What Can MI Do for HIV Prevention and Care

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					           Nonprofit Consulting Services, LLC                                                     Volume 10 Issue 9

                                                                                                  S e p t em b e r 20 0 8




           NCS NEWS
                                  What Can MI Do for HIV Prevention and Care?
INSIDE THIS ISSUE:                Sylvie Naar-King, Karen Ingersoll, Merav Devere, & Sharon Zang

Community Section           8     The Horizons Project
                                  Sylvie Naar-King
CALENDAR            OF
                                            The Horizons Project, a comprehensive continuum of HIV services for youth
EVENTS                            from HIV prevention to counseling and testing to HIV care. The program incorporates
                                  MI for HIV prevention with youth in detention, for HIV outreach to encourage HIV test-
SEPTEMBER 16, 17 & 18 -
                                  ing among young African American men who have sex with men, for youth engage-
3-DAY TRAINING TRACK II
                                  ment in HIV care, for medication adherence and secondary prevention. It is also initi-
2025 WEST 11TH STREET             ating computer applications for adherence and sexual risk using the Motivational En-
Wednesday, 8:30 –10am
                                  hancement
                                  System (adapted from Ondersma and colleagues).
SEPTEMBER 10 – CM SU-                       The structure of these sessions includes:
PERVISORS’ MEETING                • Opening statement
                                  • Elicit client’s view
2223 WEST LOOP SOUTH,
                                  • Elicit change talk – readiness ruler and decisional balance options
RM   416                          • Feedback (not normative but based on baseline assessment)
NEXT MONTH                        • Summary and Key Question
                                  • Option for change plan
 OCTOBER 2 -ORIENTATION
                                  The training protocol included:
2025 WEST 11TH STREET             • 2 day training
                                  • Weekly group supervision
OCTOBER 15 - CM IN-               • Review of audiotapes
SERVICE                           • Review of MITI Coding
2025 WEST 11TH STREET                       The individual projects include:
                                  Project 180: Prevention for Primarily African American Adolescents in Detention
Wednesday -Friday
                                  Two MI sessions in one week in the facility delivered by peer outreach workers. Data
8:30 –10am                        pre to post-intervention show immediate improvements in readiness to change. Three
                                  month follow-up data show reductions in substance use and unprotected sex. MITI
OCTOBER - CULTURAL                coding suggested difficulties in reflection to question ratio and for the ratio of complex
COMPETENCE WORKSHOP               reflections to simple reflections. Brothers Saving Brothers: MI to Encourage HIV C&T
2025 WEST 11TH STREET             among YAAMSM (16-24) Youth were randomized to a single brief MI session con-
                                  ducted in the context of street outreach versus a traditional outreach session. A sig-
Thursday 9:00am –1:00pm
                                  nificantly greater percentage of youth agreed to an HIV test following the MI session
FYI                               compared to youth who received traditional outreach. MITI coding suggested difficul-
                                  ties in reflection to question ratio and for the ratio of complex reflections to simple re-
NOVVEMBER 4-6 - 3-DAY
                                  flections. It was noted that we do not have data on MITI coding validity for brief inter-
TRAINING - TRACK 1                actions and for interactions outside of traditional mental health/substance abuse ser-
2025 WEST 11TH STREET             vices. Get Here Get Down: MI for Youth Engagement in HIV Care HIV+ youth re-
8:30am -3:30pm                    ceived an MI session
                                  at baseline and at 6 months. Youth were randomized to receive the sessions from a
                                  masters level provider or a peer outreach worker. MITI coding from peer sessions
• Registration available online   were equivalent or better than those from masters level providers. The effect size for
  at nonprofitconsulting.com      improvement attendance to HIV appointments was larger for the peer providers than
  or drop us a line at info       for the masters level providers. Data revealed equivalent scores between an MI ses-
  @nonprofitconsulting.com        sion at baseline and at 6 months. These findings suggest that peer outreach workers
                                  can be effectively trained to provide MI.
Page 2                                                                                                   Volume 10 Issue 9



   Healthy Choices
           A pilot study suggested that MI in a 4 session MET intervention, can be used to improve viral load, unpro-
   tected sex and substance use in HIV+ youth (Naar-King et al., 2006). This intervention is currently
   being testing in a multi-site clinical trial with 186 youth. Participants in this breakout session discussed the appro-
   priateness of MI for adolescent populations. A majority felt that few modifications were needed. Adolescents do not
   get “bored” with reflections, and love affirmations and emphasizing personal control.

   Improving Medication Adherence and Reducing Cocaine Use with a Motiva-
   tional Intervention in HIV+ Adults
   Karen Ingersoll
   Sporadic and consistent cocaine use increases non-adherence to HIV medication. Adherence must be extremely
   high to achieve suppression of HIV virus. Better adherence relates to lower morbidity, disease progression, and
   lower mortality. Because there have been no interventions available to address both cocaine use and non-
   adherence among HIV+ persons, we set out to develop and test a new therapy. The Cocaine and Adherence
   Readiness Treatment (CART) intervention was revised from a 4 to 6 session MI counseling intervention.
   The following outline describes the CART intervention:
   • Opening Session: Cocaine, HIV and Self-Monitoring
   • Social Support, Stigma, and Disclosure
   • Decisional Balance, Goals, and Personalized Feedback
   • Confidence and Temptation
   • Goals and Coping Skills
   • Progress and Plans
   The following outline describes the video control intervention (matched for dose and timing):
   • Positively: Adults coping with HIV/AIDS
   • Taking Control: Adherence
   • Substance Abuse and HIV Care
   • Stress, Nutrition, and Exercise
   • Substance Use, Safe Sex, and Spirituality
   • Portrait of Addiction

