Defining the components of street outreach for HIV prevention: the contact and the encounter.

Health departments and community-based organizations across the United States are funded by the Centers for Disease Control and Prevention to conduct street outreach to facilitate risk reduction among a variety of hard-to-reach populations who are at risk for human immunodeficiency virus infection and other sexually transmitted diseases. The interaction between the client and outreach worker is the fundamental element of any street outreach activity. However, little has been written about the relationships that develop on the street between workers and clients to promote, support, and sustain behavior change. This paper describes two types of interactions that occur in street outreach intervention activities: the contact and the encounter. As part of a comprehensive evaluation of street outreach, interactions between workers and clients were described and analyzed during the formative phase of the AIDS Evaluation of Street Outreach Projects. For purposes of the evaluation, a contact was defined as a face-to-face interaction during which materials and/or information are exchanged between an outreach worker and a client (or small group of clients). An encounter was defined as a face-to-face interaction between a worker and client going beyond the contact to include individual assessment, specific service delivery in response to the client's identified need(s), and a planned follow-up. The contact provides a means to initiate interaction with potential clients in the community. It is the encounter that provides more significant opportunity for helping the client initiate and sustain behavior change. The discussion suggests techniques for enhancing the encounter between outreach workers and clients using the conceptual framework of the social work helping relationship. Five elements of the encounter are defined and developed: screening, engagement, assessment, service delivery, and follow-up. The encounter represents an enhancement of the traditional street outreach interaction and a more systematic approach to promoting the behavioral change goals of the AIDS Evaluation of Street Outreach Projects. Recommendations are suggested for implementing the encounter in street outreach programs serving hard-to-reach populations.