About You

E-Mail Address:
First Name:		Last Name:
Professional Title:
Agency Name:
City of Employment:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Experience and Education

How long have you provided HIV social work, case management, or related services?
Less than 1 year	1 to 2 years	3 to 5 years	More than 5 years

In which setting do you currently work: (Check all that apply)
Hospital or university-based clinic
Solo/group private medical practice
Public funded community health center
State, county, or city health department
Substance abuse treatment center
Mental health treatment center
Community-based organization (CBO)
Other setting (specify)

What formal education program have you completed?
	Social Work Major	Other
Associate degree
Bachelor's degree
Master's degree
Doctoral degree
Other

What percentage of your time is spent in:
Direct services		%
Supervision		%
Administration or management		%
Receiving training or education		%
Other activities		%
Total		%

How many people living with HIV have you cared for in the PAST MONTH?

Overall HIV/AIDS Knowledge Self-Assessment

Please take a moment to think how you would answer the following questions about HIV/AIDS under the three knowledge areas (Basic, Intermediate, Advanced) and then indicate your overall level of knowledge by checking the appropriate box.

Basic What do the letters H-I-V and A-I-D-S mean? How is HIV spread? How do you prevent the spread of the HIV? If a patient says to you "my CD4 count is very low", what does that mean? What is the difference between HIV and AIDS?

Intermediate How does HIV infection affect the body? What are symptoms of HIV infection? What is harm reduction? Do CD4 counts get higher or lower with worsening HIV disease? What is the meaning of other major infections present in a person with HIV?

Advanced What part of the body is most impacted by HIV? When do you initiate treatment for an HIV+ patient? How do you increase adherence to treatment? When is it appropriate to change treatment? What common infections are associated with HIV?

I assess my overall level of knowledge about HIV/AIDS at:
Basic	I can answer some or all questions under Basic.
Intermediate	I can answer all questions under Basic, and some or all questions under Intermediate.
Advanced	I can answer all questions under Basic and Intermediate, and some or all questions under Advanced.

Knowledge and Skill Self-Assessment

Listed below are some knowledge and skills specific to an HIV case manager's role in caring for HIV+ patients.  Please read them and then select the number in the rating column that best represents your level of knowledge, skill, and attitude.

1 = low <---------------> 5 = high

Self-assessment of Knowledge and Skills	Rating
Knowledge of medical terminology	1	2	3	4	5
Knowledge of clinical manifestations of HIV	1	2	3	4	5
Knowledge of HIV diagnostic tests and disease progression	1	2	3	4	5
Knowledge of medical management of newly diagnosed HIV+ patients	1	2	3	4	5
Knowledge of Highly Active Antiretroviral Therapy (HAART)	1	2	3	4	5
Knowledge of metabolic complications of HIV and HAART	1	2	3	4	5
Knowledge of resistance testing and salvage therapy	1	2	3	4	5
Knowledge of opportunistic infections	1	2	3	4	5
Knowledge of HIV/Hepatitis C co-infection	1	2	3	4	5
Knowledge of health insurance eligibility criteria and covered benefits, including Medicaid, Medicare, ADAP, and commercial insurance	1	2	3	4	5
Skill in developing a comprehensive, individualized service plan	1	2	3	4	5
Skill in patient monitoring to assess the service plan's efficacy	1	2	3	4	5
Skill in periodic re-evaluation and adaptation of the service plan over time	1	2	3	4	5
Skill in assessing and treating mental illness among HIV+ patients	1	2	3	4	5
Skill in assessing and treating substance abuse among HIV+ patients	1	2	3	4	5
Skill in assessing the housing needs of HIV+ patients and addressing those needs	1	2	3	4	5
Skill in providing treatment adherence counseling to ensure readiness for, and adherence to complex HIV/AIDS treatments	1	2	3	4	5
Skill in providing patients with HIV education to expand "health literacy"	1	2	3	4	5
Skill in HIV medication education, including side effects and their management	1	2	3	4	5
Skill in assessing factors likely to contribute to poor adherence to HIV treatments and develop strategies to address those factors	1	2	3	4	5
Skill in conducting appointment adherence interventions	1	2	3	4	5
Skill in ensuring timely and coordinated access to medically appropriate levels of health, psychosocial, and other services	1	2	3	4	5
Skill in working with physicians, nurses, dentists, and other medical care providers to meet patients' needs	1	2	3	4	5
Skill in coordinating and following up on medical treatments	1	2	3	4	5
Skill in ensuring continuity of clinical and support services	1	2	3	4	5
Skill in coordinating health insurance benefits, including prior authorizations, identifying caps on benefits, etc.	1	2	3	4	5

Tell Us More

What are your greatest challenges in conducting medical case management?

What training topics would assist you to learning more about HIV medical case management?