Session 9

COUNSELING and FOLLOW-UP

Learning Objectives
By the end of this session, the student will be able to: (1) describe the basic principles in counseling; (2) explain the different steps or approaches in counseling; (3) enumerate the guide or tips for effective counseling; (4) describe the elements of follow-up care; and (5) explain how to provide follow-up care

Session 9-a

Counseling

Good Communication
 reassure

mother that the child will receive good care of home treatment depends on how well you communicate with the child’s mother

 success

needs to know how to give treatment and understand the importance of treatment

Use Good Communication Skills

♥ ♥ ♥

ASK and Listen to find out what the child’s problems are and what the mother is already doing PRAISE the mother for what she has done well ADVISE her how to care for her child at home CHECK the mother’s understanding

Advise mother how to care for her child at home
When Teaching:  use words s/he understands  use teaching aids that are familiar  give feedback when s/he practices, praise what was done well and make corrections  allow more practice, if needed  encourage the mother/caretaker to ask questions and then answer all questions

3 Basic Teaching Steps
1.

Give information Show an example Let her practice

3.

5.

Give information
 Explain

to the mother how to do the task. For example: – How to apply eye ointment – Prepare ORS – Soothe the throat

Show an Example
 Show

how to do the task. For example: – How to hold a child still and apply eye ointment – Mix ORS solution, or – Describe how she will prepare a safe remedy to soothe the throat

Let her practice
 the

most important part of teaching a task  the mother is more likely to remember something that she has practiced than something she has heard

Good Communication Skills
Check the mother’s understanding ♥ avoid asking leading questions and questions answerable with a simple yes or no ♥ good checking questions describe WHY, HOW or WHEN she will give treatment ♥ give the mother time to think and then answer ♥ praise the mother for correct answers ♥ if she needs it , give more information, examples, or practice

Good Communication Skills
Teaching to treat local infections at home:

explain what the treatment is and why it should be given ♥ describe the treatment steps listed on the TREAT charts ♥ watch the mother do the first treatment ♥ tell her how often to do the treatment at home ♥ if needed, give the mother the tube of tetracycline ointment or a small bottle of gentian violet ♥ check the mother’s understanding before she leaves

Good Communication Skills and Counseling
Teach the caretaker to give oral drugs at home:
♥ ♥

♥ ♥

determine the appropriate drugs and dosage for the child’s age or weight tell the mother the reason for giving the drug including: why you are giving the drug and what problem is it treating demonstrate how to measure a dose ask the mother to give the first dose to her child

Good Communication Skills and Counseling
Teach the caretaker to give oral drugs at home:  ask the mother to give the first dose to her child.  explain carefully how to give the drug, then label and package the drug.  if more than one drug will be given, collect, count and package each drug separately.

Good Communication Skills and Counseling
Teach the caretaker to give oral drugs at home:  explain that all the oral drug tablets or syrups must be used to finish the course of treatment, even if the child gets better;

check the mother’s understanding before she leaves the clinic.

Session 9-b

Follow-up Care

A. Immediately
Advise to return immediately if the child has any of these signs Any sick child
Not

able to drink or drink or breastfeed Becomes sicker Develops a fever
Fast

If the child has no pneumonia: cough or cold, also return if: If the child has diarrhea, also return if:

breathing Difficult breathing
Blood

in stool Drinking poorly

B. Follow-up visit table
If the child has: Pneumonia Dysentery Malaria, if fever persists Measles with eye or mouth complications Persistent diarrhea Acute ear infection Chronic ear infection Feeding problems Any other illness, if not improving Pallor Very low weight for age Return for follow-up in: 2 days

5 days

14 days 30 days

C. Next well-child visit
 Advise

when to return for the next immunization according to the immunization schedule

Follow-up care
 If

the child does not have a new problem, use the IMCI follow-up instructions for each specific problem: – assess the child according to the instructions – use the information about the child’s signs to select the appropriate treatment – give the treatment

Follow-up care

see if the child is improving on the drug or other treatment that was prescribed may need to try a second-line drug

For follow-up visit
If the child has:
   

Return for follow up not later than:

Pneumonia Dysentery Malaria, if fever persists Fever malaria unlikely or uncomplicated fever, if fever persists Measles with eye or mouth complications

2 days

For follow-up visit
If the child has:
    

Return for follow-up:

Persistent diarrhea Acute ear infection Chronic ear infection Feeding problem Any other illness, if not improving

5 days

For follow-up visit

If the child has: Pallor Low (very low) weight for age

Return for follow-up: 14 days 30 days

When to Return Immediately
For young infants age 1 week up to 2 months:  breastfeeding or drinking poorly  becomes sicker  develops fever  fast breathing  difficult breathing  blood in the stool

When to Return Immediately
For children age 2 months to 5 years:
If the difficult breathing child has NO PNEUMONIA (COUGH or COLD), ask them to return, if there is:  fast breathing If the child has diarrhea, also return if:  blood in stool  drinking poorly

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