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

As noted earlier, the 10 adolescent SPNS projects differ from one another in their outreach methods. The following points highlight some of the issues related to outreach that cut across the various projects:

Most of the 10 adolescent SPNS projects use a combination of agency and individual outreach methods.

Perceived Major Successes of Outreach
All 10 adolescent SPNS projects have indicated that outreach has served to enhance their programs by increasing awareness of services in the community, as well as bringing individual youth into services. Most importantly, the 10 adolescent SPNS programs have indicated that outreach has helped them better reach youth living with HIV and those at-high-risk-for-HIV. The adolescent SPNS projects report that outreach has not only enabled them to reach more young people needing services, but it has also played a major role in encouraging youth to return for ongoing intervention. Other benefits of outreach for these programs include reports that outreach has helped the programs increase enrollment, improve visibility and recognition in the community, help fledgling organizations be taken more seriously by other service providers, and improve collaborative efforts with other local agencies.

Perceived Major Challenges for Outreach Efforts
It appears that some unexpected lessons have been learned by this group of projects related to their outreach efforts. For several of the adolescent SPNS projects, one effect of increasing outreach efforts has been that demand for services sometimes exceeded capacity. As a related issue, project staff found that sometimes outreach efforts have led to contact with youth needing more specialized services (e.g., substance abuse treatment, mental health care) than agencies may have capacity to provide with existing resources. Another type of challenge identified by a number of projects was that certain outreach strategies were found to be effective for certain types of services, but not others. Several of the projects indicated that they faced institutional barriers or resistance when attempting agency outreach with some organizations in their network. Finally, many of the projects identified a need for ongoing staff development and support, with particular mention of assistance with organizational skills, stress management, and dealing with difficult issues such as violence, grief, and loss. Yet, in spite of these challenges, the adolescent SPNS projects have used outreach to obtain great success in developing and maintaining services for youth in need of HIV services.

These issues and others are presented in more detail in Table 3-1. The efforts of each adolescent SPNS project for agency and individual outreach are described, as are the major successes and challenges related to outreach as identified by each project.

Table 3-1
Summary of Characteristics of the Adolescent SPNS Projects: Outreach Efforts

