VIETNAMESE AND AMERICANS IN PARTNERSHIP TO FIGHT HIV/AIDS

Transcription

1 Tr ainer Manual Training Curriculum on Drug Addiction Counseling Appendix VIETNAMESE AND AMERICANS IN PARTNERSHIP TO FIGHT HIV/AIDS

2 In July 2011, FHI became FHI 360. FHI 360 is a nonprofit human development organization dedicated to improving lives in lasting ways by advancing integrated, locally driven solutions. Our staff includes experts in health, education, nutrition, environment, economic development, civil society, gender, youth, research and technology creating a unique mix of capabilities to address today s interrelated development challenges. FHI 360 serves more than 60 countries, all 50 U.S. states and all U.S. territories. Visit us at

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4 VIETNAMESE AND AMERICANS Tr aining Curriculum on Drug ADDICTION Counseling APPENDIX IN PARTNERSHIP TO FIGHT HIV/AIDS

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6 APPENDIX Appendix I 3 Appendix II 21 Appendix III 25

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8 APPENDIX I - Sample Schedule Training Agenda Basic Training Course on Drug Addiction Counseling Goal and Objectives Goal: To provide prospective counselors with knowledge on drugs, drug addiction and its consequences, drug treatment modalities, drug addiction counseling skills and techniques, and relapse prevention therapy to enhance the effectiveness of their work with drug users and recovering drug users. Objectives: By the end of this training curriculum, participants will be able to - Describe the roles and responsibilities of drug addiction counselors Explain the principles and practice of drug addiction counseling Describe common drugs, drug use patterns and consequences of drug use as they apply in Vietnam Explain the basis of addiction, recovery and relapse Explain basic information about different models of drug addiction treatment including - abstinence-based treatment models and - substitution treatment models Explain drug treatment services available in Vietnam Explain factors influencing successful drug addiction treatment Describe the counseling process Describe the components and steps involved in conducting a client assessment Develop an individualized management plan and provide ongoing follow-up and support Develop basic drug addiction treatment counseling skills and techniques in the following areas: - Client assessment - Motivational interviewing - Goal setting - Problem solving - Counseling skills - Relapse prevention with focus on: - Managing high-risk situations - Refusal skills - Coping with cravings - Dealing with lapse and relapse - Stress management - Time management Appendix 3

9 APPENDIX I - Sample Schedule Day 1 Time What Process/Learning Objective Deliver by: Welcome Representatives of donor(s) and organizers Welcome participants Participants expectations, Training objectives, Training agenda Ground rules, divide participants into groups and assignments Pre-test Tea break Introduction to drug addition counseling: Lunch Basic concepts of drug addition counseling Key principles in drug addiction treatment counselling Self introduction through a game Write learning expectations on pieces of colored paper. Elicit feedback and discussion from participants, and review training agenda. Summarize on flipchart Participants divided into 4 groups. Groups 1-3 for recap sessions, Group 4 for energizer activities Develop ground rules and feedback rules Give definition of counseling Understand the context of counseling Understand myths about drug use and drug users Identify differences between counseling and health education Identify attributes of an ideal counselor Define drug addiction counseling Explain the role of drug addiction counseling List four general principles for effective communication Explain the differences between empathy and sympathy Identify the principles of drug addiction counseling Explain the implication of each principle 4 Training Curriculum on Drug Addiction Counseling: Trainer Manual

10 APPENDIX I - Sample Schedule (cont.) Day 1 (cont.) Time What Process/Learning Objective Deliver by: Counseling techniques Tea break Identify a range of counseling techniques that will be taught in the course Discuss their application and context in drug addiction counselling Counseling skills Demonstrate basic counselling skills Understand the difference between counseling skills and counseling techniques Practice using counseling skills through roleplaying: One exercise each skill Evaluation and wrap-up Fill out Evaluation form for DAY 1 Appendix 5

