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

项目摘要/摘要 2015年，华盛顿州金县成为美国第一个实现世界卫生组织90-90-90目标的城市地区，但 过去八年对维持这一成功提出了挑战。精神疾病之间的相互作用 和物质使用，由于社会脆弱性(无家可归、贫困)而加剧，代表着 使金县的艾滋病毒流行永久化。经历无家可归的人既面对个人-也面对 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 社会支持和耻辱阻碍了获得护理的机会，以前的负面经历可能会加剧这种情况 与医疗系统的关系。结构性障碍，如贫困、住房不稳定、交通有限、缺乏 保险和医疗费用的减少，可能会使传统的医疗保健环境基本上无法进入 经历无家可归的人，他们是艾滋病毒高危人群。认识到这一现实，金县资助了 自2018年以来，作为EHE计划预防支柱的一个关键组成部分，设立了四个低障碍初级保健诊所。这些 网站提供无需预约的医疗服务和激励措施，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、丁丙诺啡和性传播 感染(STI)控制)。但是，未得到满足的精神健康治疗需求的巨大负担仍然是阻碍 利用这些无需预约的服务。目前提案的目标是改编单一会议的叙述 在低门槛初级保健诊所以无需预约的方式提供治疗干预 已经在接受治疗了。在加拿大安大略省各地，无预约心理治疗诊所提供单一疗程 叙事方法，创建一种非病理性、协作性和以能力为导向的解决方式 无预约环境下人们的心理健康需求。目前19个月提案的目标是1) 使这一有效的无障碍心理治疗诊所干预措施适用于低障碍初级保健；以及2) 在一个社区的两个低门槛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临时收容中心。我们将进行一项 混合方法评估计划的前6个月，以评估实施情况、服务和患者 结果。这项提议是提供直接解决高需求的服务的独特机会 金县EHE计划中的优先事项缺口。在提案的最后，我们将有一个有背景的和 经过调整的低障碍心理健康干预，我们可以扩大规模，在全面的混合体中进行测试 有效性--执行试验。

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.