            Seven participants (5 African-American women and 2 African-American men, all cocaine dependent) en-
   rolled in the CART study pre-pilot trial. No attrition observed. Results were promising; with improvements in adher-
   ence and days using cocaine noted.
            In the pilot study so far, 26 HIV+ non-adherent patients in HIV care have been recruited; 12 have been
   randomized to Video, 14 to CART counseling. Most characteristics were equivalent across groups. All participants
   were cocaine dependent by SCID/MINI criteria. Fifty percent are female, 72% African-American, 77% unemployed,
   50% heterosexual. They were immune health compromised: mean baseline CD4 count = 365, mean viral load
   37,434. At baseline, the mean adherence rate = 65%, mean proportion of days using cocaine = 27%. Common co
   morbidities included Major Depression, Anxiety Disorders, and Alcohol Use Disorders. Regarding retention, 18/26
   completed all 6 treatment sessions; 20 completed 5 treatment sessions; 19 completed 2 Month (post-treatment)
   Follow Up;
   12 completed 5 Month Follow Up. Preliminary outcomes are positive. Participants in both groups are improving
   their medication adherence, having a positive impact on biological markers of HIV disease including viral load and
   CD4 count. Additionally, they are reducing the percent of days using cocaine from 29% of days to 12% of days.
   Both intervention conditions seem promising at present, but the sample size is still too small to have adequate
   power to detect group differences. Using MI to target two behaviors among patients with HIV not seeking treat-
   ment appears to be a promising method to improve the health of people living with HIV.

   Incorporating MI into an Infectious Disease Medical Unit
   Sharon Zang
             Training staff and providers to adopt brief motivational assessment, strategies, and skills benefited patient
   outcomes of treatment compliance and decreased risk taking behaviors. Staff training was completed in a three
   day session. Physician training was on-going with 1 hour trainings per month and onsite supervision. This adapta-
   tion of training for the physicians and their on-site, real-time supervision allowed physicians to improve their appli-
NCS NEWS                                                                                                                Page 3


  cation of MI assessments; strategies and skills.

  Action Research and Reflective Practice:
  Exploring and Negotiating the Way Ahead in Developing MI and MI Super-
  vision Service at Somerset Bay
  Merav Devere
           Somerset Bay (SB) is a small HIV organization that was established in 1992 to provide residential care
  for people dying of AIDS related illnesses. In 2003 I was approached by SB regarding delivering MI training and
  MI clinical supervision training. We agreed on 6 days MI training x 4 to be taken by all nurses and support work-
  ers and 15- day MI clinical supervision course.
           Why MI?
  • Genuine wish to provide clients with the best care: The changing nature of HIV following the introduction of
  antiretroviral therapy has changed the type of support they need to manage their life and medication better. In
  addition different clients seek residential support; more chaotic clients who present with multiple issues.
  • New director who wants to bring something new and sees MI as an approach that will give SB the edge when
  seeking funding in a competitive field.
  • MI is seen as an alternative to the medical model presented by the NHS HIV referring unit. MI
  seems to be more in line with SB’s ethos and values.

           The MI training started in January 2004. The MI clinical supervision training, which was meant to be de-
  livered in parallel to the MI training, started in Feb 2005, more than a year after the first MI batch finished. It fin-
  ished in October 2005. The action research started in November
  2005 and finished a year later in November 2006. Action research was undertaken as a collaboration between
  myself and the supervisors with the aim of improving the way in which MI and MI supervision is introduced into
  the workplace, following the classical spiral of: planning – action – observing – reflecting – re-planning – action –
  and so on. This action research, however, started in the middle of the process in reflection after the supervisors
  observed that the practitioners were not using MI in the unit, which they interpreted as resistance.

           The research focus centered on the question: How can an organization
  improve the way it introduces and manages a significant change, i.e., the introduction of MI
  and MI supervision, in its approach to its own service?
  This is divided into sub-questions:
  1. How does Somerset Bay’s staff, including management, supervisors and supervisees, understand the main
  reason/aim of introducing MI to SB? Do they agree with it, and how appropriate do they think MI is to reach this
  aim?
  2. How might MI and MI supervision be introduced to the organization most effectively in light of the responses it
  has received so far? What went well? What went wrong and what can be learned from it?
  3. How effective is MI supervision with regard to staff development including development of MI skills and confi-
  dence in using MI? How can it be improved?

           The research was conducted in collaboration with 7 MI supervisors in SB and myself, using qualitative
  methods of data collection and analysis including questionnaires, interviews, peer group supervision meetings,
  process notes and other relevant written materials. The data was analyzed MI for HIV Prevention and Care ¦
  continued MINT Bulletin (2007) Vol. 13, No. 3 Page 18 A Publication of the Motivational Interviewing Network of
  Trainers using discourse analysis.
  Question 1
  There seems to be some consensus over the value of MI and its philosophy of care as well as an understanding
  of the reasons for introducing it. There also seems to be an agreement that at least some aspects of MI are con-
  gruent with the values and culture of nursing in general and SB in particular. However, not surprisingly, the direc-
  tor of services and the supervisors seem to express a much more enthusiastic response. The nurses and sup-
  port workers, although supportive, express more reservations:
  “With my nursing hat on, I think they are very, very similar. I think it is about empathy, and about supporting and
  about giving information…I think where some of the uncomfortable sits is where
  the perception is that it is being prescriptive if you are goal setting. With my MI hat on, it is actually not my goals,
Page 4                                                                                                    Volume 10 Issue 9



    it is the client’s goals.”

