This R03 project addresses provision of HIV-related services to severely mentally ill people-a major area of research for the National Institute of Mental Health. This project explores factors in mental health case management that present opportunities and barriers to providing HIV prevention services to seriously mentally ill (SMI) clients. Estimates show higher HIV transmission rates among the SMI than the general population; and studies of HIV prevention in this population have focused on researcher-led rather than provider-led interventions. Little is known about roles service providers can play in encouraging SMI clients to acquire knowledge, attitudes, skills, and behaviors necessary to prevent HIV transmission. This study builds understanding of ways that case managers may systematically offer HIV prevention services, as well as ways that administrators, funders, and other professionals affecting case managers may support such services. Since few case management agencies have formal HIV-related services, this research focuses on intent to adopt and support HIV prevention as a predictor of the attempt to actually provide such services in the future.
The specific aims of this project are to (1) develop an understanding of the attitudes, beliefs, perceptions, and practices (i.e., factors) that influence the intent of case managers, case manager administrators, funders, and opinion leaders to adopt and support HIV prevention services for SMI clients; then (2) develop a strategy for disseminating and institutionalizing HIV prevention in case management. The resulting strategy will lead to an R01 proposal for testing this approach's effectiveness in case management practice. This project uses a triangulated methodology to gather data in a 27-county region in Pennsylvania. Data are collected in stages, starting with focus groups of case managers to learn about key influencing factors. Findings inform questions in a follow-up mail survey of a sample of case managers. Survey findings, in turn, inform interviews with a sample of administrators, funders, and opinion leaders identified by case managers, then final case-manager interviews. After each stage, a panel of experts in HIV prevention and mental health research determines the most important factors to be studied in the next stage, and ultimately proposes a dissemination strategy of HIV prevention for SMI clients. This sequenced approach bridges the gap between research and treatment practice, with the ultimate goal of slowing HIV transmission in the SMI population.
|Encandela, John A; Korr, Wynne S; Hulton, Kathleen et al. (2003) Mental health case management as a locus for HIV prevention: results from case-manager focus groups. J Behav Health Serv Res 30:418-32|