Association for Women in Psychology Conference

1. 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

2. Presentation Overview • The participants • The intervention • Preliminary outcomes • Challenges/Discussion

3. 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.

4. 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:

5. <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.

6. 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

7. other 4% heroin alcohol 29% 26% marijuana 13% crack/cocaine 28% Primary Drug of Choice

8. 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

9. 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.

10. 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

11. ServicesOutreach and Recruitment: • Outreach • Brief Intervention • Transportation Referral Sources: • 69% SSTAR Services Also: • Child welfare • Legal system • School system • Self referral

12. ServicesTreatment Readiness Case Management Intake and Assessment Treatment Coordination Benefits Procurement Motivational Interviewing Practical/Life Skills One-on-One Support

13. 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.

14. 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

15. 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

16. 100% 80% 60% 46% 40% 31% 20% 0% Intake 6 months Program Participant Drug Use at Enrollment and 6 months* *p=.04

17. 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

18. 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

19. 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

20. Challenges • Harm reduction model • Length of treatment services • Sustainability Discussion/Questions

21. 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.”