Session 4: HTS for Children and Adolescents

Counselling Children and Adolescents

This section will address the principles, skills, techniques and strategies for counselling children and adolescents in the context of HTS. We will review pre- and post-test counselling for children.

Learning Objectives

By the end of this section, you will be able to:

Describe the core principles of counselling for children and adolescents.
Analyse potential challenges in the provision of effective counselling for children and adolescents.
Use strategies to overcome challenges in counselling children and adolescents.
Use essential skills and techniques required for effective counselling for children and adolescents.
Counsel children, families, and adolescents with competence in pre and post-test counselling.

Learning Activities

How to Dance (10 min)
View the following short video of a song that was produced by HIV-positive children and adolescents. This is the first time a group of HIV-positive children and adolescents have come out publicly to describe the way they learned to “dance in the storm” despite the challenges in their lives.
Credit
Africaid Zvandiri, Zimbabwe

As you get into the content for this section, consider how this video made you feel. Take a moment to just consider for yourself answers to the following questions:
- How do you think a child or adolescent would feel hearing this song?
- What are the challenges that the children in this video describe? What can you do to help address those challenges?
Knowledge Check (10 min)
1During a counselling session you realize that Chipo, aged 14, is not being given a chance to talk by her caregiver. Select all the counselling techniques that would be appropriate to use in this situation.
1. Vacation
2. Empty chair
3. Blocking
4. Clarifying
5. Externalizing
6. Affirming
A, C, D, and F are correct. There are many techniques that would be appropriate, all of which involve finding a respectful way to engage Chipo. This can be done through direct communication with Chipo or addressing the caregiver (by asking them to leave or asking them to allow Chipo to speak).
2Tarisai, aged 16, starts crying after receiving a positive HIV test result. Which of the following principles and skills could you use? Select all that apply.
1. Vacation
2. Use of silence
3. Commenting on process
4. Enactment
5. Purposeful expression of feelings
B, C, and E are correct. Using your best judgment to choose the most appropriate principles and skills takes practice. Remember that you will take different approaches depending on the circumstances. Some of the skills and techniques that you could use include those that give her the time and space to process the information she has just received. You can do this through empathetic listening, allowing time for her to be silent, and acknowledging her strengths. Commenting on the process could be used if you are recognizing her non-verbal behavior, such as if she has tears in her eyes or if she is looking down at the floor. Purposeful expression of feelings would allow Tarisai to express her own feelings of shock, anger, sadness or whatever she feels. Be honest, open, and reassuring. Allow her time to ask questions and remind her of the discussion you had during the pre-test counselling.
3Kenneth is 6 years old. He has been brought in for an HIV blood test by his caregiver. He asks you whether the test is painful. Select all of the counselling skills that would be appropriate to use.
1. Establishing a relationship
2. Insist that it’s for his own good
3. Talk openly and honestly
4. Give choices
5. Restrain if necessary
A, C, and D are correct. It is always helpful to establish a trusting relationship with the client. No matter what the age, you want to be respectful and honest. You do not want to cause any distress or make it so that the client will not want to return. You can give choices, such as which arm Kenneth would like to use.
4Anesu, age 12, has been attending your clinic for four years. She has been on ARVs for two years and is doing very well. She lives with her aunt and uncle who are supportive. Anesu has come for her review and you notice she is anxious and withdrawn. She explains to you that people at school are asking questions about why she misses school every month. What counselling skills and techniques would you use to help Anesu? Select all that apply.
1. Vacation
2. Empty chair
3. Questioning
4. Shifting alliance
5. Empowering
B, C, and E are correct. You can help Anesu by making sure she has the right information and asking her some questions to further assess her situation. You can help her to practice how she can respond by role playing with an empty chair as her schoolmates and helping her to see her own strengths. It is essential to acknowledge how challenging this is and to be supportive, respectful, and caring.
5Netsai, a 13-year-old girl, is upset and crying after finding out about her HIV status. What can you do to establish a relationship with a client who is crying? Select all that apply.
1. Listen attentively
2. Promise that things will get better
3. Encourage expression of feelings
4. Share your own feelings
5. Provide correct information
A, C, and E are correct. It is essential to provide a supportive environment for Netsai so that she can express her emotions freely and openly. Remain patient and allow Netsai time to process the information. Do not make promises you cannot keep or tell her what you think or feel. Validate her feelings and give correct information to her without lecturing. Your goal is to help her cope with this information and then later to help her to make choices and decisions that will prolong and improve the quality of her life.
6Farai, a 10-year-old boy, has been HIV-positive since birth. He has recently moved with his family and is a new client in your clinic. On his first visit you begin to establish a relationship with him by asking questions. Which of the following questions are open-ended? Select all that apply.
1. How old are you?
2. Can you tell me about your family?
3. Do you like school?
4. Where were you living before here?
5. Can you tell me about your favorite activity in school?
B and E are correct. A, C, and D are closed-ended questions. Open-ended questions open up conversations. When you ask an open-ended question, you don’t know what the child’s answer is going to be. Close-ended questions usually limit conversation to a one or two-word response, and sometimes those kinds of questions end the conversation.
7Chenai, aged 14 and HIV positive, has come to you during her clinic visit and told you that she started dating. She is very worried about whether to tell her boyfriend her HIV status. She tells you that she spends a lot of time with him and sometimes is late in taking her medicine.

