MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES FOR HIV POSITIVE, HOMELESS, AND AT-RISK YOUTH. Louise H. Chase, MSW, Elizabeth Goodman, MD, Peter M. Keenan, RN, BSN, Durrell Fox, BS, Cathryn L. Samples, MD, MPH, Robert Garcia, MSW, Margaret Kiwanuka, MSW, Jan Paradise, MD, Elizabeth R. Woods, MD, MPH, Children’s Hospital, Harvard Medical School, Boston Medical Center, Martha Eliot Health Center, Sidney Borum Jr. Health Center, Boston, MA.

OBJECTIVE: HIV positive and homeless youth often experience severe mental health (MH) and substance abuse (SA) problems and can be challenging to engage in care. This study provides a program evaluation of MH and SA services (individual, group, family/couple counseling/therapy, 12-step group, HIV support group, and peer support group) in a multi-site model program.

DESIGN: Data were collected by providers at four urban health care sites serving high risk adolescents in a network of care through standardized contact and intervention forms. Variables associated with receiving a MH and/or SA referral, obtaining MH/SA services, and requiring crisis intervention care were examined using Chi-square, t and Mann-Whitney U tests.

RESULTS: There were 1,232 individuals with sufficient information for this report: mean age 20.1±2.9 years; 62.9% female; 42.2% youth of color; and 13.6% homeless youth. Of these youth, 106 received MH/SA referrals, 165 MH/SA services and 39 crisis interventions. Patients were more likely to be referred for MH/SA services if they received HIV information and referral (17.9% vs. 6.8%, p<0.00001), MH/SA screening (82.0% vs. 5.5%, p<0.00001), outreach (10.6% vs. 6.5%, p=0.011), and medical services (12.1% vs. 4.3%, p<0.00001). Also, more likely to be referred were younger clients (19.1 vs. 20.2, p<0.001), youth reporting sex with an HIV positive partner (58.8% vs. 5.2%, p<0.00001), sex with an injection drug user (IDU) (56.0% vs. 6.5%, p<0.00001), substance abuse (48.4% vs. 3.5%, p<0.00001), survival sex (45.5% vs. 6.4%, p<0.00001), or males with same sex experience or self-identified as gay or bisexual (26.2% vs. 8.5%, p<0.00001). 60% of the adolescents referred received MH/SA services vs. 9% not referred (p<0.00001). Six of the 10 predictors of referrals were positively associated with obtaining MH/SA services. An outreach encounter was negatively associated with obtaining services. Crisis intervention was more likely to be provided to patients with the following risk behaviors; sex with an HIV positive partner (23.5% vs. 1.4%, p=0.00040), sex with IDU (12.0% vs. 1.7%, p=0.016), substance abuse (14.5% vs. 1.2%, p=0.00001), survival sex (12.1% vs. 2.1%, p=0.011), and males who have same sex experiences (10.8% vs. 3.5%, p=0.012). Patients with more interventions were more likely to receive MH/SA referrals (Mann-Whitney U, p<0.00001) and MH/SA services (Mann-Whitney U, p<0.00001).

CONCLUSIONS: Youth with high risk behaviors were referred to and obtained more MH/SA and crisis services than others. The association of the number of visits to the health care site and receiving services underscores the critical importance of integrating mental health services into medical visits for these vulnerable youth.

Related Information:

Evaluation Of A Model Health Care For Homeless, At Risk And HIV Positive Youth
The Evolution Of An Adolescent-Specific Network Of Care For HIV-Positive, Homeless And At-Risk 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
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