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Client-Provider Interaction Client-Centered Counseling

Client-Provider Interaction Client-Centered Counseling. Client-Centered Care. Seeing client-provider interactions through the eyes of the client. Effective client-provider interactions are centered around the client's needs. Important Qualities for All Service Delivery Staff.

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Client-Provider Interaction Client-Centered Counseling

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  1. Client-Provider InteractionClient-Centered Counseling

  2. Client-Centered Care Seeing client-provider interactions through the eyes of the client Effective client-provider interactions are centered around the client's needs.

  3. Important Qualities for All Service Delivery Staff • Respect and empathy for the client • Communication skills • Acceptance of valuesand beliefs differentfrom one’s own • Impartial attitude toward all clients

  4. Important Qualities for Reproductive Health Care Providers • Comfortable discussing sexuality and other personal issues • Unbiased position regarding reproductive health issues • Ability to support client’s informed decisions • Technical knowledge and skills

  5. Gender Affects Client-Provider Interactions • When sex of provider and client is different, client may be: • hesitant to discuss sensitive issues • uncomfortable having clinical procedures • In couple counseling, provider should pay equal attention to partners’ needs Gender – roles prescribed for women and men in culture or society Source: FHI, 1998.

  6. Informed and Voluntary Choice Informed about options Range of choices Voluntary decision the foundation of effective reproductive health counseling

  7. Client-Provider Interactions Affect Informed and Voluntary Choice • Help clients assess reproductive health goals • Provide clients with complete, accurate, understandable information • Guide clients through process of making a decision • Do not express personal preferences or pressure clients • Be respectful and accepting of all clients

  8. Characteristics of Effective Counseling Sessions • Client-centered • Interactive • Private and confidential • Individualized Providers need to adapt to challenging conditions.

  9. Tools for Effective Counseling • Communication skills • Technical information • Ability to guide the counseling process

  10. Communication Skills Skills needed: • Active listening (both nonverbal and verbal) • Ability to use simple language Effective communication helps clients feel more comfortable talking about needs.

  11. Types of Communication • Nonverbal:what is observed and sensed • Verbal:what is said and heard Active listening involves nonverbal and verbal skills

  12. Verbal Communication Skills • Using appropriatetone of voice • Giving verbalencouragement • Asking questions • Paraphrasing andreflecting feelings

  13. Nonverbal Communication Skills • Paying full attention • Using facial expressionsthat show interest and concern • Using encouraginggestures such asnodding the head

  14. Clear and Simple Language • Improves communication • Prevents misunderstandings • Avoids intimidation and confusion Practice can help providers use clear, simple language.

  15. Technical Information • Sexuality during all life stages • Family planning and fertility awareness • STI/HIV/AIDS prevention and treatment • Pregnancy, delivery, postpartum/postabortion care • Infertility management • Reproductive cancer detection and treatment • Gender-related abuses • Nutrition • Risk assessment, exams, and procedures

  16. Beginning assessment of client’s needs Middle informed decision End after decision Stages in Counseling

  17. Remembering the Counseling Process Sequence of steps Key elements GATHER G – greet A – ask T – tell H – help E – explain R – return REDI R – rapport-building E – exploration D – decision making I – implementing CLIENT C – client-centered L – listening I – interaction E – exploration N – nonjudgmental T – trust Balanced Model Greet Diagnose needs Discuss/choose Screen Give information Verify comprehension Ensure follow-up RESPECT R – rapport E – empathy S – support P – partnership E – explanations C – cultural competence T – trust Five As A – assess A – advise A – agree A – assist A – arrange Source: JHU, 1998; EngenderHealth, 2003; WHO, 2006; Population Council, 2006; FHI 1999; ARHP, 2003.

  18. Beginning: Initial Assessment Assess the client’s needs and preferences based on: • Reproductive health goals and concerns • Reproductive and sexual history and fertility intentions • Medical history and current problems • Knowledge and previous experience • Other relevant factors Tailor information to the client’s needs.

  19. Middle: Making an Informed Choice Effectiveness How method is used Side effects Other method characteristics Medical eligibility Avoid giving too much information.

