INDIVIDUAL COUNSELLING MODEL OF SERVICE supporting our communities through counselling services MARCH 2017
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AIDSACTIONCOUNCIL INDIVIDUAL COUNSELLING MODEL OF SERVICE
OUR PURPOSE
THE PURPOSE OF THIS DOCUMENT IS TO DEMONSTRATE THE VALUE AND EFFECTIVENESS OF THE AIDS ACTION COUNCIL’S COMMUNITY-DRIVEN COUNSELLING SERVICE MODEL. THE COUNCIL CARES ABOUT THE SUSTAINED AND EVOLVING WELLBEING OF PEOPLE LIVING WITH AND IMPACTED BY HIV AND MEMBERS OF THE LESBIAN, GAY, BISEXUAL, TRANSGENDER, INTERSEX AND QUEER (LGBTIQ) COMMUNITY. OUR COUNSELLING MODEL ADHERES TO THE COMMUNITY-BASED EVIDENCE OF WHAT WORKS FOR OUR CLIENTS. THE NEEDS OF OUR COMMUNITY UNDERPIN OUR COUNSELLING MODEL, SERVICE PHILOSOPHY, THERAPEUTIC APPROACH AND STAFFING COMMITMENTS.
OUR CELEBRATION OF A DIVERSE COMMUNITY
The Council’s core focus and strategic priority is to build strong, connected and supportive communities that are free of new HIV transmissions, marginalisation, discrimination and stigma2. The Council wants to improve community access to quality counselling care and support for people living with and impacted by HIV and the sex and gender diverse LGBTIQ community. The Council strives to meet the needs and values of our community.
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OUR COMMUNITY VALUES: INCLUSIVENESS AND RESPECT. LEADERSHIP AND COMMUNITY PARTNERSHIP.
STRENGTH, RESILIENCE AND EMPOWERMENT.
INTEGRITY AND PROFESSIONALISM.
GOOD WILL, CREDIBILITY, SAFETY AND TRUST. CONNECTION AND COMMUNITY OWNERSHIP.
OUR AIM THE AIM OF THE COUNCIL’S COUNSELLING MODEL IS TO: > Value, support and deliver a counselling service based on community need for inclusive, respectful, culturally relevant, individualised and professional counselling services. > Improve community access and engagement with a credible, trustworthy and safe community service free of marginalisation, discrimination and stigma2. > Represent community values of empowerment, resilience, strength, education and advocacy. > Improve the physical, psychological and social wellbeing of people who live with HIV or are sexuality or gender diverse. > Offer support from professional, qualified, accredited and community-focused counsellors who are supported with appropriate training and supervision. > Provide opportunities for student counsellors to experience, learn and contribute to the diverse needs of our community. > Encourage personal and community growth through nurture and a positive strengths-view of client potential and the opportunity for healthy outcomes. > To connect individuals with partner organisations to build strong, connected and supportive communities.
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AIDSACTIONCOUNCIL INDIVIDUAL COUNSELLING MODEL OF SERVICE
OUR CLIENTS Our community counselling service is needed to support an estimated 25 300 HIV positive people in Australia and the 11 in 100 Australians who identify as sex or gender variant or with diverse sexuality3. Our counselling services are provided to members of the community regardless of age, gender, sexual orientation, lifestyle choice, cultural background, religious belief or economic circumstances2.
PEOPLE LIVING WITH HIV ARE OUR PRIORITY 40% of our counselling clients are HIV positive. Our counselling services for people living with and impacted by HIV are free and prioritised. People who have been newly diagnosed with HIV will be provided a counselling appointment within one business day of contacting the service. The counselling service also works with those impacted by HIV including partners, family members, parents and children.
OUR CLIENT-BASE INCLUDES:
> People living with or impacted by HIV and people from high HIV prevalence countries. > LGBTIQ communities inclusive of clients who are sexuality or gender variant. > Aboriginal and Torres Strait Islander people. > Culturally and linguistically diverse people. > Men who have sex with men. > Sex workers. > People who inject drugs. > Referrals from partner organisations.
