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3. Linking HIV-Negative Youth to Prevention Services in 12 U.S. Cities: Barriers and Facilitators to Implementing the HIV Prevention Continuum

Author

Doll, Mimi, Fortenberry, J Dennis, Roseland, Denise, McAuliff, Kathleen, Wilson, Craig M, and Boyer, Cherrie B

Subjects
Health Services and Systems, Biomedical and Clinical Sciences, Public Health, Health Sciences, Pediatric, Mental Health, Behavioral and Social Science, Prevention, Infectious Diseases, Health Services, Clinical Research, HIV/AIDS, Pediatric AIDS, Adolescent Sexual Activity, 8.1 Organisation and delivery of services, Prevention of disease and conditions, and promotion of well-being, Health and social care services research, 3.1 Primary prevention interventions to modify behaviours or promote wellbeing, Infection, Good Health and Well Being, Adolescent, HIV Infections, Health Services Accessibility, Humans, Interviews as Topic, Male, Mass Screening, Patient Acceptance of Health Care, Pre-Exposure Prophylaxis, Qualitative Research, Sexual and Gender Minorities, Young Adult, Linkage to prevention, High-risk HIV-negative youth, HIV prevention, HIV prevention infrastructure, YMSM of color, Medical and Health Sciences, Education, Psychology and Cognitive Sciences, Biomedical and clinical sciences, Health sciences, Psychology
Abstract

PurposeLinkage of HIV-negative youth to prevention services is increasingly important with the development of effective pre-exposure prophylaxis that complements behavioral and other prevention-focused interventions. However, effective infrastructure for delivery of prevention services does not exist, leaving many programs to address HIV prevention without data to guide program development/implementation. The objective of this study was to provide a qualitative description of barriers and facilitators of linkage to prevention services among high-risk, HIV-negative youth.DesignThematic analysis of structured interviews with staff implementing linkage to prevention services programs for youth aged 12-24 years.MethodsTwelve adolescent medicine HIV primary care programs as part of larger testing research program focused on young sexual minority men of color. The study included staff implementing linkage to prevention services programs along with community-based HIV testing programs. The main outcomes of the study were key barriers/facilitators to linkage to prevention services.ResultsEight themes summarized perspectives on linkage to prevention services: (1) relationships with community partners, (2) trust between providers and youth, (3) youth capacity to navigate prevention services, (4) pre-exposure prophylaxis specific issues, (5) privacy issues, (6) gaps in health records preventing tailored services, (7) confidentiality of care for youth accessing services through parents'/caretakers' insurance, and (8) need for health-care institutions to keep pace with models that prioritize HIV prevention among at-risk youth. Themes are discussed in the context of factors that facilitated/challenged linkage to prevention services.ConclusionsSeveral evidence-based HIV prevention tools are available; infrastructures for coordinated service delivery to high-risk youth have not been developed. Implementation of such infrastructures requires attention to community-, provider-, and youth-related issues.

Published
2018

9. Parental Employment Status and Symptoms of Children Abused during a Recession

Author

Tobey, Trina, McAuliff, Kathleen, and Rocha, Celina

Abstract

Incidences and severity of child abuse have increased since the start of the recession. This study examined the relationship between employment status and severity of symptoms in children abused during a recession year. Participants included 154 females and 65 males between 2 and 17 years old referred to Dallas Children's Advocacy Center after surviving child sexual abuse, physical abuse, and/or neglect. We found that child abuse survivors whose mothers were unemployed showed higher symptom severity. Larger differences were found when participants were broken down by age, ethnicity, and living situation. Father's employment status did not affect symptom severity probably because many children lived with single mothers. We concluded that child abuse survivors whose mothers are unemployed have increased risk for psychological symptoms. (Contains 2 tables.)

Published
2013
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15. Empowered and disempowered voices of low-income people with disabilities on the initiation of government-funded, managed health care

Author

Steltenpohl, Crystal, Williams, Amber, Back, Lindsey, Keys, Christopher, Viola, Judah, and Mcauliff, Kathleen

Subjects
Asistencia gestionada, Social Psychology, Grupo marginado, media_common.quotation_subject, Population, lcsh:BF1-990, Social and Behavioral Sciences, Políticas de asistencia sanitaria, PsyArXiv|Social and Behavioral Sciences|Social and Personality Psychology|Community, Nursing, Health care, Developmental and Educational Psychology, Psychology, Medicine, Empowerment, education, PsyArXiv|Social and Behavioral Sciences|Social and Personality Psychology, Applied Psychology, media_common, Government, education.field_of_study, bepress|Social and Behavioral Sciences|Psychology, Disability, Community Psychology, Family caregivers, business.industry, Focus group, bepress|Social and Behavioral Sciences|Psychology|Community Psychology, FOS: Psychology, PsyArXiv|Social and Behavioral Sciences, Managed care, Marginalized group, lcsh:Psychology, Healthcare policy, bepress|Social and Behavioral Sciences, Discapacidad, bepress|Social and Behavioral Sciences|Psychology|Personality and Social Contexts, business, Medicaid
Abstract

The health and healthcare of vulnerable populations is an international concern. In 2011, a Midwestern state within the U.S. mandatorily transitioned 38,000 Medicaid recipients from a fee-for-service system into a managed care program in which managed care companies were contracted to provide recipients’ healthcare for a capitated rate. In addition to cost savings through reductions in preventable and unnecessary hospital admissions, the goals of the managed care program (MCP) included: (1) access to a more functional support system, which can support high and medium risk users in the development of care plans and coordination of care, and (2) choice among competent providers. The population transitioned was a high-need, high-cost, low-income, and low-power group of individuals. The evaluation research team used focus groups as one of many strategies to understand the experience of users during the first two years of this complex change effort. The article explores empowerment in terms of users and their family caregivers’ ability to make meaningful choices and access resources with regard to their healthcare. Specifically, factors empowering and disempowering users were identified within three thematic areas: (1) enrollment experiences, (2) access to care and (3) communication with managed care organizations and providers. While the change was not optional for users, a disempowering feature, there remained opportunities for other empowering and disempowering processes and outcomes through the transition and new managed care program. The results are from 74 participants: 65 users and 9 family caregivers in 11 focus groups and six interviews across two waves of data collection. MCP users felt disempowered by an initial lack of providers, difficulty with transportation to appointments, and challenges obtaining adequate medication. They felt empowered by having a choice of providers, good quality of transportation services and clear communication from providers and managed care organizations. Recommendations for increasing prospects for the empowerment of healthcare users with disabilities within a managed care environment are presented.

Published
2016

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