Michele Issel | University of North Carolina at Charlotte (original) (raw)

Papers by Michele Issel

Public Health Nursing, 2013

This study discusses the challenges and characteristics of effective public health nursing leader... more This study discusses the challenges and characteristics of effective public health nursing leaders in local health departments and barriers to effective leadership during the hyperturbulent conditions of 2008-2010. Participants were drawn from a purposive sample of seven directors of nursing (DON) in six county LHDs in two states for this qualitative study using inductive methods. Semistructured telephone interviews were conducted, using open-ended questions. Data analysis consisted of coding, pattern identification, and theme development, assisted by the use of ATLAS.ti™. Credibility was achieved through intercoder agreement and resonance of the findings with participants. Two underlying challenges emerged: leadership dissonance and leading through ambiguity. Three key effective leadership attributes identified were as follows: collaborative change management, life-long learning, and being visionary. DONs identified extrinsic and intrinsic barriers to leadership effectiveness and leading change in public health systems and PHN practice. Results suggest ways to support PHN leaders in order to overcome barriers to effective leadership such as defined leadership competencies, continuing education, and mentorship opportunities.

Nursing economic$

Many states are faced with Medicaid fiscal constraints; therefore, reimbursable versus un-reimbur... more Many states are faced with Medicaid fiscal constraints; therefore, reimbursable versus un-reimbursable program costs must be clearly delineated. This study demonstrates a method to measure costs for Medicaid prenatal case management.

Online Journal of Public Health Informatics, Jan 13, 2014

Objective: Data collection and management by local health departments (LHDs) is a complex endeavo... more Objective: Data collection and management by local health departments (LHDs) is a complex endeavor, complicated by system level and organizational factors. The purpose of this study was to describe the processes and use of information systems (IS) utilized for data collection, management, and sharing by LHD employees.

Public Administration Quarterly, 1997

ABSTRACT In the last decade, maternal and child health (MCH) programs in local health departments... more ABSTRACT In the last decade, maternal and child health (MCH) programs in local health departments (LHDs) have faced a changing landscape. While MCH service delivery may have changed, the expectation to perform the Essential Public Health Services (EPHS) continues. The Maternal, Child, and Adolescent Health (MCAH) 2012 Survey was developed by NACCHO and the UIC School of Public Health with input from CityMatCH and AMCHP and distributed to a nationally representative sample of 546 LHDs, randomly selected by NACCHO and stratified by jurisdiction size (<50,000, 50,000-499,999, 500,000+); LHDs serving large jurisdictions were oversampled. The survey included questions about LHD MCAH services and questions to measure the performance of the EPHS. The mean number of services provided by LHDs was 13.1 or 39.4% (95% CI 36.5-42.2%) of the 35 possible services. On average, medium sized LHDs provided significantly more services (14.2) than small (12.4) or large LHDs (13.0). There was a significant positive relationship between the number of services provided and overall EPHS performance (p <.01). In three of four service domains, those LHDS providing more than 75% of services in that domain had significantly higher mean EPHS scores. In sum, LHDs with a more robust service delivery portfolio were more likely to have higher EPHS scores. However, as these are cross-sectional data, the direction of the relationship is not clear. While prior research suggests that LHDs with more comprehensive services are more likely to perform the EPHS, the mix and match of services that maximizes EPHS performance needs to be explored.

ABSTRACT With the implementation of the ACA, it is essential for the public health sector to eluc... more ABSTRACT With the implementation of the ACA, it is essential for the public health sector to elucidate its role with respect to its mission of assuring population health, and to clarify its role with respect to the private health care system. To that end we examined the value-added to the population health enterprise of successful Public-Private Partnerships (PPP), those found in the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in Illinois, the Illinois Breast and Cervical Cancer Program (IBCCP). Key Informant (KI) interviews were conducted with IBCCP Lead Agency (LA) Coordinators (n=35/36) in winter 2012-2013 focused on IBCCP implementation. Analysis was conducted using Atlas.ti software. The KI interviews revealed the existence of highly developed PPP between the IBCCP LAs and individual medical providers and hospitals across Illinois. The interview data suggest that the small amount of funding provided by IBCCP to each LA in Illinois has been used to build and sustain robust PPP in the majority of the IBCCP communities. The PPP networks that have been developed through the IBCCP can be seen as an unplanned benefit of the CDC’s investment in breast and cervical health through the NBCCEDP. While the IBCCP/NBCCEDP might be considered a “boutique” categorical program which some may consider no longer necessary as individuals gain insurance under the ACA, the KI data underscore the critical role of public sector dollars, not only to serve individuals and communities directly, but to mobilize the private sector to act and become advocates for underserved communities.