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WHY IS THE COUNCIL HERE? PEOPLE LIVING WITH OR IMPACTED BY HIV: THE FACTS AND FIGURES:
> People living with HIV report higher levels of socioeconomic depravation, social isolation (both in the LGBTIQ and broader communities), withdrawal from society, stigmatising behaviours and poor self-image2,13. > HIV positive people are at an increased risk of developing mental health issues. > The World Health Organisation [WHO] promotes counselling and psychosocial services as an integral part of health care for people living with or impacted by HIV14. There is evidence that community-focused HIV counselling works to promote inclusion, connectivity and wellbeing and reduces marginalisation2. > Our client intake data shows the demand for specialised HIV counselling increases every year2. Referrals from partner agencies are also increasing.
> The Council sees an increase in demand for relationship and family support including the needs of serodiscordant (positive and negative partners) couples.
LGBTIQ CLIENTS: THE FACTS AND FIGURES:
> The mental health and psychological safety of LGBTIQ people is among the poorest in Australia8. > 34% of LGBTIQ people hide their sexuality or gender identity when accessing support services for fear of discrimination, abuse and violence4.
> LGBTIQ people are more likely to suicide than the general population. Transgender people are nearly eleven times more likely to suicide12.
> At least 36.2% of trans and 24.4% of gay, lesbian and bisexual Australians met the criteria for experiencing a major depressive episode, compared with 6.8% of the general population 12.
> The rates of depression in gay men are disproportionally higher than the general population and the risk of depression or mood disorder is one and a half times higher on average among gay men 6,7.
> Issues such as coming-out and transition combined with stigma and discrimination create minority stress which is a real and traumatic experience for LGBTIQ people9.
> Health services and practitioners are poorly informed and have prejudicial attitudes about trans issues (including refusal of service or restricted pathways) and the realities of trans people’s lives and experiences5.
AUSTRALIANS MEETING THE CRITERIA FOR EXPERIENCING A MAJOR DEPRESSIVE EPISODE25
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36.2%
24.4%
6.8%
TRANSGENDER
GAY, LESBIAN AND BISEXUAL
GENERAL POPULATION.
AIDSACTIONCOUNCIL INDIVIDUAL COUNSELLING MODEL OF SERVICE
WHY IS THE COUNCIL NEEDED? PEOPLE LIVING WITH AND IMPACTED BY HIV BENEFIT FROM QUALITY SUPPORT SERVICES
Although HIV diagnoses have been declining in recent years, the Council has experienced an increasing need for counselling around HIV support, testing, treatment, sexual negotiation, education and advocacy. Counselling is helpful across many points in a HIV journey, including prior to testing, the time following a positive diagnosis, working through the implications of a diagnosis, managing relationships and quality of life choices into a positive future14. The counselling includes strategies for coping with the life adjustments of a HIV, the exploration of strengths and resilience and managing the normal feelings of fear, isolation, anger and confusion. There is also increasing community awareness and uptake of innovative treatment and sexual safety options such as pre-exposure prophylaxis [PrEP] and rapid home testing. Short-term counselling is considered critical in enhancing adherence to treatment regimens and promoting sexual safety and negotiation14.
THE COMMUNITY NEED FOR COUNSELLING SERVICES INCREASES EVERY YEAR
The Council is committed to improving the physical, psychological and social wellbeing of people who access the counselling service. Our 2015/2016 client contact data shows that the number of clients accessing our counselling service has risen by more than a quarter. The Council is well placed to serve the evolving counselling needs of our communities, especially at stressful points of transition and to bridge the service gaps within the mainstream counselling offering.
COMMUNITY ACCESS TO QUALIFIED, ACCREDITED, PROFESSIONAL AND CULTURALLY TRAINED COUNSELLORS
Our counsellors are qualified, accredited, professional and culturally competent. Our counsellors understand the challenges and strengths of the LGBTIQ and HIV positive community experience. Our counsellors recognise that clients’ have complex needs and it is constructive and positive for the client to engage partner agencies that have specialised skills (and shared community values) which may be appropriate for referral. The Council looks to coordinated client support pathways and partnership engagement to promote the prospects of sustained client recovery.
Counselling is helpful across many points in a HIV journey, including prior to testing, the time following a positive diagnosis, working through the implications of a diagnosis, managing relationships and quality of life choices into a positive future14.
