A. Successful completion or graduation

Once your clients accomplish their goals, you and your clients, in consultation with your supervisor, should decide if the next step is graduation from the program or if some additional CRCS support is needed to maintain safer behaviors.

There is no fixed number of sessions that CRCS clients must attend before graduation, unless your State or local regulations require them to do so. In two PCM demonstration projects, the mean number of risk counseling sessions per client was between four and six sessions, but the range was quite wide. In practical terms, many clients had a few sessions while a small number had a larger number of sessions. Keep in mind that clients’ needs and strengths vary, so you should expect a range in the numbers of risk counseling sessions per client.

One thing to keep in mind about discharge: If your client does not appear to be making progress after several risk reduction counseling sessions, you may want to reevaluate not only the prevention plan but also whether or not CRCS is the right intervention for your client at this time. It could be that some other strategy would be more appropriate, such as substance use or mental health treatment. Keeping to the recommended re-assessment every 90 days, in addition to your daily case notes, should help you keep track of your clients’ progress.

Successful completion of CRCS results from accomplishing risk-reduction goals, and this could require any number of sessions. Remember that, early on in CRCS sessions with clients, it’s often a good idea to introduce the notion of discharge and why discharge is a goal of the program. At the time of graduation, the CRCS counselor should make sure that clients have access to resources that can help them maintain their risk reduction changes (e.g., support groups; other, less intensive interventions). Some clients may relapse and need to re-enroll in CRCS services.

B. Other types of discharge

Some CRCS clients leave the program without graduating -

• Some clients may be incarcerated or enter drug treatment while enrolled in CRCS. Each agency should have its own policy regarding whether these clients are discharged or placed into inactive status.
• The client may quit the program. Participation in CRCS is strictly voluntary – the client can choose not to participate at any time.
• The client may stop attending sessions without offering an explanation. In this case, the agency should develop policies and procedures regarding the number of attempts made to contact clients who have ‘disappeared’. Contact attempts can include phone calls, home visits, visits to places frequented by your client, and speaking with your client’s other healthcare providers. Typically, after a predetermined number of contact attempts or a predetermined passage of time, your agency will place the client’s file into inactive status. The agency should determine the amount of time a client’s file can be ‘inactive’ before the client is discharged.
• The agency may also choose to discharge a client if the client poses a threat to staff members.
• The CRCS program is unable to help the client who does not want to focus on risk reduction.
• The client may have moved away or be deceased.

Remember to document each contact effort and client response!

Lessons from the field

“Our prevention counselors introduce the idea of eventual discharge very early in the process of developing a relationship with the client, to emphasize that prevention counseling is not life-long counseling. Clients are also told that the door is always open to them should they need to return to the program at any time. It is important to note, however, that a client’s particular situation should be taken into consideration before the client is discharged due to lack of contact.” Sending a letter to the client to tell them that they will soon be discharged from the program has proved to be successful in re-engaging clients who were non-responsive to other modes of communication. When to let clients go – Sometimes clients feel they will need your services forever. But your job is primarily to see that their risk for HIV infection or transmission is reduced, that they have met their risk reduction goals. If clients need you for other services that are not related to risk reduction, and they have met and can sustain their risk reduction goals, you should try to refer them to another program that can deliver the services they need. CRCS is not intended to be psychotherapy. Clients may need services that will help them deal more effectively with risk, such as mental health or substance use counseling, but which are outside the scope of counseling services provided by CRCS. Clients can be referred to these programs and either remain in or come back to CRCS after receiving other services, depending on the seriousness of their needs.

Go to section 3