Presentation on theme: "Health Education & HIV Prevention for the Substance Abuser."— Presentation transcript:
Health Education & HIV Prevention for the Substance Abuser
P I Course Goals This workshop should enable participants to: Describe the primary purposes and goals of their agency, and clearly communicate their roles and functions to residents upon entering a community Develop knowledge and skills for obtaining information about their target communities upon first and subsequent contacts Understand the characteristics of both substance abusers and target communities Improve their current interpersonal communication skills, and recognize how application of these skills will enhance their roles as community health outreach workers
P II Course Goals Learn a one-on-one approach to educating street contacts about HIV Infection and AIDS by assisting them in personalizing their risk and negotiating & reinforcing risk reduction behavior change Define clearly the impact of drug abuse and addiction in their target community, and understand the unique challenge this poses for effective prevention education Examine a variety of sexual behaviors, and know how to discuss sexuality in the community with clear, non-judgmental, and effective HIV prevention messages (continued)
P III Course Goals Use a decision-making model to anticipate and plan appropriate responses to typical crises among substance abusers Understand several common community outreach problems that can compromise the worker’s credibility or jeopardize his or her well-being and learn how best to handle them
P1 Common Ground Commit to Attend Cellular phones and beepers on SILENT mode or OFF mode Confidentiality Respect Opinions of Others Monitor Self-Disclosure
P1 Feedback is: Non Judgmental Constructive Specific Provides Alternatives Received Non-Defensively A Gift!
P2 Ethnographer of target population and neighborhood Researcher, gathering data to help identify community service funding needs Strategist on effective HIV/AIDS prevention with target population. Community Health Educator Risk Reduction Counselor to SAs and their sexual partners & the community in general Monitor, supporter and reinforcer of individual change Resource identifier and referral person Trainer of drug treatment programs, HIV/AIDS service providers, community based and other service providers Roles of Outreach Workers
P2 Advocate for and negotiator of services to clients Community organizer and community leader of HIV/AIDS prevention groups, individuals and resources Presenter of information on latest developments in HIV/AIDS, treatments and resources Roles of Outreach Workers
P3 Webster’s Dictionary: “the extending of services or activities beyond current or usual limits” Heritage Dictionary “a systematic attempt to provide services (education) beyond conventional limits, as to particular segments of the community” Types of Outreach Street Outreach: in shooting galleries, crack houses, etc. Community Outreach: in churches, treatment & youth centers, etc. A Definition of Outreach
P4 addicted to: crack, alcohol, sex, dealing drugs, etc. unemployed homeless limited “text book education” intelligent sex workers mentally ill fearful / non-trusting / disconnected apathetic / pre-occupied Description of Target Outreach Populations
P5 appear abandoned evidence of drug usage / unclean transit stations / bus depots jails bars parks / libraries laundry mats / liquor stores under bridges / street corners shelters / soup kitchens / blood banks day labor camps men / women clubs Description of Outreach Settings
P6 As you develop a map of your outreach target community, include the following: geographical boundaries of target areas specific locations where clients may be found in the target areas high risk behaviors that clients may engage in (prostitution, IDU, crack, etc.) existing agencies and institutions that may influence how outreach activities are conducted other significant influences (weapon sales, gangs, porno rings, etc.) gender, age, sexual orientation, cultural identity / norms A Community Map
Sunday__________________________________________________________ ________________________________________________________________ Monday_1/30/04: Quad II, from 8-11 am will pass out condoms at McAllister Park / 1-4 pm presentation & testing in Quad I on 1st Street Tuesday__Jennifer: In Quad III, on 5th Ave, will do a short presentation on RR that will be followed by HIV testing. Out/8am In /11am. Wednesday______________________________________________________ ________________________________________________________________ Thursday________________________________________________________ ________________________________________________________________ Friday__________________________________________________________ ________________________________________________________________ Saturday________________________________________________________ _____________________________________________________ P6 Planned Activity
P7 HIV / AIDS education to active substance abusers -- given limited, possibly inadequate, human and financial resources HIV Outreach Barriers to Substance Abusers Relational problems, including stigma by association, in one’s own community and family Substance abusers abiding suspicion or distrust, especially of “health authorities”, may prevent workers from getting close enough to have an effect Involvement in personally threatening situations, such as violence, police raids, pressure by grateful clients to accept drugs or stolen property Anxiety about, and the potential for, relapse for recovering workers
P8 Learn from the experiences and perspectives of other outreach programs and workers Ways to Remove Barriers to HIV Outreach Build skills through simulated training exercises Spend time studying and becoming accepted by the community and groups to be served Advocate for more appropriate services for substance abuse and other targeted communities Use a team approach to solving problems Continue to work on self and keep self in check (recovery) Meet with police and local officials
P9 Culture is the integrated pattern of human behavior that includes thoughts, speech, action, and artifacts. It depends on the capacity of humans for learning and transmitting knowledge to succeeding generations. It takes into account the customary beliefs, social forms, and material traits of a racial, religious, or social group. A racial trait is an inherited characteristic or feature. A cultural trait is a learned behavior. Common denominators of cultures are basic life practices performed by members of every society. Definitions Regarding Culture We learn our Culture, we are not born with it!