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ACCESS TO NON-DISCRIMINATORY, NON-JUDGEMENTAL AND DE-STIGMATISED COUNSELLING
The Council provides an anonymized, confidential, inclusive and community-focused space for diverse community members to safely access counselling. The work of the Council is based on the values that underpin a nonjudgemental approach that is supportive of sexuality and gender variance or alternative ways of expressing sexuality or gender that may reside outside society norms. The Council recognises that the need for counselling in our community is often the result of the cumulative impact of discrimination, trauma, rejection and social prejudice that creates an experience of minority stress9.
SUPPORT FOR GENDER VARIANT CLIENTS
Being gender variant is not a biological or mental health issue, it is a human right. Differences in gender identity and a journey of gender transition are often accompanied with significant distress particularly access to compassionate and educated support services. The Council provides counselling support for gender variant clients including a focus on legitimisation, affirmative and strength-based support for people who may or may not choose to transition. The Council also recognises that it is not a specialist service for gender variant clients and these clients may require coordinated and supportive access/referral to a gender clinic or medical service.
OTHER CONTEMPORARY COUNSELLING ISSUES INCLUDE:
> HIV as a chronic but manageable illness.
> Using pre-exposure treatments (PrEP) or an undetectable viral load (UVL) as responsible sexual health negotiation. > Sexual, physical and emotional safety in a queer digital space. > Online apps and the safe disclosure of HIV status and/or gender or sexuality variance > Support for LGBTIQ community with relationship, parenting and domestic violence issues. > Support services for indigenous and culturally and linguistically diverse people. > Pornography, sex and online addictions. > Community ageing issues and age-appropriate services. > Referrals for accessing non-discriminatory medical care.
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AIDSACTIONCOUNCIL INDIVIDUAL COUNSELLING MODEL OF SERVICE
OUR ETHICS
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CONFIDENTIALITY
CLIENT AUTONOMY
The Council believes that all people have the capacity to grow, make positive changes and deserve an environment free of harm10. Our clients are invested in improving their wellbeing and the Council supports their capacity for self-initiated change. Our clients are expert in understanding their world and their lived experience. The Council also recognise that people are entitled to make mistakes and learn from them.
The Council holds confidentiality as an ethical value and priority10. Client details are either de-identified or electronically or manually secured. Under no circumstances are client details provided to referral agencies without explicit client consent.
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INTEGRITY
Counselling is both a professional and interpersonal relationship. Our counselling activities are undertaken with professional intent and are not incidental. Our counsellors work within a clearly contracted, principled relationship that respects the autonomy of the client 11. The Council always works towards positive and constructive client outcomes and a positive view of working toward discharge.
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OUR COUNSELLING TEAM QUALIFIED, ACCREDITED AND PROFESSIONAL
The Council employs a qualified, accredited and professional counselling team co-ordinated by a senior counsellor and qualified counselling supervisor. All counsellors are committed to clinical practice that sits within their qualifications and scope of practice. The Council works with professionals who are either accredited by, or working towards accreditation by these professional associations:
> Australian Counselling Association (ACA). > Psychological and Counselling Federation of Australia (PACFA). > The Australian Association of Social Workers (AASA). The counselling team also includes qualified community volunteer counsellors and counselling student placements through recognised tertiary institutions. All staff must comply with the AIDS Action Council’s Professional Code of Conduct. Counselling students are also subject to the code of conduct of their educational body.
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AIDSACTIONCOUNCIL INDIVIDUAL COUNSELLING MODEL OF SERVICE
STUDENT COUNSELLING PLACEMENTS
The Council is committed to supporting student counsellors through a structured and supervised program. Student counsellors make a valuable contribution to the counselling needs of people living with HIV and LGBTIQ clients. Students build both capacity within the service and provide valuable insight to improving the process and supporting the community. Our student program grows the expertise and experience of the mental health sector in a well-supported professional environment. The Council encourages students completing tertiary qualifications in counselling and people with recognised training and/or experience in counselling to complete a placement with the organisation. The Council is particularly interested in working with people who are passionate about working with LGBTIQ and gender variant communities, communities impacted by HIV, sex workers, people from high prevalence countries and people who inject drugs. The Council works with both the higher education institution and the student to create a placement that meets the strategic counselling objectives of the Council and the learning objectives of the student. The placement is flexible enough to cater for different supervision and direct client contact and professional development opportunities. The Council encourages students or academic supervisors who would like to work with the Council to approach us with their learning requirements.
