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。这些受试者的细目 仍在登记的如下：15名感染女性，5名 未感染的女性、5名感染的男性和3名未感染的男性。四 登记的受试者已经结束研究，三名未感染的女性和一名 被感染的男性。离开研究的受感染对象被重新安置 到德克萨斯州的一个设施，那里没有到达地点。为了增强 在这项研究中，有几个策略已经到位。首先， 家访的频率正在增加，以保持兴趣和 坚持不懈。此外，新的社会工作者/个案经理将专注于 完全依赖于那些从事护理的青年，并协调所有的外展 是另一个人干的。大多数离开这项研究的年轻人 都是未受感染的对照雌性。为了解决这个问题，这项研究 团队正在与其他正在处理高风险问题的小组密切合作 青年以确定那些表现出对医学有一定坚持的青年 访问，其中许多人已经在此与提供商建立了关系 机构。 已经制定了几项计划，以加强招聘和留住。第一, 项目准入将希望让更多的年轻人参与艾滋病毒咨询和 测试。外展工作人员已增加，并将重点放在更多 直接街头推广以及与供应商的持续对话 社区，其中许多人已经将青年视为可及者。 在议定书中保持年轻人是研究小组的一个主要目标。 除了更密集的家访和病例管理外，一些独特的 项目正在开始或正在开发中。如前所述，我们有 获得其他资金，以提供生活方向计划 围绕学校和职业康复与青年开展密集工作。 该项目的协调员在诊所会见了这位青年， 讨论了该计划，并鼓励年轻人参与。对…的希望 这个节目是为了给这些年轻人的目标和梦想，他们的生活和 实现这些目标所需的支持和发展。这是一项旨在 改变许多年轻人的宿命论态度，这反过来又将 希望能有助于坚持。社会工作者和其中一名同龄人 教育工作者正在开发一个生命方向计划的延伸，以 在小组环境中与青少年一起讨论诸如就诊等问题 依从性、服药依从性、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，并 他亲自面对了所有这些问题。希望这些团体， 与个人咨询一起，将帮助年轻人不仅看到 护理的好处，但也要批判性地看待他们的生活并发展 个人计划和战略，以更好地坚持医疗养生法。

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.