Expanded and Enhanced Treatment Services in a Los Angeles OTP
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Transcript of Expanded and Enhanced Treatment Services in a Los Angeles OTP
Expanded and Enhanced Treatment Services in a Los Angeles OTP
Funded by The Center for Substance Abuse Treatment
Targeted Capacity Expansion for Substance Abuse Treatment and HIV/AIDS Services (TCE/HIV)
1H79 TI126196H79 TI15867
The Matrix InstituteProject Director: Michael McCann
Integrating HIV and HCV Groups into an OTP Setting
Dan George
Matrix Institute on Addictions
Los Angeles, CA
This Section Will Focus on:
The Implementation of Manualized, Gender-specific HIV Groups
The Creation of a HCV Education Group
The Nuances of Group Implementation and Their Resulting Impact on Program Services
And………………………………………….
………….. Pamela Lee Anderson?
TO BE CONTINUED……………….
HIV and HCV- Affecting Our Population
HIV & IDUhigh risk needle-sharing practicesNew AIDS cases reported in 2000, 28%
IDU associated (CDC)
HIV & Crack usehigh risk sexual behaviorsstronger association in women than men
(Edlin,et al. 1994)
HIV and HCV- Affecting Our Population
Hepatitis C3.9 – 5 million Americans infected (CDC)Approx. 60% of infections due to needle-
sharing70-96% long-term IDUs have been
exposed (Hepatitis Association)
HIV Groups-Why Gender Specific
Analysis of Studies Evaluating HIV education within SAT programs (Prendergast et al, 2001)
Reviewed 18 StudiesRanged in lengthRanged in type of intervention
Important Variables
Intensity of interventionEducation only vs skills acquisition (role-
play)
Use of peer group discussion
Separate sex sessions
HIV/AIDS Prevention for Women in Drug Treatment
NIDA Sponsored
Principal Investigator: Rita Strombeck, PhD.
GOAL: Develop and Evaluate educational program targeting women in drug tx.
“Women Talking”
Women Talking
Adaptation of AIDS Risk Reduction Model3 stages: recognition of risk commitment to reducing riskCommitment to seeking resolution
Video and group discussions4 X 2-hour sessions
Educational Topics
Recognition of Risks
Commitment to Change
Sex Behaviors
Drug injection Behavior
Abbreviated Study Design
2 Sites- LA & Chicago83 Women intervention group83 Women control group
Experimental GroupBaseline interview Intervention (4 –sessions)1-month post interview3- month post interview
Abbreviated Study Design
Control GroupBaseline interviewNO INTERVENTION1-month post interview3- month post interview
Each participant received $25 gift certificate per interview
Study Results:
Tx Grp Participants demonstrated: Increase in HIV Knowledge/ Risk
Recognition
Increase in Personal Susceptibility
Increase in Commitment/ Motivation of Behavior Change
Project Effect on OTP Program Services
“Women Talking” incorporated into “in-house” Women’s HIV group
“Women Talking” used as educational component of group
Modified Women’s group includes the following additional teaching strategies: Role-playing for negotiating safer sex behavior Personalized risk assessments
Time Out! for Men
Time Out! for Men module created in 1996
Based off the “Time Out! For Me” women’s psychoeducational workshop (Bartholomew, Chatham &
Simpson, 1991).
Time Out! for Me evaluated in methadone maintenance programs Increased knowledge & self-esteem
Time Out! For Men
8 X 2-hour sessions
Adapted into TCE program 90 minute sessions
Required participation for new enrollees
Volunteer participation for ongoing clients
Men’s Group Objectives
Improve communication skills
Improve relationships
Challenge gender-role stereotypes
Increase knowledge on Men’s Health
Increase knowledge on HIV & STI’s
Men’s HIV Group
General response is positive
Increase in knowledge (pre/post snapshot)
Expression of “openness” in group
Provide incentives: coffee and donutsCertificates upon completion
Men’s HIV Group- Nuances
Difficulty with retention
8- sessions may be too longReduce to four sessions Incorporate HCV groupMandatory for all new TCE program admits
Hepatitis C Education Group
TCE funding- antibody test 94% +
Created due to a general lapse in knowledge among patients.
Many misunderstandings and myths
“Pamela Lee Anderson”- Mainstream myths
Create an education group curriculum to disseminate info in a quick/efficient manner
HCV Group Topics
Disease Overview (hx, statistics)
Symptoms
Modes of Transmission
Tx Options Combotherapy (pegylated interferon & ribavirin)
Healthcare maintenance and MD follow-up
Positives of Methadone Maintenance
HCV Curriculum- Learner Domains
Cognitive Learner objective: increase knowledge of
transmission, symptoms, tx options Evaluative criteria: pre/ post test scores
Affective Learner Objective: increase perceived risk and
perceived “controllability” Evaluative Criteria: pre/ post test, observation
during discussions
Learner Domains
BehavioralLearner Objective: increase MD
evaluation follow-up and reduce needle-sharing
Evaluative criteria: MD follow-up rates and reported needle-sharing practices (post 6-months)
Process Evaluation & Effect on Program Services
Integration of 1X HCV group within HIV specific series
Add/ Use role-playing communication strategies re: MD
Lack staffing to conduct HCV follow-up interviews for evaluation
Expanding Program Services
Maintained/ Established strong HIV/HCV testing and counseling services In-house HIV testing/ counseling by County
(rapid testing now offered)Valley Community Clinic Mobile Unit (HCV/
STD testing/ counseling)