A model integrating mental health and primary care services for families with HIV

The need to integrate mental health and primary care service delivery for individuals and families living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) has been well documented. Accessibility, flexibility, and cultural specificity are qualities necessary, but generally lacking, in existing models of integrated care. In this paper, NOAH (No One Alone with HIV), an innovative, hospital-based program of family-focused HIV mental health services, will be described. NOAH is designed to meet the needs of primary care providers, allied professionals/paraprofessionals, and the diversity of inner-city patients they serve. Central to the model are population-specific "family health facilitators," who collaborate with providers by offering mental health interventions at one or more levels along a continuum of service intensity. Whenever possible, primary care team members are empowered to manage mental health problems directly. When more intensive services are required, responsibility for direct intervention transfers to the family health facilitator. With the locus of inner-city HIV primary care shifting from hospitals to neighborhood health centers, this hospital-based program has been extended into the community to support the early integration of mental health and primary care services at the community level.