• DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: (737) 255-4300

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POPS Chapter 9 - Disease Intervention Specialist Performance Standards


These performance standards represent detailed instructions regarding the way in which the Disease Intervention Specialist (DIS) is expected to apply acquired knowledge and skills to critical elements of daily work in sexually transmitted infection (STI) prevention, including HIV.

For supervisors, these standards can be a tool to help evaluate the capabilities and deficiencies of a DIS. Standards can help identify workers who are especially proficient in specific performance areas. These workers can then become candidates for assignments involving greater responsibility or technical skills that can enhance career development.

When performance does not meet expectations, standards assist supervisors in identifying customized training needs for DIS. If a DIS is unable to perform at an acceptable level after a reasonable amount of remedial training or supervisory coaching, these standards can provide a framework for corrective action.

The success of DIS effort is evaluated both by disease intervention outcomes, as measured against program objectives, and by the quality of individual effort. It is the responsibility of the DIS to become familiar with these standards and to incorporate them into their performance of program activities. The DIS should seek guidance and clarification from their supervisor on any doubts or questions about these performance standards.

Staff members have a duty to report any suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies and procedures related to performance under any DSHS contract. The staff member shall make a report no later than three (3) working days from the date the staff member has knowledge of reason to believe such activity has taken place. The staff member will notify their central office public health follow-up consultant regarding the reporting of this issue.

The Disease Intervention Specialists Performance Standards have been received and discussed.

Employee Signature     Date  
Supervisor Signature     Date  

 

9.1 Professional Conduct and Work Relations

Each DIS belongs to an established personnel system -- federal, state, or local -- and will observe the codes of conduct established by his/her employer with regard to punctuality, substance abuse, political activity, conflicts of interest, and other personnel policies. Every DIS represents both the State of Texas and the local health agencies in the performance of daily activities. In general, the more stringent requirements among these agencies are the ones to which the DIS will conform in regard to professional conduct. The following standards for DIS will foster successful working relationships at the local level.

  • Conducts all activities with honesty, integrity, and confidentiality

  • Manages interactions with health officials and other local professionals with tact and diplomacy. DIS will present themselves in a professional manner and treat all individuals with respect

  • Treats clients, co-workers, and the general public with courtesy, dignity, and respect

  • Observes operational policies regarding lines of authority and communication and use of resources, facilities, and equipment

  • Informs the supervisor at the earliest opportunity of any actual, potential, or perceived conflicts which may arise and which may have a negative influence on the conduct of program activities

 

9.2 Confidentiality

The sensitive and highly personal nature of HIV/STI information requires strict confidentiality in the course of activities. Maintaining confidentiality means more than not revealing names. To maintain confidentiality, no information will be divulged which could lead to the identity of the client. Program success depends on health practitioners and clients recognizing that all HIV/STI staff observe the principle of confidentiality. The DIS is bound by such rules and laws regarding confidentiality as may be specified by his/her employing agency, as well as those of the State of Texas and of the local jurisdiction in which work is performed.

 

9.2.1 Medical and Laboratory

Custody and management of medical and laboratory records is the legal responsibility of the local health officer/authority (or of the individual health provider). When accessing these records in the course of daily activities, it will be done in a manner that serves to protect the confidentiality of the records.

 

9.2.2 Investigative

The local health officer is also responsible for safeguarding the Field Record, CDC 73.2936 [CDC]. Even though the disease intervention team primarily manages the Field Record, it documents the basis upon which the health officer exercises legal authority to provide for STI examination and treatment of individuals.

 

9.2.3 Interview Record

The Interview Record, CDC 73.54, is a standard format that organizes information obtained by the DIS under the professional assurance of confidentiality. Custody and management of the Interview Record is the joint responsibility of the DIS and the supervisor.

 

9.2.4 Client Confidentiality

The DIS safeguards the privacy of all persons served by the health department and of those who become involved in the disease intervention process by observing strict confidentiality of information. The DIS shares information only with authorized persons on a need-to-know basis. In this case, authorized persons are health professionals who are bound by medical/professional rules of confidentiality and who are involved in providing health services to the individual in question. Attempts by any other person to obtain records or information will be reported by the DIS to the supervisor and documented in accordance with program policy.

 

9.2.5 HIV/STI Public Health Follow-Up (PHFU) Confidential Information Security Procedures

Proper maintenance and disposition of records is crucial to maintaining the confidentiality of persons involved with partner services. Qualified staff conducting partner services must follow the HIV/STI Public Health Follow-Up (PHFU) Confidential Information Security Procedures.

 

9.2.6 HIV/STD Breach of Confidentiality Response Policy (HIV/STD 303.001)

The policy HIV/STD Breach of Confidentiality Response (HIV/STD 303.001) applies to all DSHS employees, IT staff, temporary employees, volunteers, students, DSHS program contractors, and any other person who could potentially view and/or have access to HIV/STI confidential information.

All persons affected by this policy, as specified above, are responsible for the reporting of suspected breaches.

 

9.3 Case Management

Case management is the systematic pursuit, documentation, and analysis of medical and epidemiologic case information that focuses on opportunities for disease intervention. The primary purpose of case management is to develop a timely plan and identify opportunities for disease intervention to prevent the further spread of STIs within the sexual and social network of known cases.

Case management efforts entail seven steps:

  1. Pre-interview analysis,

  2. Original interview,

  3. Post interview analysis,

  4. Referral of at-risk individuals (sex/needle sharing partners and clusters),

  5. Cluster interview(s),

  6. Re-interview(s), and

  7. Case closure.

Refer to the Passport to Partner Services module for Syphilis Case Management and VCA for additional information.

