SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 3, Issue 18 (September 4, 1998)

Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Introduction

Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.

St. Louis Trainings Result in Changes in Practices and Better Services for Triply-Diagnosed Persons

The Missouri Department of Health project was designed to create, implement, and evaluate the effectiveness of a coordinated system of care through a collaborative effort between the Departments of Health and Mental Health. The project specifically targets multiply-diagnosed individuals with HIV/AIDS – those who are mentally ill and/or have a concomitant substance abuse problem. A major component of this project is to cross-train case managers and other healthcare professionals to increase their ability to recognize clinical manifestations of those who are dually- or multiply-diagnosed in order to generate referrals among agencies and improve care for clients. Trainings were held in Kansas City, St. Louis and rural (Southeast) sections of Missouri. Trainings in St. Louis brought together 164 health and mental health providers from local agencies. Training topics included HIV/AIDS treatment, risk reduction strategies, the need for coordination between health and mental health providers, and the needs of multiply-diagnosed individuals.

How many clients in case managers' caseloads are triply-diagnosed? One of the goals of the Missouri Department of Health was to determine the number of triply-diagnosed individuals being seen. Thirty-seven of the trainees participated in 6-month follow-ups, reporting that 52 patients in their caseload (n = 2093) were triply-diagnosed, 58 had co-occurring HIV and psychiatric issues, and 64 patients had HIV connected with substance abuse issues.

How did the trainings help meet the needs of triply-diagnosed individuals? When asked how the training increased their ability to help this population, over half of the respondents (57 percent) indicated that they had gained new information from the training; 41 percent indicated that their case management practices had changed; and 43 percent indicated that they made referrals for appropriate care as a result of the training.

How did the St. Louis trainings change practices for case managers working with triply-diagnosed individuals? One year following the training, 15 case managers completed structured telephone interviews as part of a qualitative evaluation to examine how they had implemented information from the trainings. Respondents reported many changes in case management practices due to having attended the training, including the following:

• Increased knowledge of culture, structure and resources of the community for multiply-diagnosed clients

• Simplified reporting and data collection

• Increased comfort in non-traditional helping roles in working with the target population

• Increased comfort in outreach methods to target multiply-diagnosed clients

• Increased analysis of clinical outcomes for the target population

• The promotion of information exchange among peers working with triply-diagnosed individuals

In addition, respondents indicated that in those case plans that called for referrals, 60 percent of multiply-diagnosed individuals were referred to an agency. Ninety clients were referred successfully, and of those, 66 percent received treatment.

The results of the follow-up interviews with training participants suggest that the training has directly improved case management practices and increased identification and referral of dual- and multiply-diagnosed clients with HIV, therefore leading to better services for diagnosed persons in St. Louis.

For further information contact Mary T. Menges, Bureau of HIV/AIDS Care, Missouri Department of Health, P. O. Box 570, Jefferson City, MO, 65102-0570, 573.751.6439, 573.751.6447 (fax), mengem@mailhealth.state.mo.us.

SPNS/Fax is produced by The Measurement Group–PROTOTYPES Evaluation and Dissemination Center (EDC). Editorial comments should be made to The Measurement Group at 5811A Uplander Way, Culver City, California 90230, 310.216.1051, 310.670.7735 (fax).
 

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