1. Pre-service Education on FP and AYSRH
Session I Topic 2
Counseling
*Note to the Instructor: Before you begin this topic, provide students with Handout #1 Balanced Counseling Strategy Plus Summary. Suggest that students read through the summary prior to beginning this session.
• Ask: From the first Lesson on Concepts of Family Planning what are some of the barriers to use and continued use of contraceptive methods?
• Accept responses that include – lack of perceived risk of pregnancy due to breast feeding and infrequent sex, fear of contraceptive methods and side effects, misunderstanding about FP methods, influence of others and perceived or real spousal no approval of FP.
• Explain that this lesson is linked with the right of any client to information, choice, opinion, confidentiality, privacy, a non-judgmental attitude on the part of the provider and respect.
• Explain that counseling in family planning is very important because it influences Clients to make a voluntary informed choice to use family planning and to choose a family planning method that suits their reproductive plans. If clients voluntarily chose a method they are likely to continue to use it. If clients know what to except about the method the benefits and side effects they are likely to continue using the method.
• Ask students to close their eyes and think about a time when they received good counseling or advice to solve a problem from someone /friend or relative. Think about what made it a good experience.
• Ask for responses, acknowledge and record on flip chart.

2. Voluntary Informed Choice
Meaning:
Informed choice is a voluntary, well-thought out decision that a person makes, based on information given, counseling received and understanding gained.
Requirements for Success:
Accurate information, clearly given, ensuring client has understood.
A wide variety of contraceptive methods provided without pressure or provider bias to make a specific choice.
Need to feel confident about the information and that use of FP will be safe and beneficial to them, their children, spouse/partner and family.
When she can start the method and when it can start to be effective. On that day is always the best
• Explain that on this part of the session we will talk about voluntary informed choice.
• Ask what they understand is the meaning of each of the words- voluntary, informed and choice?
• Allow trainees to respond; use responses to help define voluntary informed choice:
• Display Slide 2: Voluntary Informed choice to supplement their answers.
• Review the requirements for success of Voluntary Informed Choice and link this to their responses during the self-reflection exercise.

3. Helping Clients to make a Voluntary informed choice
Client should understand all the information accurate and complete
Misunderstanding must be cleared up
Client must see and touch the method
Information must be client focused
Use effective counseling skills
For a client who does not want a child for many years or does not want anymore children, start with long acting methods like IUD or implants or permanent methods
Ask students if they were to make a voluntary choice about family planning what would help them?
Record responses
Display Slide 3: Helping Clients to Make a Voluntary Informed Choice
Mention that providers have a key role to play if they use good counseling skills, have good interpersonal relationships with their clients and give accurate information.
Ask students for practical ways they can help a client make a voluntary informed choice.

4. Effective Counseling Skills
Establish good interpersonal relations and environment of respect and trust
Ask open ended questions
Ask appropriate closed ended questions
Active listening
Be encouraging
Paraphrasing
Observe and respond to non-verbal cues
Use visual aids, let her touch and feel methods
Respect her rights
Tell students that you will go through the skills for effective counseling. You will ask them to give examples now and again.
Tell them that you will go through the skills and they will practice them in counseling simulation.
Emphasize the need to:
Always show respect, care and concern “treat him/her the way you want to be treated”
Build on what client already knows.
Do not look distracted or be busy on your phone with client in front of you “put your phone away on vibrate”
The client should be the center of focus all the time.
Display Slide 4: Discuss each point, demonstrate how each point might be done and give examples and ask students to add their own examples.

5. Role-Play Practice Counseling Skills
Role Play Objectives:
Identify Counseling skills
 Practice using counseling skills
Instructions
Observe and take note to skills used by the provider
Use the checklist.
While you prepare for role –play ask participants to read the checklist
Each participant will be required to share their observation
Role-Play 1: Practice Counseling Skills
Divide students into small groups.
Explain that they will take turns to practice counseling skills:
Display Slide 5: Role-Play Practice Counseling Skills
Give the groups instructions for observation of role play.
Use Role Place Scripts: Mrs. Kalule
While you prepare for role play ask students to read slide 5.
Give the role play scripts and ask each to read, emphasize the skills you would like the provider to display.
Allow 15 minutes for groups to practice the role play and allow 5 minutes for group discussion.
Plenary/Discussion
Ask: the providers to mention which counseling skills they observed being used. Acknowledge and record on flip chart.
Ask what they feel helped Mrs. Kalule to make a choice? Acknowledge.
Ask: Ask the student playing Mrs Kalule how she felt and what counseling skills she felt helped her?
Introduce the topic- Balanced counseling
Explain: that this part of the lesson students will learn how to conduct client focused counseling by going through the stages of counseling and, tasks and sequence of each step.
Go through each step of the balanced counseling, explaining elaborating on each step.
Explain that this is balanced counseling and that students will note that it integrates other reproductive health, including HTC and STD and child health that client might need.
Inform students they will observe the stages through a role play.

