Promoting Risk Assessment &
Behavior Change to Prevent the
Spread of Infectious Disease
Among Substance Abusers
Glenda Cla...
Workshop Objectives
 To discuss the epidemiology, symptoms,
and methods of transmission of STDs,
hepatitis, HIV and tuber...
Workshop Objectives
 To identify and utilize strategies and models
to work cooperatively with clients to set their
priori...
Introductions
Who are you?
What kind of work do you do?
Why did you decide to attend this
workshop?
What is one behavior t...
Ground Rules
Infectious Disease
HIV/AIDS
STDs
Syphilis
Gonorrhea
Chlamydia
Hepatitis C
Tuberculosis
Contexts Influencing
High-Risk Behavior
 Substance use settings
 Social networks
 Geographic region
 Income and social...
Population Groups with
Especially High Risks
 Certain racial and ethnic groups
 Men who have sex with men (MSM)
 Homele...
Population Groups with
Especially High Risks
 Men and women involved in
international slave trafficking (i.e.
“indentured...
STD’s
The Bottom Line
Remember to use your 5 senses
Gonorrhea- Overview
 Gonorrhea is caused by a bacterium that
grows and multiplies quickly in moist, warm
areas of the bod...
Gonorrhea – Possible
Symptoms
Men:
 Yellow pus-like discharge from the urethra
 Dysuria, frequent urination, and blood i...
Gonorrhea – Possible
Complications
 Pelvic inflammatory disease (PID), a major
cause of infertility
 Gonorrhea during pr...
Gonorrhea – Screening,
Prevention and Treatment
 Screening is recommended for anyone
exposed to an infected individuals
...
Syphilis Overview
 The organism that causes syphilis is
called Treponema pallidum.
 The bacterium spreads from the sores...
Syphilis - Stages
 Primary: A painless sore or lesion called
a “chancre” appears that lasts from 1- 5
weeks and heals wit...
Syphilis - Stages
 Latent: Usually no visible symptoms are
present
 Late: Develops in one-third of persons
with untreate...
Syphilis – Risk Assessment
Screening and Testing
 Risk assessment varies
 Screening involves gathering subjective
data. ...
Syphilis - Treatment
 If syphilis is detected early, it can be
completely cured with antibiotics, any
damage to the body ...
The National Plan to
Eliminate Syphilis from the
United States
 Epidemic re-emerged in the 1990s by
persons infected and ...
Chlamydia - Overview
 Chlamydia infection is the leading STD
in the nation
 Chlamydial infection is caused by a
bacteriu...
Chlamydia - Overview
 Rate of infection is highest in young
adolescent women
 Chlamydial infections are responsible for
...
Chlamydia -
Complications
Women
 Pelvic Inflammatory
Disease (PID)
 Infertility
 Ectopic pregnancy
 Premature labor
 ...
Chlamydia – Screening
and Treatment
 Screening for chlamydia infection is strongly
encouraged for high-risk pregnant wome...
Genital Herpes - Overview
 Genital herpes is a contagious viral
infection that affects an estimated 30
million people in ...
Genital Herpes - Overview
 Genital herpes is a contagious viral
infection that affects an estimated 30
million people in ...
Genital Herpes -
Transmission
 Sexual contact with someone who has an
outbreak of herpes sores in the genital area
 Oral...
Genital Herpes – Diagnosis,
Screening and Treatment
 Testing is recommended for clients with
genital, rectal, or oral ulc...
Human Papillomavirus
(HPV) - Overview
 An estimated 20 million people in the US
are infected
 More than 100 types of HPV...
HPV – Possible Symptoms
 HPV infections often does not cause
visible symptoms
 The virus can remain latent in the
skin, ...
HPV – Diagnosis,
Screening and Treatment
 Diagnosis of genital warts is made by
recognizing lesions.
 Regular pap smears...
Hepatitis - Overview
 Hepatitis A (HAV) – once known as
infectious, or short-incubating; not
commonly sexually transmitte...
