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Youth-to-Youth–Peer Workers in HIV/AIDS Youth Programs:
A Peer Development Guide
Preface
Two concepts have become increasingly recognized in the field of adolescent HIV service delivery; the first is a model of adolescent health promotion commonly referred to as youth development and the latter is a research practice known as empowerment evaluation. When combined, these models can effectively be used to sustain the most lasting and significant health outcomes among youth and young adults at highest risk for or infected with HIV.
Empowerment evaluation has emerged as a research model that helps program participants or clients evaluate themselves and their program to improve practice and foster self-determination by involving them in the development and implementation of the methodology. Typical empowerment evaluation models, for example, are a partnership between program participants, who act as facilitators, and an outside professional evaluator, who often serves as a coach and oversees the research process.
Variations of empowerment evaluation have been extremely successful in measuring outcomes within public health programs, especially those that focus on HIV and substance use prevention, because these programs rely so much on rich qualitative findings about changes in participant behavior and attitude. The empowerment evaluation approach is key with these programs, because it reflects the true needs of a given community, thereby allowing them to establish sensitive goals and identify the steps and resources necessary to meet them. Traditional evaluations, in which evaluators are perceived as outsiders who may not be sensitive to the given goals of the program, are often too external and objective to capture a rich enough set of data. Rather, empowerment evaluation shifts the focus from external to an internal, community-based focus inherent in the program participants themselves.
The results of programs that use empowerment evaluation methodologies are multi faceted. Programs are enhanced due to a bridged gap between program managers and constituents. Such programs more sensitively and accurately address the needs of participants, who are viewed as assets in program development. Outcomes are driven by the true need of the community and not by outside evaluators or program staff who are often detached from these needs. Additionally, empowerment evaluation methodologies assist program participants in building self-determination, community bonding, and valuable life skills.
The same elements intrinsic to empowerment evaluation models for youth prevention and health promotion programs are also rooted in youth development philosophy. Like empowerment evaluation, a youth development approach is built upon community-wide collaborations. This approach builds skills among program participants and fosters self-determination and resilience among them. Youth program participants are considered as part of the solution and not just the focus of the problem. Understanding the connection between youth risk and resiliency provided the foundation for several youth-driven, HIV care and prevention demonstration projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA) from 1993 – 1998. These programs were designed, delivered and evaluated by young people – the real experts of their health needs.
Research has proven that the only adolescent health promotion programs that sustain outcomes over an extended period of time foster and promote healthy youth development. The SPNS Programs’ resounding successes were due in large part to four core tenets that helped guide their service delivery models. They first strove to maintain the community’s capacity to address the health needs of youth and young adults, and at the same time identified the necessary conditions for on-going change. They strengthened community adults' and families' capacity to support youth in their homes, in the classrooms, and on the streets through the integration of respectful and positive youth/adult partnerships. They taught youth to be productive citizens, and trained them to meet their fullest potential. Finally, in order to improve long-term outcomes for youth entering adulthood, they promoted economic self-sufficiency through employment skills building and linkage to appropriate resources.
The nexus between empowerment evaluation and youth development within the context of HIV services has made a significant difference for several of the SPNS Programs’ clients and staff. This guide contains valuable lessons learned by both peer and adult staff who worked within seven of these demonstration projects. The seven project are Bay Area Young Positives (San Francisco, California); Children's Hospital of Boston/Boston HAPPENS (Boston, Massachusetts); Health Initiatives for Youth (San Francisco, California); Greater Bridgeport Adolescent Pregnancy Program/Teen Outreach Primary Services (Bridgeport, Connecticut); Indiana Youth Group/Youth Access Project (statewide in Indiana); Walden House, Inc. (San Francisco, California); and YouthCare (Seattle, Washington). While the purview of the guide’s lessons and practical tips is HIV service delivery, its contents offer a wealth of relevant information that can be applied in a variety of youth-focused programs.
Bill Bourdon
Health Initiatives for Youth
March 1999
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