Match the examples of how you might use the following skills and techniques with Chenai.
Address the adherence issue that came up in discussion. Allow her to tell her story and share her feelings. Pay attention to her non-verbal communication and show that you are interested in what she is saying. Let Chenai know that you appreciate she is there with you and show concern for her boyfriend. You should always check your understanding of what the client has said by seeking clarification and never make assumptions. Check with Chenai to see what she would like to accomplish during counselling. Is it help with disclosure? This will give Chenai an opportunity to practice how she will talk to her boyfriend about her HIV status.

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8Your supervisor brings Nyika, a 7-year-old boy, to you for adherence counselling and tells you to “Meet him at his level”. What does it mean to “meet a child at their level”? Select all that apply.
1. Getting down low to make eye contact.
2. Using creative methods to help them express their feelings.
3. Behaving like a child yourself.
4. Encouraging them to talk about general things that interest them before going on to discuss their personal lives.
5. Using slang, or words that children use when they talk with their friends.
A, B, and D are correct. You should use correct and appropriate language with a child. Show interest in the child and start the session by establishing a relationship. This can be done by being welcoming and showing interest in Nyika and explaining what your role is. You can do this through discussion and by allowing him to express himself with drawing, play, or storytelling.
9Fadzai, aged 6, comes to see you. She is shy and looks like she might cry. What techniques would you use to help establish a relationship with her? Select all that apply.
1. Ask her mother what the problem is.
2. Show that you are interested in Fadzai.
3. Give her a hug.
4. Play a game with her.
5. Use positive body language and facial expressions at all times.
B, D, and E are correct. Children need to feel safe, secure, and confident that they can trust the counsellor in order for them to communicate what they are thinking and feeling. You do not want to touch a child without first asking their permission.
10Chenjerai, aged 9, comes to you and appears very upset. You decide to use drawing to enable him to communicate without having to put it into words. Which techniques would you use? Select all that apply.
1. Ask him to draw a picture of something that makes him angry.
2. Ask him to draw anything he wants.
3. Ask him to describe what is happening in the drawing.
4. Describe what you see.
5. Ask, “How do the people in the drawing feel about what is happening?”
A, C, and E are correct. Drawing can be a powerful activity to help Chenjerai communicate his emotional state without needing to put it into words. Ask him to draw something related to what you want to explore and ask him to describe what is in the picture using open-ended questions, rather than telling him what you see.
11Matipa, aged 8, comes to you and tells you that she has done something very naughty and is not taking her medicine. You decide that instead of asking a lot of questions and trying to get her to talk about what challenges she is facing, you will use the storytelling counselling technique. All of the following techniques are appropriate except:
1. Use a folktale or fable to convey a message.
2. Ask Matipa what she thought was the message of the story.
3. Use characters in the story who are her family and Matipa.
4. Ask Matipa if she wants to make up a story, perhaps about a girl who was very sad.
C is correct. A story can serve as a useful tool for problem solving. At the end of the story, encourage Matipa to talk about what happened to confirm that she understood its relevance. Listening to a story about someone in a similar position can be very comforting. It can give Matipa the sense of being understood, and it can help her to recognise that she is not alone. Because this is a story, you should not use real names or events.
12Ngoni, a 5-year-old boy, is very withdrawn and uncommunicative. You decide to use play to understand what type of emotions he is experiencing. Which of the following would you do when using this technique? Select all that apply.
1. Let him lead the play.
2. You lead him through the play.
3. Use comments to see if you understand what he is communicating (for example, “I see that the mummy is so sick that she cannot get out of bed”).
4. Ask, “What is going to happen next?”
5. Give him just one toy so that he does not get overwhelmed.
A, C, and D are correct. Play is an important way that children explore their feelings about events and make sense of their world. When children play, much of their activity involves imitation or acting out, which helps us to begin to understand what type of emotions they are experiencing. When using play as a counselling tool, let the child lead while following, observing, and commenting on the process. Give the child a variety of materials.
Soldier Game Part 1 (10 min)
Watch the video, “Soldier Game.”
Credit
Video by I-TECH Zimbabwe based on Soldier Game from Africaid Zvandiri, Zimbabwe.

