Los Angeles Collaboration: Childrens Hospital Los Angeles (Los Angeles) and Harm Reduction Central (HRC) (Hollywood)
While a growing number of studies demonstrate the efficacy of HIV prevention and harm reduction interventions targeted to injection drug using (IDU) adults, no comparable research has been conducted with youth who are IDUs, sexual partners of IDUs and/or other high risk drug abusing adolescents. In the LA collaboration, a storefront harm reduction service and needle exchange site (HRC) collaborated with Childrens Hospital Los Angeles to assess a series of interventions for drug using youth. Project objectives sought to:
- Determine whether participation in these services is associated with a reduction in HIV risk behaviors,
- To evaluate whether some critical “dose” of the intervention is needed before youth begin to change their behavior,
- To evaluate whether some interventions are more desirable and/or more effective at engaging the target population, and
- To evaluate the interventions’ effectiveness at moving youth into drug treatment programs and/or more stable living circumstances.
- Project services provided for youth at HRC included: peer case management in collaboration with the LA County Dept. of Health Services, Narcotics Anonymous meetings, detox/rehab resources, and on-site harm reduction materials for youth.
- Arts programming was an integral part of services provided at HRC. A total of 252 alternative group activities were conducted during the project period, including: sculpture workshops, Web TV (free email), video production, a doll-making workshops, movie nights, musical events, health information sessions, drawing and photography workshops and theater events.
- Over an 18 month period, 889 youth participated in needle exchange at HRC, including 264 new youth who accessed services for the first time.
- A total of 292 youth ages 24 and younger received case management services.
- HRC staff actively participated in ongoing collection of evaluation data during the SCHEP contract. Data collection is now part of HRC activities and approximately 200-300 Scantron forms are now completed each week by staff. These data are valuable for documenting service utilization.
- Program and research staff jointly participated in the development and formulation of survey instruments for the cross-sectional analysis of clients interviewed.
- Researchers conducted a process evaluation of HRC activities over an 18 month period. Evaluation information was collected in journals by program staff and evaluators.
- 97 youth ages 16-24 participated in a structured cross-sectional survey.
- Descriptive data were collected from participants, including information on demographics, needle sharing, access to safe needles, sexual behavior and sexual related risk, drug injection history, and service utilization. Of youth surveyed, 84% were over 18, 88% reported they had ever injected, and 48% of all youth had used HRC for more than six months.
- 18 in-depth qualitative interviews were conducted with current and former HRC clients. These interviews revealed information about the ways in which HRC has made an impact on youth. The staff learned that although these interviews were valuable, they were quite time and labor intensive, and may not have been representative of the entire youth population at HRC.
- Focus groups conducted were successful for gaining direct input from clients about survey questions and client satisfaction.
Summary of Research Findings:
- Scantron data collected were able to indicate that 77% of youth participated in needle exchange, 25% engaged in counseling and testing, and 22% participated in alternative art activities.
- For the outcome measuring HRC utilization and drug treatment, youth who had come to HRC five times or more in the last six months were more likely to be currently trying to quit or cut down their use of drugs than youth who came less frequently.
- For the outcome measuring HRC utilization and HIV risk behavior, no correlation was found between the Scantron service utilization forms and HIV risk behavior, but significant correlation were found between self-reported use of services and HIV risk behaviors.
- Qualitative interviews with former HRC clients confirmed that contact with HRC played a role in their movement toward treatment. Moreover, youth interviewed believe that even though HRC promotes tolerance of drug users, it does not promote drug use, and HRC helped youth stay healthy while they were using drugs.
- Qualitative interviews revealed the ways in which HRC assisted youth, primarily by helping youth take care of themselves. Youth also agreed that HRC was effective in promoting harm reduction.
Last modified: January 20, 2011