11 APPENDIX I - Sample Schedule (cont.) Day 2 Time What Process/Learning Objective Deliver by: Recap of Day 1 Group Drugs, drugs use its and consequences Alcohol Tea break 10: Basis of drug addition Factors influencing successful treatment Lunch 13: Basic treatment principles Tea break Heroin addiction treatment Evaluation and wrap-up Increase their knowledge about drugs, Understand drug use and its consequences Increase their knowledge about effects of alcohol and consequence of alcohol use, Games: effects of alcohol, heroin, ecstasy Explain the basis of addiction Criteria to diagnose drug addiction using ICD 10: Examples and discuss Explain recovery and relapse Describe the factors that influence successful treatment Link these factors to their application in the Vietnam context Identify the principles for successful treatment Understand drug addiction treatment services available in Vietnam Explain basic information on different types of drug addiction treatment approaches including: - Abstinence-based treatment models - Substitution treatment models 6 Training Curriculum on Drug Addiction Counseling: Trainer Manual

12 APPENDIX I - Sample Schedule (cont.) Day 3 Time What Process/Learning Objective Deliver by: Recap of Day 2 Group The Stage of Change Model and key concepts in motivational interviewing Principles and procedures for motivational interviewing Tea break Linking motivational interviewing to stage of change strategies Lunch Client assessment Tea break Understand the Stages of Change Model Understand which intervention strategies/ plans are most likely to work with clients who are at different stages of change Realize unhelpful assumptions that prohibit behavior change Understand the concept of motivational interviewing Understand the principles of motivational interviewing Understand the interplay between the Stages of Change Model and motivational interviewing Understand the basic principles of motivational interviewing Understand the steps in an motivation interviewing intervention Demonstrate knowledge and skills in roleplaying Learn how to apply motivational approaches in counseling Understand why client assessment is important Understand the assessment procedure and content Demonstrate knowledge and skills of client assessment through rol- playing Learn how to apply assessment knowledge and skills in counseling Role-plays of client assessment Appendix 7

13 APPENDIX I - Sample Schedule (cont.) Day 3 (cont.) Time What Process/Learning Objective Deliver by: Problem solving Goal setting Evaluation and wrap-up Understand the rationale of problem solving Understand the steps in the problem solving Role-play to demonstrate knowledge and skills in problem solving Learn how to apply problem solving in counseling Understand the rationale of goal setting Understand the main characteristics of goal setting Understand the use of a structured goal setting method Role-play to demonstrate knowledge and skills in goal setting Understand the relationship between problem solving and goal setting Learn how to apply goal setting skills in counseling 8 Training Curriculum on Drug Addiction Counseling: Trainer Manual

14 APPENDIX I - Sample Schedule (cont.) Day 4 Time What Process/Learning Objective Deliver by: Recap of Day 3 Group Relapse prevention therapy Tea break Discuss and identify reasons for relapse Understand and be able to explain the Model of Relapse and relapse process Identifying high risk situations that lead to relapse Understand strategies in addressing and coping with high-risk situations Understand and be able to explain Global Relapse Prevention Therapy Interventions Understand and be able to explain Specific Relapse Prevention Therapy Interventions Refusal skills Discuss rationale for learning refusal skills Understand how to refuse politely Discuss non-verbal measures Discuss verbal measures Practice heroin refusal skills Coping with cravings Lunch Time management Tea break Understanding craving Describing craving Identifying craving triggers Plan for coping with cravings Understand how important time management is for counseling Address time management issues with clients Understand the connection between time management and relapse Practice designing a timetable Appendix 9

15 APPENDIX I - Sample Schedule (cont.) Day 4 (cont.) Time What Process/Learning Objective Deliver by: Stress management Understand stress Understand the symptoms of stress Understand the causes of stress Understand how stress affects clients Understand ways to mitigate Stress (Relaxing exercise as an example) Summaries Summary of key content, questions and answers 10 Training Curriculum on Drug Addiction Counseling: Trainer Manual

16 APPENDIX I - Sample Schedule (cont.) Day 5 Time What Process/Learning Objective Deliver by: Recap of Day4 Group Additional Role play Problem solving and goal setting. Putting it together Discussion Relapse prevention: Relapse cues identification Coping with cravings Refusal skills Time management Stress management Tea break Additional Role play Lunch Questions and answers Tea break Post course assessment Feedback and final questions Close Assessment/stage of change/motivational interviewing. Putting it together Appendix 11