 

9.3.1 Case Management Folders

The individual folders must contain the following for each related case:

  • A copy of the infected patient’s Field Record (FR), if applicable

  • The original Interview Record (IR) and the most current printed Interview Record from STD*MIS; destroy previous Interview Record if Interview Record is updated

  • DIS notes from all interviews. Notes are to be reflective of the interview format

  • Case management forms:

    • Original Patient Information Sheet

    • Case Review Sheet

    • Re-interview Record

    • Cluster Interview Record

    • Case Closure Request/Approval

  • VCA sheet on all 710 and 720 cases, and 730 cases with symptoms, or related cases

  • Copies of all associated field records (partners, suspects/social contacts, and associates)

 

9.3.2 Lot System

A lot system is a case management tool that relies on a records management system to assure all obtainable information regarding the continuing management of cases is contained in a centralized location and is readily accessible to all responsible workers. The individual folders that constitute the lot system should have a “lot number” assigned sequentially, by date reported. Associated cases may be assigned the same lot number if they are related for any “logical” reason, for example, patients are related (i.e., they name one another as sex partners or are linked through clustering) or cases share something in common, such as working for the same company or living in the same apartment building.

Programs should make use of current technology to facilitate DIS record keeping and case management, including computer storage and case analysis software, when available. Storage of records should be carefully maintained and should adhere to security and confidentiality policies.

The individual folders should be filed in a logical sequence. A case management system should include a cross-reference list kept in a book, card file, or computerized system should be established with information such as:

  • Assigned lot number,

  • Patient name,

  • Date of interview, and

  • Diagnosis, etc.

 

9.3.3 Case Management Objectives

  • Cases are to be completed and submitted within one business day to the first line supervisor for review.

  • Cases are to have accurate assigned date and interview date. The assign date is determined when the DIS has sufficient information that indicates a new infection has occurred and requires public health follow up.

    • For high priority investigations, syphilis cases are to be interviewed within 3 days and HIV cases are to be interviewed within 7 days from the date of assignment

  • Cases have an accurate interview period based on testing and interview history.

  • Interviewed cases will have completed demographics (age, race, ethnicity, sex, zip) and risk factors for the original patient.

  • Investigations must begin within one day of receipt of the field record. Initiate a Field Record for all interview period sex/needle sharing partners and other high-risk individuals that have adequate locating information. The initiation date on the Field Record will be the same date the interview was conducted (original interview, re-interview, or cluster interview).

  • If insufficient information is obtained to initiate an investigation, document sex partners or other priority individuals in the "marginal contact" section of the Interview Record (Original Patient Information Sheet) and on the re-interview sheet. Marginal partners, suspects/social contacts, and associates will be thoroughly record-searched and followed for additional information. The original patient will be re-interviewed to obtain additional locating on marginal partners, suspects/social contacts, and associates. When in doubt as to whether information is sufficient to initiate a Field Record, discuss it with the supervisor.

  • Complete the initial visual case analysis forms at the same time the Interview Record is prepared in a manner which:

    • Establishes the correct interview and critical periods

    • Addresses exposure gaps and discrepancies in data obtained

    • Identifies informational needs

    • Indicates potential source/spread relationships by following the ghosting hierarchy

  • Maintain ongoing case management by:

    • Identifying the informational needs of the individual case and of interrelated cases in the case management folder

    • Using appropriate forms to develop agendas for anticipated interviews, cluster interviews, and re-interviews

    • Assuming responsibility for critical communications with the disease intervention team

    • Remaining abreast of the progress of case elements assigned to other team members as well as OOJ contacts and clusters

    • Promptly pursuing case objectives and outcomes resulting from personal analysis, supervisory input or contributions by other team members, including efforts to assist in cases managed by other team members

    • Reviewing and documenting open cases with current data, updates, plans, and case development directives at least once a week

    • Seeking supervisory guidance as soon as case management activities appear to be stalled

 

9.3.4 Case Management Minimum Standards

  • Assure that syphilis case management activities result in disease intervention for at least 60% of syphilis cases interviewed.

  • Achieve a treatment index of at least .75 for early syphilis cases interviewed by DIS.

  • 85% of syphilis cases are interviewed within three days from the date of assignment (from STD*MIS).

  • 85% of HIV cases are interviewed within seven days from the date of assignment (from STD*MIS).

  • 85% of cases are submitted to supervisor within one day of original interview.

  • Narratives are clearly composed and legibly written with interviewer’s impressions and patient’s motivations noted.

  • 95% of cases have a detailed plan of action submitted.

  • 85% of cases have an accurate assigned date.

  • 85% of cases have an accurate original interview date.

  • 95% of interviewed cases have completed demographics for the original patient (age, race, ethnicity, sex, and zip code).

  • 95% of cases have completed risk factors.

  • 95% of the primary and secondary syphilis cases reviewed have symptoms documented at the time of exam.

  • 95% of the syphilis cases with symptoms (current or historic) have accurate symptom durations.

  • 85% of the eligible syphilis cases have VCA sheets attached and the cases are plotted accurately.

  • 95% of cases have original interview notes are attached to the case.

  • 95% of the original interview notes are reflective of the interview format.

  • 95% of eligible cases have had a second disease added to the case.

  • 95% of all eligible partners from interviews (OI, RI, CI), are initiated as appropriate.

  • 85% of cases have a correct corresponding initiation date for all related field records. (Partner, suspect, and associate field record dates of initiation correspond to the interview (OI, RI, CI) dates).

  • 85% of HIV/syphilis re-interviews and cluster interviews have a re-interview or cluster sheet prepared with follow-up questions pertinent to the case.

  • 85% of re-interviews are conducted within seven days of the original interview.

  • 70% of eligible partners (A, B, F and 3, 4, 6, and 7) have a documented cluster interview.

  • 95% of clusters have the relationship to the case documented on the field record.

  • 85% of all re-interviews and cluster interviews are thoroughly documented on appropriate re-interview and cluster interview forms.

  • 85% of cases reflect weekly DIS review and action until the case is closed.

  • 85% of supervisor comments are addressed/responded to within two days of receipt of the case back from the supervisor.

  • 85% of cases open more than seven days have documentation of the DIS seeking guidance from a supervisor.

  • 85% of the early syphilis cases with an associated case have appropriate source/spread determination.

  • 90% of the early syphilis cases have a recent (last 90 days) documented HIV test result or a documented previous positive result.

  • Ensure that 90% of HIV-positive clients interviewed successfully complete their first early intervention appointment.

  • 85% of early syphilis cases are closed within 45 days from the date of the original interview.

  • 85% of HIV cases are closed within 45 days from the date of the original interview.

  • 95% of the cases reflect appropriate dispositions prior to the DIS recommendation for closure.

  • 95% of a DIS’ cases on an STD*MIS open case report are present at time of audit.

