Transcript Comprehensive Risk Counseling Services

Comprehensive Risk
Counseling Services
Volunteers of America Utah at Cornerstone Counseling
Center
Free Individual Counseling
Sessions For Those Who:
 Are HIV+
 Are sex partners with someone who is HIV+
 Have engaged in unprotected sex with multiple partners
 Inject drugs
 Sell sex or sexual services
 Have had a sexually transmitted infection during the past year
 Are involved in the PNP (Party and Play) Scene
 Abuse drugs or alcohol in addition to sexual risk factors
The CDC defines CRCS as:
“an intensive, individual level,
client-centered, risk-reduction
intervention for people at high
risk for HIV infection or
transmission”
Overall Goal of CRCS
“to promote the adoption and
maintenance of HIV riskreduction behaviors by clients
who have multiple, complex
problems and risk-reduction
needs”
How It Works
“CRCS provides multiple sessions of client-centered HIV
risk-reduction counseling. It helps clients initiate and
maintain behavior change to prevent the transmission of
HIV.
“It also addresses competing needs that may make HIV
prevention a lower priority.
“CRCS addresses the relationship between HIV risk and the
myriad other psychosocial issues experienced by clients
such as: substance abuse, mental health, trauma, grief &
loss, socioeconomic & cultural factors, and physical health.”
CRCS Objectives
• Decreasing the number of sex partners and needle-sharing partners
• Enhancing motivation to change & self-efficacy through education
about injection drug use and sexual behavior risk-reduction
strategies
• Increasing use of condoms and other safer-sex practices
• Adhering to HIV and other prescription medication regimen
• Taking an active role in the care one receives
• Weighing pros & cons of postponing &/or abstaining from sex
• Making referrals to community resources including: STI testing &
counseling sites, partner notification services, case management,
social & recovery support groups, and medical care
What we do at Cornerstone:
 Provide 500+ hours of no-cost individual risk-reduction
counseling sessions to at least 50 different clients each year
 Coordinate with other HIV prevention agencies in the
community to generate referrals and assist our clients in
accessing much-needed resources
 Adapt individual sessions to fit the particular needs and
circumstances of each client who comes through our doors
CRCS Session Themes Include:
 Current level of motivation for incorporating risk reduction strategies
 Initiating & Negotiating safer-sex practices with a partner
 Increasing self-awareness, self-regard, and self-efficacy
 Mitigating compulsive/addictive behavioral patterns
 Enhancing motivation for decreased drug & alcohol abuse
 Identifying and implementing more adaptive coping skills in
response to difficult emotions and life stressors
 Addressing the underlying issues which lead to high-risk behaviors
including: depression & anxiety symptoms, trauma, insecure
attachment, codependency, grief & loss, shame, marginalization
Who We Are:
John Bonner, LCSW
CRCS Program Manager & Primary
Service Provider
Mara Ashby, LCSW
ATS Director & CRCS Service Provider
Audrey Rice, LPC
Director of Cornerstone Counseling
Center at Volunteers of America Utah
Who We Serve:
 MSM (Men who have Sex with Men)
 IDU (Injection Drug Users)
 Individuals living with HIV/AIDS
 Racial and Ethnic Minorities
 “High-Risk Negatives”
Core Principles of HarmReduction Counseling
A. Behavioral change is affected by multiple factors
(behavioral determinants or influencing factors)
including:
1. Perceived seriousness (or severity, consequences) of condition.
2. Perceived susceptibility to (or risk of) condition.
3. Knowledge, attitudes, and beliefs about condition.
4. Perceived and actual social norms related to the behavior
(influence of peers, family, cultural and religious norms).
Core Principles of HarmReduction Counseling
5. Self-efficacy (belief in one's ability to carry out a specific
behavior).
6. Skills required to implement the behavioral change.
7. Barriers and facilitators to intended change.
8. Perceived and actual cost (financial or personal).
9. Access to services and supportive resources.
10. Power dynamics, including distribution of power between
partners in relationships as well as differential systems of
power on a macro-level which can lead to oppression,
stigmatization, ostracization, & disenfranchisement.
Core Principles of HarmReduction Counseling
B. Knowledge alone does not usually produce behavior change:
1.
Education can be a powerful and efficient tool to increase knowledge, but is
insufficient to effect sustained behavioral change.
2.
Education is principally a cognitive intervention while counseling
fundamentally involves itself with the processing of unresolved inner conflicts
and often subconscious personal feelings, attitudes, values & beliefs.
3.
Traditional education has focused on disseminating information while
counseling is a collaborative, ongoing dialogue between client and provider in
which the client is the chief guiding resource on his or her own life and goals.
4.
Education typically seeks to help individuals understand a subject better
whereas counseling primarily aims to help individuals understand themselves
better.
5.
The nature of counseling allows it to be a more intimate & personalized
experience than an educational setting or context alone can normally provide.
Prochaska’s Stages of
Change Model
 Postulates that behavior change occurs along a
continuum of five stages:
1) Precontemplation (no intention to change).
2) Contemplation (considering eventual change).
3) Preparation (taking steps to implement change).
4) Action (practicing actual behavioral changes).
5) Maintenance (sustaining long-term, consistent
behavior change).
Moving Through the
Stages of Change
 Collaboratively identify target behavior(s) and
realistically ascertain current stage of readiness for
change along the continuum.
 Utilize a variety of counseling strategies and
resources to help facilitate clients’ [nonlinear]
journeys of moving from one stage to another.
 Recognize and normalize that relapse is very often a
part of the process of recovery for the majority of
people trying to change.
 Remember that change happens incrementally.
 Validate, endorse, & commend even small changes.
Motivational Interviewing
 “Directive, client-centered counseling approach for
eliciting behavior change by helping clients explore and
resolve ambivalence.” AKA weighing the pros & cons
 On the one hand…. On the other hand….
 “Something about this must be working for you.”
 Main goal is to have clients make the case for change
 Roll with resistance and let clients chart the course
Fundamental Harm-Reduction
Counseling Skills
 Talk with, rather than to, the client.
 Maintain an objective, empathic, non-judgmental attitude.
 Use open-ended questions. Avoid asking “why.”
 Let the client lead. Focus on issues they identify as problematic.
 Support positive risk-reduction changes they’ve already made.
 Reinforce significance of having sought out help in the first place.
 Help identify barriers to change. Aim for setting SMART goals.
 Be patient in walking with the client down what can be a long,
challenging path to making sustained behavioral changes.
Questions & Discussion
Thank you for your participation.
Feel free to contact me:
John Bonner, LCSW, [email protected] (801) 355-2846