A Trauma Informed Approach to Serving HIV+ Women

Background: Families First is a federally funded program to reduce child abuse and neglect among families impacted by HIV through a trauma-informed approach to provide integrated medical, mental health, substance use, and home-based parenting services to the family system.  Women living with HIV are disproportionately impacted by co-occurring mental illness and substance use disorders, leading to multiple barriers to engaging in care and poor outcomes not only for women, but also for their affected children.  Integrated, evidence-based medical, mental health and substance use treatment allows for delivery of comprehensive services to HIV-positive women and their at-risk children.

Methods: Fifty-five HIV-positive women (≥ 18 years) who were parenting and using substances received evidence-based interventions within the medical home model in this quasi-experimental multisite demonstration project.  Services were provided in English or Spanish in the clinical setting as well as in the home.  In addition to HIV primary care and case management services, we provided: psychiatry, mental health counseling, parenting support, and substance use treatment.  We applied the BASIS-24, a validated self-report behavioral assessment, at baseline and 6-month follow-up.  Lab results were analyzed to measure changes in HIV viral suppression at baseline and 24-month follow-up.  

Results: We observed improved viral suppression, reduced substance use and enhanced mental health functioning.  From baseline to 24-month follow-up (N=31), we observed a 23% increase in number of women with undetectable viral loads.  Among participants with baseline and follow-up mental health assessments (N=21), we observed a 20% overall decrease in behavioral risk symptoms from baseline to six-month follow-up.  Substance use composite scores for recent substance use also decreased by 20%.

Conclusions: This demonstration project allowed for the study of a patient population with complex medical and psychosocial needs. Study indicators demonstrated initial program efficacy to achieve positive health outcomes for HIV-positive mothers who use substances.  Integrated models, which include the family system, providing substance use and mental health treatment in the context of HIV medical care are effective in improving well-being and health for high-risk families.  Multidisciplinary treatment teams are essential to address the diverse needs of families impacted by HIV with co-occurring mental illness and substance use disorders.