1314. HOME CARE: Reaching Our Lost to Follow-up Patients and Overcoming Barriers to Care Utilizing Nontraditional Care Models

Background Of the 11098 people living with HIV in southeast Michigan, over 30% are out of care, with transportation being the most commonly identified barriers. To address this barrier and re-engage patients into care, we introduced an HIV homecare program. The objective of this study was to describe the implementation of the homecare program and document the outcomes of patients enrolled. Methods In 2016, WSUPG ID clinic saw 1990 patients and had additional 95 clients who were virally unsuppressed and lost to care for 12 months. We called all 95 of these clients and offered homecare. We also advertised our program internally, to the Detroit Public Health Departments’ Data to Care Program (Link up Detroit), and to community-based organizations. Referred patients were seen by a NP/MA team supervised by an infectious disease attending. HIV medical care delivered in home utilized same standards of care as for outpatient setting, including lab draws and counseling. Patients also had the ability to text/call provider directly on the program cell phone. This project was funding through a Part A Ryan White MAI grant. Results Of the 95 clients out-of-care, 38 (40%) were unreachable, 41 (43%) were reachable and 16 (17%) did not qualify (relocation, incarcerated, deceased, in-care at the time of call). 5 (5%) enrolled in homecare and additional 29 patients were referred to our program. A total of 34 patients enrolled from September 20, 2017 to September 20, 2018. Among the 34 clients, mental health barriers were the most frequently reported (depression in 20, schizophrenia or bipolar in 7, anxiety in 23, and history of trauma in 11). Of the 34 clients, 24 have achieved virologic suppression at least once during their enrollment. Among the 26 clients with 6+ months of follow-up, 17 have achieved virologic suppression. Conclusion Homecare offers a new, innovative healthcare delivery system which is effective at achieving viral suppression in a challenging patient population and is a successful strategy to re-engage patients in care. Disclosures All authors: No reported disclosures.

Barriers and facilitators to physical and mental health help-seeking among Congolese male refugee survivors of conflict-related sexual violence living in Kampala

In Uganda, over 1.3 million refugees have fled armed conflicts from neighbouring countries, with about 251 730 refugees from the Democratic Republic of Congo (DRC) alone. In this article we report on a qualitative research study on the help-seeking behaviour of Congolese male refugee survivors of conflict-related sexual violence (CRSV) living in Kampala, Uganda. We recruited 10 Congolese male survivors of war-related rape and 6 Ugandan service providers (psychologists, social workers and physicians) who participated in individual interviews focused on barriers and facilitators to care seeking in Kampala, Uganda. We found that the major barriers to help-seeking were socio-cultural and political factors, health system and infrastructural barriers, poverty and livelihood barriers, physical effects of CRSV, fear of marital disharmony and breakup, and self-sufficiency The major facilitators were social support, symptom severity, professionalism among service providers, availability of free tailored services and information, education and communication. On the basis of our findings, we recommend that a multidisciplinary and multisectoral approach is important to address these barriers. In addition, we suggest that the Ugandan government should develop legislation and health policies to create protection for men who have experienced sexual violence.Keywords: armed conflict; conflict-related sexual violence; male refugee survivors; help-seeking; physical and mental health; barriers; and facilitators

Removing mental health barriers to education: A community project

Introduction: Attention-deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children – affecting 2% to 16% of the school-age population (National Resource Centre on AD/HD, 2013). However, in South Africa, data on prevalence rates, access to care and treatment for ADHD are limited and research is lacking. Many children- especially those in underprivileged communities- suffering from ADHD remain undiagnosed, or if diagnosed, do not receive optimal treatment. The Goldilocks and The Bear Foundation provides screening for ADHD and other mental health disorders to learners at school level. We will be presenting the statistics compiled for the first year of operation (July 2017 – June 2018).Methods: In the schools visited, children are referred to the Foundation by the School Based Support. Collateral information is obtained from educators and parents, and parental consent secured before any child is evaluated. Trained nurses do the basic physical screening and behavioural observations for each child. All information is collated and controlled by a trained psychiatrist or psychologist, who determine the possible diagnosis and refer accordingly (either to the community clinic, school doctor, optometrists, audiologists, educational psychologist or occupational psychologist). A detailed database was built capturing all the aforementioned information.Results: We have visited 18 schools (N = 12 447), of which 13 schools participated (N = 8780). A total of 543 children (6.2%) from the school population were screened. The ratio of boys to girls was 2:1, with an age range of 5–14 years. Of the children included in the current analysis (to be updated at the end of the study period), 2.7% were diagnosed with ADHD and 0.67% with depression and/or anxiety. Further detail will be provided with regard to risk factors and comorbid conditions and problem areas.Conclusion: Although mental health clinics exist in the public sector, children with ADHD often never reach this point of diagnosis and treatment because of a lack of awareness and knowledge in their communities. Improved outcomes are possible to achieve if patients suffering from ADHD are diagnosed as such and receive multi-modal intervention – which would include psychopharmacological interventions, behavioural interventions and support.

The use of family group conferences in mental health: Barriers for implementation

Summary The number of compulsory admissions in Dutch psychiatry has increased in the past 25 years. The reduction of coercion with Family Group Conferences in youth care has been successful. How, when and under what conditions can Family Group Conferences reduce coercion in adult psychiatry, is subject of an extensive inquiry. This paper, however, focusses on the reverse question, namely, in what circumstances can Family Group Conferences not be deployed? An answer to this question provides insights regarding situations in which Family Group Conferences may (not) be useful. Barriers in 17 cases were examined using multiple case studies. Findings The following barriers emerged: (1) the acute danger in coercion situations, the limited time available, the fear of liability and the culture of control and risk aversion in mental health care; (2) the severity of the mental state of clients leading to difficulties in decision-making and communication; (3) considering an Family Group Conference and involving familial networks as an added value in crisis situation is not part of the thinking and acting of professionals in mental health care; (4) clients and their network (who) are not open to an Family Group Conference. Applications Awareness of the barriers for Family Group Conferences can help to keep an open mind for its capacity to strengthen the partnership between clients, familial networks and professionals. The application of Family Group Conferences can help to effectuate professional and ethical values of social workers in their quest for the least coercive care.