17 APPENDIX I - Sample Schedule Training Agenda Advanced Training Course on Drug Addiction Counseling Day 1 Time What Process/Learning Objective Welcome Representatives of donor(s) and organizer(s) Training objectives Refresh the topics and skill building sessions on drug addiction treatment counseling from the previous training 9:30-10:30 Counseling procedures Tea break Review the counseling techniques and skills learned in the 1st course Lunch Presentation and discussion, record on flipchart as needed. Participants will be able to describe the purpose of the training Feedback and discussion from the participants based on their experiences in drug addiction counseling List the counseling procedures Explain the interactions between the steps of the procedures Practice providing counseling sessions according to the counseling procedures through role-plays Apply goal-setting and problem-solving techniques in role-plays Counseling skills: Attending, opening questions, summary, probing, silent, listening, and rolling with resistance Counseling techniques Review client assessment Group discussion: Asking participants why we need to assess clients, when to do it and what areas of information are needed for the assessment. Participants will understand the importance of client assessment Two pairs of participants role-play. Feedback on the role-plays Tea break Practice taking a client s drug use history (role-play): trainer in the role of a client and a participant in the role of a counselor 12 Training Curriculum on Drug Addiction Counseling: Trainer Manual

18 APPENDIX I - Sample Schedule (cont.) Day 1 (cont.) Time What Process/Learning Objective Review of motivational interviewing Evaluation and wrap-up motivational interviewing is a useful strategy for those who have ambivalence about changing behavior (including drug use) Appropriate timing of this strategy within overall case management Appendix 13

19 APPENDIX I - Sample Schedule (cont.) Day 2 Time What Process/Learning Objective Recap of Day Alcohol and related problems Tea break Treatment of heroin addiction Lunch Review problem solving and goal setting with role-play Counseling techniques: Conflict Resolution Tea break Define nature of alcohol related problems Understand the continuum of risk for alcohol consumption Define low-risk drinking levels Understand the pharmacokinetics of alcohol Describe different therapies of drug addiction treatment available in international setting Describe strengths and limitations of each of the therapies Suggest therapy combinations to enhance effectiveness Participants will also have a basic understanding of the effects of methadone and naltrexone as treatments for heroin addiction Understand the context of problem solving techniques Describe the steps involved in problem solving Describe common difficulties encountered in problem solving Implement problem-solving techniques Describe why short-term goal setting is important Describe the steps involved in goal setting Describe the relationship between goal setting and problem solving Define conflict Identify conflict resolution styles Identify conflict resolution steps Demonstrate understanding of principles in practical exercise and resolution of possible everyday life conflicts 14 Training Curriculum on Drug Addiction Counseling: Trainer Manual

20 APPENDIX I - Sample Schedule (cont.) Day 2 (cont.) Time What Process/Learning Objective Approaches to address Risk Reduction and HIV prevention during counseling Evaluation and wrap-up Understand the definition of risk reduction Understand the principles of risk reduction Understand the practice of safe injection and safe disposal of used needles and syringes Vein care Prevention of overdose Appendix 15

21 APPENDIX I - Sample Schedule (cont.) Day 3 Time What Process/Learning Objective Recap of Day Relapse prevention revision and skills enhancement in: Managing high-risk situations Refusal skills Coping with cravings Dealing with lapse and relapse Tea break Practice with real clients Lunch Working with families to enhance their support to recovering drug users Tea break Counseling technique: Time management 16:00-17:00 Counseling technique: Stress management Evaluation and wrap-up Revision of lessons from previous training by asking probing questions to the participants This session will be interactive and draw on participants previous learning. All facilitators will need to encourage participants to reflect on their understanding around these issues and use that as the basis of filling in any missing components. It needs to be very interactive Practice working with real clients Apply counseling procedures and appropriate counseling skills and techniques Feedbacks by observers and clients Understand the role of the family in recovery Understand the effect that substance use has on the family Understand how the family can provide enhanced support to drug users Understand key content of a supportive family meeting Understand how important time management is for counseling Address time management issues with clients Understand the connection between time management and relapse Understand stress Understand the symptoms of stress Understand the causes of stress Understand how stress affects clients Understand ways to mitigate Stress 16 Training Curriculum on Drug Addiction Counseling: Trainer Manual

