California HIV Counselor Training Module 1 Overview of the training Introductions Housekeeping How to pass Overview of testing flow Mod 1 (1 of 10) Overview of the Training Build counselor skills Learn to run rapid tests Learn to perform finger sticks
Trainers will demonstrate role plays Participants will practice what they learn Mod 1 (2 of 10) Introductions Briefly tell us: Your name Where you provide testing How long youve been in the field Mod 1 (3 of 10) Agenda and Housekeeping
Name tags Fire exits Restrooms Participant manual Agenda Mod 1 (4 of 10) Working Agreements
Take care of yourself and the group Feel free to contribute, and also to listen Use language clients use Think critically Mod 1 (5 of 10) Bike Rack Park items for later Mod 1 (6 of 10) Action Plan Before I start counseling (Appendix E)
How do I handle partner violence ? Where do I find referral listings? Mod 1 (7 of 10) How to Pass 1. Attendance Be here for the entire training, fully participate & be willing to learn. 2. Counseling
Trainers will observe all of you doing 4-5 role plays and will pass you based on our cumulative observations. Use of basic client-centered counseling skills; Improvement over the course of the training; and Incorporation of our feedback into your practice role plays. 3. Correctly answer 80% or more of the questions on the Post-Training quiz. 4. Run Rapid Test - 100% Run & read 5 rapid tests with no errors on the paperwork. Be observed by a trainer running all steps of one of the 5 tests and do all steps correctly. 5. Ability to do finger sticks - 100% Mod 1
(8 of 10) Why Focus on Testing A New HIV Diagnosis Reduces Risk Behavior Colfax. Et al. AIDS, 2002 People who know they have HIV are much less likely to pass it on* The sooner a person begins treatment, the better their Mod 1 health outcomes will be (9 of 10) Session Flow Welcome,
Framing, Consenti ng Sample Collectio n Mod 1 (10 of 10) Assessing and Preventio n Counselin g
Yes? No? Results and Counselin g Referra ls Close Counseling Background (Knowing the Client) Module 2 Assessing context Look at how we change
Stages of change (Activity) Harm reduction Mod 2 (1 of 13) Context. is the clients story things that make up the clients life. (read Appendix A) Mod 2 (2 of 13) Whats Going On Has 3 kids
Alcohol use Strong Social Network High school education Bad job Lives in small town Easily angered Mod 2 (3 of 13) Considering how we change
When was the last time someone successfully changed your behavior? When was the last time you successfully changed someone elses behavior? What is helpful from other people when you are trying to make a change? What is not helpful? Mod 2 (4 of 13) Brainstorm What are some health risks taken by people you know or behaviors of your own that may compromise health? Why do people (we) engage in behaviors that cause them (us) harm?
Whats going on behind the behavior? Mod 2 (5 of 13) Stages of Change Mod 2 (6 of 13) We all Want to Change Something (Activity) Think of something you want to change something you feel comfortable sharing. In this exercise you will get the chance to play the counselor and the client.
- Listen carefully with the goal of understanding. Give no advice! (further instructions on next slide) Mod 2 (7 of 13) Instructions Ask in this order.. 1. What change would you like to make? Listen for 3 to 5 minutes 2. Why do you want to make this change? 3. How might you go about it to succeed? 4. On a scale of 0 to 10, where are you? 5. Why are you at a ___ and not zero? 6. Give summary of the motivations for change.
