HTS for Children and Adolescents

Week 1: Children and Adolescents & HIV

Notes: Content in this week covers modules 3-4 in the HTS for Children and Adolescents manual. Keep in mind that everyone has their own style of counselling. Some of the questions will ask you to write down your thoughts about different topics in your workbook and then “compare answer”. We have provided sample responses from experts. You may find that you have written something that is not listed. This does not necessarily mean your response is wrong.

Learning Objectives

  1. Demonstrate self-awareness in the provision of quality HTS for children and adolescents
  2. Assess your own personal values and beliefs that influence the provision of HTS
  3. Demonstrate an understanding of legal and ethical issues encountered in HTS for children and adolescents
  4. Describe the different needs of children and adolescents
  5. Reflect on the role of the PC in child and adolescent HTS
Practice

This week pay attention to how you are counselling children and adolescents related to legal and ethical issues. You will share a challenging situation you handled with your WhatsApp partner. Use your Action Plan to document your challenges and plans related to this week’s topic.

Learning Activities

  • Video: Sarah (15 min)
    Instructions

    View the following short video of an 11-year-old girl living with HIV. In your workbook, write down your answers to the questions below.

    Credit: United Nations Development Programme (UNDP)
    Questions
    1. What attitude does the girl have about living with HIV?
    2. Why does she have this attitude?
    3. In your work, what have you observed about the attitudes of children and adolescents living with HIV?
    4. In your work, how can you support adolescents living with HIV to have a positive attitude, like the girl in this story?
  • Video: Importance of Getting HIV Tested (15 min)
    Instructions

    View the following video of 3 children talking about the importance of getting tested early for HIV. In your workbook, write down your answers to the questions below.

    Credit: Africaid Zvandiri, Zimbabwe
    Questions
    1. What reason do each of the children give for getting tested for HIV early?
    2. How has getting tested for HIV benefited their lives?
    3. What do you do in your work as a PC to encourage children and caregivers to get tested for HIV?
    4. What are some challenges you’ve encountered when encouraging testing and how have you overcome these?
  • Self-Assessment on Attitudes, Values, and Beliefs (20 min)
    Instructions

    Explore your self-awareness, attitudes, and beliefs about children and adolescents. Complete the assessment in your workbook. When you are done, answer the follow-up questions, then tap the button to see feedback.

    1. Is there anything that surprised you about your responses?
    2. Do you see any patterns in your responses?
    3. Judging from your responses, do you see any behaviours that you need to change to become a more child friendly counsellor?
    4. What behaviour do you plan to change after completing this exercise?
    Answer Feedback
  • Case Study: Impact of HIV on Children and Adolescents - Rufaro (20 min)
    Instructions

    Complete the case to learn more about the impact of HIV on children and adolescents. Refer to the HTS for Adolescents and Children Manual module 3 (pages 22-45) if you need to refresh your memory.

    Background

    Rufaro, a mature orphan, is 15 years old. She is HIV-positive and lives with 2 siblings: one is negative and the other is positive and on treatment. They attend school and live in the same hut together, which has one room for sleeping, cooking and eating. The roof is leaking. The clinic and school are 12 km away. They do not have electricity or water; they get their water from a borehole 2 km away. Firewood is scarce, so they use cow dung for fuel, which they collect on the way to and from school. Whenever possible the siblings attend church. Rufaro cares for her younger siblings. The one who is on ART has many health issues. Consequently, Rufaro misses a lot of school.

    Answer the questions below about Rufaro and her family and the impact of HIV.

    1.What stressors is Rufaro dealing with? (Select all that apply.)

    2.From the following list, identify the possible social stressors Rufaro may be dealing with. (Select all that apply.)

    3.What are the physical, psychological, social, and spiritual needs for Rufaro and her family? Consider how you would work with Rufaro to address these four areas. Write your responses in your workbook then tap the compare answer button.

    • Physical needs
    • Psychological needs
    • Social needs
    • Spiritual needs

    Compare Answer

    4.What adolescent friendly counselling techniques will you use with Rufaro? (Select all that apply.)

    5.Give examples of how you might use the following 5 counselling techniques with Rufaro. Write your responses in your workbook then tap the compare answer button.

    • Building a relationship
    • Widening the system
    • Empowering/Empathy
    • Storytelling
    • Play

    Compare Answer

    6.You wonder if Rufaro is sexually active. What do you do next?

  • Podcast: The Right to Have Children (20 min)
    Instructions

    Listen to this podcast from the book Red Ribbons and Roses, created by a group of HIV positive youth. In your workbook, write down your answers to the questions below.

    Credit: Africaid Zvandiri, Zimbabwe
    Questions
    1. What did the people in the stories say about their right to have a baby?
    2. How did they care for themselves and their baby?
    3. What was the result?
    4. How can you support HIV positive people who want to have babies?
  • Check Your Knowledge: Understanding Children and Adolescents (15 min)
    Instructions

    Complete these quiz questions to check your knowledge on children and adolescent development.

