Appendix E-1

• The training made me think about what services are appropriate for street youth and what services street youth might go to. I now discuss with the client the referrals I am making and how the client feels about them. I look to see how appropriate the referral is for the client, in terms of if the client will actually go. 2
• The teamwork helped me to know when I am over my head. I can send people elsewhere, like to their therapists. For example, a resident was very agitated and I wasn't able to deal with him. I directed him to the dream therapist (there is also a hypnotherapist on staff), and it changed him greatly. The residents have re-occurring frightening dreams and the therapist lets them know what the symbols may mean. 15
• Before, we had nothing. 17
• It gave us more options for referrals (that is, housing) that we did not know of before. 18
• I am more familiar with what services are available now. The project helped us with that. We take advantage of peer support, for example. 34
• It didn't affect our referral process. 41
• Now, if a patient is HIV-positive, we refer them to perinatal care, whereas that didn't happen before. 59
• Now, we do more referrals because in the training we learned about different services, such as housing, the Ryan White CARE Act, and the psychological issues patients may experience. We now know that we can utilize social workers to identify resources in the community. 65
• I am more aware of the resources available to people with HIV/AIDS. 70
• I made confidential referrals for HIV counseling and testing. It surprised me that they would want confidential referrals because of the public awareness. 84
• I was given resources that I didn't know existed, which I gave to the clinical coordinator who gives our referrals to the youth at our organization. 89
• I now have a list of training attendees as resources for referrals. 103
• It confirmed that for all patients who have multi-type treatment the need to be seen by doctors who deal with those who are high-risk. We have referrals to hospitals when patients come in undiagnosed. We now can consult with them. 104
• It made us aware of the WIN program and we now know that it's a referral source for us. 112
• I learned about more resources and we can tell our providers, who we train, about them. 114
• The training improved it. Now, I am more aware of the referral network and it has increased the contact that we have with university services available to our patients. 115
• We have had no one to refer as of yet. The training gave us a bigger list to refer them, though. I am prepared for the future. We are more heavier into drugs where we are. 119
• I really have no opportunity to utilize it, but there is a stronger base if we were to. We have more current references and we have an easy-to-use reference guide. In terms of referencing the disease, they gave us pictures of rashes, graphics, algorithms, those types of things if I should need them. The pictures would be very helpful. 120
• I am more aware of the services, for example the Valley AIDS Council. We never made referrals there before the training. 128
• I met some service providers, including agencies from the region and added them to my list. I haven't used them yet but I added their names to my Rolodex. 133
• It improved because we got to meet people from different agencies in the region, and we learned about the services offered by the project. 148
• I now do more referrals because the training increased the number of resources we have available to refer patients to. 150
• I received some current brochures from local support groups, so now I can refer patients to some of those people. 159
• It has greatly improved because it has made me aware of different services that are available for youth. 160
• It made me aware of the referral system in Chicago for HIV services. 175
• There is definitely more access to services. I was made aware that there is such a thing, its location, and how to get in touch with them. 179
• I had to learn different resources in treatment, which aren't that many. 191
• In the sense that I know of a lot more referrals I can make for information and legal assistance in HIV/AIDS cases. They gave us a directory of resources in treatment and in the USA. 193
• The training offered us a lot of resources in the community that I can offer my patients. I was not aware of these resources before. 195
• I have a book that has phone numbers of different places, like clinics and where patients can go to for financial help. I give out a lot of those booklets when inmates are released. 197
• It has made me aware of what services are out there in the free world where we can refer inmates. 199
• If I can’t deal with situations here, I know where to send my patients. 213
• I search out particular people in the service system to make appointments. The training help me network with other service providers. 227
• I was given "Metro Teen AIDS" as another referral source. 229
• I do referrals on the board, professionally. If women have questions, I tell them on an official capacity. I'm learning what is available. That information was given at the workshop. 234
• It gave us more options for referrals than we had before. Before, the only agencies we used were the AIDS Bureau and Whitman Walker. Now, we also use other government agencies. 236
• Referrals are a lot better because I feel secure in the information I get from the project, since their goal is to benefit women and they know about service agencies with the same goal. 238
• We got information about available resources for my clients. 241
  