P10 age grading bodily adornment child rearing cleanliness training cooperation courtship education dancing ethics etiquette family feasting folklore food taboos funeral rites games gestures greetings hospitality housing hygiene joking kin groups kinship language law marriage meal times medicine mourning modesty with bodily functions music obstetrics personal names post-natal care problem solving property rites puberty customs religious rituals sexual restrictions sports status trade visiting water sports Common Denominators of Culture
P11 In your manual, please describe your primary and secondary racial or cultural identification: Primary Identification: Secondary Identification: Cultural Identification Exercise
P12 Please answer the following questions. Your responses will be shared with the group on a voluntary basis only. When and what is your earliest recollection of your primary and secondary cultural identity? What were the positive and negative experiences related to your cultural identity growing up? What thoughts, feelings, or actions by others are the most offensive to you from that cultural base? What negative thoughts, feelings, or actions have you experienced in the past about other cultures? Cultural Identification Exercise
P12 What are the positive and negative influences that your cultural identity has had on your career? What is most valuable to you as a member of that primary cultural identification? If someone wants to get to know you in terms of your culture, what one statement would you tell them? What would you tell them for your primary identification? What would you tell them for your secondary identification? Cultural Identification Exercise
Meet Me : Put yourself in situations where you will be exposed to other groups of people. Be able to identify, study and discuss your own cultural memberships with others. Greet Me : Gauge your entry into groups by the roles of the host group. If you don’t know proper etiquette or actions, be silent and observe. Ask when and how to ask questions. Try Not to Beet Me : Learn that there are different meanings to different words and actions. Begin as if learning a new vocabulary and language. Do not defend what is offensive to others, even though it was not your intent to offend. Try to understand new interpretations by not being defensive or offensive. Competition does not fit into this process. Meet Me, Greet Me
P12 Reach Me: Be proactive in making connections based on study, interaction, and correcting your own mistakes. Most people appreciate genuine interest and will help you learn. Teach Me: Ask for help from members of various cultures when you don’t understand. When some of the same things are defined in your culture differently from the way they are defined in others, take the opportunity to discuss these differences so that learning is a fun, two way process. Know When to Leave Me: The new culture is not yours. You can’t take it or get rid of it. We must allow for differences to make our world interesting and full of new experiences. We can only be who we are and take pride in our history. Each culture has a need for time and space to come together, organize and celebrate as a group without other influences. Meet Me, Greet Me
Addict Legal Consumers Moral Medical P13 Community Perception of Addicts Social
P14 Different segments of the community will tend to view addicts from different perspectives. Moral - Legal: some people believe that drug users are weak people or criminals Social - Behavioral: some people believe that drug users are exhibiting “bad” behavior that was learned in their families or communities Medical: some people believe that drug users are sick and have a chronic illness Consumers: some people see addicts as consumers of goods or valued business assets (continued) Community Perceptions of Addicts
P14 Moral - Legal Social - Behavioral Medical Consumers Which segments of the community have which perceptions? What kind of impact do you think each segment of the community will have in terms of helping or hindering your outreach efforts? Think of different strategies to overcome these obstacles and ways to assist in working with other segments of the community Community Perceptions of Addicts
P15 The Four “N’s” of Community Work Neighborly Natural Not Know-sy Non Judgmental
P16 Neighborly acknowledging people by name and talking to them about how they are doing treating people with respect and appreciation for their interests showing your concern for their problems offering to assist with problems - short of solving problems for them Natural not pushing too hard or too fast for acceptance acknowledging your anxiety as natural and dealing with it keeping your unique role -- and its limitation explicit finding a style appropriate to you and your role The Four “N’s” of Community Work
