Accessing mental health support shouldn’t take months, but across many clinics in the U.S., average wait times still hover between six to 12 weeks.1 For many people, reaching out for help is already a major step. Being told to wait or, worse, placed on a list and never contacted again can be a serious deterrent.2
For people with HIV or those at higher risk, such as men who have sex with men (MSM), these barriers are compounded. Stigma, fear of discrimination in health care settings, family rejection, and a lack of culturally affirming, affordable care often prevent individuals from seeking or staying engaged with mental health services.3-6
This matters. Mental health is not an optional add-on; it’s a core component of whole-person care. When mental health needs are unmet, HIV prevention, treatment adherence, and overall care engagement suffer.3 Yet despite the clear connection, integrated services remain out of reach for many of the communities that need them most.
Meeting the goals of the Ending the HIV Epidemic (EHE) initiative will require more than expanding testing or scaling up PrEP. It will require care models that integrate mental health and HIV services, something that remains the exception rather than the norm.
In many community-based clinics, mental health care simply isn’t available on site. In larger health systems, access is often fragmented across departments, referral systems, and long waitlists.7 Whether due to location, system complexity, or staffing shortages, too many individuals are left without timely support when they need it most.
Some progress has been made. Behavioral interventions, especially those rooted in evidence-based approaches have shown real promise in improving ART adherence, supporting behavior change, and boosting engagement in care.8 These models reinforce what frontline providers have long known: psychosocial support is not a luxury in HIV care, it’s a necessity.
But implementation remains a challenge. Many of these interventions are delivered by providers who require ongoing training, supervision, and clinical infrastructure, resources that often disappear when research funding ends.9
A Solution to Constraints
In recent years, researchers and clinicians have increasingly turned their attention to a promising question: What if just one session could make a real difference? It’s not just a thought experiment. Decades of research show that the biggest gains in traditional therapy often happen early, sometimes within the first few sessions.10 Single-session interventions (SSIs) aim to capture that early momentum in a condensed, accessible format.
SSIs are brief, structured programs designed to deliver meaningful support in just one encounter, whether that’s a 45-minute meeting with a trained provider or a self-guided session via app, website, or mobile device.11-12 They’ve been used in diverse settings: mental health clinics, emergency departments, schools, primary care practices, and even on smartphones while patients wait for longer-term care.13 Why now? Because traditional therapy, while effective is often out of reach. Long waitlists, insurance hurdles, transportation issues, and stigma can all stand in the way. SSIs offer an alternative: lower-barrier, evidence-based support that meets people where they are.
And the science backs it up. In a recent umbrella review of more than 400 clinical trials led by our team, over 80 percent of studies reported clinically meaningful improvements in outcomes such as depression, anxiety, and treatment engagement.13 In direct comparisons with multi-session therapies, SSIs held their own, outperformed by traditional therapy in only one of four meta-analyses of 12.
What’s more, SSIs are starting to show potential beyond mental health. A separate meta-analysis found that SSIs helped reduce risky sexual behaviors among adolescents and young adults, including increased condom use and fewer instances of condomless sex without PrEP protection.14 In another review conducted by our team, SSIs were associated with improved attitudes toward HIV testing, reduced HIV-related stigma, and, in at least one study better engagement in HIV care.15
How SSIs Work
So how can something so brief lead to such meaningful results?
The answer lies in the underlying theory. Many SSIs are based on established psychological frameworks, including social cognitive theory, which emphasizes self-efficacy, goal setting, and behavior activation.13 These programs are designed to help individuals identify what’s important to them, build motivation, and take small but meaningful steps toward change, whether that’s starting PrEP, managing depression, or re-engaging in care.
By targeting the beliefs, emotions, and behaviors that drive decision-making, SSIs offer a scalable, flexible tool that fits into the realities of modern care, especially in resource-limited settings.
One such example is the Single-Session Consultation (SSC), developed by Dr. Jessica Schleider and our team. The SSC was designed with a specific goal in mind: to provide meaningful, structured support at the moment someone reaches out for help, without the delays that often follow a referral or waitlist.16-17
Rooted in Solution-Focused Brief Therapy (SFBT; CITW), an evidence-based therapeutic model, the SSC is delivered in a single 45-minute session. It follows a semi-structured protocol that helps individuals identify their own strengths and build a personalized action plan, something tangible they can take with them and revisit as needed.
