Robert Wood Johnson AIDS Program - Mental Health & Social Services

Psychosocial Services

Each patient, as well as their affected family members, is offered psychosocial
services by RWJAP’s psychologist and family case worker. A psychosocial
assessment is performed upon entry into care to determine the patient/family needs
and is reassessed at subsequent medical visits. The following services are offered to
patients and their families:

• Adherence evaluation for medication compliance
• Individual counseling sessions
• Mental status screenings for anxiety and depression, as well as other mental health difficulties
• Referrals to outside mental health agencies and psychiatrists
• Assistance with financial/medical benefits; state and federal programs; social services and legal issues.

Educational / Vocational Services

RWJAP’s Mental Health Services team provides guidance and support to patients and
families regarding their educational needs. The Program Psychologist, a Licensed
Psychologist and Certified School Psychologist, reviews patient’s current reports, refers
for testing as appropriate and along with patient and family, determines a treatment
plan.

Educational/Vocational Services include:

• Patient advocacy
• One-to-one educational/vocational planning sessions
• SAT and college application assistance
• Referrals to appropriate educational/vocational services and agencies.

Family Case Management

The Robert Wood Johnson AIDS Program’s Nurse Case Managers and the Program's Family Case Manager provide nurse case management services for HIV infected and exposed infants, children, youth, and their families. HIV exposed infants are followed for 18 months while HIV infected children and youth are followed from diagnosis through the continuum of their disease process. The medical and psychological needs and medical management of the HIV infected children and youth are intricate and complex. They require close monitoring of lab work, imaging studies, and complex medication regimens and medication adherence. Due to the increased longevity of the perinatally infected children and adolescents their psychosocial needs must be addressed. Their normal growth and development is confounded by their disease process, complexities of disclosure, medication adherence, and confounding manifestations of the disease itself which require a multidisciplinary approach.

Transitional Services

Today, HIV/AIDS is a considered a chronic illness and perinatally infected children enjoy longevity. Currently pediatric HIV care extends to youth 24 years of age. The goal of transition is for these older youth to transition their care to Adult Providers. This transition period begins in the early to mid-teen years providing patients with experience as disease managers. It is RWJAP’s experience that the HIV+ pediatric population require continued “intensive case management and psychosocial support” through this transition phase.