P16 Not Know-sy assuming you know nothing about anything but HIV/AIDS (and even your clients may be able to instruct a thing or two.) active listening without “screen” of prior experience “window shopping” -- total openness to all observable activities, problems, events and their potential meaning Non-Judgmental examining your own values and attitudes and questioning how these may affect your interpretive and other community work skills suspending notions of what is “right” for you embracing the notion that others have their “right” solutions approaching typically “suspect” persons (e.g, personnel in the the police department) as potential allies The Four “N’s” of Community Work
P17 Personal Safety: Do not put yourself in risky situations. The potential for danger in this line of work should neither be over-dramatized nor underplayed. The turf on which the work is to be done can be tough. Do not take unnecessary risks. Professionalism: Maintain your role and know the seriousness of your tasks. Know your limits. Value the work being done and your important role in helping to stem the HIV/AIDS epidemic. This is life or death work. Limit setting is vital. Stay within your professional role, and always understand what is to be done. Professional Standards for Outreach Workers
P17 Credibility: Build trust with those individuals in the community with whom you need to work Diffuse any suspicions Build trust not only with substance abusers, but also with community leaders and owners of stores, bars, and neighborhood hangouts. Presence: Presence includes all of the above plus developing an effective personal style so that individuals on the street and community leaders value your role as a resource person and view you as an authority in the community. Professional Standards for Outreach Workers
P18 Do’s and Don’ts Do Do Not Carry ID at all times Let clients know the limits of your job Emphasize the value of your job and the loss if you or your job is endangered. Maintain confidentiality Go in pairs Respect clients Set boundaries Wear neutral colors Let someone know where you are Drink or do other drugs on the job Buy or receive drugs Buy or receive property of any value from clients. Ask about or listen to trafficking information (except to locate outreach areas. Reveal too much personal information. Transporting clients Wear jewelry or expensive shoes/clothes, etc.
P19 Approaches to Target Populations Key escort Gatekeepers Target Population Leafletting Outreach worker begins here
P20 There are at least three basic approaches one can take to enter a given target population. All are appropriate, and they are not mutually exclusive. As listed below, these approaches represent increasingly closer access to your contact for risk reduction education. Leafletting: street corners, facilities or events where you can reach the community with materials or presentations Basic Approaches to Target Populations “tupperware” type parties sports / community centers parks / playgrounds
P20 Getting to know Gatekeepers: persons (perhaps in some of the mentioned locations) who have frequent contact with and know the lives of the people in their community Arranging to be escorted by insider: opinion leaders (perhaps some gatekeepers) within the population Basic Approaches to Target Populations
P21 Commitment Responsibility Humor Qualities of Effective Outreach Workers Sensitivity Personal Insight Knowledgeable Approachability Common Sense Patience ???
P22 1. Empathy is the ability to understand what another person is experiencing and communicate that understanding. Characteristics of Helping People 2. Respect is appreciation of the dignity and worth of another human being. It also implies that we accept the fact that each individual has a right to choose, possesses free will, may make his or her own decisions, and has the strength and capacity for making it in life. 3. Genuineness is the ability of an individual to be freely and deeply him/herself, without phoniness, role-playing, or defensiveness. 4. Concreteness is the ability to keep communications specific and get to the what, why, when, where and how of something. The concrete helper prevents the client from avoiding or escaping the issues at hand.
P22 5. Confrontation is risky and can precipitate a crisis, but it is often through such crises that the beginning of true growth occurs in the client’s life. Characteristics of Helping People 6. Self-Disclosure is the revealing of personal feelings, attitudes, opinions, and experiences on the part of the outreach worker for the benefit of the client. 7. Immediacy is dealing with the present feelings between the client and the outreach worker in the here and now. It provides the opportunity to work out problems and difficulties in an ongoing relationship so that the client profits from the experiences. 8. Charisma is the dynamic force and magnetic quality of the outreach worker. Charismatic people are those who are obviously in command of themselves and communicate to others their sense of competence and security.
