Welcome to the Acción Mutua web-seminar: LINKS: Incorporating Mental Health into CRCS

1. Welcome to the Acción Mutua web-seminar:LINKS: Incorporating Mental Health into CRCS

2. Acción Mutua is a capacity building assistance (CBA) program of AIDS Project Los Angeles in collaboration with the César E. Chávez Institute of San Francisco State University Funded by the Centers for Disease Control and Prevention

3. LINKS: Incorporating Mental Health into CRCS Karla Kahler, LMFT Mickie Robbins, LMFT Mental Health Prevention Specialist Program Manager Mental Health Program AIDS Project Los Angeles

4. Outline • Introduction of CRCS • Background of LINKS • Trauma and High Risk Behavior • Goal of LINKS • LINKS behavioral theories • Who are LINKS’ clients • Challenges and Successes • Recommendations

5. Introduction of CRCS (PCM) Intensive, individualized client-centered counseling for adopting and maintaining HIV risk-reduction behaviors. It is for HIV-positive and negative individuals at high risk for acquiring or transmitting HIV and STDs and struggle with issues such as substance use and abuse, physical and mental health, and social and cultural factors that affect HIV risk.

6. Background of LINKS • Previous PCM program at AIDS Project Los Angeles many clients had underlying mental health issues • LINKS: One-on-one psychotherapy service with an emphasis on HIV prevention

7. Mental Health & Prevention • Prevention focus on the overall well-being of the client. • Increasing the overall well-being of a client decreases symptoms of depression, anxiety and other mental health illnesses, promoting social support, decreasing risk of homelessness, improving medication adherence and decreases addictive behaviors .

8. Mental Health & Prevention (cont.) • Example: • Underlying depression and crystal use • using crystal to self medicate his depression • client wants to work on his depression- that’s the goal • If client’s depression decreases, there will usually also be a decrease in risk behavior (crystal use) • If overall mental health is improved, then risk is decreased

9. LINKS’ Clients Potential clients must be: • be high or moderate risk • mental health needs • men who have sex with men • HIV positive*

10. High Risk (definition) Client reports practicing unprotected sex OR sharing injection drug paraphernalia at least 3 times in the previous 3 months with someone who is HIV+ OR status unknown AND has one or more of the following: • A diagnosable mental illness • A diagnosable substance use disorder in the past 3 months OR reports having sex while high on any substance in the past month • Has a diagnosis or symptoms associated with sexual compulsion • Is homeless or in unstable housing • Has a sexually transmitted disease OR has exchanged sex for food, money, shelter or drugs in the past 3 months 

11. Moderate Risk (definition) Client reports having unprotected sex or sharing injection drug paraphernalia with a person who has HIV or status unknown at least once in the past year OR has any one of the co-factors listed before

12. Trauma and High Risk Behavior

13. Early Childhood • Neglect • Physical abuse • Sexual abuse • Emotional abuse • Addictive Behaviors • Drug addiction • Sexual addiction • Other addictions Desire to Cope Repeated Attempts to Cope • Acting Out Behaviors • Substance Use • High Risk sex • Later Childhood • Social isolation • Social rejection • Other perceived trauma

14. Goal of LINKS To decrease high risk behavior and increase an overall sense of well-being in our HIV+ MSM clients. • The LINKS Program uses Mental Health Professionals to address traumas with our clients. • Currently providing services are a LMFT (licensed marriage and family therapist), ASW (Associate Social Worker) and a Marriage and Family Therapist trainee.

15. Theories used in LINKS • Harm reduction • Motivational interviewing • Client centered/strength based approach • Object relations

16. Harm Reduction • All theories used in the LINKS Program are within the context of harm reduction. • Harm Reduction Psychotherapy is a non-judgmental approach to helping clients reduce the negative impact a specific behavior has on their lives.

17. Harm Reduction (cont.) It respects that people use drugs for a variety of reasons. It addresses the complex relationship that people develop with drugs and alcohol. Drug and alcohol issues are addressed simultaneously with social and occupational concerns and psychological and emotional issues.

18. Motivational interviewing Directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. It is focused and goal-directed. The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal. 

19. Motivational interviewing (cont.) A few key components of MI: • Motivation to change is elicited from the client, and not imposed • It is the client's task to articulate and resolve ambivalence • Direct persuasion is not an effective method for resolving ambivalence • The therapeutic relationship is more like a partnership or companionship than expert/recipient roles

20. Strength based/client centered Acknowledges and builds on skills the client already has. Focuses on times when the problem was not present or is present to a lesser degree. Explores how the client has been able to be successful in the past and apply it to the current situation.

21. Strength based/client centered (cont.) Example: If a client is thinking about telling a new partner about his HIV status and has been able to disclose his status to his parents/friend, a strength based intervention might be something like: “I really see you being able to disclose your status to your parents as a huge success. How were you able to do that? How can you use this success in other areas of your life?”

22. Object Relations Object relations theorists believe that we are relationship-seeking rather than pleasure-seeking. The importance of relationships in the theory translates to relationships as the main focus of psychotherapy, especially the relationship with the therapist.

23. Object Relations (cont.) For example, how a client relates with a therapist can be similar to how that client related to his early childhood caregiver (usually his mother or father).

24. How is LINKS different from other mental health models? • Risk is defined in broad terms • Clients are exclusively high or moderate risk • Our mental health clinicians have specialized training, education, and experience in prevention, which enables them to integrate both prevention and mental health • Our specific goals are risk reduction related

25. LINKS’ Clients • Have had sexual abuse or trauma during childhood • Currently dealing with substance abuse issues • Have a diagnosable mental illness • Almost all have dual diagnosis • Engage in unprotected sex with multiple partners • Are homeless or have unstable housing. • Have issues of self-acceptance related to sexual orientation and HIV diagnosis

26. Lessons Learned • Structured appointments are important but need flexibility • A client has to be motivated to decrease risk. If the client is attending session there is a motivation • Need to work with client’s own pace

27. Challenges • Pre-conceived CRCS models by funders • Budget limitations • Dedicated mental health staff • Increased demands from the community • Outcomes • Reliability of initial assessment • Timeframe to improve overall well-being

28. Successes • Good retention rates • Completion of intake and assessment • Completion of at least 5 sessions • Clients are able to • Decrease their risk • Improve overall well-being

29. Recommendations • Work closely with a mental health practitioner • Use motivational interviewing, harm reduction techniques and strength-based models • Be open and non-judgmental when working with clients • Each client is an individual and each treatment plan should be tailor-made and client centered

30. Questions & Comments iGracias ~ Thank You!

31. For more information or to learn how to receive CBA services, contact us at: 213.201.1345 www.accionmutua.org Thanks for Your Participation