Objective: To provide comprehensive health care services to HIV positive and HIV at-risk adolescents and young adults in a rural area.
In a Nutshell: A nurse practitioner and trained peer educators travel in a HealthMobile – an RV-sized vehicle with an examination room and basic medical equipment – to provide services three days a week, from about 4 to 7 p.m., throughout Sullivan County. The peer educators, who are paid $9 an hour, do oral HIV risk assessments and harm-reduction education. The nurse tests for sexually transmitted infections and pregnancy, and provides counseling and contraception services. The nurse also runs an in-house clinic at the sponsoring hospital for at-risk teens four days a week.
When and Where: The Catskill Regional Medical Center started Catskill Adolescent Treatment Services (CATS) in September 2002, adding the HealthMobile and peer educator components that October. Sullivan is a mountainous county with about 72,000 residents.
Staff: CATS was developed by Catskill Regional’s AIDS program administrator, Gerard Ilaria; director of infectious diseases, Gary Good; and nurse practitioner John Nelson, all of whom continue to run it. The HealthMobile is operated by Nelson, a driver and two to five peer educators each night. The peer educators are ages 16 to 21.
Obstacles: Finding transportation for youth who want to use the services confidentially. The hospital contracted with two taxi companies to drive adolescents to and from the clinic or the HealthMobile.
Cost: $115,000 a year for CATS. The hospital used a state grant to purchase the $225,000 HealthMobile, which is used during the day for mammograms and other adult care screenings.
Who Pays: The program began with a $50,000 Ryan White grant from the U.S. Department of Health and Human Services. Now the New York State Department of Health’s AIDS Institute fully funds CATS through its Adolescent Prevention Services program.
Youth Served: CATS has served more than 400 adolescents, about half of whom used the HealthMobile. Of those, 58 percent were girls, about half were white, and 10 percent were in residential drug rehabilitation facilities.
Youth Turn-On: Those who use CATS “have identified the confidential and nonjudgmental care as being the best thing about the program,” Nelson says, “besides the free condoms.”
Youth Turn-Off: First-time visitors to the clinic and HealthMobile have strong fears of their confidentiality being breached. Research Shows: In about two years, CATS has tested 408 adolescents for sexually transmitted infections. Ten tested positive for HIV and 28 tested positive for other STD infections. In a county with one of the highest high school dropout rates in the state, all five of the peer educators who are past high school age have gone to college.
What’s in the Way: No money is available to add a full-time social worker to help provide mental health care at the clinic and in the HealthMobile.