2. What type of general services does your organization provide? Please check all that apply.

Transcription

1 1. The National Viral Hepatitis Roundtable (NVHR) has entered a 3 Year Cooperative Agreement with the Centers for Disease Control and Prevention (CDC) to increase testing for hepatitis C among individuals born between 1945 and 195 (Baby Boomers). As part of our agreement, we plan to develop our organization s networking, educational, and capacity building activities and develop best practices for increasing hepatitis C testing and linkage to care. An essential part of this agreement is understanding the current efforts around hepatitis C testing undertaken by our member organizations and other organizations around the country and opportunities to start, assist with, and spread these efforts across our networks. We are asking these questions to assess your needs for technical support and your interest in collaboration. In this survey, we will be asking about: The populations your organization serves. The hepatitis screening and treatment services your organization provides. The reach of your organization. The needs of your organization. Please complete this brief survey to assist us in achieving this goal. Your responses will inform NVHR's program focus. 1. Name and contact information for your organization. Contact Person: Organization: City: State: Phone: 2. What type of general services does your organization provide? Please check all that apply. Primary Care Specialty medical care please specify in comments box below Patient Support (e.g., case management, support groups, etc.) Patient Education General Public Education Provider Training Awareness Advocacy Other please specify Page 1

2 3. What diseases does your organization focus on? Please check all that apply. Hepatitis B Hepatitis C HIV/AIDS Other please specify 4. Which of the following services does your organization provide to clients on a regular basis? (Check all that apply) Viral hepatitis education materials Viral hepatitis community education and outreach Risk assessment and vaccination for hepatitis B Testing for hepatitis B Testing for hepatitis C Rapid testing for hepatitis C Treatment of hepatitis B Treatment of hepatitis C Referrals for chronic hepatitis B treatment Referrals for chronic hepatitis C treatment Support groups for patients with Hepatitis C Patient navigation Other (please specify) 5. What is the geographic reach of your organization? Please check all that apply. Local Regional State National Other please specify Page 2

3 . Who does your organization reach? Please check the top three all that apply. Patients Educators (e.g. health educators, teachers, etc.) Media please describe relationship please comment in box below Policymakers (elected officials or non elected policymaker) Government Organizations (e.g., health departments, federal agencies, etc.) Payers (e.g., managed care organizations) Providers Please describe how you reach them, what the relationship is like, most effective methods of interacting, etc. 7. Are their specific demographic groups your organization focuses on? Please check all that apply: People Who Inject Drugs (PWID) Men Who Have Sex with Men/Gay and Bisexual Men Veterans Homeless Uninsured Hispanic/Latinos African Americans Asians Other ethnic groups Foreign born Incarcerated or formerly incarcerated HIV co infection Other medical conditions Baby boomers are there particular subgroups you focus on? Page 3

4 8. Approximately how many people does your organization reach annually through DIRECT services (e.g., testing, support groups, etc.) ,000 1,000 5,000 5,000 and over N/A 9. Approximately how many people does your organization reach annually through GENERAL services (e.g., website visitors, newsletter recipients, etc.): ,000 1,000 5,000 5,000 and over N/A 10. Is your organization currently doing any of the following activities to increase hepatitis C testing of baby boomers? Please check all that apply. Testing onsite Testing offsite/mobile testing Refer to offsite testing Refer to primary care for testing Working in your community to increase testing Provider education and/or training Patient education and/or awareness about testing Other please specify Page 4

5 11. Is your organization currently tracking rates of hepatitis C testing for baby boomer clients? No and we don t plan to No but we do plan to Would like to and need assistance Yes please specify 12. What type of technical assistance/capacity building would you be interested in receiving from NVHR regarding HCV awareness and testing for baby boomers? Please check all that apply. Provider education tools, handouts, and training materials Patient education tools, handouts, and training materials Technical assistance on how to configure your electronic medical record system to create automatic prompts for hepatitis C screening etc.). Educational webinars with information for patients, providers, and organizations around media opportunities (e.g. national testing day, Developing hepatitis C support groups Printed materials from CDC Items posted to NVHR website and resource library Template press releases, advocacy materials, letters to the editor Help with National Hepatitis Testing Day Other (please specify) From your experience, what do you feel are the biggest needs of your local community/constituents? 5 Page 5

6 14. From your experience in your community, how adequate do you feel local resources are for the following? Totally Inadequate Inadequate Fair Good Excellent Don't know/not sure HCV education nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Free or reduced cost HCV screening Resources for appropriate follow up medical care for infected individuals Resources for uninsured individuals to get follow up medical care for HCV nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please rank the following items in order of importance. Items will move up or down as you rank them. 15. Training Needs. My organization could use assistance with: Developing community based programming Implementing community based hepatitis C programming Developing hepatitis C educational curricula Implementing best practices for hepatitis C screening and linkage to care Conducting hepatitis C screening and linkage to care program evaluation Setting up and maintaining social networks Using multi media technology to conduct hepatitis C awareness activities 1. Data Needs. My organization could use assistance with (please number in order of importance to you, with 1 being of highest importance): Collecting hepatitis C screening and linkage to care data Managing hepatitis C screening and linkage to care data Collecting hepatitis C knowledge and behavior related data Managing hepatitis C knowledge and behavior related data Finding and using existing databases to enhance your knowledge base (e.g., linking to existing surveillance efforts, working with health department surveillance data, using epidemiological statistics to make a case) Using multi media technology to conduct hepatitis C awareness activities Page

7 17. Partnership Needs. My organization could use assistance with (please number in order of importance to you, with 1 being of highest importance): Conducting local capacity assessments Building local coalitions Maintaining local coalitions Evaluating local coalition outcomes Sharing health related resources with local and national partners 18. Technical Assistance and Training Needs. My organization could use assistance in the following form (please number in order of importance to you, with 1 being of highest importance): Group conference calls Group webinars In person meetings/conferences A series of one on one, individualized phone calls Peer to peer programming (linking mentors together with mentees) Toolkits 19. Resource Needs. My organization could use assistance with the following: Developing hepatitis C educational resources Finding hepatitis C educational resources Developing hepatitis C awareness campaign materials Finding hepatitis C awareness campaign materials Other (please specify) Page 7

8 20. Do you have expertise in any of the following areas that may be able to help NVHR s work? Please check all that apply. Developing hepatitis C educational resources Finding hepatitis C educational resources Developing hepatitis C awareness campaign materials Finding hepatitis C awareness campaign materials Other (please specify) Please offer additional comments regarding technical assistance or training that was not specifically mentioned, but would be helpful to you and your local communities: 5 Thank you for your participation. You may also Tina Broder, Program Manager, directly with questions or comments at tbroder@nvhr.org. Page 8