Transcript Exponents Presentation 5-20-11

The ARRIVE Model
An Indigenous NYC- Based Model of HIV Prevention Education
for HIV+ and at-risk Substance Users
Howard Josepher, LCSW
Founder, President/CEO - Exponents
[email protected]
212.243.3434
History
 ARRIVE was developed by Howard Josepher, LCSW at the
request of NDRI with 3-year demonstration funding (1987 –
1990) from the National Institutes of Drug Abuse (NIDA)
 Original Name: AIDS Risk Reduction for Intravenous Drug
Users and Ex-Offenders
 1988 – Triple epidemics of HIV/AIDS, Injection Drug
Use/Crack and Violence (Syndemics).
 Mandate: Engage recently released parolees known to have
IDU histories.
Evidence-Based Practices

Psycho-education (proven highly successful working with individuals with mental illness) –
provides insight into motivational circumstances/situations that prompt individuals to
‘self- medicate’

Peer Support/Role Modeling – provides ongoing inspiration that participants can
transform their lives through the adoption of new, healthier behaviors

Creation of Community – breaks the destructive cycle of isolation and depression often
brought on by sustained drug/alcohol use; (re)ignites an acknowledgement of the
individual’s spiritual self

Advocacy on Behalf of Participants – relays genuineness, concern for overall well-being,
and continued success.

Social Learning Approach - close contact (community, small team breakdowns),
imitation of superiors (peer engagement), understanding of concepts (psychoeducation), role model behavior.
Evidence-Based Theory
 Stages of Change
 Stages of Group Development
 Psycho-education
Description

ARRIVE is an eight-week program; it is delivered through twenty-four 2.5-hour psychoeducational and health & wellness sessions (similar to a 3-credit college course).

The program incorporates psycho-education and health & wellness information
disseminated in large group settings with smaller discussions (called team-breakdowns)
as well as support groups for at-risk and HIV+ participants and individual counseling.

It’s primary purpose is to teach self-management skills to address chronic health
conditions (addiction, HIV, HCV) and reduce the infection/transmission risks to
themselves and their sexual and drug-sharing partners. Through personal investment in
the process, participants enhance self-esteem.

A large number of participants have criminal justice histories and have encountered long
periods of homelessness.

Active and recovering substance users are welcomed – HARM REDUCTION.
Core Elements
Ongoing engagement of each
participant at multiple levels:
 psycho-educational and health &
wellness informational sessions

support groups
 small team breakdowns

individual counseling
All facilitated by past graduates,
recovering individuals, persons with
compromised immune systems and
formerly incarcerated. (PEERS)
Evidence of Effectiveness
 Successfully implemented for more than two decades
 More than 9,500 graduates all of whom attend voluntarily
 Current waiting list extends to October cycle.
 Exponents is the largest contract under the current portfolio of
HRR awards.
 Funded through NYCDOHMH/HRR since 1991.
 Cited in SAMHSA’s TIP 44 (substance abuse treatment for adults
in the criminal justice setting) as an evidence-based practice
Evaluation Data
 Two external evaluations have been conducted on the
ARRIVE model:
 1991 - Wexler, H., Magura, S., Beardsley, M.
 2009 - Barreras, R., Drucker, E.
Evaluation Findings (1991)
 394 parolees w/histories of IDU (81% male, 57% Black, 33%
Latino/Hispanic; avg. age: 35)
 Sixty-one percent were engaged in the intervention (experimental
group)
 Sixty-eight percent completion rate
 Substance use-related findings: Compared to individuals in the
comparison group, participants were less likely to have friends
who were IDUs, reported lower frequencies of cocaine sniffing
and marijuana smoking, and had more involvement in substance
abuse treatment programs.
Evaluation Findings (cont’d)
 Participants were:
 more likely to be tested for HIV
 less likely to have been arrested
 possessed higher levels of employment during the follow-up
period.
Evaluation Findings (2009)
•
71% OF CURRENT OR FORMER DRUG USERS REPORTED AN
INCREASED ABILITY TO DEAL WITH STIGMA
•
41% INCREASE IN SELF-EFFICACY RELATED TO EMOTIONAL
RESPONSE TO HIV STATUS
•
30 % INCREASE RELATED TO HIV DISCLOSURE SELF-EFFICACY
•
37% INCREASE IN HIV TREATMENT ADHERENCE
Recommendations for future
HRR-Supported Programming
Content:
Evidence-Based Practices
Context:
 Non-judgmental engagement (flexible continuum)
 Strength-based vs. Deficit-based
 Person-centered (provide recovery options)
 Holistic Wellness Approach (PCSI)
 Environment that is peer-informed and peer-led
THANK YOU