Transcript Document

Client-Provider Interaction
Client-Centered
Counseling
Client-Centered Care
Seeing clientprovider
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
• Respect and empathy for the client
• Communication skills
• Acceptance of values
and beliefs different
from one’s own
• Impartial attitude
toward all clients
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
Gender Affects Client-Provider
Interactions
Gender – roles prescribed for women
and men in culture or society
• 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
Source: FHI, 1998.
Informed and Voluntary Choice
Informed
about options
Range of
choices
Voluntary
decision
the foundation of effective reproductive health counseling
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
Characteristics of Effective
Counseling Sessions
• Client-centered
• Interactive
• Private and
confidential
• Individualized
Providers need to adapt to challenging
conditions.
Tools for Effective Counseling
• Communication skills
• Technical
information
• Ability to guide
the counseling
process
Communication Skills
Effective communication helps clients feel
more comfortable talking about needs.
Skills needed:
• Active listening (both nonverbal
and verbal)
• Ability to use simple language
Types of Communication
Active listening involves nonverbal and
verbal skills
• Nonverbal:
what is observed
and sensed
• Verbal:
what is said
and heard
Verbal Communication Skills
• Using appropriate
tone of voice
• Giving verbal
encouragement
• Asking questions
• Paraphrasing and
reflecting feelings
Nonverbal Communication Skills
• Paying full attention
• Using facial
expressions
that show interest
and concern
• Using encouraging
gestures such as
nodding the head
Clear and Simple Language
• Improves communication
• Prevents misunderstandings
• Avoids intimidation and confusion
Practice can help providers use clear,
simple language.
Technical Information
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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
Stages in Counseling
Beginning
assessment of
client’s needs
Middle
informed
decision
End
after
decision
Remembering the Counseling Process
Sequence of steps
GATHER
G
A
T
H
E
R
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–
–
–
–
–
greet
ask
tell
help
explain
return
Five As
A
A
A
A
A
–
–
–
–
–
assess
advise
agree
assist
arrange
REDI
R
E
D
I
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–
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Key elements
CLIENT
rapport-building
exploration
decision making
implementing
C
L
I
E
N
T
–
–
–
–
–
–
client-centered
listening
interaction
exploration
nonjudgmental
trust
Balanced Model
RESPECT
Greet
Diagnose needs
Discuss/choose
Screen
Give information
Verify comprehension
Ensure follow-up
R
E
S
P
E
C
T
–
–
–
–
–
–
–
rapport
empathy
support
partnership
explanations
cultural competence
trust
Source: JHU, 1998; EngenderHealth, 2003; WHO, 2006; Population Council, 2006; FHI 1999; ARHP, 2003.
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.
Middle:
Making an Informed Choice
Effectiveness
How
method
is used
Other
method
characteristics
Side
effects
Medical
eligibility
Avoid giving too much information.
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
Range of Choices for Clients with HIV
1. Fertility decision:
desire pregnancy?
Pregnancy
desired
No
2. Informed decision(s):
contraceptive method?
STI/HIV prevention?
Contraceptive
counseling
Yes
Ongoing HIV
counseling
Intended
pregnancy
Safe/effective
contraception
3. Treatment decision(s):
ARV therapy for self
and partner?
PMTCT?
Adapted from: Cates, 2001.
Pregnancy
counseling
ARV
treatment
Yes
PMTCT
services
No
Yes
No
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
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.
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.
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.
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
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)
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
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 of using condoms to provide
additional protection from pregnancy
(in case hormonal contraceptive effectiveness
is compromised by ARVs)
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
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
• Discuss available support systems:
– family
– community
– social
– legal
– nutritional
– child health
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