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Sexually
Transmitted Diseases > Program Guidelines > Partner Services
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Types of interviews and their objectives The following section describes three types of interviews: the original interview, the reinterview, and the cluster interview. All interviews should employ the techniques in the section that follows, titled "Other important interviewing concepts." In any interview situation the interviewer should always pursue information on pregnant females who would benefit from STD screening and should ultimately ensure prenatal care. For example, the interviewer should always ask the interviewee (male or female) if they know anyone who is pregnant. If yes, the interviewer should then ask if they know if the pregnant person is receiving prenatal care. If the answer is no, the person should be initiated for follow-up and the interviewer should offer screening and have a specific prenatal service provider for referral. The objective of the original interview (Appendix B) is to prevent further transmission of disease through the prompt identification and examination of all elicited partners and suspects. The original interview is designed to ensure the patient understands the seriousness of the infection and the importance of their cooperation in STD/HIV prevention and control efforts. It is also designed to provide client-centered counseling to develop a personalized risk reduction plan and to increase the likelihood that all partners and suspects are disclosed so that they can receive an examination and treatment. A fundamental part of the original interview (as well as reinterviews and cluster interviews) is partner elicitation. Elicitation is the process by which the interviewer assists the patient in identifying partners and other high-risk individuals (suspects) who might benefit from a medical examination. The goal of partner elicitation is to obtain sufficient information to confidentially locate, notify, and refer the partners or suspects for necessary examination, treatment (if appropriate), and risk reduction counseling. Referrals to other medical and social services (such as HIV early intervention, prenatal care, or substance abuse treatment) are an important aspect of original interviews. The interviewer should make every effort to create an accessible and appropriate referral and should also follow up to ensure that any referral appointment is kept. All information obtained in an original interview should be documented on a standardized form, an example of which is located in Appendix E. When a patient is diagnosed and treated in a nonpublic health clinic setting, or when a patient exits the clinic prior to the DIS conducting an interview, the original interview must be assigned for field follow-up at the earliest opportunity and with the expectation that the interview will:
In accordance with local practice, the DIS should confer with the supervisor (or designated co-worker) before completion of a patient interview if:
The DIS should elicit a commitment from the patient to pursue identified information needs, establish an appointment for reinterview, and determine best time(s) and alternate methods for reaching the patient. When appropriate, the DIS arranges for a field tour with the patient to identify home addresses, to point out locations where partners hang out, where the patient met a partner, etc. The DIS concludes by addressing any questions, providing reassurance on any problem areas, restating commitments, providing handouts, and planning for the reinterview. While the original interview is intended to elicit all interview period partners and suspects, the reinterview of persons with high-priority infections (HIV, early syphilis, or other high-priority infections, based on local criteria) is usually warranted. A reinterview may be required, for example, when a patient has clearly evaded discussing or referring all partners or suspects during the original interview. A reinterview (Appendix C) is any interviewing session following the initial interview with a STD patient. DIS conduct reinterviews when indicated, or when requested by the supervisor, and always with a plan to accomplish specific objectives that are the product of careful review and analysis. Reinterviews are conducted to:
In most program areas, reinterviews are conducted with a plan to obtain information necessary to advance disease intervention. The benefits to be derived from reinterviews are further enhanced when conducted within reasonable time frames—normally within 72 hours of the last interview. The time and place of the reinterview should be set during the original interview process. DIS should document the results of reinterviews on a STD Reinterview Record within time frames established by the local program. At a minimum, the documentation must address information needs previously established for the reinterview and must provide an updated analysis. The updated case is made available for supervisory review or is given to the appropriate case manager at the earliest reasonable time after the DIS completes the documentation. When interviewing patients regarding partners, adequate information for disease intervention is not always known or able to be obtained. Therefore, other intervention strategies, such as cluster interviewing, are initiated to expedite the intervention process. The cluster procedure has progressed through many stages since at least 1950 (Spencer, 2000) and currently consists of selective interviewing of partners, suspects, and associates who are not known to be infected at the time of the interview. The purpose of the cluster interview (Appendix D) is to gather information about previously unnamed or uninitiated partners, suspects, or associates of known cases. The cluster interview is designed to further expedite the disease intervention process by expanding the base of information about any high-risk groups associated with the infected person. This information in turn may be used by the program to determine the appropriateness of screening activities, including risk or demographic profiles and the geographic location of target groups for screening. Cluster interviews should be planned, time permitting, and are particularly helpful in outbreak situations. They require skill and time commitment by the interviewer in exchange for returns that are often difficult to estimate in advance. The DIS conducts cluster interviews, as indicated by case analysis or when requested by the supervisor, with a plan to accomplish specific objectives such as:
In conducting STD cluster interviews, care must be taken never to indicate that any specific person is infected with any disease, has been exposed to disease, or has been examined for disease. In the interview, the patient should be provided with:
Other important interview concepts Motivational techniques to encourage voluntary disclosure The ability to motivate patients to voluntarily disclose information about their partners and others is central to the success of disease control and prevention. An interviewer can use a number of techniques to motivate disclosure. Several approaches are described in the Employee Development Guide and the two week introduction to STD Intervention course. One example, the LOVER approach, is a very effective method of addressing patients' questions and encouraging disclosure of information. Using this approach, the interviewer will Listen, Observe, Verify, Evaluate, and Respond to the patient's issues. The interviewer must listen to what the patient is saying and observe any non-verbal cues that the patient is giving. The information must be verified and evaluated against other known information and the DIS must respond to the information given. Another example is providing information about a potential issue such as same-sex transmission, complications, etc., followed by an open ended question. In addition, the interviewer can appeal to patient's sense of responsibility to other members of their community and to their responsibility to themselves with regard to re-infection. To increase the likelihood for success, motivational techniques should be tailored to the specific needs of the patient. Visual aids are also very helpful and can be used to depict the potential consequences of untreated infection. Suggestions for successful motivation of disclosure include:
Client-centered approach to risk reduction Counseling patients who are sexually active is likely to be more effective when counseling strategies are shaped to fit the individual patient's needs. To ensure patient-centered STD and HIV prevention counseling, interviews should be based on CDC's standards for prevention counseling, including a discussion of risk reduction strategies the patient will be able to realistically attempt, as well as specific strategies to assist the patient with making these changes. Referrals to other medical and social services are an important aspect of all interviews. Although the focus of interactions is disease intervention, the interviewer should remain sensitive to other health or social needs of individuals served in the STD clinic or through the disease intervention process. Training will help DIS recognize and address problems that interfere with sexual health, such as intimate (or domestic) violence, substance abuse, and homelessness. When such needs are expressed by a patient or are otherwise perceived, the DIS should facilitate appropriate referrals to other available services in a tactful manner that does not interfere with disease intervention priorities. Local programs should develop a community referral guide or directory, including such services as:
When local policies allow, DIS should facilitate the referral by making a telephone call in the patient's presence and attempt to secure the first available appointment. All referrals should be documented in case management notes. The DIS should further assist patients by guiding them to a contiguous service area, providing directions to other locations, and offering transportation. Referrals should be documented and confirmed. Referrals made for the reasons listed below need to be followed up to ensure that they were successfully completed:
Unsuccessful referrals for these priority services require documentation and immediate action, including additional contact with the patient.
Page last modified: August 16, 2007 Page last reviewed: August 16, 2007 Historical Document Content Source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention |
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Program Operations Guidelines for STD Prevention
