Curriculum Evaluation and Assessment of Multicultural Genetic Counselor Education

Multicultural competence in genetic counseling integrates racial-cultural knowledge, awareness, and skills into clinical interventions and research practices. Researchers and educators often cite racial-cultural factors as obstacles for visible racial-cultural people seeking help. However, the professional's unfamiliarity of how his or her own racial-cultural group affiliations are influenced by the history of discrimination and oppression coupled with their lack of self-understanding of racial-cultural issues for him- or herself has also limited the effectiveness of genetic counseling. The purpose of this study is to evaluate the effectiveness of the Handbook of Cross-Cultural Genetic Counseling, a multicultural curriculum developed for genetic counselor education for increasing multicultural counseling competence. The multicultural curriculum was evaluated for its effectiveness of increasing multicultural counseling competence using a nonequivalent control group design. A participant's multicultural counseling competence was hypothesized to increase after being taught the curriculum. The curriculum was effective for increasing multicultural counseling competence. Additionally, achieved multicultural counseling competence was not influenced by when the curriculum was taught. Trend analyses measuring the longitudinal impact of the curriculum on multicultural competence were significant. Implications of the results are discussed.     

Expansion of Genetic Services Utilizing a General Genetic Counseling Clinic

We established a general genetic counseling clinic (GCC) to help reduce long wait times for new patient appointments and to enhance services for a subset of patients. Genetic counselors, who are licensed in Tennessee, were the primary providers and MD geneticists served as medical advisors. This article describes the clinic referral sources, reasons for referral and patient dispositions following their GCC visit(s). We obtained patients by triaging referrals made to our medical genetics division. Over 24 months, our GCC provided timely visits for 321 patients, allowing the MD geneticists to focus on patients needing a clinical exam and/or complex medical management. Following their GCC visit(s), over 80 % of patients did not need additional appointments with an MD geneticist. The GCC allowed the genetic counselor to spend more time with patients than is possible in our traditional medical genetics clinic. Patient satisfaction surveys (n?=?30) were very positive overall concerning the care provided. Added benefits for the genetic counselors were increased professional responsibility, autonomy and visibility as health care providers. We conclude that genetic counselors are accepted as health care providers by patients and referring providers for a subset of clinical genetics cases. A GCC can expand genetic services, complement more traditional genetic clinic models and utilize the strengths of the genetic counselor health care provider.     

The Value of a Genetic Counselor: Improving Identification of Cancer Genetic Counseling Patients with Chart Review

Advances in genetics are changing cancer care and requiring institutions to maximize the unique skills of genetics professionals. The identification of genetic syndromes is vital for prevention and management of families with high cancer risks. Despite this, high risk individuals who qualify are often not referred. Genetic counselors could review oncology charts to improve identification. A genetics assessment tool developed by NCI Community Cancer Centers Program was used to perform self-assessment of the genetics program. A weekly report of all new oncology patients was provided to a genetic counselor for chart review. In 2010, 58 % of all eligible patients (n?=?152) were offered a genetics evaluation. In 2011 this improved to 70 % (n?=?167), which was a statistically significant difference, X ²(1)?=?5.13, p?=?0.02. By cancer site, ovarian cancer referrals also showed statistically significant improvement, X ²(1)?=?6.36, p?=?0.01. Breast and colon referrals were improved but not significant. Over 10 months, 129 patients were identified through the chart review program. Three were confirmed to have a genetic mutation for a hereditary cancer syndrome. An average week included review of 73 charts for 10 medical oncologists, 4 radiation oncologists, and 4 pediatric oncologists which generated 60–80 min of work for the genetic counselor. This program improved patient identification and quality, and allowed physicians to become more aware of opportunities for genetic counseling and more patients to receive genetic counseling and testing.     