 

9.4 Interviews

The Interview is the encounter with the patient which allows the DIS to identify individuals who have been exposed to a sexually transmitted infection. Together with partner notification, it is the foundation for high priority STI intervention. Interviews must be conducted as quickly as possible to prevent continued transmission by past and current partners. The focus of the interview is to:

  • Prevent the development of disease in exposed partners by ensuring rapid examination and administering preventative treatment or prompt testing,

  • Ensure treatment or testing of persons who are infected, reducing transmission,

  • Assist patients in risk reduction endeavors, and

  • Identify distinct risk groups and locations for concentrated screening efforts to take place.

The preferred method for an interview is face-to-face in a confidential environment. Telephone interviews are not encouraged but are considered acceptable, with supervisor approval, when all other reasonable efforts to meet in person have been unsuccessful.

The DIS is responsible for planning, conducting and documenting three types of interviews. This includes:

  • The Original Interview

  • The Re-Interview

  • The Cluster Interview

The DIS will follow the Original Interview format as outlined in the Passport to Partner Services training modules. learnpartnerservices.org

The Original Interview format is specifically designed to:

  • Build rapport,

  • Address concerns,

  • Motivate the patient, and

  • Elicit information about sex and/or needle-sharing partners (at the appropriate time) in order to stop the spread of infection.

The DIS will use proper communication and interviewing skills as outlined in the CDC’s Passport to Partner Services training modules.

 

9.4.1 Interview Minimum Standards

As outlined in the Passport to Partner Services training modules, the DIS will conduct Pre Interview Analysis, which begins the interview process. The pre-interview analysis is done to examine as many facts as possible to prioritize work, prepare questions, establish interview and critical interview periods, identify conflicts or informational gaps and anticipate client concerns. Evidence of pre-interview analysis may occur verbally between the supervisor and DIS or from case documentation.

DIS will conduct all Original Interviews following the interview format:

  • Introduction

    • Introduce self

    • State role/purpose

    • Explain confidentiality

  • Patient Assessment

    • Address concerns

    • Social history

    • Disease comprehension (CHART)

      • Complications of Disease

      • HIV Connection

      • Asymptomatic nature of infection

      • Re-infection

      • Transmission

  • Disease Intervention

    • Partners

    • Suspects

  • Risk Reduction

  • Conclusion

    • Commitments

    • Re-interview plans

    • Take-home messages

DIS will use communication skills as outlined in the Passport to Partner Services training modules to conduct interviews. The ten communication skills are:

  • Demonstrate professionalism

  • Establish rapport

  • Effective listening

  • Open-ended questions

  • Communicate at the patient’s level of understanding

  • Give factual information

  • Solicit patient feedback

  • Use reinforcement

  • Offer options, not directives

  • Use appropriate nonverbal communication

DIS will use the LOVER method as outlined in the Passport to Partner Services training modules to problem-solve concerns raised by the client.

The LOVER method is:

  • Listen (to the client’s concerns)
  • Observe (the non-verbal cues from the client)
  • Verify (what you hear/see)
  • Evaluate (are there gaps? Is the information credible? etc.)
  • Respond (to the client’s concerns)

DIS will demonstrate analytic capabilities and problem solving skills to overcome barriers posed by clients including recognizing exposure gaps and confronting discrepancies in client responses.

The DIS will seek guidance from a supervisor (or designated co-worker) in situations when: exposure gaps cannot be explained, no source candidate has been elicited, informational inconsistencies exist, and/or the DIS experiences dissatisfaction or uncertainty regarding the results of the interview.

DIS will elicit and document contracts and timelines with clients regarding partner notification or identified informational needs, establish a tentative date and time for the re-interview, and provide referrals for additional assistance as needed.

Interview Outcomes

  • 90% of reported early syphilis cases are interviewed for sex partners, suspects/social contacts, and associates.

  • At least 85% of reported early syphilis cases will be interviewed within three days of confirmation of the case report.

  • Achieve a partner index of at least 2.0 for early syphilis cases interviewed by DIS.

  • Achieve a cluster index of at least 1.0 for early syphilis cases interviewed by DIS.

  • At least 85% of reported new HIV cases will be interviewed for partners, suspects/social contacts, and associates.

  • At least 85% of interviewed new HIV-positive cases will be interviewed for partners, suspects/social contacts, and associates within seven days of confirmation of the case report.

  • Achieve a partner index of at least 2.0 for HIV-positive cases interviewed by DIS.

  • Achieve a cluster index of at least 1.0 for HIV-positive cases interviewed by DIS.

  • Achieve a partner index of at least 1.0 for GC cases interviewed by DIS.

  • Achieve a partner index of at least 1.0 for CT cases interviewed by DIS.

  • 75% of the early syphilis cases are re-interviewed within seven days.

  • 75% of the HIV cases are re-interviewed within seven days.

  • 85% of the interviews have documented pre-interview analysis.

 

9.5 Field Investigation and Notification

It is the responsibility of the DIS to ensure persons who are infected with HIV/STI, or who are at risk of acquiring an infection, receive appropriate medical care at the earliest possible time to interrupt disease transmission and to prevent complications of disease. Efforts to contact and communicate with infected patients, partners, and those at risk must be carried out in a manner that preserves the privacy of all involved (refer to 9.2 Confidentiality). Field activities may challenge the ability to maintain confidentiality; DIS must anticipate solutions and be able to respond appropriately and confidently.

 

9.5.1 Field Investigation Preparation

Effective management of field investigations demands organization of: work load, priority investigations, pouch, and field visits.

To avoid duplication of effort and to expand locating information, the DIS performs a record search immediately after initiating an investigation by examining available resources. The record(s) search and results will be completely and neatly documented on the Field Record.

The DIS will follow-up on reactive laboratory findings for priority STIs with the responsible (or reporting) healthcare provider. Ideally before the client is initially contacted, the DIS will secure a proper diagnosis and or disposition based on clinical manifestations, history of infection, and/or laboratory evidence. The DIS will attempt to reach the health provider within one day of assignment of the Field Record. Failure to reach the provider will necessitate a field visit to the health provider to gather information about testing, treatment, and other pertinent information. When the DIS is unable to confirm test results or treatment, notification may be conducted using a modified message with supervisory approval.