Hepatitis A - Overview
Hepatitis A:
 Found in the stool (feces) of persons
with with hepatitis A
 Usually spread from pe...
Hepatitis B - Overview
Hepatitis B:
 Blood/body fluids from an infected
person enter the body of a person who is
not immu...
Hepatitis B – Prevention
and Treatment
 Persons at high-risk for sexual
transmission of hepatitis B include men
who have ...
Hepatitis B – Prevention
and Treatment
 Vaccinations carry minimal but potential
risk and side effects and general
discom...
Hepatitis C - Overview
Hepatitis C:
Occurs when blood or body fluids from
an infected person enter the body of a
person wh...
Hepatitis C - Overview
Hepatitis C:
Has been known to be transmitted
heterosexually, but the magnitude of
this risk is unk...
Hepatitis Testing
 Substance abuse treatment programs
should routinely screen for hepatitis B and
vaccinate all susceptib...
Information Update on
Viral Hepatitis D (HDV)
 Endemic in the Mediterranean, Balkan
Peninsula, former Soviet Union, parts...
Information Update on
Viral Hepatitis E
 Acute, self-limited form of viral hepatitis
spread by fecally contaminated water...
Information Update on
Viral Hepatitis G
 Some cases of presumed viral hepatitis are
not attributable to hepatitis A-E.
 ...
Human Immunodeficiency
Virus (HIV) - Transmission
 Overwhelming majority of cases are
transmitted sexually (exposure to b...
HIV Manifestations
 Chills and fever
 Night sweats
 Unexplained weight
loss, loss of appetite
 Lethargy
 Cough, short...
HIV Treatment
 HIV-related mortality has declined
dramatically because of the use of highly
active antiretroviral therapi...
Tuberculosis (TB) -
Overview
 When an individual with no previous
exposure to TB inhales a sufficient number
of tubercle ...
TB Conditions That Increase
the Risk of Developing TB
Disease
 HIV infection
 Diabetes
 Substance abuse (especially dru...
TB – People at Risk
 Populations with high
prevalence of TB
infection
 Close contacts of
persons with infectious
TB
 Fo...
TB- Screening and
Diagnosis
 Screening is done to identify
Infected persons at high risk for TB
Persons with TB disease...
TB - Symptoms
 Symptoms of pulmonary TB
 Productive, prolonged cough
 Chest pain
 Spitting or coughing up blood
 Syst...
TB – Medical Evaluation
 Persons suspected of having TB should be
referred for a complete medical evaluation
including:
...
HIV/AIDS Prevention
 Primarily transmission occurs via
two routes
Sharing contaminated syringes,
needles, and other drug...
Key Issues
 Substance abuse increases the risk of
contracting HIV.
 Substance abusers are at risk for HIV
infection thro...
Key Issues
 Substance abuse treatment serves as
HIV prevention.
 HIV/AIDS, substance abuse disorders
and mental disorder...
Promoting Risk
Assessment &
Behavior Change
Where do I stand?
Personalizing Risk
Content
 Beliefs about the modes of disease infection
 Substance use, including sharing drug-
injecti...
The Stages of
Change
Prochaska & DiClemente
Motivational Interviewing
 Motivational interviewing is based on
motivational psychology. The model
was developed by Mill...
Components of a
Motivational Interview
The following components are key to
conducting an effective motivational
interview:...
Motivational Interviewing
Approach
The following elements are part of a motivational
approach in interviewing
 Giving adv...
Reporting Requirements
 Reporting Anonymously
 Using Qualified Service Organization
Agreements (QSOAs)
 Medical Emergen...
Anonymous Disclosure
 Under Anonymous or Non-Patient-
Identifying Disclosures, a program is
allowed, for example to discl...
Medical Emergency
Exception
 Under the Medical Emergency
Exception, a program may disclose
patient-identifying informatio...
Medical Emergency
Exception
 A program can report a communicable
disease to public health officials only if
the following...