    Points to consider:
    • Is there a conflict between person-centered ideology that acted as the driving force in British nursing (Kitson,
    1996) and the dominant managerial ideology of health care with its emphasis on efficiency and productivity?
    • In this context is MI a ‘compromise’ or a ‘mediator’ between two conflicting ideologies?
    Question 2
    “I think there should be more consultation with the clinical team, with the nursing team. To me personally it all
    felt a bit rushed and it all felt as there wasn’t enough discussion and enough planning. Because of that there
    has been some resistance from the clinical unit. Understandably ...cause they are quite stressed at the mo-
    ment. They see it as more work on top of heavy workload. They also feel from my discussion…they also felt it
    was quite monolithic, large new kind of way of working coming in and that they didn’t feel confident that they
    have the skills to be applying to what they do.” (Supervisor and team leader) This quote demonstrates some of
    the problems that the supervisors identified. However using the framework of the action research and the prin-
    ciples of MI the supervisors managed to turn things around. They did it by rolling with resistance and involving
    staff in finding solutions and compromises.
    Question 3
    Starting the MI supervision groups took much longer than originally anticipated and by the time this action re-
    search finished there had only been 3 supervision sessions. The data however suggests that the MI supervi-
    sion has played a vital role in the process of using MI. In fact I believe that without it the project would not have
    survived. This is inline with research that suggests that training on its own is not enough. An ongoing support
    in the work place is necessary to allow the implementation of what had been learned in training.

              The following quote from a supervisor’s reflective journal demonstrates this point:
    “I feel there was a definite shift this week in the nurses understanding of the application of MI with clients in
    specific situations…

              By focusing on looking at the situation from the client’s perspective and how the client may view what
    his needs are, which could be different to how the nursing team view the client’s needs, the supervisees man-
    aged to identify that the client was in pre-contemplation, so explored what MI skills they could utilize…We dis-
    cussed rolling with resistance and working with challenging the client’s behavior. W. identified that empathy
    and support was key to the client’s needs at this point.”
    Some additional points:
    • Analyzing the discourses reveals differences in perspectives and emphases between senior management,
    the supervisors and the practitioners. Generally speaking it seems that senior management is more occupied
    with issues of cost, survival in a competitive field and control; the supervisors are concerned with how to im-
    plement the change in the most effective and least resistance-provoking way; and the practitioners are con-
    cerned with practical questions of: how is this going to be used? Is this going to affect my levels of autonomy?
    Will it involve more work? Will I be able to do it? •
    These action research findings are consonant with other studies of attempts to introduce organizational
    change through top-down decrees of empowerment, where such attempts were regarded as an attempt at
    direct control by management (McDonald and Harrison, 2004). • Generally speaking, the supervisors in the
    context of providing MI supervision seem to prefer to steer away from managerial functions like monitoring or
    evaluating supervisees’ use of MI. They prefer to focus on the supportive, educational and motivational func-
    tions. This is consonant with other research findings that suggest that some clinical supervisors feel uneasy in
    particular around the task of evaluating supervisees’ work (Carroll, 1996).
    • One aspect that is missing from the texts is the expression of emotions. Supervisors seem to feel more com-
    fortable talking about practical issues than expressing anxiety, disappointment or any other emotions.

              One of the supervisors explained it as follows:
    “You have to go with the flow and not get too emotionally involved, cause it is too upsetting to get too involved,
    or you start having negative thoughts about it thinking ‘oh it shouldn’t be taking that long. You know personal
    failure rather than maybe that’s just the way it has to be.”
    Doing this action research has taught me great deal about the organizational dynamic and processes in rela-
    tion to their specific context. I have a greater understanding of the resistance I sometimes experience in train-
NCS NEWS                                                                                                            Page 5




   ing and of the role of the trainer (and MI for HIV Prevention and Care ¦ continued the action researcher) as
   someone who is expected to meet the different and sometimes contradictory needs and expectations of not
   only management and staff, but also funders and referrers.

             Researching MI in context has also helped me understand the appeal of MI to both management and
   staff. I believe that the integration of person-centred principles and short-term directive goal oriented techniques
   has the potential perhaps of meeting both staff and management expectations and cultures. The action re-
   search and the creation of an MI supervision group have proved to be very effective by providing the space for
   reflection and negotiation between the different perspectives and expectations. It is reasonable I believe to as-
   sume that even more effective and long lasting results could have been achieved if all stakeholders, including
   service users and funders, took part in the process.

            In summary, MI provides an approach which is short term and directive and therefore suits the culture
   we live in, alongside offering empathic and respectful attitude to clients. This research I believe demonstrate
   how MI principles can be mirrored in an organisational level to help practitioners and managers alike deal with
   the demands that rapid changes in the external circumstances bring about.

   References
   Carroll, M. (1996). Counselling Supervision, Theory Skills and Practice. Cassell. Kitson, A. L. (1996). Does
   nursing have a future? British Medical Journal 313, 1647-1651.
   McDonald, R. and S. Harrison (2004). Autonomy and modernisation: The management of change in an English
   primary care trust. Health and Social Care in the Community, 12, 194-201.




           Texas HIV/STD E-Update
         Information from the Texas Department of State Health Services' HIV/STD Program


   Upcoming Events

   September 10-12, 2008
   3rd Annual Coastal Bend HIV/AIDS and Substance Abuse Conference, Corpus Christi. Sponsored by
   Coastal Bend AIDS Foundation and Workers Assistance Program. To learn more, contact Olufemi Faweya
   at 800-982-9629 or olufemif@cbaf.org.

