ISP DIS Assessment Word Version

Form approved

^{ATTACHMENT B}

_{Assessment of Internet Partner Services}

OMB No. 0920-0879

Expiration Date 03/31/2014

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_{1. Assessment of Internet Partner Services (IPS) Activities in STD Programs}

Thank you for agreeing to participate. This assessment was developed to help the CDC Division of STD Prevention better understand the current status of IPS activities nationwide. The information in this data collection instrument will be used to technical assistance needs and future training opportunities. The assessment should take no more than 25 minutes to complete and your participation is completely voluntary. All information obtained from your responses will be kept secure and you may opt to complete the assessment anonymously. Aggregate data may be shared broadly through

publications or other methods, such as webinars or training, but site­ or individual ­ specific data will only be shared with permission from the site or individual. If you have any questions or comments about the assessment, you may contact Frank Strona at FHS3@cdc.gov or 415­355­2016

For the purposes of this assessment, we have defined IPS as the use of the internet and other technologies (e.g. texting) to conduct partner services, including partner notification (PN), and/or for record searches and gathering personally identifiable information for STD/HIV prevention and control purposes.

IPS activities do not include outreach or outreach activities such as recruitment to testing and screening events, promotion of health resources, etc.

Public reporting burden for this collection of information is estimated to average 25 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC Reports Clearance Officer, 1600 Clifton Road, MS D­74, Atlanta, GA 30333, ATTN:PRA (0920­0879)

_{Assessment of Internet Partner Services Activities II}

^{2. Participant Information}

_*1. Please take a moment to share the following:

_{Health Department:}

Job Title:

State: 6

_{Assessment of Internet Partner Services Activities II}

_{3. About Program IPS Services}

_{2. In which of the following divisions of your Health Program, does IPS operate within?}

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_HIV

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_STD

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_{Combined HIV/STD}

_{Other (please specify)}

_{3. Does your program currently conduct IPS?}

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_Yes

_{mlj No}

Additional Comments

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6

_{Assessment of Internet Partner Services Activities II}

_4.

_{4. If “No”, has your program ever conducted IPS?}

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_Yes

_{mlj No}

Additional Comments

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6

_{Assessment of Internet Partner Services Activities II}

_5.

_{5. If “Yes”, why was IPS discontinued? (check all that apply)}

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_{Lack of funding}

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_{Lack of staff/not enough staff}

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_{No trained staff}

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_{Leadership resistance/Lack of Interest}

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_{Staff resistance/lack of interest}

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_{Legal issues}

Other/ Additional Comments

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6

_{Assessment of Internet Partner Services Activities II}

_6.

_{6. If “No”, why has IPS never been conducted? (check all that apply)}

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_{lack of funding}

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_{lack of staff/not enough staff}

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_{no trained staff}

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_{leadership resistance/lack of interest}

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_{staff resistance/lack of interest}

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_{legal issues}

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Other/Additional Comments

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6

Assessment of Internet Partner Services Activities II

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7. About Your Protocols & Guidelines

7. Does your program have a written IPS protocol?

C' Yes

C' No

C' Don't Know

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_8.

_{8. Was the IPS protocol written in response to a CDC funded requirement?}

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_Yes

_{mlj No}

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_{Don't Know}

_{9. Are you currently following the Protocol?}

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_Yes

_{mlj No}

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_{Don't Know}

_{10. What guidelines were they based on? (Select one)}

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_{NCSD National Guidelines for Internet­based STD & HIV Prevention}

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_{Not based on other guidelines}

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_{Don’t know}

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Other STD program (please specify)

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_{Assessment of Internet Partner Services Activities II}

_{9. How Does Your Site Offers IPS}

_{11. For which infections does your program offer IPS? (Check all that apply)}

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_HIV

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_Syphilis

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_Chlamydia

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_Gonorrhea

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Other (please specify) or additional comments

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^{12. Which staff in your program conduct IPS? (Check all that apply. We understand that}

staff my have duplicate roles. Please check the answer that most similarly matches the job titles of those conducting IPS)

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_{Community Health/Outreach Workers}

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_{DIS, CDI, or similar position}

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_{Program Supervisors/Managers}

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_{All of the above}

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_{None of the above, IPS is conducted by an outside organization such as a CBOs}

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Other (please specify)/Additional Comments

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_{13. Are you one of the people in your program who conducts IPS?}

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_Yes

mlj ^No

Assessment of Internet Partner Services Activities II

_{14. Which of the following are part of your program’s IPS activities? (Check all that apply)}

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_{Case report investigations (eg. Following up on positive tests, assuring treatment)}

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_{Record searches}

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_{Field investigation (locating and notifying patients)}

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_{Linking and referring patients to care and services}

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_{Partnership development with key stakeholders (labs, Drs., venues)}

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Other (please specify)/Additional Comments

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6

Assessment of Internet Partner Services Activities II

15. By checking yes or no, which of the following can you do?

_{Yes No}

Access sexually explicit sites like Adam4Adam to gather information for PN?

Create IPS­ or health department­ related profiles on sexually explicit sites?

Use sexually explicit sites for partner notification?

Access social networking sites like Facebook to gather information for PN?

Create profiles on social networking sites?

Use social networking sites like Facebook for partner notification?

Send emails from work email address for partner notification?

Access an electronic partner services program like InSpot?

Use texting (aka SMS or short message system) for partner notification?

Use mobile applications like Grindr to gather information for PN?

Use mobile applications like Grindr for partner notification?