In your workbook, write down your answers to the questions below.
1. What do you do differently when you are discussing HIV with adult or child clients?
2. How do you explain HIV to children?
3. How do you explain the immune system to children?
4. How will you use the Solider Game in your clinic?
Susan and Mary Part 1 (30 min)
Susan is 8 years old. She has been brought to see you by her 15-year-old sister, Mary. Their parents are both late and they are staying alone. Susan has been coughing for a few days and has recurrent diarrhoea. It seems that there are a number of children with the “flu” at Susan’s school. Mary tells you that Susan has been a sickly child most of her life but she thinks it is because Susan is a picky eater, unlike herself. Susan has been evaluated in the past for the diarrhoea and the tests were negative. Mary was advised to make sure the water they were drinking was boiled and stored in clean containers, and to limit the amount of raw fruit Susan was eating. Her sister is worried about her and is asking for your help.
1What is the first thing you do when Susan and Mary appear in the counselling room? Select the best response.
1. Send Susan to the waiting area
2. Build a relationship with Susan
3. Build a relationship with both Susan and Mary
4. Send Mary to the waiting area
5. Send Susan for treatment
B is correct. While it’s important to build a relationship with both, it’s best to build a relationship with the youngest first.
2What will you do to build a relationship with Susan and Mary? List 2-3 ideas, then tap the compare answer button to compare your answer to an expert’s.
- You should come and sit near Susan.
- Call Susan and Mary by their names.
- Acknowledge them for coming.
- Assess whether Susan knows what is wrong with herself.
- Assess if she knows the reason for her coming to see you and see if she wants to play.
- Ask if she has any friends at school.
- Ask about her relationship with her teacher and fellow students.
3What questions would you ask Susan to assess her developmental stage? Select all that apply.
1. Can you tell me what has been happening to you?
2. Is anything worrying you?
3. What is your favorite color?
4. Have you been unwell?
5. Do you know what HIV is?
A, B, and D are correct. You already have begun a relationship and you do not need to ask questions such as C and E which are unrelated to finding out what Susan is able to understand. The questions you ask will influence the information you provide and the way you share it. You want to focus your questions so that you can adjust the pre-test counselling session to her level of comprehension and maturity. You want Susan to know why she is at the clinic today.
4What questions will you ask Mary to find out why she has brought her younger sister, Susan to the clinic? Select all that apply.
1. What has brought you here today?
2. Why have you waited so long to bring Susan in?
3. Is there anything you would like us to help you with?
4. How much exposure have you had to Susan’s body fluids?
A and C are correct. You should work with Mary to further assess their situation. You do not want to be accusatory or shut her down. It is important to continue to gather information at this time. It is also too early in the conversation to get into the prevention discussion, since you have not talked about taking the HIV test yet.
Once you have begun establishing rapport with Susan, you explain to her that your job is to help kids who come to the clinic, and that you would like to help her. Focusing your attention on Susan, you ask her about why she has come to the clinic today and if she can tell you what she is feeling. Susan tells you that sometimes she has problems sleeping because of her cough. She also said at school she has to go to the bathroom a lot because her tummy hurts and she has a runny stomach. You thank her for talking to you about her sickness.

Susan has been coughing occasionally as you have been talking to her. You tell Susan that since she is in the clinic it would be good for her to let the nurse listen to her chest and see if there is medicine that will help the cough go away. Together with Mary, you walk Susan to the clerk’s desk to register for a clinic visit.

Susan is evaluated by the clinic nurse. Mary was told that Susan needed to take an antibiotic along with cough medicine and if she didn’t see improvement in three days or if Susan got worse, they were to return to the clinic immediately. Mary whispers to you that she was told that Susan needed to have an HIV test just to make sure she was not positive. You see that Mary is very upset and crying, but trying to hide her tears from Susan. Susan tells you she is tired and wants to go home. There is another PC across the hall and you ask her if Susan can rest in her room while you speak to Mary.

