Bright Spot: CLEAR: Choosing Life: Empowerment! Action! Results!

Photo by Gabrielle Elleirbag on Unsplash

This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.


Detailed Description

CLEAR is for males and females age 16 and older living with HIV/AIDS or at high-risk for HIV. This client-centered program is delivered one-on-one using cognitive behavioral techniques to change behavior. The objectives of CLEAR are to increase behaviors that promote: healthy living; effectively facing the challenges of daily living; positive feelings, thoughts, and actions; and developing daily routines to stay healthy.

Expected Outcomes

CLEAR aims to help clients maintain health, reduce HIV and other STD transmission, and improve their quality of life. Core elements of CLEAR are: Development of emotional awareness through use of a Feeling Thermometer and identification of the link between feelings, thoughts, and actions (F-T-D framework) Identification of one's Ideal Self to help motivate and personalize behavior change Teaching, modeling, and practicing Short-and-Long-Term Goal Setting Teaching, modeling, and practicing SMART Problem-Solving Teaching, modeling, and practicing Assertive Behavior and Communication

Failing Forward Moments

Additional details can be found on the Effective Interventions CLEAR website.

Cost Details

As of July 2014, there is no cost for using the intervention materials. Costs for supporting staff member time (FTEs) would vary by organization.

Key Steps for Implementation

Pre-Implementation Tasks: Hire a program manager, attend program manager web-assisted training, develop a community advisory group, identify stakeholders, secure buy-in: promote CLEAR to stakeholders, identify a CLEAR champion, develop an implementation budget and plan, conduct a needs assessment, network with and market to other agencies and community organizations, select/hire counselors, select/hire clinical supervisor, train counselors, determine client eligibility for participation in CLEAR, determine attendance policy, develop marketing plan: identify recruitment sites, educate referral sources on who is appropriate for CLEAR, develop guidelines which address client retention, obtain incentives, secure intervention resources (space, transportation, child care, etc.), recruit, screen, and enroll clients.

Implementation Tasks: conduct five core skill sessions following the implementation guide, conduct one to six menu domains, following the implementation guide, based on the client's prevention plan, conduct one wrap-up session with each client

Policies, Laws and Regulations

If offering HIV testing with CLEAR, clients will learn their HIV status when they return for their test results. CBOs must follow state laws regarding disclosure of HIV status to sex and needle-sharing partners. CBOs are obligated to inform clients of the organization's responsibilities if a client receives a positive HIV test result and the organization's potential duty to warn. CBOs also must inform clients about state laws regarding the reporting of domestic violence, child abuse, sexual abuse of minors, and elder abuse.

Required Staffing (FTEs)

  • One 25% FTE Program Manager
  • One 10% FTE licensed Clinical Supervisor or consultant
  • Two 50% FTE counselors
  • One 50% FTE Program Assistant (optional)

Special Infrastructure

Confidential space: CLEAR sessions should be conducted in a comfortable space that is free from interruptions. This space should include a table for taking notes and reviewing various handouts.

  • CLEAR forms: Part 1, Part 2, Part 3, Part 3
  • CLEAR Procedural Guide
  • CLEAR Agency Readiness Checklist
  • Agency Readiness Checklist
  • Office space with secure (private) counseling rooms
  • Paper, markers, pens/pencils, masking tape, folders, certificates
  • Workbooks
  • Forms and handouts
  • Magazines
  • Male and female anatomical models
  • Male and female condoms
  • Lubricants
  • Evaluation instruments
  • Network of agencies providing services to the intended target population. Incentives for participants (optional)


Both counselors and clinical supervisors should participate in training and continuing education to ensure they have the requisite skills to successfully implement CLEAR. Program managers, executive directors, and key stakeholders should participate in the overview webinar to ensure they are aware of CLEAR program planning, implementation, and evaluation issues. To register for CLEAR training, visit the National Network of Prevention Training Centers (NNPTC) website.

Types of Staff

Trained counselors or mental health professionals, Clinical supervisor (clinical psychologist, marriage and family therapist, or social worker), Public Health Educators

Outcome Measures

  • Observation of clients' behavior change motivation
  • Outcome monitoring data for post test interviews
  • Clients' risk-related personal goals (identified initially and throughout the intervention)
  • Observations of clients' practice of emotional awareness
  • Observations of clients' practice of goal-setting skills
  • Observations of clients' practice of assertive communication and behavior skills

Process Measures

  • Number of clients recruited for CLEAR
  • Number of clients enrolled in CLEAR
  • Number of clients who completed all Core Skill Sessions
  • Number of clients who completed a full domain of Menu Sessions
  • Sociodemographic characteristics (age, race, ethnicity, gender, sexual orientation, HIV status, etc.)
  • Clients' risk-related personal goals (identified initially and throughout the intervention)
  • Fidelity to sessions and their components
  • Barriers and facilitators identified
  • Data from clients
  • Data from staff
  • Number of sessions conducted
  • Length of sessions
  • Description of activities conducted/material covered during each session
  • Number and type of materials disseminated

 Related Topics

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Sexual and Reproductive Health

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