Many agencies want to start the change process by reviewing policies and administrative arrangements. It may be better to start with the point of service, where the client is. This permits you to identify the specific practice areas where changes are needed.

For example, infectious disease providers may need to learn to ask alcohol and drug screening questions with clients with HIV or other sexually transmitted diseases. Mental health providers could conduct the tests with their clients. Addiction treatment providers can be trained to identify IV drug users who should be referred for infectious disease screening, and may do rudimentary screening themselves.

Clinicians in all three fields may have clients who drop out, saying "Those people don't understand why I can't do what they tell me to." Training might help with behavior change models.

It is probably best to start by asking providers to describe what training or skills they need, and begin developing strategies to support the changes that would make them possible at the point of service. Starting at the other end, by looking at agreements, can keep your focus off the details that make real change possible.

Once you have identified the points of service that need to be considered, you can look at current agency agreements in relation to specific challenges. Then, you can develop strategies to address the challenges.

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