The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT), Center for Mental Health Services (CMHS), and Center for Substance Abuse Prevention (CSAP) is accepting applications for fiscal year (FY) 2014 MAI CoC Pilot-Integration of HIV Medical Care into Behavioral Health Programs. The purpose of this jointly funded program is to integrate care (behavioral health treatment, prevention, and HIV medical care services) for racial/ethnic minority populations at high risk for behavioral health disorders and high risk for or living with HIV. The grant will fund programs that provide coordinated and integrated services through the co-location of behavioral health treatment and HIV medical care. This program is primarily intended for substance abuse treatment programs and community mental health programs that can co-locate and fully integrate HIV prevention and medical care services within them. However, if it is demonstrated that co-location is not possible and full integration can still be achieved through other means, this will be acceptable. SAMHSA funds must be used for behavioral health screening; primary substance abuse and HIV prevention; substance abuse, mental health, and co-occurring treatment; creation of infrastructure to provide integrated care; HIV and hepatitis screening and testing, and hepatitis vaccination.
Substance abuse, mental health, and co-occurring treatment and HIV medical services must be integrated through either the co-location of services or other means that demonstrate full service integration, e.g. providing transportation to get clients to the HIV medical provider, providing a nurse for case management to monitor both the HIV and behavioral health services that the client is receiving. Co-location is defined as providing the HIV services within the physical space of the behavioral health program. If co-location is not possible, the applicant must provide a plan for fully integrating behavioral health and HIV primary care. Integration is defined as the clients receiving the entire spectrum of HIV medical care in conjunction with the behavioral health services being received. See Appendix N of the RFA for more information on co-location and integration requirements.
Grant funds must be used to serve the populations of focus for this program: racial/ethnic minority populations at high risk for or have a mental and/or substance abuse disorder and who are most at risk for or living with HIV, including African American and Latino women and men, gay and bisexual men, transgendered persons, and substance users. Other high priority populations, such as American Indian/Alaskan Natives, Asian Americans, and other Pacific Islanders may be included based on the grantee’s local HIV/AIDS epidemiological profile.
As a result of this program SAMHSA expects the following outcomes: 1) increased HIV testing to identify behavioral health clients who are unaware of their HIV status; 2) increased diagnosis of HIV among behavioral health clients; 3) increased number of clients who are linked to HIV medical care; 4) increased number of behavioral health clients who are retained in HIV medical care; 5) increased number of behavioral health clients who are receiving antiretroviral therapy (ART); 6) improved adherence to behavioral treatment and ART; 7) increased number of behavioral health clients who have sustained viral suppression; and 8) increased adherence and retention in behavioral health (both substance use and mental disorders) treatment. It is expected that effective person-centered treatment will reduce the risk of HIV transmission, improve outcomes for those living with HIV, and ultimately reduce new infections. SAMHSA also expects an increase in behavioral health screenings, and a decrease in burden of behavioral health disorders in the surrounding community through partnering with community based organizations to provide substance abuse and HIV primary prevention services.
The majority of those with behavioral health disorders and HIV infection currently must obtain services for these conditions in separate settings (the substance use and/or mental disorder is treated in a behavioral health program and the HIV care is provided in a separate medical services program). [See Appendix L of the RFA: Background information.] This can be burdensome for individuals in poor health with conditions that are frequently associated with cognitive impairment (HIV infection, substance use, and mental disorders) leading to gaps in medically necessary services. This, in turn, can lead to poor behavioral health and clinical outcomes. In addition, persons living with HIV are disproportionately affected by viral hepatitis, with HIV infection accelerating the progression of viral hepatitis and subsequent liver related problems. In order to improve behavioral and HIV outcomes for racial and ethnic minority populations, it is necessary to co-locate and integrate these services. The development of models that co-locate and fully integrate HIV care and, as necessary, primary care health services for this population in substance abuse and mental health treatment programs will expand on SAMHSA’s previous work to address elements of the National HIV/AIDS Continuum of Care strategy, Viral Hepatitis Action Plan, and fill significant gaps in behavioral healthcare in the United States.
MAI CoC Pilot-Integration of HIV Medical Care into Behavioral Health Programs is one of SAMHSA’s services grant programs. SAMHSA intends that its services grants result in the delivery of services as soon as possible after award. Service delivery should begin by the 4th month of the project at the latest.
SAMHSA has demonstrated that behavioral health is essential to health, prevention works, treatment is effective, and people recover from mental, substance use, and co-occurring mental and substance use disorders. To continue to improve the delivery and financing of prevention, treatment and recovery support services, SAMHSA has identified eight Strategic Initiatives to focus the Agency’s work on people and emerging opportunities. More information is available on the SAMHSA Strategic Initiatives page. This program specifically aligns with SAMHSA’s Health Reform Strategic Initiative to further support efforts related to the integration of mental health, substance use disorder, and primary care services and the building of critical business skills within the behavioral health provider system.
The MAI CoC Pilot-Integration of HIV Medical Care into Behavioral Health grant program seeks to address behavioral health disparities among racial and ethnic minorities by encouraging the implementation of strategies to decrease the differences in access, service use, and outcomes among the racial and ethnic minority populations served. (See Appendix J of the RFA: Addressing Behavioral Health Disparities).
This grant program is being jointly funded by CSAT, CSAP and CMHS to provide behavioral health screening; primary prevention; substance abuse, mental health, and co-occurring treatment; HIV and hepatitis screening and testing; and hepatitis vaccination. The grant program is authorized under Sections 509 (Substance Abuse Treatment), 516 (Substance Abuse Prevention), and 520A (Mental Health Services) of the Public Health Service (PHS) Act, as amended. These sections of the PHS Act are SAMHSA’s authorities for funding services to meet priority substance abuse treatment, substance abuse prevention, and mental health needs of regional and national significance. The combination of these authorities permits SAMHSA to announce and administer this jointly funded grant program as it is described and being announced within this document. Please see Section II of the RFA - Award Information - for a description of how these funds may and may not be used. This announcement addresses Healthy People 2020 Mental Health and Mental Disorders Topic Area HP 2020-MHMD and Substance Abuse Topic Area HP 2020-SA.