Expanded and Enhanced Treatment Services in a Los Angeles OTP

1. 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 TI12619 6H79 TI15867 The Matrix Institute Project Director: Michael McCann

2. Integrating HIV and HCV Groups into an OTP Setting Dan George Matrix Institute on Addictions Los Angeles, CA

3. 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………………………………………….

4. ………….. Pamela Lee Anderson?

5. HIV and HCV- Affecting Our Population HIV & IDU high risk needle-sharing practices New AIDS cases reported in 2000, 28% IDU associated (CDC) HIV & Crack use high risk sexual behaviors stronger association in women than men (Edlin,et al. 1994)

6. HIV and HCV- Affecting Our Population Hepatitis C 3.9 – 5 million Americans infected (CDC) Approx. 60% of infections due to needle-sharing 70-96% long-term IDUs have been exposed (Hepatitis Association)

7. HIV Groups-Why Gender Specific Analysis of Studies Evaluating HIV education within SAT programs (Prendergast et al, 2001) Reviewed 18 Studies Ranged in length Ranged in type of intervention 18 studies- ranged in length of intervention: type of intervention (education- skills acquisition)18 studies- ranged in length of intervention: type of intervention (education- skills acquisition)

8. Important Variables Intensity of intervention Education only vs skills acquisition (role-play) Use of peer group discussion Separate sex sessions

9. 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”

10. Women Talking Adaptation of AIDS Risk Reduction Model 3 stages: recognition of risk commitment to reducing risk Commitment to seeking resolution Video and group discussions 4 X 2-hour sessions

11. Educational Topics Recognition of Risks Commitment to Change Sex Behaviors Drug injection Behavior

12. Abbreviated Study Design 2 Sites- LA & Chicago 83 Women intervention group 83 Women control group Experimental Group Baseline interview Intervention (4 –sessions) 1-month post interview 3- month post interview

13. Abbreviated Study Design Control Group Baseline interview NO INTERVENTION 1-month post interview 3- month post interview Each participant received $25 gift certificate per interview

14. Study Results: Tx Grp Participants demonstrated: Increase in HIV Knowledge/ Risk Recognition Increase in Personal Susceptibility Increase in Commitment/ Motivation of Behavior Change

15. 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

16. 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 Me Evaluation- participants that attended most sessions demonstrated increased knowledge & self-esteem Time out for Me Evaluation- participants that attended most sessions demonstrated increased knowledge & self-esteem

17. 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

18. 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 Communication skills- listening (restatements, acknowledging body language), being assertive, not aggressive (use “I” statements), conflict resolution Improving relationships- relationships are often strained due to addiction Increase Men’s health/ STI- reproductive function, testicular self-exam, regular MD evaluation for prostateCommunication skills- listening (restatements, acknowledging body language), being assertive, not aggressive (use “I” statements), conflict resolution Improving relationships- relationships are often strained due to addiction Increase Men’s health/ STI- reproductive function, testicular self-exam, regular MD evaluation for prostate

19. Men’s HIV Group General response is positive Increase in knowledge (pre/post snapshot) Expression of “openness” in group Provide incentives: coffee and donuts Certificates upon completion Snapshot of pre/post test demonstrate increased knowledge and verbal expression of group OpennessSnapshot of pre/post test demonstrate increased knowledge and verbal expression of group Openness

20. Men’s HIV Group- Nuances Difficulty with retention 8- sessions may be too long Reduce to four sessions Incorporate HCV group Mandatory for all new TCE program admits

21. 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 Time Life- “The New Silent Killer” Created anxiety among patientsTime Life- “The New Silent Killer” Created anxiety among patients

22. 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 Healthcare maintenance- impact of diet, alcohol Positives of Methadone- allows stability, more realistic view may be compare methadone to heroin use, not methadone vs. “no-methadone”Healthcare maintenance- impact of diet, alcohol Positives of Methadone- allows stability, more realistic view may be compare methadone to heroin use, not methadone vs. “no-methadone”

23. 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

24. Learner Domains Behavioral Learner Objective: increase MD evaluation follow-up and reduce needle-sharing Evaluative criteria: MD follow-up rates and reported needle-sharing practices (post 6-months)

25. 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 Integration of HCV into HIV series limits patient burden Patients did not know how to seek direct answers to their questions while seeing an MD. Often felt “rushed”. BE ASSERTIVE and create question checklistIntegration of HCV into HIV series limits patient burden Patients did not know how to seek direct answers to their questions while seeing an MD. Often felt “rushed”. BE ASSERTIVE and create question checklist

26. 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)