Service use patterns of youth with, and at high risk for, HIV: A care typology

This paper uses confirmatory structural equation models to develop and test a theoretical model for understanding the service utilization history of 4 679 youth who received services from 10 national HIV/AIDS demonstration mod els of youth-appropriate and youth-attractive services funded by the Specia l Projects of National Significance (SPNS) Program, HIV/AIDS Bureau, Health Resources and Services Administration. Although the projects differ from o ne another in the areas of emphasis in their service models, each is target ed to youth at high risk for HIV, or those youth who have already contracte d HIV, Collectively, the projects represent a comprehensive adolescent HIV service model. This paper examines the characteristics of the services prov ided to young people ranging from outreach to intensive participation in me dical treatment. Major typologies of service utilization are derived empiri cally through exploratory factor and cluster analysis methods. Confirmatory structural equation modeling methods are used to refine the exploratory re sults using a derivation and replication strategy and methods of statistica l estimation appropriate for non-normally distributed service utilization i ndicators. The model hypothesizes that youth enter the service system throu gh a general construct of connectedness to a comprehensive service model an d through service-specific methods, primarily of outreach or emergency serv ices. Estimates are made of the degree to which a comprehensive service mod el drives the services as opposed to specific service entry points.