Transcript RSAT Training Tool: Trauma-Informed Correctional Care

Prevention and Treatment Needs
of RSAT Clients at
Risk for or Living with HIV/AIDS
RSAT Webinar
Prevention and Treatment Needs of Offenders
at risk for or living with HIV/AIDS
Niki Miller, M.S. CPS
Advocates for Human Potential
[email protected]
7/20/2015
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Who Needs this Information?
A lack of information and training, specifically within the correctional
workforce, has been identified as a barrier to reducing the spread of HIV.
Addiction Professionals
Case Managers
Mental Health
Counselors
Volunteers
Program Staff
Administrators
Healthcare Staff
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Security Staff
Chaplains
Community Corrections
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Why is early detection so important?

One million people are infected
with HIV in the US; at least 25%
do not know it.

The transmission rate is 3.5
 About 40% of AIDS deaths are
times higher for those who don’t attributable to drug use.
know they are HIV+.


Substance use multiplies the risk
of HIV infection by 12.
1 in 5 HIV+ individuals in the US
pass through correctional
facilities each year.
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Course Objectives

Increase knowledge of best practices for preventing, detecting
and treating HIV/AIDS in corrections.

Enable staff to support HIV screening and meet the SUD
treatment needs of at-risk and HIV+ offenders.

Increase staff’s ability to modify health risk behaviors, pre and
post release, and access re-entry resources.

Explain ethical mandates for confidentiality and reporting new
cases of HIV, and legal challenges to discriminatory practices
and segregation.
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Module I
HIV/AIDS in Correctional Treatment Settings

Basic information on HIV/AIDS, modes of transmission
and estimated rates among offenders

HIV screening guidelines for corrections and for
substance treatment settings
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Resources, links to training centers, inmate education
materials and info on notification procedures
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Module I:
New Guidelines
Module I: Research

Centers for Disease Control (CDC) - routine “opt-out” HIV
screening in primary care for all 13-64 years old
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CDC guidelines for pregnant women, prenatal care and
prevention of mother-to-child transmission.

The National Commission on Correctional Health Care
voluntary, routine, universal screening, informed consent
and opt out rights.

Center for Substance Abuse Treatment: rapid-testing/
referral to treatment an evidence-based practice
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Module I:
Priorities for Program Staff
Module I: Research
Accurate information on preventing transmission
 Risk reduction interventions modify sex & drug use behavior
Convey benefits of knowing their status
 Today, HIV+ status is far from the death sentence it once was
Emotional support
 Better clients face a difficult diagnosis while in treatment
Effective substance use disorder treatment
 Quality, fidelity and continuing care
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Module I:
Abstinence Violation at Release
Module I: Research
Majority are infected before entering correctional systems;
small numbers contract HIV in correctional facilities

Substance use - predictor of high risk sexual behavior at release
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Studies show some offenders have unprotected sex and use IV
drugs within hours of release
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Goal: modify post-release drug use and sex high risk behaviors
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
Module I: Legal Issues in HIV Testing pg. 22 in manual
Module I: Research


HIV Testing laws for each state
State laws specific to testing prison & jail inmates
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Federal BOP testing guidelines – mandates for high risk
inmates
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National HIV/AIDS Consultation Center: info on state
laws; hotline for questions
Familiarize staff with facility & state guidelines; align
practices accordingly…
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Module I:
Resource Pages
Module I: Research
Resource pages (pgs. 20, 40, 58 & 75 ) in the manual can
help locate:
• State laws on notification
• Testing & clinical guidelines for
corrections
• Guidelines on pregnancy
• Federal BOP HIV guidelines
• Client and family fact sheets
• Training and consultation
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• Hotline number for questions
• HIV addiction treatment best
practices
• HIV evidence-based intervention
• HIV/AIDS re-entry resources
• Advocacy and legal information
• Exposure protocols for staff
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Module II:
HIV in Addiction Treatment
HIV in Addiction Treatment
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Linked to unsafe sexual behaviors; target behaviors
for clients
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HIV testing procedures and types
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Legal and ethical & counseling practice issues
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Module II:
Pre and Post-test Counseling
Module I: Research
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Working w/healthcare professionals to provide pre and
post test information
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In correctional settings, inmates may seek pre and
posttest counseling from program staff
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Drug and sex risk reduction messages at each contact
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Offer testing, info on risk reduction & preventing
transmission to others
Enable HIV+ persons to inform drug & sex partners
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Module II:
Types of Tests
Module I: Research
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All HIV testing requires a second confirmation test
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Rapid test- results within an hour; often best approach
to testing of jail inmates; best practice in addiction
treatment
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Conventional test- ELISA looks at antibodies in serum
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Confirmatory test- usually use Western Blot
High risk inmates may benefit from repeating the test
in 3-6 months
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Module II:
 HIV
Hepatitis,
HIV
and
IV
Drug
Use
Module I: Research
prevention can reduce medical care costs
 Hepatitis
B virus (HBV); Hepatitis C virus (HCV)
more easily transmitted; co-infection common.
 Rates
of HCV are epidemic = 10 x the rate of the
general public; 33% higher for women offenders.
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Module III
Meeting the Needs of HIV+ Clients
Approaches & treatment needs of HIV+ clients differ at
each stage of disease:
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Anti-retroviral treatment adherence issues
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Care transitions & re-entry planning for HIV+ offenders
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Resources for community-based care & housing
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Complicating medical conditions
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Module III:
Challenges of Diverse Care Needs
Module I: Research
Program staff is offender’s source of addiction recovery treatment
and support. A team approach ensures they function within the
scope of knowledge and training.
Case
Management
Addiction
Treatment
Medical Care
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Mental
Health
Treatment
CognitiveBehavioral
Treatment
HIV+
Inmate
Social Skills
Training
Housing
Re-Entry
Support
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Module III:
Care Needs at Each Stage
Module I: Research
HIV+ offenders have many of the same treatment needs as
other RSAT clients: support for changing their behavior.
But, their circumstance may differ:
•
•
•
•
•
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Offenders who do not disclose their HIV+ status
Offenders HIV+ with limited access to care
Offenders not yet at the point of needing treatment
Offenders for whom treatment is medically indicated
Offenders undergoing treatment in the community
Offenders with full blown AIDS
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Module III:
What is HAART?
Module I: Research
Highly Active Anti-retroviral Therapy.

