Oduction ToBasic Counselling Andunication Skills:or Unity .

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The opinions expressed in the report are those of the authors and do not necessarily reflectthe views of the International Organization for Migration (IOM). The designations employedand the presentation of material throughout the report do not imply the expression of anyopinion whatsoever on the part of IOM concerning the legal status of any country, territory,city or area, or of its authorities, or concerning its frontiers or boundaries.IOM is committed to the principle that humane and orderly migration benefits migrants andsociety. As an intergovernmental organization, IOM acts with its partners in the internationalcommunity to: assist in meeting the operational challenges of migration; advanceunderstanding of migration issues; encourage social and economic development throughmigration; and uphold the human dignity and well-being of migrants.International Organization for Migration17 route des Morillons1211 Geneva 19SwitzerlandTel: 41.22.717 91 11Fax: 41.22.798 61 50E-mail: hq@iom.intInternet: http://www.iom.intISBN 978-92-9068-531-9 2009 International Organization for Migration (IOM)All rights reserved. No part of this publication may be reproduced, stored in a retrievalsystem, or transmitted in any form or by any means, electronic, mechanical, photocopying,recording or otherwise without the prior written permission of the publisher.20 09

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ContentsAcknowledgements.7Introduction.9How to use this manual. 11Who should use this manual. 13Day One. 15Session 1: Introduction to pandemic influenza. 17Session 2: Introduction to counselling. 29Session 3: The Six Step Process for counselling. 33Session 4: Counselling and confidentiality. 39Day Two. 43Session 5: Basic communication andcounselling skills. 45Session 6: Session planning. 55Session 7: Using the Six Step Process. 59Session 8: The Six Step Process. 67Day Three. 73Session 9: The Six Step Process. 75Session 10: Coping during a crisis. 85Day Four. 97Session 11: Bereavement and anger. 99Session 12: Closing the training. 107Conclusions. 109Evaluation of the training. 111Bibliography. 113Glossary. 1155

AcknowledgementsAcknowledgementsIOM would like to acknowledge the financial support of USAID tothis project through the Central Fund for Influenza Actions (CFIA).We also want to acknowledge the work of Mrs Rahele Malança,a psychologist contracted by IOM to work on the development ofthis manual with the project coordinator Dr Anita A. Davies, projectassistant Mr Roberto Pitea, Ms. Chiara Frattini and Ms Abigail Frankan intern with IOM.We would also like to acknowledge IOM staff who were involvedin the review of this document: Dr Nenette Motus, Dr SajithGunaratne, Ms Jaqueline Weekers and Ms Valerie Hagger.This manual has been drawn from a wide variety of sources,including other manuals and field guides, as well as documents andarticles produced by IOM Member States, regional and countryoffices.7

IntroductionIntroductionThis manual was developed and tested as part of the IOM pandemicpreparedness for migrants and host communities project. Themanual was designed to assist children, adolescents, adults andfamilies living in migrant and host communities and help them copeduring and in the aftermath of a pandemic.It is important to understand that, people handle difficult situationsdifferently and not all members of a community will cope in thesame way. People will experience a wide range of reactions whenexposed to distressful events, ranging from the mild to the severe.Some can be amazingly resilient. When a group of people share adifficult experience, some are able to work through it and move onwith their lives, while others require more support.The purpose of this training is to revise and strengthen yourcounselling skills, skills you may not even be aware you possess, aswell as refine your communication skills. We will review the stepswe use in the process of counselling and practice them in varioussituations.We must realize that for many individuals in both host and migrantcommunities, this may not have been their first exposure to trauma.However, a previous experience of responding to similar situationsand the ability to recuperate can often be used as a stimulus inovercoming their present situation.9