The DIS begins investigative action on priority follow-up field records within one day of assignment or of DIS initiation. High priority investigations require an initial attempt to locate an individual within the first 24 hours (phone call or field visit). When initial telephone attempts fail to reach the individual, or when the client does not follow through with a commitment, the DIS will make a field visit on the second day of the investigation or as directed by supervisor.

It is incumbent upon the DIS to make the most efficient use of field time and to conduct each field investigation thoroughly in order to maximize the impact of this activity. The DIS must ensure necessary materials and equipment are available in the field including but not limited to: netbooks, wireless access cards, disease pictures, mobile phones, GPS, maps, calendar, appointment/referral cards, venipuncture kit, and appropriate forms.

The DIS prepares for field investigations by:

  • Arranging investigations by investigative/intervention priority,

  • Planning a route to address the greatest number of investigative priorities in the most efficient sequence,

  • Including lower priority field activities that are located near high priority investigations,

  • Consulting the supervisor on the potential for pooling work when distant locations are involved, and

  • Arranging work in the planned sequence at the front of the investigative pouch.

Planning is essential, especially in high crime areas. Field notes will be prepared before leaving for the field to improve efficiency and alertness. Program multiple stops into the GPS before departing the office. Reading maps, programming a GPS, or writing referral notes can divert the attention of the DIS and create safety issues.

 

9.5.2 Activities in the field

Before leaving the car for a field visit, the DIS:

  • Reviews the Field Record in order to memorize all pertinent data and to establish the precise objective(s) of the visit;

  • Observes the environment and anticipates investigative obstacles; and

  • Stows the investigative pouch, confidential forms, and valuables in a secure place.

The DIS gathers client locating information from sources in a manner that serves to improve upon the original data provided, including previously unknown information such as:

  • Full name and physical description;

  • Precise address, including apartment number, and full description of the location;

  • Identity of co-residents;

  • Telephone number, cell phone number, email address, chat handle;

  • Type, place, and hours of employment;

  • Hours most likely at home;

  • Habits;

  • Hangouts and who they associate with;

  • Description of individual's car and tag number; and

  • Where the individual can be found ‘now’, at the time of the interview.

Note: When additional information is obtained, the DIS should act on it immediately (e.g., field visit to work site). All new information should be recorded on the appropriate re-interview or cluster interview form. Information pertinent to an open field record should also be documented on the working copy of that field record.

When you reach the individual being sought (field, phone or internet), the DIS conveys a sense of urgency and confidentiality which motivates the client to participate in the disease intervention process by:

  • Establishing the identity of the client;

  • Engaging the client in a private conversation;

  • Identifying self and conveying the reason for visit;

  • Establishing rapport and demonstrating concern;

  • Informing the client of the STI at issue and of their risk status;

  • Interviewing high priority clients in the field;

  • Clustering the client for other high risk persons;

  • Collecting appropriate specimens;

  • Referring the client for immediate medical attention; and/or

  • Transporting the client to the nearest available clinic, if needed.

 

9.5.3 Field Specimen Collection

The DIS shall perform venipuncture for blood specimen collection only after receiving training and demonstrating their competency to draw blood to the satisfaction of the local/regional health authority. The DIS will obtain consent from the client prior to performing venipuncture.

Standing delegation orders must be in place to allow DIS to perform venipuncture for blood specimens (see Chapter 12 STI Clinical Standards). DIS are required to draw a minimum of five bloods every month to maintain their skill sets.

The DIS will encourage and offer both HIV and syphilis testing at the time of venipuncture, regardless of the reason for initiation.

The DIS will perform venipuncture in the field in the following situations:

  • Syphilis contacts with last exposures greater than 90 days or syphilis contacts that have not been motivated to come in for exam and treatment.

  • HIV contacts; encourage the client to come to the clinic for a full STI screen, but draw the blood in the field.

  • Suspects and associates, unless known to be exposed or having symptoms, will have their blood drawn in the field. Encourage the client to come to the clinic for a full STI screen, but draw the blood in the field.

  • When confirmatory testing is needed.

  • When case-related screening opportunities arise.

  • When other program-designated screenings are scheduled.

Local programs will develop policies, procedures, and provide adequate training prior to implementation of new technologies.

 

9.5.4 Dealing with Alternative Outcomes

When the client wants to access care from a non-health department provider, the DIS attempts to arrange/confirm the appointment personally. The DIS apprises both the health provider and the individual of the need for recommended testing, counseling, and treatment and determines when the test results will be available.

When there is no response at the door of the individual sought, the DIS checks for occupants at the side and back of the building if access is not barred and it appears safe.

When the individual sought is not encountered, the DIS explores reasonable sources of information to confirm locating information including but not limited to:

  • Gathering information about the individual's living situation, lifestyle, habits, identity of co-habitants or co-residents, etc;

  • Looking at names on the mailbox;

  • Recording the license plates and descriptions of cars in driveway;

  • Speaking with neighbors, apartment managers, building superintendents;

  • Speaking with postal employees and other delivery personnel;

  • Speaking with local business people; and

  • Speaking with children in the area.

When the individual sought is not encountered at a confirmed place of residence, the DIS leaves a referral notice in a sealed envelope marked personal or confidential (Referral Card). The DIS may add a personal note of urgency to the form. The DIS may leave referral notices with co-residents, building managers, employers, under the door, or in any area where the referral is protected and not accessible to children or casual visitors. Referral notices cannot be placed in or affixed to any postal/mail box (U.S. Postal Service Code 1702, 1705, 1708, and 1725). The DIS should not leave a third referral notice at the same address except with supervisory consent.

When locating information appears invalid, the DIS should transpose house and street numbers and check similar locations in the immediate vicinity. Before returning to headquarters from distant locations, the DIS should contact the supervisor (or other designated team member) by telephone to inquire about emergent needs she or he should attend to before returning to the office.

