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

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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.