Prevention Interventions for Substance Abuse Professionals

1993 MMWR Recommendations HIV counseling should be Client Centered HIV counseling should be Client Centered Tailor to the behaviors circumstances and special needs of the person being served Tailor to the behaviors circumstances and special needs of the person being served HIV counseling should include a personalized client risk assessment HIV counseling should include a personalized client risk assessment HIV counseling should result in a personalized plan for the client to reduce the risk of HIV infection / Transmission HIV counseling should result in a personalized plan for the client to reduce the risk of HIV infection / Transmission

Important Points Must be client focused Must be client focused Must focus on a personalized risk assessment and personalized action plan Must focus on a personalized risk assessment and personalized action plan Intervention is not just education Intervention is not just education

Six Major Steps to Prevention Counseling Introduce and orient the client to a session Introduce and orient the client to a session Identify the clients personal risk behaviors and circumstances Identify the clients personal risk behaviors and circumstances Identify safer goal behaviors Identify safer goal behaviors Develop a client action plan Develop a client action plan Make appropriate referrals and provide support Make appropriate referrals and provide support Summarize and close the session Summarize and close the session

Opinion Poll

Question What did you observe? What did you observe? How did it feel to defend an opinion that was not your own? How did it feel to defend an opinion that was not your own? How can a counselor achieve “non- judgmental behavior?” How can a counselor achieve “non- judgmental behavior?”

Points It is impossible to be completely non- judgmental. It is impossible to be completely non- judgmental. You need to be aware of your own values, judgments, prejudices so you can recognize them before discussing these issues with clients. You need to be aware of your own values, judgments, prejudices so you can recognize them before discussing these issues with clients. Don’t dump your issues into your clients lap Don’t dump your issues into your clients lap Examine what makes you feel uncomfortable Examine what makes you feel uncomfortable What triggers that response What triggers that response Deal with the issue or refer the client. Deal with the issue or refer the client.

Use Basic Counseling Techniques Open ended questions Open ended questions Attend well Attend well Offer options, not directives Offer options, not directives Buffet Buffet Give information simply Give information simply No jargon No jargon

Risk and Safer Goal Behaviors Need to identify what the client does that puts them at risk for acquiring a BBP. Need to identify what the client does that puts them at risk for acquiring a BBP. Need to identify behaviors that prevent or reduce the risk. Need to identify behaviors that prevent or reduce the risk. Pure harm reduction here Pure harm reduction here Identify what action steps the client can make to achieve the safer goal behavior. Identify what action steps the client can make to achieve the safer goal behavior.

Example Current risk behavior Current risk behavior Unprotected anal sex Unprotected anal sex Background Background has used condoms occasionally in the past has used condoms occasionally in the past Safer goal behavior Safer goal behavior Use condoms more often Use condoms more often

Barriers and Benefits Doesn’t have condoms when needed Doesn’t have condoms when needed Afraid of partner reaction Afraid of partner reaction Not sure how to bring it up Not sure how to bring it up Condoms ruin the mood Condoms ruin the mood Friends think they are important to use. Friends think they are important to use. Client feels safer when they are used. Client feels safer when they are used. Care about their future. Care about their future. Reduces risk for HIV Reduces risk for HIV

Action Steps What can they do?

Referrals Are important Are important Help client define priorities Help client define priorities Discuss options Discuss options Offer the referral Offer the referral Only refer to known and trusted sources Only refer to known and trusted sources Assess client response to referral Assess client response to referral Facilitate an active referral Facilitate an active referral DEVELOP A FOLLOW UP PLAN DEVELOP A FOLLOW UP PLAN

Referral Groups Medical Practices Medical Practices Appropriate counseling services Appropriate counseling services Public Health Public Health Others Others

Closure Provide a review of what you have discussed. Provide a review of what you have discussed. Make sure client is ready to closure the session Make sure client is ready to closure the session

Advantages Can do in 15 minutes Can do in 15 minutes Can be combined with other aspects of substance abuse treatment Can be combined with other aspects of substance abuse treatment

Issues Know the local public health professionals Know the local public health professionals Who provides services? Who provides services? Have knowledge of referral services Have knowledge of referral services Some aspects are pure case-management Some aspects are pure case-management May not have resources May not have resources