P23 Listen for accurate details and feelings - the client’s story (don’t follow up with your own story) Observe clients physical condition and body language Sort client’s needs and priorities (for information and referral) Respond by using your helping characteristics and skills to provide information, referral and support Listening, Observing, and Information Sorting
P24 Addiction is characterized by: a compulsion to use mood altering drugs -urge that is experienced both physically and psychologically. loss of control over the use of drugs -inability to “decide” how much or how often to use. continued use even with negative consequences -drug becomes priority, negative consequences are not perceived to be a result of drug use. possibly inherited substance abuse -studies show linkage much like with diabetes and heart disease A Working Definition of Substance Addiction
P24 Addiction is characterized by: family and social problems because of use -relationships change due to drug-induced personality changes. attempts to control use and cut back -change drugs, etc., but still return to use possibility of relapse after the addict is clean -statistics show that without support, many are unable to sustain changes A Working Definition of Substance Addiction
P25 Physical Deterioration Addict Behaviors / Characteristics Social Consequences bad teeth weight loss shakes skin problems poor hygiene abuse unemployment isolation homelessness legal issues
P26 Denial is avoiding a painful or anxiety-producing situation by “blinding” ourselves to its existence. Some may insist that a given fact “just can’t be true”, despite evidence to the contrary. Example: “I don’t care what you say about my needing treatment! I know myself, and I can stop on my own!” Defense Mechanisms Rationalization is providing “explanations” to excuse inconsistent or irrational behavior. If we are aware that our behavior is irrational, yet make excuses for it anyway, we are “alibiing”. If we believe our own excuses, we are “rationalizing”. Example: “I know I got high and made a fool of myself last night, but here’s why…”
P26 Minimizing is protecting ourselves from worry or anxiety about a problem by making it seem less important than it is. Example: “Yes, I’ve had withdrawal symptoms, but only the mild ones.” Defense Mechanisms Externalization is acting as though outside forces or circumstances cause us to act in self-destructive ways. Believing this, we do not have to take responsibility for our own behavior. Example: “I got high because she wouldn’t stop nagging me.” Intellectualization is the use of lengthy argument or small detail to distract from the task at hand. Example: “The outreach worker mispronounced immunodeficiency, so what could I possibly learn from him?”
P27 Much of the daily life of an addict centers around obtaining and using drugs. To do this successfully requires dedication and determination, much like a career. Everyday crises are those threats to the ongoing cycle of : 1. Getting money to buy drugs 2. Obtaining drugs 3. Using drugs At the same time, the life of a substance abuser is often full of multiple problems, any of which could require intense work to resolve. Let’s list the every day problems that an addict faces that might threaten an interruption in the drug-using cycle or cause a “crisis” Crisis and Street Life
P27 What are the every day problems that an addict faces that might threaten an interruption in the drug-using cycle or cause a “crisis”? Crisis and Street Life 1. Outreach Workers Dealer busted, etc. Incarceration Police No drugs available Weather Std’s/ Illness No $$$ Effective prevention educators must avoid getting caught up in these problems and, at the same time, intervene when appropriate with information and referrals
P28 Below is a list of types of addiction treatment programs that may exist in your area. As these are discussed, note any information that will assist in your referral of clients to treatment. Local Addiction Treatment Modalities 1. Detoxification 2. Inpatient Treatment 3. Therapeutic Communities 4. Halfway Houses 5. Methadone Maintenance 6. Outpatient Counseling 7. Self -help Programs Modality Services Provided
P29 To help us understand various aspects of sexuality and to assist us in building a common vocabulary for this workshop, the following key terms are defined below: Basic Definitions Gender - our maleness of femaleness, based on: Sex - sexual activity or behavior; what we do to express erotic feelings; what is meant when we say “having sex”. Gender assignment - the biological component of being male or female. Gender identity - the psychosocial expression of maleness or femaleness, often referred to as masculine or feminine and influenced by social norms.
P29 Basic Definitions Sexual Orientation - the manner in which we are oriented to have sex Sexuality - the experience of being sexual; whether male or female, encompassing behavioral, psychological, emotional, social, and orientation components. Homosexuality is when people are oriented to have sex only with people of the same gender. Heterosexuality is when people are oriented to have sex only with people of the opposite gender. Bisexuality is when people are oriented to have sex with people of either gender.