    1.What is the definition of a child? (Select all that apply.)

    2.What is the reason that adolescents have changes in thinking, problem solving, social skills, and relationships? (Select all that apply.)

    3.Describe how the characteristics of adolescents listed below can have a positive or a negative effect on their prevention, care, support, and treatment of HIV. Write your responses in your workbook then tap the compare answer button.

    • Inquisitive
    • Desire for independence
    • Influenced by peers

    Compare Answer

  • Video: Role of PCs in Child and Adolescent HTS (10 min)
    Instructions

    View this video of counsellors discussing their role in caring for children living with HIV. In your workbook, write down your answers to the questions below.

    Credit: United Nations Development Programme (UNDP)
    Questions
    1. What struck you about the video?
    2. What motivates you in your role as a PC supporting HIV positive children and adolescents?
    3. Who supports you professionally when working with children and adolescents? How does this support affect you?
  • Check Your Knowledge: Myth or Fact? (20 min)
    Instructions

    Answer true or false to the following statements about children. Some are common myths and some are facts. You decide.

    1.Children can develop behavioral problems as a result of not being able to express their feelings.

    2.Children do not understand complex issues and have no feelings.

    3.A child living with HIV may become clinically depressed after a parent dies.

    4.Children should not talk when adults are present.

    5.Children living with HIV may have low self-esteem.

    6.Children should not say the names of sexual organs.

    7.Babies, toddlers, preschoolers, primary school children, and adolescents have unique developmental characteristics.

    8.Children should not go to funerals or they will be haunted by spirits.

    9.Boys should not be allowed to cry.

    10.Girls do not need as much education as boys.

    11.Adolescents are aged 10-19.

    12.An adolescent is an individual for whom most services are provided by caregiver.

    13.All adolescents are capable of making sound decisions.

    14.Adolescents are in the age of confusion.

    15.An adolescent is someone who is always independent.

    16.An adolescent finds solace with friends outside the home.

    17.Adolescents are easily manipulated.

    18.Adolescents can be temperamental because of hormones in their blood system.

    19.All vertically infected adolescents are ill.

    20.All children and adolescents are vertically infected.

  • Case Study: Legal and Ethical Issues - Child (20 min)
    Instructions

    Complete the case to learn more about legal and ethical issues related to counselling children.

    Note: You can refresh your knowledge of the legal and ethical guidelines on pages 51-59 of the HTS for Children and Adolescents manual.

    Background

    Chengetai is 5 years old. He has been unwell for the past year with recurrent ear infections, diarrhoea, and herpes zoster. His mother, Joyce, was advised by her local clinic that she should bring Chengetai to you for HIV testing. During the pre-test information session, Chengetai’s mother informs you that she has changed her mind and does not want him to be tested.

    1.What do you do next? Select all of the statements that are correct next steps.

    You spend some time in discussion with Joyce and you ask her questions about her family life and her access to the clinic. She responds that she was not booked because she is the fourth wife of a 60-year-old polygamist, who is the leader of an apostolic sect and does not believe in conventional medicine. She delivered in a clinic by default because she was visiting her sister when she went into labour. She was offered an HIV test, which she refused, but allowed them to do whatever they deemed necessary for the baby, including BCG vaccine. She told you that they gave her information on breastfeeding and check-ups.

    2.You can see that Joyce loves her child and is concerned about his health because she has brought him to clinic. She expresses several concerns. In your workbook write what you would say to address these concerns below. When you are done, tap the compare answer button.

    • “When you test me you will introduce your own blood, which is infected, and then you tell me that I have HIV.”
    • “HIV is due to witchcraft and my husband is the leader of the Apostolic so I am immune to HIV.”
    • “I’m not HIV positive because I’ve heard that women who are HIV positive cannot have children.”
    • “When I test positive then that will mean that I am considered dead.”
    • “I’m afraid my husband will divorce me because I came to the clinic. He will think that I disobeyed him. He doesn’t want me to visit clinics because it goes against his religious beliefs.”

    Compare Answer

    3.Joyce expresses concern that if Chengetai tests positive, everyone will think she has HIV too. What would you tell Joyce about confidentiality? (Select all that apply.)

    4.What would you say to Joyce to encourage her to get Chengetai tested? In your workbook, write down 3-4 statements you would say, then tap the compare answer button.

    Compare Answer

    Read about the best interests of the child below and then answer a few questions.