The Inner World of the Genetic Counselor

The external experience of genetic counselors reflects and is processed in their personal inner worlds. A small window into that private interior is opened here revealing the strengths and frailties, vulnerabilities and sensitivities professionals bring to bear in their work. The relational, human interplay—between counselor and colleagues, counselor and clients, counselors in their nonprofessional roles relative to others—is the primary focus of the interior experience.     

Genetic Counselors in Startup Companies: Redefining the Genetic Counselor Role

Genetic counselors (GCs) have recently begun moving into non-clinic based roles in increasing numbers. A relatively new role for GCs is working for startup companies. Startups are newly established companies in the phase of developing and researching new scalable businesses. This article explores the experiences of four GCs working at different startup companies and aims to provide resources for GCs interested in learning more about these types of roles. The article describes startup culture, including a relatively flat organizational structure, quick product iterations, and flexibility, among other unique cultural characteristics. Financial considerations are described, including how to understand and evaluate a company’s financial status, along with a brief explanation of alternate forms of compensation including stock options and equity. Specifically, the article details the uncertainties and rewards of working in a fast-paced startup environment that affords opportunities to try new roles and use the genetic counseling skill set in new ways. This article aims to aid GCs in determining whether a startup environment would be a good fit, learning how to evaluate a specific startup, and understanding how to market themselves for positions at startups.     

Assessment of Current Genetic Counselor Practices in Post-Visit Written Communications to Patients

Providing patients with post-visit written communication (PVWC) is a long-standing component of genetic counseling. However the depiction of this practice in today’s clinical landscape is limited. To better describe this practice, we surveyed practicing clinical genetic counselors to ask if they send post-visit communications to patients and if so, what are the types, the average length, and the average time spent writing. They were also asked the perceived purpose of providing PVWC, if/how the practice has changed over time, and factors influencing the practice. Eighty three percent (233/280) of participants reported sending patients PVWC. Of those, 93% sent at least one communication written in patient-friendly language. The type of communication varied by specialty. Prenatal genetic counselors were less likely to send patient-specific letters and hybrid letters (defined as letters with content intended for both a physician and a patient) than those in cancer genetics (p = 0.010, p = 0.001, respectively) or pediatric genetics (p = 0.001, p = 0.004, respectively). Prenatal genetic counselors spent less time on average writing post-visit communications (19.0 min) relative to those in cancer and pediatric genetics (30.6 min, p = 0.027 and 37.7 min, p = 0.001, respectively). The most commonly cited purpose for sending PVWC was to provide patients a formal account of what happened during the appointment. These data suggest PWVC are still regularly sent to patients but the practice is variable and is influenced by numerous factors including specialty, years of experience, and time constraints.     

The School Counselor As Consultant: A Historical Review

This article contains a historical review of the school counselor in the role of consultant. Published articles that have appeared in four APGA journals during the past 21 years provided the basis for the review. General trends in each journal and a developmental history of the consultation movement are presented. The conclusion was that a serious gap exists between the theory and practice of consultation in schools. Specific needs must be addressed for the school counselor as consultant model to be fully realized.     

Parental Involvement in School Counseling Services: Challenges and Experience of Counselor

School counselors include parents as informants in school counseling for various reasons like for consultation and client’s intervention which could lead to a different experience. The objective of the present study was to explore the challenges faced by school counselors when involving parents in the school counseling process and the ways they handle the challenges. The participants consisted of seven school counselors, with whom in-depth interviews were conducted. The subjective experiences of the school counselors were objectively interpreted by the researcher using interpretative phenomenological analysis. The research results were categorized into master and subordinate themes using double hermeneutics. The results revealed that although school counselors have their own individual perceptions of challenges and methods of handling parental inclusion in the school counseling context, there still exist similarities in their methods of handling. The study highlights school counselors’ beliefs about parents’ perceptions and expectations of counseling as well as parents’ reaction toward their child’s problem as a challenge. The findings throw light on the need for stronger evidence-based practices and policies for school counseling programs. Training and competence-building programs for school counselors would improve the service delivery.     

