1. Lessons Learned: Giving HIV Positive Results The Door – A Center of Alternatives Adolescent Health Center Carolyn Glaser, L.C.S.W. Supervisor, Health Education and Outreach June 2007 THE DooR

2. The Door Adolescent Health Center  1876 HIV Tests given in 2006  4 positive results  7 Health Educators  268 tests per Health Educator THE DooR

3. The Door Adolescent Health Center A LOW AMOUNT OF POSITIVE RESULTS A HIGH AMOUNT OF STAFF ANXIETY THE DooR

4. The Door – A Center of Alternatives The mission of The Door is to empower young people to reach their potential by providing comprehensive youth development services in a caring, supportive environment, where young people are treated with respect and confidentiality. THE DooR

5. Services Provided at The Door  Health Care  Counseling  Education  Arts and Recreation  Legal  Career THE DooR

6. 1876 Young People Tested  79% female  21% male  1% under the age of 15  32% between the ages of 15-17  41% between the ages of 18-19  26% over the age of 20  46% Black  35% Latino  5% Asian  7% White  7% Other  81% Conventional testing  19% Rapid testing (Rapid testing began in May 2006) Currently, 80% of testing is Rapid HIV Testing Demographics 2006 THE DooR

7.  Not offered to walk-in patients; only to those with appointments.  Use of venipuncture rather than the finger stick or oral swab.  Having a Social Worker or Senior Counselor “on call” during the hours that testing is offered.  Staff training. Adjustments Made for Implementing Rapid Testing THE DooR

8.  One day training for the entire Adolescent Health Center staff tailored specifically to meet our needs with a focus on delivering a positive result.  Learn appropriate language to use when delivering positive results, what needs to be covered in the post- test counseling session, anticipate patient reactions and needs.  Utilization of role playing.  Forum for staff to discuss their anxieties.  Give staff confidence – they are already comfortable with and skilled at delivering bad news. The Adolescent Health Center’s HIV Rapid Testing Training THE DooR

9.  The Health Educator who performed the pretest counseling informs the Supervisor of Health Education or her designee. Brief planning and supportive supervision takes place.  The Social Worker or Senior Counselor on duty is notified and placed on standby.  The medical provider scheduled to see the patient is notified and placed on standby.  The Health Educator delivers the result. Immediate Steps following Notification of a Preliminary Positive Result THE DooR

10.  The exploration of thoughts and feelings. (Includes screening for suicidal ideation.)  A review of the meaning of the preliminary positive result.  Access the physical and emotional stability of the young person. (Existing support systems, housing, income, mental health needs, employment/education.)  Determine immediate referrals necessary based on the stabilization assessment.  A discussion regarding medical care and the Adolescent Health Center’s linkages to primary care providers.  A review of the ways to prevent the spread of the HIV infection. The First Post-test Counseling Session Includes the Following: THE DooR

11. The First Post-test Counseling Session Includes the Following (cont.): DooR THE  A conversation about the patient’s current and past partners and partner notification.  A screening for domestic violence.  Appointment scheduling for a confirmatory test and a discussion regarding the likelihood of a positive confirmatory test result.  A conversation with the young person about how s/he will immediately cope with the diagnosis. (Example: Who will they tell? What will they do if they get very anxious or upset? What will they do for the rest of that day/week?)

12.  A blood sample is automatically sent out for the confirmatory test.  Supportive supervision of the staff member continues.  The Health Educator remains in contact with the patient as needed while s/he waits for the confirmatory result.  The Health Educator presents the experience at a team meeting so the rest of the staff can learn from his/her experience.  The patient returns for the confirmatory result and a second post-test counseling session occurs. This session will include linkages to care and the completion of partner notification. Following the Post-test Counseling Session THE DooR