Access sites like Lexus/Nexus, Accurint or the DMV records to gather information for PN?

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_{Assessment of Internet Partner Services Activities II}

_{10. About IPS Related Venues}

_{16. Which “online” venues does your program currently use for IPS? (Check all that apply)}

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_{Facebook/MySpace}

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_Twitter

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_{GPS check in sites (e.g. Foursquare)}

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_{Social/sexual GPS applications (e.g. Scruff, Grindr)}

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_{Adult social/sexual wesites sites (e.g. Manhunt, Adam4Adam, BlackGayChat)}

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_{Dating sites such as Match, eHarmony, OKcupid}

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Other (please specify)/Additional Comments

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_{17. Are there any sites you are prohibited from using?}

_mlj

_Yes

mlj ^No

Assessment of Internet Partner Services Activities II

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11.

18.If yes,from which sites?

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12.

19. Has your IPS profile ever been disabled or banned by an online venue/website?

C' Yes

C' No

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_13.

^{20. If yes, from which online venues?}

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_{21. Please state why:}

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_{because of complaints from website users/members}

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_{for conducting outreach}

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_{for sending unsolicited emails}

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_{for violating the terms of service}

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Other (please specify)

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6

_{Assessment of Internet Partner Services Activities II}

_{14. About Texting for IPS}

_{22. Which of the following texting/SMS methods do you use for IPS? (Check all that apply)}

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_{Personal mobile phone}

_fec

_{Program­supported mobile phone}

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_{Online­based texting from a computer, laptop or tablet}

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_{None, we do not use texting/SMS for IPS}

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Other (please specify)

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_{Assessment of Internet Partner Services Activities II}

_{15. About IPS Access}

^{23. In the past 12 months, which of the following barriers have you encountered related to}

_{conducting IPS? (Check all that apply)}

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_{Old equipment/computers}

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_{Prohibited from accessing to sites by local program policy}

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_{Prohibited from accessing site by IT policy}

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_{Prohibited from accessing site by firewall blockages}

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_{Considered low priority/low yield activity for DIS}

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_{Lack of training to conduct IPS}

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_{Belief that IPS negatively impacts DIS performance measures}

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_{Resistance/lack of support from program leadership}

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_{Resistance/lack of understanding from other staff}

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_{Lack of staffing}

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_{Legal issues}

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_{Have not experienced any barriers}

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Other (please specify)

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Assessment of Internet Partner Services Activities II
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16. About IPS Training
24. Have you ever participated in any informal or formal IPS-related training? C' Yes C' No

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17.

25. What were some of the IPS-related trainings you participated in?

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18.

26. Would you be interested in future IPS trainings?

C' Yes

C' No

_{Assessment of Internet Partner Services Activities II}

_19.

^{27. Which of the following training methods would you prefer?}

_{(Please rank with 1 = most preferred to 5 = least preferred)}

	Most preferred				Least preferred
Trainings at a conference or meeting	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Conference Call	mlj	mlj	mlj	mlj	mlj
On­line/Web­Based Training	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Webinars	mlj	mlj	mlj	mlj	mlj
In­house training	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Other (please specify)

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_{Assessment of Internet Partner Services Activities II}

_{20. About IPS Data Collection}

_{28. Has your program conducted an assessment of community acceptability of IPS?}

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_Yes

_{mlj No}

_mlj

_{Don't know}

Additional Comments

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^{29. What data management system does your program currently use for case}

management? (e.g., STD*MIS, PRISM, MAVEN, etc..)

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_{30. Are there IPS specific data fields in your data management system?}

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_Yes

_{mlj No}

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_{Don't Know}

_{31. Are your IPS data analyzed?}

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_Yes

_{mlj No}

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_{Don't Know}

Additional Comments

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6

Assessment of Internet Partner Services Activities II

_{32. Are your IPS data used to inform program changes/improvements?}

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_Yes

_{mlj No}

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_{Don't know}

Additional Comments

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6

_{Assessment of Internet Partner Services Activities II}

_21.

^{33. Which of the following IPS­related data variables does your program collect? (Check all}

_{that apply)}

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_{Number of Internet cases (cases involving your use of the Internet for PN)}

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_{Number of Internet cases that become “traditional” cases, that is cases with locating information such as an address or phone number}

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_{Number of text messages sent}

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_{Number of emails/posts sent}

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_{Number of websites used}

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_{Number of contacts examined via self­report}

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_{Number of contacts treated via self­report}

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_{Number of contacts examined (verified)}

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_{Number of contacts treated (verified)}

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_{Timeliness of IPS investigations}

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_{Don’t know}

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Other (please specify)/Additional Comments

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6

_{Assessment of Internet Partner Services Activities II}

_{22. About IPS Quality}

_{34. Overall, how would you rate the quality of your IPS program over the last 12 months?}

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_Excellent

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_{Very Good}

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_Good

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_Fair

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_Poor

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_{Very Poor}

Additional Comments

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_{Assessment of Internet Partner Services Activities II}

_{23. Final Comments}

^{35. What suggestions would you like to make to further improve the quality and impact of}

_{your IPS program?}

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^{36. Any additional information related to IPS that you would like to share?}

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^{37. We in the process of revising and creating new materials related to IPS. We may like to}

follow up with you in the future. By providing us with your name and email address here ­

_{you are giving us permission to contact you.}

_Name:

Email Address:

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24. Thank You
Thank you for taking the time to complete this assessment.

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