Counselor Intentions: A Critical Review of the Literature

Researchers have become increasingly interested in the role of counselor intentions in the psy-chotherapeutic process. This interest is rooted philosophically in a recognition that to understand human action, we must also understand motivation and intention. The author traces recent concepts of intentions and proposes a model that locates intentions on a continuum of counselor strategy. Techniques for measuring intentions are discussed, with an emphasis on reliability and validity problems. Published empirical studies are reviewed through 1991; a lack of findings of practical or theoretical significance are traced to methodological and design problems. Implications for practice are discussed, and recommendations for future research are suggested.     

Reduction of Health Care Costs and Improved Appropriateness of Incoming Test Orders: the Impact of Genetic Counselor Review in an Academic Genetic Testing Laboratory

The goal of this study was to evaluate the impact of genetic counselor (GC) review of incoming test orders received in an academic diagnostic molecular genetics laboratory. The GC team measured the proportion of orders that could be modified to improve efficiency or sensitivity, tracked provider uptake of GC proposed testing changes, and calculated the health care dollar savings resulting from GC intervention. During this 6-month study, the GC team reviewed 2367 incoming test orders. Of these, 109 orders (4.6%) were flagged for review for potentially inefficient or inappropriate test ordering. These flagged orders corresponded to a total of 51 cases (1–5 orders for each patient), representing 54 individuals and including 3 sibling pairs. The GC team proposed a modification for each flagged case and the ordering providers approved the proposed change for 49 of 51 cases (96.08%). For the 49 modifications, the cost savings totaled $98,750.64, for an average of $2015.32 saved per modification. This study provides evidence of the significant contribution of genetic counselors in a laboratory setting and demonstrates the benefit of laboratories working with ordering providers to identify the best test for their patients. The review of test orders by a genetic counselor both improves genetic test ordering strategies and decreases the amount of health care dollars spent on genetic testing.     

Defining the Role of Laboratory Genetic Counselor

An increasing number of genetic counselors are moving into non-clinical roles, where their primary duties do not involve direct patient contact. According to the National Society of Genetic Counselors Professional Status Survey in 2010, 23% of counselors working in non-clinical roles identified laboratory or genetic testing as their primary area of work. Using a survey, we identified 43 genetic counselors who work predominately in laboratory settings. The two primary tasks performed by participants, include acting as a customer liaison (95%) and calling out test results (88%). Nineteen participants (44.2%) also reported spending a considerable amount of time signing reports. The most prevalent areas of job satisfaction were support from laboratory directors (76.8%), autonomy (76.7%), interactions with clinicians (69.7%) and interaction with other genetics counselors (67.5%). This is the first study specifically looking at the roles of laboratory genetic counselors, which is an expanding area of genetic counseling.     

Genetic Counselor Workforce Issues: a Survey of Genetic Counselors Licensed in the State of Indiana

The aims of this study were to document movement of genetic counselors (GCs) out of clinical positions and identify factors that might help employers attract and retain clinical GCs. A confidential on-line survey of GCs ever licensed in the state of Indiana was conducted. Of the 46 respondents, most provide direct patient care (69.6 %), have worked in their current position for 5 years or less (72.1 %), and are experienced genetic counselors, having graduated between 6 and 15 years ago (43.5 %). One-third (32.6 %) reported thinking about leaving their current position at least monthly. GCs were more likely to think about leaving their current position when they provided direct patient care (p = 0.04) and worked in a hospital/clinic setting (p = 0.01). Among the 18 respondents that changed jobs in the past two years, 55.6 % currently work in a laboratory/industry setting and 44.4 % provide direct patient care, compared to 8 % of those in a stable position (N = 25) who work in a laboratory/industry setting (p < 0.01) and 88 % who provide direct patient care (p < 0.01). Genetic counselors who have changed jobs within the past 2 years were more satisfied with the possibility for advancement (p = 0.01), the recognition for work they do (p = 0.03) and feeling value from the organization (p = 0.04) in their current positions than those who have not changed jobs. Salary and flexibility were most often reported as reasons for changing jobs. This is the first documentation of the movement of GCs out of clinical roles into industry positions. This changing landscape may impact the access to clinical services and the training of genetic counseling students. This data will provide employers with data to help attract and retain GCs in clinical roles.     

