Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Philadelphia FIGHT

Name of Innovative Program: 
Integrating Mental Health, Case Management and HIV Medical Care
Sponsoring Organization
Philadelphia FIGHT
Name of Innovative Program Lead: 
Nancy Roth
E-mail Address of Innovative Program Lead: 
nroth@fight.org
Project Description: 

Philadelphia FIGHT is an integrated AIDS services organization that provides medical care, behavioral health care, substance   abuse  treatment, clinical research, case management, and education.  Most of the people we serve are  challenged with physical, mental health and substance concerns as well as chronic poverty and homelessness.  Our behavioral health programs include HIV and trauma informed, patient centered, outpatient individual, group, couple and family therapy as well as intensive outpatient (IOP) substance recovery.   All people receiving services engage with a  multidisciplinary team  including health care providers, therapists and case managers who work together to ensure that each person receives  services customized to meet their needs.   Our research suggests that our approach makes a significant difference in people's lives.  For example, more than half the people in our IOP experienced an increase in CD4 count after joining the IOP and 70% of IOP members have undetectable HIV viral loads.  People stay in our IOP for as long as they need to develop stability in their lives as measured by stable housing, clean urines, productive activity, and a comprehensive Wellness Recovery Action Plan.  FIGHT also offers GED, work readiness, computer literacy and other classes that allow people develop skills to live more healthily.

Creativity and Innovation: 

Philadelphia FIGHT's  creative and innovative systematic approach to integrated HIV care ensures that we serve the whole being of each person.  We have found that working with the whole person helps them build on their strengths and achieve lifelong goals.  For example, one woman in our IOP has been in the program for 3 years.  The first two years she never had a clean urine and she was living in a crack house.  We worked closely with her and her case manager to obtain housing for her.  Once she obtained housing, she was able to maintain sobriety.  She has been clean for nearly a year now, has completed 2/5 of her GED and has been accepted into a training program to become a home health aide once she finishes her GED--a lifelong dream.

Leadership: 

Increased integration between physical and mental health services is a hallmark of the Affordable Care Act (ACA).    FIGHT has had co-located and coordinated  physical and mental health care for more than a decade.  We have experimented with a number of different ways to facilitate communication and collaboration among staff from various disciplines to better serve our community.  FIGHT is actively engaged in a number of initiatives to share our innovations with colleagues who are attempting to come into compliance with ACA including participation in a group of AIDS Service Organization CEOs, best practice sharing through the AIDS Activities Coordinating Office (AACO) and Community Behavioral Health (CBH), and our recent entry into the Health Federation and the Pennsylvania Association of Health Centers which followed our  designation as a Federally Qualified Health Center.

Sustainability: 

Philadelphia FIGHT is fortunate to have sustainable fee-for-service funding for our behavioral health, physical health and case management services from CBH, Medicaid/Medicare and AACO respectively.  These arrangements allow us to use grant funding, donations, and internal resources to fund our innovation projects.  Our contract with CBH is now multi-year after a comprehensive review of our behavioral health services in December 2012.  We also have had 6 years of support from the Pew Trust which has allowed us to expand our behavioral health offerings.  For example, in 2013 we successfully launched behavioral health group interventions with the support of the Pew Trust.

Replicability: 

Our integrated approach to providing services to highly challenged individuals can be replicated not only with the populations we serve, but with any population that would benefit from fully coordinated services that address the whole person.  There are many barriers to fully integrated services:  the different professions speak different languages,  each specialty can be inclined to suggest that the other specialties are not pulling their weight,  it is difficult to find time to communicate effectively and appropriately about each person receiving services, and though we are co-located, we are on different floors of the same building.  We continue to look for better ways to address each of these potential obstacles and have 10 years of experience experimenting to find which approaches work better in which situations.  We would be honored to be able to share what we have learned.

Results/Outcomes: 

As a result of our innovations, we expect the people receiving services to exhibit reduced symptoms, increase housing stability, increase productive activity,  and develop a WRAP plan.  We measure symptom reduction using the Beck depression and anxiety inventories,  measure housing stability, goal attainment and productive activity by  self report, and WRAP plan completion by direct observation. In the last year we have graduated 19 people from our IOP who have met all of these goals.  Several other participants have met some of the goals:  40% of our active participants are engaged in productive activity, 20% have completed WRAPs, 50% are stably housed, and 20% are clean from drugs and alcohol for at least 3 months. In addition, we have seen a marked improvement in our behavioral health participants' HIV statistic:  Fifty percent have increased their CD4 counts and 70% have undetectable viral loads.

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