Welcome to the Acción Mutua web-seminar: LINKS: Incorporating Mental Health into CRCS Before we begin, a little about our format…  Presentation by seminar speaker (approx. 40 min.)  Followed by question and answer session (approx. 20 min.) Please press *6 on your telephone keypad to mute your line (pressing *6 again will un-mute your line) If you are experiencing difficulty with your phone connection, dial *0 for the conferencing service operator Questions submitted prior to the web seminar will be addressed first For questions that arise during the presentation, please click on the “hand” button and type your question

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

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

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

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.

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

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.

Mental Health & Prevention (cont.)  Example: Underlying depression and crystal use Underlying depression and crystal use using crystal to self medicate his depressionusing crystal to self medicate his depression client wants to work on his depression- that’s the goalclient 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 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

LINKS’ Clients Potential clients must be: 1. be high or moderate risk 2. mental health needs 3. men who have sex with men 4. HIV positive*

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 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 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 Has a diagnosis or symptoms associated with sexual compulsion Is homeless or in unstable housing 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 Has a sexually transmitted disease OR has exchanged sex for food, money, shelter or drugs in the past 3 months

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

Trauma and High Risk Behavior

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

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.

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

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.

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.

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. 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.

Motivational interviewing (cont.) A few key components of MI: 1. Motivation to change is elicited from the client, and not imposed 2. It is the client's task to articulate and resolve ambivalence a) Direct persuasion is not an effective method for resolving ambivalence b) The therapeutic relationship is more like a partnership or companionship than expert/recipient roles

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.

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?” “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?”

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.

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).

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

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

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

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

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

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

Questions & Comments iGracias ~ Thank You!

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