Summary of the Trainings Outcomes Interview Study

Appendix E-2

Overall, how would you rate the effect that the training experience(s) had on your referrals/referral patterns for your patients/clients?

Why is that?
(Responses Sorted by Rating)

Large Negative Effect – "Made It Much Worse"

No responses given

Medium Negative Effect – "Made It Worse"

No responses given

Small Negative Effect – "Made It Slightly Worse"

No responses given

Small Positive Effect – "Made It Slightly Better"

The training didn't change much as far as referral patterns go since there aren't too many available I am able to make. The training mostly changed how I think about making referrals, for example, discussing the referrals with the youth. 2

In terms of medical reviews, the consultant psychiatrist and/or the trainer does the review. There are a few more referrals to psychiatry. 8

Sometimes it affects referrals. There is a relationship between the psychologist, consultants, and nutritional consults. But this happens fairly regularly here. 11

There was no change unless I want to count encouraging referrals to doctors in an urban area. 23

Because of our referral services, people can be treated at the university. Now there's 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 had a good network of resources already, but now I have a few more resources where I can refer clients. 90

I now have a few more resources and can put a face to a name at an agency. 103

If I see an HIV patient, I make the same referral - to the university medical center. I provide them with the information and then that's it. That is the end of my contact with that patient. 106

I learned that the WIN program is a source we can use for our referrals. 112

I have never had those agencies before to refer to. 133

Now we have a more educated view of the places we can refer clients. 148

The lymph node assessment that I had learned has made a difference. 158

I don't do a whole lot of referrals. 165

There has been a little bit of change. I'm more likely to refer patients from the dental to the medical section of the prison if they have early signs of HIV. 184

I have the information. Now I have places to go to and options I can use. 189

For me, there was a small positive effect but I am sure it helped other people. There are psychologists for infected and affected members of family. There are nutritionists, social workers at the hospital. At another program they deal only with the patient. But the other agencies, like the home visiting nurses, deal with the family. We try not to hook up with HMOs or things outside of our hospital. 209

The training was basic information and I wasn't overwhelmed by the presentation. 229

We do the same things as we have always done, but now we have more resources available for our clients because of the training. 242

Medium Positive Effect – "Made It Better"

There were options that we didn't know about. 18

I learned to build a rapport first with the youth before telling them what they need and where to go to get it. 40

There is now more effectiveness in my referrals. I know where to send clients and how to move the process along more quickly now. 49

It improved our existing referral system. 72

It gave me information on how to make appropriate referrals for patients with HIV/AIDS-related mental health/illness issues. 77

I feel more aware. 91

It had the effect it did because of the information I acquired. 97

I have had to research services that are available in my county. There is not an extensive referral service in my county. So, I had to do much of the work myself in terms of finding more services for referrals. 98

I am motivated to get input from the mental health area and not to just look at a case as a nursing issue. 102

After the training, once we referred clients to "X, Y, and Z," we implemented a call back system. Two weeks later, we would call them back to insure that the clients got the services they were supposed to. 105

We were made aware of which programs offer the most appropriate services. We were able to refine our referral pattern. 114

It increased our referral sources available here so this has broadened the services we can make available to our patients. Most HIV-positive patients go to the city’s health centers for HIV-related care. 115

I now make referrals to where patient compliance to treatment may be higher. 127

There have been only a limited amount of clients that I’ve dealt with that are HIV-positive. I don't feel like I’ve made a real difference. 128

It affirmed what I already knew. 131

There was no effect in my immediate setting. 132

I didn't get enough information to inform inmates entirely about consults. 134

I know when to request consults now. 139

Several people from other institutions have been making referrals, which have increased infectious disease consults. The information about the patients that is given to the doctor have been more detailed than in the past. 140

I became more aware of the different resources available. 149

Patients understand more about where they can go to get services. 150

I actually had some tools for referrals that were current. 159

We were provided information about resources for patients and the ability to access these resources previously. We didn't have these resources before. 195

It helps to be able to give the patients something that they can kind of lean on in the outside world. 197

We are better prepared to deal with it when its time for inmates to leave. 199

It does affect responsibility in referring. We have to tell the patients’ providers that they are HIV-positive, especially when dealing with dentistry and the handling of blood. 200

Better understanding leads to better care. 212

It didn't really change in a large way the way I do referrals. 230

Now I know where services are located. 241

I can now make more referrals for women with HIV/AIDS to appropriate service agencies. 245

It is not the minimum positive effect, but it not the maximum either. It helped but there is still more to learn. 250