  
  

• We advise foster families on the HIV status of the children that they'll be caring for in order to make them more aware of the issues that might arise and the special care that will be needed by HIV-positive children. We continue our referral process, but now we acknowledge the status of a particular client upfront when making the referral to another agency. 67
• We are making more program referrals now. I'm now more aware if my staff is making and following up on referrals. 72
• I am more sensitive to how my clients feel about going to a referral. I had a case where a girl had a sexually transmitted disease and I went with the girl to the referral and was supportive of her. In the past, I may not have gone with the girl. I realized that it's not just about referrals, but being supportive. 91
• I can discretely and intelligently encourage clients to go to other services. I can now judge their responses better to what I’m saying. I draw a huge mental picture of the service for the client in a way he/she can understand it. I have become more sensitive. You can take a more proactive role when you know more. 98
• I probably wouldn't refer as quickly as before because I am more informed. 101
• I look for mental health input for difficult management issues. I am now open to making referrals for mental health issues. 102
• The training increased my knowledge and recognition of the mental issues associated with HIV and the services related to it. The trainer is also a good reference. 118
• It made me more conscious of it. There is an HIV group there. I contact the group and talk to the patients about visiting us. It didn't change it a lot though. 132
• I am more informed about making consults. 134
• Referrals for infectious disease consults have increased, especially when T-cell counts drop. The information given to the infectious disease doctor about a patient is more detailed. The physician at my prison is the only infectious disease doctor for all of the correction facilities in Georgia. All infectious disease consult requests go to me. 140
• I became more knowledgeable of the treatment modes and it improved the referral network that we have for clients. 149
• I feel as if I didn't have to refer them to somebody else because I know more. 162
• I don't make referrals to outside agencies or different services. However, I refer to the dental clinic within the correctional facility. Before being trained, you don't realize the importance of dental hygiene for HIV/AIDS patients. 165
• I'm more likely to refer patients from the dental to the medical sections of the prison if they have early signs of HIV. 184
• Ours are mainly counseling issues, not related to HIV issues. We do refer people to substance abuse counselors who do bring up the HIV issues. 185
• Yes. 189
• In terms of the materials presented, I don't think I would've picked them up before. I used to put the material on the shelf. Now, we had to read it. I got into it. The act of participating helped. Now, I'm more interested. It wasn't one of my favorite topics. I just didn't know resources before. With this training, over time, it was like I was taking a semester course. I've had the resources before, but never used them. 192
• We're pretty much self-contained. Education comes with HIV-positive patients trying to be responsible for their life and their own behavior, that is, they need to inform their health care providers of their status, such as dentists. Also, that they have rights and they can't be refused treatment. That would be discrimination. 200
• I don't usually refer patients but if the chance comes up, I would be better able to explain the rationale for referring. For example, in outpatient therapy, if we need to focus more on patients’ capabilities and rule out barriers related to psychological issues and dementia, I would be able to define what it is that patients need more focus on, be more able to specify what the patients’ needs are, and what patient care goals to work toward. 212
• I am more aware of the services available to women. 231
• I found out about more referral sources in our area that our clients can access for services. 244
• Now, I know more about services that are available that are designed specifically for women with HIV/AIDS. Now, I am making more referrals. 245
• Now I know where to send clients for services. 246
• Now I'm making more referrals for my clients. 248
• I know the resources better and how to refer people there. I have a chance to refer people to the project. 250
• We encourage our vendors and counseling and testing staff to refer newly diagnosed women to the women's collective. 251
  
  
  