    Best Interests of the Child
    A guiding legal and ethical principle for counselling children and adolescents is that the best interests of the child shall be a primary consideration. The principle applies when:

    • A child and adolescent is ill and diagnosis will facilitate appropriate care and treatment
    • A child and adolescent is a survivor of sexual abuse
    • A child and adolescent has been exposed to HIV through vertical or sexual transmission
    • A child and adolescent expresses concern that given an HIV positive result, he or she will be denied access to care and treatment by the parent/caregiver
    • A child and adolescent is concerned about MTCT

    This principle may be used under these circumstances in order for the provider to ensure that the child and adolescent is provided with adequate care and support, sometimes in conflict with the parent/caregiver. When counsellors face legal and ethical dilemmas, this principle guides the counsellor in how to manage the situation. If the counsellor acts in the best interests of the child and adolescent at all times, the child and adolescent will be protected and legal and ethical principles will be upheld.

    5.Does Chengetai’s situation apply to the principle “best interests of the child”?

    6.Select all that apply under the “best interest of the child” principle.

    7.Chengetai’s mother still refuses the test. What do you do?

    8.What would be the possible reasons to justify a decision to postpone or not test a child? (Select all that apply.)

    9.Select all that pertain to the rights of the child principle.

    Chengetai’s mother has agreed to get him tested. You recognize that since she has agreed to testing her child, it may be a good opportunity for her to get tested as well. Now you would like to provide counselling to encourage her to get tested.

    10.What could you say to Chengetai’s mother to encourage her to get tested? Write answers in your workbook, then tap the compare answer button.

    Compare Answer

    Joyce agrees to take the test.

    You conduct pre-test counselling with Joyce before giving her the HIV test. The next section presents statements you would say to her during your session.

    11.Select which general statements you would say to Joyce during her pre-test counselling session.

    12.Select which statements you would say to Joyce during her pre-test counselling session about disclosing her status.

    13.You decide to conduct a risk assessment. What questions do you ask Joyce? Write answers in your workbook, then tap the compare answer button.

    Compare Answer

    During a risk assessment, you should explore many issues, including abuse and family life. Although a client like Joyce may be coming in for a specific reason, it is often the case that other issues will arise around the health and safety of not just the child but also the entire family. Though you should always address the presenting issue, you should also be ready to also address any additional concerns.

    Note: Tap here to see a Risk Assessment questionnaire.

    Risk Assessment PDF Risk_Assessment.pdf

  • Case Study: Legal and Ethical Issues - Adolescent (10 min)
    Instructions

    Complete the case to learn more about legal and ethical issues related to counselling adolescents.

    Background

    Sibongile is 15 years old. She has attended your facility alone, requesting an HIV test. During pre-test counselling, she shares with you that she has a 17-year-old boyfriend, Peter.

    1.Can Sibongile get an HIV test today without consent from her parent?

    2.Sibongile is under 16 years of age. Consent is required before providing HTS for a child who is under 16 years of age unless she is considered a mature minor or an emancipated minor. Only then can she give informed consent for a test. What do you ask Sibongile to determine if she is a mature minor? (Select all that apply.)

    Sibongile reports that she and her boyfriend are sexually active. She is a double orphan (both parents have passed away) and has a young brother and sister she takes care of. You discover that she is having sex with her boyfriend so that he helps her with upkeep.

    3.Which of the factors below do you consider determinants that Sibongile should be treated as a mature minor? (Select all that apply.)

    4.Does Sibongile qualify as a mature minor?

    5.You learn that Sibongile is having unprotected sex with Peter. What do you counsel her about this? Write your answers in your workbook, then tap the compare answer button.

    Compare Answer

    6.What questions would you ask Sibongile to assess her social support? (Select all that apply.)

  • Video: Stigma (10 min)
    Instructions

    Watch the video, “Loyce,” which was produced by Africaid, Zvandiri in Harare, Zimbabwe. In your workbook, write down your answers to the questions below.

    Credit: Africaid Zvandiri, Zimbabwe
    Questions
    1. What was the video about?
    2. What are some of the effects of HIV stigma on children and adolescents?
    3. Have you ever seen or witnessed stigma?
    4. What will you do personally to reduce stigma in your work?
  • Action Plan (30 min)
    Instructions

    In your workbook, fill in the Action Plan for this week. There are three parts to fill in.
    Part 1: Describe a challenging case. The worksheet will help you to develop the details.
    Part 2: Create a strategy. From the ideas generated above to address the challenge, choose one and create a strategy to apply in your workplace.
    Part 3: Putting your learning into action. Using the worksheet, you will list out what you learned this week and how you will apply it to your job.

  • Partner Discussion (30 min)
    Instructions

    Using WhatsApp, send your response to the following discussion topic to your partner before midnight on Thursday. By midnight on Saturday, please post thoughtful responses to your partner’s posts. To get credit, forward the discussion to the administrator before midnight on Sunday.

    Discussion Topic: Think back to a challenging situation that you documented in your Action Plan about Legal and Ethical Issus of Testing and Counselling for Children or Adolescents. With your partner, share one challenge you faced and 2-3 ideas for taking action to resolve it. Give you partner feedback to his or her post, which can include suggestions for other actions to take or things he or she might have overlooked in his or her action plan.