Introduction to the Application of Balanced Counseling Strategy

1. Introduction to the Application of Balanced Counseling Strategy By Judith Maua DRH

2. Balanced Counseling Learning Objectives • Give an overview of the GATHER and REDI counseling models as applied in family Planning consultations and other reproductive health areas 2. Outline some of the gaps in traditional FP counseling strategies

3. Learning Objectives cont 3. Define the term Balanced Counseling Strategy (BCS) Plus and outline its importance in FP consultations 4. Present the various BCS job aids and describe their major features and roles 5. List the BCS stages

4. The Gather Process G- Greet A- Ask T- Tell H- Help E - Explain R- Return visit/ Refer

5. The REDI Process R- Rapport- building E - Explain D – Decision - making I – Implementing the decision

6. Introducing BCS • Counseling is one of the most important skills in providing integrated FP/RH/HIV services. • For counseling services to be effective , the provider must personalizethe session with each client by exploring each client’s individual situation rather than giving general information

7. Introducing BCS • Whereas the traditional counseling models- GATHER and REDI offer excellent verbal information to clients, the tools and other written materials to support the information and communication have been lacking

8. WHAT IS BALANCED COUNSELING STRATEGY? • The Balanced Counseling Strategy (BCS) is a practical, interactive, and client-friendly counseling strategy; • Balanced counseling strategy (BCS) is designed to provide the information and the tools needed to improve the effectiveness and efficiency of integrated CT/FP consultations; • The use of BCS simplifies decision-making and responds to the client’s needs and reproductive intentions

9. BCS Contd. • Results from areas where BCS has been used show that there were significant improvements in quality of care and improved client knowledge of certain FP methods • Providers have to use the BCS guide and job aids during the consultations • Good counseling models should be client centred, assure privacy and confidentiality, and emphasize the client’s right to make informed and voluntary decisions.

10. BCS Contd 2 • Good FP counseling methods enable service providers to counsel, help clients assess their situation or risk, help them make a decision and plan for behavior change

11. Limitations of Traditional FP Counseling Strategies • The balanced counseling strategy has been designed to address the limitations (gaps) of the traditional counseling approaches while at the same time reinforcing the strengths of these models. • Balanced counseling strategy (BCS) is designed to provide the information and the tools needed to improve the effectiveness and efficiency of integrated CT/FP consultations.

12. Importance of new Balanced Counseling Strategy in FP Consultation • Focuses on individual clients needs • Tailors to suite clients needs • Limits information overload

13. Introducing BCS • Some of the concepts that are key to BCS Plus strategy will become clear after the telephone exercise

14. The Telephone Exercise (15mins)

15. Processing the purpose of the telephone exercise • By the end of this exercise, participants will be able to describe the need to support verbal information with tools and written materials.

16. Key points The point of the exercise is for the participants to: • Reflect on how difficult it is to remember what one hears • To understand the need to reinforce verbal information with written tool

17. Contents of BCS Plus Tool kit • Algorithm: This is a 15-step algorithm that summarizes the steps a service provider should take to implement BCS during a FP counseling session

18. Contents of BCS Plus Tool kit cont…. • Counseling Cards: There are 14 counseling cards. The first card contains six questions that the service provider will ask to rule out if a client is pregnant. The 13 method cards are used to help narrow down the appropriate method for the client

19. Contents of BCS Plus Tool kit cont…. • Brochures: There are 13 brochures- one for each FP method represent by a method card

20. How to use BCS job aids

21. Algorithm for using Balanced Counseling Strategy plus A) Pre – Choice • Establish and maintain a warm , cordial relationship. Listen to the clients contraceptive needs • Rule out pregnancy using the method card with the checklist of questions

22. If client answers “Yes” to any of the questions “No “ to all of the questions Then Continue to step 3. Send for a pregnancy test or refer to prenatal clinic Ask client to return when she has her menstruation Provide a back up method , e.g. condom End session Rule out pregnancy cts

23. Algorithm for using BCS pluscont.. 3. Display all of the method cards. If the client wants a particular method, go to step 7 4. Ask all of the following questions and set aside method cards based on the clients response • Do you wish to have children in the future? If “ Yes” set aside vasectomy and TL cards and explain why. If “ No”, keep all cards and continue

24. Algorithm for using BCS pluscont.. • b) Are you breast feeding an infant less than 6 months old? If “ Yes”, set aside COC pills card and explain why. Discuss the option of the mini pill. If “ No”, set aside the LAM card and explain why

25. Algorithm for using BCS pluscont.. c) Does your partner support you in FP? If “ Yes”, continue If “ No”, set aside the natural methods ( Billings, Rhythm, Standard Days) and barrier methods ( Condoms, etc) cards and explain why

26. Algorithm for using BCS pluscont.. d) Are there any methods that you do not want to use or have not tolerated in the past? If “ Yes”,set aside the cards the client does not want and explain why. If “ No”, keep the rest of the cards

27. Algorithm for using BCS pluscont.. B) Method Choice 5. Give information on the methods that have not been set aside, in order of their efficacy. a) Arrange the remaining cards in order of effectiveness (number on the back of each card) b) In order of efficacy (lowest no. to highest), read the 4 attributes of each method not set aside

28. Algorithm for using BCS pluscont.. 6.Ask client to choose the method that is most convenient for her/ him 7.Determine if there are any contraindications for the method chosen, using the brochure • Together with the client, review the brochure of the method chosen and its contraindications. • If the method is contraindicated, ask the client to select another method from the cards that remained repeating the process from step 5.

29. Algorithm for using BCS pluscont.. Post – Choice 8. Inform the client about the method, using the brochure of the method as a counseling tool ( Describe the action mechanism, give use instructions, side effects and alarm signs) 9. Determine clients comprehension and reinforce key information if needed

30. Algorithm for using BCS pluscont.. 10. Make sure the client has made a definite decision and give her/him the method chosen and / or a referral and back up method, depending on the clients needs

31. Algorithm for using BCS pluscont.. D. RTI/STI/HIV Prevention, Risk Assessment and Counseling and Testing 11. Discuss RTI/STI/HIV transmission and prevention 12. Conduct HIV/AIDS Risk assessment. If RTI symptoms , treat syndromically and advise on dual protection

32. Algorithm for using BCS pluscont.. 13. Discuss and offer client opportunities for Counseling and Testing for HIV. Counsel client for negative or positive test results as per the National Protocol for Counseling and Testing clients seeking FP services 14. Give follow-up instructions, condom pamphlet and method pamphlet 15. Complete the counseling session by giving the client a follow up appointment; invite the client to return if s/he has problem and end the session with a warm and cordial attitude.

33. Thank you