Table 3.

Themes for training, QA, and proactive inhibition: high- and low-fidelity agencies

Theme	High-fidelity agencies	Low-fidelity agencies
Approach to training	. . . when we were offered the RESPECT training, we went as a whole department, and we all agreed this was a real easy fit. [Agency A, SUP]	I guess just a clarification that we [executive director and supervisor] weren’t participating in the training. [Agency E, ED/SUP]
	We met as a team and we discussed—before we even went [to the training], we discussed would this be something that would work well with what our agency does. . . it should be a team decision. We all do interventions, so any decision on what trainings or what diffusion of effective behavioral interventions we implement should be a team decision. [Agency A, SUP]	. . . we sent about half of our staff through it [training] . . . and it was just kind of whoever’s available to go went. [Agency F, ED]
	. . . we discussed it as a team, because we do work as a team, we bounced ideas off each other how the individual counselor reacts to said situation, and we use each others’ input. . . [Agency A, CN1]
	We [the agency] were proactive and contacted the people in [city] that did the training . . . and we were trying to get the RESPECT manual before the training . . . So it was a lot, all of us studying everything. [Agency B, SUP]
	Yes. We tried it out [pilot tested] with the first group of staff that were trained before anybody else was . . . [Agency C, ED]
	. . . [staff] talk about how . . . it was bumpy in the beginning . . . they piloted [the protocol] [Agency C, CN2]
QA strategies	We actually do everything you just said [QA strategies]. Ongoing training, each client has their individual file . . . we have observation. So, we do all of that and, always continuing education. [Agency A, SUP]	Well, you know, maybe having something written down [QA protocol] that having set measures that we are looking at, that would be great. [Agency D, ED/SUP]
	I use the Provider Cards, the Provider Cards are pretty much an outline. The QA form is an outline of what’s in the cards . . . [Agency A, CN2]	I: Do you have a written quality assurance protocol for RESPECT?
		R: Not that I’m aware of. No. [Agency E, CN1]
	Weekly individual supervision with each of the assigned staff. Twice monthly supervision with all of the participants in the program, all the staff. [Agency B, ED]	I: Does your quality assurance protocol for RESPECT include any of the following activities [case conferences, observation & feedback]?
		R: Hm, no. We have done none of that [case conferences] . . . no. I’ve never had anybody come out and observe me in the field [conduct COF]. [Agency E, CN1]
	[QA strategies] They all sit in on the sessions and conduct audits. They’ll audit a negative or a positive [HIV test] . . . and they’ll review that information with the employee. [Agency C, ED1]
Impact of proactive inhibition	. . . we have RESPECT and CTR as two different things, you know. . . [Agency B, SUP]	I: And how did the RESPECT model modify the existing program?
		R: I don’t know. I don’t know [later in the interview] . . . so our protocols of how we run the clinic. And it’s certainly not specific of RESPECT Again, in our environment we utilize a RESPECT intervention, but we do not call it RESPECT. [Agency D, ED/SUP]
	With RESPECT it’s just easy to implement because it was close to what we were doing . . . the only thing that I had to do differently, is the part to heighten their anxiety about whatever risk . . . because I wasn’t previously doing that. [Agency A, CN1]	The overlap between the RESPECT intervention itself, and what’s just a regular counseling and testing session and the training for the RESPECT intervention and the training that we locally provide for the HIV prevention and behavior change course are pretty similar, and it’s kind of confusing to provide, to separate the two. [Agency E, ED/SUP]
	It [the training] handheld us through the process of understanding what protocol-based counseling was because people had previous counseling experience, and so they wanted to let us understand what . . . portion of it did not have to do with our past experience [counseling] . . . [Agency C, CN1]	So honestly, with some of the clients, I take it or leave it . . . I go back to an older, more very client focused model whenever it’s someone who’s not major risk oriented or have a lot of risk areas, and if they are giving me cues, like they’re not really responding well to having their assumptions challenged, and just asking them a lot more questions. [Agency F, CN]