Appendix F-2

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• It was the combination of this training and another training that I attended. The system was already good before this training. The trainings helped make the programming a little better by giving concrete examples of ways to make the program a better "fit" for the clients. 1
• On the whole, care is changing. People are living longer. There is probably a lot of work to do, for example admission and discharge, and obtaining consults while a person is still here. A person may be here for short time. We look at a multi-disciplinary approach. 11
• I have no answer. 26
• It makes us look at the whole picture. 35
• It did reach some individuals who have been impacted but not all the individuals. Those who were reached can now provide more sensitive and appropriate services.46
• It put all questions together into one session so there's less of a chance that you'd skip something by accident. The training brought focus. Sometimes pediatric physicians become a little passive and say: "I already know this." It reiterated that counseling is important. 47
• The staff are now more aware of conditions out there and that the population with the disease is growing. 52
• It still takes awhile to get approval from our administration to get clients tested.108
• It helped improve what we were doing. There were no great revelations. It emphasized everything by having people hear it again.130
• Staff can provide more counseling and testing because we have more staff with knowledge to do it because of their participation in the training.147
• One workshop couldn't affect it that much. It helped me advocate for my target population of young gay men. 168
• We are able to get support groups started and get the correct staffing for those groups. 171
• The doctors didn't attend the training with the nurses. 172
• There is better documentation. There is more of an emphasis on counseling that has been stressed by the department ever since the session. 190
• It was an introduction to a training. It's a relatively new training to this area. This is probably people's first experience to train about this topic. It's better than nothing, but we have to have something better. 191
• There is not much of a turnover in the staff. For the most part, the staff has a lot of experience in the care of clients. They have a pretty good knowledge base. 218
• We're not there yet, in terms of social policy change. 227
• It is a small positive for me, but I'm sure a large positive effect for those women who bring in their children. It is a small step for women with children. 239
• It gave us valuable tips on appropriate care. 244
• The agency has improved in reference to the confidentiality of our clients. 248
  
  
  