   September 18-21, 2008
   2008 United States Conference on AIDS, Miami Beach, Fla. Sponsored by the National Minority AIDS Council.
   Go to www.nmac.org/index/2008-usca to learn more.

   October 15, 2008
   AIDS Update 2008, Beaumont. Sponsored by Triangle AIDS Network. Look for registration forms in August at
   www.tanbmt.com.

   October 29-31, 2008
   16th Annual AIDS Update Conference and Border Health Summit, South Padre Island. Sponsored by Valley
   AIDS Council and the Texas/Oklahoma AIDS Education Training Center. Go to www.valleyaids.org to learn
   more.
Page 6                                                                                                       Volume 10 Issue 9


                                   Case Manager Supervisos’ Meeting
                                    Wednesday, September 10, 2008
                                             8:30 – 10 AM
                                         2025 West 11th Street
                            All HIV Case Manager Supervisors from all Funding Streams Welcome



                          New Kaiser Study on the Cost of Covering the Uninsured
                          A new study issued by the Kaiser Family Foundation’s Commission on Medicaid and the Un-
                          insured finds that the uninsured will spend $30 billion out-of-pocket for health care in 2008
                          while receiving $56 billion in uncompensated care, three quarters of which will be from gov-
                          ernment sources. These findings were published in a web-exclusive article in Health Affairs
                          today.
  The study, authored by researchers Jack Hadley of George Mason University and John Holahan, Teresa Coughlin
  and Dawn Miller of the Urban Institute, is an update of a previous Kaiser study and also projects the additional
  cost to the nation’s health care system if all the uninsured were covered by insurance. If everyone were covered,
  overall costs would increase by $123 billion dollars, or an additional 5 percent of national health spending. The
  analysis does not assess how much a universal coverage plan would cost the government, which would vary de-
  pending on the details of the approach.
  The updated study also examines total and out-of-pocket spending for the uninsured. People who are uninsured
  for a full year receive less than half as much care as the insured and pay 35 percent ($583) out-of-pocket to-
  wards average health costs of $1,686 per uninsured person.
  Along with a link to this Health Affairs article, a summary of the findings and the full report with
  methodology are both available online.



                       National Conference to Help Women With
                       Addiction & Recovery
                       3rd National Conference on Women, Addiction and Recovery: Inspiring Leadership,
   Changing Lives - September 15–17, 2008
   The Substance Abuse and Mental Health Services Administration’s (SAMHSA's) Center for Substance Abuse
   Treatment (CSAT), in partnership with New Century Institute and the Florida Alcohol and Drug Abuse Associa-
   tion, is pleased to host the 3rd National Conference on Women, Addiction and Recovery: Inspiring Leadership,
   Changing Lives.
   This 2 ½-day conference will bring together a diverse audience with an interest in substance abuse treatment for
   women and women with children. A broad mix of topics will be addressed, including best practices as well as in-
   novative and emergent approaches to treating women, issues pertaining to recovery support, health and well-
   ness, as well as program administration and management. A special feature of the conference is the use of tech-
   nology transfer strategies. All sessions provide take home materials such as manuals, PowerPoint presentations
   with presenter notes, and exercises that participants can use to train other staff of their agencies.

                            SAMHSA co-sponsors 3rd National Conference
                                               on
                                 Women, Addiction and Recovery
  September 15-17, 2008
  Marriott Tampa Waterside Hotel and Marina, Tampa, Florida

  Don’t miss the 3rd National Conference on Women, Addiction and Recovery. This conference brings together the leaders, direc-
  tors and other stakeholders in women’s services to hear current research, discuss implementation and promote effective leader-
  ship to professionals and stakeholders to assist women with substance use disorders and their families.
  Visit the conference Web site for more information. http://www.fadaa.org/women/
NCS NEWS                                                                                                          Page 7




                  Spanish-Language Criminal Justice Client
                  Resources Now Available
                   SAMHSA’s Center for Substance Abuse Treatment (CSAT) announces the availability of the
                   Spanish-language version of Alcohol and Drug Treatment: How It Works, and How It Can
                   Help You. This four-page brochure informs people involved in the criminal justice system about
  substance abuse treatment resources.
  Based on Treatment Improvement Protocol (TIP) 44: Substance Abuse Treatment for Adults in the Criminal Jus-
  tice System, the brochure describes what can be gained through substance abuse treatment before trial or while
  a person is incarcerated, on probation, or on parole. It encourages people to seek help for substance use disor-
                     ders regardless of their situations. The publication can be accessed at:
                     http://www.kap.samhsa.gov/mli/docs/spanish/alcohol_drug_tx_spanish.pdf




                    Supporting Returning Veterans and
                    Their Families Is a Priority
                     In a joint effort to support returning veterans, the Substance Abuse and Mental Health Ser-
  vices Administration (SAMHSA), with the Department of Defense and Department of Veterans Affairs, is holding
  a national conference and policy academy built around enhancing mental health and substance abuse services
  for veterans and their families.
  While the conference registration is closed because of overwhelming interest, SAMHSA offers a variety of sup-
  port resources available for returning veterans and their families. Be sure to check out the latest materials of-
  fered, which can be ordered, free of charge, or downloaded and printed.