 

9.5.5 Timely and Safe Documentation

When the DIS is in a safe location, she or he will document the results of the field investigation. Documentation of field activities should occur as quickly after the activity as safely possible. DIS should drive a short distance away from the location to a safe place and document the date, time, activity, and result (DTAR). The following information is legibly, accurately, and concisely documented on the back of the Field Record using accepted abbreviations and symbols:

  • Date and time of day;

  • Type activity (e.g., FV=field visit)

  • Full physical description of site(s) visited

  • Name and description of persons encountered;

  • Investigative results, which may include next planned action (date and type);

  • Referral specifics; and

  • Directions for difficult-to-find locations, when appropriate.

 

9.5.6 Field Investigation Follow-up

The DIS follows through on all commitments and pursues new information elicited during the course of investigations, as follows:

  • Confirms appointments made and kept within one day;

  • Re-initiates action within one day when commitments fail; and

  • Pursues new locating information within one day.

When the original information provided fails to locate the individual sought, the DIS seeks to contact the source of the information at the first reasonable opportunity in order to correct or to expand locating data. Sources to contact include:

  • The client or others involved in a case;

  • Other case managers;

  • Health providers; and

  • The Interstate Communication Control Record (ICCR) desk (according to established local procedures).

When there is no direct avenue to correct inadequate locating information, the DIS discretely accesses other agency resources, such as:

  • Accurint

  • Department of Motor Vehicles

  • Postal Service

  • Utilities

  • Public Assistance

  • Local schools

  • Trade unions

  • Law enforcement (jail rosters)

  • Voter registration

  • Tax appraisal office

  • Fire department (directory/department of streets)

  • Other health department programs (family planning, WIC, TB, etc.)

  • Other community resources (hospitals, CBO, etc.)

When an investigation stalls, the DIS must apprise the supervisor or appropriate case manager at the earliest reasonable opportunity (not to exceed three days from date of initiation).

Supervisory assistance and approval is needed to close unsuccessful investigations.

 

9.5.7 Internet contact pursuit

The following standards are designed to assist trained Disease Intervention Specialists (DIS) at regional and local health departments in accessing individuals and their identified social networks through the use of Internet websites, associated chat rooms and e-mail. DIS who use these methods of communication must still maintain the high standards associated with more traditional contact procedures. Maintaining confidentiality, providing accurate and culturally sensitive health education and risk reduction messages, providing referral information and performing case management activities must be part of any investigation (including using the Internet) to contact individuals exposed to disease.

The following standards cover issues related to confidentiality, the use of chat-rooms (both public and private) to disseminate information, the use of e-mails to initiate partner services and ways to identify yourself as a health department employee. Examples for contacting individuals using e-mail as the referral mechanism are also provided. Local and regional health department STD Program staff should consult with their supervisors and Information Technology departments (IT) concerning these activities prior to implementing any of these recommendations.

 

9.5.7.1 Confidentiality

DSHS standards for maintaining client confidentiality must be followed in any type of communication that involves an individual who may have been exposed to an STI, including HIV, or with persons within the social network identified through case management activities. As these standards emphasize, face-to-face partner notification is the preferred method, followed by telephone notification. Partner notification over the Internet should be used as part of standard public health follow-up when information is available.

 

9.5.7.2 Notification Using Electronic Mail

Activities involving e-mail partner services must follow the established guidelines for telephone contacts. E-mail partner notification should stress the need for immediate communication with the DIS, either by e-mail, phone, or person-to-person, and include the DIS name, office location and phone number. No specific medical information relating to the possible exposure to a specific STI/HIV should be provided until the DIS has reasonable assurance this individual is the person the DIS is trying to locate.

As is normal practice in all interviews, identifying information from the original patient or partner (address, physical description, aliases) is used to assist in confirming the identity of the person being investigated If there is any concern about the identity of the individual or the confidentiality of the situation, the DIS should seek more traditional means for providing information to the individual.

Send all emails:

  1. Confidential;

  2. Of high importance; and

  3. With an automatic request for notification when the email is read.

Never use a private email account to conduct health department or DIS business. Never send a group email (if email addresses are provided for more than one partner, suspect, associate, etc.)

 

9.5.7.3 Notification using Chat Rooms and Screen Names

There will be occasions when a DIS has only an individual’s screen name associated with a website chat room. Sometimes an email can be sent to the individual using the screen name linked with the web address of the chat room. (Example: sexybob@gay.com). If an email is not possible, the DIS needs to determine if the use of a private chat-room is an appropriate mechanism to provide partner services.

To enter a specific chat room, contact the site provider to set up a work-related profile and screen name. Never use a personal profile or screen name to conduct DIS business. Discussions in public chat rooms should be limited to health education, risk reduction messages and general STI referral information. If DIS can locate the individual on line, ask him/her to enter a private chat room. Discussions in private chat rooms with the DIS should begin with a confidentiality statement from the DIS, followed by a confirmation of understanding from the other party. Example: The information I need to discuss with you is sensitive and of a highly personal nature. I will maintain strict confidentiality and I need you to do the same. Any dissemination, distribution or copying of this communication is strictly prohibited. Do not forward this email to others. If you are not comfortable discussing confidential matters via email, I will be glad to call you or you may call me at (555) 555-5555.

Avoid discussing specific medical information until comfortable you are communicating with the appropriate individual. Verify the individual’s identity, and ask him/her to call you, or arrange a face-to-face meeting to discuss the situation.

If you cannot convince the contact to call or meet, the notification can proceed much like a telephone contact including: notification of possible exposure, information about the disease in question, an appointment or referral for exam and treatment, and a problem solving discussion about barriers to completing the exam process. Complete locating and identifying information should be elicited and documented in the patient record.

Many websites restrict the number of contacts for public health notification. Please adhere to their guidelines.

 

9.5.7.4 Impact on Daily Business

DIS need to investigate Internet use in the original interview. If the original patient (OP) meets partners through the net, ask for the web address of the chat room(s) and screen names and email addresses of all partners. When the real name of the partner is unknown, document the screen name or email address in the last name and in A.K.A sections of the field record in STD*MIS. Other information such as chat room address, specific room within an Internet site, plus days and times for contact should be documented in the notes section of the field record.

