Evaluating HIV Mental Health Training: Changes in Practice and Knowledge for Social Workers and Case Managers. (Practice Forum)

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Social workers, case managers, and other counselors face significant challenges in working with HIV-infected clients and their families. HIV-affected populations typically require a full range of services to manage the illness and the significant stress and problems the infection causes. Service needs are increased when clients have mental health problems in addition to the HIV infection. Although social workers, case managers, and other counselors provide substantial services to HIV-infected people, they are often insufficiently prepared, a phenomenon especially pronounced when serving populations of color (Taylor-Brown & Garcia, 1995). To obtain adequate preparation, social workers must acquire knowledge regarding the unique needs of HIV-affected populations-- limited resources, organizational barriers, variation in service delivery systems. Inadequate preparation may result not only in reduced quality of services to clients and their families, but may lead to increased worker stress, job dissatisfaction, a nd burnout (Ross & Seeger, 1988).

Social workers and other mental health providers need HIV training that is updated regularly. The development of combination antiretroviral drug therapies has generated significant breakthroughs in the treatment of HIV (Ho, 1998; Palella et al., 1998), which have implications for social work practice. Infected individuals now may begin treatment sooner and follow very complex drug regimens. Many people with HIV are living longer and often are free of symptoms; HIV/AIDS is increasingly viewed as a chronic rather than a terminal illness (Ho).

Although treatment advances have greatly improved the lives of many HIV- infected people and their families, antiretroviral treatments also create challenges, particularly with treatment adherence (Linsk & Bonk, 2000). To be effective, antiretroviral drug regimens must be followed consistently and precisely and often require HIV-infected individuals to alter significantly their daily routines and eating habits. In addition, the drugs often have significant side effects, such as nausea, diarrhea, and headache, that many patients find intolerable (Singh et al., 1996). Compounding these concerns is the fact that the regimens may need to be followed indefinitely. All of these factors combined are especially challenging for patients with comorbid mental illness or substance abuse (Mehta, Moore, & Graham, 1997; Satriano, Rothschild, Steiner, & Oldham, 1999).

Inconsistent adherence not only reduces treatment effectiveness, but also may actually promote viral mutation to forms that are resistant to antiretroviral medication (Paterson et al., 2000; Perrin & Telenti, 1998; Sherer, Rajaram, Jasek, Maclean, & Teter, 1999). Viral mutations are harmful for individuals with HIV and also present serious public health risks as drug-resistant strains of the virus spread. Public health officials are already beginning to see newly infected individuals with these drug-resistant strains (Perrin & Telenti).

Despite treatment advances, HIV is associated with issues of grief and loss, disclosure to families and employers, fear, uncertainty about the future, decisions about when to start antiretroviral therapy, and potential treatment failures. Given the personal and social consequences of HIV infection, educational programs need to be comprehensive and skill based and need to demonstrate effectiveness in both increasing social worker knowledge and improving the quality of care provided to clients. Earlier research has demonstrated the need for social workers and case managers to receive HIV education (Zibalese-Crawford, Brennan, & Stein, 1995). Also, research assessing the effect of HIV education for social workers and other providers has supported the need to increase providers comfort with HIV/AIDS and willingness to work with the population (Knox, Friedrich, Gaies, & Achenbach, 1994; Riley & Greene, 1993). …