 After a Disaster: What Teens Can Do
                                                             Read Online | Order Free Copy
 (KEN-01-0092)


 National Suicide Prevention Lifeline: Having Trouble
 Coping After a Disaster? There is Hope (SVP06-              Download Now          (191 KB) | Order Free Copy
 0155)


 Recovering Your Mental Health: Dealing with the
                                                             Read Online | Order Free Copy
 Effects of Trauma: A Self-Help Guide (SMA-3717)


 Tips for Survivors of a Traumatic Event: Managing
 Your Stress During a Disaster (NMH05-0209)                  Download Now          (281 KB) | Order Free Copy


 Tips for Talking to Children After a Disaster: A
                                                             Read Online | Order Free Copy
 Guide for Parents and Teachers (KEN-01-0093)


 Veterans Affairs Suicide Prevention Hotline Bro-
 chure (VA07-SPBRO)                                          Download Now          (527 KB) | Order Free Copy


 Veterans Affairs Suicide Prevention Wallet Card
 (VA07-SPWC)                                                 Download Now          (191 KB) | Order Free Copy
Page 8                                                                                    Volume 10 Issue 9


                               Community Meetings and Events

             Affordable                            Legacy Community Health Services,
            Supervision                                                 Inc.
                 &                                                            Is proud to offer:
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        713-529-1913                            We’re Doing
                                                                                (713-830-3033)



         AFH – Program Openings AIDS Foundation Houston
         now has openings for the Burress Street Program. It                 BERING
         is the goal of the program to maintain a positive and
         healthy lifestyle through permanent housing for sin-
         gle women living with AIDS/HIV. The apartments
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                                                                  Call 713-526-1017 ext. 211

                                                                  GLBT Friendly Counselors
                                                                       $25 Flat Rate!
NCS NEWS                                                                                                 Page 9



                         Community Meetings and Events
                     Food Pantry Assistance                                   Serenity Home Health
                                                                                Provider Services
                                                                              Caring for the Elderly
   Stone Soup Food Pantry provides nutritious non-perishable food boxes           and Disabled
   specifically designed for People Living with HIV/AIDS and a supermarket    2656 South Loop West
   voucher redeemable for fresh produce or meat, personal hygiene items or             #227
   household products.                                                        Houston, Texas 77054
                                                                                  713-665-2992
   Stone Soup hours of operation are:
   Monday and Tuesday: 1:00 pm - 3:00 pm & 5:45 pm - 7:15 pm                    Personal Assistant
   Wednesday: 1:00 pm - 3:00 pm                                                      Services
   Thursday: 5:45 pm - 7:15 pm
   Saturday: 9:00 am - 2:00 pm
                                                                              We provide non-skilled
   Located at AFH, 3202 Weslayan—downstairs                                  services such as dressing,
   Call 713-623-6796 for assistance                                            feeding, bathing, meal
                                                                               preparation, hair and
                                                                              skin care, and hygiene
                                                                                        care.
              R e s u r r e c tio n M C C F o o d P a n tr y                    We would like to join
                       2 0 2 5 W e s t 1 1 th S tr e e t                       your list of providers.
                      H o u s to n , T e x a s 7 7 0 0 8                           We also accept
                                                                               Medicaid, private pay
        A c c e p tin g y o u r n o n -p e r is h a b le f o o d a n d        and private insurance.
                         to ile tr y d o n a tio n s
            f r o m 9 -5 , M o n d a y th r o u g h F r id a y .               Maria Turner, Case
                                                                                 Coordinator


    T o a c c e s s p a n tr y
    s e r v ic e s c a ll                                                        If you have a community
    7 1 3 -8 6 1 -9 1 4 9                                                    meeting or event and you would
                                                                               like to have it included in the
                   POSITIVE TRANSITIONS                                       NCS FAX NEWS, please send
         SERVING THE HIV + TRANSGENDER COMMUNITY                             your announcement via email to
                     AND MUCH MORE!                                          mmiller@nonprofitconsulting.co
                                                                                   m or you can FAX the
 A service of HACS Joseph-Hines clinic                                        information to 713-868-0063.
 Email: jayala@hacstxs.org                                                      Your submission should be
 Clinic: 713-426-0027                                                        received before the 3rd Friday of
                                                                                the month for the following
 FREE SERVICES , HORMONES , HOUSING ASSISTANCE,
 HIV MEDS ASSISTANCE, CLINIC VISITS, THERAPY VISITS                                month’s publication. -
 AND LABS
                                                                                     THANK YOU!
 FREE PROGRAM REFERRALS FOR: IMMIGRATION ASSISTANCE, NAME/GENDER
 CHANGES, RENT/UTILITY ASSISTANCE, CLOTHING ASSISTANCE AND SUPPORT
 GROUPS
Page 10                                                                                             Volume 10 Issue 9


                                Community Meetings and Events

                                                                                     The 2008-09
                                                                                      Blue Book
                                                                                             Is in!
                                                                                              Call
                                                                                        713 572-3724.
                                                                                       Cases available at:
                                                                                       Ryan White
                                                                                    Planning Council
                                                                                    Office of Support
                                                                                 2223 West Loop South, Suite
      Animal companions add so much to our lives. For people                                 240
      with a chronic or life threatening illness, such as AIDS or                    Houston, TX 77027
      cancer, the psychological and physical health benefits of                        713-572-3724
      living with a pet companion are even more significant.                            Office Hours:
                                                                                       8:00m - 5:00pm,
                 Research shows that animal companions provide:                       Monday - Friday
                    Emotional well-being                                                       Or
                    Reduction of anxiety                                         Houston Regional HIV/
                    Unconditional love and affection
                    Reduction of blood pressure                                          AIDS
                                                                                   Resource Group
      Pet Patrol is an all volunteer organization and services are               500 Lovett Boulevard, Suite
      funded by private donations and special events.                                        100
                                                                                    Houston, TX 77006
      Services Offered: vaccinations, heartworm preventative, flea preven-
                                                                                       713-526-1016
      tative, transportation to the vet, home deliveries of pet food, spay/            Office Hours:
      neuter services, and other items as needed.                                     8:00m - 5:00pm,
                                                                                      Monday - Friday
      Wish List: volunteers, pet food, litter, flea preventative, other pet
      supplies, and cash donations.