Large Positive Effect – "Made It Much Better"

I need to be continually reminded that they work as a team. The more rounds I have with the trainer, the more I am reminded. My organization has a rich history even though we are only 6 years old. When I know I am out of depth in an area, I know there is someone who can take over. 15

I am able to make referrals to the right people they need to go to. 16

Now we have a referral network; before there was nothing. 17

The assurance factor and approachability - I felt that I could refer somebody to services without reproach of any negative matter. 20

We created an entire practice guideline that is multidisciplinary from the case manager, to the nurse, to the doctors. 34

I am more aware of the sources available and where to refer the patient. Where I refer them depends on the situation and any complications. Sometimes I send them to the city. 45

We weren't even finding those patients before and now we have someone to refer them to when we do find them. 59

I learned a lot of good details from the training regarding why patients need follow-up, why they need a particular treatment regimen, and why it's important to stress to the patients that they need to follow their treatment regimens exactly. 62

We are now able to keep our patients in our community longer and can provide the care they need so that our patients don't have to go somewhere else any more to get HIV/AIDS-related care. 65

We provide more information regarding the foster children's status so that the foster family can best take care of our foster children. 67

The information provided and the confidence I acquired from attending the training were great! 68

It opened my eyes to the wealth of resources in my area. 70

It broadened our existing referral network so we have more resources available to us now. 78

I now have more resources available and I know where to send my clients. 82

I am more informed about referral options. 89

It brought up the issue that services are available. There is a way for these people to be referred. 104

It gave us more purpose or reasons why our clients need to get tested and to use precautions. 108

We now have more resources and information. We used to only do referrals for HIV patients, but now we can treat them here on site. 109

We created an entire practice guideline that is multidisciplinary from the case manager, to the nurse, to the doctors. 122

I refer clients to hospitals that have attended our trainings and offer sensitive services where clients will feel comfortable. 143

I was unaware of services for youth. 160

There is a better knowledge of the referral system. 175

I have more knowledge of referral sources for patients. 179

I haven't had many known referral resources. 192

I have added resources that I didn't know about before the training. 193

It improved my way of thinking, my point of view, and my perspective because I bring that in with all the families by explaining things with them that they might not be comfortable talking about. I incorporate this into therapy sessions. 202

Now I know where the service agencies for people with HIV/AIDS are and I’m more likely to suggest that clients go to a particular agency if I know they have risky behaviors such as IV drug use. 204

I wasn't aware of these referrals before. Now I know of them. I refer clients to the hospital where they can be counseled more in detail and be followed up on. 213

I search out particular people in the service system to make appointments, rather than schedule them through a secretary. 227

I have more referrals. I know the real deal from those services. People from the services actually came to the training and gave a whole lot of practical information. 234

HIV-positive women are so stigmatized and so misunderstood that I have to be careful and sensitive. 235.00

We have more referral sources available to use. 236

I am working with the project to get the best services for the women, and we always refer them to women-appropriate and sensitive services. None of the women we refer to services come back saying that the project referred them to insensitive programs or providers. 238

Now I know about more service agencies in my area that provide women with HIV-specific care and services. 244

The training discussed referral sources in my area. 246

It gave me more resources so I now know where services are for women with HIV/AIDS. 248

No Effect – "Didn’t Make It Better or Worse"

The training didn't talk about how to give referrals. 1

I don’t make referrals. 3

I don't make referrals. 4

I don't make referrals. 5

There was no effect because I would have to refer them to those two places I had mentioned no matter what. 6

It did not change. 19

I have no idea. 21

I never had a referral pattern. 22

Either we have referrals or we don't. We're pretty inundated with contacts from before the training. 25

If it had been new to me, it would have made a difference. I am of clinical and personal experience so there was no difference to me. Through the training, I developed contacts. Some ladies go to church to talk to young people. 30

I don't refer many patients to begin with. 32

I don't really have anyone to refer them to. The only place I can refer them to is the city and it's hard to get patients in there. 33

Our change in referral patterns was the result of necessity, not participating in the training. 39

Nothing has changed. 41

I already had contacts at the project site. I trained with the person who ran the training. 47

I had already established a fairly extensive referral network before the training that was more than satisfactory. 48

It is just the state of affairs in my area. There has always been a pretty good referral network established here. 50

I don't know. 51

There was no effect because the doctor has the final say as to where patients, under his care, are referred to. 57

It takes an issue that comes up. There has been no one coming up to me yet and I haven't been asked. This is not to say that it won't help me in the future. 58

