MODULE 7

Counseling and Education

Resource Speaker
Designation
Counseling & Education
Objectives
• At the end of the module, you will be able to:
• Describe counseling
• Distinguish the stage of behavior change the mother/caregiver is in
• Perform the different skills necessary for counseling to be
successful
• Demonstrate the steps in counseling in different situations
Counseling
• Defined as giving advice and support to the caregiver and
other people concerned, to help them deal with problems and
make important decisions regarding nutritional conditions of
children less than five years old.

• Does not refer to counseling as professional guidance of the

individual by utilizing psychological methods especially in
collecting case history data, using various techniques of the
personal interview, and testing interests and aptitudes.
Key Concepts
• The mother/caregiver is a vital part of the recognition,
monitoring and treatment of a child with MAM and SAM.

• The healthcare worker should be well-equipped in counseling to

ensure that the messages are delivered across and the
procedures are properly done.
Evidence
Session 1.
Stages of Behavior Change
Objective:
At the end of the session, you will be able to describe and distinguish the stages of
behavior change the mother and/or caregiver is/are in regarding the care of the child
with severe acute malnutrition.
Stages of Behavior
Change
 Approach to Counseling in the
Different Stages of Behavior Change
Situation Behavior Approach to Counseling
Stage
Ana is the mother of Annie, Unaware Explain what SAM is to Ana.
identified to have SAM in a Explain the benefits of
routine community visit by the identifying SAM.
health worker
 Approach to Counseling in the
Different Stages of Behavior Change
Situation Behavior Approach to Counseling
Stage
Juana is the mother of Juanito, Thinking Encourage Juana to go to the
just identified to have SAM and about it OTC to learn more about how
is now being told that she has her child can be treated.
to bring her daughter to the
OTC. She is aware of SAM
Identify the reasons or
from talking to her neighbor,
problems why she is hesitant
Ana, whose child Annie was
identified to have SAM the to go to the OTC and discuss
week before. these with her
 Approach to Counseling in the
Different Stages of Behavior Change
Situation Behavior Approach to Counseling
Stage
Teresa is the mother of Trying it Encourage Teresa to continue
Teresita, a child identified to the visits to OTC until her child
have SAM and brought to becomes well. Praise her for
OTC for the first time and her persistence and effort.
Identify and solve any
is being counseled to come
problems that might prevent
for succeeding visits her from continuing bringing
Teresita to OTC.
 Approach to Counseling in the
Different Stages of Behavior Change
Situation Behavior Approach to Counseling
Stage
Liza is the mother of Lizzie, Maintaining Praise Liza for continuing to
who was identified to have it care for Lizzie.
SAM and brought to OTC but Explain to her why there is a
has to be brought to ITC after need to carry on the
2 weeks because she was management further. Identify
not responding adequately. and solve any problems that
might prevent her from
continuing care.
END OF SESSION 1
Session 2.
Counseling Skills
Objectives:
At the end of the session, you will be able to describe the different skills
necessary for counseling to be successful:
• Establishing rapport
• Active listening
• Asking the right questions
• Giving advice
• Ensuring understanding
• Helping the mother formulate a plan and/or solution
• Breaking the bad news
Skills for Establishing Rapport

• Be friendly and respectful

• Speak in a gentle voice
• Talk to the mother/caregiver and the whole family, if necessary
• Explain the reason for talking to her (e.g. why you are doing a home visit)
Skills for Asking and Listening

• Ask open-ended questions rather than closed-ended questions

• Show that you are listening
▪ Body language
▪ Eye contact
▪ Reflect back
▪ Empathize
▪ Do not use judgmental words
Skills for Giving Relevant Information

• Accept or acknowledge what the woman thinks or feels

• Give a little, relevant information at a time based on the present
situation
oTell a story
oMake suggestions instead of commands
oGive information in short sentences and use simple language
Skills for Checking Understanding

• Check understanding using open-ended questions

• Praise when appropriate
Skills for Helping Mother Formulate
Solutions to the Problem
• Discuss what the mother, caregiver and the family plan
to do
• Together, try to solve any problems the mother, the
caregiver or the family have in adopting a behavior
Breaking the Bad News

• Sometimes it is necessary to relay bad news (e.g. worsening

condition that needs referral, death)
• How you give the news will affect their acceptance
• Use non-verbal communication
o Be kind and gentle
o Allow the mother to react in her own way
o If the mother is sitting down, sit down with her
o Touch her appropriately
o Do not leave the mother alone
Breaking the Bad News

• Use verbal skills

o Use simple non-technical terms
o Give her time to ask questions
o Speak softly
o Respect her cultural beliefs and customs
o Ask if there is anyone near the hospital/clinic who can be with
her
o Express regret
Summary

• Definition of counseling
• Stages of behavior change in the caregiver
• Different skills necessary for counseling to be successful
• Steps in counseling in different situations
ANY QUESTIONS?
END OF SESSION 2
Session 3.
Practicing Community
Counseling Skills
Objectives:
At the end of the session, you will be able to demonstrate the steps in counseling the
mother and/or caregiver in different situations involving the child with MAM and SAM:
•Identification of a child with MAM and SAM
•Decision-making for appropriate management
•Identification of a child needing immediate emergency care
•Counseling the mother whose child did not meet admission criteria for SAM
•Counseling the mother whose child did not survive
Roleplaying: Cases
Roleplaying Guidelines

• Divide into 3 groups; 1 case will be assigned to each

group
• 15 minutes to prepare
• 5 minutes presentation time
Case 1
• Juana is the mother of Juanita, just identified to
have SAM and is now being told that she has to
bring her daughter to the OTC.
• She is aware of SAM from talking to her
neighbor, Ana, whose child Annie was identified
to have SAM the week before.
Case 2
• Paula is the mother of Paulette who was
screened in the community.She did not meet the
admission criteria for SAM but had a MUAC of
12cm.
What are the key messages that you need to
convey, and describe the counseling approach that
you will do.
Case 3
• Lyn is the mother of Lynette who was screened
to have SAM and was found to be with severe
breathing difficulty. Lyn was advised to bring
Lynette to the hospital but the child died in the
ambulance.
What are the key messages that you need to
convey, and describe the counseling approach that
you will do.
Guide Questions

• Apply what you have learned in past modules:

• What key steps and concepts should be evident in the roleplaying?
• What counseling techniques should be used in these situations?

• Groups will comment and evaluate each others’ presentations:

• What are the similarities/differences from your own experience?
• What went well?/What could be improved?
• What are changes needed in your current set-up for the program to be
successful?
ROLEPLAYING