1. Please call in for audio U.S. & Canada: 1-866-740-1260 Access Code: 2011408 Texting Works! Finding People Infected with an STD via Free Google Voice Texting

2. House Keeping Presentation ≈ 45 min Question & answer ≈ 15 min This Webinar will be recorded and made available through our websites along with copies of the slides. www.sharedaction.org & www.sharedactionhd.org Please use the chat feature to ask questions.

3. Funded by The Centers for Disease Control and Prevention (CDC) to provide FREE trainings and one-on-one technical assistance for Health Departments on: (1)Evidence-Based Interventions (EBIs) and Public Health Strategies (2)Monitoring and Evaluation. (3)Organizational Infrastructure and Program Sustainability

4. Acknowledgements AIDS Project Los Angeles Center for HIV Identification, Prevention, and Treatment Services—UCLA The Centers for Disease Control and Prevention 4

5. 8/24/2012 Texting Works! Finding People Infected with an STD via Free Google Voice Texting Disease Intervention Program Multnomah County Health Department

7. Timeline

8. Short Message Service (SMS) = “Texting”

9. The Procedures

11. Golden Rules  Text messaging are not secure!  Subject to public records retention laws!  Phone Call first!  The purpose of sending a text message is to engage the individual in a voice call or face-to-face conversation  Protected health information (PHI) must never be sent via text messaging.”

12. Data from Jan 2011 - August 23rd 2012 2065 cases (GC, HIV, Early Syphilis) 24% texted (n = 497) 64% responded (n = 318)

13. Response by Gender Cases Texted Responded 1558 23% 65% MaleFemale 498 28% 61%

14. Response by Disease Cases Texted Responded 1534 23% 64% GonorrheaHIVEarly syphilis 231 23% 68% 300 28% 68%

15. Response by Age Group Cases Texted Responded 295 24% 62% 1 - 2021 - 3031 - 4041 - 60 831 24% 63% 444 24% 69% 463 24% 61%

16. Response by Race/Ethnicity Cases Texted Responded 1209 24% 67% WhiteAfrican-AmericanHispanic 425 23% 58% 184 24% 75%

17. Comparison: MSM vs. Non-MSM Cases Texted Responded 1083 23% 72% MSMNon-MSM 980 25% 55%

18. Comparison: Jan 1 st to August 23 Cases Texted Responded 745 19% 57% 20112012 803 29% 71%

19. Next Steps “Google Voice” beta testing started 6/2012  Reduce cost  Reduce Entry Barriers  Simplify the process

20. Google Voice Tips  Use your Google Voice task list to store the canned messages that have been approved by your program.

21. Why Google Voice? We rely on texting for partner notification. We have texted 497 clients and 64% have responded. Google voice provides the same capacity as a smart phone with zero cost! (Lynn George Informatics Manager)

22. Why Google Voice? Phones are: – Costly – Cell phone texting may lead to repetitive motion injuries such as Carpal Tunnel Syndrome – Sending a large number of texts via cell phone is inefficient and time consuming. (Lynn George Informatics Manager)

23. Goal of our Beta Test Reduced texting costs: Improved ergonomic safety for staff: Increased texting business practice speed and efficiency: (Lynn George Informatics Manager)

24. Google Voice Tip Each DIS team can use one Google voice account You can add a note to any text that was sent or received!

25. Google Voice Procedure Texts are an effective method for contacting individuals that are difficult to reach and do not respond to phone calls. Texts are not secure and are subject to public records retention laws. Staff should limit texts to clients who don’t respond to phone calls.

