Chapter 4:

Interventions Provided by the Adolescent SPNS Projects

As part of the cross-cutting evaluation of the adolescent SPNS projects, each program was asked to complete an "Intervention Form" for each of the service interventions they provided.

Using the Intervention Form, projects were able to code information about their service encounters, including the purpose of the activity, topics discussed, types of service providers, location of the service encounters, and referrals made at the time of the encounter. A copy of the Intervention Form is included in Appendix III.

Between the time that the intervention forms were implemented in the 10 adolescent SPNS projects in December 1993 and the end of March 1996, most of the projects had coded a number of different interventions and service efforts. The number of forms submitted for processing to the central data archive is summarized in Table 4-1.¹

Table 4-1
Number of Intervention Forms
Received Between December 1993 and March 31, 1996

Figure 4-1 shows the age distribution of the individuals who received interventions (the solid line is for females, the dashed line is for males).

Figure 4-1. Age distribution of clients who received interventions (N=1,023 males, N=1,074 females).

• Of these service recipients, males were older (mean=20.46 years) than females (mean=18.94 years). This mean difference was statistically significant, t(2,080)=10.61, p<.001.

• Clients who were known to be HIV-positive were significantly older (mean=23.49 years) than individuals for whom HIV status was unknown (mean=19.25 years), t(2076)=-19.19, p<.001.

In the remainder of this chapter, tables, charts, and text are used to summarize characteristics of the interventions provided to clients across the 10 sites. Data are presented in clusters of information about the interventions, such as the general focus of the interventions, types of individuals providing services to youth, types of interventions provided, topics discussed, and so on. For each group of results, several types of information are presented. First, a table appears that summarizes the number of sites for which the information applies (e.g., the number of sites out of 10 that offer specific types of interventions). Second, a chart shows the percentage of unduplicated individuals for whom the information applies (e.g., what percentage of males and females served by the 10 projects were provided specific types of interventions?). Major findings also are highlighted and expanded upon in text bullets following each chart. Third, findings are summarized comparing HIV-positive youth to those not identified as HIV-positive. The results based on known HIV status are described in the text, and do not appear directly in the charts. Each of the charts in this chapter summarizes data from 1,023 males and 1,074 females who received interventions from the 10 adolescent SPNS projects.² HIV status was known to be positive for 229 individuals (10.9 percent) and unknown for 1,875 of the individuals (89.1 percent). A higher percentage of males (16.5 percent) than females (5.5 percent) were HIV-positive (c ²(1, 2097)=63.74, p<.001).

The percentages for all variables by gender, HIV status, and by the interaction between gender and HIV status (e.g., percentage of HIV-positive males, percentage of HIV-positive females, and so on) are also provided in tables corresponding to those charts in the Technical Appendix to this chapter. The Technical Appendix also gives the inferential results for each effect.³ Thus, the reader can refer to the body of the chapter for descriptive written and graphical summaries of the findings, and to the Technical Appendix for specific information about percentages and inferential results for all variables by gender and HIV status.

Males received an average of 6.29 interventions per person, compared to an average of 4.06 interventions per person for females. This difference is statistically significant, t(2095)=4.30, p<.001. Youth known to be HIV-positive received, on average, many more interventions (mean=17.83) than youth whose HIV status was unknown (mean=3.58, t(2076)=-19.19, p<.001).

Types of Interventions Offered Across Sites
The first table and set of figures deal with the types of interventions that clients received and the number of sites that offered these types of sessions. As shown in Table 4-2, nearly all projects (out of 10) provided sessions that focused on prevention, treatment, and case management. Across sites, sessions involving prevention were offered most often, followed by those involving case management. Treatment-related sessions were offered across sites less than ten percent of the time (median=7.4 percent).

Table 4-2
Across Sites, What Types of Interventions Did Clients Receive?

Note. For a given site, a session was considered offered if it occurred more than five percent of the time.

Figure 4-2 summarizes information about the type and nature of the interventions received by youth served by these projects. For each type of intervention, summaries for unduplicated individuals are provided (see Appendix I for descriptive information about data at the encounter level). In the summaries for unduplicated (unique) clients, data are described in terms of percentage differences by gender (males versus females), HIV status (HIV-positive versus clients of unknown HIV status), and interactions between gender and HIV status.⁴

Figure 4-2. Percentage of unduplicated individuals who received at least one session of prevention, treatment or case management (N=1,023 males, N=1,074 females).

• More females (77.3 percent) than males (68.3 percent) received interventions that were prevention-oriented.

• Similar percentages of males and females received at least one intervention focusing on treatment.

• About one in three males (36.6 percent), whereas only about one in five females (23.0 percent), received at least one case management intervention.

