Your agency will screen potential clients for eligibility for CRCS. In general, eligibility criteria should be based on an informed understanding of the epidemic in your area and the resources available to your agency.

Agencies differ in their eligibility requirements and use a specific number of risks or combination of risk behaviors as criteria. The number of risk issues that a client reports for eligibility for CRCS may also depend on your agency’s capacity to recruit and retain high-risk clients.

Keep in mind that you will want to know enough information about a prospective client to be able to answer program evaluation questions such as --

• Are we reaching and enrolling high risk persons?
• Are we reaching and enrolling our target population?
• Who on our staff is good at reaching and enrolling these persons?

A sample screening tool template is included in Appendix B. You may revise this tool to suit your agency’s information needs and the risk characteristics of your potential clients.

The eligibility criteria should be distributed to anyone who may help with recruiting or pre-screening potential clients; for example, Ryan White case managers, medical or mental health staff, substance abuse counselors, intake staff, or outreach workers.

It is also a good idea for CRCS counselors themselves to help with screening – the screening process can be seen as the beginning of CRCS risk counseling.

Lessons from the field

In some cases, agencies recruit from programs in which clients have not recently had the opportunity for high-risk behavior, such as drug treatment programs. The agency will determine eligibility based on their familiarity with the client base and a determination that these clients need CRCS-type support in order to avoid high risk in the future. For example, an agency may hold office hours at the facility where clients are about to be released and have not engaged in any drug or sexual activities either inside or outside of the facility.

Finally, prospective clients, even though they are ‘high risk’, should be open to the idea of changing some of their risk behaviors. Experience has shown that clients who perform best in CRCS are those who either have a desire to change, have already begun to make positive changes in their lives and just need intensive counseling to hasten the process, or have at least indicated that they are willing to discuss risk reduction.

Although the highest risk persons may not currently be ready for CRCS, you should keep open the lines of communication, so that when ready, they can be enrolled in CRCS.

Lessons from the field

Some prospective clients may need referral to mental health or substance use treatment or other appropriate referral prior to enrolling in CRCS, in order to really benefit from CRCS risk prevention services.

Remember to ask about a time frame when trying to establish the risk level of a given behavior. Someone may indicate they have had several sex partners, but this may not indicate high risk if the time frame covers many years. In other words, the risk may have occurred in the distant past and may not indicate current levels of risk.

We generally recommend asking about a time period of 3 months or 90 days.

That is, since risk is episodic, asking about a short time period (such as 1 month) may not capture the high-risk behavior, but asking about a longer time period (more than 3 months) may not provide an accurate picture of risk due to poor recall and the risk being in the distant past.

PEMS NOTE: To report risk assessment data in PEMS, you need to specify the recall period as 15 or 30 days and 90 days in the initial assessment.

Go to section 2 part 2C