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 t o conduct street outreach to facilitate risk reduction among a variety of hard-to-reach populations who are at risk for human immunodeficien cy virus infection and other sexually transmitted diseases. The intera ction between the client and outreach worker is the fundamental elemen t of any street outreach activity. However, little has been written ab out the relationships that develop on the street between workers and c lients to promote, support, and sustain behavior change. This paper de scribes two types of interactions that occur in street outreach interv ention activities: the contact and the encounter. As part of a compreh ensive 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 eval uation, a contact was defined as a face-to-face interaction during whi ch materials and/or information are exchanged between an outreach work er 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 delive ry in response to the client's identified need(s), and a planned follo w-up. The contact provides a means to initiate interaction with potent ial clients in the community. It is the encounter that provides more s ignificant opportunity for helping the client initiate and sustain beh avior change. The discussion suggests techniques for enhancing the enc ounter between outreach workers and clients using the conceptual frame work of the social work helping relationship. Five elements of the enc ounter are defined and developed: screening, engagement, assessment, s ervice delivery, and follow-up. The encounter represents an enhancemen t of the traditional street outreach interaction and a more systematic approach to promoting the behavioral change goals of the AIDS Evaluat ion of Street Outreach Projects. Recommendations are suggested for imp lementing the encounter in street outreach programs serving hard-to-re ach populations.