ABSTRACT Home visiting of high-risk, low income pregnant women, also called prenatal case managem... more ABSTRACT Home visiting of high-risk, low income pregnant women, also called prenatal case management (PCM), is a community-based, health-related service for medically or socially high-risk pregnant women for the purpose of improving birth and early infancy outcomes. Very little is known about the types of interventions used to address client problems and needs. This research describes the dosage and types of interventions used with clients receiving PCM. A national survey of Medicaid reimbursed PCM programs yielded data from 188 programs. Case managers (n=339) were asked to record over 2 weeks, the number of minutes spent on each intervention provided per encounter. A standardized measure of intervention dosage was calculated by averaging the number of interventions types and quintiles of the intervention time (minutes) and of case open duration (weeks); dosage ranged from 0 to 9. Of the 4980 encounters, 26% were with adolescents. Among the prenatal encounters, the median gestational age was 24 weeks. Per prenatal encounter, women received an average of 4.4 types of interventions during 51.8 minutes, yielding an average dosage of 3.4 (SD=.96). Among infants (post-partum encounters), the median age was 17.8 weeks, with an average case open duration of 28.8 weeks during which time they received an mean of 4.5 types of interventions per encounter, yielding a dosage total of 3.8 (SD=.95). Measuring dosage of interventions delivered is feasible with three key variables. National home visiting policy, like that created under the Affordable Care Act, ought to require reporting of these variables for more nuanced outcome evaluations.

Academy of Management Annual Meeting Proceedings

Public Health Nursing, 2012

Public Health Nursing, 2013

This study discusses the challenges and characteristics of effective public health nursing leader... more This study discusses the challenges and characteristics of effective public health nursing leaders in local health departments and barriers to effective leadership during the hyperturbulent conditions of 2008-2010. Participants were drawn from a purposive sample of seven directors of nursing (DON) in six county LHDs in two states for this qualitative study using inductive methods. Semistructured telephone interviews were conducted, using open-ended questions. Data analysis consisted of coding, pattern identification, and theme development, assisted by the use of ATLAS.ti™. Credibility was achieved through intercoder agreement and resonance of the findings with participants. Two underlying challenges emerged: leadership dissonance and leading through ambiguity. Three key effective leadership attributes identified were as follows: collaborative change management, life-long learning, and being visionary. DONs identified extrinsic and intrinsic barriers to leadership effectiveness and leading change in public health systems and PHN practice. Results suggest ways to support PHN leaders in order to overcome barriers to effective leadership such as defined leadership competencies, continuing education, and mentorship opportunities.

Health Care Management Review, 2007

... methodologies. The article of Weick and Putman (2006) touched the other side of my brain, wit... more ... methodologies. The article of Weick and Putman (2006) touched the other side of my brain, with its creative attention to integrating the Eastern and Western thinking. Their ... brain approaches. L. Michele Issel, PhD, RN. Editor-in-Chief. ...

American Journal of Health Promotion, 2013

This study reports on an evaluation of the implementation of a pilot interconceptional care progr... more This study reports on an evaluation of the implementation of a pilot interconceptional care program (ICCP) in Chicago and the experiences of the participants in their first postpartum year. A longitudinal, multi-method approach was used to gather data to measure success in achieving project benchmarks and to gain insights into women's experiences after an adverse pregnancy outcome. The ICCP interventions were provided in two different health care settings. Low-income African-American women with a prior adverse pregnancy outcome were recruited to participate. Data on services delivered are available for 220 women; linked interview data are also available for 99 of these women. The ICCP focused on the integration of social services, family planning, and medical care provided through a team approach. An interview questionnaire asked detailed information about interconceptional health status, attitudes, and behaviors. A services database documented all services delivered to each participant. Key informant interviews were conducted with the ICCP project staff. Simple frequencies were generated. Chi-square and t-tests were used to compare participants and benchmarks at the two different sites. The planned delivery of interventions based on women's unique interconceptional health needs was often replaced by efforts to address women's socioeconomic needs. Although medical care remained important, participants viewed themselves as healthy and did not view medical care as a priority. Women's perceptions of contraceptive effectiveness were not always in sync with clinical knowledge. Interconceptional care is a complex process of matching interventions and services to meet women's unique needs, including their socioeconomic needs.

