Biopsychosocial Assessment Program for HIVInfected Children and Youth

1
Bio-psychosocial Assessment Program for
HIV-Infected Children and Youth

• Jennifer Lewis, Psy.D, Meena Dasari, Ph.D,
• Lisa Orban, Ph.D, Susan Abramowitz, Ph.D
• NYU School of Medicine/Lower New York Consortium
• The Ryan White CARE Act Training and Technical
  Assistance Grantee Meeting 2006
• 9th Annual Clinical Update
• August 28 31, 2006, Washington, DC

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Outline of Presentation

• Review of literature on Mental Health and
  HIV/AIDS
• Bio-psychosocial Assessment Program (BAP)
• Goals
• Components
• Treatment Planning
• Outcome Assessment
• Clinical Implications

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Needs of HIV-Infected Youth

• The HIV/AIDS epidemic in New York City is the
  largest and most complex (NYSDOH AI, 2004)
  Majority are
• Young (ages 6 24 years)
• Infected through perinatal transmission
• Living in poverty
• Living into young adulthood

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Needs of HIV-Infected Youth (cont.)

• A shift in HIV care from acute to chronic care is
  warranted (Armstrong, 1999)
• Despite improvements in medical treatments,
  HIV-infected and affected youth confront complex
  mental health morbidity and poor psychosocial
  outcomes

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Poor Outcomes for HIV-Infected Youth

• Higher rates of Depression and Anxiety
• Behavioral problems
• Interpersonal difficulties
• Increased neurological and neuro-developmental
  impairments

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Poor Outcomes for HIV-Infected Youth (cont.)

• Lower scores on developmental and cognitive tests
  over time
• Greater prevalence of substance abuse
• Difficulty negotiating sexual relationships

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Comprehensive Mental Health Assessment and
Intervention

• Given the needs and poor developmental outcomes
  of HIV- infected and affected minority youth,
  comprehensive mental health assessments and
  interventions are imperative

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Bio-psychosocial Assessment Program (BAP)

• The Pediatric Infectious Diseases Program (PIDP)
  at NYU/Bellevue developed the Bio-psychosocial
  Assessment Program (BAP) to address the needs of
  youth with HIV
• Launched June 2006,
• Empirically guided, tailored mental health
  assessment and referral program for HIV-infected
  and affected youth ages 6-24

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Goals of the BAP

• To improve the mental health outcomes of HIV
  infected and affected youth by providing
• Tailored assessments
• Referrals
• Treatment services

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BAP Model
Referral to BAP
Yes
No
Enrollment
Ongoing Treatment Planning and Clinical
Consultation
Assessment Part 1. Clinical Interview Part 2.
Neuro/Cognitive and Achievement Screen Part 3.
Audio Computer Assisted Self Interview
Treatment Planning
Feedback Session
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BAP Patient Referrals

• Target population Approximately 300 HIV-infected
  and affected youth receiving medical care at PIDP
• Referral Sources
• Psychology Team
• Medical Staff
• Social Work Department
• Enrollment occurs when patient and/or caregiver
  agrees to participate

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BAP PIDP Clinic Diversity
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BAP Patient Assessment

• Part 1 Clinical Interview
• Diagnostic Assessment
• Mini-mental Status Exam
• Part 2 Neuro/Cognitive and
  Achievement Screen
• WASI
• WRAT-3
• Trail-Making Test

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BAP Patient Assessment

• Part 3 Audio Computer Assisted Self- Interview
• Mental Health
• Depression BDI/CDI
• Anxiety BAI/MASC
• Sexual Risk behaviors
• Substance Use
• Social Support MOS
• Based on CDC measures

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Audio Computerized Assisted Self-Interview (ACASI)

• Computerized interview that visually displays and
  reads questions, to which the client responds
  using a keyboard or mouse
• Developed using QDS software
• Advantages
• Literacy issues
• Privacy
• Increase likelihood of candid responses

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ACASI

• Demonstration

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BAP Patient Feedback Session and Referrals

• Referrals are provided via a referral card
  indicating which services are recommended
• Psychology / Psychiatry
• Emergency / Crisis
• School Consultation
• Neurology (discuss referral with provider)

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BAP Patient Feedback Session and Referrals
(cont.)

• Community Outreach
• Drug/Alcohol Counselor
• Health Educator/Safe Sex Support Group
• Social Work Department 
• Referral Source is notified about case

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Table 1. BAP Treatment Planning
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BAP Treatment Planning (cont)

• Summary Reports
• Clinical Summary generated by ACASI
• Academic Summary Profile
• Multi-disciplinary Treatment Team
• Provide feedback to medical staff
• Follow up on BAP referrals and treatment

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Data Management
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Outcome Assessment how will we know if the
program is working?

• Assessment
• Number enrolled
• Number assessed broken down by
• Infected/affected
• Age
• Gender
• Ethnicity
• Number of patients with
• Depression
• Anxiety
• Substance Abuse
• High Risk Sexual Behavior
• Poor Social Support

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Outcome Assessment how will we know if the
program is working? (cont.)

• Referrals - Number of referrals by service type
• Psychology
• Psychiatry
• Substance Abuse
• Social Work
• Health Educator
• Treatment Number of visits by service type
  (same as above categories)

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Clinical Implications

• Client-level Results in tailored, individualized
  treatment plans to improve psychosocial outcomes
  for HIV-infected and affected youth
• Multi-disciplinary approach Better understanding
  of patients
• Future directions include
• To analyze BAP results
• To disseminate BAP results
• To apply BAP model in similar clinical settings

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Summary and Conclusions

• A tailored assessment program is critical for
  providing appropriate referrals and treatment
  service to youth with HIV/AIDS
• Understand the complex mental health needs
• Link individual targeted needs with intervention
• Enhance treatment planning

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Acknowledgements

• The Lower New York Consortium is funded by
  Ryan White Care Act
• Title III, Program grant no. 2H7600043-13-01
• Title IV grant, no. 5H12HA0019-12-00,
• Title IV Youth Network grant no.H12HA03805-01-00
• And
• NY State AIDS InstituteYouth Specilaized Center
  for Care and Youth Access Program grant no.
  C019100

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Contact Information

• Jennifer Lewis, Psy.D
• Senior Psychologist/Research Scientist
• [phone]
• jennifer.lewis_at_med.nyu.edu
• Lisa Orban, Ph.D
• Psychologist/Research Scientist
• [phone]
• lisa.orban_at_med.nyu.edu
• Meena Dasari, Ph.D
• Psychologist
• [phone]
• meena.dasari_at_med.nyu.edu
• Susan Abramowitz, Ph.D
• Co-Director Lower New York Consortium
• [phone]
• susan.abramowitz_at_med.nyu.edu

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References

• Belman, 1990
• Bose, 1994, 1998
• Nozyce et al, 2000
• Wolters et al., 1996
• Kalichman Sikkema, 1994