Prior to any e-mail partner service activity, DIS should attempt to obtain the geographic location of the individual. E-mail addresses with an identified geographic location outside of the DIS jurisdiction will require an “out of jurisdiction” (OOJ) field record to be initiated. When DIS know the geographic location of the partner they can provide appropriate referral information (e.g., clinic locations and times). Often at times, the OP can recall address information when prompted or can give directions and a description of the dwelling, increasing the chance of locating the patient. DIS should also encourage the OP to check her/his email and chat logs to find additional locating information, and follow up with the OP in re-interviews to obtain further locating information. When feasible, sit with the OP at a computer to obtain additional information from his/her account (e.g. Social networking sites, email, and phone book).

When a contact telephones or comes to the clinic, ask how he/she was notified. If the individual was notified via e-mail or Internet, the DIS may not have the real name. Ask the individual for his/her Internet screen name or e-mail address and conduct the STD*MIS search. Once the DIS confirms the identity of the individual through other locating information obtained from the original patient, update the field record with the real name and place an updated version of the FR in the Expected-In box. Do not delete the screen name from A.K.A.

Print all email and chat room correspondence with the date and time sent and attach it to the field record (FR).

9.5.7.5 Confirming Identity

The individual being contacted may want to confirm the identity of the DIS (who he/she is and where he/she works) to ensure your email is real. Steps to facilitate this process could be as simple as using the DIS assigned regional or local e-mail address(including the health department logo) within an email or providing a health department phone number and the name of the DIS supervisor or STI manager that could be verified by the individual. Once the individual understands this is a legitimate and urgent matter, the individual may be more likely to respond.

Always use a cell phone or landline telephone with Caller I.D. capabilities. Record the telephone number the patient called from immediately following the call.

9.5.7.6 Follow-Up

Some individuals may consider seeking services at their private medical provider. The DIS will obtain the provider information and alert the provider of the individual’s exposure when appropriate. The individual should be advised to print the e-mail from the DIS and ask the provider to call the DIS to confirm the urgency of the matter and the recommended examination, testing and treatment protocols. Before providing any information over the phone to the provider, the DIS must confirm the identity of the provider by taking a name and office phone number where the provider can be reached.

 

9.5.7.7 Email Examples

The following referral notices are examples of messages that DIS can send to an individual identified in a disease investigation as at-risk for HIV/STI. The dates in the examples are suggested and may be adjusted to accommodate holidays and weekends. A more rapid timeframe is permissible.

If, after sending an email, the partner or cluster fails to respond:

  • DIS should not send more than two emails without first talking with the supervisor, and

  • Never send more than a total of three emails.

These notices must be used by DIS. At the supervisor’s discretion, language in these examples may be adjusted to be culturally appropriate and/or appropriate to the contact’s health literacy, or for other reasons supervisory staff feel are appropriate yet still represent public health professionals. Any alteration to the format must be approved by local management and DSHS central office. Be sure to include a confidentiality statement to the bottom of all email correspondence.

 

Email - 1st attempt
Date: sent on Day 1 of the investigation

To: BOBsINLUV@worldnet.com
From: jinvestigator@tshd.texas.gov                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
Subject: URGENT HEALTH MATTER

My name is John Investigator, and I am with the Texas State Health Department. I have urgent and confidential health information to discuss with you. I can be reached at my office at (555) 234-5678. Please contact me as soon as possible. Thank you, John Investigator. 

 

Email - 2nd attempt
Date: sent on Day 3 of the investigation

To: BOBsINLUV@worldnet.com
From: jinvestigator@tshd.texas.gov                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
Subject: HEALTH DEPARTMENT MATTER

My name is John Investigator and I work with the Texas State Health Department. I attempted to contact you on 01/01/04; I have some very important health information to share with you. This is a very urgent matter, and because of the confidential nature of this information, it is vital you contact me. Please call me at (555) 234-5678. I can be reached at this number from 8am to 5pm, Monday through Friday or you can contact me using my e-mail address jinvestigator@tshd.state.tx.us or my cell phone at (555) 255-5888. To assist you in confirming my identity, I have included my supervisor’s name and phone number: Josefina Boss, Program Manager, (555) 234-5679. Please do not delay in contacting me.

John Investigator
Disease Intervention Specialist
Texas State Health Department
South Central District Office
(555) 234-5678 

 

If no response after Day 4, the DIS should discuss the situation with their supervisor. The DIS should attempt to re-interview the original patient for additional locating information and consider having the OP complete the partner-locating guide (see attached). Also consider having the original patient attempt to notify the partner. The original patient can explain that a representative from the health department will be contacting him/her with important health-related information and provide the DIS name and office number.

Note: E-mail Partner Notification in the City of San Francisco Project Area was more successful when the original patient made contact first, with a follow-up by the DIS (60%), as compared to the DIS making first contact (21%).

 

Email - 3rd attempt (option one)
Date: sent on Day 7 of the investigation

To: BOBsINLUV@worldnet.com
From: jinvestigator@tshd.texas.gov                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
Subject: CRITICAL HEALTH MATTER

I am John Investigator with the Texas State Health Department. This is my third attempt to contact you through this e-mail address. On 01/01/04 and 01/03/04, I sent you an e-mail asking you contact me ASAP, because I have urgent health information to pass on to you. It is vital that you contact me immediately. As this is my only means of contacting you at this time, I hope you take this message seriously. I can be reached at my office Monday–Friday 7:30AM through 4:30PM or at my e-mail address jinvestigator@tshd.state.tx.us, or my cell phone at (555) 255-5888. To confirm my identity you can contact my supervisor at (555) 234-5679. Please do not delay!!!

John Investigator
Disease Intervention Specialist
Texas State Health Department
South Central Office 

 

Email – 3rd attempt (option two)
Date: sent on Day 7 of the investigation

To: BobsINLUV@worldnet.com
From: jboss@tshd.texas.gov                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
Subject: SUPERVISORY HEALTH MESSAGE

My name is Josefina Boss and I work with the Texas State Health Department. You have received prior emails from one of my employees, John Investigator. As John’s supervisor, I am concerned that we have not heard from you. We have some urgent and confidential information we need to discuss with you, so please call John at (555) 234-5678, or myself at the number below.

Josefina Supervisor
Texas State Health Department
DIS Supervisor
(555) 234-5679

 

On Day 10 of the investigation and after three e-mail attempts with no response, the DIS should submit the field record to their supervisor as “unable to locate” or “H”.

