Prevention with positives promoting change while the clock ticks
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Prevention with Positives: Promoting Change While the Clock Ticks …. Robert T. Carroll, PhC, RN, ACRN Washington State Education Coordinator , Northwest AIDS Education and Training Center. Today’s Goals.

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Prevention with positives promoting change while the clock ticks

Prevention with Positives:Promoting Change While the Clock Ticks …

Robert T. Carroll, PhC, RN, ACRN

Washington State Education Coordinator,

Northwest AIDS Education and Training Center


Today s goals

Today’s Goals

  • Describe the theoretical and practical underpinnings of Prevention with Positives programs

  • Provide a brief overview of the Motivational Interview process for promoting behavior change

  • Describe the key elements of a brief motivational intervention focusing on prevention with PLWH/A


Why the emphasis on prevention with positives

Why the Emphasis on Prevention with Positives?

  • Every person

  • infected with HIV

  • was exposed by

  • a person who was

  • HIV-Positive.


What is prevention with positives pwp

New generation of prevention programs targeting individuals who

Current emphasis arises from

What is Prevention with Positives (PwP)?

  • Have already tested positive for HIV

  • May be at risk of transmitting the disease

  • CDC 5-year plan to reduce rates of infection by 1/2 over the next 5 years


Why the new focus on prevention with positives

Why the New Focus on Prevention with Positives?

  • Advancing HIV Prevention (AHP)

  • New Strategies for a Changing Epidemic

  • September 2003

  • CDC initiative to reduce barriers to early diagnosis of HIV and increase access to quality medical care, treatment, and ongoing prevention services for PLWH/A


Why a new initiative for hiv prevention

Why a New Initiative for HIV Prevention?

  • 40,000 new HIV infections still occur in the United States each year

  • One-quarter of the 850,000 - 950,000 PLWH/A in the U.S. do not yet know they are infected

  • Recent increases in syphilis diagnoses among men who know they are HIV-infected suggests an increase in risk behaviors among PLWH/A and their partners


Local trends

Local Trends

  • Insert local/regional epidemiological charts and/or graphs which provide evidence of increases in new infections related to engagement in high risk activities (i.e., increase/spikes in other STI rates)


Ahp initiative strategies

AHP Initiative Strategies

  • Make HIV testing a routine part of medical care when and where patients receive care

  • Use new models to diagnose HIV infection outside of traditional medical settings

  • Prevent new infections by working with HIV positive people and their partners

  • Continue to decrease mother-to-child HIV transmission


Prevent new infections by working with plwh a

Prevent New Infections by Working with PLWH/A

  • Publish Recommendations for Incorporating HIV Prevention into the Medical Care of Persons with HIV Infection (CDC, HRSA, NIH, and IDSA)

  • Fund demonstration projects to provide PCM for people with HIV who have ongoing high-risk behavior

  • Fund demonstration projects of new models of PCRS

  • In 2004, implement these services


Incorporating hiv prevention into the medical care of plwh a

Incorporating HIV Prevention into the Medical Care of PLWH/A

Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of AmericaMMWR 2003 July 18; 52


How does it work

How Does it Work?

  • Individual-focused PwP interventions

  • help PLWH/A reduce their transmission rates through theoretically-based interventions which--

  • Help PLWH/A feel better about themselves

  • Decrease the stigma associated with HIV

  • Help PLWH/A take responsibility for their lives and for stopping the spread of HIV


How is this accomplished

How is this Accomplished?

Prevention with Positives programs aim to build self-esteem and enrich coping skills through supportive services such as

  • Peer-based workshops and focus groups

  • One-on-one transmission risk counseling

  • Psycho-social assessment and supportive

  • interventions

  • Case management

  • HIV status support groups


Pwp programs in the u s

PwP Programs in the U.S.

  • CA office of AIDS EIP program

    • Prevention integrated with care & treatment

    • Prevention Case Management

  • HIV Stops with me: LA, SF, Boston

    • Social marketing approach

  • Prevention for HIV-Infected Person’s Project (PHIPP)

    • Multi-site CDCP demonstration project

  • Positive Power (Seattle & WA State)

    • Targeting gay and bisexual men through individual and group work

  • Partnership for Health (USC)

    • 2-day TOT program to implement

    • 4-hour individual intervention


I know there must be a theory in there somewhere

I know there must be a theory in there somewhere…

  • Yup.

