisciplinary HIV care team members

6 Training Modalities Overview Content adapted from AETC Training Levels Overview. (2003). Pacific AETC,

7 Number of Training Activities by Modality (July 1, 2011-June 30, 2012) Source: HRSA/HAB, August 2013

8 10 Most Presented Training Topics (July 1, 2011-June 30, 2012) 1. Adherence 2. Clinical Manifestations of Disease 3. Co-Morbidities 4. HIV Routine Laboratory Tests 5. Racial/Ethnic Minorities 6. Routine Primary Care Screening 7. Risk Reduction/Harm Reduction 8. Routine HIV Testing 9. Opportunistic Infections 10. Hepatitis A,B,C Source: HRSA/HAB, August 2013

9 Common Employment Settings of Trainees (July 1, 2011-June 30, 2012) Community Health Centers Hospitals/Emergency Departments Community-based Organizations Academic Health Centers State/Local Health Departments Hospital-based Clinics HIV Clinics Correctional Facilities Private Practice College/Universities Source: HRSA/HAB, August 2013

10 AETC Program Special Initiatives and Collaborations Minority AIDS Initiative (MAI) AETC HIV Testing Initiative Federal Training Centers Collaborative (FTCC) AETC Telehealth Training Centers Program (TTCP) Graduate/Health Profession Training Program National Quality Improvement/Management Technical Assistance Center (NQC) TARGET Technical Assistance Center American Indian/Alaska Native (AI/AN) Initiative

11 3 National Centers 1) AETC National Resource Center (NRC) François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey Centralizes training and clinical materials through a virtual library: Fosters collaboration among regional AETCs and local sites through national workgroups and resource development. Promotes awareness of the AETCs nationally.

12 National Centers (continued) 2) AETC National Evaluation Center (NEC) AIDS Policy Research Center at University of California, San Francisco Provides leadership in the development, design, testing and dissemination of effective evaluation models with emphasis on clinical training outcomes. Evaluates the outcomes of AETC clinical education and training programs with respect to changes in provider behavior and clinical practice.

13 National Centers (continued) 3) Clinician Consultation Center (CCC) University of California at San Francisco, San Francisco General Hospital Warmline: National HIV Telephone Consultation Service PEPline: National Clinicians Post-Exposure Prophylaxis Hotline Perinatal: National Perinatal HIV Consultation and Referral Service

14 For more information about the AETC network, you can: Contact the AETC NRC at Visit the AETC NRC website at Read the AETC blog ShareSpot at Like us on Facebook at Follow us on Twitter at Watch us on YouTube at

15 Greater than 90% of PLWH have been screened for depression in 2011, and at least 90% of those who screened positive for depression were diagnosed, and successfully treated for the depression. True False Unsure

16 Organizational vs. Individual Change Theories Unfreeze, Move (change), Freeze (1947) Lewin, K. Frontiers in Group Dynamics: Concept, Method and Reality in Social Science; Social Equilibria and Social Change. Human Relations : 5. DOI: / Stages of Change Model: pre-contemplative, contemplative, action, maintenance, relapse... (1983). Prochaska, J. O. & DiClemente, C. C. (1983). Stages and processes of self-change in smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 5, Organizational Readiness for Change Theory (2009). Weiner, B. A theory of organizational readiness for change. Implementation Science 2009, 4:67 doi: /

17 Organizational Change Theory Author: Bryan J Weiner

18 Organizational readiness for implementing change: a psychometric assessment of a new measure Christopher M Shea, Sara R Jacobs, Denise A Esserman, Kerry Bruce, Bryan J Weiner Implementation Science 2014, 9:7 doi: /

19 AETC Program Engagement in Care Toolkit Flowchart

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30 AETC Program Mental Health/Substance Use Care Clinic Readiness Assessment

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38 Conclusions Each clinic environment ( culture ) is different, so systems are going to be different. Patient populations are different, so approaches need to be individualized. Having supports and practices in place to provide feedback to care providers on what s working and what s not is an essential ongoing process (CQI). Because mental health is directly related to health outcomes, incorporation of state-of-the-science mental health care screening(s), diagnosis, treatment, and maintenance in HIV Primary Care is essential for best practice in HIV care.