• It changed the way I refer patients to care. I make sure I refer the patients to the right person. 16
• I felt very comfortable and much more willing to refer a client to trainer’s services. 20
• Because of our referral services, people can be treated at the University. Now, there are people there we can talk to. Before, we were knowledgeable, but now we know people at these agencies and it makes referrals easier. 24
• I don't refer many patients. I feel confident treating them. If I do need extra help, I get a consult, for example, dermatology. The trainer is open for questions [post-training], for example, "Do we need to stop medications, when to stop/recheck?" Intricate things are answered. We have the trainer’s e-mail and continually ask him questions. As far as the prescriptions, the training was a refresher. 32
• There has been an increase in referrals for HIV specialty care made within the hospital in order to decrease travel distance/time of patients and lapses in medical care. 39
• I move quicker now on getting clients into services they need right away. 49
• We now refer patients to services they need more often because we know better about what types of services they'll need. 62
• It improved the referrals I make for psychological evaluation. I'm not making any more referrals than before, but I now can better assess when such a referral is needed for a patient. 77
• I use the training methods to follow when I need to make referrals. I know better who to refer and how. 78
• I can now give out more referrals because I know what services and programs for youth exist and where they are located in the area. 82
• Collaborations after the training improved referrals. 86
• It improved because of the networking with other agencies. I make more referrals now. I feel more comfortable reaching out to different people and places when making referrals. 90
• When I was doing the training, I had to refer clients to a clinic for a blood test, but now I can do the test on site. My referrals have decreased as a result. It has been helpful in developing trust and alliance with clients in terms of being able to refer clients to other clinics and going with them to their referrals. 99
• The training made me look at that more. It didn't necessarily change because they refer people to the same agencies. But it did tighten the tracking of those referrals. We want to ensure they get the services they require. Sometimes three months is too long. We want to closely define the referral process. 105
• It improved our referral process. We are now more apt to tell our patients and refer them to find out about their status, and where they can go to get tested and receive services if needed. 108
• Before the training, all patients were referred to a large hospital nearby. But, the training taught us to know about the certain stages that we need to refer out for (CD4 counts, symptoms), otherwise HIV-positive patients are managed on site now. 109
• We refer clients to medical and then they are hooked up with a case manager. "After-care" is what we call it. We have a whole HIV site. 121
• I am more familiar with what services are available now. The project helped us with that. We take advantage of peer support, for example. 122
• It pointed out the necessity of other referrals. Previously, I thought I could start the management of patients, but now I see that it may be best to refer patients somewhere they would be more compliant to treatment. 127
• I started watching labs more carefully. If I see a patient in treatment failure, I refer for consults. 139
• We refer to the county service programs that offer appropriate, sensitive, personable services without judging or stereotyping them. 143
• Now, I am able to talk to them and feel comfortable and confident about talking to them about referring them to appropriate services. 171
• This hospital has not yet begun to have the volume of HIV-positive patients. This year I’ve had only 2-3 patients with HIV. They were all situations that were managed. In the future, if things come up, I'll draw up on the information and make proper referrals. 180
• Now, I'm referring more to specific services. I do this for every family regardless of whether or not they had a positive diagnosis, for example, with families with adolescents, so they can protect themselves by educating them on transmission. 202
• I'm much more willing to refer clients more quickly now and I know where they can go for services. Before, I was lost because I didn't know what services existed for people with HIV/AIDS. I'm more informed of agencies in town. I'm more inclined to tell them that they need to go if they’re practicing risky behaviors. 204
• I am very careful about that. I have always been very protective. Women are so stigmatized and so misunderstood. Some service providers are not sensitive so I protect those women and I am careful who I refer them to. It is because they are so discriminated against and treated so poorly. Attending the project’s sessions validated that for me. 235
  
  
  

• I do not make referrals. 3
• I don't refer patients. 4
• There has been no effect on referrals or referral patterns because I do not make referrals. I see patients who have already been through the medical department of the clinic where they have already received referrals. 5
• In terms of medical reviews, the consultant psychiatrist and/or the trainer do the reviews. There are a few more referrals to psychiatry. 8
• I don't make referrals. I talked them over with a nurse and made suggestions. I know what she's talking about. 10
• Usually the consults are either psychiatric or nutritional, which happen fairly regularly here. 11
• It hasn't changed my pattern because I never had a referral pattern. Instead, we have patient care conferences that give us referrals. 22
• I don't do referrals. 37
• The social workers do all of the referring. 38
• We refer patients to places that they ask us. The doctor has the ultimate say in where they go. 57
• I don't think it has changed. The primary care physician does the referrals. 123
• I don't do referrals. 194
• It hasn't changed because I don't refer patients to other services. 196
• We serve a very low-risk population here. I wouldn’t even refer anyone to HIV services. 219
• I don’t do referrals. 220
  
