Table 5.

Human Resource Change Influence on RESPECT Implementation

Number	Theme	Supporting Quote
1.1	Changes in Clients Served and	I would say that it’s a reduction in how many clients we can reach with this service… (Agency A; Provider Downsize).
1.2	Program Maintenance	RESPECT is part of our counseling and testing program. Total numbers have gone from about 2,300 to about 1,700 tests every year. So you can see that we’ve lost some actual interface unfortunately, since I’ve lost about half of my staff… (Agency B; Supervisor Downsize and Turnover; Provider Downsize).
1.3		We hired specifically because we needed an increase in staff, and we also got the funding. So I think the client load was already there. We were just really struggling to meet [the client load]… (Agency C; Provider Expansion).
1.4		The old full-time clinician relocated, so we had to hire a new staff member, and it was slow because the training…she was here four months before she was actually trained for RESPECT. Then another staff member came on, and we decided to identify her as a backup person…so that we wouldn’t be stuck with nobody being able to provide the service (Agency M; Provider Turnover and Expansion).
2.1	Changes in Skill and Knowledge	Some of those who left had a whole bunch of experience, and then you have to train somebody new. So that’s been a challenge (Agency D; Provider Downsize and Turnover).
2.2		And losing him…he was one of the first test counselors [we] had and he’s got a lot of years experience, so him leaving definitely put us in a different place as far as problem solving. But I don’t think it really created a problem because we still have [another counselor] and myself here who are long-time test counselors, and many of our original test counselors are still with us (Agency E; Supervisor Turnover).
2.3		We have a very low turnover [such] that all those people that started with us [at] implementation, they’re still with us, so they require less observation and less supervision (Agency F; Supervisor Expansion; Provider Expansion and Downsize).
2.4		We did increase the [supervision] to monthly within the last year, just because of the complexity of the addition of new staff… and the complexity of record keeping and requirements. We wanted more frequent review (Agency D; Provider Downsize and Turnover).
3.1	Changes in Workload for Remaining	A staff decrease means that the ones of us left are having to carry what they did, and so it just adds on to our workload… (Agency H; Supervisor Downsize; PD Downsize).
3.2	Employees	Well, with the one supervisor leaving, that put the load on to the other. We had a co-manager scenario, and so now it’s just one manager for the program. And our [RESPECT] counselors have a tremendous workload because the number of cases have gone up, and we’re not able to hire new staff…with the staffing changes the health educator and myself are spending more time in the clinic doing low-risk testing as much as we can…before we were hardly in the clinic at all (Agency J; Supervisor Downsize).
3.3		My workload is changing a lot just because…we recently hired some other folks who took HIV training, so that will help eliminate some of the burden (Agency I, Provider Expansion and Turnover).
4.1	Innovative Approaches to Downsizing	Since we’ve implemented RESPECT, we actually lost a person and a half. That’s how we got a volunteer though (Agency A; Provider Turnover).
4.2		We’ve got fewer staff, but we’re forming more collaborative partnerships, so we’re going to be able to reach a broader spectrum of the higher-risk population than we have in the last couple of years (Agency A; Supervisor Downsize; Provider Downsize).