The clients’ active contribution and commitment to the plan are essential for their continued participation.

Lessons from the field

Make sure clients are committed at some level to discussing risk and the potential for behavior change. Start small – that is, don’t try to cover everything at once. You will discourage clients if they see you wanting them to do it all right away. The clients most easily discouraged by big challenges are those who are most challenged in their lives by issues such as homelessness, substance use, or mental health problems. Prevention planning with CRCS clients is on-going and usually frequently revised. For example, you may want to base your initial prevention plan on small steps toward accomplishing the first goal – usually the goal most important to your client. For some clients, getting to the next CRCS session may be an appropriate first step or objective. Prevention plans should be based on a combination of clients’ risk reduction needs, priorities among those needs, and clients’ readiness to address them.

Prevention plans include --

• Setting goals – Goals are risk reduction targets on the road to risk elimination and are usually longer term; for example, I want to reduce my sexual exposure to HIV. A client should work on only one or two goals at a time, and the goals should focus on behaviors that the client is motivated to change or address. Goals should be set by your client with your help and support – they are your client’s goals, not yours.
• Setting objectives – These are tangible achievements that the client strives to accomplish on the way to meeting longer term goals; for example (using an objective that might be related to the sample goal, above), I will not use party drugs next Friday night, or I will cut my use of party drugs by 50% in the next two weeks. Objectives are more short term than goals and are increments on the way to achieving goals.

Objectives allow clients to obtain their goals over time, incrementally, and in realistic steps.

Lessons from the field

Setting concrete objectives can also help you and your client determine what kinds of skills your client needs to accomplish the objectives. As the client becomes more confident, the prevention plans change -- objectives should become more challenging and new goals, objectives, and strategies for risk reduction may be included. One person’s objective may be another person’s action step, depending on where the person is in the risk-reduction process and other issues they have to tackle.

• Assessing barriers and other influencing factors – You will want to help your clients recognize and talk about the primary barriers that might be in their way; for example, being intoxicated or high on drugs during sex; not having access to condoms; having a circle of friends who engage in risk behavior. Psychosocial factors such as unemployment, unstable housing, etc. should also be considered. Assessing barriers can also lead to determining the skills or information a client may need to overcome risk-reduction barriers.
  

  Sometimes you and your client may not realize that a barrier is present until the client faces it in an attempt to reduce risk.

  You should also pay attention to other factors that may have an influence on risk behavior or risk reduction, such as perceptions of risk, peer or group pressures, and attitudes and misconceptions regarding HIV/STD acquisition or transmission, to mention just a few of the possibilities.
  
  

• Determining appropriate action steps – This is how your client will know what to do and when. For example, a simple action step for a client would be putting a condom in her purse during your session, or buying condoms this week. Another type of action step would be enrolling in a substance use treatment program or identifying and frequenting a needle exchange location.

Lessons from the field

You can receive additional information about risk reduction readiness and other related topics at CRCS trainings. If your clients don’t want to give up risk behavior, you may be able to help them by talking about their priorities and perceptions of risk and the benefits of living healthier. If clients find risk-reduction important but are not confident in their ability to make changes, you can work with them on appropriate support services, skills, and behaviors needed for behavior change. For example, if a client would like to increase condom use within a relationship in which they feel unsure about raising the topic, you might role play the negotiation process in order to help increase confidence. Keep in mind that you can refer clients to other prevention activities, such as Healthy Relationships or Voices/Voces, if you think they might benefit from these activities – but you should then work with your client to build on the effectiveness of these interventions.

• Follow-up – Each session with your clients should provide some opportunity for you jointly to review progress and barriers in your clients’ implementation of their prevention plans. It’s important to empathize with clients who are having difficulty changing behaviors – don’t come across as being judgmental or admonish clients for failing. Always praise success.
  
  When new risk factors or barriers are identified, you and the client should agree on the appropriate revisions to the plan in goals, objectives, or action steps. You should celebrate accomplishments such as meeting goals and objectives with a sense of pride and empowerment.
  
  
• Agreement – Having your client sign and date the prevention plan and its revisions is a signal to both of you that your client agrees that the plan is reasonable and otherwise acceptable. It is a sign of commitment.

Lessons from the field

The importance of the client-centered approach cannot be stressed enough! There are no cookie cutter prevention plans for risk-reduction – meet your clients ‘where they are at’, find out what their needs and priorities are, what motivates them, and what stands in the way of risk reduction. Then you can together be creative and design a prevention plan in a way that your client will stay engaged and ultimately succeed. Make sure your clients have the most up-to-date copy of their prevention plans. It will help them keep up with their commitments.

Example of Goal-Oriented Prevention Planning

Please click on the image to view a larger version of this chart.

The objectives are shorter range aims to be accomplished on the way to meeting the longer range goals. In this example, the client needs very small steps at first (e.g., ‘Pick up 4 condoms from program office today, after this session’). The objectives must be realistic for the client, and action steps should be those that the client is likely to accomplish early on in their CRCS experience.

Please note that this is only an example. CRCS counselors should work with their clients to create client-driven prevention goals, objectives, and action steps.

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