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Prevention with Positives: Promoting Change While the Clock Ticks …

Prevention with Positives: Promoting Change While the Clock Ticks …

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Prevention with Positives: Promoting Change While the Clock Ticks …

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  1. 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

  2. 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

  3. Why the Emphasis on Prevention with Positives? • Every person • infected with HIV • was exposed by • a person who was • HIV-Positive.

  4. 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

  5. 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

  6. 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

  7. 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)

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. What do these Theories have in Common? • KNOWLEDGE + • SKILLS + • MOTIVATION + • RESOURCES + • SUPPORT = • Behavior Change!

  17. 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

  18. Transtheoretical Model of Behavior Change

  19. Transtheoretical Model(Prochaska & DiClemente, 1984)

  20. 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

  21. Brief Motivational Interviewing Works! But it must have structure and purpose…

  22. 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

  23. 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

  24. 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)

  25. MOTIVATION Key ingredient which supports the client’s ability to change.

  26. General Principles of Motivational Interviewing • Express empathy • Develop discrepancy • Avoid argumentation • Roll with resistance • Support self-efficacy

  27. 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

  28. 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)

  29. Five Key Communication Skills • Framing communication messages • Understanding the patient perspective • Active listening • Redirecting • Cocktail Party

  30. 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)

  31. PwP Internet Resources • • • PAETC, Partnership for Health Program • • Prevention with Positives: What Is It? Women Alive, Summer 2001. Cathy Olufs. •

  32. PwP Internet Resources • • Prevention with Positives: Reducing Further Transmission of HIV/AIDS.HIV Impact, March/April, 2002. Aimee Swartz. • • Archived online articles

  33. 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 •