A MODEL INTEGRATING MENTAL-HEALTH AND PRIMARY-CARE SERVICES FOR FAMILIES WITH HIV

The need to integrate mental health and primary care service delivery for individuals and families living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) has been well doc umented. Accessibility, flexibility, and cultural specificity are qual ities necessary, but generally lacking, in existing models of integrat ed care. In this paper, NOAH (No One Alone with HIV), an innovative, h ospital-based program of family-focused HIV mental health services, wi ll be described. NOAH is designed to meet the needs of primary care pr oviders, allied professionals/paraprofessionals, and the diversity of inner-city patients they serve. Central to the model are population-sp ecific ''family health facilitators,'' who collaborate with providers by offering mental health interventions at one or more levels along a continuum of service intensity. Whenever possible, primary care team m embers are empowered to manage mental health problems directly. When m ore intensive services are required, responsibility for direct interve ntion transfers to the family health facilitator. With the locus of in ner-city HIV primary care shifting from hospitals to neighborhood heal th centers, this hospital-based program has been extended into the com munity to support the early integration of mental health and primary c are services at the community level.