An Exploration of Genetic Counselors’ Needs and Experiences with Prenatal Chromosomal Microarray Testing

Because of the higher yield over traditional chromosomal analysis, chromosomal microarray analysis (CMA) is being used increasingly in prenatal diagnosis. Unfortunately, the clinical implication of many copy number variants found on prenatal CMA is uncertain, complicating genetic counseling. Recognizing that uncertain results will be encountered frequently as more of the genome is assayed prenatally, we set out to understand the experiences and needs of genetic counselors when counseling patients about uncertain prenatal microarray results, their comfort with various aspects of prenatal genetic counseling, and their interest in additional education and training about prenatal microarray testing. We first interviewed 10 genetic counselors about their experiences of providing pre- and post-test genetic counseling about prenatal CMA. Based on the findings from the counselor interviews, we developed items for a survey to assess the prevalence of genetic counselors’ attitudes towards, experience and comfort with, and educational needs regarding prenatal CMA. Based on surveys completed by 193 prenatal genetic counselors, we found that when there is an uncertain CMA result, only 59 % would be comfortable providing genetic counseling and only 43 % would be comfortable helping a patient make a decision about pregnancy termination. Being less comfortable was associated with seeing fewer patients having prenatal CMA testing. Respondents expressed a high degree of interest in additional education about prenatal CMA and counseling about uncertain results. Further genetic counselor education and training aimed at improving counselors’ personal comfort with uncertain results and communicating about them with patients is needed.     

Adherence to HAART: perspectives from clients in treatment support programs

The development of highly active antiretroviral therapy (HAART) has resulted in dramatic decreases in morbidity and mortality for HIV-infected individuals. Because the long-term efficacy of HAART is dependent on near perfect adherence, many providers offer services to support adherence, including education, regimen review, counseling, and reminder tools. Little is known regarding the utilization or efficacy of these services. In this paper, we report on data collected during 32 open-ended interviews conducted with individuals receiving services through the New York State Treatment Adherence Demonstration Project. Participants in the project reported deriving benefits from a broad range of project activities. Educational efforts helped clients to recognize HIV as a manageable, rather than terminal, illness. Information and tools focused on specific regimens provided clients with concrete knowledge and skills. Effective communication with medical providers and pharmacists was facilitated by adherence staff who proactively advocated for client needs. Program-based social support was particularly valuable for many participants, helping them to retain needed motivation and strength. Educational, practical, and supportive services were all considered valuable to clients participating in adherence support programs. A mix of services may best meet the range of needs found among persons taking HAART.     

Faculty Development in the 1990s: What It Is and Why We Can't Wait

Faculty development efforts are vitally needed in higher education today. Changes in expectations about the quality and assessment of undergraduate education, societal needs, technology, the student populations, and paradigms about teaching and learning argue for viable, credible, and creative programs. The author explores the nature and need for faculty development, discusses some faculty development options, and provides a selected number of resources.     

A teaching framework for cross-cultural genetic counseling

The increasing diversity of American society has brought growing recognition of the need to bridge cultures in the delivery of genetic counseling services. New immigrants and members of diverse ethnic groups face multiple barriers to genetic counseling services. The need to train genetic counselors to deal with cultural diversity is especially crucial in the new genetic era, given the rapid expansion of available technology, with the resulting social and ethical ramifications. A framework for teaching cross-cultural issues in genetic counseling training programs is presented that can be implemented in step-wise fashion, consistent with available resources. Cross-cultural issues can be incorporated into existing teaching and training modalities by expanding the orientation from monocultural to multicultural. Relevant clinical experience, exploration of students' preconceptions and biases, reading materials, and lectures by invited speakers can all enhance students' knowledge and sensitivity. It is critically important that training programs furnish students with the basic tools necessary for the ongoing process of learning about cultural diversity.     

Does psychopathology predict counseling duration?

Many university counseling centers have adopted case management policies in an effort to conserve limited resources. Fearing that students with more severe problems will consume too many clinical resources, many counseling centers have decided to refer such students to external agencies or providers for mental health services. However, this fear might be unwarranted because empirical research has not shown a substantial relationship between psychopathology and counseling duration. This investigation examined whether a new treatment-planning inventory, the Butcher Treatment Planning Inventory, might be useful for better understanding the relationships between various problem areas and counseling duration. Participants were new clients (students and staff members) at a university counseling center in the southeastern USA. Professional staff members and graduate students in counselor education, clinical psychology, and clinical social work provided counseling services to the participants. Lower scores on several scales predicted counseling duration. In other words, clients with lower scores on these scales (representing less psychopathology) attended more counseling sessions than clients with greater psychopathology. Therapists' background also predicted counseling duration; clients who worked with either a professional staff member or graduate student in counselor education attended more sessions than clients who worked with a graduate student in clinical psychology. The results of this study, combined with previous research, suggest that measures of psychopathology are not very useful for identifying which clients will complete long-term counseling. Until better information becomes available, actuarial tables remain the most efficient means for predicting counseling duration.     

