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HRSA HIV/AIDS Bureau's
Special Projects of National Significance [1994 - 1999]:
Missouri Department of Health
Completed
by: Lisa
A. Melchior, Ph.D.
Last
Updated: July 1999
| Achievement 1: Developed a set of customized, regional models of integrated, coordinated care for persons multiply diagnosed with HIV, substance abuse, and mental illness. | ||
|
Key
Elements for a) Customized models to meet local needs. b) Ensured local control.
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Factors that Limited a) Conflicting agendas of participating agencies. b) Changes in CARE Act financing mechanisms delayed project implementation. |
Factors
that Ensured a) Opportunity to develop positive working relationships. b) Availability of cross-training for providers. |
| Achievement 2: A model for treating multiply diagnosed individuals was implemented in the greater Kansas City using a centralized provider of medical and behavioral health care services. | ||
|
Key
Elements for a) Early delays actually allowed the project to conduct an enhanced planning and implementation phase. b) Staff developed positive working relationships with collaborating agencies in the service network. c) Provider cross-training increased awareness of issues concerning multiple diagnosis. |
Factors that Limited b) Service utilization rates by multiply-diagnosed patients was lower than expected. |
Factors that Ensured a) Coordination of care was ensured through active case management. b) Collaboration among different local and state agencies helped to link clients to needed care and to decrease duplication of services. |
| Achievement 3: A model of collaborative care for triply-diagnosed persons was implemented in the St. Louis metropolitan area by linking distinct service systems for HIV, substance abuse, and mental illness. | ||
|
Key
Elements for Two case review teams served to screen cases at the outset and then review for continuing care issues |
Factors that Limited a) Competing agendas among participating agencies b) Staff turnover and burnout c) Restrictive diagnostic criteria for mental illness created barriers to accessing mental health services |
Factors that Ensured a) Allowing for local control of the service delivery model b) Staff training provided practical, hands-on experience c) Two complementary case review teams permitted systematic monitoring of client care and treatment plans d) Active case management component freed direct service providers from additional administrative duties |
| Achievement 4: A model for treating persons with co-occurring diagnosis of HIV disease, substance abuse, and mental illness in rural Missouri was implemented through coordination by a centralized comprehensive mental health facility. | ||
|
Key
Elements for a) Created a one-stop-shopping model to facilitate access to care. b) Conducted early education and outreach to the community about the program’s services, eligibility criteria, and ways to access care. |
Factors that Limited a) Stigma and limited knowledge about HIV in rural areas created barriers to accessing care. b) Large travel distances to services, as well as for program staff to attend meetings and trainings in metropolitan areas. c) Staff turnover affected continuity of care. |
Factors that Ensured a) Allowing for local control of the service delivery model. b) In-home case management visits increased access in rural communities. c) Establishing good working relationships with service providers. |
Lessons Learned from this Project
Project Index for Achievements and Lessons Learned
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