Finding the underserved: directions for HIV care in the future.

The demographic, behavior, and background characteristics of 4,804 participants in 17 national demonstration projects for HIV medical and/or psychosocial support services were coded for an index of "service need" or possible under-representation in the traditional healthcare system. Fifteen items were coded including status as a person of color, lack of private insurance, unemployment/disability, problem drinking, crack cocaine use, heroin use, other illicit drug use, less than 12 years of education, criminal justice system involvement, children requiring care while the patient receives services, sex work, being the sex partner of an injection drug user, unstable housing, primary language not English, and age less than 21 or over 55 years. Most (87.7%) of the program participants had four or more of these factors present. Through CHAID modeling, those groups with the highest levels of service need and vulnerability were identified. These data suggest that these projects, designed to attract and serve individuals potentially underrepresented in the health services system, had in fact achieved that goal. Implications of the changing demographics of the HIV epidemic for the health service delivery system are discussed.

Effects of HIV/AIDS education and training on patient care and provider practices: a cross-cutting evaluation.

Initial and continuing training in HIV/AIDS service provision is a critical way to enable the nation's health providers to use state-of-the-art developments and perspectives. Typically, the efficacy of HIV/AIDS training programs is evaluated using assessments administered to trainees immediately following the training. This study reports cross-cutting findings from telephone interviews conducted with 218 trainees an average of 8 months after training. Long-term training effects are examined in three domains: (a) general perspectives on HIV/AIDS; (b) health care provider service provision; and (c) changes in procedures and operations at the health care system level. The findings show the different ways that the training experience had long-term positive and observable effects in these three domains. In some cases, background characteristics and job positions predicted the specific type of reported training effects. The pattern of results suggests ways in which training methods can be targeted to specific audiences.

Healthcare provider characteristics and perceived confidence from HIV/AIDS education.

This study reports findings from six training projects designed to keep health providers up-to-date on emerging developments and approaches in HIV/AIDS care. Participants were 3,779 individuals who described themselves, their professional background, and their specific experience in the HIV/AIDS field. These characteristics were compared with their self-reported confidence in managing clients, counseling clients, providing services, and the training topics. A repeated-measures design examining level and change of confidence showed little support for links between provider characteristics and confidence due to HIV/AIDS training experience. Thus, knowing a provider's background does not necessarily provide diagnostic information about who might most benefit in improved confidence from HIV/AIDS educational training. These results suggest that HIV/AIDS training programs may be targeted broadly-to a wide range of healthcare providers of diverse backgrounds-with little or no impact on overall levels and changes in provider confidence.

Systems change resulting from HIV/AIDS education and training. A cross-cutting evaluation of nine innovative projects.

An evaluation of nine diverse HIV/AIDS training programs assessed the degree to which the programs produced changes in the ways that health care systems deliver HIV/AIDS care. Participants were interviewed an average of 8 months following completion of training and asked for specific examples of a resulting change in their health care system. More than half of the trainees gave at least one example of a systems change. The examples included the way patient referrals are made, the manner in which agency collaborations are organized, and the way care is delivered.

Psychosocial characteristics of pregnant women with and without a history of substance abuse.

This study was undertaken to identify the psychosocial characteristics and service needs of pregnant women with substance abuse histories. Two hundred and twenty-five pregnant women defined as having high-risk pregnancies for psychosocial reasons were interviewed using a structured questionnaire when they presented for prenatal care at a large urban clinic. Women who admitted to problems with substance abuse were compared to those who denied a history of substance abuse. Women with an admitted history of substance abuse were significantly older, had more children, were more likely to live on their own or in an institutional setting, and more frequently reported that they currently smoked cigarettes. In addition, women with substance abuse problems delayed prenatal care an average of one month longer. Other differences between the two groups, as well as the implications of the findings for social work practice in health care settings, are discussed.

Hospital boarder babies and their families: an exploratory study.

Data were abstracted from the medical and social work charts of 20 newborns who were classified as boarder babies and their mothers (N = 18) to identify bio-psycho-social factors associated with boarding. The findings show that the mothers whose newborns remained in the hospital as boarders were usually drug users, had other children in out-of-home placement, and over half are periodically homeless. Most of these mothers also lacked informal social support. The major health problems of infants were prematurity and associated infections. The total number of infant boarding days was 195 for a total of $117,000 in unreimbursed costs to the hospital. Practice and program implications and directions for future research are discussed.