How to usethis manualThe training is based on the full interaction and involvement of allparticipants in the training and aims to promote the ownership of itsmessages.The trainer should ensure that all participants are fully involved inthe training and are offered opportunities to talk on the variousissues under consideration. Group work should help facilitate suchinteraction. The composition of groups should be periodicallychanged to allow maximum levels of exchange. Each group shouldselect a reporter on a rotating basis so that every participant is giventhe opportunity to report in plenary.Every effort should be made to have a balanced genderrepresentation throughout the training. It is essential that seatingarrangements facilitate face-to-face discussion and group work tomotivate the participants. Ideally each group - five to seven peoplemaximum - should work around a table and the tables should bearranged in order to avoid the “back to school” image of rows.The trainer’s posture and approach should also be informal and nottraditional lecturing. The times suggested can be modified at thediscretion of the trainer.The Manual is organized in sessions. Each end of session is met witha break. Handouts for each session are described within the text.You will also note that there will be discussion points, role play andtime for feedback.11How to use this manualThis manual should be used in a highly participative way.

In order to deliver the training, trainers should have the followingequipment at their disposal:Introduction to Basic Counselling and Communication Skills: IOM Training Manual For Migrant Community Leaders and Community Workers flip chart for the trainer and one for each working group;coloured markers;tape;clock or watch;Post-It notes/ small pieces of paper;name tags;the first day: two wash basins, one with clean water, a bar ofsoap and either a towel or paper towels; each participant should be provided with a notebook and apen.12

Who should usethis manual?This manual can be used in a variety of settings such as institutionsor communities.The trainer should provide the following information at thebeginning of the training: time schedule;individual responsibilities in the trainers’ team;administrative and financial procedures;emergency procedures;parking, transportation, food and other facilities;possible social events.13Who should use this manual?This manual is for the training of development, community health orother humanitarian workers who engage with migrants and mobilepopulations.

Day One8:30 – 9:00RegistrationSession 19:00 – 9:209:20 – 9:509:50 – 10:0010:00 – 11:0011:00 – 11:1511:15 – 11:351. Welcome and introduction2. Getting to know each other3. Training objectives4. Introduction to pandemic influenza5. Hand washingBreakSession 211:35 – 12:2012:20 – 12:3012:30 – 13:301. Introduction to counselling2. Aims of counsellingLunch breakSession 313:30 – 14:3014:30 – 15:0015:00 – 15:201. The Six Step Process for basic counselling2. Principles of basic counsellingBreakSession 415:20 – 15:5015:50 – 16:2016:20 – 16:4516:45 – 17:001. Counselling role play2. Confidentiality3. Confidentiality role play4. Summary of the day15Day OneAgenda

Introduction to Basic Counselling and Communication Skills: IOM Training Manual For Migrant Community Leaders and Community WorkersDay One: Objectives To get to know each other To introduce the concept of an influenza pandemic To demonstrate proper hand washing techniques for diseaseprevention and control To explain to members of the community the importance ofproper hand washing techniques for disease prevention andcontrol To identify the concepts of basic counselling To define confidentiality16

Session 1: Introduction to pandemic influenza2. Getting to know each other .30 minutesThis exercise will allow the participants to get to know each otherand become familiar with the training environment.TRAINER: Ask each participant to introduce himself/herself with thefollowing:NameWhere you are fromYour organizationYour job title and responsibility Make sure each participant has a visible name tag3. Training objectives.10 minutesTRAINER:Refer to Handout 1: Training objectives Discuss the objectives with the group and answer anyquestions. Ask the participants what they think they are going to learn inthis course? List the responses on the flip chart and explainthat we will refer to this list at the end of the course. Should anyone mention expectations that you know will notbe met in the course, this is the time to explain that and why.17Session 11. Welcome and introduction.20 minutes

4. Introduction to Pandemic Influenza.1 hourTRAINER:Refer to Handout 2: Things to know about pandemic influenza5. Hand washingIntroduction to Basic Counselling and Communication Skills: IOM Training Manual For Migrant Community Leaders and Community WorkersRefer to Handout 3: Hand Washing(15 minutes)List Key Messages :1.2.3.TRAINER:Hand out Post-It notes or small pieces of paper. Ask participantsto list one new thing that they have learnt today. Collect andstick them on the flip chart and later read them aloud to ensureparticipants understood the materials.TRAINERBreak time: 20 minutesRemind participants the time the next session starts. Tell them youwill start on time.Remind participants where toilets and other facilities are to befound.18

Handout 1: Training Objectives19Session 1 To be able to define and describe a pandemic. To be able to raise awareness of the importance of effectivehygiene in a pandemic situation. To be able to describe the concept of counselling. To be able to employ effective counselling skills. To be an effective communicator while counselling. To understand and respect the rights and responsibilities of allthose concerned.

