Seattle YouthCare's prevention, intervention, and education program: a model of care for HIV-positive, homeless, and at-risk youth.

YouthCare's project for youth who are human immunodeficiency virus (HIV)-positive or at high risk for becoming HIV positive is one of 10 supported by Special Projects of National Significance Program, HIV/Acquired Immunodeficiency Syndrome Bureau, Health Resources and Services Administration. Throughout its 23-year history, YouthCare has focused on serving runaway, homeless, sexual minority, and other youth "on the margins." To respond effectively to the needs of these youth, YouthCare has developed creative service approaches including involving youth in program design and taking the programs to where the youth live. Building on this experience, the agency developed a continuum of services which has provided care to 906 youth, including 37 who are HIV positive. The five major elements of the model include: (a) youth-specific HIV antibody test counseling, (b) outreach, (c) intensive case management for HIV-positive youth, (d) prevention services for youth at high risk of HIV infection, and (e) peer involvement. Quantitative evaluation helped in identifying youth served by the project (e.g., over one third self-identify as a sexual minority) and the sites at which services should be provided. Preliminary results from qualitative evaluations have stressed the importance of teamwork in designing clinical interventions and providing support to direct-service staff. This report's conclusion stresses that case management for this population, even though time and resource-intensive, is effective, and that services need to be flexible and tailored to each client's needs.