Program	Location	Brief Description of Agency Outreach Efforts	Brief Description of Individual Outreach Efforts	Perceived Major Successes of Current Outreach Efforts	Perceived Major Challenges for Current Outreach Efforts
Bay Area Young Positives, Inc. (BAY Positives)	San Francisco, California	BAY Positives provides outreach to other agencies through in-services and provider education on youth sensitivity. BAY Positives has mentors from different agencies. BAY Positives receives many agency referrals. Project staff attend community meetings to discuss psychosocial issues among youth with HIV. BAY Positives provides consulting to agencies across the nation on how to start up a peer-driven program like BAY Positives. BAY Positives participates in a national conference on HIV, specifically focused on youth issues.	As of December 1, 1994, a media campaign was launched, which consisted of billboards around San Francisco and small posters in buses and bus shelters. The purpose of this campaign was to recruit volunteers and members (clients). BAY Positives has been advertised on radio and TV, and through printed interviews with project staff. Advertisements are targeted specifically to prospective members (clients). BAY Positives representatives attend health fairs held in high schools and at street fairs. BAY Positives representatives attend public activities related to HIV and social events.	Due to the media campaign, membership at BAY Positives has increased, and more youth have been newly HIV tested. BAY Positives is taken more seriously by other agencies. Volunteers from the community have increased (members-clients have come to BAY Positives as volunteers first).	There are no resources to accommodate increased members (clients). More members (clients) have special issues (e.g., substance abuse, homelessness), but BAY Positives does not have the resources to deal with their immediate needs.
Children’s Hospital of Boston (CHB), Boston HAPPENS Project	Boston, Massachusetts	Boston HAPPENS provides in-service training, lectures, presentations, and case management meetings. There are monthly network meetings which are interactive, topic- and case-based, with the topics chosen by the community advisory board. Joint community activities and peer leader open house activities have been organized by Boston HAPPENS. Boston HAPPENS engages in an active program of continuous expansion of the referral and service networks. Boston HAPPENS aids youth by connecting peers to services.	Van and street outreach are provided by agencies in Boston HAPPENS. Street outreach is conducted in such "youth areas" as the Boston Commons. Basic necessities such as food and clothing are available for drop-in youth at some project locations. Boston HAPPENS connects youth with HIV counseling and testing services, adolescent-specific medical and mental health services, and HIV care. Outreach with Boston HAPPENS peer leaders is conducted in community centers and hospital-based clinics. Peer waiting room outreach is conducted with pamphlets, videos, condoms, and advice. Boston HAPPENS project staff attend health fairs.	More youth are being served by Boston HAPPENS due to linkages formed with other agencies. Implementation of this program has been successful. This program has reached the at-risk population in Boston. There has been a wide variety of services available and facilitated care. Early identification and delivery of HIV counseling and testing services (which are the portals to care) have increased. More homeless youth are being connected to care. Community recognition of Boston HAPPENS and community involvement have risen. Many presentations, workshops, and inservice trainings have been offered.	Connecting agencies and outreach providers was more effective than providing more street outreach. Appropriate professional staff are needed in key locations and in medical/nursing care to provide services to youth. A wide range of cultural groups need to be connected, with each staff integrated into the care structure. The Boston HAPPENS Project plans to integrate the peer leaders into street outreach to ease workload. The peer leaders need extensive supervision and mental health support. There is a need to understand the impact of managed care on health care delivery.
Childrens Hospital Los Angeles (CHLA)	Hollywood (Los Angeles), California	CHLA provides outreach to other Hollywood agencies through regular network meetings. CHLA provides staff training to other agencies. The Computer Assisted Adolescent Referral System (CAARS) has been requested by various agencies in Hollywood. This system enables youth to identify local services that meet their needs. CHLA works with PROTOTYPES to develop relationships with schools, churches, and other community agencies with access to young people. CHLA provides in-service trainings to those agencies. CHLA organizes an Adolescent HIV Consortium, which works on issues relevant to youth, HIV testing, linking youth to medical services, and HIV education in schools.	The Gay and Lesbian Community Service Center conducts bar and club outreach in the Hollywood area targeted towards gay and lesbian youth. HIV educational and prophylactic materials are distributed during brief contacts. HIV prevention and risk-harm reduction counseling is provided during contacts with youth identified as being high-risk. They also link high-risk youth with the SPNS clinic. PROTOTYPES conducts street outreach in various community settings such as bus stops, outside schools, and churches. Outreach staff provide brief contacts, longer encounters, service assessment, and referrals. Staff also provide youth with transportation for their clinic appointments. CAARS provides service information to youth without staff assistance via computer referrals to local services.	Awareness of the SPNS clinic has increased over the course of the project. CAARS has been instrumental in raising awareness of services among at-risk youth and service providers in the Hollywood area. CHLA maintains a consistent presence in bars and clubs frequented by gay and lesbian youth. CHLA is beginning to gain access to continuation and alternative schools. CHLA is forming relationships with churches that have traditionally not been interested in the services offered by this program.	Difficulty linking youth reached through bar outreach into services at the SPNS clinic. However, bar outreach has effectively raised awareness of risk-harm reduction issues. Safety concerns for gay and lesbian staff and youth conducting club outreach.
Greater Bridgeport Adolescent Pregnancy Project (GBAPP)	Bridgeport, Connecticut	Teen Outreach Primary Services (TOPS) provides ongoing education with a nontraditional approach. TOPS invites community agencies to participate in recreational and social activities for youth. This project maintains relationships with agencies to track youth referrals.	Client outreach is conducted on the street, by word of mouth, flyers developed by teens, and graffiti writing on the walls of stores that volunteered to advertise for TOPS. TOPS also works with other agencies, such as the health department, juvenile corrections, churches, and others to provide outreach to youth.	Larger numbers of youth are seeking out TOPS services and asking about medical referrals, condom distributions, social events, academic services, substance abuse programs, and advocacy for those involved with the criminal justice system. Awards from youth and other agencies in the area.	Safety of the peers and case managers who do street outreach. Resistance by the Board of Education to sex education for young people between 15 and 18 years of age. Need for re-education of law enforcement agencies about outreach efforts. Need for a larger facility to house the program due to increased numbers of youth.
