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

项目总结/摘要 2015年，西澳金郡成为美国第一个实现世卫组织90 -90-90目标的城市地区， 过去八年对保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）加剧了吸毒和吸毒现象， 使金郡的艾滋病疫情得以延续无家可归的人面临着个人和 获得医疗保健的结构性障碍。个人层面的因素，如精神症状，有限的 社会支持和耻辱感阻碍了获得护理的机会，并可能因以往的负面经历而加剧 与医疗保健系统。结构性障碍，如贫困、住房不稳定、交通不便、缺乏 保险和医疗费用，可以使传统的医疗保健机构基本上无法进入， 无家可归的艾滋病高危人群。认识到这一现实，金郡已资助 自2018年以来，四个低障碍初级保健诊所作为EHE计划预防支柱的关键组成部分。这些 网站提供无障碍的医疗保健和激励措施，以帮助人们参与有效的艾滋病毒 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）。但是，未得到满足的心理健康治疗需求的巨大负担仍然是一个障碍， 利用这些服务。本提案的目标是采用单一会议叙述 治疗干预将在低障碍初级保健诊所提供， 已经在接受治疗了在整个加拿大的安大略，无预约的心理治疗诊所提供一个单一的会议 叙述性方法，以创建一种非病理化、协作和以能力为导向的方式来解决 在无预约环境中人们的心理健康需求。目前19个月提案的目标是：1） 调整这种有效的无障碍心理治疗诊所干预，以适应低障碍初级保健的背景;以及2） 在一个社区的两个低障碍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救助中心。我们将进行 对该计划的前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。这一提案是一个独特的机会，可以提供直接解决高风险问题的服务。 金郡EHE计划中的优先级差距。在提案结束时，我们将有一个情境化的和 适应低障碍的心理健康干预，我们可以扩大规模，以测试在一个全面的混合 有效性试验。

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.