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Promoting Risk Assessment and Behavior Change for Prevention of Spread of Infectious Disease Among Substance Abusers

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Promoting Risk Assessment & Behavior Change to Prevent the Spread of Infectious Disease Among Substance Abusers
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  • List Evaluation Questions for Day I
  • Prevention planners tend to focus on one aspect or another of the problem. Substance abuse treatment providers focus on the quality of substance abuse treatment, encouraging HIV prevention efforts or helping IDUs who continue to inject to obtain sterile syringes
    What has been your primary focus?
  • Promoting Risk Assessment and Behavior Change for Prevention of Spread of Infectious Disease Among Substance Abusers

    1. 1. Promoting Risk Assessment & Behavior Change to Prevent the Spread of Infectious Disease Among Substance Abusers Glenda Clare G. Portlynn Clare & Associates g_portlynnclare@hotmail.com
    2. 2. Workshop Objectives  To discuss the epidemiology, symptoms, and methods of transmission of STDs, hepatitis, HIV and tuberculosis;  To discuss the connection between substance abuse and infectious disease;  To identify and practice using effective screening and assessment tools;  To identify, support and enhance self- directed change behaviors in their clients
    3. 3. Workshop Objectives  To identify and utilize strategies and models to work cooperatively with clients to set their priorities and time lines for action  To develop effective drug and sexual behavior change interventions that are appropriate to their clients’ readiness for change.  To discuss issues of confidentiality pertinent to substance abuse and infectious disease.
    4. 4. Introductions Who are you? What kind of work do you do? Why did you decide to attend this workshop? What is one behavior that you have tried to change
    5. 5. Ground Rules
    6. 6. Infectious Disease HIV/AIDS STDs Syphilis Gonorrhea Chlamydia Hepatitis C Tuberculosis
    7. 7. Contexts Influencing High-Risk Behavior  Substance use settings  Social networks  Geographic region  Income and social factors
    8. 8. Population Groups with Especially High Risks  Certain racial and ethnic groups  Men who have sex with men (MSM)  Homeless individuals  Incarcerated individuals  Injection drug users (IDUs)  Female sex workers and IDUs  Adolescents  Immigrant Population
    9. 9. Population Groups with Especially High Risks  Men and women involved in international slave trafficking (i.e. “indentured servants,” “mail-order brides,” “garment workers”)  Trans-gendered male to female on injection hormone therapy  Trans-gendered male to female sex workers
    10. 10. STD’s The Bottom Line Remember to use your 5 senses
    11. 11. Gonorrhea- Overview  Gonorrhea is caused by a bacterium that grows and multiplies quickly in moist, warm areas of the body such as the cervix, urethra, mouth, throat , or rectum  Gonorrhea can be spread in the following ways:  Penis to vagina sex  Penis to mouth “oral” sex  Penus to retum “anal”sex  Mouth to vagina “oral” sex  Passed from an infected mother to a baby during birth
    12. 12. Gonorrhea – Possible Symptoms Men:  Yellow pus-like discharge from the urethra  Dysuria, frequent urination, and blood in urine  Adenopathy of groin lymph glands  Pain during pelvic exam Women:  Vaginal discharge  Irritation of the external vagina and dysuria  Abnormal menstrual bleeding
    13. 13. Gonorrhea – Possible Complications  Pelvic inflammatory disease (PID), a major cause of infertility  Gonorrhea during pregnancy may cause spontaneous abortion, premature labor, increased neonatal morbidity and spread from mother to infant.  Infection may cause swollen or tender testicles, urethral stricture, and disseminated gonococcal infection (DGI)  Often used to determine sexual abuse in children
    14. 14. Gonorrhea – Screening, Prevention and Treatment  Screening is recommended for anyone exposed to an infected individuals  All persons with gonorrhea should be screened for chlamydia, syphilis, and HIV  Clients & patients should be given information about the source of spread, mode of transmission, incubation period, and treatment  Gonorrhea can be cured with antibiotics, any damage to the body cannot be repaired
    15. 15. Syphilis Overview  The organism that causes syphilis is called Treponema pallidum.  The bacterium spreads from the sores of an infected person to mucous membranes of the genital area, the mouth or the anus of a sexual partner. It can also pass through broken skin on other parts of the body  A pregnant woman with syphilis can pass the bacterium to her unborn child  Syphilis can be controlled with antibiotic therapy
