The AIDS Institute is committed to promoting, monitoring, and supporting the quality of clinical services for people with HIV in New York State. The Adolescent Quality Learning Network (AQLN) is a collaborative of 16 HIV Adolescent/Young Adult (AYA) Specialized Care Center (SCC) programs. SCCs integrate mental health, medical case management and supportive services in an HIV and primary health care setting using a multidisciplinary team model to address the needs of AYA (aged 13–24) with HIV. In collaboration with the AIDS Institute, SCC providers are actively involved in identifying quality improvement projects that recognize mental health issues that impact AYA retention in care and adherence to antiretroviral therapy (ART), and promote improved health outcomes. The quality improvement project selected aimed to raise viral suppression rates by improving access to mental health services.
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Youth with HIV face unique barriers to care. Challenges in transitioning to adulthood include new adult responsibilities, becoming parents, college transitions, housing transitions, maintaining health care coverage, and pill exhaustion (especially for those with perinatally acquired HIV). Mental health services and support can address these barriers to care.
Mental health assessments are conducted for all program participants, and mental health services are routinely included in a program participant’s service plan regardless of a specific identified risk.
Mental health care providers, including psychologists, social workers, and peers, actively participate in multidisciplinary case conferences to ensure mental health needs are being met.
Physically locating mental health staff in the same corridor as medical staff makes the referral to mental health care more fluid and informal. Mental health care is also normalized through warm hand-offs from one staff member to another and by having informal chats with clients when they come in for medical visits instead of scheduled therapy appointments.
Staff minimize the use of terms that might be considered stigmatizing, such as “therapist.” Instead, the types of supports and benefits clients might receive are described without emphasizing the need for a referral to “mental health care.”
During multidisciplinary case conferences, care teams identify ways in which peers can support youth, such as discussing barriers to medical care or taking medications, issues around stigma, or resources for sexual health or healthy relationships. Peers then reach out to individuals to provide guidance and support.
Peer-facilitated group chats with youth allow them to raise questions and share experiences. In turn, peers share issues discussed with the multidisciplinary care team. If applicable, a clinician can present information and solutions at subsequent group chats or Q/A sessions. For example, clients expressed concerns with COVID-19 and, later, the vaccine. This led to the multidisciplinary care team clinician hosting related Q/A sessions.
The AQLN launched a mental health project in 2018 with the collaboration of 16 adolescent HIV care providers throughout New York State, resulting in improved access to mental health services for youth. The AQLN found that the providers with integrated and opt-out mental health services and destigmatizing practices were the most successful in increasing mental health care utilization and viral suppression rates.
| Category | Information |
|---|---|
| Evaluation data | 2014–2018 data collected on clients receiving services from AQLN- participating providers. |
| Measures |
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| Results |
Between 2014 and 2018, among 1683 adolescent clients in participating programs, the following results were seen:
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Source: Improving ARV Adherence in Ryan White Adolescent Programs in New York State. National Ryan White Conference on HIV Care & Treatment 2020 poster.
“The mental health piece is provided as just part of their routine care, which is what I think works so well. It's really just normalized. ‘Hey, I'm the program social worker. It's part of our routine care that I meet with you to just see how you're doing and what's going on, set up some goals."
- Hospital and health center partnerships. AQLN includes robust partnerships across the following organizations: Albany Medical Center Hospital; The Brooklyn Hospital Center; Bronx Care Health System; Community Health Project/Callen-Lorde; NYCHHC Harlem Hospital; NYCHHC Jacobi Hospital; Kaleida Health; Montefiore Medical Center; Mount Sinai Adolescent Health Center; Northwell Health Center for Young Adult, Adolescent and Pediatric HIV; New York Presbyterian Hospital; NYU School of Medicine; Research Foundation of SUNY-Stony Brook University Hospital; Research Foundation of SUNY-Downstate Medical Center; Research Foundation of SUNY-Upstate Medical University Hospital; and Westchester County Health Care Corporation.
- Provider support. The AQLN supports providers in the provision of quality care for youth. Participating providers identified mental health as an important determinant of overall health. Barriers to care and goals were identified by the team, and strategies to address those goals were developed.
- Provider learning collaborative. Participating providers met quarterly to share implementation strategies, successes, and challenges, data on impact of mental health process changes, and viral suppression and outcome data. Participants were encouraged to use learnings to inform adaptations to their approaches and adopt best practices shared during the meetings.
- Providers relied on existing and ongoing resources as the initiative does not have a separate funding stream. Costs for meeting participation are covered through grant funds as needed. For the most part, efforts are fully embedded into program standards and provider activities.
- Members of the AQLN continue to collaborate and share lessons learned as part of their relationship with the New York State Department of Health, AIDS Institute.
- Participating providers had flexibility to develop their own mental health interventions within the framework of AQLN collaborative meetings, allowing them to meet the needs of program participants and address geographic and facility-specific variation.
- Participating providers shared utilization and viral suppression metrics during quarterly meetings/calls. The learning collaborative values transparent performance data sharing to talk through challenges, data patterns/trends, indicator definitions, and opportunities for improvement in AYA accessing mental health services and assessing the impact on viral suppression.
- “Lightning rounds” during the quarterly meetings gave all providers the opportunity to provide updates on the critical aspects of the program and address strategies for improvement.
