Genetic Counseling organizations Clinical Supervisor Psychosocial - PDF document

A collaborative effort between 18 Genetic Counseling organizations Clinical Supervisor Psychosocial Skills across the US Training and Canada Kathleen Brown, MS, CGC Karin Dent, MS, CGC Jessica Giordano, MS, CGC 2019 Andrea Shugar, MS, CGC “You do psychosocial really well!” • The speakers have no conflicts of interest to declare. • Speakers: – Kathleen Brown, MS, CGC • University of Colorado, Anschutz Medical Campus – Karin Dent, MS, CGC • University of Utah – Jessica Giordano, MS, CGC • Columbia University Medical Center/New York-Presbyterian – Andrea Shugar, MS, CGC • University of Toronto, Sick Kids Andrea Shugar, MS, CGC Who are we as genetic counselors? How should we view genetic counselling? “The challenge for our profession will be to combine the skills needed for teaching and counseling, requiring unusually gifted and flexible professionals” Seymour Kessler, 1997 “The central ethos should be to bring the psychosocial component into every aspect of work” Weil 2003 Teaching Model Counselling Model “Genetic counseling…should be conceptualized as a highly circumscribed form of psychotherapy, in which effective communication of genetic information is a central therapeutic goal” Austin, 2014 Andrea Shugar, MS, CGC Andrea Shugar, MS, CGC

GC interactions in 2016 Learning Objectives Meiser et al 2008 and Paul et al 2015 • Delineate specific psychosocial skills students should have the ability to utilize at varying developmental stages Psychosocial of training. communication • Discuss and strategize solutions to supervisor challenges and barriers in training students on utilizing and expanding psychosocial skills. Biomedical communication Clinician dominance in dialogue • Utilize specific genetic counseling models to aid in structuring and guiding genetic counseling student progression in advanced skill development. Andrea Shugar, MS, CGC Reminder: A New Definition of Genetic Counseling: National Learning Objectives Society of Genetic Counselors’ Task Force Report • Delineate specific psychosocial skills students should “Genetic counseling is the process of helping people understand and adapt to the medical, psychological and familial implications of genetic contributions to have the ability to utilize at varying developmental stages disease”. This process integrates the following: of training. • Interpretation of family and medical histories to assess the chance of • Discuss and strategize solutions to supervisor challenges disease occurrence or recurrence. and barriers in training students on utilizing and • Education about inheritance, testing, management, prevention, expanding psychosocial skills. resources and research. • Utilize specific genetic counseling models to aid in • Counseling to promote informed choices and adaptation to the structuring and guiding genetic counseling student risk or condition. progression in advanced skill development. Journal of Genetic Counseling, Vol. 15, No. 2, April 2006 ( c 2006) DOI: 10.1007/s10897-005-9014-3 Introduction • Development of PS across the training spectrum • Reminder of PBCs Domain II: Interpersonal, Psychosocial and Counseling Skills – Focusing on Role* Beginning student Intermediate student Advanced student • (9) Employ active listening and interviewing skills to identify, assess, Contracting Create an agenda for the session and Elicit the clients’ expectations, Amend the agenda based on the and empathically respond to stated and emerging concerns present to the client. perceptions and knowledge of genetic clients’ needs and understanding. counseling and the purpose of the visit. • (10) Use a range of genetic counseling skills and models to facilitate informed decision-making and adaptation to genetic risks or conditions Skills : Building rapport, open questions, aligning with client, building client self esteem, flexible agenda • (11) Promote client-centered, informed, non-coercive and value-based decision-making *Roles are based on the ACGC management/counseling roles for the logbook.

Learning Objectives Role Beginning student Intermediate student Advanced student • Delineate specific psychosocial skills students should Psychosocial Assessment Identify and record basic elements Recognize and record more Develop and discuss a plan with have the ability to utilize at varying developmental stages of psychosocial assessment (e.g. detailed elements of patients for needed marital status, occupation) psychosocial assessment (e.g. psychosocial work (e.g. referral, of training. unresolved grief, fear, anger) decision-making tools) Psychosocial support / Build alliance with patient/family; Discuss clinical information Discuss clinical information • Discuss and strategize solutions to supervisor challenges use empathic statements while assessing client’s reaction while making psychosocial counseling appropriately and gauge understanding of assessment of the client’s and barriers in training students on utilizing and information; use psychosocial reaction/understanding and strategies to address client then helping the client/family expanding psychosocial skills. needs. integrate the information into his/her life; integrate psychosocial activities with • Utilize specific genetic counseling models to aid in other activities of the GC session; use advance structuring and guiding genetic counseling student psychosocial strategies. progression in advanced skill development. Skills : primary empathy, immediacy, building client self esteem, promoting informed decision making, advanced empathy, confrontation Barriers/challenges for students Barriers/challenges for students • Concern about prying into clients’ privacy when • In our 21 survey responses, “ fear ” was mentioned 13 times asking questions about feelings from supervisors ie: – “Student's fear of exploring an issue. They ignore/don't • Anxiety about not knowing what to say or how to recognize the opportunity of exploring further and go on with respond their agenda.” – “Fear of saying the wrong thing Fear of not patient's crying Fear • General lack of confidence in their ability to help of being yelled at by a patient Fear of offending a patient by a client over-calling an emotion Fear of offending a parent by • Feelings of imposter syndrome- who am I to addressing their child's developmental delay.” – “The biggest challenge has been the students' fear of saying the address these concerns?! wrong thing or making the situation worse.” Borders et al . 2006 Barriers/challenges for students Barriers/challenges for supervisors • As supervisors, we have to be able to justify why we do • Recognizing psychosocial skills go beyond interactions what we do to ourselves with clients – As novice supervisors, this can be especially challenging – “As a supervisor in a lab setting, it has been challenging to • Balancing how to prioritize client needs and the get students to see the psychosocial aspects of the non- students needs in a session direct patient care roles” – “Trying to teach…during a session. So the balance between • Focusing on genetic information as priority having the student try to address something that comes up – “They are so focused on information giving that they don't during the session but making sure the patient's needs are notice when patients are in distress. It is difficult to get also met.” them to feel comfortable with addressing that issue.”