D) Assessment

In order to help the client reduce risk behaviors, you will need to assess your clients’ knowledge, attitudes, and beliefs about HIV and STD transmission. You will also need to determine which behaviors put your client at risk of acquiring or transmitting HIV and other STDs. In addition, it’s important to gather information about psychosocial factors that may affect risk. This assessment should take place as early as possible in the CRCS process and may take more than one CRCS session.

Lessons from the field

The assessment should not be a structured set of questions; rather, it should be a conversation that reduces anxiety and motivates confidence and disclosure, especially in the initial stages of the assessment. You might think of the assessment as a two-stage process: Stage 1 – In the context of your getting to know your client, you will begin to develop a good picture of their risk issues. This will occur during your first session with the client, and may extend beyond the first session to other sessions. Stage 2 – This is the point at which you need to obtain more specific information about risk or ask about topics that may not have been addressed. At this point, you may need to refer to a set of questions, explaining to the client the importance of your understanding the nature of the issues they face in order to better help them address those issues. While the initial assessment provides a baseline for client monitoring and program evaluation, keep in mind that some clients tend to disclose more risk after having participated in CRCS for some time. That is, as clients become more comfortable with their CRCS counselors, they open up more about sensitive issues. Although it may appear that participation in the program increases risk, it is actually disclosure of risk that increases during a successful client-counselor relationship. Some agencies have clients write a short paragraph about what they want out of CRCS, or fill out a brief survey about their risk behavior, to jump-start the initial assessment. A stronger relationship between CRCS staff and client makes the assessment easier and more accurate.

The recruitment phase and engagement process prior to enrolling clients will contribute to developing your relationships with your clients

Assessment topics

The following topic areas can be discussed during assessment. You may want to discuss some of these issues with your clients, even though you may not provide referral services related to these issues, because they pose barriers to risk reduction or increase risk behavior.

For clients who are either HIV-negative or HIV-positive -

• Demographic information
• Health status
• Personal relationships
• Alcohol and substance use
• STD history
• Mental health
• Sexual history
• Social and environmental support
• Skills and confidence to reduce HIV risk
• Intentions and motivation for behavior change
• Barriers to safer behavior
• Protective factors, for example, culturally defined values and behaviors that reduce risk
• A list of services in which the client is currently enrolled
• A list of services for which the client may be eligible but not currently enrolled

For clients who are HIV-positive, you may also add –

• Access to medical care and HIV treatment.
• Adherence to HIV treatment, if applicable
• HIV status and personal relationships; partner notification
• Other health-related issues

You may not cover all of these assessment topics with each client, nor will you discuss all relevant items at one session. Some of these topics may come up later as your clients become more comfortable with you as their CRCS counselor. At a minimum, however, the counselor should at least touch on each topic to ascertain whether it is relevant for the client.

You should try to address the topics listed above during the initial assessment, however you should obtain this information in an informal, conversational manner. You might consider beginning your assessment session with the following types of questions.

“You have heard about CRCS from our outreach counselor. How do you think CRCS can help you?”

Then discuss the risk and other issues that your client raises. Information from the assessment should be recorded on the initial assessment form that your agency is using, either unobtrusively during the session or after the session. Later in the session, or during a later session, you can ‘fill in the blanks’ of the assessment form by asking questions in a more structured way. For example –

“You’ve told me a lot about the needs that you have and how CRCS can help you. Now I have more questions that I need to ask you to make sure that we’ll be helping you as much as we can.”

Thus, the point of the initial assessment is to get to

1. Know the client
2. Identify the most pressing risk-related issues
3. Understand some of the details surrounding these issues

With these goals, you should have a conversation with your client during which you raise the assessment issues in a natural way. This is a skill that may take some practice, and counselors should be trained and practice initial assessment before they see clients. Getting to know a client well enough to gain their trust and complete the initial assessment may take more than one session.

In sum, the initial assessment is so important in CRCS because it allows the counselor to identify the most pressing risk reduction issues and psychosocial issues affecting risk reduction. It also helps to begin deepening the relationship with your client.

Remember to prioritize risk reduction needs with your client – typically there are only one or two primary needs that should be dealt with at a time. Dealing with those successfully will pave the way for helping your client to address other issues. With this information, you can begin working on the prevention plan with the client.

Go to section 2 part 2E