Brief Motivational Interventions in Public Health STD Clinics with Methamphetamine and Other Drug Us

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Brief Motivational Interventions in Public Health
STD Clinics with Methamphetamine and Other Drug
Users

• Barbara E. Warren, Psy.D., Director of Research,
  LGBT Community Center, New York City
• John Yu, Ph.D., Senior Research Scientist, New
  York State OASAS
• Phil Appel, Ph.D., Research Scientist, New York
  State OASAS
• Lucia Clark, Research Scientist, New York State
  OASAS

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Background

• This presentation will report findings from a
  pilot study and the first six months of an
  implementation study that is using SBIRT
  (screening, brief intervention and
• referral to treatment) within New York City STD
  clinics to encourage and empower patients,
  including a significant cohort of MSMs using
  methamphetamine, to implement harm reduction,
  mediate risk behaviors and access treatment
  and/or other services as needed.
• The intervention model has been adapted from
  SBIRT to include a BMI -brief motivational
  intervention designed to be used within this
  setting.
• The program is a unique collaboration between the
  New York City Dept. of Health, the New York State
  Office for Alcohol and Substance Abuse Services,
  the federal Center for Substance Abuse Treatment,
  the New York City Lesbian, Gay, Bisexual and
  Transgender Community Center and local treatment
  and community-based drug and HIV/AIDS services
  providers.

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Background

• Recent research indicates
• 20 of patients with STIs show symptoms of
  alcohol or drug abuse but only 1 ever receive
  treatment
• In MSMs who present for STD testing in urban U.S.
  public health clinics, correlation between
  testing positive for HIV/other STIs and
  methamphetamine use
• SBIRT and BMI are effective evidence based
  practices for reaching drug users who present in
  medical crisis

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Intervention

• SA Counselors in clinics, working with PHAs and
  Clinic medical personnel
• High risk patients who test positive on universal
  modified CAGE-A screening offered on-site
  immediate brief (10-30 minutes) session, while
  waiting for results or to see physician
• Patients connected to appropriate level of care
• Expedited pipeline to treatment and other
  services with assessment subsidy as needed

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BRIEF INTERVENTION PROTOCOL

• ESTABLISHING RAPPORT
• ASKING PERMISSION TO DISCUSS AOD USE
• DISCUSSION OF THE PROS AND CONS OF SUBSTANCE
  USE-connection to STI risk
• ELICITING THE GAP BETWEEN CONTINUING AOD USE
  AND PATIENTS DESIRED QUALITY OF LIFE/CHANGES
• NEGOTIATING AN ACTION PLAN
• MAKING A REFERRAL
• Client accepts immediate referral to treatment if
  the client decided that is his/her best option,
  and the SUI makes those arrangements
• Client declines immediate referral for treatment
  but makes appointment for another session for
  follow up.
• Client refuses immediate referral to treatment
  but accepts referral information and educational
  materials, for later/future reference

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Cumulative Project ResultsFebruary - August ,
2008
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Project Link Demographic Profile All Patients
Screened
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Project Link Demographic Profile Patients
Screening Positive
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Project Link Demographic Profile 123 Patients
Referred to Treatment
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Crystal Meth Use as Reported by Patients Referred
to Treatment

• Of the 123 patients referred to treatment, 45 MSM
  (37)
• Of the 123 patients referred to treatment, 12
  meth users (10)
• Of those 12 users, 10 identified as MSM (83)
• Of the 12 MSM meth users, 58 men of color

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Project Link Demographic Profile Positive
Screened MSMs
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Summary

• MSMs who use NYC Clinics to test for HIV/STIs are
  using crystal meth at significantly higher rates
  than reflected in general population data being
  collected
• Placing substance abuse interventionists trained
  in SBIRT/BMI in public health STI testing clinics
  offers a unique opportunity to engage these MSMs
  and other high risk populations