title: Impact of on-site social work services on the documentation of client and family-centered information: the experience of Ryan White CARE Act (Title IV) pediatric program sites in Maryland.
abstract: BACKGROUND
  The purpose of this study is to (1) describe client and maternal demographic, social, and medical characteristics of pediatric clients receiving medical and social services at Ryan White (Title IV) program sites, and (2) determine the impact of on-site social work services in documenting client and family-related information used to assess the psychosocial needs of the families affected by human immunodeficiency syndrome and acquired immunodeficiency syndrome (HIV/AIDS).
  
  
  METHODS
  We studied infants born to known HIV-infected women who received HIV-related medical services at a federally funded Title IV Ryan White CARE Act provider site in Maryland. Eligibility criteria included < 24 months of age at time of initial clinic visit, a history of birth to a known HIV-infected woman, and a minimum of one comprehensive clinical visit for medical evaluation at a selected Title IV provider site. Study populations were categorized into three independent clinic cohorts. A pre- and postintervention study design was used to assess the impact of the intervention (i.e., on-site social work activities) on variables of interest. Clinic cohorts were (a) preintervention group (N = 181), from January 1, 1986 to December 31, 1989; (b) initial postintervention group (N = 216), from January 1, 1991 to December 31, 1992; and, (c) long-term postintervention group (N = 197), from January 1, 1993 to March 1, 1994. Client and maternal demographic, social, and medical information were recorded and statistical comparisons between pre- and postintervention clinic cohorts were completed with the use of standard statistical methods.
  
  
  RESULTS
  Pediatric clients were predominantly African American (94%), lived in low-income family units reflected by the prevalence of public assistance programs (i.e., Medicaid), had a high likelihood of Medicaid enrollment (> 80%), and reported a high frequency of social disruption (e.g., protective services interventions and housing difficulties). Greater than half of all medical records documented the "mother" as the client's primary caregiver in the three cohorts (a,b,c, above) pre- and postintervention cohorts, 51%, 65%, and 66.5%, respectively. Over two-thirds of the mothers among all cohorts were reported to have a current or past history of illicit drug use or alcohol abuse, 69%, 62%, and 67.5%, respectively. Postintervention groups, both initial and long term, were significantly more likely than the preintervention group to have documented medical record information relevant to a history of protective services, housing problems, and maternal demographic, social, and clinical information. Maternal HIV-related clinical status and select social factors (e.g., drug use, housing) remained underreported in both postintervention groups.
  
  
  CONCLUSIONS
  Title IV pediatric clinical sites deliver services to a predominantly urban, poor, minority community-the population at greatest risk for pediatric HIV-infection in Maryland. Alternative family members as the primary caregiver for infants and children was common and increased over time. These findings demonstrate that Title IV funded programs have been successful in the documentation of valuable client and maternal information necessary for the development of family-centered clinical and support services to a highly vulnerable population of HIV at-risk or infected infants and children in Maryland.
authors.affiliation: Center for AIDS Services Planning and Development, AIDS Administration, Maryland Department of Health and Mental Hygiene, Baltimore, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Palenicek
authors.forename: J
authors.initials: J
authors.lastname: Hidalgo
authors.forename: N
authors.initials: N
authors.lastname: Hutton
authors.forename: B
authors.initials: B
authors.lastname: Weiss
authors.forename: P E
authors.initials: PE
authors.lastname: Vink
authors.forename: J G
authors.initials: JG
authors.lastname: Palcnicek
mesh_terms: D000328:Adult; D015142:Baltimore; D002662:Child Health Services / Q000458:organization & administration*; D005260:Female; D005380:Financing, Government; D015658:HIV Infections / Q000517:prevention & control*; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records / Q000592:standards*; D009313:National Health Programs; D015397:Program Evaluation; D012947:Social Work / Q000458:organization & administration*