P30 Sexual Behaviors and Safer Sex Practices As prevention educators, we will discuss a variety of sexual behaviors with our clients. For the following terms that you and your clients may use to discuss sexual behaviors, indicate what body fluids may be present, and how the behavior may be altered in some way to become safer.
P30 Sexual Behaviors and Safer Sex Practices Term Body Fluids Present R.R. Precaution Scatting Sex with a virgin Fisting Rimming Fellatio Cunnilingus Necrophilia Red winging Anal sex Stump sex
P31 Decision making Steps 1. See the situation clearly: Use listening skills to determine all the elements of a crisis situation. 2. Know what the client wants: Encourage clients to set priorities and explore their own needs. 3. Expand the possibilities Help clarify priorities and add information and resources. 4. Evaluate and Decide: Examine options and strategize a plan of action including follow-up plans. 5. Take action: Responsible parties follow through on action plans and reassess.
P32 Crisis Intervention Many outreach workers will be “crisis managers”. A role that will require identifying immediate problems to be solved and the most appropriate person to do this. Workers must learn : time management skills strategy development where to find adequate resources how to help someone in a crisis situation determine if it is a crisis or an attempt to sidetrack
P32 Crisis Intervention In figuring out how to problem-solve, you may find it helpful to ask yourself the following questions: 1. How would you assess the presenting problem or need? 2. What would your goal be with this person? 3. What would your first step be with this person? 4. Would you need to make a referral? 5. What would you need to know to make the referral? 6. How would you make the referral?
P33 Intervention Scenarios Ramon, a 23-year-old, was one of your first contacts on the street. Through several weeks of seeing him, you have a feeling you have won him over. When you see him today, he tells you that he is working and “making some real money”, all “under the table.” He wants to know if you’ll lend him money to get a picture ID made so he can cash his checks. How would you help? Yvonne, an 18-year-old mother of two baby girls, sees you on the street and tells you how bad off her babies are. They haven’t been able to eat for a few days, plus the 6-month-old is still really sick. She wants you to help. How would you help? 1. 2.
P33 Intervention Scenarios Sibyl is a 30-year-old woman who tested positive on the HIV antibody test a few months ago. Since that time, she’s been shooting dope, dropped in and out of a treatment program (where she perceives she was poorly treated), been kicked out of her apartment, lost her job, been abandoned by her family, had continuing poor health, and remains unclear about her AIDS- related status. She relates this story to you and says she’s at her wit’s end. What would you do? Rocky is 18 years old and has survived on the streets since he ran away three years ago. He has been a willing contact for you on the streets and has taken the prevention message and tried to talk to others. Several weeks ago, looking tired and thin, Rocky told you he was thinking about entering a treatment program. He had been in a therapeutic community last year for his amphetamine and occasional heroin use. He split after a month. He says he wants to enter treatment now because he is not feeling well plus he has been harassed almost daily by two particular cops. They would stop him and confiscate his dope. Recently, they have been letting him keep his stuff, but now they some info from him. How would you help? 3. 4.
P34 Intervention Scenarios Annie is a 36-year-old whom you occasionally see during the late afternoon. Her contacts with you have been brief. Her knowledge about prevention, particularly with sexual activities, seems sold. She always takes any spare condoms you have to give her. Today, Annie seeks you out. Obviously, she has been beaten, and she tells you that she needs help. She has no place to live and only he clothes she is wearing. How would you help? Tiny is 41 years old and has been in methadone treatment for 6 years. However, too many dirty urines got him kicked off the program 2 months ago. From a street contact, you heard that Tiny overdosed nearly a month ago. He was taken to the emergency room at the city hospital. Once past the initial crisis, hospital staff, concerned about Tiny’s coughing and self reported weight loss, conducted several tests. He tested seropositive, and a bronchoscopy procedure showed evidence of pneumocystic carinii pneumonia. Tiny was treated for the pneumonia and released yesterday. He sees you on the street and wants help finding a place to stay. How would you help? 5. 6.
P35 Building Strategies for Conduct SCENARIOS - pages of your participant manual 1. What action would you take to handle this incident? 2. What are your reasons for taking these actions? 3. How do you decide what is the right or wrong course of action? 4. How could this incident have been prevented?