Preparing Counselors to Meet the Needs of the Handicapped

The Education for All Handicapped Children Act (PL 94–142) mandates a number of counseling and allied services for the handicapped and their parents. In many cases counselors will need to acquire additional information and training to meet the needs of this special population. This article outlines many competencies that need to be considered in developing pre-service and in-service programs for counselors serving the handicapped. Hosie discusses several professional development areas relating to these competencies, and provides resources and training materials.     

What Young People Want: A Qualitative Study of Adolescents’ Priorities for Engagement Across Psychological Services

This article examined commonalities in adolescents’ priorities for engagement with psychological support in the context of contemporary youth culture in New Zealand. These were explored across a range of different services including a face-to-face hospital-based mental health service, a face-to-face school-based counseling service, a telephone counseling service and a new form of counseling using mobile phone text. Interviews were conducted with 63 young people aged 13–18 who had used at least one of these services. A thematic analysis identified that there were common priorities for participants across the different services including their need to keep control; not to have their parents involved; to have a relationship with a counselor which was more like a friendship than a professional relationship; to talk freely and be listened to; and to have the service be accessible and flexible enough to fit around their lives. Text and telephone counseling were seen to be particularly appropriate for meeting some of these needs. Professionals working with young people should consider offering a suite of options for psychological support, allowing young people to balance their different needs and priorities and thus facilitate their engagement.     

International Counseling: An Opportunity for Culture-Specific Counseling With the New Zealand Maori

Evidence of multiculturalism in New Zealand has become common throughout the educational system in the last two decades. In spite of these efforts, Maori leaders contend that the schools have failed to meet the needs of Maori students, citing continuing high dropout rates and low academic achievement of Maori youth to support their claims. Many Maoris are demanding a separate educational system for their youth. An embedded component of any improved education delivery system for the Maori involves the development of adequate and appropriate guidance and counseling services for Maori youth. A culture-specific model seems to be a most appropriate one.     

A School-Based Approach to Stress Management Education of Students

Stress in children and adolescents has been linked to a variety of physical and emotional problems as well as to poor school performance. Because of these negative effects, school-based special services providers need to implement stress management education programs it optimal learning and development are to occur. Behavioral and cognitive-behavioral coping skills training have been effective in helping students deal with school-related stressors. An approach for stress management education is presented which addresses curriculum content, target trainees, environmental supports, and identification of trainers.     

Psychological Aspects of Genetic Counseling. IX. Teaching and Counseling

The goals, philosophies, and procedures of the teaching and counseling approaches to genetic counseling are differentiated and compared. The teaching approach, inherited from academic practitioners earlier in this century, appears to remain the dominant form of contemporary practice. With the introduction of more nonphysician professionals, attempts are being made to combine a teaching model with counseling procedures. The goals of the two models are conspicuously different; one attempts to end up with an educated counselee whereas the other hopes to leave the latter psychologically more autonomous and functional. Both models have strengths and limitations. The teaching model is essentially a form of health education, not counseling, and, with some exceptions, tends to fulfill its goals. The strategy of teaching, however, tends to undermine the psychological self-directedness of counselees and thus interferes with the processes they need to draw on to make autonomous decisions. The strength of the counseling model is in helping counselees reach decisions and deal with the personal meaning of information. However, applying this model makes huge demands on the professional. Greater attention needs to be given by training programs to the pedagogical and counseling skills genetic counselors may need in their professional work.     

Placement Counseling: Focus on the Community College

Because of the vocational emphasis in the two-year college, placement is even more important here than in other institutions. Statistics accentuate the employment needs of two-year college students during their attendance at college and after graduation. Despite the needs, placement services have not been adequately developed. Counseling needs in the two-year colleges are varied and complex. There is a need for career counseling, counseling for career flexibility, preparing for the job interview and how to keep a job, follow-up, counseling and developing opportunities for minorities as well as concern with handicapped, veterans, and marginal students. Community awareness and participation is essential. To accomplish this, an adequate, well-prepared staff is required.     

Genetics Education for Health Professionals: Strategies and Outcomes from a National Initiative in the United Kingdom

The National Health Service (NHS) National Genetics Education and Development Centre was established by the Department of Health in 2004 to help drive and co-ordinate genetics education for health professionals working outside specialist genetic services. This paper reviews the experiences and lessons learned to date. At the outset, it was clear that understanding the learning ethos, preferred delivery methods and attitudes towards genetics of different NHS healthcare groups was vital. We collected evidence by undertaking needs assessments with educators, practitioners and patients. We have determined the genetics knowledge, skills and attitudes which they said were needed and translated these into learning outcomes and workforce competences in a continuum of education. Beginning with core concepts introduced (and examined) pre-registration, the continuum continues with development of concepts post-registration as appropriate for role, leading to practical application and assessment of competences in the workplace. These are supported by a portfolio of resources which draw heavily on patient based scenarios to demonstrate to staff that genetics is relevant to their work, and to convince educators and policy makers that genetic education is likely to result in real clinical benefit. A long term educational policy, inclusive of learners, educationalists and their institutions must be evidence based, flexible and responsive to changes in workforce structure, provision of clinical services and conceptual and financial commitments to education. The engagement of national policy, regulatory and professional bodies is vital ().     

