When coupled with management of care, implementation of parity in insurance benefits for behavioral health care can improve insurance protection without increasing total costs.

This paper examines factors associated with adherence to antiretroviral medications (ARVs) in an HIV-infected population at high risk for non-adherence: individuals living with psychiatric and substance abuse disorders. Data were examined from baseline interviews of a multisite cohort intervention study of 1138 HIV-infected adults with both a psychiatric and substance abuse disorder (based on a structured psychiatric research interview using DSM-IV criteria). The baseline interview documented mental illness and substance use in the past year, mental illness and substance abuse severity, demographics, service utilization in the past three months, general health and HIV-related conditions, self-reported spirituality and self-reported ARV medication use. Among the participants, 62% were prescribed ARVs at baseline (n_542) and 45% of those on ARVs reported skipping medications in the past three days. Reports of non-adherence were significantly associated with having a detectable viral load (p < 01). The factors associated with non-adherence were current drug and alcohol abuse, increased psychological distress, less attendance at medical appointments, non-adherence to psychiatric medications and lower self-reported spirituality. Increased psychological distress was significantly associated with non-adherence, independent of substance abuse (p < .05). The data suggest that both mental illness and substance use must be addressed in HIV-infected adults living with these co-morbid illnesses to improve adherence to ARVs.

The results of the second National Heart, Lung, and Blood Institute survey of primary care physicians suggest that additional inroads need to be made in the dissemination of the national guidelines for the management of CHD risk factors in children, including appropriate use of pharmacologic agents.

Evidence‐based treatments (EBTs) are interventions that have been proven effective through rigorous research methodologies. Evidence‐based practice (EBP), however, refers to a decision‐making process that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service providers’ knowledge of EBP and perceived advantages, disadvantages, reasons for not implementing full EBT protocols, and attitudes toward EBTs. Qualitative examination of mental health service providers’ definitions of EBP reveals confusion between the terms EBP and EBT. Service providers indicated several advantages and disadvantages of using EBTs. Analysis suggests that many perceived EBT disadvantages would be eliminated if EBTs are implemented as part of the EBP approach, thus allowing for clinician expertise and patient characteristics to be combined with EBTs. Alternatively, distinguishing between EBP and EBT may be more confusing than useful for most community mental health practitioners, which indicates new terminology may be needed.