Health Initiatives for Youth (HIFY)	San Francisco, California	Health Initiatives for Youth (HIFY) clients provide assistance to agencies by working with them on projects that are youth focused. Clients sit on planning councils and participate in decision-making bodies. The Speakers Bureau provides presentations to decision-makers. In collaboration with other agencies, HIFY provides training conferences to agencies upon request. HIFY participates in a national conference on HIV, specifically focused on youth issues.	The Speakers Bureau provides presentations to high school students and other youth. HIFY holds free conferences for youth on HIV issues. The National Alliance of Positive Youth gives young individuals with HIV opportunities to contribute information and write for various publications produced by its national advocacy team. HIFY provides clients with opportunities for leadership.	Increased number of clients that reflects the success of the program. Improved collaboration efforts with local agencies.	Ongoing need for staff development in skills training, stress management, and basic organizational skills. Difficulty identifying the project’s client target population. Difficulty deciding which populations HIFY would like to reach. Difficulty dealing with young people who are dying.
Indiana Youth Access Project (IYAP)	Statewide in Indiana	The Indiana Youth Access Project (IYAP) provides presentations about youth and their experiences. IYAP provides information and statistics to agencies. Staff training specifically designed for different agencies is provided (e.g., to psychiatric hospitals; residential treatment programs; boys and girls clubs, primary, middle, and high schools; universities; medical facilities; and other youth-serving agencies). IYAP has created and maintained its social service and mental health network. IYAP provides outreach to youth ministers and the Catholic church. IYAP maintains contact with the community professionals, business people, friends, and family. IYAP holds fund-raisers to market the program to the city.	Street outreach is conducted by trained youth and an adult supervisor. They locate gay, lesbian, bisexual, or transsexual youth on the streets or in community settings such as schools, mental health or medical facilities, or social environments. Forms of outreach include hotlines, media advertisements about the program via high school, local, and weekly entertainment newspapers, referrals to youth-sensitive agencies, and gay community switchboard referrals.	Increased enrollment of youth in IYAP. There have been increased numbers of referrals from other agencies. Success of the street outreach program. This is substantiated by youths who successfully transition from support on the streets to access of broader services. Indicators of success include instances when youth: developed better relationships with parents, continued school, did not commit suicide, left prostitution, and followed through with medical providers. Recognitions of IYAP throughout the community.	The limited budget for peer counselors and advertisements to youth. Burnout among peer counselors. Finding committed and responsible youth to conduct peer outreach. Accessing public and private schools to provide support materials and educational programs for youth. Dealing with the legalities associated with HIV testing among minors.
University of Alabama, Birmingham, Teenage Access Project (TAP)	Birmingham, Alabama	The Teenage Access Project (TAP) provides outreach to young women between the ages of 10 and 21 through agencies in the community, such as shelters for young women, alternative schools for delinquent youth, adult learning centers, and recreation areas. TAP holds 1-2 hour sessions to present current information about TAP to other agency staff.	TAP provides six hour risk-harm reduction sessions in other agencies for young women. Agency-sanctioned outreach is used because Alabama is a conservative state. TAP offers HIV counseling and testing to agencies that request these services. A TAP line (warm line) is available to youth to learn about the program.	Requests from agencies in the community that TAP provide HIV counseling and testing services and risk-harm reduction sessions. 60 percent of youth who have received HIV testing return. Risk-harm reduction sessions that empower the young women. Requests from other agency staff for training to hold risk-harm reduction sessions themselves. Inclusion of TAP staff on the planning council for Ryan White and a CDC community planning council for AIDS prevention.	Difficulty enrolling 10-14 year olds due to the legal requirement of parental consent forms. Trouble accessing the school system and churches. Rescheduling of outreach and risk-harm reduction sessions as agencies change their agendas. Lack of interest among health care providers regarding TAP’s outreach efforts.
University of Minnesota, Youth and AIDS Projects (YAP)	Statewide in Minnesota	YAP provides technical assistance to all youth-serving agencies in the state. HIV testing and counseling. Adolescent early intervention program.	Outreach workers make contact with young gay and bisexual men at bars, schools, and coffee houses. Advertisements about the program are made through flyers and local newspapers. Social events are held to attract young people. The Disease Intervention Specialist sends youth identified as having HIV to YAP; usually, youth with HIV do not come into this project by themselves.	Meeting last year’s goals of reaching 120 young men in the prevention component of the program. Providing over 150 with HIV services the previous year. 100 percent return rate for HIV test results. Successful community education.	Poor follow-through among youth with services that have been arranged by their case manager. Difficulty with client follow-up. Difficulty finding housing for youth. Financial problems among youth, as many do not have jobs.
Walden House, Inc.	San Francisco, California	Walden House provides outreach to other agencies, such as departments of social services and juvenile probation. Presentations are provided to agencies on how to identify young people with HIV and those who are engaged in at-risk behavior. This project participates in a national conference on HIV, specifically focused on youth issues.	Provides direct individual outreach; rather, this project establishes linkages with other agencies, which refer clients to them. Walden House provides information to other agency staff who then make this information available to young people when they conduct outreach.	Walden House has been successful in providing an almost on-demand detoxification service to young people on the streets. Ability to enroll youth the same day they call in for detox services. Strong linkages established with other service providers, which increased access to care. Increased enrollment of youth with HIV in Walden House.	Difficulty in reaching institutionalized youth between the ages of 13 and 18. Great need for early HIV testing and education among young people. Not as many youth tested positive for HIV in Walden House testing sites as expected, leading the project to other outreach strategies.
YouthCare	Seattle, Washington	YouthCare provides outreach to drop-in centers and clinics through staff meetings, in-service meetings, and informational interviews YouthCare staff participate in coalitions and systems meetings.	Individual outreach is conducted on the streets. Project staff provide coverage at needle exchange sites and drop-in centers. Transportation is provided to free clinics. The clinics and drop-in centers provide information to their clients about YouthCare. YouthCare provides outreach on the streets, in drop-in centers, and clinics. YouthCare staff also provide outreach to other agencies through staff meetings. YouthCare staff provide outreach to other agencies by attending planning councils and community planning groups.	Increased number of referrals via agency outreach. Recognition that youth and people with multiple diagnoses do not transition well into the care system and do not receive services. Impacts on all three levels: system, agency, and client levels.	Limited services available to nondisabled individuals with HIV, especially youth (e.g., housing). Not as many youth tested positive for HIV in YouthCare testing sites as expected, leading the project to other outreach strategies.