    16. 16. Syphilis - Stages  Primary: A painless sore or lesion called a “chancre” appears that lasts from 1- 5 weeks and heals without treatment  Secondary: Rashes may be on the palms of the hands, bottoms of the feet, or all over the body. Symptoms may include fever, swollen lymph glands, headaches, hair loss, weight loss and muscle aches, and may last 2-6 weeks
    17. 17. Syphilis - Stages  Latent: Usually no visible symptoms are present  Late: Develops in one-third of persons with untreated syphilis. Symptoms may include paralysis, insanity, blindness, swollen joints, personality changes, impotency, aneurysm, and tumors on the skin, bones or liver
    18. 18. Syphilis – Risk Assessment Screening and Testing  Risk assessment varies  Screening involves gathering subjective data. It should be repeated every year if at-risk behavior continues  Testing concerns performing medical tests (e.g., blood tests, tests on the discharge of open sores, or examination of spinal fluid) on symptomatic patients
    19. 19. Syphilis - Treatment  If syphilis is detected early, it can be completely cured with antibiotics, any damage to the body cannot be repaired  Treatment involves large doses of penicillin given by injection into a muscle  Repeated blood and bacteria tests are needed to determine if treatment has been successful or if re-infection has occurred
    20. 20. The National Plan to Eliminate Syphilis from the United States  Epidemic re-emerged in the 1990s by persons infected and affected by HIV/AIDS  1998, over 50% of infectious cases reported in 28 counties in the South  Syphilis elimination is defined as the absence of sustained transmission in the United States  Syphilis elimination is defined as the absence of transmission of new cases within the jurisdiction except within 90 days of report of an imported index case
    21. 21. Chlamydia - Overview  Chlamydia infection is the leading STD in the nation  Chlamydial infection is caused by a bacterium, Chlamydia trachomatis, and is transmitted during vaginal or anal sexual contact with an infected person  A pregnant woman may pass chlamydial infection on to her newborn during delivery, causing subsequent neonatal eye infection or pneumonia
    22. 22. Chlamydia - Overview  Rate of infection is highest in young adolescent women  Chlamydial infections are responsible for about 20 to 30 percent of diagnosed Pelvic Inflammatory Disease (PID) cases
    23. 23. Chlamydia - Complications Women  Pelvic Inflammatory Disease (PID)  Infertility  Ectopic pregnancy  Premature labor  Early rupture of fetal membranes  Increase neonatal morbidity Men  Nongonococcal urethritis (NGU)  Epididymitis  Urethral stricture  Infertility
    24. 24. Chlamydia – Screening and Treatment  Screening for chlamydia infection is strongly encouraged for high-risk pregnant women, adolescents, and clients with multiple sexual partners  Routine testing of all pregnant women is recommended  Clients should be provided with information about their infection. Identify level of risk and making a plan to prevent re-infection  Chlamydia can be cured with antibiotics, but any damage to the body cannot be repaired
    25. 25. Genital Herpes - Overview  Genital herpes is a contagious viral infection that affects an estimated 30 million people in the US. 500,000 new cases every year  The virus remains in certain nerve cells of the body for life, causing periodic symptoms in some people
    26. 26. Genital Herpes - Overview  Genital herpes is a contagious viral infection that affects an estimated 30 million people in the US. 500,000 new cases every year  The virus remains in certain nerve cells of the body for life, causing periodic symptoms in some people
    27. 27. Genital Herpes - Transmission  Sexual contact with someone who has an outbreak of herpes sores in the genital area  Oral-genital sex with someone who has an outbreak of oral herpes  Sexual contact with someone who is infected but has no noticeable symptoms  Neonatal infection at the time of passage through the birth canal (typically from mothers with no history of clinically apparent genital herpes)
    28. 28. Genital Herpes – Diagnosis, Screening and Treatment  Testing is recommended for clients with genital, rectal, or oral ulcers.  At the onset of labor, all women should be examine for the presence of lesions. The baby should be delivered by casesarean section if symptoms or signs are present  Clients should be provided with information about their infection. Identify level of risk and making a plan to prevent re-infection  Herpes can be treated with medication but cannot be cured
