The proposed work represent the first steps in the development of a larger program to change the context in which sexual risk assessment and sexual risk reduction interventions occur in substance abuse treatment agencies. Previous research in addiction treatment and primary care settings suggests that clients in substance abuse treatment engage in high risk sexual behaviors; that sexual risk behaviors show some decline simply with engagement in treatment, and that professionals can be trained to implement risk-reduction interventions with their clients. This is important in the context of reducing risks of HIV and STD transmission in this population. A multi-phase program with the goal of pilot testing a low-cost, brief HIV risk assessment and prevention intervention with adults in substance abuse treatment is proposed. Phase 1: Develop an audio computer-assisted self-interviewing (ACASI) based HIV risk assessment and feedback tool. A tool previously developed and used in a multi-site, randomized clinical trial, the Sexual Behavior Inventory (SBI), will be modified for use as a brief assessment and feedback tool, Being Safe in Treatment (BEST). Modifications will include shortening the assessment and adding a client and a staff feedback report. The client report will identify the behaviors that put them at risk for HIV and other STDs and will include suggestions for reducing risks. The staff report will include the same client report information plus suggested approaches for the counselor to inquire about client risk behaviors. Phase 2: Determine the acceptability of the BEST for use by both clients and counselors. The BEST assessment will be administered to 16 men and 16 women enrolled in substance abuse treatment. Clients and treatment providers will be provided with the BEST feedback reports. Four focus groups will be conducted with clients completing BEST, and two focus groups will be conducted with staff who will review sample BEST feedback reports. Clients completing the BEST will complete a brief survey regarding the ease of completing the assessment tool. Based on the feedback, the BEST will then be modified to improve question clarity, delete any sections deemed irrelevant, or add sections which respondents felt were lacking. The above process will then be repeated with 16 additional men and 16 women in substance abuse treatment and their counselors in the effort to finalize the tool. Phase 3: Conduct a pilot study on the effectiveness of the BEST to increase counselor-client communication about HIV risk behaviors. The BEST assessment will be administered to 200 substance abuse clients newly admitted to treatment. The assessment will be repeated after three months. Clients will be randomized to one of 4 conditions in a 2 (client feedback) by 2 (counselor feedback) design. We hypothesize that the combination of BEST assessment with feedback to both clients and counselors will be more effective at increasing communication between client and counselor about sexual issues than assessment only or assessment with feedback to only the client or the counselor. Prior research has demonstrated that many individuals in substance abuse treatment are engaging in HIV risk sexual behaviors and therefore are appropriate targets for HIV prevention interventions. However, it appears that discussions about sexual risk are not occurring at an appropriate frequency in substance abuse treatment settings due to multiple individual and environmental barriers. This project proposes to develop computer assisted procedures to assist patients and providers in getting needed discussions started regarding sexual risk behaviors. ? ? ?
| Hartzler, Bryan; Beadnell, Blair; Calsyn, Donald A (2014) Use of sexual risk assessment and feedback at intake to promote counselor awareness of subsequent client risk behavior during early treatment. Subst Use Misuse 49:1270-7 |
