Southeast AETC
| Southeast AETC Trainee Quote |
During follow-up three months after an education program, one participant noted that the trainer had:
"...showed us some pictures of things like oral candidiasis and then a patient came in with thrush and I actually saw that before the doctor did. I told him that something was not right with the patient. So we did an HIV test and it was positive. Had that trainer not shown me what it looked like, I would never have known what I was looking at when the patient was describing his discomfort."
- Dental assistant
After accessing a training program" |
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Illustration: Intensive On-site Training in Small Federally-Funded Clinics
The Southeast AETC (SEATEC) offers an Intensive On-Site Training (IOST) Program using the Targeted Clinic Model. In the Southeast, HIV medical care is often provided in small federally-funded clinics with one or perhaps two clinicians. It can be difficult for these clinicians to leave the clinic for needed clinical training, so SEATEC offers on-site one-on-one training. A SEATEC instructor is sent to the clinic to teach during patient visits in local clinics. The target audience for the Intensive On-Site Training Program is clinicians providing medical care in RWCA Title III-funded clinics. The secondary audience is all additional staff at the clinic site.
SEATEC employs a nurse practitioner with 17 years of experience providing HIV medical care. She travels frequently to provide on-site training for clinicians in priority clinic settings. While at the clinic site for clinician training, she provides an HIV update for all staff and technical assistance as needed on clinic scheduling and other administrative aspects of HIV care. Her training visits are one to three days in duration. At the completion of the visit, the instructor returns to the SEATEC office with a list of materials needed by the clinic, such as medical textbooks and copies of U.S. Public Health Service HIV treatment guidelines. These materials are collected and mailed to the site.
SEATEC conducts ongoing outcome evaluations with IOST participants who are contacted at three and 12 months after the training. Since the evaluation study began in December 2001, 24 participants who completed advanced clinical trainings have been contacted, with 16 (67%) agreeing to participate. All participants were able to cite examples of how they have used the skills and knowledge of the IOST at their clinic to treat HIV-infected clients as well as to identify new HIV cases and to initiate care. Areas of reported change include better use of early signs and symptoms of HIV, lab tests and interpretations, and patient education, all of which have been tied to improved outcomes for clients.
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| All participants were able to cite examples of how they have used the skills and knowledge of the IOST at their clinic. |
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Participants at one-year follow-up were able to cite ongoing examples of the maintenance of skills and knowledge changes, specifically discussing systematic changes. One participant reported that she now "reviews all of the lab work that we do at the clinic so I can assess what the viral load and CD4 count are doing to see if the patient's labs are deteriorating, and then react appropriately if medications need to be changed, the regimen needs to be strengthened, or a genotype needs to be ordered."
Outcomes
Immediate/Short-term:
 | Increased awareness of additional training opportunities, technical assistance resources, and supportive materials. |
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| Improved access to clinical and training consultation. |
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| Increased skills and knowledge by clinic staff. |
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| Enhanced ability to identify new cases of HIV and link patients to care. |
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Mid-term/Long-term:
| Implemented system changes in practice settings. |
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| Continued involvement and follow-up with learners strengthens relationship with SEATEC. |
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| Recruited new IOST participants to the evaluation pool. |
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| Clinical Consultation Group Participant Quote |
"Prior to my participation in this group I often felt like a lone wolf when I was attempting to offer some new practice with difficult clients. Many of my clients require complex care or have multiple diagnoses. Having consultation with a variety of perspectives in this group gave me a sense that I had a team of innovators supporting me. Often the interventions that I was attempting required stretching my own abilities as I used new skills and designs. It helped to tell colleagues in my work settings that I had received consultation on using a method such as motivational interviewing or strength-based case management. I felt more confident about trying new things and received clearer ideas from others in the group about methods to employ. Another benefit was that I gained confidence and poise as a trainer consultant. The group has also created a unique forum for in-depth discussions on issues such as racism, sexism, power, and poverty related to my work. I have also formed important professional, collegial relationships as a result of the group. Finally, and most importantly, the group has helped me deal with the "burned-out" frustration I have inevitably experienced as a result of such challenging work."
- Annie P. Fahy, BSN, CAC
Participant in a Clinical Consultation Group
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Illustration: Clinical Consultation Group
SEATEC offers group clinical consultation via telephone and ongoing clinical consultation. Clinicians in mental health and drug treatment settings who work with HIV-infected patients face tremendous challenges in providing comprehensive clinical care to their clients. SEATEC classroom training initiatives provide clinicians with a thorough grounding in didactic knowledge and some practice at implementing that knowledge through new clinical skills. However, clinicians need ongoing support to make these new skills a part of daily clinical interactions with patients. SEATEC offers mental health and substance abuse treatment professionals that opportunity through monthly clinical consultation groups as a part of the Minority AIDS Initiative. In these groups, clinicians present challenging clinical cases or discuss barriers to care. They receive consultation from clinical peers and facilitators about their options. This clinical consultation program has supported a core group of Atlanta clinicians since February 2002 (through RWCA Title I funds). Because of the success of the Atlanta group, SEATEC formed clinical consultation groups in Alabama, Kentucky, and rural Georgia in mid-2004.
SEATEC supplements the Clinical Consultation Group with funding from the Metropolitan Atlanta RWCA Title I program, which offered financial support to purchase a variety of textbooks, clinical resources for individual and group counseling, and reference guides to treatment modalities for clients with co-occurring clinical needs.
Outcomes
Immediate/Short-term:
| Established ongoing, regularly scheduled access to clinical consultation services. |
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| Developed a network of colleagues for cross-fertilization of resources and creative ideas. |
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| Increased confidence in providers to effectively manage HIV-infected patients. |
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| Developed professional expertise and maturity through clinical problem solving and exposure to seasoned clinician/consultants and diverse colleagues. |
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Mid-term/Long-term:
| Transitioned participants from learner to trainer. Four clinical consultation group members now serve as regular consultant trainers with SEATEC on the complex issues related to dual diagnosis in persons with HIV. |
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| Established solid network of peers. |
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| Expanded learning model to Alabama, Kentucky, and Georgia. |
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| Continue support for group members in their efforts to use clinical skills not only in their individual settings but also in larger collaborative networks that can foster new approaches across systems of care. |
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