Promoting family-focused evidenced-based practice in frontline HIV/AIDS care

This chapter addresses challenges involved in disseminating evidence-based interventions to frontline HIV/AIDS care settings, to encourage more high-quality services for families affected by HIV/AIDS. In order to inform this discussion, this chapter examines the many ways in which HIV affects families, the rationale for reaching families through HIV-related service settings, and the many barriers that must be overcome. Next, we provide an overview of the Special Needs Clinic, which offers an exemplary model of a continuum of services organized to support families coping with HIV/AIDS alongside co-morbid medical and mental health problems, poverty, and substance use. Lessons learned at the Special Needs Clinic highlight some inherent difficulties in dissemination of behavioral and psychosocial interventions for families affected by HIV/AIDS, even under the best of circumstances. Next, we turn to results of the Family ACCESS to Care Study, based on interviews with 68 providers, 622 persons living with HIV/AIDS (PLHA), and 195 of their family members from 22 different community service agencies in New York City. Findings of this study demonstrate those PLHAs and their family members express high levels of unmet need for marital and family therapy and other family-focused services. Despite relevant training and experience, agency staff members perceive a mismatch between family-focused interventions and agencies' mission. Staff and family members also differ in the priorities they ascribe to different evidence-based interventions. Dissemination research focused on local experimentation and problem solving is needed to overcome challenges, bridge differences in perspectives, and build a strong foundation of support and care for families affected by HIV/AIDS.