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1. What is the single best thing we can do to help change the behavior of patients regarding the use of condoms & latex barriers?

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Staff Survey for Prevention PI Plan

1. What is the single best thing we can do to help change the behavior of patients regarding the use of condoms & latex barriers?

( ) Provide Condoms/Latex barriers

( ) Teach them how to use a condom ( ) Help them find a way to talk to sex partner about condom use. ( ) Convince them that condoms are effective

2. What is the single best thing we can do to help change the behavior of patients regarding the use of clean needles?

( ) Provide Clean Needles ( ) Teach them how to clean works ( ) Connect them to a needle exchange program

3. What is the single best way you can think of delivering prevention messages?

( ) Posters ( ) Videos ( ) Mailings ( ) One-on-one Education ( ) Groups ( ) Designated Education Days (ex. Mondays) ( ) Handing out literature ( ) Other _____________________________________________________

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Prevention Plan Activities

1. Distribute Condoms at every visit

Condoms would be given to social workers, Launa, Irveline, Gerald & Gilbert. They will offer patients condoms as every visit.

2. Track condom distribution

A log sheet would be developed to track distribution of condoms. (See attached draft)

Distribution of condoms will also be documented on gilberts harm risk reduction form & progress notes.

3. Ensure staffs have the most up to date cutting edge prevention information & tools.

A. Distribute Stages of Change (Transtheoretical) Model B. Educate & test staff knowledge

C. Observe staff in session, using the Motivational Interviewing techniques.

D. Send staffs to conferences, workshops & Seminars

Still Pending:

Have a Transtheoretical Model in-service to educate staff. <- Gilbert volunteered to create a powerpoint presentation & game.

I did not get volunteers to help so I would like to assign staff the following: Develop an observation tool to observe staff using Motivational Interviewing techniques. Å I would like to assign Joyce & Joan to develop tool

Develop a test for staff on using the Transtheoretical Model <- I would like to assign Lauri & Annette to develop this tool.

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Consumer Survey for Prevention PI Project

Patient Name ______________________ Date _____________________ 1. What is the single best thing that your provider can do to help you change

your behavior regarding the use of condoms & latex barriers?

( ) Provide Condoms/Latex barriers ( ) Visible & Available written information ( ) Help me to understand consequences that can occur

( ) Teach me how to use a condom ( ) Help me find a way to talk to sex partner about condom use. ( ) Convince me that condoms are effective ( ) Help me understand my behavior ( ) Help me talk about my feelings about condom use in a safe environment

2. On the last occasion that you did not use a condom what stopped you from doing so?

( ) I didn’t want my partner to suspect HIV status ( ) I was in a big hurry ( ) I was under the influence of drugs/Alcohol ( ) I did not care ( ) Partner did not want me to ( ) I forgot ( ) I did not have any condoms ( ) I did not think it mattered I have HIV already ( ) I trust my partner and did not think I needed one ( ) Condoms don’t fit me ( ) Sex is not good with condoms

3. What is the single best thing that your provider can do to help you change your behavior regarding the use of clean needles?

( ) Provide Clean Needles ( ) Teach me how to clean my works ( ) Connect me to a needle exchange program ( ) Connect me to an after hours exchange

program.

4. On the last occasion that you did not use a clean needle what stopped you from doing so?

( ) I was under the influence of drugs/Alcohol ( ) I did not care ( ) I did not have any clean needles ( ) I did not know where to go to exchange needles

5. What is the single best way you would like to be given prevention messages?

( ) Posters ( ) Videos ( ) Mailings ( ) One-on-one Education ( ) Groups ( ) Designated Education Days (ex. Mondays) ( ) Handing out literature ( ) Other _____________________________________________________

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Interfaith Medical Center

Primary Care Center

Risk/Harm Reduction Encounter Form

( ) Initial Assessment ( ) Quarterly Re-Assessment Date_________

Transmission reduction, past and present

sexual activities:

( ) Client reports practicing abstinence. For How Long__________ ( ) Client reports practicing safer sex. For how long ____________ ( ) Client reports not practicing safer sex.

What does the patient believe the single best thing that the provider could do to help change behavior regarding the use of condoms & latex barriers?

__________________________________________________________

On the last occasion that the patient did not use a condom what stopped him/her from doing so?

__________________________________________________________

Client provided with condoms/latex barriers ( ) Yes ( ) No

If not practicing safe sex or abstinence, assess client’s stage of readiness for change & discuss interventions.

Stage of readiness for change

Pre-contemplative Contemplative Preparation Action Maintenance

Discuss interventions

_______________________________________________________________ ________________________________________________________________ ________________________________________________________________

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Interfaith Medical Center

Primary Care Center

Risk/Harm Reduction Encounter Form

( ) Initial Assessment ( ) Quarterly Re-Assessment Date____________

Transmission reduction, past and present

Substance use/abuse history:

( ) Client reports no history of substance use/abuse problems.

( ) Client reports no history of injecting drugs.

( ) Client reports s/he does not share syringe/works.

( ) Client reports active drug/alcohol use. Type________________________ ( ) Client reports active cigarette use.

What does the patient believe the single best thing that the provider could do to help change behavior regarding the use of drugs and/or cigarettes?

__________________________________________________________

If patient has used drugs or cigarettes, assess client’s stage of readiness for change & discuss interventions.

Stage of readiness for change

Pre-contemplative Contemplative Preparation Action Maintenance

Discuss interventions

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Client Signature _____________________Staff Signature__________________

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Condom Distribution Log

References

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