HTS for Children and Adolescents

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

  1. Define counselling
  2. Describe the core principles of counselling for children and adolescents
  3. Analyse potential challenges in the provision of effective counselling for children and adolescents
  4. Use strategies to overcome challenges in counselling children and adolescents
  5. Use essential skills and techniques required for effective counselling for children and adolescents
  6. 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

  • 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, Zimbabwe
    Questions
    1. What challenges are described in the song for children born with HIV?
    2. What did the young people in this video demand?
    3. How did they describe their hopes and their fears?
    4. 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?
    5. How do you think an adolescent or child with HIV would feel if they heard this song?
    6. The song mentions that adolescents call HIV “muzvezve”, “just to make fun”. What do they mean by this?
    7. How can you encourage children and adolescent clients living with HIV to fight stigma and discrimination?
    8. How can you, as a counsellor, help fight stigma in the community?
  • Check Your Knowledge (20 min)
    Instructions

    Complete these quiz questions to check your knowledge on the principles, techniques and skills of counselling children.

    1.During 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.

    2.Tarisai, aged 16, starts crying after receiving a positive HIV result. Which of the following principles and skills could you use? Select all that apply.

    3.Kenneth 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. Tap the following counselling skills that would be appropriate to use.

    4.Anesu, age 12, has been attending your clinic for 4 years. She has been on ARVs for 2 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.

    5.Netsai, 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.

    6.Farai, 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.)

    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
    • Empty chair
    • Prioritising
    • Clarifying
    • Affirming

    Compare Answer

    8.Your 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.

    9.Fadzai, 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.

    10.Chenjerai, 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.

    11.Matipa, 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. Which of the following would you do when using this technique? Select all that apply.

    12.Ngoni, 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.

    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.

    Compare Answer

  • 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
    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?
  • 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.

    1.What is the first thing you do when Susan (age 8) and Mary (age 15) appear in the counselling room? Select the best response.

    2.What will you do to build a relationship with Susan and Mary? Write responses in your workbook then tap the compare answer button.

    Compare Answer

    3.What questions would you ask Susan (age 8) to assess her developmental stage? (Select all that apply.)

    4.What questions will you ask Mary to find out why she has brought her younger sister, Susan to the clinic? (Select all that apply.)

    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.

    5.What 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.)

    6.Can Mary give consent for Susan to have an HIV test? Select the best response.

    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.

    Compare Answer

    8.What questions would you ask Mary to measure her understanding of HIV and AIDS? Select all that apply.

    9.What questions would you ask Mary to assess her risk for exposure to HIV? Select all that apply.

    10.What would you say to encourage Mary to get tested for HIV today? Select all that apply.

    11.What would you say to encourage Mary to give consent for Susan to get tested today? Select all that apply.

    12.Mary 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.

    13.After building rapport and spending a few minutes talking to Susan, what are the relevant questions you want to ask her to find out what she knows about HIV? (Select all that apply.)

    14.You 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?

    15.Who is receiving the pre-test counselling?

    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.

    16.What would you say to Susan about possible test results and their meaning? Select all that apply.

  • 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.

    1. What skills and techniques did you notice in your responses to clients?
    2. What particular areas do you feel confident and skilled in?
    3. What behaviour do you plan to change after completing this exercise?
  • 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.

    1.Next, you explain the blood testing procedure to Susan. What do you tell Susan? Select all that apply.

    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.”

    2.After 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.

    3.Susan is worried about the test hurting. What do you say? Select all that apply.

    4.Mary and Susan decide to get the HIV rapid test. What are the options for Susan and Mary to receive their HIV test results? Select all that apply.

    5.After 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?

    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.

    Compare Answer

    7.How would you explain the “window period” to Mary? (Select all that apply.)

    8.You 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.)

    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?
    • What will happen to her?
    • Who else is going to know she has HIV?
    • How did she get HIV?

    Compare Answer

    10.In the final post-test counseling step, you want to make sure that you plan follow up care and support for Mary and Susan. What do you do? (Select all that apply.)

    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.

    11.After you say good bye to Mary and Susan, which registers and forms do you need to fill in? (Select all that apply.)

    12.When will Susan be entered into the ART register?

  • 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: There are 2 parts this week.

      1. List the counselling technique which you use most often in providing HTS for children or adolescents.
      2. Give an example of a situation when you have used it.
      3. Share the context of the case and how you used the technique.
      4. What made it successful?
      5. How it could have been better?
      1. 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.
      2. Provide a specific activity that you will take action on.