GOOD MORNING

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GOOD MORNING

• Illinois Infertility Prevention Project
• Partner Services Training

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Region V Infertility Project

• RVIPP was established in 1994 to reduce the
  incidence of chlamydia and resultant
  complications that cause infertility

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Goals of Region RVIPP

• Targeted Screening
• Treatment
• Partner Referral
• Education Training

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Partner Services Management

• Disease Intervention Through Referral and
  Treatment of
• At Risk Sexual Partners to Chlamydia

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Partner Notification in STD Management

• Study done by Kent et al (Presented at the CDC
  National STD Conference, 1996)
• 579 women treated for chlamydia and returning for
  a test of cure
• 15 had sex with a main partner without knowing
  if they had been treated, and
• 40 had sex with a casual partner without knowing
  if they had been treated.

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Partner Notification in STD Management

• Study done by Hillis et al (American Journal of
  Obstetrics and Gynecology, 1994)
• 38,866 females with their first chlamydia
  infection
• 54 under the age of 15 were reinfected within
  nine months, and
• 30 of those between 15-19 years of age were
  reinfected within nine months.

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Objectives

• Demonstrate facilitation of a client-centered
  discussion of chlamydia and appropriately answer
  client questions
• Feel ethically emotionally comfortable with sex
  partner elicitation

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Objectives

• Demonstrate the use of the key client motivators
  in explaining to the client the benefits of
  getting all appropriate sex partners examined and
  treated
• Demonstrate the ability to identify all sex
  partners from the critical exposure period

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Objectives

• Demonstrate the ability to increase the skill
  level or capacity of the client to notify each
  sex partner as appropriate
• Improve ability to identify and resolve the
  problems of clients who are reluctant to have
  their sex partners notified

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Sex Partner Elicitation and Notification Is

• Confidential, Voluntary and Non-coercive
• Within a Critical Exposure Period
• Provides Disease Intervention
• Prevents Complications

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Confidentiality

• For the purpose of this course
• Confidentiality is the assurance that any
  personal information related by a client
  regarding his/her sexual partners, as well as any
  information contained in the clients medical
  record will not be disclosed.

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Consequences of Breaching Confidentiality

• Loss of credibility
• Loss of voluntary participation
• Legal and financial repercussions

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Counseling Concepts

• 1. Focus on Feelings
• 2. Manage Your Own Discomfort

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Focus on Feelings

• Attend
• Listen
• Identify
• You seem.
• Respond
• Some people
• What can you do about this?

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Manage Your Own Discomfort

• Recognize Your Own Values
• Acknowledge Your Discomfort
• Manage It
• Management Barrier Removal

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Basic Counseling Skills

• Attending
• Using open-ended questions
• Giving information simply
• Confrontation

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Attending

• Body Language
• Nonverbal Cues Verbal Cues
• Environment

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Open-ended Questions

• Questions that can not be answered with a simple
  yes or no
• 5 Ws (Who, What, Where, When, Why)
• Polite Imperatives

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Giving Information Simply

• Concise
• Relevant
• Understandable

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Counseling Format

• Introduction
• Addressing Patient Concerns
• Disease Comprehension and Five Key Motivators
• Sex Partner Elicitation
• Coaching the Self-Referral
• Risk Reduction
• Conclusion

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Step 1 Introduction

• Name
• Role
• Purpose
• Confidentiality
• Test Results

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Step 2 Client Concerns

• Start where your client is
• Use open-ended questions
• Focus on feelings

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Step 3 Disease Comprehension

• Tell me what you know about chlamydia
• Affirm clients knowledge
• Provide medical information simply
• Use the Five Key Motivators

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Five Key Motivators

• I. Sexual Transmission
• II. Asymptomatic Nature of Disease
• III. Risk of Reinfection
• IV. Complications Consequences
• V. Increased Chance of HIV Infection

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Partner ElicitationCommunication Styles

• Non-assertive
• to relinquish ones rights and/or position in
  deference to others
• Assertive
• to claim and maintain ones rights and/or
  position without compromising the rights of
  others
• Aggressive
• to demand ones rights and/or position at the
  expense of others

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Communication SkillsAssertion Theory

• Counselor must believe in himself or herself.
• Counselor must believe in the activity to be
  performed.
• Counselor must execute his or her belief with a
  planned set of responses.

