Protocol-Based Counseling Quality Assurance Standards

The Protocol-Based Counseling Quality Assurance Standards (QA) were created as part of a Centers for Disease Control and Prevention (CDC) funded project to assess what it takes to create quality assured prevention counseling in the real world. The project required the development of tools to help risk reduction specialists (RRS) understand and implement the 2001 CDC Revised Guidelines for HIV Counseling, Testing, and Referral . As a part of this project, the Texas Department of State Health Services (DSHS) convened a Prevention Counseling Tools Advisory Group. The Advisory Group helped to determine the required core elements for the counseling tools and helped to develop quality assurance plans; these standards are a result of their work.

In early 2005, DSHS staff conducted a series of statewide presentations highlighting the implementation and evaluation of the Protocol-Based Counseling (PBC) project in Texas. The presentation is available for review on-line or for download in PowerPoint format at the website listed on the cover page. Please contact either or if you have questions about the presentation.

The Quality Assurance Standards and related forms support the implementation of protocol-based counseling by DSHS contractors.

As you read this document, please keep in mind the following:

• Protocol-based counseling (PBC) is an evidence-based intervention.
• This intervention can be carried out separately from testing and referral.
• There have been replicated studies that show this intervention reduces clients' risk behaviors and new STD infections.
• This intervention focuses on plan-based prevention counseling. Plan-based counseling provides a framework for risk reduction specialists to use during the session and makes it more likely for the essential elements of the intervention to be covered. The essential elements of a prevention counseling session include:
• Introducing and orienting client to the session
• Enhancing client's self-perceived risk
• Exploring client's most recent risk
• Reviewing client's previous risk reduction experiences
• Summarizing patterns of risks and triggers (putting risk in context)
• Negotiating a realistic and acceptable risk reduction step
• Identifying sources of support and providing referrals
• Summarizing and closing the session
• In Texas, this intervention also includes:
• Supporting test decision counseling (when appropriate)
• Providing results simply and supportively
• Providing partner elicitation (when appropriate)
• QA refers to actions taken by supervisors and program managers to ensure that the intervention is consistently implemented across risk reduction specialists and across settings. Quality assurance activities include ensuring risk reduction specialists receive training and other activities to further his/her development; assessment of client satisfaction and client flow; record keeping; and evaluation activities including risk reduction specialist observation, feedback, and documentation review.

Protocol-Based Counseling Quality Assurance Standards

Appendix A: Risk Reduction Session Observation Tools
A-1. Risk Reduction Observation: Initial Session (Revised 3/07)
A-1o. Risk Reduction Observation: Initial Session - Original Version (Revised 3/07)
A-2. Risk Reduction Observation: Follow-Up Session for Negative HIV and/or HCV Results (Revised 3/07)
A-3. Risk Reduction Observation: Follow-Up Session for Positive HIV Result (Revised 3/07)
A-3o. Risk Reduction Observation: Follow-Up Session for Positive HIV Result - Original Version (Revised 3/07)
A-4. Risk Reduction Observation: Follow-Up Session for Positive HCV Result (Revised 2/07)
A-5. Risk Reduction Observation: Follow-Up Session for Positive HIV and HCV Results (Revised 2/07)
A-6. Risk Reduction Observation: Initial Session for Rapid Test (Revised 3/07)
A-7. Risk Reduction Observation: Follow-Up Session for Negative HIV Rapid Test Result (Revised 3/07)
A-8. Risk Reduction Observation: Follow-Up Session for Preliminary Positive HIV Rapid Test Result (Revised 3/07)
Appendix B: Risk Reduction Specialist Self-Assessment Tools
B-1. Risk Reduction Self-Assessment: Initial Session (Revised 3/07)
B-1o. Risk Reduction Self-Assessment: Initial Session - Original Version (Revised 3/07)
B-2. Risk Reduction Self-Assessment: Follow-Up Session for Negative HIV and/or HCV Results (Revised 3/07)
B-3. Risk Reduction Self-Assessment: Follow-Up Session for Positive HIV Result (Revised 3/07)
B-3o. Risk Reduction Self-Assessment: Follow-Up Session for Positive HIV Result - Original Version (Revised 3/07)
B-4. Risk Reduction Self-Assessment: Follow-Up Session for Positive HCV Result (Revised 3/07)
B-5. Risk Reduction Self-Assessment: Follow-Up Session for Positive HIV and HCV Results (Revised 3/07)
B-6. Risk Reduction Self-Assessment: Initial Session for Rapid Test (Revised 3/07)
B-7. Risk Reduction Self-Assessment: Follow-Up Session for Negative HIV Rapid Test Result (Revised 3/07)
B-8. Risk Reduction Self-Assessment: Follow-Up Session for Preliminary Positive HIV Rapid Test Result (Revised 3/07)
Appendix C: Risk Reduction Specialist Personal Review Tools
C-1. Risk Reduction Specialist Personal Review: Initial Session (Revised 3/07)
C-2. Risk Reduction Specialist Personal Review: Follow-Up Session (Revised 3/07)
Appendix D: Risk Reduction Session Documentation
D-1. Chart Review Form (Revised 2/07) Word version
D-2. Summary of Chart Reviews (Revised 2/07) Word version
D-3. Initial Session: Session Documentation Form (Revised 2/07) Word version
D-4. Follow-Up Session: Session Documentation Form (Revised 2/07) Word version
D-5. Rapid Session: Session Documentation Form (Revised 2/07) Word version
Appendix E: Risk Reduction Session Observation Notes
E-1. Risk Reduction Observation Notes: Initial Session (Revised 3/07)
E-2. Risk Reduction Observation Notes: Follow-Up Session for Negative HIV and/or HCV Result (Revised 3/07)
E-3. Risk Reduction Observation Notes: Follow-Up Session for Positive HIV Result (Revised 4/07)
E-4. Risk Reduction Observation Notes: Follow-Up Session for Positive HCV Result (Revised 3/07)
E-5. Risk Reduction Observation Notes: Follow-Up Session for Positive HIV and HCV Results (Revised 3/07)
Revised Protocols
Initial Session (Revised 8/07) Spanish version
Follow-Up Session: Negative HIV and/or HCV (Revised 8/07) Spanish version
Follow-Up Session: Positive HIV (Revised 8/07) Spanish version
Follow-Up Session: Positive HCV (Revised 8/07) Spanish version
Follow-Up Session: Positive HIV and HCV (Revised 8/07) Spanish version
Rapid Test: Initial Session (Revised 8/07) Spanish version
Rapid Test: Negative HIV (Revised 8/07) Spanish version
Rapid Test: Preliminary Positive (Revised 8/07) Spanish version

Last Updated August 30, 2007