Over the past nine years at CAPS, my research has revolved around qualitative methods for understanding the process of HIV test counseling in order to develop structural interventions at test sites to improve the quality of counseling and prevent HIV infections. These structural interventions address two obstacles to quality HIV prevention services we identified in our analysis of recorded HIV test sessions: excessive paperwork and a lack of counselor training and supervision.
In the current system, counselors spend one quarter to half the session completing epidemiological questionnaires about each client’s past risks, time that could be better spent on behavioral risk reduction counseling. Test site administrators spend more time on collecting this paperwork for the local health department than training and supervising counselors. In collaboration with the San Francisco Department of Public Health and Magnet test site, we developed and successfully piloted a structural intervention to streamline paperwork and enhance counseling. Clients complete a self-administered questionnaire using a handheld touch screen computer prior to the session. Counselors do not have access to the client survey data during the session. The new method radically changes the dynamics of the counseling session and streamlines data entry. Client data are transmitted electronically into local and state databases without the need for manual data entry by health department staff. Most importantly, the intervention facilitates counseling because counselors no longer have to interview clients about past risks, leaving more time to probe about the client’s current risks and develop a risk reduction plan. Counselors also report that the self-administered survey prepares clients for the session by helping them to articulate their specific concerns, resulting in more focused discussions and realistic plans for risk reduction. Over the next year, we will work with the State Office of AIDS and local health departments to adapt the client self-administered questionnaire for use at other test sites.
To address the need for counselor training and supervision, we are adapting two innovative methods we developed in our research on test counseling process – “time charts” and Interpersonal Process Recall (IPR) – to help counselors understand how they currently structure the session in order to manage their multiple roles as counselor, health educator, and data collector. Time charts are horizontal bar graphs that provide a visual representation of the sequence and duration of various communication formats such as counseling, data collection, or health education. During follow-up interviews with clients and counselors, I used IPR by having counselors listen to the session recordings, frequently stopping the recording to elicit their feelings about the session process. We found that the combination of time charts and IPR has great potential as a tool for counselor supervision and training. In order to enhance current training and supervision efforts outside of a research context, we collaborated with the developer of Transana, a free, open source program designed for analysis and transcription of digital video and audio files. A new version of the software will be released in the coming weeks and we are working with two counseling agencies, Stonewall Project and Magnet test the feasibility of having counselors useTransana to analyze their sessions and measure changes in the quality of supervision and counseling. The software allows counselors and supervisors to review session recordings from a networked computer thus allowing for asynchronous, remote supervision and training. The software will also enable us to measure the impact of our current intervention on counseling while building the capacity of test site staff to provide individualized training and quality assurance.
These structural interventions will build the capacity to implement evidence-based approaches by first addressing the fundamental barriers to counseling: lack of training and supervision and excessive paperwork. The tools we are developing for HIV test counseling will have wider applicability in many clinical and outreach contexts and provide a platform for training and supervision of clinicians in various fields.
Please see my website for more information on these methods.
- IMPACT (Investigating Motivations for Participation in Anal Cancer Prevention Trials)
- A Structural Intervention to Improve HIV Test Counseling
- Using technology to streamline client data collection and improve HIV test counseling
- Methods Core
- 2000, Ph.D, (Medical Anthropology), University of California , Berkeley
- 1992, M.A (Medical Anthropology), University of California , Berkeley
- 1990, B.A (History), Columbia University , New York , NY
Last modified: December 4, 2014