The primary goal of CRCS is to help HIV-positive and HIV-negative persons who are at high risk for HIV transmission or acquisition to reduce risk behaviors and address the psychosocial and medical needs that contribute to risk behavior or poor health outcomes.

This is a clarification of the 1997 PCM Guidance, which indicates that there should be no duplication of case management services.		We’re suggesting the following program changes - CRCS staff do not conduct case management if client has been or can be referred to other case management. CRCS staff should refer clients to available case management and other services and monitor clients’ use of these services. CRCS staff can provide case management or referrals if the client has no existing case manager or referral system or if a particular service isn’t covered by case management. In any case, CRCS staff work with other service providers and help with referrals and coordination.
Psychosocial service utilization can contribute to risk reduction.

The primary focus is on client needs, therefore building and establishing in your agency a tradition of staff working closely together to support clients is important to the success of interventions such as CRCS.

Lessons from the field

"I only do risk reduction counseling – our case managers don’t have time to do much of it, and if I provided case management services, I wouldn’t be able to ever get to risk reduction with my clients. But that doesn’t stop me from, say, making a referral to housing or substance abuse treatment when our case manager is busy and it’s a clear need of the client – I’m just sure to let her know and talk about it in case conferences."

Originally, PCM was a hybrid of psychosocial case management and risk reduction counseling for all clients. However, we have learned that staff and clients often were confused about who provides what type of service because some clients already had a case manager. There has also been resistance from case managers about sharing clients with CRCS programs and vice versa. And, some clients are hesitant to disclose risk to those who provide access to benefits, such as case managers.

For all these reasons, CDC now recommends that CRCS prevention counselors focus primarily on risk-reduction with all clients. In addition, the CRCS prevention counselor can provide case management services, but only if theses services are not available to CRCS clients. In cases where your clients do utilize other case management services, you can still provide referrals for particular services not handled by existing case management. And you should keep in mind how the services that clients use affect their risk reduction efforts.

CRCS service strategies --

• CRCS counselors focus on risk reduction, and case managers provide access to support services, especially for HIV-positive clients.
• CRCS counselors provide both risk reduction and case management services when case management services are not otherwise available to clients.
• In all cases, CRCS counselors work closely with other service providers to help high risk, high need clients reduce their risks.

Lessons from the field

PCM staff currently do not conduct case management, and we have clear boundaries around who does what within the agency – and the clients always know who to go to for what service. And we have strong team approaches to serving clients. Teamwork is enhanced by physical proximity, sharing tasks when needed (bartering), buy-in from management, and the mobile advocates serving as a bridge between the prevention and care functions of the agency. This model works very well for us and helps us provide better services to our clients.

ⁱ Glynn MK, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003 [Abstract T1-B1101]. Presented at the 2005 National HIV Prevention Conference, Atlanta, GA; June 14, 2005.

ⁱⁱ Fleming PL, Ward JW, Karon JM, Hanson DL, DeCock KM. Declines in AIDS incidence and deaths in the USA: a signal change in the epidemic. AIDS 1998; 12(suppl A):S55–S61.