  20. End: Discussing the Chosen Method • Explain chosen method in more detail • Prepare client for potential side effects • Ensure client understands correct use • Provide memory aids when possible • Explain how procedures will be done • Discuss when and why client may need to return to clinic

  21. Fertility decision: desire pregnancy? Pregnancy desired No Yes 2. Informeddecision(s):contraceptive method? STI/HIV prevention? Pregnancy Contraceptive Ongoing HIV counseling counseling counseling Intended Safe/effectivecontraception pregnancy 3. Treatment decision(s): ARV therapy for self and partner? PMTCT? ARV PMTCT treatment services No Yes No Yes Range of Choices for Clients with HIV Adapted from: Cates, 2001.

  22. Essential Counseling Skills for Meeting Needs of Clients with HIV • Be sensitive to circumstances of women and couples with HIV • Respect clients’ rights • Ensure that all women, regardless of HIV status, are free to make informed choices about pregnancy and contraception • Assure privacy and confidentiality

  23. Essential Counseling Skills for Meeting Needs of Clients with HIV continued ... • Help clients consider how HIV affects individual circumstances and needs • Tailor counseling session to needs of client • Facilitate partner involvement and offer partner counseling • Provide comprehensive, factual, unbiased information • Support client’s RH decisions, even if you disagree Avoid any type of coercion. Source: Chervenak, 1996.

  24. For clients with HIV:Counseling about Pregnancy Providers should discuss: • Pregnancy does not accelerate HIV disease progression • Condom use to prevent STI/HIV transmission between partners • Risks/rates of mother-to-child transmission • ARV drugs reduce transmission at delivery Source: McIntyre, 1998; Bessinger, 1998; European Collaborative Study and the Swiss HIV Pregnancy Cohort, 1997; Vimercati, 2000; Gray, 2005; Working Group on Mother-to-Infant Transmission of HIV, 1995; Dabis, 2000.

  25. For clients with HIV: Counseling about Pregnancy continued ... • Malaria during pregnancy may increase risk of • HIV transmission to infant • miscarriage • Artificial feeding or exclusive breastfeeding reduces postpartum transmission • Implications of rearing a child with HIV • Availability of family support • Location/logistics of care and treatment Source: ter Kuile, 2004; WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality, 2000.

  26. For clients with HIV: Safer Ways to Achieve Pregnancy If planning for pregnancy, discordant couples should: • Avoid trying to achieve pregnancy if viral load is high (early infection or AIDS with no ARV treatment) • Consider artificial insemination in cases where male partner is not infected • Limit unprotected sex to ovulation window of menstrual cycle in cases where female is not infected

  27. For clients with HIV: Counseling about Contraception Providers should discuss: • Characteristics of contraceptive methods • Possible side effects and complications • Method effectiveness and ability to use correctly • Implications/drug interactions for women with HIV who choose hormonal contraception and: • are on ARV therapy • are taking rifampicin or rifabutin (coinfection with TB)

  28. For clients with HIV: Counseling about Contraception continued ... • Limitations of methods in preventing pregnancy and STI/HIV transmission • Advantages of dual protection, including dual method use • Partner’s willingness to use condoms, condom negotiation strategies • When to return and where to access services

  29. Counseling about contraception, for clients with HIV:ARVs and Hormonal Contraception For women using ARV drugs and hormonal contraception, providers should discuss: • Importance of taking pills on schedule • Need to return for NET-EN injection on time • Possibility ofusing condoms to provide additional protection from pregnancy (in case hormonal contraceptive effectiveness is compromised by ARVs)

  30. For clients with HIV: Additional Counseling Topics • Importance of knowing partner’s HIV status • encourage partner testing if status is unknown • discuss health implications/prevention strategies for discordant/concordant couples • Considerations in disclosing HIV status • risk of abandonment • violence • loss of financial support

  31. Discuss available support systems: • family • community • social • legal • nutritional • child health For clients with HIV: Additional Counseling Topics continued ... • Offer referrals to other RH services as needed: • STI management/treatment • postpartum, postabortion, antenatal care • HIV care and treatment

  32. Summary General principles: • Treat the client well • Be interactive • Individualize • Avoid too much information • Act on client’s decision • Help the client understand and remember

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