Project Title: The Boston Adolescent HIV Network Program: Early Interventions and Comprehensive Health Care For HIV Positive and At Risk Adolescents.

Grantee: Children's Hospital

Location: Boston, MA

Project Director: Elizabeth R. Woods, M.D., M.P.H.

Category: (A); "Continue to expand and ensure access to health and support services..."

Adolescents Targeted: HIV positive, homeless, and at risk youth who are 12-24 years old residing in metropolitan Boston.

Problem Statement: Because little research exists on health services utilization by homeless and HIV positive adolescents, we propose a model program to advance knowledge in this area of adolescent-specific services. The Boston Adolescent HIV Network Program, now called The Boston HAPPENS (HIV Adolescent Provider and Peer Education Network for Services) Program, is an innovative project that provides a network of care for homeless, at risk, and HIV positive youth across 8 agencies.

Major Goals:

1. To provide and evaluate a system of coordinated HIV care to adolescents from within, or referred to, the Boston HAPPENS Program.

2. To continue a Network of outreach, care and services for HIV positive, at risk, and homeless youth identified through the Network sites.

3. To increase knowledge of adolescent HIV-related issues by expanding the dissemination activities to include regional trainings, guest editing a journal volume of the ten adolescent SPNS models of care, and performing a health services evaluation of the national data set.

HIV Service Delivery Model: HAPPENS provides a city-wide network of culturally and developmentally appropriate adolescent-specific care including (1) outreach and risk reduction counseling through professional and adult supervised peer staff, (2) access to appropriate HIV counseling and testing support services (CTSS), (3) medical crisis counseling, (4) health status screening and services needs assessment, (5) primary and referral care services including nurse case management, multi-disciplinary team care, access to clinical trials, social, mental health, substance abuse, and basic needs services (food, clothing, and shelter), (6) follow-up and outreach to ensure continuing care, (7) integrated care and communication between providers in the metropolitan Boston area, and (8) regional and national dissemination of information regarding care models of high risk youth by professional and youth staff. This innovative network of youth-specific care offers a continuum from street outreach to referral and HIV specialty care that crosses institutional barriers.

Accomplishment of the First Three Years: The program has established and maintained a Network of coordinated care serving 41 HIV positive and 1,237 at risk youth. Health care professionals and trained peer leaders link HIV positive and at risk youth to primary and referral care by multi-disciplinary teams. Three hospitals, three neighborhood health centers, and two multi-service youth outreach agencies provide outreach, counseling, and testing support services (CTSS), coordinated care, case management, episodic, primary, and HIV care, and treatment. Clinical intake and flowsheets for consistency of HIV care are in place. The cross-cutting and site-specific evaluations are in place including qualitative and quantitative components.

Evaluation and Design Measures: We have worked with the SPNS cross-cutting evaluation to implement at our site the encounter driven health services evaluation for out target population, the Brief Natural History evaluation for HIV positive youth, and the Structural Evaluation to monitor the evolution of the Network. In addition, we have performed program-specific qualitative evaluation of focus groups, peer leadership training, clinical case summaries for presentations, and quantitative evaluations of our network meetings, provider and client consumer opinion; developed a new appointment tracking form to measure reasons for appointment non-adherence; and implemented health status and quality of life measures. The evolution of this program will demonstrate the importance of this model of care for youth in our target population.

Dissemination Activities: Our focus group findings on youth care preferences, a review on homeless youth, a chapter on HIV care, a case report, and several brief news articles have been published or are in press. Initial results from the program model, clinical flowsheets, HIV seroprevalence surveys, health services, and peer leadership training have been presented at national meetings. Our dissemination of information includes our Network Meetings; a Newsletter, local, regional, and national presentations; and inservice trainings and case management meetings. We will combine qualitative data with the Bridgeport program for a joint manuscript. We propose to edit a volume of JAH with TMG and the LA and Minnesota SPNS projects. In addition, we propose a collaborative health services evaluation of the national data set and initiate a regional series of one-day trainings.