8.2 Counseling

Part II: Guidelines for Client Services and Clinic Management

  1. Method Counseling:
  2. STD and HIV Counseling:
  3. Preconception Health:

The primary purpose of counseling in the family planning setting is to assist clients in reaching an informed decision regarding their reproductive health and the choice and continued use of family planning methods and services. The counseling process is designed to help clients resolve uncertainty, ambivalence, and anxiety about reproductive issues and to enhance their capacity to arrive at a decision that reflects their considered self-interest.

The counseling process involves the mutual sharing of information and offers more than education and providing information. Counseling assists clients in dealing with their feelings about the information. The staff role is to help clients:

  • Explore, express and manage feelings;
  • Define alternatives;
  • See circumstances realistically;
  • Cope with anxieties and pain;
  • Mobilize for action on a decision;
  • Recognize and draw on her/his own strengths and the support system of her/his environment.

Persons who provide education/counseling should be knowledgeable, objective, nonjudgmental, sensitive to the rights and differences of clients as individuals, culturally aware, and able to create an environment in which the client feels comfortable discussing personal information.

In some cases, the type of counseling that the client needs is beyond the scope of that which can be provided on a short term basis in the family planning clinic. The clinic staff, therefore, must maintain a list of referral resources for meeting the client's long term counseling needs.

Method Counseling:

Method counseling refers to an individualized, face-to-face, dialogue with a client that covers the following:

  • Results of the physical examination and lab studies;
  • Effective use of the contraceptive method chosen and the benefits, risks, safety, limitations and efficacy of the method;
  • Warning signs and complications to report to the provider;
  • Possible side effects of the methods;
  • How to discontinue the method selected;
  • Information regarding back-up method use;
  • Use of emergency contraception;
  • Planned return visit schedule;
  • Emergency 24-hour telephone number;
  • The location where emergency services can be obtained when the clinic is closed; and
  • Appropriate referral for additional services as needed.

STD and HIV Counseling:

All clients must receive thorough and accurate counseling on STD's and HIV. This counseling is an individualized, face-to-face, dialogue with a client in which there is a discussion of personal risks for STD's and HIV.

A risk assessment must be completed. Clients with behaviors that put them at risk for STD's and HIV must be given advice regarding risk reduction and must be advised whether clinical evaluation is necessary.

Family planning staff/counselors must offer STD and HIV counseling that includes, at a minimum, the following:

  • Education about STD's, HIV infection and AIDS, including the modes of disease transmission and behaviors that place clients at risk;
  • The relationship between HPV and cervical cancer;
  • STD symptoms or absence of symptoms;
  • The relationship between CT/GC and infertility;
  • Information on risks and infection prevention;
  • Risk reduction strategies;
  • HIV testing availability; and
  • Ways to inform partner(s) of potential risk.

All clients must be encouraged to use condoms, in addition to another method of contraception, for the prevention of STDs and HIV.

Preconception Health:

Since roughly half of the U.S. pregnancies are unintended, the agency must provide basic preconception health education to clients at key visits, such as initial visits, annual visits, and negative pregnancy test visits. Though ever under time constraints, clinic staff can use the rapport and trust they establish over time to help the client desirous of, or at risk for, pregnancy.

At a minimum, all clinics must provide information on the topics below. In addition, they must provide a handout on preconception health, with opportunities for discussion. The topics to be included in routine preconception education are:

  • Key messages: Half of pregnancies are unintended. Be healthy in your "childbearing" years. As you set life goals for education and employment, make planning for any future pregnancy a key to your success.
  • Use highly effective methods to prevent, plan or space a pregnancy.
  • Stop or greatly reduce smoking, alcohol and street drugs.
  • Practice safer sex. Use condoms.
  • Know your HIV status. Be tested unless you are sure.
  • Know your rubella, tetanus, and hepatitis immunization status.
  • Eat a variety of healthy foods.
  • Engage in regular weight bearing exercise.
  • Maintain a healthy body weight.
  • Practice good oral health.
  • Finish all medication if diagnosed with any STD. Make sure partner(s) are treated.
  • Take 400 mcg folic acid daily. Check the dosage on a multi-vitamin you take now.

Documentation of all counseling provided must be included in the client's medical record. Refer to Appendix I for Routine Preconception Education guidance and checklist.

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