American Journal of Public Health, 2011

We developed a process through which community outreach workers, whose role is not typically that... more We developed a process through which community outreach workers, whose role is not typically that of a trained researcher, could actively participate in collection of qualitative evaluation data. Outreach workers for a community-based intervention project received training in qualitative research methodology and certification in research ethics. They used a Voice over Internet Protocol phone-in system to provide narrative reports about challenges faced by women they encountered in their outreach activities as well as their own experiences as outreach workers. Qualitative data contributed by outreach workers provided insights not otherwise available to the evaluation team, including details about the complex lives of underserved women at risk for poor pregnancy outcomes and the challenges and rewards of the outreach worker role. Lay health workers can be a valuable asset as part of a research team. Training in research ethics and methods can be tailored to their educational level and preferences, and their insights provide important information and perspectives that may not be accessible via other data collection methods. Challenges encountered in the dual roles of researcher and lay health worker can be addressed in training.

Efforts to reduce perinatal mortality have focused predominantly on medical care. However, women ... more Efforts to reduce perinatal mortality have focused predominantly on medical care. However, women at most risk for adverse perinatal outcomes have numerous social problems affecting their ability to access prenatal care. Their social problems are generally not recorded in the medical record and these women are often hard to reach. Therefore, a needs assessment is difficult to conduct. Data were collected from lay outreach workers who canvassed two low-income, predominantly African-American Chicago communities. Using a Voice-over IP system, over 13 months, seven lay outreach workers telephoned in 69 stories of women who faced particular hardships with the service delivery system. The stories were analyzed for themes that captured the texture of the lives of this hard-to-reach population. Both the outreach workers and the women who shared stories gave informed consent. The themes included: general health issues (i.e., chronic illnesses), mental health issues (i.e., substance abuse, str...

American Journal of Public Health, 2011

We developed a process through which community outreach workers, whose role is not typically that... more We developed a process through which community outreach workers, whose role is not typically that of a trained researcher, could actively participate in collection of qualitative evaluation data. Outreach workers for a community-based intervention project received training in qualitative research methodology and certification in research ethics. They used a Voice over Internet Protocol phone-in system to provide narrative reports about challenges faced by women they encountered in their outreach activities as well as their own experiences as outreach workers. Qualitative data contributed by outreach workers provided insights not otherwise available to the evaluation team, including details about the complex lives of underserved women at risk for poor pregnancy outcomes and the challenges and rewards of the outreach worker role. Lay health workers can be a valuable asset as part of a research team. Training in research ethics and methods can be tailored to their educational level and preferences, and their insights provide important information and perspectives that may not be accessible via other data collection methods. Challenges encountered in the dual roles of researcher and lay health worker can be addressed in training.

Maternal and Child Health Journal, 2015

This study sought to characterize differences between pregnant adolescents and adults in the type... more This study sought to characterize differences between pregnant adolescents and adults in the types of problems addressed by case managers, and to assess subsequent differences in the types of interventions used with both groups. Data stem from 3947 client encounters, provided by 223 case managers in 92 Medicaid-reimbursed prenatal case management programs; the clients were confirmed to be either adolescents (<20 years of age) or adults. Case managers provided information on each client encounter that occurred during 10 workdays over a 20 workday period using the Case Management Intervention Record , a data collection tool. The Chi square test and the Mann-Whitney U test were used to compare the types and number of problems, the types of intervention received, and the mean number of intervention minutes between adolescents and adults. Adolescents experienced an average of 3.9 problems whereas adults experienced an average of 3.2 problems (p < 0.001). Compared to adults, adolescents were significantly more likely to experience problems in the areas of pregnancy health, family, education/job, transportation, and housing. With respect to breadth of interventions, adolescent clients were significantly more likely to receive support, clinical acts, and to be given tangible items compared to adult clients. On average, case managers spent significantly more time per encounter with adolescents than with adults overall (mean 56.6 vs. 50.3 min), and on educating, assessing, coaching, and monitoring. Age related differences have both programmatic and provider implications. The intervention typology can be used to evaluate PCM programs serving high risk population.

