Assessing the STIRR Model of Best Practices for Blood-Borne Infections of Clients With Severe Mental Illness

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http://psychservices.psychiatryonline.org/cgi/content/abstract/61/9/885

Psychiatr Serv 61:885-891, September 2010

doi: 10.1176/appi.ps.61.9.885

© 2010 American Psychiatric Association

Assessing the STIRR Model of Best Practices for Blood-Borne Infections of

Clients With Severe Mental Illness

Stanley D. Rosenberg, Ph.D., W. Goldberg, Ph.D., B. Dixon, M.D.,

M.P.H., L. Wolford, Ph.D., P. Slade, Ph.D., Seth Himelhoch, M.D.,

M.P.H., Gerard Gallucci, M.D., Potts, M.S., Tapscott, M.S. and

J. Welsh, M.D.

Dr. Rosenberg is affiliated with the Departments of Psychiatry and of Community

and Family Medicine, Dartmouth Medical School, 1 Medical Center Dr., Lebanon, NH

03756 (e-mail: stanley.rosenberg@...). Dr. Goldberg, Dr. Dixon, Dr.

Slade, Dr. Himelhoch, Ms. Potts, Ms. Tapscott, and Dr. Welsh are with the

Department of Psychiatry, University of land University College, Baltimore.

Dr. Wolford is with the Department of Psychological and Brain Sciences,

Dartmouth College, Hanover, New Hampshire. Dr. Gallucci is with the Department

of Psychiatry, s Hopkins University, Baltimore.

OBJECTIVES: People with co-occurring severe mental illness and a substance use

disorder are at markedly elevated risk of infection from HIV, hepatitis B virus

(HBV), and hepatitis C virus (HCV), but they generally do not receive basic

recommended screening or preventive and treatment services. Barriers to services

include lack of programs offered by mental health providers and client refusal

of available services. Clients from racial-ethnic minority groups are even less

likely to accept recommended services. The intervention tested was designed to

facilitate integrated infectious disease programming in mental health settings

and to increase acceptance of such services among clients.

METHODS: A randomized controlled trial (N=236) compared enhanced treatment as

usual (control) with a brief intervention to deliver best-practice services for

blood-borne diseases in an urban sample of clients with co-occurring disorders

who were largely from racial-ethnic minority groups. The " STIRR " intervention

included Screening for HIV and HCV risk factors, Testing for HIV and hepatitis,

Immunization against hepatitis A and B, Risk reduction counseling, and medical

treatment Referral and support at the site of mental health care.

RESULTS: Clients randomly assigned to the STIRR intervention had high levels

(over 80%) of participation and acceptance of core services. They were more

likely to be tested for HBV and HCV, to be immunized against hepatitis A virus

and HBV, and to increase their knowledge about hepatitis and reduce their

substance abuse. However, they showed no reduction in risk behavior, were no

more likely to be referred to care, and showed no increase in HIV knowledge.

Intervention costs were $541 per client (including $234 for blood tests).

CONCLUSIONS: STIRR appears to be efficacious in providing a basic, best-practice

package of interventions for clients with co-occurring disorders.