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Step 4 Sex Partner Elicitation

• Getting all partners treated
• prevents consequences of untreated disease.
• prevents reinfection.
• interrupts the spread of the disease.

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Sex Partner Elicitation Steps

• Transitional Phrase
• Methods of Referral
• Partner Elicitation

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Transitional Phrase

• Weve talked about chlamydia and how serious the
  disease is and the fact that people who are
  infected may not have any symptoms. Its
  important that we get all of the people youve
  had sex with during the last . days examined
  and treated to stop the spread of chamydia and
  make sure that those who are infected dont
  develop complications.

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Critical Exposure Period (GC/ CT)

• Time period when the client could have
• contracted or spread his/her infection.
• Asymptomatic Clients
• 60 days prior to the positive test
• Symptomatic Female Clients
• 60 days prior to onset of symptoms
• Symptomatic Male Clients
• 15 days prior to onset of symptoms
• (GC)
• 30 days prior to onset of symptoms
• (CT)

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Methods of Partner Referral

• Health department
• Self - referral (Client)

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Health Department Referral

• Establish agreement with health department to
  accept sex partner referrals.
• Advantages to health department referral
• client retains anonymity
• health department presence indicates importance
  of referral
• health department can answer disease-related
  questions
• Counselor elicits
• names
• locating and identifying information
• last exposure date

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Step 5 Self-Referral

• Prepare the client
• Loss of anonymity
• Partner under no obligation to maintain
  confidentiality
• Must be handled promptly to avoid complications,
  reinfection, further transmission

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Coaching the Client

• Notification of exposure
• Disease comprehension
• Referral and disease management
• Reactions and problems
• Follow-up

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Notification of Exposure

• What will you say?
• How will you bring it up?
• Where will you do it?
• When will you do it?

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Disease Comprehension

• Asymptomatic
• Transmission
• Complications
• Pamphlet?

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Referral and Disease Management

• What clinic or doctor
• When will he make an appointment
• Pamphlet ?

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Reactions and Problems

• How will your partner react?
• How will you handle that reaction?

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Follow-up

• Will your client follow up with partner to
  determine if he has been examined and/or treated?

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Client Reluctance to Participate in Partner
Services

• The Anatomy of a Problem The anatomy is the
  heart of every barrier to compliance a client
  has a perception of a situation and a plan to
  deal with it.The client retains that plan unless
  the health care provider understands both
  perception and plan - then tailors motivations to
  the clients situation.The health care provider
  must demonstrate that the outcome of the clients
  plan could be worse than the outcome of the
  health care workers plan.

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Problem Solving

• Lover Methodology
• Listen for verbal indicators to identify the
  existence of a problem (e.g., stalling,
  questioning, silence, illogical statements,
  arguing, ect.)
• Observe for nonverbal indicators to identify the
  existence of a problem (e.g., diverting eye
  contact, defensive body posture, fidgeting,
  nervous behavior, etc.)
• Verify the anatomy of the problem. This may
  require several substeps
• Feeling responses I sense this is bothering
  you.
• Content reponses What I hear you saying is
• Open-ended questions What are you worried
  about?
• Evaluate the situation, the motivators that may
  work for the client, and the possible responses.
  Note that one of three basic things will motivate
  a client
• the solution is beneficial to the client
• the solution is beneficial to the partner
• the solution is beneficial to the health care
  worker/public health
• Respond with a solution and deliver the
  motivation sometimes a response will be a
  confrontation.

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Five Motivators

• Use the Five Motivators in discussion with the
  client to develop her internal motivation for
  getting her sex partners tested and/or treated
  for chlamydia.

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Spread - Reinfection Diagram
Origninal patient, infected and treated
Spread from patient
Spread from partner
Spread from partner
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Delivering Confrontation

• Provide Information - supplement missing
  information or correct a misunderstanding
• Direct Challenge - address a manipulation, deceit
  withholding of information
• Self-Involvement - actively challenge or
  demonstrate intention to follow-up on the
  clients information.
• Withdrawal of Reinforcement - recall praise
  given, e.g., a client was commended earlier for
  showing concern about the seriousness of the
  disease, but now they refuse to discuss their
  partners.

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Step 6 Conclusion

• What Questions Does Client Have
• Summarize the Session
• Always look for opportunities to provide positive
  feedback and to express support for any positive
  steps or changes in attitudes, beliefs, or
  behavior.