Feingold A, Slammon W R
Division of Psychiatry, Boston City Hospital, Boston University School of Medicine, MA 02118.
Gen Hosp Psychiatry. 1993 Sep;15(5):290-300. doi: 10.1016/0163-8343(93)90021-f.
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.
对于感染人类免疫缺陷病毒（HIV）和获得性免疫缺陷综合征（AIDS）的个人和家庭而言，整合心理健康与初级保健服务的必要性已有充分记载。可及性、灵活性和文化特异性是整合照护现有模式中必要但普遍缺乏的特质。本文将介绍诺亚计划（NOAH，即“无人独自面对艾滋”），这是一项创新的、以医院为基础的、以家庭为重点的艾滋心理健康服务项目。诺亚计划旨在满足初级保健提供者、相关专业人员/辅助专业人员以及他们所服务的市中心患者的多样性需求。该模式的核心是针对特定人群的“家庭健康促进者”，他们通过在连续服务强度的一个或多个层面提供心理健康干预措施，与提供者展开协作。只要有可能，初级保健团队成员就被赋予直接管理心理健康问题的权力。当需要更强化的服务时，直接干预的责任就转交给家庭健康促进者。随着市中心艾滋初级保健的重点从医院转向社区健康中心，这个以医院为基础的项目已扩展到社区，以支持在社区层面早期整合心理健康和初级保健服务。