                                                                               TRANSHOUSTON.COM
          Pet Patrol, A People Pet Partnership is a non-profit 501
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          low-income pet owners who are living with a challenging                           Online!
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                          illness and the frail elderly.
                 www.thepetpatrol.org                                          FREE▪NO POPUPS▪NO FUNKY ADS

                                                                              TG BLPGS, TG FORUMS, TG GALLERY,
                         or                                                    TG WEB ART, TG ARTICLES, TG RE-
                                                                              SOURCES, TG HORMONES, TG JOBS,
                   281 733-7696                                                TG SUPPORTGROUPS, AND MORE!

                                                                                     www.transhouston.com
NCS NEWS                                                                                                                        Page 11



                               Community Meetings and Events




                             ARE YOU SPRY?                                                                  SPRY Goes
             Seniors Preparing for Rainbow Years [SPRY]                                                     Digital!
                                                                                                            We are very pleased to
  Growing older may be a difficult and lonely time for Gay, Lesbian, Bisexual and Trans-                    introduce our new SPRY
  gender seniors. But you are not invisible, and you shouldn’t have to go back into the closet,             website, created by
  just because you are getting older and may need help.                                                     Becky Holmes, CIWA.
                                                                                                            One of the challenges we
                                                                                                            face in trying to reach out
  SPRY strives to shine a light into the lives of GLBT seniors for them to be able to experience            to Gay, Lesbian, Bisex-
  prideful, bold and bright rainbow years.                                                                  ual and Transgender sen-
                                                                                                            iors is finding them. So
                                                                                                            many are isolated and
      I know what it stands for, but what exactly is SPRY?                                                  never venture into Mon-
          SPRY provides mental health and support services for GLBT persons who are age 60                  trose or get involved with
          and older, including assessment, peer support, counseling, case management, and psy-              the community. We hope
          chiatry.                                                                                          that this new website will
                                                                                                            get the attention of those
                                                                                                            internet savvy GLBT
      How much does it cost?                                                                                seniors. The SPRY So-
         SPRY services are FREE OF CHARGE to anyone who is gay, lesbian, bisexual or                        cial calendar will be
         transgender, and age 60 or older.                                                                  available online through
                                                                                                            web site. In other SPRY
                                                                                                            news, the drop-in center
      What if I’m not sure I need counseling or any of the other SPRY Program services?                     on the first floor is open
        That’s an excellent question. The best place to start is to talk to one of our trained out-         every Thursday from 1-3
        reach workers who can explain the                                                                   p.m. for GLBT seniors
        services in person and help you determine what you might need. They even have a                     age 60 and older. There
        handy “needs assessment” tool to make it                                                            will be coffee and oppor-
        easy.                                                                                               tunities to socialize with
                                                                                                            one another. You do not
                                                                                                            need to be a SPRY client
      How do I begin?                                                                                       to join in. As you look
         Call either Montrose Counseling Center at 713.529.0037 (and press 0) or call Legacy Commu-         around the new website,
         nity Health Services at 713.830.3025.                                                              be sure to check out our
         If you call Montrose Counseling Center, you may either tell the receptionist that you would like   new SPRY Videos! One
         to speak with a SPRY outreach worker, or go ahead and schedule an intake with a licensed           is for consumers, and the
         therapist. After the intake, you will be assigned to a counselor and/or case manager who will      other is for senior service
         contact you to schedule an appointment that is convenient for you. If you prefer, you may leave    providers to let them
         a confidential message at the Legacy Community Health Services number, and someone will            know about our aging
         call you back.                                                                                     population and its needs.
Page 12                                                                                                   Volume 10 Issue 9


                                Community Meetings and Events
                                                             Rehabilitation Program
                                                                 A comprehensive rehabilitation program designed to help
                                                             clients combat the effects of HIV, such as body composition
                                                             changes, diet management, and medication side effects.

      3311 Richmond, Suite 100, Houston, TX 77098              Clients evaluated for 7 Entry Criteria Points:
                                                                Suboptimal Body Cell Mass
     Did You Know that You Can Receive Nutrition                Central Adiposity
                                                                Elevated Lipids and Glucose
                    Counseling at
                                                                Limited Flexibility
          Legacy Community Health Services?                     Poor Cardiovascular Capacity
                                                                Strength Deficits
    Our registered/licensed dietitians provide nutritional      Functional Capacity and Pain
     counseling on diet and supplement recommenda-               Referral forms and screening required for entry.
      tions for building the immune system, managing
                                                               * This program is available to RW grant eligible clients only.
      the side effects associated with medications and
    general wellness issues such as obesity and diabe-       Physical Therapy Services
                             tes.
                                                                 All services performed by a licensed physical therapist.
    During nutritional counseling sessions dietitians will       Referral from MD and diagnosis required for all new pa-
    perform a thorough history and perform BIA testing       tients
                                                                 Beneficial in treating:
       to determine complete body composition. This              -Reduce muscle & joint pain
     measure may be used as criteria for entry into the          -Improve muscle tone and flexibility
                                                                 -Manage musculoskeletal disorders
     rehab program as well as offering a basis for die-          -Assist Recovery from injury or accident
              tary and wellness recommendations.                 -Alleviate pain (ie: peripheral neuropathy)

     For information on setting up an appointment               * Services available under RW
                                                             grant, Medicaid, Medicare,
          and eligibility, please call: 713-830-3033.            Managed Care Plans, and as a fee
                                                             -based service.