    29. 29. Human Papillomavirus (HPV) - Overview  An estimated 20 million people in the US are infected  More than 100 types of HPV have been identified, over 30 of which are sexually transmitted  Several types of HPV can lead to genital warts, the most recognizable sign of genital HPV infections  Other types have been closely associated with the development of cervical cancer and other genital cancers
    30. 30. HPV – Possible Symptoms  HPV infections often does not cause visible symptoms  The virus can remain latent in the skin, so infected persons may not be aware of their infection and potential risk of complications  Genital warts, when visible, occur in or around the vulva, vagina, cervix, phneum and canal, urethra, and glans penis
    31. 31. HPV – Diagnosis, Screening and Treatment  Diagnosis of genital warts is made by recognizing lesions.  Regular pap smears can detect cellular changes in the cervix that are due to HPV infection. It may take years for the cellular changes to occur  HPV can be treated by removing the warts, but the virus cannot be eradicated.  Appropriate treatment can be given to prevent the cellular changes from progressing to cancer
    32. 32. Hepatitis - Overview  Hepatitis A (HAV) – once known as infectious, or short-incubating; not commonly sexually transmitted  Hepatitis B (HBV) – once known as serum, or long incubating; can be sexually transmitted; only vaccine preventable STD  Hepatitis C (HCV) – once known as parenterally transmitted (or blood-borne), non-A, non-B; has been known to be transmitted sexually, but magnitude of risk unknown; injection drug use is the leading factor for contracting HCV
    33. 33. Hepatitis A - Overview Hepatitis A:  Found in the stool (feces) of persons with with hepatitis A  Usually spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A  Not commonly sexually transmitted
    34. 34. Hepatitis B - Overview Hepatitis B:  Blood/body fluids from an infected person enter the body of a person who is not immune  Spread by having sex with an infected person sharing or being stuck by needles, or from an infected mother to her baby during birth  A sexually transmitted disease  The only vaccine-preventable STD
    35. 35. Hepatitis B – Prevention and Treatment  Persons at high-risk for sexual transmission of hepatitis B include men who have sex with men, heterosexual men, women with multiple sex partners and intravenous drug users  CDC recommends vaccination for those listed above, as well as for residents of correctional or long-term care facilities, persons seeking treatment for STDs, commercial sex workers, and health care workers
    36. 36. Hepatitis B – Prevention and Treatment  Vaccinations carry minimal but potential risk and side effects and general discomfort and reactions are possible  Most persons with hepatitis B infection recover and return to normal, but 2 – 10 percent may develop chronic hepatitis
    37. 37. Hepatitis C - Overview Hepatitis C: Occurs when blood or body fluids from an infected person enter the body of a person who is not immune Is spread by sharing needles or “works” when “shooting” drugs, by needlesticks or sharp exposures on the job, or from an infected mother to her baby during birth
    38. 38. Hepatitis C - Overview Hepatitis C: Has been known to be transmitted heterosexually, but the magnitude of this risk is unknown at this time Causes approximately 75 to 85 percent of patients with acute HCV infection to remain chronically infected, with the associated risk of cirrhosis
    39. 39. Hepatitis Testing  Substance abuse treatment programs should routinely screen for hepatitis B and vaccinate all susceptible individuals. Additional testing needs to be done as follows:  Serologic testing for hepatitis A should be done only for persons with acute hepatitis  Serologic testing for hepatitis C should be done for all persons with identified risk factors; and  Routine hepatitis A and B immunization should be done for injection drug users
    40. 40. Information Update on Viral Hepatitis D (HDV)  Endemic in the Mediterranean, Balkan Peninsula, former Soviet Union, parts of African and Middle East and Amazon basin of South America. Infection via interfamilial & sexual contact  Uncommon in general population in non- endemic regions - but does occur in IDUs & persons with the frequent exposure to blood products & their sexual contacts  Prevention based on HDV vaccination in susceptible individuals.
