Christopher G. Mitchell

Treating Anxiety in a Managed Care Setting: A Controlled Comparison of Medication Alone Versus Medication Plus Cognitive-Behavioral Group Therapy

Objective: A controlled comparison of the effects of medication alone and medication in conjunction with cognitive-behavioral group therapy in the treatment of panic disorder. Method: A quasi-experimental research design was used to compare posttest anxiety scores of clients who received medication alone (n= 26) and those who received weekly therapy in addition to medication (n= 30). The Somatic, Cognitive, Behavioral Anxiety Inventory, a 36-item Likert scale, was used to measure anxiety. One treatment consisted of the prescribed use of medication; the second treatment consisted of medication plus 8 weeks of cognitive-behavioral therapy. Results: Analysis of variance revealed significant differences in posttest anxiety scores between the two groups. Members of the medication plus therapy group had lower posttest anxiety scores than those who received medication alone. Conclusions: The findings support the hypothesis that medication in conjunction with cognitive-behavioral therapy is more efficacious than medication alone to treat panic disorder.

HIV prevention in practice: an assessment of the public health response of physicians and nurses in the Midwest.

Epidemiological trends in HIV infection in the United States suggest existing primary and secondary prevention efforts are inadequate. Healthcare providers may be missing valuable opportunities to engage in necessary public health services, such as prevention education, risk assessment, and case finding. This study examined the HIV-related practice behaviors and training needs of physicians and nurses in the Midwest. A cross-sectional survey method was employed. A questionnaire was mailed to a probability sample of 1,500 physicians and registered nurses licensed as of August 1999 in one of six Midwestern states. A total of 534 physicians and nurses replied to the survey, and over half had received prior HIV-related continuing medical education and training. One third of nurses and 26.8 percent of physicians reported that they did not engage in any HIV-related public health role in their practice. Physicians with prior HIV continuing medical education and training were 3.1 times more likely to report HIV-related public health services in their practice than providers without prior training (p = .004). Nurses with prior experience serving HIV-infected patients were 2.0 times more likely to identify a public health role (p = .012). These findings reflect the need for greater awareness among medical providers of the importance of assuming a public health role with the HIV epidemic.

Changes in service delivery following HIV/AIDS education of medical and mental health service providers: results of a one-year follow-up.

This study examined changes in service delivery patterns of health and mental health service providers one year after a training on the fundamentals of HIV/AIDS and mental health. Paired t-tests for 424 training recipients showed significant increases in delivery of HIV-related services, and these remained significant while controlling for additional training, job changes, region (urban, rural, suburban), and provider discipline. Multiple logistic regression analysis revealed a significantly greater likelihood of providing direct services to HIV+ individuals among male providers, those with more years of HIV experience, those in counseling disciplines, and those working in a new job since the training.

Integrating HIV Prevention Into Substance User Treatment: Current Practices and Challenges

Despite well-organized prevention efforts, HIV continues to spread in the United States. Injection drug users (IDUs) and other substance users who engage in high-risk behaviors are at particularly high risk for contracting HIV. Substance abuse counselors therefore are in a unique position to present HIV prevention messages to their clients. This article reports the results of a study that surveyed counselors in an urban setting (n = 116) to assess their knowledge of HIV, their current HIV prevention practices, and their attitudes about integrating HIV prevention more fully into their work. The article concludes with a discussion of the surveys limitations and its implications for training.

Patient Satisfaction with Manualized Versus Standard Interventions in a Managed Care Context

Objective: This article reviews the current debate surrounding the use of manualized treatments within behavioral health settings and presents the results of an exploratory study (N = 230) that examined client satisfaction with structured, time-limited treatment versus unstructured individualized treatment. Method: The study employed a survey design using the Client Satisfaction Questionnaire (CSQ-8) to determine levels of client satisfaction with the two distinct treatment options: standardized group treatment versus unstructured, individual therapy. Results: The data suggest that clients are equally satisfied with both types of intervention and that this satisfaction is consistent across descriptive variables. Conclusions: The report concludes with a discussion of the implications of these findings for social work practitioners and administrators and the implications for future research.