  
  

• The training didn't talk about how to give referrals, so my referral patterns haven't changed at all. 1
• In terms of referrals, we can refer our clients to two clinics only because they are the ones that are free, so nothing changed because of the training. 6
• We haven't gotten to stage yet. We haven't actually defined referral. Before, we had our own infectious disease physician. Now that we are part of a network with a major hospital group, I don't know the level of impact. 9
• It did not change. 19
• It didn't change my referral patterns. 21
• No. 23
• No. 25
• No. 30
• It is pretty much the same. 33
• I can now tell what the youth really need and I know where the agencies are that will best meet their needs. 40
• There is not much difference. If I were to refer a teen, it would make a difference. Now, I know how to prescribe and where to treat patients, as well as more about new services available and prescription options. 45
• No. 47
• It hasn't changed my referral process. 48
• This hasn't changed because of the training. 50
• This hasn't changed since the training. 51
• I'm not sure this was covered in the training course. 53
• It’s about the same as before. There are no real differences. 58
• It hasn't had an effect on our referrals. 61
• The training hasn't impacted referrals. 66
• It has improved the system, but I only have one case. 68
• There have been no changes in referrals. 73
• It hasn't changed our referral patterns at all. 76
• It hasn't changed our referral patterns. 80
• We have specialists on the premises to refer patients to. 81
• I work for a Level 3 institution, so a good referral system is already in place. 83
• I had learned about referrals prior to the training. 85
• The training has no effect on my referrals. 87
• The rounds have had no effect on referrals. 88
• I have always been good at referring. 92
• There has been no change because my referrals have always been good. 93
• There has been no effect in that regard. 94
• I haven't done that yet but I would refer them as needed. 95
• It has not changed. 96
• It has improved. 97
• There has been no effect. 100
• We only do referrals for patients who test HIV-positive. 107
• It didn’t change. 110
• It hasn't changed our referrals. 111
• There has been no impact. 113
• I don't remember the effect of the training. 116
• I have not made any referrals so far. 117
• We refer to the same services, before and after the training. 124
• There is no difference. 130
• Nothing that was introduced was new. 131
• There has been no effect. 136
• There has been no effect. 138
• It does not apply to where I work. There are no referrals because it is a closed system. 141
• It hasn't changed. 142
• It hasn't changed. 144
• No changes have been made. 145
• There has been no effect. 146
• It has not changed very much. 147
• The training hasn't affected it. 153
• The training really hasn't changed it. We already have our own listing and a lot of resources. We have our own psychologist and social worker, so the referrals are already there. 154
• We have an in-house physician assistant. A patient comes in and I know the symptoms, so I will refer him straight to the physician assistant. 158
• It hasn't really changed much. 163
• There is not a lot of out-referring. When it's time for an inmate’s discharge, I get in touch with the social worker, who sets up additional resources for the inmate after he/she leaves the prison. 164
• There have been no changes. 166
• It hasn't affected it at all. 167
• The training hasn't influenced it that much. 168
• There has been no effect. 170
• There have been no changes. 172
• There have been no changes. 173
• No. 176
• No. 177
• No. 178
• We really, in our area, have not seen HIV-positive and AIDS patients. I haven't really had to do referrals. I had a good knowledge of referral services from before. 182
• No. 186
• No. 190
• There has been no effect. 198
• No changes have been made. 203
• There have been no real changes because we are corrections, and within our system, we have our own specialists. 206
• We didn't change that. We already have a good program. We have a lot of support at the hospital. We work with agencies at the hospital that deal with HIV specifically and we meet with them once or twice a year, sometimes three times a year, depending if they are a new agency or not. We get updated on the kids. If there is a problem case, we talk about it, and make sure everything is intact. 209
• The referrals are in-house. There’s a standard way to do them. 210
• It hasn’t changed at all. 224
• It hasn't changed because I know of a lot of the services that are available to women. I didn't learn of any new referrals. 230
• No changes have been made. 240
• It hasn’t changed. 242
• It didn’t change. 243

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