Couple relationship education in Australia

In Australia, the strengthening of marriage through relationship education has received strong governmental policy support and some modest financial support. Couple relationship education services are offered by a variety of community-based, church-affiliated, and church-based providers. There is a strong emphasis on providing programs that are developed locally in response to perceived couple needs and government policies. Available evaluations show that most couples who attend education value the service, but relationship education providers need to do a better job reaching out to couples at high risk for future relationship problems, and more research is needed on the effects of education on long-term marital outcomes. There is significant scope for building on current initiatives to incorporate evidence-based approaches and to expand the program reach to more couples.     

Managing Demands on Counseling Services: The Colorado State University Experience

As we move into the next decade, greater student demands for counseling services, increased severity of presenting problems, and long waiting lists are becoming a reality at university and college counseling centers. These trends, coupled with limited financial resources, suggest that new models of case management and treatment are needed to maintain quality services. This article describes the development of a time-limited and managed-care treatment policy at the University Counseling Center at Colorado State University. It is offered as one agency's attempt to become more proactive in defining its responsibilities and limits regarding emerging challenges and changes on college campuses.     

Career support for migrants: Transformation or adaptation?

The complex interfaces created by migration not only challenge core beliefs about the purpose of career guidance and counseling but also about the precise nature and level of the support required for migrants. However, the issue has had little academic attention. While traditional theories informing the practice of career guidance and counseling implicitly reflect a commitment to social equality, they were developed in relatively homogenous Western capitalist contexts that were strongly individualized, masculine, secular, action and future focused. As career guidance and counseling services in more individualized countries seek to meet the needs of a growing number of clients from more collectivist cultures, the universal relevance of such models is increasingly open to challenge. This article explores three core challenges posed by migration for the theory and practice of career guidance and counseling. The first relates to the very purpose of these types of services for migrants; the second, to the way in which migration requires a realignment of the relationship of theory with practice; and the third relates to the need to redefine service delivery models for this client group. The extent to which notions of “quality” in services are culturally dependent will also be considered, together with the potential for general service improvements being stimulated by the provision of high quality services for migrants.     

Reinterpreting the purpose of premarital counseling

Summary Premarital pastoral counseling is a broader activity than is often suspected, going beyond a set of interviews designed to prepare a couple for marriage. Its purpose is to extend the resources of the Gospel and the Church to a couple at a critical period in their lives. In the case of Bill and Gretchen, this meant reassessing their guilt over having had intercourse prior to marriage and setting it within the context of God's forgiveness. It meant helping Bill's mother to meet certain of her personal needs, and it meant helping Bill to understand his own interpersonal relationships more clearly. Later observation showed that, as a couple, Bill and Gretchen were able to sustain a meaningful relationship with each other and to meet the continuing stresses placed upon their marriage as they tried to help Bill's mother and father.The adoption of the purpose advocated here enables the pastor to avoid the contagion of emergency feelings, to set meaningful partial goals for his work with a couple in various stages of the premarital counseling relationship, and to set premarital counseling squarely within the context of his total pastoral ministry.     

Psychological Aspects of Genetic Counseling. X. Advanced Counseling Techniques

Four procedures commonly used by experienced counselors are described: simple interview formulations, helping clients think through their problems, reframing, and role playing. Each procedure is illustrated by examples. Among other things, the goal of these procedures is to promote the autonomy and self-directedness of clients and thus are particularly valuable in circumstances requiring a nondirective stance. The need is underscored for a more active counseling stance appropriate to the psychological and problem-solving needs of genetic counselees.     

The Experience of Leader-Led Peer Supervision: Genetic Counselors' Perspectives

As we proceed through our professional lives, it is essential that we challengeourselves in order to continue to develop our genetic counseling skills. Conferences, workshops,post-graduate courses, journal clubs, and involvement in professional organizations havebecome the traditional methods of continuing education for post-graduate geneticcounselors. While these forums address the need to stay updated on scientific orinformation-based topics, there is little available to counselors to promote growth incounseling skills. A group of Boston-based genetic counselors describe how their leader-ledsupervision group has established a setting to meet the needs of its members both forsupport and continued counseling training. We outline here the evolution of this group andhow it has become a valued part of our professional lives. We feel that the model of leader-ledpeer supervision holds great value in helping genetic counselors continue to enhancetheir interpersonal skills in a supportive, safe, and challenging environment. It is our hopethat others will elect to form similar groups in their own communities, thereby creating newopportunities for growth within the genetic counseling profession.     

Current issues in South African career counselling and availability of teachers in science and technology

Employability seems to be a major consideration for prospective students' career choices. To facilitate accountable career counseling understanding of students' needs and choices of careers through research is essential. Programs for increased specific training are needed as well as improvement in basic training to meet a growing national labor crisis in South Africa.