effective ways of interviewing: practical experience … · 1. demonstrate techniques to improve...
TRANSCRIPT
TUBERCULOSIS CASE MANAGEMENT AND CONTACT INVESTIGATION INTENSIVE
MARCH 19-22, 2019
EFFECTIVE WAYS OF INTERVIEWING:
PRACTICAL EXPERIENCE SKILL PRACTICUM
LEARNING OBJECTIVES
Upon completion of this session, participants will be able to:
1. Demonstrate techniques to improve communication during a tuberculosis interview
2. Understand and demonstrate the components of a TB interview
3. Develop an effective plan for a TB interview
4. Demonstrate strategic ways to locate TB patients and their contacts
5. Identify when it is important to conduct re-interviews
6. Understand and demonstrate the use of clustering and social network methods to expand a
contact investigation
INDEX OF MATERIALS PAGES
1. Effective ways of interviewing: Practical experience skill practicum – slide outline Presented by: Renee Simmons-Wilkins
19
SUPPLEMENTAL MATERIAL
None
ADDITIONAL REFERENCES
None
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 1
Renee Simmons-Wilkins
By the end of the training, participants will be able to:
1. In class, demonstrate techniques to improve communication during a tuberculosis (TB) interview
2. Understand and demonstrate the components of a TB interview
3. Develop an effective plan for a TB interview
4. Demonstrate strategic ways to locate TB patients and their contacts
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 2
5. Identify when it is important to conduct re-interviews
6. Understand and demonstrate the use of clustering and social network methods to expand a contact investigation
Establish rapport
Provide TB education
Identify contacts
Determine the infectious period
Identify where transmission has occurred
Identify which contacts are high risk and need follow up
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 3
Having a planned “agenda”
Using open-ended questions
Establishing rapport
Keeping control of the conversation
Paraphrasing
Reflecting
Clarifying
Having an interpreter
Which of the techniques below can improve communication?
Closed-Ended Questioning:
Requires only a “yes” or “no” response
Can you tell me…?
Do you…?
Are there…?
Have you ever…?
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 4
Requires MORE THAN a “yes” or “no” response
Who…?
What…?
When…?
Where…?
How…?
Why…?
Describe…
Open-Ended Questioning:
Can you tell me when you had your last TB test?
Do other people live here?
Do you have friends?
Have you ever worked?
Did you have an HIV test?
Do you use recreational drugs?
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 5
Here’s what we know:
• A 30-year-old white male
• Hospitalized
• Positive smear
• Culture pending
• Positive drug screening for opiates
Use only open-ended questioning to obtain more
information
Introduction
Body
Conclusion
Follow-up
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 6
How would you introduce yourself?
How would you explain your purpose?
How would you establish rapport?
What would you do to gain the patient’s confidence?
How would you discuss confidentiality?
How would you identify and resolve problems?
How would you go about providing TB education?
What would you do to reinforce the treatment plan?
What methods would you use to assess and encourage adherence?
What type of interviewing strategies would you use to obtain contact information?
How would you check in to find out if the patient has further questions?
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 7
What main points would you summarize?
How would you reinforce the earlier discussion of confidentiality?
How would you end this TB interview?
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 8
When do you plan?
Why do you plan?
How do you plan?
Safety?
What resources do you use to locate a patient and
contacts?
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 9
Trying different times of the day
Chatting with kids who love to talk
Finding the nosy neighbor
1. Review all records
2. Prioritize investigation activities
3. Map out field activities
4. Gather and prepare essential materials
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 10
What is a re-interview?
An interview after the first meeting with the patient
A planned interview
Can be done by another staff member
Can be conducted one or more times
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 11
When is it important to conduct a re-interview?
Obtain additional information
Identify additional and/or missed contacts
Enhance upon your case investigation
Develop stronger trust and rapport
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 12
In this exercise, you each will play the role of the
• Patient
• Interviewer
A group of people involved in common behaviors or activities such as:
Common behaviors(drug or alcohol use, prostitution)
Common activities (floating card games, selling drugs)
Same places (church, work, beauty salons, dialysis center)
Other connections that promote disease transmission?
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 13
Social networking reduces the emphasis on individuals and focuses on the “group” and places in which infection might exist.
A planned interview with a contact to a case
A method of identifying other possible places of transmission
A strategy to widen or narrow an investigation
A technique to prove or disprove the patient’s side of the story
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 14
There is insufficient contact information
You feel that the patient is not being truthful or forthcoming
You feel that there are additional sites of transmission that have not been identified
To practice identifying additional locations and contacts using a social network and clustering approach
To practice a cluster interview
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 15
A 32-year-old male with one child
Substance user
July 2015:
Onset of cough and weight loss
Diagnosed with bronchitis
Robin’s infectious period: July 2015 – September 2016
September 2016:
TST negative and chest x-ray with right upper lobe cavity consistent with pulmonary TB
Sputum AFB smear and positive cultures for M. tb
HIV status unknown
Isolated in hospital for 4 weeks
Currently on the standard 4TB drug regimen
Facilitator will play three roles:
• Original patient (Robin)
• Good information source person #1
• Good information source person #2
Ask the facilitator questions to identify places
and people
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 16
Cases and contacts were only known by “nicknames”
Multiple interviews conducted
Little identifying and locating information
Complements traditional contact investigation approach
Identifies additional contacts
Interrupts disease transmission
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 17
Effective interviewing is an essential ingredient to TB control efforts
Properly planning and executing interviews and contact investigations are important in establishing priorities and identifying contacts at high risk
Re-interviews identify additional information and are instrumental to a thorough investigation
Social networking and clustering identifies sources of information and potential places of transmission
1. California Department of Public Health and California Tuberculosis Controllers Association. Joint Guidelines for Tuberculosis Treatment and Control in California. 2001. http://www.ctca.org/guidelines/index.html
2. Center for Disease Control. MMWR. Essential Components of TB Prevention and Control Program.1995. http://www.cdc.gov/mmwr/pdf/rr/rr4411.pdf
3. New Jersey Medical School National Tuberculosis Center. Performance Guidelines for Contact Investigation: The TB Interview-Supervisor's Guide for the Development and Assessment of Interviewing Skills, Course materials for the Effective TB Interviewing and Contact Investigation, and TB Interviewing for Contact Investigation: A Practical Resource for the Healthcare Worker. Available at http://www.umdnj.edu/ntbc.
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 18
4. New Jersey Medical School National Tuberculosis Center. Tuberculosis Field Investigation: A Resource for the Health Care Worker. 2004.
5. Center for Disease Control. Guidelines for the investigation of contacts of persons with infectious tuberculosis. MMWR Morb and Mortal Wkly Rep. 2005; 54 (RR-15): 1-62.
Center for Disease Control for original materials adapted for some of the course content
California Department of Public Health Services Sexually Transmitted Disease Control Branch
Local Tuberculosis Control programs in California
California Department of Public Health Tuberculosis Control Branch
Curry International Tuberculosis Center
Effective Ways of Interviewing: Practical Experience Skill PracticumRenee Simmons-Wilkins
TB Case Management and Contact Investigation IntensiveMarch 19-22, 2019 19
Please contact:
Renee Simmons-Wilkins
Phone: (209) 684-1540