FACTORS TO CONSIDER IN MAKING CURRICULUM DECISIONS ABOUT TREATMENT GUIDELINES

As interventions based on practice guidelines spread within social work practice, educators must determine how, if at all, these guidelines may be incorporated into the curriculum of undergraduate and graduate social work education. This article provides an overview of the history and the debate surrounding practice guidelines and identifies key considerations that must be addressed in order for faculty to make a rational and deliberate decision regarding the inclusion of practice guidelines within the curriculum.

Housing as a Social Determinant of Health: Exploring the Relationship between Rent Burden and Risk Behaviors for Single Room Occupancy Building Residents

A growing body of health determinants research recognizes that housing and health are intimately linked. This study explores the relationship between rent burden (the ratio of rent to income) and health risk behaviors among a sample of single room occupancy (SRO) building residents. Cross-sectional data were gathered from a sample of 162 residents living in privately owned, for-profit SROs in Chicago. Findings indicated that participants who had full rental subsidies and thus were designated in a no-rent-burden category were more likely to engage in risk behaviors including illicit drug use, having multiple sexual partners, and having sex without a condom, in comparison to participants with moderate or high-rent burdens. These findings suggest that interventions to increase housing stability and affordability and bolster reliable income sources (in addition to rental subsidies) may be key in reducing risk behaviors and improving health for vulnerably housed populations such as SRO residents.

Homelessness and residential instability as covariates of HIV risk behavior among residents of single room occupancy housing

ABSTRACT Homeless and unstably housed individuals are at increased risk for contracting HIV. This study examined multiple indicators of housing instability and their association with HIV risk for a sample of low-income residents living in single room occupancy (SRO) buildings in Chicago (n = 163). In the multivariate analysis, prior homelessness was associated with recent illicit drug use (adjusted odds ratio = 3.14) and self-identifying as homeless was associated with having multiple sexual partners (adjusted odds ratio = 2.99). The number of months participants had lived at the SRO was not significantly associated with any risk behaviors. Results suggest that residential stability and housing histories vary considerably among SRO residents, and that it is critical to use precise definitions to capture multiple dimensions of housing to better understand their potential relationship with HIV risk.

HIV Prevention in 2009: Success and Challenges to an Effective Global and Domestic Response

In 1981, the first AIDS cases were reported to the Centers for Disease Control and Prevention (CDC). Now, more than 25 years into the epidemic, HIV infection continues to spread worldwide. The World Health Organization estimates that there are approximately 33 million adults and children living with HIV globally and another 2.7 million newly infected in 2007 (WHO). Women account for 50% of those living with HIV worldwide and young people under 25 years of age account for half of all new infections. Turning to the United States, we see a similar trend with approximately 1,106,400 people infected and an estimated 56,000 new infections annually (CDC, 2008). The poor and disadvantaged—populations typically served by social worker and other social service professionals—are disproportionately affected both at home and abroad. Given these statistics, the prevention of HIV remains an urgent priority. The good news is that we know prevention works. Although HIV continues to spread, the rate of new infections would be dramatically higher if there had not been coordinated prevention efforts in the past. In fact, the CDC estimates that prevention interventions have averted more than 350,000 new infections in the United States alone (CDC, 2009). Despite this success, however, the prevention of HIV remains remarkably complex and challenging at both the individual and contextual levels. Gender inequality, ongoing discrimination of vulnerable groups, HIV stigma, and poverty are just some of the contextual factors that affect individuals’ risk reduction efforts. Fortunately, despite this complexity, we have learned a great deal about prevention and what works. Building on what we know about prevention, the CDC in the United States has a three-fold prevention strategy of (1) funding evidence-based interventions, (2) tracking the epidemic to ensure that prevention dollars and interventions are directed to the proper populations, and (3) partnering with researchers to identify and develop innovative interventions to address specific needs of high risk groups (CDC, 2009). Central to this strategy is the CDC’s commitment to the dissemination and utilization of evidence-based HIV prevention interventions. Through the Dissemination of Evidence-Based Journal of HIV/AIDS & Social Services, 8:309–312, 2009 Copyright # Taylor & Francis Group, LLC ISSN: 1538-1501 print=1538-151X online DOI: 10.1080/15381500903455935