In your discussion with Mary, she informs you that her parents are late and had both been very ill before they died. She also tells you that she has been taking care of Susan and they are on their own. Mary tells you that she knows that HIV can make you very sick and die. She is worried that because her parents died of HIV that Susan may have the disease. You tell her that this could be a possibility and that you would recommend testing Susan for HIV. Since Mary has shared with you that she and Susan live on their own, you will need to determine if Mary can consent for Susan’s HIV test.
5What questions would you ask Mary to assess if she, as the caregiver, is able to give consent to an HIV test? Select all that apply.
1. Who do you live with?
2. How old are you?
3. Is there any other adult that takes care of you and Susan?
4. Have you ever been tested for HIV?
A, B, and C are correct. Mary is 15, which means that she qualifies as a mature minor. She does not have any adult in her life that is serving in the role as caregiver for her or her sister, and she lives alone with Susan. At this time whether or not she has taken an HIV test does not have relevance in assessing her competence as a caregiver.
6Can Mary give consent for Susan to have an HIV test? Select the best response.
1. Yes
2. No
3. It is not clear yet.
A is correct. Mary qualifies as a mature minor and is the caregiver for Susan, so she can give consent for Susan to be tested for HIV.
7Now that you have determined that Mary is a mature minor and is the caregiver for Susan, what topics do you need to discuss with Mary during the pre-test counselling session? List 3-4 topics, then tap the compare answer button.
- Family background, living situation and social situation.
- Understanding of the differences between HIV and AIDS, HIV transmission, and HIV prevention.
- Determine Mary’s social support network since she is caring for Susan alone.
- Ask Mary if Susan understands what happened to her parents.
- Ask if you will be able to name HIV to Susan.
- Conduct a risk assessment to ascertain her exposure to HIV infection (such as MTCT route, sexual contact, and contact with infected body fluids while caring for parents).
Note: It is important to talk about risk assessment with Mary because she is a mature minor with no support, which puts her in a higher risk category. She should also be offered an HIV test.
8What questions would you ask Mary to measure her understanding of HIV and AIDS? Select all that apply.
1. How can you tell if someone has HIV?
2. What is HIV?
3. What are the benefits of getting tested for HIV?
4. What does an HIV positive result mean?
All are correct. The only way to know if someone is HIV infected is by a blood test. You cannot tell if someone has the virus by looking at them. You can use the Soldier Game to provide a good description of HIV. The Soldier Game can assist you in providing a clear and simple explanation of the virus for all ages of children and adolescents. Addressing what the client knows about HIV will help him or her understand the information needed to begin taking medication if the client is positive. If he or she is negative, you can discuss the ways one can stay negative.
9You should ask Mary all of the following questions to assess her risk for exposure to HIV except:
1. Could you have put yourself at risk by sharing utensils with your mother during meals?
2. Could you have put yourself at risk of getting HIV when you washed your mother’s bedding?
3. Have you had any sexual contact yet?
4. Could you have been infected by HIV while disposing off your mother’s excreta?
A is correct. During the risk assessment, you want to assess the type of care that Mary gave her parents while they were ill at home and if there was any exposure to body fluids and if so was there proper infection control. You don’t want to mislead Mary or ask her a tricky question. She is also old enough to have had sexual debut so it is important to explore her sexual activities.
10What would you say to encourage Mary to get tested for HIV today? Select all that apply.
1. Our country has a high burden of HIV; hence the government is urging everyone to know their HIV status.
2. Tell her that the onus is on her to get tested or Susan may not have anyone to take care of her.
3. HIV cannot be seen by the naked eye and is only revealed by a test.
4. The right treatment is only possible after investigations like an HIV test.
A, C, and D are correct. Be sensitive and informative in encouraging Mary to get tested. You should not frighten her or make her feel judged, as in the response in B.
11What would you say to encourage Mary to give consent for Susan to get tested today? Select all that apply.
1. Susan has missed a lot of school due to ill health and this is the surest way of finding what is wrong with her.