Public Health Nursing, 2013

This study discusses the challenges and characteristics of effective public health nursing leader... more This study discusses the challenges and characteristics of effective public health nursing leaders in local health departments and barriers to effective leadership during the hyperturbulent conditions of 2008-2010. Participants were drawn from a purposive sample of seven directors of nursing (DON) in six county LHDs in two states for this qualitative study using inductive methods. Semistructured telephone interviews were conducted, using open-ended questions. Data analysis consisted of coding, pattern identification, and theme development, assisted by the use of ATLAS.ti™. Credibility was achieved through intercoder agreement and resonance of the findings with participants. Two underlying challenges emerged: leadership dissonance and leading through ambiguity. Three key effective leadership attributes identified were as follows: collaborative change management, life-long learning, and being visionary. DONs identified extrinsic and intrinsic barriers to leadership effectiveness and leading change in public health systems and PHN practice. Results suggest ways to support PHN leaders in order to overcome barriers to effective leadership such as defined leadership competencies, continuing education, and mentorship opportunities.

Nursing economic$

Many states are faced with Medicaid fiscal constraints; therefore, reimbursable versus un-reimbur... more Many states are faced with Medicaid fiscal constraints; therefore, reimbursable versus un-reimbursable program costs must be clearly delineated. This study demonstrates a method to measure costs for Medicaid prenatal case management.

Online Journal of Public Health Informatics, Jan 13, 2014

Objective: Data collection and management by local health departments (LHDs) is a complex endeavo... more Objective: Data collection and management by local health departments (LHDs) is a complex endeavor, complicated by system level and organizational factors. The purpose of this study was to describe the processes and use of information systems (IS) utilized for data collection, management, and sharing by LHD employees.

Public Administration Quarterly, 1997

ABSTRACT In the last decade, maternal and child health (MCH) programs in local health departments... more ABSTRACT In the last decade, maternal and child health (MCH) programs in local health departments (LHDs) have faced a changing landscape. While MCH service delivery may have changed, the expectation to perform the Essential Public Health Services (EPHS) continues. The Maternal, Child, and Adolescent Health (MCAH) 2012 Survey was developed by NACCHO and the UIC School of Public Health with input from CityMatCH and AMCHP and distributed to a nationally representative sample of 546 LHDs, randomly selected by NACCHO and stratified by jurisdiction size (<50,000, 50,000-499,999, 500,000+); LHDs serving large jurisdictions were oversampled. The survey included questions about LHD MCAH services and questions to measure the performance of the EPHS. The mean number of services provided by LHDs was 13.1 or 39.4% (95% CI 36.5-42.2%) of the 35 possible services. On average, medium sized LHDs provided significantly more services (14.2) than small (12.4) or large LHDs (13.0). There was a significant positive relationship between the number of services provided and overall EPHS performance (p <.01). In three of four service domains, those LHDS providing more than 75% of services in that domain had significantly higher mean EPHS scores. In sum, LHDs with a more robust service delivery portfolio were more likely to have higher EPHS scores. However, as these are cross-sectional data, the direction of the relationship is not clear. While prior research suggests that LHDs with more comprehensive services are more likely to perform the EPHS, the mix and match of services that maximizes EPHS performance needs to be explored.

ABSTRACT With the implementation of the ACA, it is essential for the public health sector to eluc... more ABSTRACT With the implementation of the ACA, it is essential for the public health sector to elucidate its role with respect to its mission of assuring population health, and to clarify its role with respect to the private health care system. To that end we examined the value-added to the population health enterprise of successful Public-Private Partnerships (PPP), those found in the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in Illinois, the Illinois Breast and Cervical Cancer Program (IBCCP). Key Informant (KI) interviews were conducted with IBCCP Lead Agency (LA) Coordinators (n=35/36) in winter 2012-2013 focused on IBCCP implementation. Analysis was conducted using Atlas.ti software. The KI interviews revealed the existence of highly developed PPP between the IBCCP LAs and individual medical providers and hospitals across Illinois. The interview data suggest that the small amount of funding provided by IBCCP to each LA in Illinois has been used to build and sustain robust PPP in the majority of the IBCCP communities. The PPP networks that have been developed through the IBCCP can be seen as an unplanned benefit of the CDC’s investment in breast and cervical health through the NBCCEDP. While the IBCCP/NBCCEDP might be considered a “boutique” categorical program which some may consider no longer necessary as individuals gain insurance under the ACA, the KI data underscore the critical role of public sector dollars, not only to serve individuals and communities directly, but to mobilize the private sector to act and become advocates for underserved communities.