                                    NOW – Ethics Home Study Program!
      In addition to our on-site classes, NCS now offers ETHICS CEU program by mail! This class- Ethics-A Practical
    Approach for Healthcare- provides the 3-hours of ethics credit for social workers, LSWs, LMSWs, LMFTs & LPCs as
                                            required by the State of Texas annually
   Classes by mail are $55 which includes all shipping and handling charges. MC, VISA and checks are accepted.
   To purchase, FAX the information below to 713-526-3057 or mail this completed form with your check to NCS.
   Your course book, instructions and test will arrive 7-10 business days after payment is received.
   Name___________________________________ Daytime phone (_____)-__________

   Mailing Address ________________________________________________________

   City _________________________________ State ___________ Zip _____________

   Credit Card #_________________________________________exp (mo/yr)_________
NCS NEWS                                                                            Page 13




                Positive Recovery In Action
                 IMPACT Recovery Celebration
             National Alcohol & Drug Addiction Recovery Month
       “Join the Voices for Recovery: Real People, Real Recovery”
                        Friday September 12, 2008
                          11:30 AM to 3:00 PM
                        Recovery Stories begin at 11:30 AM
                           Program begins at 1:00 PM
                              Joseph Hines Clinic
                                 1710 West 25th Street
             Parking at 2550 Ella Blvd, on the corner of 25th & Ella Blvd.
                                Houston, Texas 77008

                                    Scheduled to present
                    Prayer to be conducted by Rev. William Lawson
                       The Salvation Army Harbor Light Choir
                       City Councilman Adrian Garcia
                     Congresswoman Sheila Jackson Lee
                         Light refreshments will be served!
                           Please RSVP by September 5th
                                          Contact
            Sonya Adams 713-526-0555 ext 215 Etalia Castillo 713-526-0555 ext 213
                   sadams@hacstxs.org               ecastillo@hacstxs.org

                                       www.hacstxs.org
                               Music Services by DJ Freddy B
                 Parking courtesy of Young & Restless Children’s Consignment
Page 14                                                                                       Volume 10 Issue 9


                              Community Meetings and Events
                                      National Health Information Center

                                      Courtesy of the 2008 National Health Observances, National
                                      Health Information Center, Office of Disease Prevention and
                                      Health Promotion, U.S. Department of Health and Human
                                      Services, Washington, DC.”
                                      For a full calendar go to
                                       http://www.healthfinder.gov/library/nho/nho.asp

   1 - 30                                                    1 - 30
   National Alcohol and Drug Addiction Recovery Month National Yoga Month
   Substance Abuse and Mental Health Services Administration Yoga Health Foundation
   Center for Substance Abuse Treatment                      4051 Glencoe Avenue, #10
   Office of the Director, Consumer Affairs                  Marina del Rey, CA 90292
   1 Choke Cherry Road, 2nd Floor                            (310) 928-3720
   Rockville, MD 20857                                       support@yogamonth.org
   (800) 729-6686
                                                             www.yogamonth.org
   (240) 276-2750
                                                             Materials available
   (240) 276-1630 Fax
                                                             Contact: Johannes R. Fisslinger
   info@samhsa.gov
   www.recoverymonth.gov
   Materials available
   Contact: Consumer Affairs
   1 - 30                                                    1 - 30
   Ovarian Cancer Awareness Month                            Prostate Cancer Awareness Month
   National Ovarian Cancer Coalition                         National Prostate Cancer Coalition
   500 NE Spanish River Boulevard, Suite 8                   1154 15th Street NW
   Boca Raton, FL 33431                                      Washington, DC 20005
   (888) OVARIAN (682-7426)                                  (888) 245-9455
   (561) 393-0005                                            (202) 463-9455
   nocc@ovarian.org                                          (202) 463-9456 Fax
                                                             info@fightprostatecancer.org
   www.ovarian.org
   Materials available                                       www.fightprostatecancer.org
   Contact: Jane E. Langridge                                Materials available
                                                             Contact: Jamie Bearse




                                        Family Planning Services
                                   For all Texas women and men of childbearing age

                  Birth Control (Depo Provera) - Well Women Exams (Pap Smears) - Well Male Exams
                            Screening & Treatment for Sexually Transmitted Diseases (STDs)
                               Services are offered at a very low cost for those who qualify

  For more information and to schedule an appointment call: 713-830-3000
  215 Westheimer Road, Houston, Texas 77006

  www.legacycommunityhealth.org
NCS NEWS                                                                                                                      Page 15


                                      Community Meetings and Events
     This event is sponsored by the
     Houston-Gulf Coast Chapter
 of the Association of Nurses in AIDS
                    Care
                   and the
   Texas/Oklahoma AIDS Education            Houston-Gulf Coast Chapter
            Training Center.
                                                                        3rd Annual Day of Education
                                                                         Friday, September 26. 2008
  5 hours of type I continuing education                        United Way, 50 Waugh Dr., Houston, TX, 77007
 units have been applied for through the                            7:30 to 8:30 AM: Registration/Breakfast
 Association of Nurses in AIDS Care
                 and the                                      8:30 to 9:30: Dermatological Manifestations of HIV
 Texas State Board of Social Worker                                         Stephen Frank O’Brien, MD,
                Examiners                          Medical Director, East Bay AIDS Center, Alta Bates Summit Medical Center

