REACH--REACHING FOR EXCELLENCE IN ADOLESCENT HEALTH CARE

到目前为止，已有33名青年参加了REACH研究。 费城儿童医院 这些科目的分类， 仍在登记的人数如下：15名感染女性，5名 未受感染的女性，五名受感染的男性和三名未受感染的男性。 四 入组的受试者已经退出研究，三名未感染的女性和一名 被感染的男性 离开研究的受感染受试者被重新安置 德克萨斯州的一家工厂，那里没有REACH网站。 加强 在研究中，有几种策略。 一是 家访的频率正在增加，以保持兴趣， 坚持。 此外，新的社会工作者/个案经理专注于 完全依靠那些参与护理的青年， 是另一个人 大多数离开研究的年轻人 是未受感染的对照组雌性。 为了解决这个问题，研究 该小组正在与其他从事高风险工作的小组密切合作， 青年，以确定青年谁表现出一定的坚持医疗 访问，其中许多人已经与供应商建立了关系， 机构。 已制定若干计划，以加强征聘和留用工作。 第一、 ACCESS项目希望让更多的年轻人参与艾滋病毒咨询， 试验. 外联工作人员已经增加，并将侧重于更多的 直接的街头宣传以及与供应商的持续对话， 社区，其中许多人已经将青年转介到REACH。 在方案中保持年轻是研究团队的主要目标。 除了更密集的家访和个案管理，一些独特的 项目已经开始或正在开发中。 如前所述，我们有 收到其他资金，以提供一个生活方向计划， 在学校和职业康复方面与青年开展深入工作。 该项目的协调员在诊所会见了年轻人， 讨论该计划，并鼓励青年参与。 的希望 这个项目是为了给这些年轻人的生活目标和梦想， 实现这些目标所需的支持和发展。 这是一个程序， 改变许多年轻人的宿命态度，反过来， 希望有助于坚持。 社工沿着其中一名同伴 教育工作者正在开发一个扩展的生活方向计划， 在小组中与青少年一起讨论诊所访问等问题 依从性、药物依从性、营养、物质使用问题等。 同伴教育者是一名年轻男子，他也感染了艾滋病毒， 亲自面对所有这些问题。 希望这些团体， 沿着个别辅导，将帮助青少年不仅看到 护理的好处，但也要批判性地看待他们的生活， 个人计划和策略，以更好地遵守医疗制度。

To date, 33 youth have been enrolled into the REACH study here at The Children's Hospital of Philadelphia. The breakdown of these subjects who are still enrolled is as follows: fifteen infected females, five uninfected females, five infected males, and three uninfected males. Four enrolled subjects have come off study, three uninfected females and one infected male. The infected subject who has left the study was relocated to a facility in Texas where there is not a REACH site. To enhance retention in the study, several strategies are in place. First, the frequency of home visits is increasing in order to maintain interest and adherence. In addition, the new social worker/case manager is focussed completely on those youth engaged in care, with all outreach coordinated by a different individual. The majority of youth who have left the study have been uninfected control females. To address this problem, the study team is working closely with other groups who are working with high-risk youth to identify youth who have demonstrated some adherence to medical visits, many of whom already have a relationship with a provider at this institution. Several plans are in place to enhance recruitment and retention. First, Project ACCESS will hope to get more youth engaged in HIV counseling and testing. The outreach staff has been increased and will focus on more direct street outreach as well as ongoing conversations with providers in the community, many of whom have already referred youth for REACH. Maintaining youth in the protocol is a major goal of the study team. Besides more intensive home visitation and case management, some unique programs are beginning or under development. As mentioned, we have received other funding to provide a Life Directions program doing intensive work with youth around school and vocational rehabilitation. The coordinator of the program meets with the youth in the clinic, discusses the program, and encourages youth to participate. The hope of this program is to give these youth goals and dreams for their lives and the support and development needed to achieve them. This is a program to change the fatalistic attitude of many youth which, in turn, will hopefully help adherence. The social worker along with one of the peer educators is developing an extension of the Life Directions program to work with youth in a group setting to discuss such issues as clinic visit adherence, medication compliance, nutrition, substance use issues, etc. The Peer Educator is a young man who is also infected with HIV and has personally confronted all of these issues. The hope is that these groups, along with individual counseling, will help youth to not only see the benefits of care but also to look at their lives critically and develop individual plans and strategies for better adherence to medical Regimens.