Promising Results
The results so far have been promising. Across multiple evaluations in both in-person and telehealth settings, the SSC has shown significant impact.16-17 Patients reported reduced hopelessness, increased motivation, and improved problem-solving, all while waiting for more traditional therapy to begin. In measured outcomes, this translated to:
- Decreased hopelessness (effect sizes: d = 0.72–1.43)
- Increased sense of agency (d = 0.82–1.11)
- Boosted motivation for change (d = 0.49)
- Reductions in depression and anxiety symptoms over two to four weeks (d = 0.20–1.63)
One of the SSC’s key strengths is that it’s problem-agnostic, it’s offered to anyone presenting with emotional distress, regardless of the specific issue. It’s also highly scalable: it has been successfully delivered by providers across a range of training levels, from bachelor’s-level staff to licensed clinicians, with just a few hours of training (~2.5 hours) required.16-17
Because of its flexibility and growing evidence base, the SSC is already being integrated into real-world care settings, including community mental health clinics, school counseling programs, and most recently, emergency departments, where it’s being used to support both youth and adults experiencing acute distress.
Building on this momentum, our team has launched a new partnership with Project VIDA, a community health clinic in Chicago. This pilot project, supported through recent funding, aims to adapt the SSC for individuals with HIV. The goal is to integrate the model into HIV care settings to address co-occurring mental health needs and support treatment engagement, without adding new burdens to already overstretched systems.
Adapting Brief Interventions for the Digital Era
As part of our broader work with SSIs, our team has also been exploring how these brief, evidence-based programs can be delivered without a provider through self-guided, digital formats. That work led to the development of Keep It Brief! (KIB!), a streamlined adaptation of Keep It Up! (KIU!), one of the first digital HIV prevention programs designated by the Centers for Disease Control and Prevention as a “best evidence” intervention.18-21
Originally launched in 2009, KIU! was designed for diverse young MSM and uses interactive multimedia to improve sexual health knowledge, promote safer sex practices, and strengthen healthy relationship skills. It has been evaluated in multiple trials, including a national implementation study involving more than 2,000 cisgender young MSM. The outcomes were strong: a 40 percent reduction in STI incidence, increased PrEP uptake and adherence, and lower rates of condomless anal sex.20
But despite its success in controlled studies, real-world implementation presented challenges. Feedback from community-based organizations delivering KIU! highlighted several barriers: modules were too lengthy, the program required significant time investment, and the research assessments added logistical burden.22 In clinics facing high caseloads, staff shortages, or limited tech infrastructure, sustaining delivery became increasingly difficult.
KIB! was created to address those barriers. KIB! keeps the core aims of KIU! but delivers them in a 25–35-minute single-session format, making it more practical for busy clinics, outreach teams, or mobile delivery. The content is tailored to where someone is in their HIV prevention journey.
- For PrEP-naïve users, KIB! addresses common concerns like stigma, misinformation, and fear of side effects.
- For individuals currently on PrEP, or those who’ve stopped and are considering restarting, KIB! offers up-to-date information on the full range of options: daily oral PrEP, long-acting injectables (like Apretude), and event-based dosing.
- Relationship context also matters: KIB! dynamically adjusts its messaging for users who are single, monogamous, or in open relationships, making the content feel more relevant and resonant.
So far, the feedback has been encouraging. End-users, particularly MSM, have rated KIB! as highly acceptable and functional, citing the brevity, clarity, and personalization as major strengths. Its modular design also allows for quick content updates. For example, following FDA approval of Lenacapavir (a twice-yearly injectable PrEP), new educational content was added without overhauling the platform.
While evaluation is ongoing, early pre- and post-testing suggests that KIB! may be a lighter touch but highly scalable option for HIV prevention, without sacrificing effectiveness.
Closing the Gap: One Session at a Time
Like their use in mental health, single-session interventions are not designed to replace comprehensive therapy or long-term HIV care. And they shouldn’t. But they offer something equally valuable: a bridge, a way to meet urgent needs, lower barriers, and offer meaningful support right now. As the public health landscape continues to evolve, SSIs stand out for their simplicity, adaptability, and potential to scale. They aren’t meant to solve everything, but in systems where access is uneven and demand is high, these brief interventions can offer a starting point that’s often missing, especially for adolescents and young adults.
And in a world where people are still waiting for a therapist, a PrEP referral, a provider who understands them, sometimes one well-timed session can be enough to keep the door open. If we’re serious about ending the HIV epidemic and tackling the mental health crisis, we need to stop designing care systems for people with unlimited time, resources, and bandwidth. We need to start designing for real life – for the person who’s scared to ask for help, the one who missed their last appointment, or the one who just needs something today.
