Background:
The Multnomah County Health Department staff in Portland, Oregon desired an evidence-based method of counseling to prevent the spread of STDs and HIV. In 2003, the work group invited Rochester's Center for Health and Behavioral Training to train staff in their stage-based Rochester STD/HIV Behavioral Counseling model (RoSHBeC).

Objective:
Implement a standardized evidence-based behavioral counseling strategy to help decrease effects of HIV, HCV, and STDs.

Method:
Through an iterative group process, MCHD adapted the RoSHBeC model for use by STD clinicians in 2005. STD and HCV prevention were added to the prevention target behaviors. DIS and Community Health Specialists involved in outreach decided that RoSHBeC wasn't feasible for use in the field, and were trained in MI techniques. Medical record forms were modified to include Behavioral Counseling components. STD clinicians meet monthly for case reviews, led by a Health Educator, to continue to refine skills.

Result:
Clinicians feel confident they have incorporated BeC counseling strategies into STD visits. They appreciate that the model gives them a common language and structure yet retains flexibility for personal style and approach. Ongoing work is being done to clarify messages and behaviors for people living with HIV, in the context of serosorting and potential concerns about superinfection, and to clarify how harm reduction fits with targeted behavioral counseling. A format for evaluating measurable outcomes has yet to be created, although process evaluation shows that STD clinicians identify stage of change and target behavior, and appropriately match the counseling strategy to the stage.

Conclusion:
Stage of change behavioral counseling model has been successfully implemented by STD clinicians to influence individual behavior change, an essential component of an STD prevention program.

Implications:
Evidence-based stage of change counseling models can be adapted and integrated by clinicians into STD clinical visits.