• I haven't seen the full effect. I am being optimistic. 9
• There is more cooperation in care. 10
• On the whole, care is changing. People are living longer. There is probably a lot of work to do, for example admission and discharge, and obtaining consults while a person is still here. A person may be here for short time. We look at a multi-disciplinary approach. 11
• Probably the trainer’s perspective allows people to have insight they may not otherwise have and an alternative explanation for situations that others wouldn't have thought of. What I can imagine is say a medical issue or the combination of medications cause issues or psychological problems. Before, it was not considered a possibility. Now, there are other alternatives to treatment and other approaches. 13
• We've been able to provide more quality appropriate care.18
• We now have an increased awareness surrounding HIV. 21
• It reaffirmed suspicions about the need for a patient to go to the city. 23
• It informed a lot of people what they need to know. It got rid of a lot of myths. 30
• Things are more standardized. 32
• Staff are more loving, caring and patient with clients now that they know why patients behave as they do when they have delirium and other AIDS related mental health issues. 37
• Staff are aware that they need someone like the trainer available to see our patients and to consult with our staff instead of using their medical physician who doesn't have any specific knowledge of AIDS-related mental disorders. 38
• It provided a format and guidelines to educating ancillary staff so that they have a unified understanding of the disease overall. 48
• Before I did this, most of my pregnant women opted not to have the HIV test done. Now, there are more options to get their HIV test done. 56
• It opened up the door that reminds us of what we are dealing with. 57
• Through the training, case workers have become more sensitive to people with HIV/AIDS. 63
• The information provided was good. It was solid information that made me think about the advantage of talking about the disease with all of my patients. 64
• We are now seeing more clients than before since we have the tools to treat those with HIV/AIDS. 65
• The education made all the staff aware of the problem and how to deal with them most efficiently. We now have a wealth of resources available to all of the staff at our agency. 67
• It pointed us in the right direction in terms of proper protocols. 70
• We have a better understanding now of how to best discuss and solve confidentiality issues. 73
• Our patients' sensitivity to HIV testing (especially pregnant mothers) and counseling has greatly improved because of what we learned in the training. 81
• I am still pushing, but I am frustrated that changes haven't occurred more quickly. 83
• We have more people now that are more up to date about HIV than they were before the training. 95
• We have gone from using one psychologist once a week to having a psychologist at the care conferences. There has been a shift from a small mental health impact to a getting more input from mental health to determine care needs. 102
• We do more screening now and make sure that we get consent before we do HIV tests. 107
• Awareness increased among staff regarding the different mental illnesses. 111
• Counseling and testing is now a routine procedure done with all patients. Now our process continues to improve. We have more efficient tools and processes, which equal fewer patients falling through the cracks. 113
• Now our process continues to improve. Now we have more efficient tools and processes, which equal fewer patients falling through the cracks. 114
• I am more aware that the HIV population is increasing and that we should be prepared to treat more HIV-positive patients here in the future. 115
• I haven’t had that much experience dealing with HIV-positive patients. 128
• It affirmed what we already knew. 131
• The networking aspect of the training is always good. 133
• The trainers did what they came to do, but there was not a lot of time for all of the information. 134
• The staff can offer more education to patients now. 145
• Because of the training, more employees are capable of counseling than before. We now have more than the original 3-4 staff members who can do counseling since they learned about it in the training. 146
• There is less confusion now in policy regarding determining what to do and why. 149
• I can provide better overall care for patients needing HIV-related care. 150
• It was very nicely formatted especially for the new staff. I told them how to use it. 153
• It armed everyone with the same knowledge. For example, someone comes in with a sore throat and they give him a certain medication. He comes in the next day bleeding all over. You are exposed to a potential HIV-positive person because you didn't recognize the symptoms. 158
• Any time people get educated, the better the care that gets delivered. 161
• There is a process of getting people started on their medications. 162
• The nurses are the first line of defense. They can share information from the training. 165
• If there is better documentation, then there's better assurance that people were given the option of testing. 176
• There is more standardization and more documentation. 180
• I don't see a lot of changes in my staff. When I presented at the staff meeting, some people jumped on the bandwagon and some didn't. To rate the effect "much better" it would've had to affect just about everybody. 181
• This is a standardized approach. The State requires that we all should be doing the same thing. 185
• There is more focus on confidentiality because it protects patients more. 200
• I had the opportunity to establish relationships with other providers at the training so I can refer to them and get information from other agencies. 202
• The format was very understandable and covered all the basics, and we could ask questions when we were in groups. The open discussion with the trainer was very good too. 203
• I got a lot of information from there, but the care we were giving was adequate. 208
• The awareness of the information presented. 212
• Before, there was no such protocol. 213
• People know more about the mental illness part of HIV. 220
• I think it was a positive effect, but I can't really explain why. 230
• Now I know where services are located that provide appropriate services for women in this area. 241
• It is not the minimum positive effect, but it is not the maximum either. It helped but there is still more to learn. 250
  
  
  