2. Bringing Susan here shows that you care about her health, and the decision for her to undergo the test lies with you.
3. Too much time has already been lost.
4. There is nothing to worry about.
5. I will be really proud of you.
A and B are correct. You need to be honest and keep your own feeling out of the discussion. You should not make her feel bad for what has already happened but focus on providing information to empower her to make a good decision.
12Mary has agreed to take the HIV test and has given consent for Susan to take the test. You have been told by Mary that Susan is aware that her parents died from HIV. Mary has agreed that it is fine to name HIV when you are talking to Susan. You bring Susan back into the counselling room and engage her in the conversation. She is looking better. She is eating a biscuit and drinking water. What do you say to Susan when she is back in the room? Select all that apply.
1. It’s good to have you back. Did you rest while I was speaking to your sister?
2. I know you need to get home. Let’s try to finish this appointment.
3. Let’s talk about a test we are going to do.
4. I see you were drawing pictures. What are some things you like to draw?
5. Do you have any questions for me Susan?
A, C, D, and E are correct. Once again it is necessary to build rapport and create a relaxing and empowering environment before getting into the main topic. B is incorrect because you want to ensure that you do not rush Susan to finish the appointment.
13After building rapport and spending a few minutes talking to Susan, all of the following are relevant questions you want to ask Susan to find out what she knows about HIV except:
1. What do you know about HIV?
2. What have you learned in school about HIV?
3. Since your parents died of HIV, what does this mean for you?
4. How do you think your parents caught HIV?
5. Do you know anybody with HIV?
D is correct. By probing what she knows, you want to be non-judgmental and appropriate with your questions.
14You determine that Susan has minimal knowledge of HIV and decide it is a good opportunity to demonstrate the Soldier Game technique with her. She follows and responds appropriately. Mary is present for this activity and Mary and Susan together demonstrate the Soldier Game back to you. Susan now knows about HIV and what it does to the body. What should you do next?
1. Ask Susan if she wants to be tested.
2. Provide more counselling.
A is correct. Even though she is a minor and her caregiver has previously given consent, as part of being child friendly it is important to ask Susan if she wants to be tested. This would allow Susan to give permission for the test. It is good counselling practice to involve Susan in matters pertaining to her own health.
15Who is receiving the pre-test counselling?
1. Susan
2. Susan and Mary
3. Susan’s sister, Mary, on behalf of Susan
B is correct.
Next you summarize HIV transmission routes and discuss the virus, giving examples again from the Solider Game technique. You also recap how the virus progresses from a time where nothing is seen to when a person becomes sick. You are careful to involve Susan so she has an opportunity to offer her thoughts and ask questions. You also discuss prevention, like being careful when dealing with open wounds and to avoid sharing a toothbrush. You also explain how taking the HIV test could help Susan, talk about what is involved in the test, and discuss what the results could mean.
16What would you say to Susan about possible test results and their meaning? Select all that apply.
1. The HIV result can be positive, which means that you should be re tested to verify your status before you are initiated an ART.
2. The result might come up positive, which means you have the HIV in your blood.
3. The HIV result can be negative, which means currently you have no HIV in your blood.
4. The HIV result can be inconclusive which means your HIV status has not been determined. You will need to be retested after 14 days.
5. The HIV result can be negative, which means you won’t need to test again in your lifetime.
B, C, and D are correct. You want to explain that for a positive result there is need to verify HIV status prior to ART initiation and that for a negative result, retesting will be according to risk. For inconclusive results it means that one of the tests that should confirm HIV has not yet picked the antibodies to HIV, so she will need to be retested after 14 days.
Susan and Mary Part 2 (15 min)
As you recall from Part 1 of this case, Susan is 8 years old. She has been brought to you by her 15-year-old sister, Mary. Their parents are both late and they are living alone. Susan has been coughing and was referred to the clinic nurse for an evaluation. The decision was made to give Susan a trial of antibiotics along with cough medicine. Mary was told to bring Susan back if she was not better in a few days or if she got worse.