  • Most PwP programs are based on one or many of the seven most popular theoretical models of (HIV) health promotion/risk behavior change


Seven theoretical models hiv health promotion risk behavior change

Seven Theoretical Models (HIV) Health Promotion & Risk Behavior Change

  • Health Belief model

  • AIDS Risk Reduction Model

  • Trans-theoretical model

  • Social Cognitive Theory model

  • Theory of Reasoned Action

  • Theory of Planned Behavior

  • Information-Motivation-Behavioral Skills model


What do these theories have in common

What do these Theories have in Common?

  • KNOWLEDGE +

  • SKILLS +

  • MOTIVATION +

  • RESOURCES +

  • SUPPORT =

  • Behavior Change!


Transtheoretical model prochaska diclemente 1984

Transtheoretical Model(Prochaska & DiClemente, 1984)

Six stages of behavior change

  • Precontemplation:Not even thinking about it

  • Contemplation:Thinking about it

  • Determination/Preparation:Taking steps to start behavior

  • Action: Person tries behavior

  • Maintenance: Person does behaviorregularly

  • Relapse: Person slips up & needs to make adjustments


Transtheoretical model of behavior change

Transtheoretical Model of Behavior Change


Transtheoretical model prochaska diclemente 19841

Transtheoretical Model(Prochaska & DiClemente, 1984)


Transtheoretical model prochaska diclemente 19842

Transtheoretical Model(Prochaska & DiClemente, 1984)

  • Change is an incremental process and not a discrete outcome

  • Change takes time

  • Harm/risk reduction is a good goal

  • Relapse is the rule, not the exception

  • Two dimensions: stages and processes

Key assumptions of the model


Prevention with positives promoting change while the clock ticks

Brief Motivational Interviewing Works!

But it must have structure and purpose…


First things first

First Things First!

  • Work with the patient to identify a behavior to be targeted for change

  • Identify where the patient stands on the readiness-to-change continuum

  • Establish with the patient incremental goals – appropriate to their readiness - to move toward the desired change


Remember

Remember…

  • Document, Document, Document!

  • Ensure full staff understanding of, buy-in for, and consistency in delivery of the plan.

Initial plan, subsequent encounters, outcomes, and changes to the plan


Frames active ingredients of the effective brief motivational interview

FRAMES:Active Ingredients of the Effective Brief Motivational Interview

  • F:Feedback

  • R:Responsibility

  • A:Advice

  • M:Menu

  • E:Empathy

  • S:Self-Efficacy

(Miller & Rollnick, 1991)


Motivation

MOTIVATION

Key ingredient

which supports

the client’s

ability to change.


General principles of motivational interviewing

General Principles of Motivational Interviewing

  • Express empathy

  • Develop discrepancy

  • Avoid argumentation

  • Roll with resistance

  • Support self-efficacy


Phases of the motivational interview practice

Phases of the Motivational Interview Practice

  • Build motivation for change

    • Sensitive questioning and reflection encourage the person to articulate self-motivational statements and the arguments for change

  • Strengthen commitment to change

    • Motivation-building moves to key questions designed to evoke problem-solving and commitment to change


But what can i do in a brief period of time

But What Can I Do in a Brief Period of Time?

  • If all you have is a short time in which to make an impact--

  • seek at least

  • not to do any damage

  • by entrenching resistance and discouraging change.

  • (Miller & Rollnick, 1991)


Five key communication skills

Five Key Communication Skills

  • Framing communication messages

  • Understanding the patient perspective

  • Active listening

  • Redirecting

  • Cocktail Party


Brief intervention talking points

Brief Intervention Talking Points

  • Compliment any protective behavior

  • Ask a question/s about sexual behavior and disclosure

  • Discuss sexual behavior and disclosure

(adapted from the Partnership for Health Program, PAETC, University of Southern California)


Pwp internet resources

PwP Internet Resources

  • www.aidspartnershipca.org/pfp.html

  • www.paetc.com/partnershipforhealth.html

    • PAETC, Partnership for Health Program

  • www.aegis.com/pubs/woalive/2001/WO2001-0607.html

    • Prevention with Positives: What Is It? Women Alive, Summer 2001. Cathy Olufs.

  • www.hivstopswithme.org


Pwp internet resources1

PwP Internet Resources

  • www.omhrc.gov/OMH/aids/impact/HIV_march2002.pdf

    • Prevention with Positives: Reducing Further Transmission of HIV/AIDS.HIV Impact, March/April, 2002. Aimee Swartz.

  • http://www.thebody.com/treat/prevpos.html

    • Archived online articles


Contact information

Contact Information

  • Robert T. Carroll, PhD (c), RN, ACRN

  • WA State Education Coordinator

  • NW AIDS Education & Training Center

  • 901 Boren Ave., Suite 1100

  • UW Box #359932

  • Seattle, WA 98104-3508

  • 206-685-0226

  • [email protected]


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