Handout 2: Things to know about pandemicinfluenzaPandemic influenza is a new type of influenza virus. It is not seasonalinfluenza or avian influenza or swine influenza.Introduction to Basic Counselling and Communication Skills: IOM Training Manual For Migrant Community Leaders and Community Workers1. Seasonal influenzaSeasonal Influenza is an acute viral infection that spreads easily fromperson to person.Influenza circulates worldwide and can affect anybody in any agegroup.Influenza causes annual epidemics that peak during winter intemperate regions.Influenza is a serious public health problem that causes severeillnesses and deaths for higher risk populations.An epidemic can take an economic toll through lost workforceproductivity, and strain health services.Vaccination is the most effective way to prevent infection.2. H5N1 influenza (Avian influenza)Avian influenza refers to a large group of different influenza virusesthat primarily affect birds. On rare occasions, these bird viruses caninfect other species, including pigs and humans. The vast majority ofavian influenza viruses do not infect humans. An influenza pandemichappens when a new subtype emerges that has not previouslycirculated in humans.For this reason, avian H5N1 is a strain with pandemic potential,since it might ultimately adapt into a strain that is contagious amonghumans. Once this adaptation occurs, it will no longer be a birdvirus--it will be a human influenza virus. Influenza pandemics arecaused by new influenza viruses that have adapted to humans.20

3. H1N1 influenza (Swine influenza)Swine influenza refers to a large group of different influenza virusesthat primarily circulate among swine. Although these virusesnormally infect swine only, on some occasions they cross the speciesbarrier and infect humans. When a new subtype able to spread fromperson to person emerges, it can cause an influenza pandemic ashumans have no immunity that protects them.4. Pandemic influenzaAn influenza pandemic occurs when a new influenza virus emergesand starts spreading easily around the world from person to person.Because the virus is new, the human immune system will have nopre-existing immunity. This makes it likely that more people will getill with pandemic influenza, and will have more serious disease, thanhappens with normal influenza.5. Influenza pandemics are recurring events.An influenza pandemic is a rare but recurrent event. Threepandemics occurred in the previous century: “Spanish influenza”in 1918, “Asian influenza” in 1957, and “Hong Kong influenza” in1968. The 1918 pandemic killed an estimated 40–50 million peopleworldwide. That pandemic, which was exceptional, is consideredone of the deadliest disease events in human history. Subsequentpandemics were much milder, with an estimated 2 million deaths in1957 and 1 million deaths in 1968.A pandemic occurs when a new influenza virus emerges and startsspreading as easily as normal influenza – by coughing and sneezing.Because the virus is new, the human immune system will have nopre-existing immunity. This makes it likely that people who contractpandemic influenza will experience more serious disease than thatcaused by normal influenza.21Session 1For this reason, swine H1N1 is another strain with pandemicpotential, since it might ultimately adapt into a strain that iscontagious among humans. Once this adaptation occurs, it will nolonger be a swine virus--it will be a human influenza virus. Influenzapandemics are caused by new influenza viruses that have adapted tohumans.

