Week 2: Counselling Children and Adolescents
Notes: Content in this week covers modules 5-6 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
- Define counselling
- 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
Practice
This week pay attention to the principles, skills, techniques, and strategies for counselling children and adolescents that you use most often in your work. You will share this with your WhatsApp partner. Use your Action Plan to document what you will improve about the pre and post-test counselling you provide to children and adolescents.
Learning Activities
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Video: How to Dance (15 min)
Instructions
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. In your workbook, write down your answers to the questions below.
Credit: Africaid Zvandiri, ZimbabweQuestions
- What challenges are described in the song for children born with HIV?
- What did the young people in this video demand?
- How did they describe their hopes and their fears?
- The children in this song are of a “different generation” than their parents. What has changed and what has remained the same related to stigma and discrimination of PLHIV?
- How do you think an adolescent or child with HIV would feel if they heard this song?
- The song mentions that adolescents call HIV “muzvezve”, “just to make fun”. What do they mean by this?
- How can you encourage children and adolescent clients living with HIV to fight stigma and discrimination?
- How can you, as a counsellor, help fight stigma in the community?
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Check Your Knowledge (20 min)
Instructions
Complete these quiz questions to check your knowledge on the principles, techniques and skills of counselling children.
7.Chenai, 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. Give examples of how you might use the following skills and techniques with Chenai. Write your responses in your workbook then tap the compare answer button.
- Listening 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.
- Empty chair This will give Chenai an opportunity to practice how she will talk to her boyfriend about her HIV status.
- Prioritising Address the adherence issue that came up in discussion.
- Clarifying You should always check your understanding of what the client has said by seeking clarification and never make assumptions. Check in with Chenai to see what she would like to accomplish during counselling. Is it help with disclosure?
- Affirming Let Chenai know that you appreciate she is there with you and show concern for her boyfriend.
13.Wonai is a Primary Counsellor. She has been counselling Tendai, a 7-year-old boy, for the past 40 minutes. She is feeling frustrated that she isn’t able to understand what he is feeling, even though she has been talking with him for a long time. What challenges could Wonai be facing? Write your responses in your workbook then press the compare answer button.
- Tendai’s age and developmental stage may make it difficult for him to articulate his thoughts and feelings.
- Tendai may find it difficult talking with strangers.
- Tendai may find it difficult to trust adults or strangers.
- Tendai may not have been given the opportunity to talk or be listened to on a regular basis.
- Wonai may have inadequate training or experience in counselling children.
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Video: Soldier Game - Understanding HIV (20 min)
Instructions
Watch the video, “Soldier Game.” In your workbook, write down your answers to the questions below.
Credit: Video by I-TECH Zimbabwe based on Soldier Game from Africaid Zvandiri, Zimbabwe.Questions
- What do you do differently when you are discussing HIV with adult or child clients?
- How do you explain HIV to children?
- How do you explain the immune system to children?
- How will you use the Solider Game in your clinic?
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Case Study: Susan and Mary, Part 1 (40 min)
Instructions
Complete the case to learn more about pre-testing techniques for children and adolescents. Refer to the HTS for Adolescents and Children Manual module 6 (pages 76-95) if you need to refresh your memory.
Background
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.
2.What will you do to build a relationship with Susan and Mary? Write responses in your workbook then tap the compare answer button.
- 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.
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 3 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.
7.Now 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? Write the topics in your workbook 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.
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.
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Self Assessment: Pre-test Counselling with Children (20 min)
Instructions
Think about a recent situation you have had when you were providing pre-test counselling to a child. Complete the assessment in your workbook.
- What skills and techniques did you notice in your responses to clients?
- What particular areas do you feel confident and skilled in?
- What behaviour do you plan to change after completing this exercise?
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Case Study: Susan and Mary, Part 2 (20 min)
Instructions
Complete the second part of the case to learn more about post-test counselling techniques for children and adolescents. Refer to the HTS for Adolescents and Children Manual module 6 (pages 76-95) if you need to refresh your memory.
Background
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.
You describe the procedure to Susan, saying, “Before the needle, a big rubber band that feels like a balloon will be wrapped around your arm. The band will feel tight like someone is squeezing your arm. The nurse will clean a small patch of skin on your arm. This will feel cold. The needle will be put into your arm and blood will go into the needle. You may feel a pinch that can sting or hurt a little or you may feel nothing at all. Once the blood is taken, the needle comes out and a small bandage is put on the spot where the needle was.”
6.Mary 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? Write your answers in your workbook, then tap the compare answer button.
- Basic facts of HIV
- The meaning of the negative result
- Explanation of the window period
- Encourage her to come back for re-testing after 3 months to close the window
- 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
9.Mary asks some questions about Susan’s positive result. How would you answer these questions? Write your responses in your workbook, then tap to compare your answer.
- Does this mean my sister is going to die? Reassure her that by showing up for appointments and taking the medicines correctly every day without missing any doses Susan can live a healthy life.
- What will happen to her? Tell Mary that you will need to treat her immediate health issues, and then put her on anti-retroviral medication.
- Who else is going to know she has HIV? Tell Mary that except for the clinic staff providing care for Susan, no one will know if Mary doesn’t tell them.
- How did she get HIV? Tell Mary that you don’t know for sure, but that it was likely from their mother when she was pregnant, during delivery, or during breastfeeding.
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 escort them to the next level of care and say goodbye. You notify the provider that Susan is not aware of her status.
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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.
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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: There are 2 parts this week.
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- List the counselling technique which you use most often in providing HTS for children or adolescents.
- Give an example of a situation when you have used it.
- Share the context of the case and how you used the technique.
- What made it successful?
- How it could have been better?
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- Review your Action Plan, and share one thing you will change about the way you provide pre- and post-test counselling and testing to children and adolescents.
- Provide a specific activity that you will take action on.
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