Summary: Risk Assessment and Counseling
Risk assessment and counseling are core tasks in the genetic counseling process. These tasks require the genetic counselor to use versatile approaches and skills, while maintaining awareness of personal perceptions that could lead to bias in the counselor’s choice of how/what information is shared with specific clients. Simultaneously, the counselor must listen and watch carefully for the client’s reactions. Interpretation of risk is “in the eye of the beholder,” based on the client’s unique past experiences, learning opportunities, etc. When counseling individuals who are deaf, the counselor will need to take time to build trust and use cultural empathy skills. This case points out that most individuals who are deaf have grown up in a unique learning environment in special schools and without the benefit of incidental learning cues from the hearing community. The counselor will want to keep the discussion simple and straightforward without using complex terminology or Western culturally-grounded clichés that do not translate into ASL. It is important for Ellen to regularly ask for feedback about any information presented in the session and not rely on Jean’s head nodding to confirm her understanding. Mnemonic tools such as PRACTICE may help the counselor structure the discussion to gain a better understanding of client perspectives. The counselor’s attention to, and interpretation of, client non-verbal communication cues should be filtered through the context of the client’s cultural framework. This case illustrates the importance of knowing about acceptability of certain non-verbal cues in the Deaf community. To promote effective communication with a culturally Deaf client, the counselor should maintain eye contact with the client as much as possible. In our case, Ellen probably felt surprised, or even scared, when Jean banged on the table. If Ellen had known more about the culturally Deaf community, she would realize that Jean was simply trying to get the counselor’s attention!
Cultural Competence
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Self assess on knowledge, feelings, and attitudes towards people who deaf.
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Consider how your attitudes and beliefs can affect risk communication in genetic counseling.
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Consider your focus on verbal vs. non verbal communication in genetic counseling sessions.
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Be sensitive and listen to your clients. Ask clients to express preference for terms (hearing loss, deaf, hard of hearing). The term hearing “impaired” should not be used.
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Send an information packet and forms before the session.
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Plan for extra time for taking medical and family histories and counseling.
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Ask clients how they prefer to communicate. If a certified ASL interpreter will facilitate the session, meet with the interpreter before the session to review terminology, etc.
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Be sure your office is well lit, limit visual distractions, keep objects away from your mouth, and speak directly to the client.
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Deaf people are high context communicators. Allow them to share information or ask questions that may not seem directly relevant, but that may help them integrate the information into their world.
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Use neutral language. Use chance vs. risk. Use condition vs. disease.
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Use cultural mnemonics such as PRACTICE to explore the patient’s understanding, concerns, and interest in genetic tests.
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Prepare and use visual aids. First, explain the content of the illustration orally through the interpreter, maintaining eye contact, allow the client time to study the visual aid, and then proceed to explain the concept using the visual aid.
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Send a written summary of the session written using principles of low health literacy.
- Find ways to step deeper into the world of Deaf culture.
- Ask the client if taking advantage of technology, such as using a smart phone to communicate at times via text messages, would be acceptable.
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