ABSTRACT Home visiting of high-risk, low income pregnant women, also called prenatal case managem... more ABSTRACT Home visiting of high-risk, low income pregnant women, also called prenatal case management (PCM), is a community-based, health-related service for medically or socially high-risk pregnant women for the purpose of improving birth and early infancy outcomes. Very little is known about the types of interventions used to address client problems and needs. This research describes the dosage and types of interventions used with clients receiving PCM. A national survey of Medicaid reimbursed PCM programs yielded data from 188 programs. Case managers (n=339) were asked to record over 2 weeks, the number of minutes spent on each intervention provided per encounter. A standardized measure of intervention dosage was calculated by averaging the number of interventions types and quintiles of the intervention time (minutes) and of case open duration (weeks); dosage ranged from 0 to 9. Of the 4980 encounters, 26% were with adolescents. Among the prenatal encounters, the median gestational age was 24 weeks. Per prenatal encounter, women received an average of 4.4 types of interventions during 51.8 minutes, yielding an average dosage of 3.4 (SD=.96). Among infants (post-partum encounters), the median age was 17.8 weeks, with an average case open duration of 28.8 weeks during which time they received an mean of 4.5 types of interventions per encounter, yielding a dosage total of 3.8 (SD=.95). Measuring dosage of interventions delivered is feasible with three key variables. National home visiting policy, like that created under the Affordable Care Act, ought to require reporting of these variables for more nuanced outcome evaluations.

Academy of Management Annual Meeting Proceedings

Public Health Nursing, 2012

Public Health Nursing, 2013

This study discusses the challenges and characteristics of effective public health nursing leader... more This study discusses the challenges and characteristics of effective public health nursing leaders in local health departments and barriers to effective leadership during the hyperturbulent conditions of 2008-2010. Participants were drawn from a purposive sample of seven directors of nursing (DON) in six county LHDs in two states for this qualitative study using inductive methods. Semistructured telephone interviews were conducted, using open-ended questions. Data analysis consisted of coding, pattern identification, and theme development, assisted by the use of ATLAS.ti™. Credibility was achieved through intercoder agreement and resonance of the findings with participants. Two underlying challenges emerged: leadership dissonance and leading through ambiguity. Three key effective leadership attributes identified were as follows: collaborative change management, life-long learning, and being visionary. DONs identified extrinsic and intrinsic barriers to leadership effectiveness and leading change in public health systems and PHN practice. Results suggest ways to support PHN leaders in order to overcome barriers to effective leadership such as defined leadership competencies, continuing education, and mentorship opportunities.

Health Care Management Review, 2007

... methodologies. The article of Weick and Putman (2006) touched the other side of my brain, wit... more ... methodologies. The article of Weick and Putman (2006) touched the other side of my brain, with its creative attention to integrating the Eastern and Western thinking. Their ... brain approaches. L. Michele Issel, PhD, RN. Editor-in-Chief. ...

American Journal of Health Promotion, 2013

This study reports on an evaluation of the implementation of a pilot interconceptional care progr... more This study reports on an evaluation of the implementation of a pilot interconceptional care program (ICCP) in Chicago and the experiences of the participants in their first postpartum year. A longitudinal, multi-method approach was used to gather data to measure success in achieving project benchmarks and to gain insights into women's experiences after an adverse pregnancy outcome. The ICCP interventions were provided in two different health care settings. Low-income African-American women with a prior adverse pregnancy outcome were recruited to participate. Data on services delivered are available for 220 women; linked interview data are also available for 99 of these women. The ICCP focused on the integration of social services, family planning, and medical care provided through a team approach. An interview questionnaire asked detailed information about interconceptional health status, attitudes, and behaviors. A services database documented all services delivered to each participant. Key informant interviews were conducted with the ICCP project staff. Simple frequencies were generated. Chi-square and t-tests were used to compare participants and benchmarks at the two different sites. The planned delivery of interventions based on women's unique interconceptional health needs was often replaced by efforts to address women's socioeconomic needs. Although medical care remained important, participants viewed themselves as healthy and did not view medical care as a priority. Women's perceptions of contraceptive effectiveness were not always in sync with clinical knowledge. Interconceptional care is a complex process of matching interventions and services to meet women's unique needs, including their socioeconomic needs.