 1 hour of CME credit is provided by the                                 9:30 to 10:30: Universal Screening
 Robert Michael Educational Institute,                            Robin Hardwicke, PhD, RN, AACRN, FNP-C,
                    LLC                                       University of Texas Health Science Center at Houston

This event is intended for nurses, physi-                      10:30 to 11:00: Break/Exhibits (in building foyer)
cians, social workers, and other health
professionals interested in                  11:00 to 12:00 PM: Improving Adherence; a Psychosocial Perspective for Nurses,
the care and treatment of those with HIV.                       Physicians and other Healthcare Professionals
                                                          Danilo Novoa, LCSW, LCDC, Counselor and Psychotherapist
Cost for the event is as follows:
                                              12:00 to 1:00: Lunch/ Presentation: Once-Daily Protease Inhibitor-Based HAART:

Prior to September 19, 2008:                          Considerations in the Selection of a Regimen in Patients with HIV
ANAC Members: $35.00                                                             Philip Keiser, MD,
Non-ANAC Member Participants: $50.00          Associate Professor, The University of Texas Southwestern Medical Center at Dallas,
Students: $25.00                                                    Division of Infectious Diseases, Dallas, TX
                                                              Courtesy of Robert Michael Educational Institute, LLC
After September 19 or At the Door
Registration:                                                    1:00 to 1:30: Break/Exhibits (in building foyer)
ANAC Members: $50.00
Non-ANAC Member Participants: $65.00                                        1:30 to 2:30: Anal Dysplasia
Students: $25.00                                                           Elizabeth Yu Chiao, MD, MPH,
                                            Instructor, Baylor College of Medicine, Houston, TX, Department of Medicine, Division of
 For More Information or to Register for                                        Infectious Diseases
        the Event Please Contact:
              Norma Cooper                                  2:30 to 3:30: Case Management of the Patient with HIV
              832-824-1443                                                     Fernando Garcia, MD,
  njcooper@texaschildrenshospital.org                          Medical Director and Physician, Valley AIDS Council


      Program is Subject to Change                                            3:30 to 4:00: Evaluation
Page 16                                                                               Volume 10 Issue 9



                            IMPACT                            Vision Services
             Behavioral Healthcare Program                            now available at
          Providing Substance Abuse and Mental
                     Health Services                       Frost Eye Clinic
                                                                           part of
         Houston Area Community Services, Inc.,
     (HACS) provides FREE Substance Abuse and          Legacy Community
    Mental Health Outpatient Treatment services for
     Persons Living With HIV/AIDS. Treatment is
                                                         Health Services
              individualized for each client.
    Substance Abuse clients are prepared for Outpa-            Why use vision services?
    tient Treatment services as HACS utilizes a pre-   General vision exams by an optometrist
     treatment program consisting of individual and             Prescription for glasses
      group motivational counseling sessions. Sub-                 Contact lens fitting
      stance abuse groups are held regularly to meet     Order glasses or contacts at reduced
                    the client’s needs.                                 rates
      Mental Health clients are provided individual    Ophthalmologist screening for CMV and
           sessions with professional therapist.                  other disorders
    HACS provides referrals to Housing and Primary
                           Care.                                 How do I get started?
                                                           Call to schedule an appointment
     HACS Intensive Outpatient Treatment Pro-
                                                                      713-830-3033
    gram specializes in treatment services for sub-
          stance abusing HIV+ individuals.
                                                              Cost / Coverage available?
    For Information – Contact                           Ryan White grant funding for annual
                                                               exams and glasses
    Etalia Castillo
    713-526-0555 ext. 213                                   Medicare & Medicaid accepted
    ecastillo@hacstxs.org                                  Select insurance plans accepted

    Sonya G. Adams, LCDC                                             Fee-for-service
    713-526-0555 ext. 215
    sadams@hacstxs.org
                                                                         Location
                                                         Legacy Community Health Services
             Houston Area Community Services, Inc.
                                                               3311 Richmond Suite 100
          ٠ 3730 Kirby Drive #300 ٠Houston, TX 77098
                                                       *Clients receiving grant funding must first es-
               ٠713-526-0555 ٠ www.hacstxs.org
                                                        tablish eligibility with Legacy Community
    Funding is provided by SAMHSA-CSAT and HOPWA                      Health Services.
                         grants.                        (Please call 713-830-3033 for more informa-
                                                       tion or to schedule an eligibility appointment.)
NCS NEWS                                                                                                         Page 17




                     Community Meetings and Events




                                                2008 NASW/Texas Annual Conference


                                            November 6, 2008 through November 8, 2008
                                                  Galveston Convention Center
                                                     5222 Seawall Boulevard
                                                  Galveston Island, TX 77551

                                             For more information go to www.naswtx.org




                               Coalition for the Homeless of Houston/Harris County, Inc.
                                        Phone: (713) 739-7514 -- Fax: (713) 739-8038
   Find a resource guide for all homeless individuals and families on the street. All of the programs help homeless
                   people directly. The document is now on-line @ www.homelesshouston.org
Page 18                                                                                     Volume 10 Issue 9




    Map provided by MapQuest.          Most trainings are held at 2025 West 11th Street, Houston , TX 77008




               W E ARE ON THE W EB                                                   Nonprofit Consulting Services, LLC
                                                                                         1302 Waugh Drive, PMB 636
     WWW . NONPROFITCONSULTING . COM                                                            Houston, Texas 77019

                                                                                                Phone: 713-868-5409
                                                                                                  Fax: 713-868-0063
                                                                                Email: mmiller@nonprofitconsulting.com