• The staff works together during rounds, which gets everyone talking. Effective communication didn't happen before the rounds were put in place. There is much more cooperation and better communication among staff now. 3
• I don't take the status quo as automatically being the best for the client. It may be the best, it may not be. Your questions get answered. Positive changes have occurred because of that. But because the trainer doesn't have a close association with the residents, she can make suggestions for psychological evaluation for the resident that may be off base. She doesn't know them, so there is no one-to-one relationship. Her word is not from God, but she is very willing to discuss things. 15
• They're studying it more and know a lot more about it. This was not the case before the training. 16
• This was not the case before the training. 17
• We're able to network with one another with information and experience. Prior to this training, we didn't have the tools to do this. 20
• Anything is better than where we were before. 34
• People in HIV services put their best foot forward without much of a budget or funding; and they also deal with a lot of political issues. Training has kept evolving. 36
• The trainer has a concrete way of looking at patients' issues and helping staff sort out patients' behavior and medication regimens. 42
• Through conversations, I know that they diagnose more cases, are more able to follow up and staff much more comfortable with the situation. 45
• There is awareness of how to better treat these clients. 55
• We never had anything before. 59
• I learned that HIV/AIDS patients are the same as any other patients. That is, our staff needs to be cautious and provide help to people with HIV/AIDS as they would for anyone else. 62
• We know what safety measures should be taken and what actions must be taken when accidents occur. 78
• My co-workers have a better understanding of the issues. 85
• There was a wide variety of people who attended the trainings, which allowed for sharing of information, streamlining of available services, and networking. 89
• There was a heightening of awareness of resources. It’s amazing how many people don't know what is out there. 104
• It would open services to a lot more people. 105
• Through an established relationship with the local health department, we've received more referrals to our agency for HIV patients. 109
• We were able to develop task forces for HIV and positively impacted our standards for HIV counseling and testing. The training enabled us to develop a standard pediatric plan. 112
• The documentation policy is now more standardized. This type of care has been officially added to our system (in admissions). 119
• Anything is better than where we were before. 122
• The patient is treated in a better way. We are not making them feel worse. 124
• It gives me an opportunity to focus on a select group such as women within childbearing years. We work with them on a personal basis, teaching them the ways they can contract the disease. I can promote means of having safe sex. It promotes the idea of having safe sex.1 29
• It was a good experience for the group. 132
• More of the staff has become educated about HIV. 140
• Any aspect of the program that they can teach the inmate is a large positive effect. We have more knowledge and that is the bottom line. This helps us have more responsibility for ourselves. It makes them want them to take responsibility for themselves. Explaining the lab work to the patient, what the results mean, how it improved based on exercise, nutrition, and medication adherence. They can see it in black and white. They see the results, how the numbers come up. They don't have a lot of responsibility in this environment so any knowledge they can have is good and welcome. This group is good. 157
• A lot of people did not have any experience before. It provided reality to what we were doing because it brought feelings to the surface. 160
• Because of the information we received on how to go about doing things. And also the various types of health care services that one can get. 163
• After the training, you have to know what to do, how to counsel patients, to let them know it is not the end. They must know that if they are treated, if they have a positive attitude, if they have the inner strength to take their medication and to get counseling, then they can take it one day at a time. 167
• Since the training, more staff are trained on HIV counseling and testing, so we can offer better care since we have more qualified staff now. 170
• More standardized care lets nurses know what to expect. It really works! 175
• More standardized medical records equal a better continuum of care. Plus, in prison, you can better follow-up on patients. You can always get your patients to come in. 179
• It made everybody aware of different symptoms and medications and referrals. 186
• The staff is more aware. We make sure we have our gloves and alcohol. We need to spend more time and take universal precautions. We did it before, but we took things more for granted. 192
• Simply because if nobody tells you suggestions on how to handle certain situations or even teach you general hygiene rules, you're liable to not bring up a hands-on approach. If you don't know how to help, you might come off as someone who doesn't want to be there. Clients need to feel like they can just trust you. 193
• I think we have better continuity of care as our inmates travel from one facility to another. 195
• HIV-positive clients get better care and services since staff now knows about resources available in the community and since staff isn’t afraid to recommend that a client go for needed services. 204
• The care is more coordinated. The kids like to be around other kids and the moms like it because they can meet and talk to other mothers with HIV-infected children. 209
• The program had to do with if you supposedly had HIV-positive patients and how you would treat them. It took away the stigma of the HIV-positive patient. It showed me that they're just like you. 219
• It was a wake-up call. 228
• We were able to take the information from the training, like the priorities of each service category and how much money should go to each category. Hopefully, women were influenced and excited about taking part in the process. There were women from the training that attend the meetings. 234
• I keep the fact that the basic services we take for granted may be difficult to obtain for other women. 235
• It was easier to relate to providers and clients with updated materials, and the project is always a good referral source. 238
• It helped me look at the issue more broadly because I know that it's not limited to poor people. 246
  
