1. Association for Women in Psychology Conference “A Model of Integrated Treatment for Women with Co-Occurring Disorders who are at High Risk for HIV” Presented at the: March 11, 2007 San Francisco, California By Donna L. Caldwell, PhD

2. Presentation Overview I.The participants II.The intervention III.Preliminary outcomes IV.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 Average Age: 34 (range 17-60) Ethnicity: Participant Demographic Data

5. Education Level of Participants <9th grade 7% 9-11th grade 22% 12 or GED 36% >12th grade 35% Of the 351 cities and towns in MA ranked by educational attainment level, Fall River ranks last.

6. Income Level of Participants 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

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

8. Drug Treatment 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

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. 52% 50% 20% 13% 11% 9% 6% 9% 0% 20% 40% 60% 80% 100% Major Depression PTSD Other Anxiety Disorders Bipolar I Disorder Bipolar II Disorder Substance Induced Mood Disorder ADD/ ADHD Other Mental Health Diagnoses

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

12. Services Treatment 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 Referral Services Family Planning: Case Finding and Reproductive Health Services Access to Health Care Intensive Outpatient Group Harm Reduction

15. Program Participant Income at Enrollment and 6 months 4% 11% 30% 31% 24% 2% 11% 15% 28% 44% 0% 20% 40% 60% 80% 100% Full- time Part- time Unem- ployed, looking Unem- ployed, not looking Unem- ployed, disabled

16. 46% 31% 0% 20% 40% 60% 80% 100% Intake6 months Program Participant Drug Use at Enrollment and 6 months* *p=.04

17. 6% 34% 15% 45% 17% 47% 19% 17% 0% 20% 40% 60% 80% 100% none1-10 days11-20 days21-30 days Percent of Participants Reporting Serious Depression at Enrollment and 6 months* *p=.001

18. Percent of Participants Reporting Serious Anxiety at Enrollment and 6 months* 8% 28% 23% 42% 17% 38% 21% 25% 0% 20% 40% 60% 80% 100% none1-10 days11-20 days21-30 days *p=.018

19. 2% 10% 20% 24% 43% 8% 12% 24% 27% 0% 20% 40% 60% 80% 100% Not at all slightlyconsi- 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.”