Hepatitis
Hep Talk Year Five
The HepTalk Project is rapidly heading towards its final phases, with the completion of on-site training workshops at 10 of the 27 participating clinics, and a distance learning version of this training offered to the remaining 17 sites. Distance learning courses were set up on-line, via the MCN website, in the Moodle course management system. The Moodle distance learning courses closely parallel the three onsite modules: Migration Health, Hepatitis Overview, and Effective and Efficient Risk Assessment.
A significant component of the on-site training was the use of standardized patient instructors. One of our three trained instructors accompanied a HepTalk team member to each clinic, and, in the role of a migrant client, visited 2-3 providers during regular clinic hours. Following the clinic visits, the standardized patient instructor provided feedback, specifically about conducting an effective and efficient risk assessment. The HepTalk team member conducted the three training modules following the standardized patient instruction, and included discussion of the standardized patient experience. Many clinics responded very positively to the training.
We used videotaped mock clinic visits to simulate this experience in the Effective and Efficient Risk Assessment module for the distance learning component.
The HepTalk team is now conducting final follow-up visits to clinic sites having completed the training. Team members at follow-up visits will observe, shadow clients, and collect data to help assess the effect of the HepTalk training.
The HepTalk online courses will be available on the MCN website in 2008.
Hep Talk Resources
The position paper "Hepatitis Screening, Immunization and Testing for Mobile Populations and Immigrants from Latin America and the Caribbean" is available here. This paper clarifies standard hepatitis recommendations for these populations.
Complementing that publication is the HepTalk resource "HepQuick: Transmission, Risk, Prevention and Vaccination Information." This includes all of the Centers for Disease Control information for Hepatitis A, B and C on one page, and includes specifics for mobile clients and recent immigrants from the position paper.
Also available here are two patient education resources developed by clinics in the HepTalk project. These posters, in both English and Spanish, can be printed on a normal computer printer and used in your clinic. These are examples of effective educational tools developed by individual clinics. Thanks to Planned Parenthood of Central Michigan for sharing their great poster and Bluegrass Farmworker Health Center for sharing their simple but very effective condom sign (they have it posted in the restroom)! If YOUR clinic has developed easy-to-reproduce and use resources to aid in hepatitis and communicable disease prevention that you would be willing to share, please send them to us at dempander@earthlink.net
MCN has a new very useful resource for clinics: "Recommended vaccines for recent immmigrants from Mexico." This guide provides recommendations for offering vaccines to non-high-risk recently arrived Mexican immigrants, by age, to bring them up-to-date with the US recommendations.
Also check out the "HepTalk Listserve Archives" (link at left) for monthly resources on hepatitis and patient communication topics.
Hep Talk: Patients as Co-Authors of Their Hepatitis Prevention Plan
MCN, in partnership with CHEC (Community Health Education Concepts), was awarded a five-year grant from the Center for Disease Control. The goal of the grant, called Hep Talk, is productive communication, between primary care providers and patients who migrate for purposes of work or family unification, about risk and prevention of Hepatitis A, B, and C.
Prevention
of hepatitis is a complex task. Risk portraits for each person are
unique, and include specific factors, such as inadequate housing
and sanitation, often encountered by mobile populations. To elicit
these portraits requires adept interviewing skills on the part of
the clinician. Prevention strategies can include relatively straightforward
approaches such as immunization of a child, but will also most likely
include more emotionally charged and complex behavior change considerations
around personal and family hygiene, sex, and illegal drug use.
Hep Talk posits that patients will engage in discussions of emotionally-charged issues surrounding Hepatitis A, B, or C risk and prevention if the clinic environment includes the following: access to language-appropriate information on hepatitis, consistent with the CDC Guidelines; the occasion to discuss emotionally-charged personal health topics; and clinicians able to anticipate, recognize, encourage, and participate in these discussions.
Protective behavior change in regards to hepatitis infection will result from a productive discussion of hepatitis risk factors, including those with high emotional valences, and prevention mechanisms that are culturally and practically feasible for the patient. Patients will sustain these discussions of emotionally charged risk and prevention issues if the clinic environment includes clinicians who have the skills to be receptive to the patient cues and conversation AND to follow up appropriately. The clinician must engage the patient in determining what strategies are most important and most possible in that person's life. The prevention plan that is "co-authored" by the patient will be most likely to be adopted.
To increase the potential for this kind of clinic environment, Hep Talk developed a clinic site assessment for federally-funded Migrant and Community Health Centers and local health departments in order to provide appropriate information and multiple opportunities for hepatitis risk and prevention discussion. The project also developed a Standardized Patient Training (SPT) and self-training materials for MHC clinicians. Hep Talk is evaluating the use of site assessment + standardized patient training, and the use of site self-assessment + self-training. At the end of the project, Hep Talk will disseminate the results of the project and the training tools developed
Additional information on this project can be found on the CHEC website.
Clinical Excellence
Resource Categories
Featured Resources
Hepatitis Charting
This resource provides a straightforward tool to use to develop effective hepatitis risk assessment with adult clients through your clinic charting system.
Hepatitis Web Study
From the Seattle STD/HIV Prevention Training Center and the University of Washington. This excellent site provides interactive, case-based modules related to the clinical care of persons with Viral Hepatitis A, B, and C. Easy to access!
Update: Prevention of Hepatitis A After Exposure to Hepatitis A Virus and in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP)
MMWR October 19, 2007 / 56(41);1080-1084 (See separate resource listing and link for Q&A about these new recommendations.
Questions and Answers: Prevention of Hepatitis A after Exposure to Hepatitis A Virus and in International Travelers: Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP)
This document answers commonly asked questions about the revised guidelines.
Vaccine Equivalency Chart: Mexico and Arizona
A comparison of Mexico's Immunization Schedule and the U.S. C.D.C. recommended schedule from US and Mexico Border Health Comission, Arizona Delegation
A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States Advisory Committee (ACIP). Part 1: Immunization of Infants, Children, and Adolescents
MMWR 2005,54(No. RR-16) Please note: Be sure to access the 3 important appendices to get the complete document.
A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States Part II: Immunization of Adults
MMWR 2006,55(No. RR-16) Please note: Be sure to include the 3 appendices to get the complete document.
Prevention of Hepatitis A Through Active or Passive Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
MMWR 2006;55[No.RR-07].
Benefits of Screening for Hep C
Because HCV-infection is usually silent until very late in the course of the disease, awareness and education are essential to identify infected individuals and encourage them to seek medical attention.
Binational Immunization Guide: Interpreting Immunization Schedules Mexico to California
This Guide provides information on Mexico's Immunization Schedule, including number of doses and recommended ages.