• There were no statistically significant differences between males and females in the number of sessions focused on prevention, treatment, and case management.

Additional Findings Based on HIV Status
Individuals identified as HIV-positive (compared to individuals for whom HIV status was unknown) were less likely to receive interventions related to prevention (33.3 percent versus 77.7 percent), but were more likely to receive at least one intervention related to treatment (34.2 percent versus 15.7 percent) and case management (58.8 percent versus 26.1 percent).

Those who received interventions, HIV-positive clients compared to clients of unknown HIV status participated in more interventions that primarily addressed prevention (mean=13.56 versus 2.49), treatment (12.53 versus 3.95), and case management (11.84 versus 3.49).

For prevention, treatment, and case management, HIV-positive men were less likely to receive services than HIV-positive women.

Intervention Providers Across Sites
Table 4-3 shows the number of sites (out of 10) that conducted interventions provided by specific types of staff, as well as the percentage of times the provider offered these services. There was considerable service provider variability across sites, with most of the sites using case managers and counselors and none of the sites using psychiatrists. Across sites, case managers conducted the interventions most frequently.

Table 4-3
Across Sites, Who Provided the Intervention?

Note. For a given site, a service provider was considered to have offered a service if the person provided that service more than five percent of the time.

Figure 4-3 presents the percentage of male and female clients who received services from providers of various backgrounds and training.

Figure 4-3. Percentage of males and females who received services at least once from various service provider types (N=1,023 males, N=1,074 females).

• Of the clients who received interventions, both males and females were more likely to have received services from case managers, physicians, nurses, and counselors than from other types of service providers.

• Females were more likely than males to be served by nurses (38.9 percent versus 23.5 percent), health educators (10.9 percent versus 4.6 percent) and social workers (18.8 percent versus 14.0 percent), whereas males were more likely than females to be served by case managers (59.0 percent versus 43.1 percent), other mental health workers (2.5 percent versus 1.1 percent), counselors (25.7 percent versus 21.2 percent), and peer counselors (17.5 percent versus 6.9 percent).

• For those clients who received at least one intervention, males participated in a higher average number of interventions by social workers and counselors than females (mean for social workers=3.69 versus 2.57; mean for counselors=5.08 versus 2.43).

• On the average, males tended to receive more interventions from social workers (mean=3.69) and counselors (mean=5.08) than did females (mean=2.57 and 2.43 respectively).

Additional Findings Based on HIV Status
HIV-positive individuals (compared to individuals with unknown HIV status) were less likely to have been served by physicians (15.8 percent versus 29.0 percent), nurses (15.8 percent versus 33.3 percent), outreach workers (5.7 percent versus 19.6 percent), and counselors (18.4 percent versus 24.0 percent). However, HIV-positives were more likely to have been provided service by case managers (64.9 percent versus 49.2 percent), social workers (19.7 percent versus 16.1 percent), other mental health workers (4.4 percent versus 1.4 percent), public health workers (23.7 percent versus 0.3 percent), peer counselors (60.1 percent versus 6.2 percent), and teachers (4.4 percent versus 1.3 percent). Of the interventions provided by this group of programs, many of the HIV-positive youth were served primarily by paraprofessional staff.

There were no differences, as a function of HIV status, for percentages of individuals served by psychiatrists, health educators, and psychologists.

Of the clients receiving interventions, HIV-positive clients compared to clients of unknown HIV status received a higher average number of interventions by physicians (mean=5.61 versus 1.74), nurses (mean=12.03 versus 1.86), case managers (mean=12.15 versus 3.01), counselors (mean=11.38 versus 3.15), peer counselors (mean=12.83 versus 6.42), and teachers (mean=4.70 versus 1.25).

A lower percentage of HIV-positive males received services from a physician or nurse than males with unknown HIV status, or females of either status. A significantly higher percentage of HIV-positive males received services from a social worker or peer counselor than males with unknown HIV status or females of either status.

Types of Interventions Received by Clients Across Sites
The next set of tables and figures describes the specific content of interventions received by clients. Table 4-4 presents the number of sites (out of 10) that offered various types of interventions and the median percentage of time that the interventions were offered. Most projects provided interventions about HIV risk assessment, HIV prevention, and HIV post-test counseling, whereas few sites provided medical-emergency and substance abuse/mental health screenings. The type of intervention provided most frequently to clients was categorized as HIV prevention.

Table 4-4
Across Sites, What Types of Interventions Did Clients Receive?

Note. For a given site, a session type was considered offered if it occurred more than five percent of the time.

Figure 4-4 below illustrates the percentage of project clients who received various types of HIV service interventions.

Figure 4-4. Percentage of males and females who received at least one session of various types of HIV services/interventions (N=1,023 males, N=1,074 females).