    41. 41. Information Update on Viral Hepatitis E  Acute, self-limited form of viral hepatitis spread by fecally contaminated water  Occurs endemically in developing countries (Asia, African and Central America) Rare cases have been described in travelers returning from endemic regions  Extremely high mortality rate when infection occurs in pregnancy, particularly in the third trimester. No HEV vaccine available
    42. 42. Information Update on Viral Hepatitis G  Some cases of presumed viral hepatitis are not attributable to hepatitis A-E.  HGV infection is common (1-2% of US blood donors have HGV RNA detectable in their serum). Agent is transmitted by transfusion  Chronic HGV infection does not appear to commonly cause important liver disease and does not alter the course of chronic HCV infection. The vast majority of cases of acute non A-E hepatitis have no evidence of HGV infection
    43. 43. Human Immunodeficiency Virus (HIV) - Transmission  Overwhelming majority of cases are transmitted sexually (exposure to body fluids, such as semen, blood and vaginal or cervical secretions)  Other cases are spread by parenteral transmission either by transfusion of contaminated blood or blood products or through injection with a blood-contaminated needle or syringe  A third route of HIV transmission is perinatal transmission, which may occur during pregnancy, delivery, or breast-feeding
    44. 44. HIV Manifestations  Chills and fever  Night sweats  Unexplained weight loss, loss of appetite  Lethargy  Cough, shortness of breath  Visual changes, including visual field defects  Recurrent or persistent sinusitis  Abdominal pain, diarrhea  Persisten, recurrent Candida vaginitis in women  Cervical/vaginal dysplasia  Neurological conditions, headaches, difficulty concentrating, short-term memory loss, pain in extremities  Easy bruising or abnormal bleeding associated with low platelets
    45. 45. HIV Treatment  HIV-related mortality has declined dramatically because of the use of highly active antiretroviral therapies (HAART) and prophylaxis against traditional opportunistic diseases (e.g., Kaposi’s sarcoma, hepatitis C, TB, pneumocystis carnii pneumonia)  As therapies prolong life expectancy of HIV- infected persons, other chronic diseases such as hepatitis C increasingly cause mortality. HIV co-infection, HIV immunosuppression, and substance abuse all influence HCV liver-related disease progression
    46. 46. Tuberculosis (TB) - Overview  When an individual with no previous exposure to TB inhales a sufficient number of tubercle bacilli into the lungs, tuberculosis infection occurs  While most other infections disappear when overcome by the body’s defenses, TB does not. Persons who have been infected by TB harbor the organism for the remainder of their lives unless they have received prophylactic isoniazid  Only 1 out of 10 persons with a positive tuberculin test will ever develop an active case of TB
    47. 47. TB Conditions That Increase the Risk of Developing TB Disease  HIV infection  Diabetes  Substance abuse (especially drug injection)  Infection within the past 2 years with M. tuberculosis  Chest X-ray findings suggestive of previous TB ( in a person who received inadequate or no treatment)  Prolonged corticosteriod therapy  Other immunosuppressive therapies  Low body weight (10 percent or more below the ideal)
    48. 48. TB – People at Risk  Populations with high prevalence of TB infection  Close contacts of persons with infectious TB  Foreign-born persons from areas where TB is common  Medically underserved, low-income populations, including high-risk racial and ethnic groups  The elderly  Residents of long-term care facilities  Persons in correctional facilities, homeless shelters, and nursing homes  Person who inject drugs  Identified high- prevalence groups such as migrant farm workers or homeless persons  Persons who have occupational exposure to TB
    49. 49. TB- Screening and Diagnosis  Screening is done to identify Infected persons at high risk for TB Persons with TB disease who need treatment  TB skin testing is safe during pregnancy, and if active TB is found, treatment should not be delayed  The preferred method of screening for TB infection is the Manoux tuberculin skin test