 

Chat Room Profile
Screen name: statehealth1

Name: John Investigator

Location: Anywhere, Texas

Occupation: I am a Disease Intervention Specialist with the Texas State Health Department.

Hobbies & Interests: I talk with people who have, or may have, a Sexually Transmitted Disease (STD), like Syphilis or HIV, about where to get tested and treated. I also talk with people about how to reduce the chances of getting an STD, or passing a disease on to others.

Pictures: For more information, visit our website www.texasstatehealth.org 

 

DIS need to have tracking system for Internet activities such as logs for tracking attempts, replies and dispositions.

9.5.7.8 Where to get assistance with Internet contact pursuit

The Houston Department of Health and Human Services (HDHHS) Bureau of HIV/STD and Viral Hepatitis Prevention Internet Partner Specialist (IPS) can assist with or initiate online notifications statewide. Several websites have been identified by the Bureau, including, but not limited to, the list below.

  • Adam4adam.com
  • BarebackRT.com
  • Blackplanet.com
  • Facebook.com
  • Gay.com
  • Manhunt.net
  • Myspace.com
  • Twitter

Guidelines for submitting a notification request to the Internet Partner Specialist:

  • DIS will document the screen name(s) and which social networking website(s) the infected client communicates with the exposed contact

  • DIS will consult with his/her supervisor for contact information of the current IPS.

  • DIS should provide the IPS codes only to assist in identifying the nature of notification (P1 to 700; S3 to 900, etc.)

  • DIS should include contact information for themselves and their Supervisor (Office and cell numbers, email addresses)

  • The IPS with conduct follow-up, within 2 business days of notifying a contact, with the investigating agency to determine if the contact responded to the initial message and decide whether a follow-up message is necessary.

  • The IPS will, within 7 business days from the request for notification, contact the investigating agency to determine if the contact was seen by a health care agency

  • Disposition of contacts in less than 7 days should be reported to the IPS immediately

  • DIS and FLS are encouraged to forward the IPS any additional websites clients provide during interviews in order to establish a statewide profile for that site.

9.5.7.9 Self notification using the internet

InSpot is a self-notification tool first launched in San Francisco, CA for people who had been diagnosed with an STI. It is a user-friendly internet partner notification (IPN) service created in 2004 by ISIS Inc. as a web project; the purpose is to utilize current technology to prevent the transmission of disease and educate communities.

The website ( inspot.org) provides: a method of STI self-notification through a variety of anonymous or confidential e-mail postcards, up-to-date information on STI signs and symptoms, tips for self-notification, a search method for locating a local clinic for testing and treatment, and a listing of online resources.

 

9.5.8 Minimum Standards for Field Record (Pouch)

  • 95% of field records are present in pouch and match the open field record report generated from STD*MIS.

  • The number of field records open more than seven days does not exceed 20% of the total open field records (excluding pending field records).

  • 95% of field records are organized appropriately by activity.

  • 95% of field records have a documented record-search within 24 hours of assignment to DIS.

  • 95% of phone calls or field visits are made within 24 hours of field records’ assignment date.

  • When telephone calls fail to reach clients within the first 24 hours after assignment, DIS conduct a field visit by close of business of the second working day after assignment. (95%)

  • DIS requests, documents, and acts upon supervisory input on field records open more than 72 hours. (95%)

  • 95% of field records have daily documentation for each work day each the field record is open until closure.

  • 95% of documentation is legible, informative and includes date, time, activity, and result (DTAR) on field records

9.5.8 Investigations

  • 95% of Field Records have record search results documented within one day of assignment.

  • 95% of the high priority investigations (syphilis and HIV) document an attempt to locate the client (phone call or field visit) within one day of assignment.

  • 95% of Field Records are documented in accordance with the DIS guidelines (date and time of day, type activity (e.g.: field visit (FV)), persons encountered, investigative results).

  • 70% of new partners to early syphilis are examined.

  • 85% of the located new partners, suspects/social contacts, and associates of HIV positive clients are tested for HIV.

  • 70% of new partners to HIV are examined.

  • 75% of syphilis partners, suspects/social contacts or associates located are examined within seven days.

  • 65% of located partners to HIV are closed to final disposition within seven calendar days of initiation.

  • 95% of D, G, H, J, and L dispositions are submitted by DIS to the supervisor prior to closure.

  • 85% of initiated and examined in-jurisdiction neonatal and prenatal reactive serologic tests for syphilis (STS) will be dispositioned within seven calendar days.

  • 75% of initiated and examined reactive STS are closed to final disposition within seven calendar days of initiation.

  • 65% of initiated and examined partners to early syphilis are closed to final disposition within seven calendar days of initiation.

  • 75% of GC/CT partners, suspects/social contacts and associates located are examined within seven days.

  • 90% of outreach screening activities will be documented within seven days including all lab results. The minimum documentation will include: screening location, number tests by disease, number of positive tests by disease, and the number of new cases identified by disease.

  • The DIS will perform at least five field blood tests each month.

  • The DIS will use resources effectively in planning field activity.

  • The DIS prioritizes and organizes field records according to program expectations.

  • The DIS prioritizes field visits geographically.

  • The DIS ensures necessary materials and equipment are available (referrals, GPS, envelopes, working pens, pouch, maps, blood kit).

  • The DIS displays awareness of, and practices, field safety.

  • The DIS maintains patient confidentiality during field activities.

  • The DIS manages circumstances which present obstacles to executing referrals in a professional manner.

  • The DIS utilizes field resources in executing referrals.

  • The DIS recognizes and motivates persons who may assist in an investigation.

  • The DIS motivates persons to seek examination and treatment.

  • The DIS pursues and performs syphilis and HIV screening while in the field.

  • The DIS documents investigative activities completely, clearly, and accurately at each stop according to program and DSHS POPS.

  • The DIS documents mileage at departure, after each stop, and at the end of the day when conducting field activities.

  • The DIS checks in via cell phone (when possible) with FLS and surveillance before returning to clinic.

 

9.6 Partner Services in Clinical Facilities

DIS working in programs which offer clinic services will be expected to provide partner services to patients during clinic hours. Scheduling will be administered by the program supervisor.

DIS will exhibit an understanding of STI clinical care and demonstrate a verbal understanding of STI diagnostic test results.

