Families First

Families First

ucsd

4076 Third Ave., Suite 301
San Diego, CA 92103
(619) 543-8089
Website
Download project description [PDF]

Project Director
Stephen A. Spector, M.D.
saspector@ucsd.edu

Project Coordinator
Jennifer Lewis, Ph.D.
jelewis@ucsd.edu

Project Evaluator
Maria Zuniga De Nuncio, Ph.D.
mlzuniga@mail.sdsu.edu

Sponsoring Organization
University of California San Diego, Mother-Child-Adolescent HIV Program

History & Overview

History & Overview

The University of California San Diego Mother-Child-Adolescent HIV Program (UCSD-MCAHP) is a university-based, multidisciplinary HIV program that has provided comprehensive, family-centered medical care, social services and research to women, children and youth (13-24) since 1989. The program is a division of the Department of Pediatrics and offers a medical home with wraparound family-centered, culturally competent HIV care to infants and children, birth through young adulthood and their families throughout the county.  Services include HIV prevention, testing, outreach, primary and HIV specialty care, pediatric, obstetrics, gynecology, medication adherence counseling, access to clinical trials, case management, health education, nutrition services, mental health, developmental assessments, and linkages to research.  Case management, peer navigation, and medical transportation are available to support engagement and retention in care.  UCSD-MCAHP provides HIV care in four co-located clinics: a developmentally appropriate pediatric HIV clinic, a youth-friendly adolescent HIV clinic, a women’s clinic, the Fem Owen co-located in the UCSD adult HIV program and a perinatal HIV clinic in the women’s health services clinic. UCSD provides ambulatory and inpatient HIV care with medical specialty care (hepatology, oncology, dermatology, gynecology, radiology, pulmonary care) on-site.

 

Service Delivery Model

Service Delivery Model

Families First seeks to reduce the risk of child abandonment and neglect through early identification and implementation of a countywide integrated intervention designed to treat substance abuse and mental illness in HIV positive parents and to develop and support their role as active, engaged parents.  The project coordinates integrated medical and mental health, family-based early substance abuse prevention, early intervention, child and family mental health counseling, and home-based parenting skills training.  The services are provided to HIV positive, substance abusing women who are of childbearing age and/or pregnant; perinatally exposed (HIV and dangerous drug) infants and young children; and their biological families, including older siblings throughout San Diego county. Services are client-centered, flexible, responsive, and focus on the women and her family, not just her illness.

 

Staffing

Staffing

Clinicians at MCAHP have the training, expertise and support to help reduce stigma and discrimination and to provide high-quality, safe and compassionate care to HIV women. The staff understands the cultural/social context of issues affecting sexuality, sexual health, confidentiality, HIV disclosure and partner notification. Our program hires friendly, warm, dependable, long-term staff that share similar life experiences and cultures and are able to relate well with positive women.

A multi-disciplinary team provides the interventions. Primary HIV medical care providers, psychiatrists, substance abuse counselors, mental health clinicians, case managers and parenting educators collaborate to address the family system.  Board certified psychiatrists specialize in maternal mental health.  The mental health/substance abuse specialists hold master’s degrees in social work and a CA license. As members of the multidisciplinary team, they have the primary responsibility of providing mental health assessments and services to families and provide leadership, coaching and consultation to other team members regarding mental health issues. Services are provided using the following modalities: individual, family and group counseling through evidence-based treatment approaches. The parent-child specialists hold master’s degrees in social work and are responsible for building relationships with, and providing support to, families. They identify service needs and provide evidence-based, home-based parent training/support. Masters level social work case managers assist clients in coordinating services with community agencies and serve as role models for appropriate parent-child interactions.

 

Community Collaboration

Community Collaboration

Due to the complexity of health problems and social issues, no single program or profession can provide the breadth of services required by these families. Multidisciplinary treatment teams and multiagency collaborations are essential to address the diverse needs of families affected by HIV/AIDS from medical and behavioral health to social support, developmental services, and legal assistance. Interdisciplinary and multi-agency collaboration occur at many junctures in service provision: in clinical practice; on home visits; in clinics; and at care planning conferences. Partnership meetings serve as an effective way to regularly bring together stakeholders to discuss emerging needs, gaps in services, barriers to care, and to monitor service utilization, reduce duplication and organize educational programs.  Quarterly training and program updates facilitate smoother interagency coordination and referrals, ensuring that service providers understand program eligibility criteria, and help HIV-infected women and youth obtain a full continuum of services. The discussions lead to collaboration, joint planning and cooperative efforts.

 

Evaluation/Outcomes

Evaluation/Outcomes

A rigorous evaluation of our evidence-based interventions and the medical home model demonstrates the impact on positive health outcomes.  Outcomes include reduced viral load, increased CD4, as well as, enhanced mental health functioning and parenting skills among substance abusing HIV positive women. Specifically, we expect a 10% decrease in mental health symptoms as evidenced in DAPPR , a 10% increase in parenting efficacy, an increase in viral load, and an increase in patient satisfaction. Results will serve as a vehicle for disseminating “lessons learned” throughout San Diego and to other localities.