You have conducted pre-test counselling and both sisters have consented to being tested for HIV.
1Next, you explain the blood testing procedure to Susan. You should tell Susan all of the following except:
1. “Your sister has brought you in here to find out why you are coughing. A test will help us understand how to make you better.”
2. “It won’t hurt.”
3. “Do you have any questions?”
4. To get the blood, a nurse will do a small prick on your finger.
B is correct. You do not want to mislead Susan. Be sure to give Susan correct information and you could even show her some of the equipment that will be used, if possible, to ease her anxiety.
You describe the procedure to Susan, saying, “cold. Your finger will be cleaned using spirit swab which will feel a bit cold. The area will be left to dry and you will get a small prick. The first drop of blood will be wiped away then a small amount of blood will be collected into a small tube and the test will be done.
2After hearing about the procedure, Susan changes her mind, and says she does not want to get tested. How would you explain the advantages to her? Select all that apply.
1. You have been ill for some time and this test will help the doctors/ nurses find out why.
2. The treatment you are going to get after this test will help you to be strong and healthy again.
3. Would you like to meet some other children your age who have been ill like you but are now well after taking the test?
4. If you don’t take this test, you are just going to get more and more ill.
A, B, and C are correct. You do not want to use scare tactics with the child as it is contrary to the principles of child counselling.
3Susan is worried about the test hurting. What do you say? Select all that apply.
1. Try to be a ‘big girl’.
2. I can understand why you’re a bit nervous, but the test is actually only a little bit painful and then it wears off.
3. The benefits of getting tested outweigh the pain of the prick.
4. It’s really worth it to do it, because it can help you to know how to stay well.
5. It will not hurt.
B, C, and D are correct. Be honest and don’t push the child’s concerns under the carpet. Do not shame them by making them feel as though they are acting immature.
4Mary and Susan decide to get the HIV rapid test. All of the following are options for Susan and Mary to receive their HIV test results except:
1. Susan receives her results alone.
2. Susan has no say in how she receives the results.
3. Mary and Susan receive their results together.
4. Mary receives both results alone.
5. Mary receives her own result alone and then brings in Susan for hers.
A is correct. Mary has the choice as the caregiver for how to receive the results.
5After you explain the options for receiving results to Mary, she chooses to receive both results alone. Their results come back showing Mary has tested HIV negative and Susan has tested HIV positive. What is the first thing that you do when you bring Mary in for the results?
1. Tell her “The results are what I thought they would be.”
2. Ask, “Are you ready to hear the results of the tests?”
3. State “Let’s go through the risk reduction.”
4. Begin by saying, “You two have different results.”
B is correct. The first thing that you want to do is to find out if Mary is willing and ready to receive the results. This can be ascertained by noticing if her nonverbal cues match what she says.
6Mary states she is ready for her results and you feel that she is emotionally prepared through her verbal and nonverbal communication. You share with Mary that her result came out negative. What do you need to cover in the post-test counselling? List 4-5 items, then tap the compare answer button.
- Basic facts of HIV
- The meaning of the negative result
- Do risk assessment and
- Assist Mary to come up with a risk reduction plan
- Explanation of when she should come for a retest
- Confirmation of understanding the result and the implications
- Discussion of sexual and reproductive health issues (more on this in Week 3)
- What Mary can do to remain negative
- Give Mary the opportunity to ask questions
7You give Mary Susan’s positive results. Mary is very upset and starts to cry. What do you do to demonstrate your support? Select all that apply.
1. Use positive body language such as sitting next to her, holding her hand, and talking directly to her to show that you are there to support her and her sister.
2. Encourage her in how she can support Susan and also find support for herself.
3. Suggest that she bring Susan into the room to share the result with her.
4. Give her time by not rushing and moving on with more information and discussion.
A, B, and D are correct. C is incorrect because you do not want to pressure Mary into telling Susan about her status if she is not ready. After Mary has had time to think and respond, you can move on to discussing the result and how she feels.
8In the final post-test counseling step, you want to make sure that you plan follow up care and support for Mary and Susan. You should do all of the following except:
1. Refer Susan to peer supported counselling services.
2. Explore community support near their home.
3. Communicate with the school to make sure they accommodate Susan.
4. Refer to local aid for food support.
5. Remind them that you will be there for their future visits and will continue to assist them.
C is correct. You have the responsibility to ensure that any physical, social, emotional, spiritual, or mental needs that arose in the session are addressed through follow up care and support and appropriate referral.
You wrap up the session with Susan and Mary by reassuring them that you will be available and let them know how to reach you and other health workers if you are not available to help. You provide the care or escort them to the next level of care and say goodbye. You notify the provider that Susan is not aware of her status.
9After you say good bye to Mary and Susan, which registers and forms do you need to fill in? Select all that apply.
1. HTS Register
2. Laboratory form for sputum
3. TB Screening form
4. HTS Client Intake Form (CIF)
5. TB Presumptive Case Register
6. OI ART Care booklet
A, B, C, and E are correct. When filling in the HTS register, only the columns on results given, date given and follow up are entered after post-test. The other columns and CIF will have been completed during the test.
Key Points (5 min)
- Many of the principles, techniques and skills for counselling children are the same as counselling adults but it is important to remember that counselling children has unique issues and you need to be able to adjust your style to the understanding and development of the child.
- There are tools that can be used to help explain HIV, such as the Soldier Game.
- Pre-testing for children varies in how it is delivered, depending on the age and understanding of the child and also depends on the caregiver’s comfort level.