P36 Community Conduct Scenarios For 6 months, you’ve been working with a male contact and his wife. The wife is seropositive, but the husband has refused to be tested. They share needles and do not practice safe sex, claiming that “if one goes, we both go”. You see them everyday in the park and, in a friendly and non- threatening way, encourage them to practice risk reduction. They have been having a dispute with their apartment manager. The husband says he has a shotgun that he will use if the manager tries to evict them. What do you do with this information that will neither jeopardize your ability to work with these people nor compromise the safety of the apartment manager? 1.
P36 Community Conduct Scenarios You and your partner have just started working with a young female injection drug user, whom you have met several times near the corner store. She tells you that she is willing to practice safe sex, but that her boyfriend (whom you’ve never met) gets violent whenever she brings up the subject. You notice that every time you and your partner see her, she will only talk with you. In fact, she is starting to flirt with you and completely ignores your partner. You can no longer avoid the fact that she is “coming on” to you. Then she tells you that her boyfriend is very jealous and would KILL anybody he thought was messing around with her. She tells you that he is coming out of the store any minute. She asks you to stay and talk with him. How do you handle this opportunity to do outreach to a new and difficult client without risking physical violence? 2.
P37 Community Conduct Scenarios You are talking to a group of IV drug users informally while they are hanging out in an alley. Actually, you used to hang out with them, and you know them all. They start to shoot up and pas the needle around to you after they have cleaned it. When you refuse, the start to give you a hard time. The indicate that they won’t think you’re “cool” if you don’t accept their offer of a free hit and that maybe they won’t even listen to what you have to say about AIDS. How do you handle this situation? A hotel desk clerk, who has been one of your key contacts, calls you to complain about a female injection drug user living at the hotel. “She has AIDS and won’t stop tricking out in front of the hotel, especially when she’s on the run.” The desk clerk wants to know if she can have the woman arrested for “spreading AIDS around”. The drug user has not told you she has AIDS. The few times you have seen her working in the streets, she wouldn’t even take condoms from you. What is the law in this situation, and then how do you approach this woman? 3. 4.
P37 Community Conduct Scenarios Your new outreach program has been getting a lot of favorable attention from the media. It is your project’s policy to have media people meet with the project coordinator or director at the office first to establish the ground rules for filming your project out in the community. The ground rules are in writing. You have set up a table on a busy street corner, when a reporter and his film crew pull up and park across the street. You had been interviewed by this reporter last week - an “on the street” news piece that had been set up as per your project’s policy. The reporter comes over to you, while the camera films from across the street. The reporter explains that he now wants to talk to “real” drug users about the effectiveness of the program. The camera crew attracts a lot of attention out on the street, and your clients are trying to see if anyone wants to volunteer to shoot up in silhouette on camera. Everyone asks the reporter if he will pay for a bag and he agrees. When you start to object, the scene gets even hotter. How do you proceed? 6.
P37 Community Conduct Scenarios You are sitting in the local cafeteria, drinking coffee and talking to a male client whom you know fairly well. The police come in to make one of their periodic sweeps of the place. Just then, another guy sits down next to your client and passes him a bag under the table right in front of the police. What do you do? An antibody-positive female client who is an active drug user informs you that she is pregnant. You have been working with her for several months, and you have not been able to get her to go for any medical care or for a checkup. She wants you to tell her whether or not she should have an abortion. Child Protective Services have removed her three older children from her because of child abuse and criminal neglect. What do you tell her? A client asks you if you want to buy a brand new car stereo cd player with a detachable face along with some brand new speakers for $50. You don’t have a radio for your car. What do you do ?
P38 Community Conduct Scenarios You are talking with three injection drug users about safer needle practices. Another person, obviously drunk and high, begins shouting that you are a “narc” sent to set people up to get busted. He gets louder. The three drug users walk away. You are left to handle this man. As you walk away, he follows you and begins to curse at you. How do you proceed? During a talk on the streets, a man says to you, “We hear the rap, now move on, chump.” You want to keep talking because the others seem interested. The guy insists, “It’s time to move on.” He then slowly displays the handle of a pistol tucked in his pants. How do you proceed?