https://www.slideshare.net/COREGroup1/priotizing-behaviors-for-scalable-intregrated-and-quality -- Packard

1. Food and Nutrition Technical Assistance III Project (FANTA)
FHI 360 1825 Connecticut Ave., NW Washington, DC 20009
Tel: 202-884-8000 Fax: 202-884-8432 Email: fantamail@fhi360.org
Website: www.fantaproject.org
TACKLING THE “C” IN NACS
IPC FOR NUTRITION ASSESSMENT, COUNSELING,
AND SUPPORT
MARY PACKARD
TECHNICAL ADVISOR, SOCIAL AND BEHAVIOR
CHANGE
CORE Group Global Health Practitioner Conference
April 20 – 21, 2017

2. FANTA: Food and Nutrition Technical
Assistance III Project
NACS
A client-centered approach to
deliver nutrition assessment,
counseling, and support
along the continuum of care
in facility and community
settings.

3. Improving the “C” in NACS
NACS
connections
client-centered
contextualized
COUNSELING
It’s a CHALLENGE!

4. Weaknesses identified
• TMI: too much information
• Not enough asking and listening
• Neglect of barriers and benefits most salient for client
• Use of visual aids is weak, with little to no training
• Weak or absent supportive supervision and coaching
Biggest problem: the way counseling gets defined

5. Guiding principles
• Distinguish between the content of counseling vs. the
delivery (the “what” vs. the “how”)
• Effective counseling is: client-centered
context sensitive and
action oriented.

6. FANTA’s Counseling Model: the “how”
ASK open
questions and
LISTEN to the
client
PRIORITIZE
the client’s most
important
problems
EXPLAIN
with client
TEACH BACK
SUGGEST
and DISCUSS
what the client
can do
PLAN
and AGREE on
action steps
1. How have you been feeling?
2. What have you been eating?
3. How is your treatment
going?
4. What do you
understand?
5. What makes it hard to do ____?
6. What/who can support you to do
_____?
GREET the client SHOW kindness and respect
?

7. FANTA’s competency based training method
• Practice in role play triads
• Repeat practice of key skills, building upon each other
• Use checklists to focus on the target skills and structure
feedback
• Have actual clients come into workshop for practice
• Practice in the field on the last day if possible
• Follow up coaching & mentoring

8. Sample checklist
for Session 1 on “asking & listening”
During the counseling session…
1 How many open-ended questions did the counselor ask?
Did the counselor… Y N
2 Ask about diet?
3 Ask about medication?
4 Ask about symptoms?
5 Ask clarifying questions?
6 Use reflective listening (reformulate what client said)?

9. How to put the brakes on “telling”?

10. During the counseling session…
1 How many questions did the counselor ask before starting to
give information or advise the client?
Did the counselor… Y N
2 Verify client’s understanding of information presented?
3 Have client identify goal?
4 Have client consider possible action steps toward goal and
choose one to try?
5 Ensure client feels confident she or he can take that action (if
not, choose another)?
6 Make referrals and/or schedule next appointment?
Checklist for Session 4 on action planning

11. When full counseling is not possible…
• Real-world limitations to
implementing quality
counseling
• BMI wheel as a gateway to
counseling

13. • You can live long and well with HIV or TB if you take
your medicine every day.
• If you skip doses, the medicine may stop
working and you can get sick.
• Your health care provider can help
you manage side effects of
medicines.
• Living with infection means your body needs regular care
to stay well.
• Do not miss your regular checkups.
• Go to the clinic whenever you feel sick.
• Ask health care providers to
connect you with other helpful
services and support.
• A nutritious diet is powerful
support for good health.
• Different foods help you in different
ways, so eat a variety from all the food
groups.
• Do not eat “junk” foods, which do not help your
body in any way.
• Eating well means eating enough, eating a variety of
foods, and avoiding junk food.
• Germs are too small to see, but
they can make you sick with
diarrhea and other illness.
• You can stop germs from getting into
your body and making you sick.
• Drink only boiled or treated water.
• Do not defecate in the open. Use a latrine.
• Wash hands with flowing water and soap or ash after
passing stool and before eating or cooking.
• Keep food covered and cooking tools clean.
FANTA’s Core Needs Graphic

14. Results
• Zambia – evaluation underway to document impact of
enhanced counseling initiative
• Nigeria – value of even limited counseling with visual aids
• Côte D’Ivoire – full, enthusiastic adoption of the 3-day
counseling training package
• Malawi, Mozambique, Lesotho – adopting and adapting job
aids and training approaches
Common feedback: people love practical!

15. In conclusion
Counseling may seem easy – but it’s not!
Great benefits to clients from counseling quality improvement
Key strategy for improvement:
1. SIMPLIFY & PRIORITIZE the content
2. Make the process more INTERACTIVE
Apply to both counseling and to training
Contact: mpackard@fhi360.org
Great resources at: https://www.fantaproject.org/