Valuable Conversations: training resources
In counselling, the aim of reflective practice is to discover our own experiential knowledge:
- knowledge gained from reflection-ON-action; the ability to think about something you have done e.g. within supervision
- knowledge gained from reflection-IN-action; the ability to think about, modify, test, and remodify what you are doing when you’re doing it.
Service providers who consistently practice self-reflection and self-awareness appear to be able to manage complex clients who might otherwise trigger negative reactions in the worker.
Fetal Alcohol Spectrum Disorder Information
- Fetal Alcohol Spectrum Disorder (FASD) is caused by Prenatal Alcohol Exposure (PAE).
- Diagnosis is a multidisciplinary, time intensive process.
- Shaming women about their alcohol use stops engagement for behaviour change and/or accessing support.
- The impact of PAE is difficult to predict and can be lifelong.
- The National Health and Medical Research Council (2020) recommends:
- women who are pregnant or planning a pregnancy should not drink alcohol; and
- for women who are breastfeeding, not drinking alcohol is safest for their baby.
Links to useful FASD resources:
- Valuable Conversations - Critical periods of fetal development
- FASDHub - Training and support
- Telethon Kids Institute - Fetal Alcohol Spectrum Disorder
- NoFASD - Australian Foundations in FASD Course
- National Health and Medical Research Council - Australian guidelines to reduce health risks from drinking alcohol (2020)
- Foundation of Alcohol Research and Education - Fetal Alcohol Spectrum Disorder
- Mental Health Commission - FASD training
- Feedsafe App
Trauma Informed Care and Practice
According to Poole (2013), becoming a trauma-informed service starts with acknowledging:
- The high prevalence of trauma.
- That trauma can impact on a person’s psychological and neurobiological development.
- People do the best they know how in order to survive; these adaptations are functional.
- Trauma, substance use, mental health and physical health problems are interrelated.
A shift in organisational culture:
- Affects all aspects of service delivery.
- Applies to all staff - not just clinicians.
- Must be embedded in policies, procedures and practice.
- Begins with a widespread recognition of the impact trauma has on mental health and alcohol and other drug use.
Trauma Informed Care and Practice principles:
- Safety: Throughout the organisation, the clients and staff should feel physically and psychologically safe; the physical setting is safe and interpersonal interactions promote a sense of safety.
- Trustworthiness and transparency: Organisational operations and decisions are conducted with transparency and with the goal of building and maintaining trust among everyone involved with the organisation, including clients. This involves creating clear expectations about what treatments will involve, who will provide services, and how care will be delivered.
- Voice and choice: The organisation aims to strengthen the experience of choice for the client. It recognises every person’s experience is unique and requires an individualised approach.
- Collaboration and mutuality: There is true partnering between staff and clients (to help ‘level out’ power differences), and staff recognise that healing can happen through relationships in: meaningful sharing of power; decision-making; and treatment planning.
- Empowerment: The individual strengths of the client are recognised, built on, and validated. New skills are developed as needed. Strengths are used to empower the client in the development of their treatment.
- Cultural, historical and gender issues: The organisation incorporates policies, protocols, and processes that are responsive to the racial, ethnic, and cultural needs of individuals served, that are gender responsive, and that incorporate a focus on historical trauma. It may also require an understanding of cultural security; including appropriate gender/roles of staff and clients.
Links to useful TICP resources:
- National Health Service - Trauma Informed Practice for the Workforce
- Weston and Thomas - FASD and complex trauma: a resource for educators (2018)
- FASDHub - FASD Language Guide (2019)
It is highly likely that people will feel ambivalent about a behaviour they know is harmful; that is, they will be aware of both positive and negative aspects of what they’re doing.
Motivational Interviewing (MI) is a counselling intervention in which the worker uses a client-centred, empathic approach in order to support the client to voice their own reasons for why they should change their behaviour.
The worker’s role in MI is to create a non-judgemental conversation in which their client can explore their own ambivalence.
Consider using the Spirit of MI, or CAPE:
- Compassion: to actively promote your client’s welfare and give priority to their needs.
- Acceptance: honouring and respecting each client’s autonomy; seeking to acknowledge their strengths and efforts. Acceptance does not mean approval.
- Partnership: an active collaboration between experts, acknowledging that your clients are the undisputed experts on themselves.
- Evocation: your clients already have within them much of what they need to make changes; choose a strengths-focused rather than deficit-focused approach.
The Righting Reflex is the service provider’s desire to fix what seems wrong with the client and to put them on a better course. Without reflective practice, the Righting Reflex can get in the way of practicing CAPE.
Remember to use micro-counselling skills of OARS:
- Open-ended questions are brief questions that produce IN DEPTH answers. This invites partnership and collaboration.
- Affirmation by acknowledging clients’ strengths or action; many clients are failed self-changers who may feel demoralised or at least doubtful that change is possible. Affirmations are sincere and usually offered sparingly.
- Reflections are client-centred with a focus of listening to and understanding the client’s dilemma. The primary goal should be to see the situation from the client’s perspective.
- Summaries are a form of reflective listening and are useful to:
- communicate your interest in the client’s experience/situation
- build rapport
- focus on important parts of the discussion
- shift attention/direction.
Use them frequently; but be mindful that too much information can be difficult for the client to work through.
Links to useful MI resource
- Prevention Institute - Motivational interviewing: discussing alcohol use with a pregnant woman
Poole’s Holistic framework for FASD prevention (2008) is a useful guide for identifying and understanding prevention. It illustrates how FASD prevention can be undertaken at multiple levels by numerous service providers.
Links to useful FASD prevention campaigns and resources:
- Valuable Conversations - FASD prevention activity planner template
- Alcohol.Think Again - ‘One Drink’ campaign
- Strong Spirit Strong Future - Promoting Healthy Women and Pregnancies campaign
- National FASD Strategic Action Plan (2018-2028)
Brief Intervention (BI) has proven to be effective:
- in a wide range of settings in relation to a wide range of health-related behaviours such as smoking, taking medication, alcohol use, and exercise; and
- with pregnant women in reducing their alcohol use, particularly when they are combined with a motivational interviewing approach.
The Five A's is a useful model for guiding service providers on conducting a BI for reducing alcohol related harm.
- Ask all clients of child-bearing age about their alcohol use (honour their right to say no).
- Assess their level of alcohol using the AUDIT-C.
- Advise clients that women who are pregnant or planning a pregnancy should not drink alcohol; and for women who are breastfeeding, not drinking alcohol is safest for their baby.
- Assist women to reach their health goals through information, counselling, care and motivational interviewing.
- Arrange appropriate referrals.
Links to useful BI resources:
- FASD Hub Australia - AUDIT-C
- Mental Health Commission - Alcohol and other drug resources for health professionals
Page last updated: 18 February 2021