• Females were more likely than males to receive at least one session for all services characterized as HIV-related: risk assessment, testing, pre- and post-test counseling, HIV prevention counseling, and/or risk reduction.

• More than one in two females received at least one HIV risk assessment (54.9 percent) and at least one HIV prevention intervention (52.4 percent).

• Of the above-related HIV services, the smallest discrepancy for services received between males and females was for HIV post-test counseling (21.6 percent versus 25.4 percent).

• Of the clients who received at least one intervention, males participated in more prevention interventions that were not directly HIV-related than females (mean=2.64 versus 1.84).

• Males tended to receive a greater number of interventions focused on prevention (other than HIV-related) (mean=2.64) compared to females (mean=1.84).

Additional Findings Based on HIV Status
Individuals identified as being HIV-positive were less likely than individuals whose HIV status was unknown to receive at least one session of the following HIV counseling and testing services: HIV risk assessment (11.4 percent versus 53.3 percent), HIV tests (3.9 percent versus 40.5 percent), HIV pre-test counseling (2.6 percent versus 43.3 percent), HIV post-test counseling (4.8 percent versus 25.8 percent), HIV prevention (18.8 percent versus 50.6 percent), and other prevention (16.2 percent versus 32.9 percent). This pattern suggests that youth living with HIV already have been tested and know their HIV status before seeking services from the adolescent SPNS projects.

Of the clients receiving interventions, HIV-positive clients received more interventions than clients of unknown HIV status relating to HIV risk assessment (mean=1.69 versus 1.29), HIV testing (mean=1.44 versus 1.14), HIV post-test counseling (mean=1.55 versus 1.09), HIV prevention (mean=3.19 versus 1.69), and other prevention (mean=9.65 versus 1.72).

The next chart, Figure 4-5, shows the percentage of males and females who received medical services from the 10 adolescent SPNS projects.

Figure 4-5. Percentage of males and females who received at least one session of medical services (N=1,023 males, N=1,074 females).

• Females were more likely than males to receive all services classified as medical, except for medical walk-in services. Gender differences emerged for receipt of medical laboratory tests (not HIV; 16.5 percent of females versus 12.6 percent of males); medical appointments (25.3 percent of females versus 15.5 percent of males); and family planning (19.6 percent of females versus 1.3 percent of males). No differences across gender were identified for physical exams, emergency room services, medical walk-in services, and substance abuse/mental health screenings.

• About one in four females (25.3 percent) received medical services by appointment (compared to one in eight males; 15.5 percent), and about two in five females (19.6 percent) received family planning services (compared to one in 100 males; 1.3 percent).

• There were no significant differences between males and females in the number of medically oriented service interventions received.

Additional Findings Based on HIV Status
Individuals who were identified as being HIV-positive compared to individuals whose HIV status was unknown were less likely to receive physical exams (11.4 percent versus 21.8 percent), lab tests (not HIV (9.2 percent versus 15.2 percent), and medical walk-in services (6.6. percent versus 23.4 percent). HIV-positive individuals were more likely than individuals with unknown HIV status to receive medical emergency services (7.0 percent versus 1.7 percent) and substance abuse and mental health screenings (9.2 percent versus 3.5 percent). No differences in the number of medical services by appointment or family planning emerged based on HIV status.

Of the clients receiving interventions, more services were received by HIV-positive clients compared to clients of unknown HIV status for medical physical exams (mean=2.54 versus 1.38), medical laboratory tests (not HIV related; mean=4.33 versus 1.33), medical emergency (mean=2.88 versus 1.06), medical appointments (mean 7.27 versus 1.63), medical walk-ins (mean=5.13 versus 1.63), family planning (mean=3.30 versus 1.48), and substance abuse/mental health screenings (2.67 versus 1.65).

HIV-positive males were least likely (compared to HIV-positive females and males and females of unknown HIV status) to receive any of these services.

Types of Psychosocial Services Received by Clients Across Sites
Descriptive information about the types of psychosocial services received by clients is provided in Table 4-5 and Figure 4-6. As seen in Table 4-5, individual counseling is offered by all of the projects (a median of 28.6 percent of the time) and family-couple counseling is offered by only one project (with a median of 1.9 percent of the time).

Table 4-5
Across Sites, What Types of Psychosocial
Services Did Client Receive at Interventions?

Note. For a given site, a psychosocial service was considered offered if it occurred more than five percent of the time.

Figure 4-6 summarizes the percentage of males and females who received psychosocial services, such as counseling and crisis intervention, from the 10 adolescent SPNS projects.

Figure 4-6. Percentage of males and females who received at least one session of psychosocial services (N=1,023 males, N=1,074 females).

