CLIENT RECRUITMENT AND ENGAGEMENT  

• Protocols for client engagement and related follow-up must be developed, such as requiring a minimum number of follow-up contacts within a specified time period.

SCREENING AND ASSESSMENT

• PCM program staff must develop screening procedures to identify persons at highest risk for acquiring or transmitting HIV and who are appropriate clients for PCM.
• All persons screened for PCM, including those who are not considered to be appropriate for PCM, must be offered counseling by the prevention case manager and referrals relevant to their needs.
• Thorough and comprehensive assessment instrument(s) must be obtained or developed to assess HIV, STD, and substance abuse risks along with related medical and psychosocial needs.
• All PCM clients must participate in a thorough client-centered assessment of their HIV, STD, and substance abuse risks and their medical and psychosocial needs.
• Case managers must provide clients a copy of a voluntary informed consent document for signature at the time of assessment. This document must assure the client of confidentiality.

DEVELOPMENT OF A CLIENT- CENTERED PREVENTION PLAN  

• For each PCM client, a written Prevention Plan must be developed, with client participation, which specifically defines HIV risk-reduction behavioral objectives and strategies for change.
• For persons living with HIV and receiving antiretroviral or other drug therapies, the Prevention Plan must address issues of adherence.
• The Prevention Plan must address efforts to ensure that a PCM client is medically evaluated for STDs at regular intervals regardless of symptom status.
• For clients with substance abuse problems, the Prevention Plan must address referral to appropriate drug and/or alcohol treatment.
• Clients must sign-off on the mutually negotiated Prevention Plan to ensure their participation and commitment.
• Client files that include individual Prevention Plans must be maintained in a locked file cabinet to ensure confidentiality.

HIV RISK-REDUCTION COUNSELING  

• Multiple-session HIV risk-reduction counseling aimed at meeting identified behavioral objectives must be provided to all PCM clients.
• Training and quality assurance for staff must be provided to ensure effective identification of HIV risk behaviors and appropriate application of risk-reduction strategies.
• Clients who are not aware of their HIV antibody status must receive information regarding the potential benefits of knowing their HIV serostatus.
• Clients must be provided education about the increased risk of HIV transmission associated with other STDs and about the prevention of these other STDs.
• PCM program staff must develop a protocol for assisting HIV seropositive clients in confidentially notifying partners and referring them to PCM and/or counseling and testing services. For persons receiving treatment for opportunistic infections and/or antiretroviral therapy(ies), counseling to support adherence to treatments/therapies must be provided.

COORDINATION OF SERVICES WITH ACTIVE FOLLOW-UP  

• Formal and informal agreements, such as memoranda of understanding, must be established with relevant service providers to ensure availability and access to key service referrals.
• A standardized written referral process for the PCM program must be established.
• Explicit protocols for structuring relationships and communication between case managers or counselors in different organizations is required to avoid duplication of services, for example, how to transfer or co-manage PCM clients with Ryan White CARE Act case management.
• Communication about an individual client with other providers is dependent upon the obtainment of written, informed consent from the client.
• A referral tracking system must be maintained.
• Annual assessment of relevant community providers with current referral and access information must be maintained.
• A mechanism to provide clients with emergency psychological or medical services must be established.

MONITORING AND REASSESSMENT OF CLIENTS' NEEDS AND PROGRESS

• Prevention case managers must meet on a regular basis with clients to monitor their changing needs and their progress in meeting HIV behavioral risk-reduction objectives. Individual meetings with a client must be reflected in the client's confidential progress notes.
• A protocol must be established defining minimum, active efforts to retain clients. That protocol should specify when clients are to be made "inactive."

DISCHARGE FROM PCM UPON ATTAINMENT AND MAINTENANCE OF RISK-REDUCTION GOALS  

• A protocol for client discharge must be established.

STAFF QUALIFICATIONS  

• Staff must be provided written job descriptions and opportunities for regular, constructive feedback. In addition, staff must be provided opportunities for regular training and development.
• Organizations must hire case managers with the appropriate training and skills to complete the PCM activities within their job description.
• All staff must be knowledgeable of confidentiality laws and agency confidentiality policies and procedures.

COORDINATION OF PCM WITH RYAN WHITE CARE ACT CASE MANAGEMENT

• An explicit protocol for structuring relationships with Ryan White CARE Act case management providers must be established and should detail how to transfer and/or share clients.
• PCM must not duplicate Ryan White CARE Act case management for persons living with HIV, but PCM may be integrated into these services.

QUALITY ASSURANCE  

• Clear procedure and protocol manuals for the PCM program must be developed to ensure effective delivery of PCM services and minimum standards of care.
• Written quality assurance protocols must be developed and included in procedure and protocol manuals.
• Client PCM records must contain a copy of the voluntary informed consent document and the Prevention Plan showing the client's signature.

ETHICAL AND LEGAL ISSUES  

• Confidentiality
  • Organizations must have well-established policies and procedures for handling and maintaining HIV-related confidential information that conform to state and federal laws.
  • These policies and procedures must ensure that strict confidentiality is maintained for all persons who are screened, assessed, and/or participate in PCM.
  • Most states have well-established and stringent confidentiality laws specifically related to information about HIV/AIDS.
• Voluntary and Informed Consent
  • A client's participation must always be voluntary and with the client's informed consent.
  • Documentation of voluntary, informed consent must be maintained in the client's file.
  • In addition, a client's informed consent is required before a prevention case manager may contact another provider serving that same client.
• Cultural Competence
  • Organizations must make every effort to uphold a high standard for cultural competence, that is, programs and services provided in a style and format respectful of the cultural norms, values, and traditions that are endorsed by community leaders and accepted by the target population.
  • Cultural appropriateness and relevance are critical to the success of any HIV prevention activity.
• Professional Ethics
• PCM must be governed by the same general professional ethics that govern most human service fields such as social work, counseling, and clinical psychology.
• Discharge Planning
  • Organizations must make efforts to ensure that clients have received appropriate referrals and are adequately receiving needed services at the time of discharge (graduation). 
• Duty to Warn
  • Organizations must be familiar with state and local procedures/requirements related to duty to warn other individuals at risk or in physical danger.

Go to Appendix C