THE EVOLUTION OF AN ADOLESCENT-SPECIFIC NETWORK OF CARE FOR HIV-POSITIVE, HOMELESS AND AT-RISK YOUTH. Elizabeth R. Woods, MD, MPH, Yvonne G. Lin, MS, Carla M. Bann, MA, Nerissa L. Abriam, BA, Maurice W. Melchiono, RN, MS, C-FNP, George J. Huba, PhD, Children’s Hospital, Boston, MA, The Measurement Group, Culver City, CA, and University of North Carolina, NC.

OBJECTIVE: Examining changes in available services and barriers is essential for planning youth-oriented HIV services in a given region. We evaluated changes within a linked service network of care for HIV-positive, homeless and at-risk youth in a large metropolitan area.

DESIGN: A standardized interview was used to assess the availability of 26 services and 18 ancillary services provided by 20 urban youth-specific service agencies in year 1 (T1) and year 3 (T2) of the program. The survey included types of services offered, availability of services through referrals, familiarity with Title I of the Ryan White Care Act (Title I) (scored 1-4) and the barriers to expanding service levels (scored 1-7). T1 and T2 comparisons were made with repeated measures ANOVA, McNemar, and paired t tests. A larger group of care providers (36) from core network sites completed a second instrument rating interagency knowledge, referral patterns and general satisfaction with services and network agencies. Nonmetric multidimensional scaling (MDS) was used to graphically model changes in the relationships of the core agencies between T1 and T2.

RESULTS: Agencies’ characteristics, activities, or populations served did not vary significantly over time. However, of the 26 agency services examined, significantly more individuals accessed vocational training [mean=55 (T2) vs. 8 (T1); F (1,1) = 245, p=0.041]. Available services for drug abuse problems increased 45% from 7 to 13 (McNemar test; p=0.031). Agencies were significantly more familiar with Title I (mean score 3.35 vs. 1.40; paired t (19) = 5.80, p<0.001) and represented on the Title I Planning Committee (McNemar test, p=0.039). By McNemar test, significantly fewer referral services existed in T2 than in T1 including: (1) tuberculosis screening (p=.031), (2) shelters for battered women (p=.003), (3) aftercare for drug abusers (p=.001), (4) individual counseling (p=.002), (5) family counseling (p=.004), (6) 12-step programs for the general population (p=.012), (7) 12-step programs for HIV-positive individuals (p=.012), and (8) 12-step programs for women (p=.012). Over the two years, increasing disorganization within the region’s interagency networks (mean score 3.7 vs. 2.6, p=0.05) had the most significant change of the barriers to improving services; especially for outpatient mental health services (mean score 3.8 vs. 2.5, p=0.015). MDS analyses indicate that subclusters of network agencies have remained stable, but referral patterns appeared less dependent upon historical knowledge about the project over time.

CONCLUSIONS: The first two years of the program witnessed some improvement in patients accessing vocational training as well as increased familiarity and involvement with the Title I by agencies in the region. However, referral sources declined for substance related and social support services. Despite regional changes in network affiliations, the relationship between agencies have stayed stable over time. Evaluating changes within a care network is important in order to recognize and respond to evolving service needs for this population in a defined region.

Related Information:

Evaluation Of A Model Health Care For Homeless, At Risk And HIV Positive Youth
Health Service Needs For HIV Positive And At-Risk Young Women
Providing Mental Health And Substance Abuse Services To HIV Positive And Homeless Youth
Mental Health And Substance Abuse Services For HIV Positive, Homeless, And At-Risk Youth
Do High Risk Youth Use Targeted HIV Testing Services: Experience Of A Program Of Care For High Risk Youth
Youth Involvement In The Boston Happens Program

Evaluation and Dissemination Center: Innovative Models of Adolescent HIV/AIDS Care 1993-1998