    50. 50. TB - Symptoms  Symptoms of pulmonary TB  Productive, prolonged cough  Chest pain  Spitting or coughing up blood  Systemic symptoms of TB  Fever  Chills  Night sweats  Easy fatigability  Loss of appetite  Weight loss
    51. 51. TB – Medical Evaluation  Persons suspected of having TB should be referred for a complete medical evaluation including:  Medical history  Physical exam  Mantoux tuberculin skin test  Chest X-ray  Bacteriologic exam (when sputum or other body fluid are examined by culture for bacteria  A positive bacteriologic culture for tuberculosis confirms the diagnosis of TB
    52. 52. HIV/AIDS Prevention  Primarily transmission occurs via two routes Sharing contaminated syringes, needles, and other drug injecting equipment Unprotected sex with infected individuals
    53. 53. Key Issues  Substance abuse increases the risk of contracting HIV.  Substance abusers are at risk for HIV infection through sexual behaviors.  Despite the fact that primary spread is associated with same sex activities amongst men and male injection drug use, HIV is rapidly spreading among women and adolescents
    54. 54. Key Issues  Substance abuse treatment serves as HIV prevention.  HIV/AIDS, substance abuse disorders and mental disorders interact in a complex fashion  High-risk behaviors for HIV transmission – sex, drug use, sharing of injection materials and tattooing – occur in correctional facilities.
    55. 55. Promoting Risk Assessment & Behavior Change
    56. 56. Where do I stand?
    57. 57. Personalizing Risk Content  Beliefs about the modes of disease infection  Substance use, including sharing drug- injection equipment  Unsafe sexual activity  Other exposures to potentially contaminated blood products, semen or equipment  Involvement in the above activities among or with people from locations of high levels of infectious disease  Physical symptoms that may be related to substance abuse and infectious disease
    58. 58. The Stages of Change Prochaska & DiClemente
    59. 59. Motivational Interviewing  Motivational interviewing is based on motivational psychology. The model was developed by Miller and Rollnick  Motivational interviewing can be used with anyone at any time  In motivational interviewing the job of the clinician is to find out what motivates an individual to change a behavior to a desired one
    60. 60. Components of a Motivational Interview The following components are key to conducting an effective motivational interview:  Express empathy  Develop discrepancy  Avoid argumentation  Roll with resistance  Support self-efficacy
    61. 61. Motivational Interviewing Approach The following elements are part of a motivational approach in interviewing  Giving advice  Removing barriers  Providing choices  Decreasing desirability  Practicing empathy  Providing feedback  Clarifying goals  Active helping
    62. 62. Reporting Requirements  Reporting Anonymously  Using Qualified Service Organization Agreements (QSOAs)  Medical Emergency Exception  Criminal Activity  Court-Ordered Disclosure
    63. 63. Anonymous Disclosure  Under Anonymous or Non-Patient- Identifying Disclosures, a program is allowed, for example to disclose a patient’s name and state of health and even his or her whereabouts, as long as in doing so it does not also disclose that the client is in substance abuse treatment
    64. 64. Medical Emergency Exception  Under the Medical Emergency Exception, a program may disclose patient-identifying information to medical personnel in a medical emergency that requires immediate medical intervention
    65. 65. Medical Emergency Exception  A program can report a communicable disease to public health officials only if the following conditions are met The presence of an infected or allegedly infected individual in the program could be said to constitute a medical emergencyu Public health officials are medical personnel

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