The small but growing empirical literature concerning mental health service delivery via telephone suggests that in the future there will be more research using this modality, particularly research that focuses on overcoming barriers to reaching underserved populations. Competent performance of the intake function in these services will require substantial staff training and support. To highlight these training and support issues, this article describes Project ARIES, an AIDS prevention telephone-counseling study for men who have sex with men. We describe the skills, knowledge, and sensitivity necessary to staff the intake function of the project and conclude with suggestions for others who intend to implement similar services.
Project ARIES was a four-year (1991 to 1995) AIDS prevention study conducted at the University of Washington School of Social Work. The experimental intervention involved cognitive-behavioral group counseling delivered over the telephone to men who have sex with men and who were seeking assistance in reducing their risk of HIV transmission.
Earlier research pointed to ongoing high-risk sexual behavior in a substantial minority of men who have sex with men (Ames & Beeker, 1990; Ekstrand & Coates, 1990; Hays, Kegeles, & Coates, 1991; Kelly, St. Lawrence, Brasfield, et al., 1990; Martin, Garcia, & Beatrice, 1989; Peterson et al., 1992; Ruefli, Yu, & Barton, 1992; St. Lawrence, Hood, Brasfield, & Kelly, 1989; Stall et al., 1992) and suggested that prevention approaches emphasizing skills training were effective in increasing condom use (Kelly, St. Lawrence, Betts, Brasfield, & Hood, 1990; Leviton et al., 1990; Roffman, Beadnell, Downey, & Ryan, 1992; Valdiserri et al., 1989). In addition, empirical studies of telephone counseling pointed to the potential of this delivery method in overcoming psychological and geographic barriers to serving men who have sex with men, particularly those who were closeted or living a great distance from communities with gay-sensitive HIV prevention programs (Roffman, Beadnell, Downey, & Ryan, 1992; Roffman, Beadnell, & Ryan, 1992; Roffman, Ryan, Downey, & Beadnell, 1993).
To ensure the likelihood of recruiting a diverse group of individuals in terms of ethnicity and life experience, we organized a focus group of men of color and a marketing advisory group. After a series of meetings at which strategies and materials were reviewed and critiqued, we produced a series of posters and display advertisements that featured men of different ethnicities accompanied by copy that attempted to articulate a variety of experiences, including closetedness, anxiety related to unsafe sexual practices, sexual desire, and the fact that knowledge does not always translate into action (Fisher et al., in press).
Publicity included advertisements in gay periodicals, newspaper feature stories, and quarterly mailings to gay clubs and agencies (for example, HIV and sexually transmitted disease clinics, AIDS service providers, and social services agencies) (Fisher et al., in press). Promotional materials indicated that the counseling was offered free, that all contacts would take place over the telephone via a toll-free number, and that participants had the option of remaining anonymous (Roffman, Beadnell, Ryan, & Downey, 1995).
Goals for Intake
Intake workers were trained to accomplish five tasks: (1) educate callers about the project's purposes and the nature of the intervention; (2) explain the research context within which the services were being offered, including random assignment of clients to immediate or delayed counseling and the necessity of periodic data collection interviews; (3) determine the eligibility of those who expressed interest; (4) obtain informed consent and initiate the enrollment process for eligible individuals; and (5) attempt to identify alternative resources for callers who were either ineligible or not interested in enrolling.
To accomplish these tasks, intake workers first sought to establish rapport with each caller. Without the usual benefit of visual cues (for example, an office, credentials on the walls), the worker had to convey that the project was a gay-affirming and sex-positive service as well as a safe place to talk. Through tone of voice, ease in discussing sensitive issues, and willingness to listen, the intake worker affirmed the normalcy of the caller's apprehension about discussing sensitive topics such as difficulty avoiding high-risk sexual behaviors.
To determine whether the program would be a good match for the caller's needs, the intake worker needed to clearly communicate details about both the telephone-counseling process and the nature of the commitment the individual would be making as a research participant. Education about the study involved clarifying its auspices, objectives, services provided, periodic assessment procedures, and possible benefits and risks to the participant. The worker explained that participants would be asked to agree to being interviewed a number of times before, during, and after counseling. Potential participants were then screened for eligibility according to three criteria: participants must be male, must be age 18 or older, and must have engaged in three or more acts of unprotected oral or anal sex with another man in the prior three months. Those who were not interested or who were deemed ineligible were offered help in finding alternative resources.
Obtaining informed consent was the next step. In lieu of reviewing a written consent form during an in-person intake, a 10-minute taped message from the project director informed potential participants about the study's many details. Each applicant was assigned a code and given a toll-free telephone number to gain...