Assessment as Intervention? Development of a Sexual Health History Calendar for Youth

Background and Purpose: Because most HIV infections among young people occur through sexual activity, assessing sexual history can be critical for both social work researchers and practitioners who work with youth. Typically, sexual risk is assessed using self-administered questionnaires because they are quickly and easily administered. However, in addition to notable limitations of the accuracy of retrospective data collected (Belli, 2004; Ostrow, Kessler, Stover & Pequegnat, 1993), standardized questionnaires do not facilitate insight into respondents' patterns of risk. The purpose of this study was to develop a data collection instrument which would help young people at high risk for HIV infection recall risk behaviors accurately while facilitating positive behavior change.

Methods: A Sexual Health History Calendar (SHHC) was developed for use with youth seeking sexual health services at a teen health clinic in a Midwestern city. The SHHC is based on the Life History Calendar (LHC) method which has been shown to enhance the quality of respondents' retrospective reports of events (Belli, 1998; Axinn, Pearce & Ghimire, 1999). The SHHC was designed collaboratively with clinic staff to provide a parallel assessment to the self-administered survey method of collecting state-required sexual health information.

Results: The SHHC instrument is a visually appealing calendar-based assessment of co-occurring risk behaviors anchored by contextual cues from other life domains including important personal life, family, school and work events. The SHHC focuses on two related risk domains: sexual behavior and substance use. Specifically, respondents are asked to report the following sexual risk behaviors for the last 12 months: number of partners (male and female), protected and unprotected sex, STI symptoms or diagnosis (themselves or partners), sex with a stranger, and giving/receiving money or drugs for sex. Respondents are also asked to report their own or a partner's substance use and sex while intoxicated. Additionally, the SHHC includes questions designed to help youth reflect on their health histories (i.e., connections between events, times when they may have wanted to make different decisions, and plans for making different choices in the future).

This poster will describe SHHC interview procedures and provide a comparative illustration of the standard self-administered clinic assessment and SHHC instrument. A second illustration will provide a visual dissection of each component of the SHHC to highlight elements of the instrument development process and demonstrate ways it could be adapted for other social work settings.

Conclusions and Implications: The self-administered SHHC instrument may be a useful alternative to standard risk assessments, particularly in environments in which social workers and other providers have limited time to assess client risk and protective factors. Further, by helping young people to gain insight into their patterns of co-occurring risky behaviors, the SHHC itself may function as an intervention by encouraging young people to avoid behaviors that may lead to HIV infection. The poster will conclude with a discussion of the advantages and disadvantages of the SHHC method for social work researchers and practitioners as well as applications of the SHHC instrument to other social work settings and populations.