COUNSELLING SUPERVISION
Counsellor supervision is an integral part of clinical practice ensuring the counsellor is regularly reviewed and developed. Access to skilled and professional supervisors enables practitioners to maintain their professional accreditation, develop their therapeutic skills, approach and practice. The supervisory process ensures the client receives the highest level of professional practice and standard of care. The Council uses a combination of internal and external supervisors, individual and group clinical supervision, academic supervision, confidential case reviews and a strong focus on reflective practice strategies to improve standards. Supervisors are registered members of professional counselling associations.
OUR SERVICE MODEL
Our current counselling model supports 25 hours per week of counselling services, however, demand exists for an expanded service 2. The Council promotes a wrap-around service model inclusive of communitydriven psychosocial support and referral to the Council’s support programs or other community-focused organisations. The Council initially provides short-term counselling for a period of six sessions but recognise there are clients who require a deeper and longer engagement. All client counselling is planned and structured with a view to improving wellbeing, a healthy discharge model and a positive exit from the service. Additional service contact hours are also available to clients, if in the future, they wish to re-access the service.
OUR SPACE
The Council provides a confidential counselling space which is welcoming, non-threatening and supported by the communities that are accessing them. Counselling is available between 10am and 4pm from Monday to Friday, with appointments also available on Thursday evenings and Saturday mornings.
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OUR COUNSELLING PROCESS CLIENT ENGAGEMENT AND INTAKE
A senior counsellor will make initial contact with the potential client and undertake a safe, inclusive and confidential assessment of their support needs. This initial conversation will include a discussion of presenting issues to ensure that the Council can provide the appropriate support to the individual.
AN INITIAL COUNSELLING MEETING
This meeting is the counsellor’s opportunity to meet with the client and is the starting point in building a mutually respectful and productive counselling relationship. This initial meeting connects the client with the counselling process, sets expectations and goals and develops the informed consent and interpersonal boundaries of a counselling relationship. An individualised case plan is developed and case notes are stored securely and confidentially.
OUR HOLISTIC THERAPEUTIC APPROACH
The Council’s counselling model celebrates diversity. As such, the Council’s therapeutic approach recognises that sexuality, gender diversity or HIV status is only part of a rich identity and clients often present due to the impact of stigma and discrimination rather than their specific sexuality. Our holistic approach accounts for needs across many areas including mental health issues, emotional distress, stigma and discrimination, sexual health and negotiation, employment, housing, substance use and support around parenting and reproductive choices. Therapeutic approaches for people living with HIV and LGBTIQ clients involves developing and validating empathic and affirmative strategies of resilience, strength and productive coping. To achieve this, the Council uses a range of therapeutic approaches but is ultimately guided by what will work best for the client. The Council recognises that the individual rather than the service is expert in their understanding their needs and livedexperience. Counselling approaches are unconditional, complementary, client-centred and flexible. An integrated therapeutic approach combining multiple modalities is proven to be more effective for the positive outcomes of diverse clients. Therapeutic approaches include, but are not limited to, person-centred therapy, cognitive behavioural therapy, transitional therapy, Gestalt therapy, solutions/strengths-based and/or affirmative therapy. The Council does not support approaches that focus on conversion or change therapy.
REVIEW
The organisation will regularly reflect on client progress and identify how successfully the counselling service and the organisation is engaging with the client. As part of the review process, there will be a supported conversation where the client identifies the strengths and limitations of the counselling engagement. This review may include referral of clients to other programs provided by the Council or referrals to other agencies and services.
Our holistic approach accounts for needs across many areas including mental health issues, emotional distress, stigma and discrimination, sexual health and negotiation, employment, housing, substance use and support around parenting and reproductive choices.
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AIDSACTIONCOUNCIL INDIVIDUAL COUNSELLING MODEL OF SERVICE
REFERRAL PATHWAYS TO THE COUNCIL:
Most people self-refer to the Council and are aware of our services through community contact. Our counselling service also accepts referrals from partners, family members and friends in addition to referrals from a range of community and partnership organisations including:
> Canberra Sexual Health Clinic. > HIV service referrals such as positive organisations and networks. > A Gender Agenda. > Relationships Australia. > Qlife. > General Practitioners, Psychologists and other Counsellors. Our Senior Counsellor responds to referrals within one business day of contact with the service.