6. All countries will be affected during a pandemic.Introduction to Basic Counselling and Communication Skills: IOM Training Manual For Migrant Community Leaders and Community WorkersOnce a fully contagious virus emerges, its global spread isconsidered inevitable. Countries might, through measures such asborder closures and travel restrictions, delay arrival of the virus, butcannot stop it. The pandemics of the previous century encircled theglobe in six to nine months, even when most international travelwas by ship. Given the speed and volume of international air traveltoday, the virus could spread more rapidly, possibly reaching allcontinents in less than three months.7. Widespread illness will occur.Because most people will have no immunity to the pandemic virus,infection and illness rates are expected to be higher than duringseasonal epidemics of normal influenza. Current projections for thenext pandemic estimate that a substantial percentage of the world’spopulation will require some form of medical care. Few countrieshave the staff, facilities, equipment, and hospital beds needed tocope with large numbers of people who suddenly fall ill.8. Medical supplies will be inadequate.Supplies of vaccines and antiviral drugs – the two most importantmedical interventions for reducing illness and deaths during apandemic – will be inadequate in all countries at the start of apandemic and for many months thereafter. Inadequate suppliesof vaccines are of particular concern, as vaccines are consideredthe first line of defence for protecting populations. On presenttrends, many developing countries will have no access to vaccinesthroughout the duration of a pandemic.9. Large numbers of deaths will occur.Historically, the number of deaths during a pandemic has variedgreatly. Death rates are largely determined by four factors: thenumber of people who become infected, the virulence of thevirus, the underlying characteristics and vulnerability of affectedpopulations, and the effectiveness of preventive measures. Accuratepredictions of mortality cannot be made before the pandemicvirus emerges and begins to spread. All estimates of the number ofdeaths are purely speculative.22

WHO has used a relatively conservative estimate – from 2 millionto 7.4 million deaths – because it provides a useful and plausibleplanning target. This estimate is based on the comparatively mild1957 pandemic. Estimates based on a more virulent virus, closerto the one seen in 1918, have been made and are much higher.However, the 1918 pandemic was considered exceptional.10. Economic and social disruption will be great.11. Every country must be prepared.WHO has issued a series of recommended strategic actions forresponding to the influenza pandemic threat. The actions aredesigned to provide different layers of defence that reflect thecomplexity of the evolving situation. Recommended actions aredifferent for the present phase of pandemic alert, the emergenceof a pandemic virus, and the declaration of a pandemic and itssubsequent international spread.12. WHO will alert the world when the influenza pandemic threatincreases.WHO works closely with ministries of health and various publichealth organizations to support countries’ surveillance of circulatinginfluenza strains. A sensitive surveillance system that can detectemerging influenza strains is essential for the rapid detection of apandemic virus.23Session 1High rates of illness and worker absenteeism are expected, andthese will contribute to social and economic disruption. Pastpandemics have spread globally in two and sometimes three waves.Not all parts of the world or of a single country are expected to beseverely affected at the same time. Social and economic disruptionscould be temporary, but may be amplified in today’s closelyinterrelated and interdependent systems of trade and commerce.Social disruption may be greatest when rates of absenteeismimpair essential services, such as power, transportation, andcommunications.

13. Pandemic influenza phasesSix distinct phases have been defined to facilitate pandemicpreparedness planning, with roles defined for governments,industry, and WHO.FigurePANDEMIC INFLUENZA PHASESIntroduction to Basic Counselling and Communication Skills: IOM Training Manual For Migrant Community Leaders and Community WorkersPHASE 5-6/PANDEMICPHASE 4POST PEAKPOSTPANDEMICPHASES 1-3TIMEPREDOMINANTLYANIMALINFECTIONS:FEW HUMANINFECTIONSSUSTAINEDWIDESPREADHUMAN TOHUMANHUMANINFECTIONTRANSMISSIONPOSSIBILITYOF RECURRENTEVENTSDISEASEACTIVITY ATSEASONALLEVELSSource: WHO 2009.14. Influenza symptomsFlu is characterized by rapid onset of respiratory and generalizedsigns and sy

Introduction to Basic Counselling and Communication Skills: IOM Training Manual For Migrant Community Leaders and Community Workers Handout 2: Things to know about pandemic influenza Pandemic influenza is a new type of influenza virus. It is not seasonal influenza or avian influenza or swine influenza. 1. Seasonal influenza Seasonal Influenza is an acute viral infection that spreads easily .

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