American Journal of Public Health, 2011

We developed a process through which community outreach workers, whose role is not typically that... more We developed a process through which community outreach workers, whose role is not typically that of a trained researcher, could actively participate in collection of qualitative evaluation data. Outreach workers for a community-based intervention project received training in qualitative research methodology and certification in research ethics. They used a Voice over Internet Protocol phone-in system to provide narrative reports about challenges faced by women they encountered in their outreach activities as well as their own experiences as outreach workers. Qualitative data contributed by outreach workers provided insights not otherwise available to the evaluation team, including details about the complex lives of underserved women at risk for poor pregnancy outcomes and the challenges and rewards of the outreach worker role. Lay health workers can be a valuable asset as part of a research team. Training in research ethics and methods can be tailored to their educational level and preferences, and their insights provide important information and perspectives that may not be accessible via other data collection methods. Challenges encountered in the dual roles of researcher and lay health worker can be addressed in training.

Efforts to reduce perinatal mortality have focused predominantly on medical care. However, women ... more Efforts to reduce perinatal mortality have focused predominantly on medical care. However, women at most risk for adverse perinatal outcomes have numerous social problems affecting their ability to access prenatal care. Their social problems are generally not recorded in the medical record and these women are often hard to reach. Therefore, a needs assessment is difficult to conduct. Data were collected from lay outreach workers who canvassed two low-income, predominantly African-American Chicago communities. Using a Voice-over IP system, over 13 months, seven lay outreach workers telephoned in 69 stories of women who faced particular hardships with the service delivery system. The stories were analyzed for themes that captured the texture of the lives of this hard-to-reach population. Both the outreach workers and the women who shared stories gave informed consent. The themes included: general health issues (i.e., chronic illnesses), mental health issues (i.e., substance abuse, str...

American Journal of Public Health, 2011

We developed a process through which community outreach workers, whose role is not typically that... more We developed a process through which community outreach workers, whose role is not typically that of a trained researcher, could actively participate in collection of qualitative evaluation data. Outreach workers for a community-based intervention project received training in qualitative research methodology and certification in research ethics. They used a Voice over Internet Protocol phone-in system to provide narrative reports about challenges faced by women they encountered in their outreach activities as well as their own experiences as outreach workers. Qualitative data contributed by outreach workers provided insights not otherwise available to the evaluation team, including details about the complex lives of underserved women at risk for poor pregnancy outcomes and the challenges and rewards of the outreach worker role. Lay health workers can be a valuable asset as part of a research team. Training in research ethics and methods can be tailored to their educational level and preferences, and their insights provide important information and perspectives that may not be accessible via other data collection methods. Challenges encountered in the dual roles of researcher and lay health worker can be addressed in training.

Maternal and Child Health Journal, 2015

This study sought to characterize differences between pregnant adolescents and adults in the type... more This study sought to characterize differences between pregnant adolescents and adults in the types of problems addressed by case managers, and to assess subsequent differences in the types of interventions used with both groups. Data stem from 3947 client encounters, provided by 223 case managers in 92 Medicaid-reimbursed prenatal case management programs; the clients were confirmed to be either adolescents (<20 years of age) or adults. Case managers provided information on each client encounter that occurred during 10 workdays over a 20 workday period using the Case Management Intervention Record , a data collection tool. The Chi square test and the Mann-Whitney U test were used to compare the types and number of problems, the types of intervention received, and the mean number of intervention minutes between adolescents and adults. Adolescents experienced an average of 3.9 problems whereas adults experienced an average of 3.2 problems (p < 0.001). Compared to adults, adolescents were significantly more likely to experience problems in the areas of pregnancy health, family, education/job, transportation, and housing. With respect to breadth of interventions, adolescent clients were significantly more likely to receive support, clinical acts, and to be given tangible items compared to adult clients. On average, case managers spent significantly more time per encounter with adolescents than with adults overall (mean 56.6 vs. 50.3 min), and on educating, assessing, coaching, and monitoring. Age related differences have both programmatic and provider implications. The intervention typology can be used to evaluate PCM programs serving high risk population.