POPS Chapter 19 - Individual and Group HIV Prevention Interventions
Purpose: This chapter provides guidelines for the delivery of quality services for individual and group HIV prevention interventions. These guidelines are written to assist facilitators in providing these interventions to individuals most vulnerable to acquiring or transmitting HIV.
DSHS contractors should review the CDC’s Effective Interventions or the Compendium of Evidence Based Interventions and Best Practices for additional resources.
HIV prevention services should be centered on the individual receiving the intervention. Services should also be culturally responsive with respect to race, ethnicity, gender, gender identity, sexual orientation, age, language, literacy, relationship status, and other relevant factors.
Interventions are most effective when scaled up to impact more people and organizations. DSHS contractors must have a plan in place to increase the “reach” of the intervention.
19.1.1 Priority Populations
Behavioral change interventions must focus on populations most vulnerable to acquiring or transmitting HIV. Local epidemiological data should be used to determine which populations should be prioritized.
Adapting or tailoring interventions may be necessary to meet the unique needs of the local priority population. These adaptations must be based on theory, justified need, and/or observation, and must be approved by DSHS in writing prior to implementation.
19.1.2 Community Assessment
Agencies funded for individual and group level interventions are required to conduct an initial assessment of their community. Once the initial assessment is conducted, agencies are required to conduct ongoing assessments and integrate data from assessments to determine changes that may have occurred in the community. Agencies will make changes to programs accordingly.
See also the Introduction to Community Assessment Tools.
In order to reach persons most vulnerable to HIV, agencies will need to know what behaviors and other factors are related to HIV vulnerability, who is engaging in these behaviors or is affected by these factors, and where to identify the priority population(s). This process will help to tailor messages and services in a way that resonate with the priority population(s) and develop a plan for how to engage these communities.
DSHS contractors are expected to develop a recruitment plan that outlines when, where, and how recruitment of the priority population(s) will be conducted. The plan must include ideas about where to reach the priority population(s), as well as the specific recruitment strategies and messages that will be used for engaging them in HIV prevention services.
In order to have an effective and innovative program, resources should be dedicated to implementing a recruitment plan. Successful programs typically:
- hire and train specific recruitment staff who are separate from other prevention staff, and who are from the communities you serve;
- build partnerships in the community to ensure multidirectional referrals and expand recruitment networks;
- use innovative approaches for reaching the priority population through the internet and social media;
- offer tangible reinforcements to reach previously underserved subpopulations, generate interest in new services, or increase retention; and
- provide supportive services that meet the needs of individuals beyond HIV-related services.
A comprehensive recruitment plan aims to deliver strategic, culturally responsive, community-based recruitment strategies that engage the priority population and motivate them to access HIV prevention services.
DSHS contractors are expected to collaborate with other organizations that have a history of working with and recruiting the priority population(s). Agencies must seek input from community stakeholders, such as their Community Advisory Board (CAB), to select the most appropriate recruitment strategies.
DSHS contractors must use community assessments to evaluate and improve recruitment strategies. If it is determined that your program is not reaching the priority population, or your agency is not on track to meet performance measures, different recruitment strategies should be considered.
All information is confidential. At minimum, facilitators are expected to maintain and demonstrate a high level of confidentiality regarding the information of individuals being served and strictly adhere to the policies and procedures of their agencies. Releasing any information to unauthorized persons which leads to the disclosure of an individual’s identity is a breach of confidentiality and punishable by applicable statutes and administrative regulations.
Violation: In accordance with Health and Safety Code HSC §81.103 Confidentiality; Criminal Penalty, breach of confidentiality is a Class A misdemeanor and is punishable by up to one year in jail and fines of up to $5,000. Violation of confidentiality is also a civil offense that may result in liability for damages plus fines.
Participant charts must be maintained for all individuals participating in an individual level behavioral intervention. An organized system for arranging materials in files that is consistent throughout all files must be implemented. Files must include:
- Signed consent to receive services;
- Signed confidentiality form;
- Proof of HIV status, if applicable;
- Assessments or documents specific to the intervention, if applicable; and
- Documentation of referrals, if applicable.
Interventions for groups may or may not maintain individual participant charts according to the intervention. All group interventions must have documentation for each completed “cycle” of the intervention. A completed “cycle” is when all required sessions of the intervention have been completed. Sign-in sheets for group level interventions must also be maintained.
Contractors must maintain policies and procedures to address quality assurance and training requirements. Prior to facilitating an intervention session, personnel must:
- Complete the necessary trainings as required by DSHS;
- Complete training on the specific intervention, if applicable;
- Observe an experienced facilitator conduct at least four sessions, if available; and
- Be observed by a supervisor facilitating at least four sessions.
A person or persons responsible for data collection, submission and quality assurance is to be in place per DSHS requirements. For more detailed information, visit the DSHS prevention data page.
*Note-many behavioral interventions include a staff observation tool and/or a chart/documentation review tool in the training materials that can be used. If it is not included, it is the contractor’s responsibility to develop these tools.
19.4.1 Staff Training
Contractors must maintain policies and procedures to address quality assurance and training requirements. Prior to implementation of a client level intervention personnel shall:
- Complete the required training approved by DSHS.
- If a program is implementing an established intervention based on CDC’s effective interventions:
- Staff implementing the intervention will complete training on the specific intervention, if applicable;
- Staff will follow the observation and/or chart documentation tool in the intervention’s training materials. If a staff observation tool is not included, the contractor shall develop its own tools to ensure fidelity to intervention.
19.4.2 Staff Observations
Observations of intervention facilitators must be conducted according to the following schedule:
|Length of time the staff member has been performing the intervention:||Staff will be monitored at least:|
|3 months or less||One out of every 3 sessions|
|4 to 6 months||Twice a month|
|7 to 12 months||Monthly|
|1 to 2 years||Quarterly|
|2 years or more||Every six months|
A staff observation tool specific to the intervention must be used and all staff observations are to be documented and available for DSHS review.
19.4.3 Individual Level Chart Reviews
Interventions that require individual participant charts must have chart reviews conducted on a regular basis according to the following schedule:
- For facilitators with less than six months’ experience, 20 percent of charts should be audited monthly, or at least four per month, whichever is greater; and
- For facilitators with more than six months’ experience, 20 percent of charts should be audited quarterly, or at least four per quarter, whichever is greater.
19.4.4 Group Level Chart Reviews
Interventions for groups may or may not have individual participant charts according to the intervention. All group behavioral interventions must have documentation for each completed “cycle” of the intervention. A completed “cycle” is when all required sessions of the intervention have been completed. A review must be conducted for each completed cycle.
A chart review tool specific to the intervention must be used and all chart reviews are to be documented and available for DSHS review.
Satisfaction surveys must be conducted annually. Findings from the surveys should be used to improve services. Documentation of this improvement must be available for DSHS review.
The agency will have a system in place that complies with current confidentiality laws to protect client or patient records and documents maintained in connection with HIV/STD prevention activities. Retention and record destruction guidelines are detailed in Program Operation Procedures and Standards Chapter 2. See sections 2.3 and 2.4 for further information on retention and destruction of client records.