Prevention with Positives: Promoting Change While the Clock

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Prevention with PositivesPromoting Change
While the Clock Ticks

• Robert T. Carroll, PhC, RN, ACRN
• Washington State Education Coordinator,
• Northwest AIDS Education and Training Center

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Prevention with PositivesPromoting Change
While the Clock Ticks
This program is partially funded through Grant
No. 1 H4A HA 00051-01 Health Resources and
Services Administration, US Department of Health
and Human Services
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Todays Goals

• Describe the theoretical and practical
  underpinnings of Prevention for 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 PLWHA.

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Why the emphasis on Prevention with Positives?

• Every person
• infected with HIV
• was exposed by
• a person who was
• HIV-Positive.

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What is Prevention for Positives ?

• A new generation of prevention programs targeting
  individuals who
• have already tested positive for HIV and
• who may be at risk of transmitting the disease to
  someone else.
• The current emphasis is borne of the CDCPs
  5-year plan to reduce the rates of infection by
  one half over the next 5 years.

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How does it work?

• The goal of individual-focused Prevention for
  Positives interventions is to help PLWHIV
  reduce their transmission rates through
  theoretically-based interventions which
• Help them feel better about themselves
• Decrease the stigma associated with HIV
• Help them take responsibility for their lives
• and for stopping the spread of HIV

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How is this accomplished?

• Prevention for positive 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

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Prevention for Positives programs in the US

• 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 Persons 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

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Okay I know there must a theory in there
somewhere

• Yup. Most P for P programs are based on one or
  many of the seven most popular theoretical models
  of (HIV) health promotion and 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

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What do these theories have in common?

• KNOWLEDGE
• SKILLS
• MOTIVATION
• RESOURCES
• SUPPORT
• Behavior Change!

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The 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 behavior regularly.
• Relapse person slips up needs to make
  adjustments.

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The Transtheoretical Model of Behavior Change
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The Transtheoretical Model (Prochaska
DiClemente, 1984)

• Key assumptions of the model
• 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.

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Brief Motivational Interviewing Works! But it
must have structure and purpose
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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.
• Document, Document, Document!
• Initial plan, subsequent encounters outcomes,
  and changes to the plan
• Ensure full-staff understanding of, buy-in for ,
  and consistency in delivery of the plan.

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FRAMES the active ingredients of the effective
brief motivational interview (Miller Rollnick,
1991)

• F Feedback
• R Responsibility
• A Advice
• M Menu
• E Empathy
• S Self-Efficacy

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• MOTIVATION
• The key ingredient
• which supports
• the clients
• ability to change.

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General Principles of Motivational Interviewing

• Express empathy
• Develop Discrepancy
• Avoid argumentation
• Roll with resistance
• Support self-efficacy

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Phases of the Motivational Interview Practice

• Building motivation for change
• sensitive questioning and reflection encouraging
  the person to articulate self-motivational
  statements and the arguments for change.
• Strengthening commitment to change
• motivation building moves to key questions
  designed to evoke problem-solving and commitment
  to change.

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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)

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Five Key Communication Skills

• Framing communication messages
• Consequences versus Advantages
• Understanding the patients perspective
• Empathy, thinking feeling
• Active Listening
• Remain quiet while client is talking
• Ask questions or restate at the end
• Use open-ended questions to ensure that client
  has voiced their concerns/issue
• Watch your body language!
• Redirecting
• Id love to hear more about that, but since
  were short on time I want to be sure we talk
  about
• Cocktail Party
• Relaxed interaction and comfort with discussing
  sensitive issues

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Brief Intervention Talking Points (adapted from
the Partnership for Health Program, PAETC,
University of Southern California)

• Compliment any protective behavior.
• Ask a question/s about sexual behavior and
  disclosure.
• Discuss the following 3 messages
• If SEXUALLY ACTIVE
• Protect yourself
• Protect your partner
• Talk to all partners about your HIV status
• If ABSTINENT
• Clarify what they mean by abstinent
• Reinforce positive behavior
• Discuss what to do if they be come sexually
  active.

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Internet ResourcesPrevention for Positives

• 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 for Positives What Is It? Women
  Alive, Summer 2001. Cathy Olufs.
• www.hivstopswithme.org
• www.omhrc.gov/OMH/aids/impact/HIV_march2002.pdf
• Prevention for Positives Reducing Further
  Transmission of HIV/AIDS.HIV Impact, March/April,
  2002. Aimee Swartz.
• http//www.thebody.com/treat/prevpos.html
• Archived online articles

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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
• carrollr_at_u.washington.edu