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Cognitive-Behavioral Intervention (CLEAR) to Promote Health and Change Behavior

June 22, 2020
Author: New Hanover Regional Medical Center

Center for Quality Improvement and Innovation (CQII)

Intervention

Implemented cognitive-behavioral program (Choosing Life: Empowerment! Action! Results! or CLEAR, an evidence-based tool) to promote health and change behavior with patients, including MSM of color.

Change Ideas

  • Delivered one-on-one client-centered cognitive behavioral techniques to change behavior.
  • CLEAR consists of five core sessions and a wrap-up session.
  • Attended a CDC CLEAR training and obtained the materials necessary to administer the intervention.
  • Held evening and weekend sessions and met clients at their homes and other locations rather than just in their office to accommodate participants’ schedules.

Summary

The Choosing Life: Empowerment, Action, Results! (CLEAR) program is an evidence-based HIV prevention and health promotion intervention for people ages 16 and older living with HIV/AIDS or at high-risk for HIV.1 CLEAR is a client-centered program to deliver one-on-one cognitive-behavioral techniques to change behavior.2 The intervention provides clients with the skills necessary to be able to make healthy choices for their lives. The goal of the intervention is to help clients maintain health, reduce transmission of HIV and other sexually transmitted diseases, and improve their quality of life. CLEAR consists of five core skill sessions, 21 menu sessions and a wrap-up session. The five core skill sessions teach the essential cognitive and behavioral skills of the program (i.e., positive self-talk, reframing, countering against negative thoughts, relaxation). Within these core skill sessions, clients also develop a personal life goal and an individual prevention plan that direct the focus and selection of subsequent menu sessions within six domains (sexual risk, substance use risk, health care and self-care, treatment adherence, disclosure, and HIV stigma). The Centers for Disease Control and Prevention’s (CDC’s) guidelines on Comprehensive Risk Counseling and Services (CRCS), formerly known as Prevention Case Management (PCM), has identified CLEAR as a structured intervention that may be integrated into the CRCS programs.

New Hanover Regional Medical Center delivered this intervention to all of their clients (cisgender and non-Hispanic, former substance users, same gender-loving men, heterosexual men and women, African-American or White), but it positively impacted their MSM of color clients. To implement this intervention, the team attended a CDC CLEAR training and obtained the materials necessary to administer the intervention. Between January and March 2019, sessions were started with new referrals from their case managers in the largest HIV-affected county in their state (New Hanover County) but expanded to two other counties between April and June 2019. Participants’ schedules were accommodated by holding evening and weekend sessions and meeting clients at their homes and other locations rather than just in their office. Participant goals varied and included getting healthier, furthering their education, and moving into other housing. By September 2019, there were a total of 32 individuals who completed this intervention. Viral suppression for their MSM of color subpopulation increased from 81.01% to 82.11% from February 2018 through January 2020, respectively.

1 Rotheram-Borus MJ, Swendeman D, Comulada WS, Weiss RE, Lee M, Lightfoot M. Prevention for Substance-Using HIV-Positive Young People: Telephone and In-Person Delivery. Journal of Acquired Immune Deficiency Syndromes. 2004. 37(2): S68–S77.

2 University of California, Los Angeles Center for Community Health Semel Institute for Neuroscience and Human Behavior. CLEAR: Choosing Life: Empowerment, Action, Results! – A one-on-one intervention with youth and adults living with HIV/AIDS or at High Risk for HIV Infection Implementation Manual.

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