7. So, what do you think youll do? Mod 2 (8 of 13) Debrief What feelings came up as you revealed your behavior? (Getting in touch with feelings is important) What did you want from the counselor? Are you ready to change your behavior? What challenges came up as the counselor? Mod 2 (9 of 13) The Client is Always the Agent of Change
Clients choose what they want to change Mod 2 (10 of 13) Harm Reduction ..is about reducing harm, not necessarily eliminating it. In the previous activity, when asked What do you think youll do? Did you come up with a step toward making the change? Did you say Ill never do that thing again? Which of these two is an example of harm reduction? Mod 2
(11 of 13) Harm Reduction Any effort a client makes to reduce harm Encourages people to envision positive change for themselves Improvements in health can occur without total elimination of harm Mod 2 (12 of 13) Examples of Harm Reduction Mod 2 (13 of 13)
Counseling Skills Module 3 Background Tools Tips Mod 3 (1 of 19) Client-Centered Counseling Provides clients an opportunity to realize how their feelings and behaviors impact their lives and affect their efforts to make changes Creates a comfortable, non-judgmental
environment in an empathetic and non-directive way Supports clients in finding their own solutions Mod 3 (2 of 19) Client-Centered Counseling Tools (Appendix B) We are going to cover strategies and skills that we use in client-centered counseling Most people use these tools to some degree in everyday life Mod 3 (3 of 19)
Setting the Tone Client-Centered Counseling Tools We. provide an empathic and non-judgmental atmosphere engage clients to talk about their experiences validate feelings validate any past attempts and successes at changes support any plan for reducing harm Mod 3
(4 of 19) Active Listening Tools Non-verbal Client Centered Counseling Tools Attention Curiosity Eye contact Body language
Head nodding Mod 3 (5 of 19) Active Listening Tools Verbal Client Centered Counseling Tools Repeating Reflecting (and double-sided reflections) Reframing These tools encourage the client to elaborate, amplify, confirm or correct, and to establish counselor understanding of the clients concerns and reasons for testing. Mod 3 (6 of 19)
Open Ended Questions Tool Client Centered Counseling Tools Questions not answered with yes or no How are you feeling? Who do you have sex with? What drugs do you like, if any? What would you like to change? Mod 3 (7 of 19)
Clients Strengths Tool Client Centered Counseling Tools Acknowledges clients strengths reinforces and acknowledges efforts, struggles, and past successes in making desired changes. Your health is important to you, this brought you in today. You tried in the past to quit meth. You are feeling defeated because you are using again. But despite knowing how hard it is, your thinking about trying again to stop. You dont give up. Mod 3 (8 of 19) Clients Strengths Tool Client Centered Counseling Tools
What a Client Strengths Tool is NOT: A tool to be over-used Being a cheerleader Acknowledging every good characteristic Mod 3 (9 of 19) Summarizing Tool Client Centered Counseling Tools Highlighting the important aspects of the session, including plans for change, in a conversational way Not a checklist! Mod 3
(10 of 19) Helpful Hints Information alone does not change behavior Mod 3 (11 of 19) Helpful Hints Feelings + Motivation = Change Help clients identify feelings around - the behaviors that might be exposing them to HIV - the changes they think they can make
- why they think changes could be beneficial Mod 3 (12 of 19) Helpful Hints Client-Centered Counseling Tools Dos: Focuses on the client's concerns and interests
Counselor listens rather than speaks Offers options rather than direction Provides support rather than advising Focuses on feelings Mod 3 (13 of 19) Helpful Hints Client-Centered Counseling Tools Dos:
View client as a partner Minimize self-disclosure Third-personing Give information simply Pause (or sit in silence) Use Process Comments when needed Mod 3 (14 of 19) Helpful Hints Client-Centered Counseling Tools Donts / Pitfalls:
Giving advise Trying to fix it Getting off topic Using health education Using logic Not keeping to limited role Mod 3 (15 of 19) Common Pitfalls
Client Centered Counseling Tools WHY Questions Why would you do that? Why would you let someone treat you that way? Implies judgment Puts client on the defensive Mod 3 (16 of 19) Counseling vs. Everyday Conversation Ramp up - increase Listening Curiosity Open-ended questions
Tone down - decrease Talking Challenging language and opinionated comments Health education, facts and statistics (Examples on next slide) Mod 3 (17 of 19) Examples From - If I were you, I would To - I have heard some people say From - Do 2 wrongs make a right? To - How do you think that might change the
situation? From - Why not just tell him to use condoms? To - Do you think this is something you can talk with him about? From - You should be angry! To - Youre angry. Mod 3 (18 of 19) Sticky Wall Exercise Using Tools of the Client-Centered Counselor Mod 3 (19 of 19)
Window Period Module 4 Define Window Period Give Examples Practice (Activity) Mod 4 1 of 5 Window Period The time it takes for a test to detect the bodys reaction to HIV Mod 4 2 of 5
HIV Antibody Window Period The time it takes for the test to detect the bodies reaction to HIV (Appendix C) Last exposure 1 month later 2 months later 3 months
