• For people who are HIV-positive, psychosocial challenges such as depression or mental illness, substance use, or homelessness may adversely affect their ability to obtain medical care, adhere to HIV/AIDS treatment, and reduce risk behaviors.
• Some HIV-negative people also experience challenging life circumstances that leave them unable to prioritize risk reduction.
• A client with an urgent need for housing, food, or treatment for substance use may find risk reduction difficult.
• Often, through less intensive, group-based prevention interventions, we find out that certain clients need the more intensive attention to risk reduction challenges such as that offered by CRCS.

Core elements

The 7 core elements of CRCS (referred to as 'essential components' in the 1997 PCM Guidance) – These elements should always be present in any CRCS program, although their design may vary to suit the client population, resources, and agency mission. The core elements are described in detail in the 1997 PCM Guidance² and are listed below.

• Develop and implement a strategy to recruit and engage high risk clients
• Screen clients to identify those who are at highest risk and appropriate for CRCS, enroll them in CRCS, and assess enrolled clients to determine specific risk and psychosocial needs
• Develop an individualized prevention plan with goals and measurable objectives
• Provide ongoing, multi-session intensive HIV risk and behavior change counseling
• Coordinate client support with other case management programs and provide referrals as needed
• Conduct on-going monitoring and reassessment of client progress and needs
• Discharge clients when they attain and can maintain behavior change goals. In preparing discharge policies, agencies should establish protocols to classify clients as “active,” “inactive,” or “discharged.” Your agency should outline the minimum active effort required to retain clients. Finally, your CRCS program should be willing to readmit clients who need new or additional risk reduction support.

Note that CRCS is, by definition, an individual level intervention. CRCS clients often are referred to support groups in order to get them ready for CRCS or to help them cope after graduation from CRCS, but CRCS itself is conducted with only one client at a time, unless the client’s partner is involved in the sessions.