Assessment of the Effectiveness of Genetic Counseling by Telephone Compared to a Clinic Visit

Maternal serum screening, also known as the triple screen, is used during pregnancy to assess the risk of carrying a fetus with specific chromosome abnormalities or open spina bifida. All women in British Columbia who screen positive are eligible for genetic counseling and are offered amniocentesis. The purpose of this study is to determine what differences (if any) exist in patients' understanding and/or anxiety when genetic counseling for a positive triple screen is conducted in person versus over the telephone. Each patient who participated was given the choice of having genetic counseling in person or over the telephone, this after a randomized design failed to elicit any participants. Using a written postcounseling questionnaire, each patient was assessed for her understanding of the information presented in the session, and her anxiety regarding her risk. In this small pilot study, no large differences were detected in patients' understanding or anxiety when genetic counseling was conducted by telephone versus in person.     

The Interface Between the Practice of Medical Genetics and Human Genetic Research: What Every Genetic Counselor Needs to Know

Genetic counselors have historically used human genetic research as an advanced information resource for their patients. Most commonly, this has been via access to information provided by gene identification studies in advance of commercial testing. More recently genetic counselors have been participating in human genetic research studies as part of the investigative team. This review provides a framework to help genetic counselors in research and clinical practice understand the historical perspectives, ethical principles, and federal regulations that govern the current practice of human subject research. Special consideration is given to the IRB process and unique issues in human genetic research. This overview is intended to help improve the ability of genetic counselors to act as advocates for their patients.     

Further Defining the Role of the Laboratory Genetic Counselor

Laboratory genetic counseling is becoming increasingly common as a result of increased laboratory services and genetic testing menus, as well as growing job responsibilities. Christian et al. (2012) provided the first quantitative data regarding the roles of the laboratory-based genetic counselor (LBGC) finding that two of the most prevalent roles are as customer liaisons and communicators of test results. The goal of the present study was to further delineate the role of the LBGC by addressing specific tasks that LBGCs are involved with on a day-to-day basis. A survey was designed to expand upon themes identified in the Christian et al. (2012) study by querying specific tasks performed in several categories of potential LBGC job duties. An invitation for LBGCs to participate was distributed via email to the membership of the National Society of Genetic Counselors (NSGC) and the Canadian Association of Genetic Counsellors (CAGC). We identified 121 genetic counselors who primarily work in the laboratory setting or whose job role includes a laboratory component. Almost all respondents performed customer liaison/case coordination (95 %), and interpretation and result reporting (88 %). The most frequently performed tasks within these categories involved addressing questions from clients, making phone calls with genetic testing results, obtaining clinical or family history information for results interpretation, and composing case-specific interpretations for unique results and/or obtaining literature references to support interpretations. The study results also point to trends of expanding roles in sales and marketing, variant interpretation and management responsibilities. Results of this study may be useful to further define the full scope of practice of LBGCs, aid in the development of new LBGC positions and expand current positions to include roles related to test development, research, and student supervision. It may also aid in curriculum updates for training programs to increase exposure to LBGC roles.     

Assessment of the Use of Spiritual Genograms in Counselor Education

Spiritual genograms collect and organize family information of a religious or spiritual nature. The authors explored the use of the spiritual genogram in counselor education. Graduate counseling students were assigned to construct and present a spiritual genogram within a course titled “Counseling and Spirituality.” An assessment of the quality of the students' learning experiences was conducted. Narrative responses were gathered from 32 advanced and postgraduate students enrolled in 1 of 4 classes over a 2‐year period. The results verified the benefits of this constructivist and experiential learning process. Implications for counselor development and further research are discussed.