  
  

• The training hasn't changed how the system in general offers care, only how I think about counseling and giving HIV results. 2
• I have not been there that long to really know. There is change all the time. I don’t know how the training specifically changed anything. 6
• My understanding is at some point in the program the trainer will help us with standards/guidelines and that hasn't happened yet. 8
• Did not change at all. 19
• What the training basically did was allow me to feel more comfortable with youth. It didn't change how we provide services. It just took out rigidity. Either you qualify for services or you don’t by being HIV positive. 25
• Most patients don't have insurance and it's hard for them to get medication. The health department won’t help them get medication. 33
• There has been no effect because I am not responsible for how the system is organized. 39
• I don't know. 41
• I don't do anything differently because of the training. 49
• It is just the state of affairs in my area. There is too much to be impacted by one training. 50
• I don't know. 51
• I personally don’t know. 58
• I don't know. 60
• We already have specific protocols in place. It changed the way residents provide care because they are more informed and aware of the care needed by people with HIV/AIDS. Residents are also more alert to look for the signs of those at-risk or possibly infected. 61
• I don't have that much contact at this administrative level. 68
• I don't have control over that at the penitentiary. 71
• It is up to each individual manager to improve care and to be more sensitive to people with HIV/AIDS. 72
• We still offer the same high level of care to our patients. 76
• We provide the same delivery of care as always. 77
• Everything was already in place before the training. 80
• We are following same guidelines that have been in effect for four years. 96
• I am not sure how to rate the effect. 99
• There isn't a large volume of HIV-positive patients. 100
• The training hasn't made any changes in the clinical aspect either. Maybe the university medical center has more patients there but I don’t see them. It's like you get the training and then you are not able to use it. 106
• We started out initially treating HIV patients, so our treatments remain the same. 110
• For the same reasons. 118
• I have been unable to utilize it, but it is important. 120
• For the same reasons. 121
• Procedurally, nothing has changed. 123
• I am not really involved system-wise. I am only involved at the associate level. 126
• No changes have been made because of the training. 139
• We operate with the universal idea that we treat everyone the same. We assume everyone has an infectious disease, so we treat all patients the same regardless of their HIV status. 144
• In part, because I am so new that I am still learning procedures here. 148
• Maybe it is because I am different position to see it. We were mandated to go to the training so I don’t know who made us go. Everyone in my area went. 151
• I have no idea.159
• The administration doesn't feel that change needs to be made. They think that the system is already adequate. 164
• Patients get the best care they can get here at our clinic. 173
• AIDS discussions rarely come up in my practice. 177
• We're a very small 38-bed hospital serving a town of 2500 people. If we had an HIV/AIDS patient, he/she probably wouldn't go to our clinic, he/she would probably go to the city. 182
• Everything is basically the same, "Do this, don't do that." Once we have a case with specific medical needs, we staff it and the nurse comes in. 189
• Our standards of care before the training remained the same. 194
• We've had the same guidelines and procedures. The things that changed were things that had to be changed because of medicines, like protease inhibitors. 197
• The care is provided the same way it always has been. The rounds only influenced care incidences. 198
• We were already doing general dentistry and are still doing general dentistry. The patients were receiving the normal standard of care then and now. 205
• It is out of our control. 206
• The information was mailed out and not to everyone in my unit, only to select people. Actually, the manager just had them and said that whoever wanted to take one, can take one. After that, nothing was done about it. Nothing was done with the information. 222
• The change was limited because the training didn't touch upon the kind of work my organization does. 236
• The only difference is that we now have more resources since the training. 242
• The training wasn't informative. I was very disappointed by it. 243
• I have shared the information I've received with the staff at our agency. 245=

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