• Higher percentages of males than females received individual counseling (31.2 percent versus 21.4 percent) and alternate therapy (3.6 percent versus 2.0 percent); a higher proportion of females than males received group counseling/therapy (13.4 percent versus 9.4 percent).

• Small percentages of males and females received family and couple counseling, crisis intervention, and alternate therapy.

• There were no statistically significant differences between males and females in the number of psychosocial service interventions received.

Additional Findings Based on HIV Status
Clients who were HIV-positive (compared to individuals with unknown HIV status) were more likely to receive at least one session of individual counseling/therapy (71.1 percent versus 20.7 percent), group counseling (22.4 percent versus 10.1 percent), family-couple counseling (4.4. percent versus 1.5 percent), crisis intervention (14.0 percent versus 4.2 percent), and alternate therapy (11.4 percent versus 1.7 percent).

Clients who were identified as being HIV-positive compared to clients of unknown HIV status received more interventions involving individual counseling (mean=6.33 versus 3.19), crisis intervention (mean=2.56 versus 1.51), and alternative therapy (mean=3.46 versus 1.52). HIV-positive males were much more likely than HIV-positive females or young men and women of unknown HIV status to receive individual counseling or group counseling.

Types of Ancillary Support Services Received by Clients
Sites varied in the types of ancillary support services that were provided at interventions. The most frequently offered ancillary support services offered by sites were information and referral, and practical support, whereas 12-step groups were not offered by any sites. Table 4-6 and Figure 4-7 show how gender and HIV status relate to these services across all sites.

Table 4-6
Across Sites, What Types of Ancillary
Support Services Did Clients Receive at Interventions?

Note. For a given site, an ancillary support service was considered offered if it occurred more than five percent of the time.

Figure 4-7 summarizes the percentage of young males and females who received various ancillary support services from the 10 projects, such as practical support and support groups.

Figure 4-7. Percentage of males and females who received at least one session of ancillary support services (N=1,023 males, N=1,074 females). 

• Approximately one in two males (48.7 percent) and females (43.8 percent) received interventions relating to obtaining information and referrals.

• Males were more likely than females to participate in 12-step groups (1.0 percent versus 0.3 percent), peer support groups (12.5 percent versus 8.9 percent), HIV support groups (8.9 percent versus 1.4 percent), information and referrals (48.7 percent versus 43.8 percent), and recreation (19.1 percent versus 6.5 percent). There were no gender differences in practical support.

• Of the clients receiving at least one intervention, on average, males participated in a higher number of interventions involving peer support groups and practical support compared to females (mean for peer support groups=5.31 versus 2.53; mean for practical support=7.47 versus 3.58).

• On the average, males received more sessions of peer support groups (mean=5.31) than did females (mean=2.53).

Additional Findings Based on HIV Status
Individuals who were HIV-positive (compared to individuals with unknown HIV status) were more likely to receive at least one session involving practical support (30.6 percent versus 17.3 percent), 12-step groups (2.6 percent versus 0.4 percent), peer support groups (35.1 percent versus 7.7 percent), HIV support groups (41.2 percent versus 0.6 percent), information and referrals (82.5 percent versus 41.7 percent), and recreation (28.5 percent versus 10.7 percent).

Of the clients who participated in interventions, those who were identified as being HIV-positive compared to clients of unknown HIV status participated in more interventions that involved practical support (mean=10.87 versus 4.26), peer support groups (mean=7.30 versus 2.35), information and referral (mean=9.02 versus 2.80), and recreation (mean=3.86 versus 2.26).

HIV-positive females were most likely to receive practical support (compared to HIV-positive males and individuals of unknown HIV status). HIV-positive males, on the other hand, were more likely to participate in peer support groups when compared to HIV-positive females and individuals of unknown HIV status.

¹ Note that the intervention forms code outpatient services; the vast majority of services provided by Walden House are in a residential therapeutic community and are recorded for the cross-cutting evaluation on residential forms, which are not directly comparable to the outpatient intervention forms.

² Gender information was not available for seven cases. Summaries involving all service encounters (8,041 interventions with males, 5,438 interventions with females, and 140 cases for which gender information was not available) are shown in Appendix I.

³ As described in the introduction to the Technical Appendix of this chapter, the inferential analyses are based on a series of logistic analyses in which gender (male, female), HIV status (status unknown or HIV-positive), and gender by HIV status interaction are used to predict whether or not the client received a particular type of intervention.

⁴ This section is purposefully focused on basic, descriptive aspects of data. For readers interested in inferential tests of these data, see the Technical Appendix to this chapter. All figures showing unduplicated individuals are given in the technical appendix, along with analyses based on gender, HIV status, and the gender by HIV status interaction.

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