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California HIV Counselor Training Module 1

California HIV Counselor Training Module 1. Overview of the t raining Introductions Housekeeping How to pass Overview of testing f low . Mod 1 (1 of 11). Overview of the Training. Build counselor skills Learn to run rapid tests Learn to perform finger sticks

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California HIV Counselor Training Module 1

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  1. CaliforniaHIV Counselor TrainingModule 1 Overview of the training Introductions Housekeeping How to pass Overview of testing flow Mod 1 (1 of 11)

  2. 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 11)

  3. Introductions Briefly tell us: • Your name • Where you provide testing • How long you’ve been in the field Mod 1 (3 of 11)

  4. Agenda and Housekeeping • Name tags • Fire exits • Restrooms • Participant manual • Agenda Mod 1 (4 of 11)

  5. 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 11)

  6. Bike RackPark items for later Mod 1 (6 of 11)

  7. Action Plan“Before I start counseling…” • How do I handle partner violence ? (Appendix E) Mod 1 (7 of 11)

  8. How to Pass • Attendance Be here for the entire training, fully participate & be willing to learn. • 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. • Correctly answer 80% or more of the questions on the Post-Training quiz. • 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. • Ability to do finger sticks - 100% Mod 1 (8 of 11)

  9. Why Focus on TestingA New HIV Diagnosis Reduces Risk Behavior • People who know they have HIV are much less likely to pass it on* • The sooner a person begins treatment, the better their health outcomes will be *References: thelancet.com Vol 373 January 3, 2009; nejm.org August 11, 2011; nejm.org April 30, 2009 Colfax. Et al. AIDS, 2002 Mod 1 (9 of 10)

  10. Session Flow Welcome, Framing, Consenting Sample Collection Assessing and Prevention Counseling Yes? No? Results and Counseling Referrals Close Mod 1 (10 of 11)

  11. Counseling Activities • Welcome, frame the session, consent • Collects sample, run test, record data • Assess HIV risk,provide counseling • Devise plan to reduce harm • Give results • Referrals, link to care and partner services, PEP, STD testing, mental health, etc. Mod 1 (11 of 11)

  12. 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)

  13. Context…. is the client’s story things that make up the clients life. (Appendix A) Mod 2 (2 of 13)

  14. What’s Going On Has 3 kids High school education Alcohol use Bad job Strong Social Network Lives in small town Easily angered Mod 2 (3 of 13)

  15. Considering how we change… • When was the last time someone successfully changed your behavior? • When was the last time you successfully changed someone else’s behavior? • What is helpful from other people when you are trying to make a change? What is not helpful? Mod 2 (4 of 13)

  16. 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 harm? • What’s going on behind the behavior? Mod 2 (5 of 13)

  17. Stages of Change Mod 2 (6 of 13)

  18. We all Want to Change Something(Activity) Think of something you want 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! Mod 2 (7 of 13)

  19. InstructionsAsk in this order….. • “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 you’ll do?” Mod 2 (8 of 13)

  20. 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)

  21. The Client is Always the Agent of Change Clients choose what they want to change Mod 2 (10 of 13)

  22. Harm Reduction… ..is about reducing harm, not necessarily eliminating it. In the previous activity, when asked “What do you think you’ll do?”… • Did you come up with a step toward making the change? • Did you say “I’ll never do that thing again? Which of these two is an example of harm reduction? Mod 2 (11 of 13)

  23. 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)

  24. Examples of Harm Reduction Mod 2 (13 of 13)

  25. Counseling SkillsModule 3 Background Tools Tips Mod 3 (1 of 16)

  26. 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 16)

  27. 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 16)

  28. Setting the ToneClient-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 16)

  29. Visual Active Listening ToolsClient Centered Counseling • Attention • Curiosity • Body language • Eye contact • Head nodding Mod 3 (5 of 16)

  30. Active Listen Tools Client Centered Counseling • 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 client’s concerns and reasons for testing. Mod 3 (6 of 16)

  31. Open Ended Questions Tool Client Centered Counseling 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 16)

  32. Client’s Strengths Tool Client Centered Counseling Acknowledges client’s 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 don’t give up.” Mod 3 (8 of 16)

  33. Client’s Strengths ToolClient Centered Counseling What a Client Strengths Tool is NOT: • A tool to be over-used • Being a cheerleader • Acknowledging every good characteristic Mod 3 (9 of 16)

  34. Summarizing Tool Client Centered Counseling • Highlighting the important aspects of the session, including plans for change, in a conversational way. • Not a checklist! Mod 3 (10 of 16)

  35. Helpful HintsFeelings + Motivation = Change • Help clients identify feelings around - the behaviors that might be putting them at risk - the changes they think they can make - why they think changes could be beneficial Mod 3 (11 of 16)

  36. Helpful HintsClient-Centered Counseling Tools Do’s • 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 (12 of 16)

  37. Helpful Hints Client-Centered Counseling Tools Do’s: • 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 (13 of 16)

  38. Common PitfallsClient-Centered Counseling Tools Don’ts / Pitfalls: • Giving advise • Trying to “fix” it • Getting off topic • Using health education • Using logic • Not keeping to limited role Mod 3 (14 of 16)

  39. Common PitfallsClient 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 (15 of 16)

  40. Sticky Board Exercise Using Tools of the Client-Centered Counselor • Mod 3 • (16 of 16)

  41. Window PeriodModule 4 Define Window Period Give Examples Practice (Activity) Mod 4 1 of 4

  42. Window Period The time it takes for a test to detect the body’s reaction to HIV Mod 4 2 of 4

  43. HIV Antibody Window Period The time it takes for the test to detect the bodies reaction to HIV (Appendix C) Mod 4, (3 of 4)

  44. Window Period(Activity) • Pair up • Decide who will play counselor first • Client’s last exposure was 3 months ago • Switch • Client’s last exposure was 7 days ago Mod 4 (4 of 4)

  45. Counseling SessionModule 5 Welcoming and Framing Consenting Assessing Prevention Counseling Mod 5 (1 of 9)

  46. Session Flow Welcome, Framing, Consenting Sample Collection Assessing and Prevention Counseling Yes? No? Results and Counseling Referrals, Close Mod 5 (2 of 9)

  47. Framing the Session Welcome, Framing, Consenting Welcome, Framing, Consenting • First I will need your written permission to test you. • We will collect a sample (blood/oral) and run the test. • While the test is processing we’ll answer questions you might have about HIV and see what brought you in today. • Then I will give you your results. • We’ll see how you’re doing and if you have any additional questions. • And then send you on your way. • Any questions before we get started? Mod 5 (3 of 9)

  48. Consenting a Client Welcome, Framing, Consenting 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 9)

  49. Consenting a Client Welcome, Framing, Consenting Welcome, Framing, Consenting Before testing and must be in writing Informed consent means that the client understands what is going to happen and agrees to the process: • Understands what the test is for (to detect HIV Antibodies) • Understands limitation of the tests (Window Period) • If rapid is reactive, a confirmatory test must be performed • All positive confirmed tests are reported to the state health department (Appendix D) Mod 5 (5 of 9)

  50. Session Flow Welcome, Framing, Consenting Sample Collection Assessing and Prevention Counseling Yes? No? Results and Counseling Referrals, Close Mod 5 (6 of 9)

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