North Carolina Community Health Center Association

NCCHCA and AIDS Education and Training Center Survey

Please return your completed assessment by fax, email or online no later than Friday, August 8, 2008.

Fax: (919) 416-4931

To download a hard copy to fax, click here.

 

ONLINE SURVEY:

Respondent: 

Email:  

Phone: 

Health Center Name:

City:     State:   

Ryan White CARE Act funding (Select all that apply)

  Not applicable        Part C             Part D        Don’t know

__________________________________________________________________________________

1.       What is your profession/discipline?  (Select one)
Select OnePhysicianPhysician AssistantNurse PractitionerAdvanced Practice NursePharmacistNurseOutreachDentistDental HygienistDental AssistantOther- specify below

If other profession/discipline, please specify:  

2.       In the past 12 months, have you worked with patients or clients in the following populations: (Select all that apply)

HIV positive without AIDS diagnosis           
Farmworkers with an HIV/AIDS diagnosis

HIV positive with AIDS diagnosis                
Farmworkers with an STD diagnosis

Had an STD that you diagnosed                     
Homeless with HIV/AIDS diagnosis                         
Homeless with an STD diagnosis

3. What length of time do you prefer for continuing professional education/training programs?  (Indicate longest duration)

Select Longest Duration PreferredNo PrefenceHalf DayFull Day

4.       What is your preference of location to receive continuing professional education/training? 

   No preference                     On-site location        

      City in which you work        State in which you work

5.       In the past 2 years, approximately how many different continuing professional education/training programs have you participated in that included HIV/AIDS-related topics?  (Select one)

Select OneNone1 - 2 Events3 - 5 Events6 - 10 Events                

6.       How often would you want clinical training/ updates focusing on HIV/AIDS related topics available to you?
Select OneAnnuallyTwice a YearQuarterly (4 times a Year)Monthly

7.       What specific HIV–related topics would you be interested in for a training event?      (Select all that apply.)  
STDs                Hepatitis B/C co-infection      MRSA              
Mental Health/Substance Abuse                            HIV Update       Special populations such as  homeless or farmworkers                   
Opt-Out HIV testing      
Other    

9. Please outline the HIV training needs of staff who are not direct primary care providers. (We may contact you for additional documentation, since clinician training is HRSA’s priority.  But we can respond to documented needs for additional kinds of HIV training for other members of the care team).

10. Please tell us about other ways the NC AIDS Education & Training Center can assist you to deliver optimum care to people living with HIV.