26. Google Voice Tip Use a “canned” approved message, add phone number, clients name and your name to message.

27. Google Voice Procedure The purpose of sending a text is to: Engage the individual in a voice call or face-to-face conversation. Or to inform them of an appointment time or meeting place or missed appointment. Protected health information (PHI) must never be sent via text messaging. References: http://www.ncsddc.org/upload/wysiwyg/documents/IGE.pdfhttp://www.ncsddc.org/upload/wysiwyg/documents/IGE.pdf

28. Procedure for texting clients via Google Voice Texts carry the same risks as voicemails. Messages may be viewed by other people Use only approved messages

29. Procedure for texting clients via Google Voice Confirm the correct number before texting! Send all texts using Google Voice Text via the account and number that is assigned to the user All texts will be documented and stored by Multnomah County in accordance with record retention requirements.*

30. Procedure for texting clients via Google Voice Clients must be informed to never send PHI to Multnomah County via text Do not erase any texts Be prepared to respond immediately

31. Procedure for texting clients via Google Voice If the individual responds with a text, respond with another text asking them to call you. Be aware of the tone of your text. It is extremely difficult to discern tone in text messages. Remain professional at all times. Texts are limited to 160 characters. Most carriers will split up an oversized message.

32. Procedure for texting clients via Google Voice Some people don’t have text plans and may be charged more. Texting should cease once contact is made with the individual or as soon as the case investigation is completed. You must first obtain the client’s written consent, unless as part of a DIS case investigation.[1][1] Personal texting with clients is strictly prohibited.

33. Information you may include in text messaging

34. Example of text that may be used  I am Jane Doe with Multnomah County and I need to speak with you. Please call me as soon as possible at 503-988-xxxx.  I am with Multnomah County and I have important information regarding your personal health. Please call me as soon as possible at 503-988-xxxx.  I am with Multnomah County and I have information regarding an urgent health matter. Please call me at 503-988-xxxx.  I have made numerous attempts to contact you. It is very important that we talk. Please call me at 503-988-xxxx.

35. Responding to text messages  If a client responds to your text with a text, use an approved message to encourage the client to call you.  Never respond to a text from an individual that contains PHI.  Instead, send a new text to encourage the individual to call you.

36. Sample responses to text messages  I am not able to give you specific information in a text message. Please call me at 503-988-3780.  I can tell you more when you call. Please call me at 503-988- 3780.  This is urgent and needs your immediate attention. Please call me at 503-988-3780.  The information I have for you is confidential. I can tell you more when you call. Please call me at 503-988-3780.  [Or ask your supervisor or manager for guidance.]

37. Documentation All texts must be documented in the client’s/contact’s record via the STD Database, including texts related to: Contact attempts Appointment reminders Missed appointments

38. Conclusions Testing can improve DIS outcomes.  60%+ of clients were able to be interviewed after not responding to a phone call and before a mailouts or field visit.  Using Google Voice can reduce or eliminate barriers to entry, no cost.

39. Citations  Kachur R, Adelson S, Firenze K, et al. Reaching patients and their partners through mobile:text messaging for case management and partner notification [letter]. Sex Transm Dis 2011;38:149 –150.  National Guidelines. Text messaging for partner notification. Available at:http://www.stdpreventiononline.org/index.php/resources/download /1300. Accessed November 2011.  Evidence Supporting the Use of Text Messaging for Partner Services Evidence Supporting the Use of Text Messaging for Partner Services  Mendez, Juan; Maher, Julie Sexually Transmitted Diseases. 39(3):238- 239, March 2012.doi: 10.1097/OLQ.0b013e3182471b31

40. Additional information Juan Mendez MA DIS Program Coordinator 503-988-3702 juan.a.mendez@Multco.us Special Thanks: Cesar Pecori CHS2 (Graphic Artist) Lindsay Jenkins (Research Analyst) Lynn George (Informatics Project Manager) For their help and support in this project!

41. For future webinars or CBA services Oscar Marquez 213.201.1641 www.sharedaction.org

42. Technical Bulletins  Focus Groups  Capacity Building Assistance  Evaluation  Survey Design  Clinical Supervision  OIPS: Internal Systems  Community Advisory Boards  Recruitment  Formative Research Broadsheets  Latino Men & Bisexuality  Day Laborers  HIV Disclosure  Transgender & HIV Risk  Youth Engagement

43. Please complete the post- webinar survey!

44. Shared Action & Shared Action HD Phone: 213.201.1641 Email: omarquez@apla.org www.sharedaction.org www.sharedactiohd.org