In our hospital, we co-manage HIV patients with the infectious disease specialists and the primary care physicians and obstetricians/gynecologists. 61

I haven't had any clients with HIV who would need related services. 66

Our referral patterns are the same and we do not have HIV-positive patients to find specialized services for them. 73

No referrals have been needed since the training. 76

We don't have any HIV patients to refer. People with HIV in our area go to the big cities to get their needed specialized care. 80

We don't need to make outside referrals. 81

I already had knowledge about referrals. 85

The referrals I make are for primary care physicians only. None of the training information has had any bearing on my referrals. 87

I don't make referrals. I can only inform other members of other disciplines about delirium. 88

My organization has always been good at referrals. 92

My referral patterns have always been good. 93

It wasn't what the course was about. 94

I would refer them as needed. 95

I'm not a primary care provider. 96

The only thing that changed was that I am able to do HIV testing on site and don't have to refer clients to another clinic for that. 99

I haven't had to make any referrals. 100

I’m not sure how to rate it because I don't have many HIV-positive patients. 101

We only do referrals when patients get a positive test, but none of our patients have tested positive yet. 107

We already had a good referral system in place before the training. 110

We already had a good referral system in place and a good working relationships with care providers. Our AIDS treatment system was very sophisticated even before the training. 111

We don't have any HIV positive individuals/patients here. 113

I have not made any referrals so far. 117

I am not the person to actually refer the patients. I identify the patients who might need care but there are microworkers, MSWs, and case managers that handle it. It is more of a team recognition and referral, which would include the trainer. 118

I didn't have to implement it but I am ready when the time comes. 119

It would be positive if I had the opportunity. But it has had no effect yet. 120

I don't deal with that. 121

The primary provider takes care of that. 123

There has been no change. 124

There is not a large amount of referrals for HIV. I refer to the allergy department within my office. 130

There was no effect in my immediate setting. 132

There were no referrals made. 136

No referrals are made. 138

I refer clients to hospitals that have attended our CAN trainings and offer sensitive services where clients will feel comfortable. 143

Patients are already being seen by different providers and I focus on immediate dental problems only since this is a walk-in clinic. 144

I have had no HIV positive patients to refer out, but because of the training, we know where we could refer people to if we needed to. 145

I already knew of the resources available to me to make referrals. 146

The training didn't offer resources for the area I work in because the other training participants were from north of the city, but my clients, (who don't have cars), live in the south part of the city. 147

There's been no change. 153

We already had the resources. 154

I'm able to answer their [patient’s] questions more. 162

We refer patients to the University and the procedures with that are the same. 163

There is not a lot of out-referring. 164

I am not doing anything differently. 166

Because of the HMOs, there is a certain way to do things. 167

We already had a good referral network in place here since we're a government agency. 168

We already had a good referral network in place here at our organization. 170

Services already existed and we do the same type of referral process. 171

There are no HIV patients to refer to services. 172

There is a good referral system in place already. We do so few referrals because we treat all HIV patients, we don't refer them out. 173

I was already aware of referrals, infectious disease and the options at the hospital. 176

I didn't learn of any new referral agencies. If I did, I forgot because I don't see many AIDS patients. 177

I was pretty much aware before the training of referral sources. The doctor I work with is very active in an AIDS task force. 178

I don't have the numbers of patients to notice any changes. 180

We haven't seen a client base. 182

We refer them anyway before the training. I haven't changed the agencies I refer my clients to. There is a contract with the state and we're required to refer clients to these agencies. 185

If I felt like a patient had been exposed to AIDS/HIV, I would've referred them anyway. I was already familiar with the University. 186

I pretty much knew how to do it. 190

I would still be referring to local health departments. We don't have many resources in this particular area. 191

I don't refer patients to other services. 196

We handle everything in-house. We have an in house psychiatrist as a psychiatric consultant. 198

I’ve always been very quick to refer patients for specialty care. 203

We are in a prison. We are more limited in that area. 206

The referrals are in-house. There's a standard way to do them. 210

We serve a very low-risk population here. I wouldn't even refer anyone to HIV services. 219

We don't have any clients with HIV to refer to related services. 224

I haven't received any referrals from the training. 231

I haven't done referrals. 240

The training didn't address any new resources available in my area that I wasn't already aware of before the training. 243

I don't know yet. The effect on referrals is too be seen. We need to strengthen that piece on our end. 251

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Go To Appendix F-1

The Measurement Group