22 APPENDIX I - Sample Schedule (cont.) Day 4 Time What Process/Learning Objective Recap of Day Anger management Tea break Managing clients with aggressive behaviors Lunch Management of intoxicated clients Develop an understanding of differences between anger and aggression Develop an understanding of what triggers anger or aggression Develop an understanding of strategies to deal with anger and aggression Identify aggressive and potentially violent behavior Identify ways to defuse and avoid potentially violent confrontations Develop crisis communication strategies Examine why people become aggressive or violent Develop strategies for managing intimidation Know when and how to exit a scene Recognize behavior which may lead to violence Look at strategies for managing our emotions, controlling fear and anger Identify the necessary personal safety steps needed to avoid or reduce physical injury Assess and manage a range of risky or dangerous situations Develop a proactive approach to reducing aggressive and violent behavior Define intoxication and know its effects Recognize evidences of intoxication at different levels Know the principles of management of intoxicated clients Practice management of an intoxicated client through role-play Appendix 17

23 APPENDIX I - Sample Schedule (cont.) Day 4 (cont.) Time What Process/Learning Objective Working with women Tea break Working with young people Evaluation and wrap-up Understand some of the characteristics of women who need treatment, their history and experiences Understand why some of these issues are challenges to accessing services for treatment Understand some of the clinical strategies that have been employed to assist women stop using drugs as well as preventing relapse Understand adolescence as a developmental life stage Identify possible significant others and how they make impact on a young persons drug use Explore clinical strategies that assist working with young people Understand young people are at a different stage in respect to brain development Discuss risk reduction approaches when working with youth Develop skills in raising the issue of drug use with young people 18 Training Curriculum on Drug Addiction Counseling: Trainer Manual

24 APPENDIX I - Sample Schedule (cont.) Day 5 Time What Process/Learning Objective Recap of Day Questions and Answers; any of the left over contents from the previous 4 days :15 Tea break 10:15-12:00 EXAM Lunch Release of exam results, questions/answers any of the left over contents from the previous 4 days Tea break Certificate Awards Ceremony, Closing Remarks Evaluation and close of training Appendix 19

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26 APPENDIX II - Sample Evaluation Sample Daily Evaluation Form (for Day 1, Advanced Training on Drug Addiction Counseling) 1. The training content today satisfied my needs. Strongly disagree Strongly agree I am more confident in my understanding of general counseling skills and techniques. Strongly disagree Strongly agree I am more confident in utilizing counseling skills and techniques in drug counseling. Strongly disagree Strongly agree I am more confident in my understanding of drugs, drug use and its consequences. Strongly disagree Strongly agree I am more confident in my understanding of the basis of addiction. Strongly disagree Strongly agree I am more confident in my understanding of heroin addiction treatment. Strongly disagree Strongly agree Appendix 21

27 APPENDIX II - Sample Evaluation (cont.) 7. I am more confident in my understanding of motivational interviewing techniques. Strongly disagree Strongly agree I am more confident in the application of motivational interviewing techniques in drug addiction counseling. Strongly disagree Strongly agree What did you like the most today? 10. Which training session could have been done better? How it could be done better? 22 Training Curriculum on Drug Addiction Counseling: Trainer Manual

28 APPENDIX II - Sample Evaluation (cont.) Sample Whole Training Course Evaluation Form 1. Overall, I feel the five-day training course satisfied my expectations. Strongly disagree Strongly agree What did you like the most in this five-day training course? 3. In the five-day training course, which training session could have been done better? How could it have done better? a. Logistics b. Class organization c. Training materials d. Trainers e. Practice sessions Appendix 23

