It is the responsibility of the DIS to ensure that persons who
have or are at risk of acquiring a STD receive appropriate medical care at
the earliest possible time. The use of the telephone for initial follow-up
activities can be an efficient use of DIS time, especially when calls are made
in the early morning or evening hours. Telephones, however, are not valuable
for in-depth investigation and confronting highly sensitive issues. Also be
aware of caller ID and like technologies, as they may compromise confidentiality.
While the field investigation may require a greater initial investment
of DIS time, it is the most effective follow-up method and frequently the most
efficient as well. All field investigations should be conducted in unmarked
vehicles.
It is incumbent upon the DIS to make the most efficient use of
field time and to conduct each field investigation thoroughly to make the most
of this activity.
To avoid duplication of effort and to expand locating information,
the DIS should perform a record search immediately after initiating an investigation
by reviewing available resources, including:
open field investigation and case interview files;
closed field investigation and case interview files;
medical records;
telephone white and yellow pages;
directory assistance;
cross directory; and
computer locator resources.
The record(s) search and results should be completely documented
on the back of the field record.
The DIS should begin investigative action on priority follow-ups
within one workday of assignment or of DIS initiation.
When initial telephone attempts fail to reach the individual
sought, or when the patient does not follow through with a commitment, the
DIS should make a field visit within one working day or as directed by supervisor.
The DIS should prepare for field investigations by:
arranging investigations by investigative or intervention priority;
planning a route that addresses the greatest number of investigative priorities in the most efficient sequence;
including lower priority field activities that are near high-priority investigations;
consulting the supervisor on the potential for pooling work when distant locations are involved;
arranging work in the planned sequence at the front of the investigative pouch; and
preparing all referral notes before leaving for the field to improve efficiency and alertness.
Before leaving for the field, the DIS should assemble standard
materials and supplies, including:
investigative pouch;
maps;
venipuncture kit;
writing materials (with spare pen);
referral forms with envelopes;
business cards;
change for parking meter and public telephone (and telephone credit card, if available);
identification card; and
materials needed to perform field interviews, e.g., visual aids, consent forms.
The DIS should record the beginning and ending odometer readings
and the distances between stops, as needed for travel reimbursement.
Before leaving the car for a field visit, the DIS should:
review the field record and memorize all pertinent data to establish the precise objective(s) of the visit;
observe the environment and anticipate obstacles to the investigation; and
stow the pouch, confidential forms, and valuables in a secure place.
When there is no response at the door of the individual sought,
the DIS should check for occupants at the side and back of the building when
the way is not barred and it appears safe to do so.
When the individual sought is not found, the DIS should attempt
to confirm the locating information in the initial visit by exploring all reasonable
sources of information, such as:
other persons encountered at the address;
names on mailbox;
neighbors, apartment managers, building
superintendents;
postal employees and other delivery personnel;
local business people; and
children in the area.
The DIS should gather patient locating information from sources
in a manner which serves to improve upon the original data provided, including
previously unknown information such as:
full name and physical description;
precise address, including apartment number;
identity of co-residents;
telephone number;
type and place of employment;
hours and habits;
hangouts and associates;
description of individual's car; and
where the individual can be found now.
When locating information appears invalid, the DIS should transpose
house and street numbers, etc., and checks similar locations in the immediate
vicinity.
When the individual sought is encountered in the field, the
DIS should convey a sense of urgency and motivate the patient to participate
in the disease intervention process by:
establishing the identity of the patient;
engaging the patient in a private conversation;
identifying self and conveying the reason for visit;
establishing rapport and demonstrating concern;
informing the patient of the STD at issue and of their risk status;
clustering the patient for other high-risk persons; and
referring the patient for the most immediate appropriate medical attention, which may include obtaining consent and collecting a specimen for testing.
When the individual wants care from a non-health department
provider, the DIS should arrange or confirm the appointment personally. The
DIS should tell both the health provider and the individual of the need for
recommended testing, counseling, and treatment, and determine when the test
results will be available. The DIS should try to get a signed release of information
form from the patient, so that test results and treatment can be confirmed.
Even when the individual sought is not found, the field visit
offers many advantages that can enhance disease intervention, such as:
information about the individual's living situation, lifestyle, habits, or about the identity of cohabitants or co-residents, etc., may be gained, along with additional locating information;
the DIS can leave a sealed referral notice
that directs the individual to the first clinic session available;
other high-risk persons may be identified; and,
the validity of the provided locating information can be determined.
When the individual sought is not encountered at a confirmed
place of residence, the DIS may leave a referral notice in a sealed envelope
marked "personal" or "confidential." The DIS may add a
personal note of urgency to the form. Referral notices may be left by the DIS
with co-residents, building managers, employers, or under the door or in any
area where the referral is protected and not accessible to children or casual
visitors. Referral notices are not placed in or affixed to any mail box (U.S.
Postal Service Code 1702, 1705, 1708, and 1725).
The DIS should not leave a third referral notice at the same
address except with supervisor's consent.
When in a safe location, the DIS should document the results
of the field investigation. The following information should be legibly, accurately,
and concisely documented on the back of the investigative form with the use
of accepted abbreviations and symbols:
date and time of day;
type activity (e.g. FV=field visit);
persons encountered;
results of investigation, which may include next planned action (date and type);
referral specifics; and
directions for difficult-to-find locations, when appropriate.
If practical, before returning to the office from distant locations,
the DIS should contact the supervisor (or other designated team member) by
telephone to inquire about emergent needs to which she or he should attend
before returning.
The DIS should follow through on all commitments and pursue
new information elicited during the course of investigations, as follows:
confirms appointments made and kept (within one working day);
re-initiates action within one working
day when commitments fail; and,
pursues new locating information within
one working day.
When the original information fails to locate the individual,
the DIS should seek to contact the source of the information at the first reasonable
opportunity in order to correct or to expand locating data. Sources to contact
include:
the patient or others involved in a case;
other case managers;
health care providers; and
Interstate Transmission of STD Intervention Information desk (according to established local procedures)
When there is no direct avenue to correct inadequate locating
information, the DIS should discreetly accesses other agency resources, such
as:
Department of Motor Vehicles;
Postal Service;
utilities;
Public Assistance;
local schools;
trade unions;
law enforcement (jail rosters);
voter registration;
tax appraisal office;
fire department (directory/department of streets);
other health department programs (e.g. family planning, WIC, TB, etc.); and
other community resources (e.g., hospitals, CBOs, etc.).
When an investigation stalls, the DIS should notify the supervisor
or appropriate case manager at the earliest reasonable opportunity (not to
exceed 72 hours). Supervisor's approval is needed to close unsuccessful investigations.
The DIS should complete and submit all assigned work to his
or her supervisor before taking planned leave.
Program Operations Guidelines for STD Prevention