Aggressive medication treatment, consisting of a
combination of at least three drugs.
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Effective for offenders in facilities but, transitions in
and out of prisons and jails result in interruption
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Low adherence to HAART is associated with poor
outcomes, including earlier death
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Module III:
Re-entry and Continuity of Care
Module I: Research
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Long term substance treatment in facilities is significantly more
effective when followed up with community treatment
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The same is true of HIV treatment
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Connections to community care, resources and a support
system are critical needs
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Re-entering HIV+ offenders best served by leaving with a 30
day supply of meds and an appointment
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Module III:
The Ryan White CARE Act pg. 58
Module I: Research
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Reauthorized in 2006-resources directed toward incarcerated
and re-entering HIV+ individuals
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Housing Opportunities for People living With AIDS (HOPWA)available to offenders if they meet income eligibility
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AIDS Drug Assistance Program (ADAP)- Administered by states
 Offenders who begin HAART in correctional tend not to
continue once released
 Those that had help filing an ADAP application were more
likely to have medications
 Low income offenders receive HIV medications
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Module IV
Module IV: Case Histories & HIV/AIDS Special Topics
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Health literacy and cultural considerations in HIV
prevention and treatment
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Engaging groups of at-risk offenders
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Issues for underserved: Youth, Women, African Americans,
Latinos
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Module IV:
HIV Issues for Underserved Groups
Module I: Research
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Health disparities profoundly impact HIV outcomes
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African Americans under represented in research
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Distrust among much of the Black community regarding
HIV, behavioral health services and research.
What works? Connect all HIV+ offenders with AIDS
Service Organizations and culturally specific community
agencies; peer-run education groups
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Module IV:
Best Practices w/Underserved Groups
Module I: Research
Good
• Use of culturally specific risk reduction
interventions from the CDC
Better
• AIDS Service Organizations or culturally specific
community groups deliver these to offenders
Best
• Have these groups train Latino, African American,
females etc. to deliver peer-led groups
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Module IV:
Examples of Interventions for
w/Underserved
Groups
Module
I: Research
Project Start–Young men leaving prisons
Safer Sex Skills Building-Sexually active
women in drug treatment
Safe on the Outs–Juvenile detention
facilities
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Questions
Module I: Research

Questions, ideas, thoughts or comments?
Sincerest thanks for your participation!
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RSAT Technical Assistance and Training Center
Contact for Niki Miller : 508-361-5848
[email protected]
HIV Manual : www.rsat-tta.com/Curricula
For more information on RSAT training and technical
assistance visit: www.rsat-tta.com/Home
Or email Jon Grand, RSAT TA Coordinator :
[email protected]
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Next Presentation
Choosing and Using Evidence-Based Curricula
February 20, 2013
2:00 – 3:00 p.m. EST
This presentation grapples with two questions:
1. What treatment issues matter most in selecting evidence-based curricula (i.e., specific EB content and
protocols) for one’s program?
2. What matters most for effective implementation of any curricula?
These questions loom larger as more EB interventions enter a growing market of tools
available to RSAT programs. Without critiquing or ranking specific products, we will focus on:
1. Deciding what your program wants a product to accomplish;
2. Selecting a product with evident capacity to do the job that might also fit well into your program; and,
3. Implementing the curriculum/intervention with both rigor and sensible adaptations.
The webinar is for program decision-makers who want to get the most treatment impact from
any given EB curriculum. And it’s for treatment staff who must deliver that curriculum and need
to somehow make it their own.
Presenter: Fred Zackon
7/20/2015
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