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30 APPENDIX III - Sample written exam with answers Question 1. List three principles of effective treatment Model answer: No single treatment is always appropriate Deals with the multiple needs of individuals, not just their drug use Needs to be readily available Remaining in treatment for an adequate period of time is critical Medication is important but not the only component Counseling and other behavior components are critical Treatment progress and continuance of drug use treatment should be monitored Treatment plans need to be assessed and modified continually Detox is only the first step Treatment should provide assessment of all needs Treatment of comorbid conditions should be integrated Question 2. Name two dimensions of treatment outcomes Model answer: Reduction in drug and alcohol use Increased personal and social functioning Improved public health and safety Question 3. Answer true or false to the following: Alcohol is a depressant. True Opiates are a stimulant. False Amphetamines are depressants. False Cannabis is a stimulant. False Question 4. List three components of heroin addiction syndrome Model answer: Tolerance Withdrawal Substance taken in larger amounts or over a longer period than intended Unsuccessful effort or a persistent desire to cut down or control substance use A great deal of time spent on obtaining the substance Appendix 25

31 APPENDIX III - Sample written exam with answers (cont.) Important social, occupational or recreational activities given up or reduced because of substance use Continued substance use despite knowledge of having had a persistent or recurrent physical or psychological problem Question 5. List three counseling skills that are used when counseling clients Model answer: Open-ended questions Reflective listening Rolling with resistance Reframing Affirmation Summarizing Question 6. List three things to avoid when counseling clients Model answer: Moralizing Ordering Threatening Arguing Disagreeing Over-interpreting Sympathizing Judging 26 Training Curriculum on Drug Addiction Counseling: Trainer Manual

32 APPENDIX III - Sample written exam with answers (cont.) Question 7. List three key differences between methadone and naltrexone Model answer: Methadone Acts like heroin Liquid Last 24 hours Can initiate while still using Can work for all Pregnant women can use it Start slow, gradual increase No effect on alcohol addiction Naltrexone Block heroin Tablet Lasts 2-3 days Need to be detoxified before starting Best for people with much to lose Pregnant women cannot use it Can start on same dose Can stop alcohol addiction Question 8. Identify three categories of intrapersonal risk for relapse Model answer: Negative emotions, negative physical psychological states, positive emotions, testing control Question 9. List three interpersonal/social reasons for relapse Model answer: Conflict, social pressure, enhancement of positive emotional states Question 10. Name three characteristics of short-term goals Model answer: Specific Measurable Achievable Realistic Timely Appendix 27

33 APPENDIX III - Sample written exam with answers (cont.) Question 11. List three behaviors that a good counselor will exhibit when managing intoxicated people Model answer: Calm Relaxed Attentive Not physically intimidating Aware of how appears Sees them in a quiet environment Avoids giving stimulants Only gets basic details Does not patronize Question 12. List the steps of problem solving Model answer: Orientation Define the problem Generate solutions Make decisions based upon pros and cons. Implement. Question 13. List three strategies to cope with cravings Model answer: Behavioral Delay Distract Decide Cognitive Positive self-talk Relaxation Imagery 28 Training Curriculum on Drug Addiction Counseling: Trainer Manual

34 APPENDIX III - Sample written exam with answers (cont.) Question 14. List three verbal refusal skills that clients can use to resist drug users Model answer: Use a clear, firm, confident tone in the voice No should be the first word out of your mouth Suggest an alternative Request behavior change so the other person stops asking Change the subject to something else Avoid using excuses and avoid vague answers Question 15. What skills do counselors need to deal with angry/violent clients? Model answer: Step 1 Defusing aggression Clear, calm, communication Empathetic listening, acknowledgement and clarification Step 2 Controlling aggression Negotiate assertively and clearly Take safety steps, space and scan Step 3 Terminate the interaction Remove yourself or ask client to leave Evade injury and call for assistance Defend yourself Question 16. Identify the three components of a formal warning you would give to control aggression Model answer: Negotiate assertively and clearly Take safety steps, keep space and scan around you Defend yourself Appendix 29

35 APPENDIX III - Sample written exam with answers (cont.) Question 17. List three steps a counselor can use to overcome fear and regain control Model answer: Self-talk Think rationally One step at a time Problem-solving actions Question 18. List three skills that clients need to acquire to manage anger Identify a range of feelings including anger Identify aggressive acts by self and others Identify potential consequences to self and other from these aggressive acts Identify self-destructive behavior Identify thoughts prior to aggressive acts Identify internal cues to feelings of anger Develop coping mechanisms for dealing with anger Express anger without loss of control 30 Training Curriculum on Drug Addiction Counseling: Trainer Manual

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