later 4 months later 5 months later 6 months later Antibodies could be
detected in as early as 2 weeks Most people develop antibodies by the end of 3 months You may want to retest to be sure
Exposure date _____ Next test_____ Final test_____ Mod 4 (3 of 5) Window Period (Activity) Pair up Decide who will play counselor first
Clients last exposure was 3 months ago Switch Clients last exposure was 7 days ago Mod 4 (4 of 5) Debrief What went well? Give examples What was challenging? What could have been done differently? Give examples Mod 4 (5 of 5) Counseling Session
Module 5 Welcoming and Framing Consenting Assessing Prevention Counseling Mod 5 (1 of 16) Welcome, Framing, Consenti ng Session Flow Sample
Collectio n Assessing and Prevention Counseling Yes? No? Results and Counseling Referrals, Close Mod 5
(2 of 16) Welcome, Welcome, Framing, Framing, Consenting Consenting Framing the Session First I will need your written permission to test you We will collect a sample and run an HIV test While the test is processing Ill answer any questions you have and well talk about what brought you in today Then Ill get you your results
Well see how youre doing and if you have any additional questions And then Ill send you on your way Any questions before we get started? Mod 5 (3 of 16) Welcome, Framing, Consenting Consenting a Client Client must be able to: Understand the language being spoken Understand the testing process
Be able to make an informed choice to test Mod 5 (4 of 16) Welcome, Welcome, Framing, Framing, Consenting Consenting Consenting a Client Before testing and must be in writing Informed consent means that the client understands what is going to happen and agrees to the process:
1. Understands what the test is for (to detect HIV Antibodies) 2. Understands limitation of the tests (Window Period) 3. If rapid is reactive, a confirmatory test must be performed 4. All positive confirmed tests are reported to the state health department (Appendix D) Mod 5 (5 of 16) Session Flow Welcome, Framing, Consentin g Sample
Collectio n Assessing and Preventio n Counselin g Yes? No? Results and Counseling Referrals, Close
Mod 5 (6 of 16) Assessing and Prevention Counseling Yes? No? Assessing Finding out about the client 1. 2. 3.
4. Client knowledge (HIV, window period) Type of exposure Context of behavior (things that drive behavior) Comfort level (and stages of change) (Appendix F) Mod 5 (7 of 16) Assessing and Prevention Counseling
Yes? No? Assessing Knowledge Find out what the client knows about HIV and the window period (Sample dialogue) What do you know about HIV? What do you know about the window period. (Appendix F) Mod 5 (8 of 16) Assessing
and Prevention Counseling Yes? No? Assessing Exposure Find out if and how the client has been exposed to HIV and how recent (Sample dialogue) Who do you have sex with and what kind of sex do you have? Do you use any drugs? Do you share needles? How often do you drink? When was your most recent possible exposure?
(Appendix F) Mod 5 (9 of 16) Assessing and Prevention Counseling Yes? No? Assessing Context Find out what drives clients behavior (context) (eg. Bare sex feels better than condom sex, relationship, addiction, etc.)
(Sample dialogue) Why do you think you keep having unprotected sex? What makes the times you use condoms different from the times you dont? What would happen if you mentioned these concerns to your partner(s)? Do you think sex would be safer if you were not using drugs? (Appendix F) Mod 5 (10 of 16) Assessing and Prevention
Counseling Yes? No? Assessing Comfort Level Around Exposure Find out if the client is comfortable with this level of exposure (and assess Stages of Change) (Sample dialogue) What youre doing may be exposing you to HIV. How do you feel about that? From 0 to 10.? (Appendix F) Mod 5
(11 of 16) Assessing and Prevention Counseling Yes? No? Prevention Counseling Helping client identify a step in lowering their risk Testing again in 6 months Not having sex with strangers without condoms Accessing needle exchange Asking partners HIV status
Mod 5 (12 of 16) Assessing and Prevention Counseling Yes? No? Prevention Counseling Explore pros and cons of behavior that might be exposing the client to HIV (Sample dialogue)
What do you enjoy about____? (barebacking, using meth, sharing needles, etc.) And what do you dislike about it? What keeps you from changing the things that you know could result in HIV infection? Mod 5 (13 of 16) Assessing and Prevention Counseling Yes? No? Prevention Counseling
Help the client come up with a stage-appropriate harm reduction step or plan (Sample dialogue) What could you do differently? Is this change realistic for you? How do you think you can remain HIV negative? What would you like to change? (Appendix F) Mod 5 (14 of 16) Assessing
and Prevention Counseling Yes? No? Prevention Counseling Have a discussion about obstacles: (Sample dialogue) What would make it more difficult to stick with your plan? How would you handle it if something gets in the way of your plan?"
(Appendix F) Mod 5 (15 of 16) Assessing and Prevention Counseling Yes? No? Assessing and Prevention Counseling Guide Find out why client is testing
Assess HIV knowledge, sexual/drug use behaviors, and comfort level with behavior Explore pros and cons of behavior Support a harm reduction step Problem solve obstacles to achieving their plan Mod 5 (16 of 16)
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