6. Balanced Counseling Role Play 2 Objectives
Identify the stages of balanced counseling
Identify the content of each stage.
Identify the counseling skills and client’s rights used.
Instructions
Listen to what provider says and record each stage and why?
Listen to the discussion between provider and client in each stage
Observe what she does about the family planning method that makes the counseling centered on Sara’s situation
Record and be ready to share in plenary.
Be ready to perform return demonstration role play and give each other feedback
Roleplay 2
Give students role play objectives and instructions.
Role Play 2 Objectives
Identify the stages of balanced counseling
Identify the content of each stage.
Identify the counseling skills and client’s rights used.
Instructions
Listen to what provider says and record each stage and why?
Listen to the discussion between provider and client in each stage
Observe what she says and does about the family planning method that makes the counseling centered on Sara’s situation.
Plenary Record and be ready to share in plenary.
Be ready to perform return demonstration role play and give each other feedback
Ask for student to play role of client. Give her the script of Sara to read through and be ready to be Sara.
Prepare provider role player.

7. Stages Balanced/Client Centered Learning
Stages 1: Pre-choice
Getting to know client and her reproductive health needs, what she already knows and used and her situation – good experience, fears or problems with method, joint decision making, preferences.
Eliminate: what seems not to be suitable for her.
Stage 2: Choice
Focusing and further elimination of contraceptive methods as relevant.
Helping voluntary choice
Note prepare the provider to mention what each stage is to the client as she goes through each stage e.g
 Pre-stage: “Before I help you to choose a method I would like to obtain information that will help us talk in detail about methods you achieve your reproductive health needs. You will notice I set some cards aside and will explain why. For example, if you do not want any more children - we will set aside permanent methods. Or ask whether you could be pregnant we postpone talking about FP and talk instead about Ante-natal care.
 Choice Stage: During the stage, we will use the information you provided above and the cards we not set aside but start with most effective methods to give more details about each method to help you to chose
 Post choice stage: After you have chosen we will talk more about the method chosen
 Last stage: we will talk about other reproductive health issues and provide the necessary help.
Prepare setting for the role play. Have all contraceptive methods and cue cards or flip chart, FP client card and other cards.
Start role play as you would do on a client and explaining why.
After the role play
• Remind the students of the role-play objectives and instructions.
• Go through each objective and ask questions.
• Ask what stages did they hear the client explain to client and why?
• What information was given at each stage?
• Display Slides 7 and 8: Stages of Balanced Counseling
Go through each stage supplement: what was missed from the role play.
Emphasize each point and that the counseling would be like a discussion, relaxed and a sharing session.

8. Stages Balanced/Client Centered Counseling
Stage 3: Post Choice
Giving more information about the chosen method.
Reaffirming choice, ensures understanding.
Stage 4: Providing Method
Screening
Method administration and post administration instructions
Scheduling return visits
Return Demonstration and practicing balanced counseling.
Tell students that they will all practice balanced counseling
Divide students into small groups
Give checklist on balanced counseling
Distribute cards and client materials
Ask each student to card out each method and paste to make a card on hard manila paper; they will use these cards and checklists throughout including when they go to the MCH/FP clinic).
Give role play scripts and ask each student to take at least 10 minutes to play role of provider, client and observer.
Observers use the checklist to note what is well done and what needs improvement.
Give feedback according to the checklist especially where the student as client needs to improve.
Ask students:
What was difficult and elaborate as necessary
Encourage continued practice among each other and to read and master the content on cards and steps and tasks on checklist.

9. Case Study Topics A 15 year old school girl A couple
Commercial sex worker
Immediate Post - partum client who has come with baby for BCG, DPT and Polio Zero
Mother who has brought her baby for DPT and Poli0 1.
A woman who has come for HTC because her husband has multiple sexual partners
An HIV positive mother
A woman who says she cannot use FP methods for religious reasons
A woman who has come for treatment of an unsafe abortion, she says she fears FP methods.
A 20 year old student who has just been treated for a miscarriage, she is newly married.
A man who has three wives and says he is tired of his wives producing, he only ever planned to have 4 children, and now between the 3 wives he has 7 and one on the way. He wants family planning methods he can give them himself.
Case Studies for Practicum
Inform each student that they will, during the evening they will write a case study that will show:
- use of counseling skills,
- application of client’s rights
- balanced counseling for voluntary informed choice of family planning and
- Provision of a family planning method. on any one of the following clients:
A 15-year-old school girl
A couple
Commercial sex worker
Immediate Post - partum client who has come with baby for BCG, DPT and Polio Zero
Mother who has brought her baby for DPT and Polio 1.
A woman who has come for HTC because her husband has multiple sexual partners
An HIV positive mother
A woman who says she cannot use family planning methods for religious reasons
A woman who has come for treatment of an unsafe abortion, she says she fears family planning methods.
A 20-year-old student who has just been treated for a miscarriage, she is newly married.
Remind students to study for the FP quiz that will be given before they go to the clinic.
A man who has three wives and says he is tired of his wives producing, he only ever planned to have 4 children, and now between the 3 wives he has 7 and one on the way. He wants family planning methods he can give them himself.