University of Washington Developmental AIDS Research Center for Mental Health (UW ARCH)

华盛顿大学心理健康发展艾滋病研究中心 (UW ARCH)

• 批准号: 10816851
• 负责人: Jane M. Simoni
• 金额: $ 22.95万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10816851
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Adoption; Advocate; Buprenorphine; Canada; Caring; Client; Clinic; Collaborations; Communities; Competence; Consensus; Counseling; County; Data; Development; Disparity; Distress; Drops; Drug usage; Electronic Health Record; Epidemic; Evaluation; Face; Feedback; Feeling; Funding; Goals; HIV; HIV risk; Health; Health Services; Health Services Accessibility; Healthcare Systems; Homelessness; Impairment; Incentives; Individual; Infection Control; Insurance; Intervention; Interview; Judgment; Medical; Medical Care Costs; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; National Institute of Drug Abuse; Ontario; Outcome; Patient Recruitments; Patient-Focused Outcomes; Patients; Persons; Pilot Projects; Poverty; Prevention; Prevention strategy; Primary Care; Provider; Province; Psychotherapy; Qualitative Methods; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Resource-limited setting; Risk; Risk Behaviors; Services; Severities; Sexually Transmitted Diseases; Site; Social support; Specialist; Specific qualifier value; Structure; Substance Use Disorder; Surveys; Testing; Therapeutic; Therapeutic Intervention; Time; Transact; Transportation; Universities; Validation; Walking; Washington; behavioral health; care seeking; community organizations; condoms; coping; depressive symptoms; design; effectiveness evaluation; effectiveness/implementation trial; evidence base; experience; follow-up; health care availability; health care quality; health care settings; high risk; housing instability; implementation evaluation; implementation study; improved; injection drug use; integrated care; medical specialties; mental health center; mental training; person centered; post implementation; pre-exposure prophylaxis; prevention service; primary care clinic; primary care services; primary care setting; programs; psychiatric symptom; psychological distress; scale up; sex; sexual violence; social stigma; social vulnerability; substance use; success; syndemic; therapy duration; urban area; walking intervention

PROJECT SUMMARY/ABSTRACT In 2015, King County WA became the first urban area in the US to achieve the WHO 90-90-90 objective, but the past eight years have presented challenges to sustaining this success. Interactions between mental illness and substance use, exacerbated by social vulnerabilities (homelessness, poverty) represent a syndemic that perpetuates the HIV epidemic in King County. People experiencing homelessness face both individual- and structural-level barriers to accessing healthcare. Individual-level factors such as psychiatric symptoms, limited social support, and stigma impede access to care, and can be compounded by previous negative experiences with the healthcare system. Structural barriers, such as poverty, unstable housing, limited transportation, lack of insurance and the cost of medical care, can make traditional healthcare settings essentially inaccessible to people experiencing homelessness who are at high HIV risk. Recognizing this reality, King County has funded four low-barrier primary care clinics since 2018 as a key component of the EHE Plan Prevention Pillar. These sites offer walk-in accessibility to medical care and incentives to help people engage in effective HIV prevention strategies (e.g., pre-exposure prophylaxis (PrEP), buprenorphine, and sexually transmitted infections (STI) control). But a tremendous burden of unmet mental health treatment needs remains a barrier to utilization of these walk-in services. The goal of the current proposal is to adapt a single session narrative therapy intervention to be provided on a walk-in basis in low-barrier primary care clinics where people are already accessing care. Throughout Ontario, Canada, walk-in psychotherapy clinics offer a single session narrative approach to create a non-pathologizing, collaborative, and competency-oriented way of addressing the mental health needs of people in walk-in settings. The goals of the current 19-month proposal are to 1) adapt this effective walk-in psychotherapy clinic intervention for the context of low-barrier primary care; and 2) conduct a pilot implementation study in two low-barrier primary care clinics that are based in a community organization that is a drop-in center for people experiencing homelessness in North Seattle. We will conduct a mixed methods evaluation of the first 6 months of the program to assess implementation, service and patient outcomes. This proposal represents a unique opportunity to provide services that directly address a high priority gap in the King County EHE Plan. At the end of the proposal, we will have a contextualized and adapted low-barrier mental health intervention which we can scale up to test in a full-scale hybrid effectiveness-implementation trial.

项目概要/摘要 2015 年，西澳金县成为美国第一个实现世界卫生组织 90-90-90 目标的城市地区，但 过去八年对维持这一成功提出了挑战。精神疾病之间的相互作用 社会脆弱性（无家可归、贫困）加剧了药物滥用和药物滥用，这是一种流行病， 使金县的艾滋病毒流行长期存在。无家可归的人面临着个人和 获得医疗保健的结构性障碍。个体因素，如精神症状，有限 社会支持和耻辱阻碍了获得护理的机会，并且可能因以前的负面经历而变得更加复杂 与医疗保健系统。结构性障碍，例如贫困、住房不稳定、交通有限、缺乏 保险和医疗费用的增加，可能会使传统的医疗保健环境基本上无法获得 无家可归且艾滋病毒高危人群。认识到这一现实，金县资助了 自 2018 年以来，作为 EHE 计划预防支柱的重要组成部分，开设了四个低门槛初级保健诊所。这些 站点提供无需预约的医疗服务和激励措施，帮助人们有效参与艾滋病毒防治工作 预防策略（例如暴露前预防 (PrEP)、丁丙诺啡和性传播疾病 感染（STI）控制）。但未满足的心理健康治疗需求带来的巨大负担仍然是治疗的障碍 利用这些上门服务。当前提案的目标是调整单一会议叙述 在人们所在的低门槛初级保健诊所无需预约即可提供治疗干预 已经在接受护理。在加拿大安大略省，步入式心理治疗诊所提供单次治疗 叙事方法创建一种非病态化、协作性和以能力为导向的解决方式 步入式环境中人们的心理健康需求。当前 19 个月提案的目标是：1) 在低门槛初级保健的背景下调整这种有效的步入式心理治疗诊所干预措施；和 2) 在社区的两个低门槛初级保健诊所进行试点实施研究 该组织是北西雅图无家可归者的临时收容中心。我们将进行一次 对项目前 6 个月进行混合方法评估，以评估实施情况、服务和患者 结果。该提案提供了一个独特的机会来提供直接解决高问题的服务 金县 EHE 计划中的优先差距。在提案结束时，我们将有一个结合实际情况的和 适应的低门槛心理健康干预措施，我们可以扩大规模以在全面的混合中进行测试 有效性实施试验。