Summary of Reports on HRSA/HAB's SPNS Adolescent Care Projects

Cross-Cutting Evaluation Highlights from
10 HRSA/HAB's SPNS Adolescent Care Projects

The Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program funded 10 national demonstration projects targeting adolescents and young adults for HIV/AIDS services in October and December 1993. The 10 projects included Bay Area Young Positives (San Francisco, California), Bridgeport TOPS Project (Bridgeport, Connecticut), Children's Hospital, Boston (Boston, Massachusetts), Childrens Hospital, Los Angeles (Los Angeles, California), Health Initiatives for Youth (San Francisco, California), Indiana State Department of Health (Indianapolis, Indiana), University of Alabama at Birmingham (Birmingham, Alabama), University of Minnesota (Minneapolis, Minnesota), Walden House (San Francisco, California), and YouthCare (Seattle, Washington). The cross-cutting evaluation of these 10 projects was conducted by The Measurement Group in collaboration with the grantees and the HRSA/HAB's SPNS.

This article summarizes three reports that have been prepared by The Measurement Group on initial findings from the cross-cutting evaluation of these 10 projects. The three reports focus on pooled results concerning outreach activities, characteristics of the youth served, and the service interventions provided by the HRSA SPNS Program Adolescent Care Projects.

Outreach Activities in 10 Adolescent-Targeted Projects for HIV/AIDS Services

The first report in the series considers the outreach activities that the projects used during the first two and one-half years of their funding cycle. The report focuses on outreach made to agencies and groups, as well as outreach made directly to individuals from the target groups for each project. Most of the adolescent-focused projects used a combination of outreach methods. Many programs specifically identified non-traditional approaches as being the most effective for working with youth.

Outreach was found to be a key element to all 10 adolescent-focused projects. At one level, outreach served to raise community awareness about youth and HIV, as well as about the specific services offered by HRSA/HAB's SPNS Adolescent Care Projects. In addition, outreach also facilitated reaching youth living with HIV and those at high risk for HIV, by increasing the number of youth contacted. Overall, the most profound effect of the outreach efforts was to ensure that youth living with HIV or at high risk for HIV were enrolled in appropriate services.

Enrolled Clients in 10 Adolescent-Targeted Projects for HIV/AIDS Services

The second report in the series focuses on the characteristics of youth enrolled in care by the 10 grantees. A key feature of this report is the development of a model that shows how youth enroll in programs as a function of their exposure to various outreach activities and strategies. Fewer youth entered services from street outreach than those contacted by other methods (such as agency outreach or self-referrals); however, those entering through individual outreach have different needs. For example, a greater proportion of youth living with HIV entered services through high-intensity street outreach than through other entry points. Thus, more intensive, individualized efforts were needed to guarantee access to care for especially disenfranchised youth.

The second report also presents a more detailed profile of youth enrolled in services. Based on a detailed psychosocial assessment done shortly after program enrollment, a number of findings emerged based on the characteristics and needs of HIV-positive youth compared to those at high risk for HIV. For example, youth living with HIV reported greater service needs and utilization than youth at high risk. HIV-positive youth differed from at-risk youth on a number of other factors as well. Overall, the youth enrolled in these programs demonstrated a number of unmet service needs, which were then addressed by the model programs.

Interventions Provided in 10 Adolescent-Targeted Projects for HIV Services

The third report in the series summarizes the service interventions provided to HIV-positive and at-risk youth by the 10 grantees. Over a 2½-year period, the 10 projects provided more than 13,000 service interventions to more than 2,000 unduplicated youth. As might be expected, HIV-positive youth received a different set of service interventions than did at-risk youth. For example, HIV-positive youth received more interventions by physicians, nurses, case managers, counselors, and teachers; more medically focused interventions, and more individual counseling and crisis intervention sessions. An interesting trend is that a greater percentage of HIV-positive youth discussed topics related to service utilization, such as HIV services and public assistance. In contrast, a greater percentage of youth not known to be HIV-positive discussed risk-related issues such as HIV risk factors and HIV testing during the service interventions.

The 10 projects consider the major successes in providing individual services to youth to include obtaining a high rate of return for services; establishing and maintaining effective relationships and communication with youth; providing services to youth in a safe environment; and increasing the number of youth receiving HIV testing.

Summary of Lessons Learned

Overall, the three reports highlight a number of lessons learned by the HRSA/HAB's SPNS Adolescent Care Projects during this period. Some of the key lessons learned are highlighted in the following table.

Major Lessons Learned about Providing Adolescent-Focused HIV Services:

  • Comprehensive services: Successful enrollment of youth into care is the result of offering a wide array of services such as medical and mental care, support groups, and housing assistance.

  • Understanding youth: Program staff must effectively understand and communicate with youth by respecting their dialect, ways of thinking, societal views, etc.

  • Recruitment strategies: Given that characteristics and locations of targeted youth often change, modifications in enrollment strategies may be necessary over time.

  • Transportation: To effectively enroll and maintain youth in services, transportation to providers/agencies should be provided (e.g., bus tokens, taxi vouchers, or actual rides).

  • Incentives: Active involvement of HIV-positive youth in various aspects of the project is often a strong motive for targeted youth to enroll in the program.

  • Individualized services: Services tailored to and responsive to a youth's individual needs should be provided to most efficiently meet the specific needs of the young person.

  • Flexible hours: The hours of a project's operation, (or provision of services), should be flexible enough for youth to access services when needed.

  • Youth-oriented providers: Service providers sensitive to youth-related issues have the best chance of reaching young people living with HIV and maintaining them in care.

Draft copies of all three reports are available from HRSA/HAB's SPNS at Room 7A-08, 5600 Fishers Lane, Rockville, Maryland 20857, 301.443.9976. They may also be viewed on the Internet at http://www.TheMeasurementGroup.com.

 

Related Information:

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

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