DIS must facilitate regular communications between themselves and clinic staff regarding prevention messages to ensure that clients receive consistent information.

DIS should expect to be evaluated regularly to ensure they are using STI intervention skills and HIV counseling and testing skills appropriately and to assure consistency of messages.

 

9.7 DIS Services in Medical Facilities

Even if the focus of Partner Services is Disease Intervention, the DIS must remain sensitive to additional health/social needs of clients served. When health/social needs are perceived by the DIS or expressed by a client, the DIS will provide the client with information on other available services to help address the need(s).

Each program should have access to (or develop) a referral guide that identifies other services within the community to help the DIS make timely referrals, as appropriate.

When possible, the DIS should assist the client by calling and setting the first available appointment or allowing the client to call from the DIS’ office. The DIS should document the referral in the case management notes.

The DIS will follow up and document completion of the following referrals to ensure successful completion of the appointment:

  • HIV positive individuals referred for early intervention/case management;

  • Clients referred for penicillin desensitization;

  • Mothers and children potentially involved in congenital cases; and/or

  • Pregnant females referred for prenatal care.

Unsuccessful referrals for these services require documentation and a re-visit with the client.

 

9.8 Other STI Counseling

The DIS may be assigned to counsel individuals regarding STDs that are not designated as "high priority". STIs such as gonorrhea or Chlamydia that are not priority may not involve case management and partner follow-up. Regardless of priority status, the DIS should perform the service professionally and efficiently and include the following:

  • The precise nature of the individual's status (infection, exposure);

  • Information regarding the course of the specific STD (e.g., modes of transmission and risk of infection/re-infection);

  • Standard health behavior messages:

  • Referral of high-risk pregnant women (as appropriate);

  • Importance of complying with medical instructions; and

  • Applicable educational literature (HIV/STI materials available from the DSHS Warehouse).

 

9.9 Special Circumstances

There will be times when DIS encounter sensitive issues that are not specifically covered by the HIV/STD Program Operating Procedures and Standards (POPS). In these instances, the DIS should immediately discuss the situation with his/her supervisor to obtain guidance.

 

9.9.1 Third-Party Consent

If it is necessary to obtain consent from a third-party for HIV and/or other STI testing due to the age, mental health status, and/or other physical disabilities of the person who is being tested, the DIS should discuss the need to obtain third-party consent with his/her supervisor and/or the Medical Director/local health authority. DSHS Central Office staff should also be notified of the situation.

 

9.10 DIS Educational Presentations

The DIS may be called upon to deliver an educational presentation to a community group or agency. The DIS must obtain approval from a supervisor to conduct the outside event.

For each outside request for an educational presentation, the DIS is responsible for:

  • Ensuring the topic relates to program priorities,

  • Establishing particulars (time of event, time allotted for presentation, location, audience) with agency or community representative,

  • Confirming learning objectives are identified by requesting agency or group, and

  • Obtaining supervisor approval of the presentation and materials.

The DIS will prepare the presentation, gather materials and create an evaluation for each presentation given.

The DIS will submit documentation of the educational presentation performed to the supervisor after the presentation has been delivered (including date, location, # of persons present, etc.).

 

9.11 Health Provider Visits

The DIS, depending on programmatic staffing and expectations, may be called upon to conduct visits to non-STI clinic health providers who offer STI services.

The purpose of these visits is to provide information about HIV/STD testing, treatment, reporting rules, and/or partner services including but not limited to:

  • Health department services,

  • Diagnostic criteria and treatment regimens,

  • Establishment or improvement of reporting activities, Local disease trend information, and/or

  • Client education materials

Prior to conducting health provider visits independently, the DIS should:

  • Receive training from a supervisor to conduct these visits;

  • Accompany a trained colleague on a previously decided number of visits; and

  • Conduct a previously decided number of health provider visits being observed by a supervisor.

To prepare for Health Provider Visits, the DIS will:

  • Schedule and document the appointment with the health provider on the program calendar;

  • Review the provider’s previous history of diagnosis, treatment and reporting;

  • Review available documentation on previous visits to the provider; and

  • Assemble program packets or applicable materials including but not limited to:

    • Copy of current reporting guidelines

    • Current STI treatment guidelines

    • Current morbidity trends (state & local)

    • ‘Health Alerts’ from the past quarter (or longer if appropriate)

    • Client education materials

    • Business cards

The DIS will submit complete documentation of each health provider visit within three days of visit for supervisory review.

  • Who the DIS met with – identification of key provider personnel,

  • Information shared and discussed,

  • Complete list of commitments and requests, and

  • Recommendations

All elements that need immediate action or consideration will be brought to the attention of the supervisor.

 

9.12 Laboratory Visits

The DIS, depending on programmatic staffing and expectations, may be called upon to conduct visits to non-health department laboratories.

The purpose of these visits can include:

  • To establish or improve reporting practices,

  • To maintain existing, cooperative relationships, and/or

  • To offer health department services,

Prior to conducting laboratory visits independently, the DIS should:

  • Receive training from a supervisor to conduct such visits;

  • Accompany a trained colleague on a number of visits prior to conducting them independently; and

  • Will assemble applicable materials for visits such as:

    • Copies of reporting regulations

    • Current health alerts and morbidity trends

    • Previous reporting history

    • Business cards

The DIS will plan laboratory visits by:

  • Making and scheduling the appointment, and

  • Recording the date and time of the visit on the program calendar

The DIS will submit complete documentation of the visit within three days for supervisory review.

Documentation will include:

Who the DIS met with,

  • Information shared and discussed,

  • Description of specimen management and reporting,

  • Complete list of commitments and requests, and

  • Recommendations

All elements that need immediate action or consideration will be brought to the attention of the supervisor.

 


 

 

Subchapters

9.1 Professional Conduct and Work Relations

9.2 Confidentiality

9.3 Case Management

9.4 Interviews

9.5 Field Investigation and Notification

9.6 Partner Services in Clinical Facilities

9.7 Referral and Linkage Services

9.8 Other STI Counseling

9.9 Special Circumstances

9.10 DIS Educational Presentations

9.11 Health Provider Visits

9.12 Laboratory Visits

Last updated May 7, 2020