REFERRAL PATHWAYS FROM THE COUNCIL:
Constructive referral relationships are made to a range of services provided by the Council itself and support services provided by other organisations. The Council provides in-house peer support services, workshops, information sessions and community connections. The Council will always get the client’s informed consent prior to referral to community and partner organisations. REFERRALS INCLUDE:
> The Council’s community and peer-based workshops, information sessions and peer support social functions. > The Council’s client services including peer support and case management. > Community connections through volunteer opportunities with the Council. > Testing clinics that are friendly to people who identify as LGBTIQ, sex workers and people who inject drugs. > Canberra Sexual Health Services. > Relationships Australia. > General Practitioners and other medical services.
ACKNOWLEDGEMENTS > AIDS Action Council of the ACT > ACT Government > Rebecca Vassarotti > Tom Skelton
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REFERENCES 1
AIDS.gov (changing to HIV.gov in 2017). (2016). Mental health. Retrieved from https://www.aids.gov/ hiv-aids-basics/staying-healthy-with-hiv-aids/takingcare-of-yourself/mental-health/
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AIDS Action Council. (2016). 2015/2016 annual report of the AIDS Action Council. Canberra, ACT: Author.
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Australian Federation of AIDS Organisations [AFAO]. (2017). HIV in Australia: 2017. Retrieved from https://www.afao.org.au/__data/assets/pdf_ file/0020/27803/AFAO-HIV-in-Australia-2017.pdf
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Australian Human Rights Commission. (2014). Face the facts: Lesbian, gay, bisexual, trans and intersex people. Retrieved from https://www.humanrights. gov.au/face-facts-lesbian-gay-bisexual-trans-and-intersex-people
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Ellis, S., Bailey, L., & McNeil, J. (2015). Trans people’s experiences of mental health and gender identity services: A UK study. Journal of Gay & Lesbian Mental Health, 19 (1), 1-17.
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King, M., Semlyen, J., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide and deliberate self-harm in lesbian, gay, and bisexual people. BMC Psychiatry, 8(70). doi: 10.1186/1471-244X-870
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Lyons, A. (2016). Mindfulness attenuates the impact of discrimination on the mental health of middle-aged and older gay men. Psychology of Sexual Orientation and Gender Diversity, 3(2), 227-235. doi: 10.1037/sgd0000164
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National LGBTI Health Alliance (2016). The statistics at a glance: The mental health of lesbian, gay, bisexual, transgender and intersex people in Australia. Retrieved from http://lgbtihealth.org.au/statistics/
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National LGBTI Health Alliance (2014). Working therapeutically with LGBTIQ clients: A practice wisdom resource. Retrieved from http://www.lgbtihealth. org.au/sites/default/files/practice-wisdom-guide-online.pdf
10 Psychotherapy and Counselling Federation of Australia [PACFA]. (2015). Interim code of ethics. Retrieved from http://www.pacfa.org.au/wp-content/uploads/2014/04/Interim-Code-of-Ethics-2015.pdf 11 Psychotherapy and Counselling Federation of Australia [PACFA]. (2015). Ethical standards. Retrieved from http://www.pacfa.org.au/practitioner-resources/ ethical-standards/ 12 Rosenstreich, G. (2013). LGBTI people: Mental health and suicide: Briefing paper (2nd ed.). Sydney, NSW: National LGBTIQ Health Alliance. Retrieved from https://www.beyondblue.org.au/docs/default-source/default-document-library/bw0258lgbti-mental-health-and-suicide-2013-2nd-edition. pdf?sfvrsn=2 13 Whetten, K., Reif, S., Whetten, R., & Murphy-McMillan, L. K. (2008). Trauma, mental health, distrust, and stigma among HIV positive persons: Implications for effective care. Psychosomatic medicine, 70(5), 531. doi:10.1097/PSY.0b013e31817749dc 14 World Health Organisation [WHO]. (n.d.). HIV/AIDS: Psychosocial support. Retrieved from http://www. who.int/hiv/topics/psychosocial/support/en/
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aidsaction.org.au
02 6257 2855 contact@aidsaction.org.au Havelock House 85 Northbourne Avenue (Gould Street entrance) Turner ACT 2612