A Preliminary Exploratory Factor Analysis of the BDSM Counselor Competency Scale

BDSM practitioners represent a large sexual minority group often overlooked, misunderstood, and unnecessarily pathologized by mental health clinicians. Although developing cultural competence for diverse and marginalized populations is widely understood to be a core component of delivering efficacious therapeutic services that can counteract these stigmatizing mental healthcare experiences, no measures currently exist that assess clinicians' self-reported competence to work with BDSM practitioners. Previous measurement work has been done to establish self-report competency scales for clinicians working with other sexual and gender minority groups, but no such scales exist for working with BDSM practitioners. In the current study, we adapted a version of the Sexual Orientation Counselor Competency Scale (SOCCS) to measure clinicians' self-reported competence to work with BDSM practitioners and did a preliminary exploratory factor analysis of the new scale (n = 124). After an initial 24-item administration, principal axis factoring of our final 17-item solution revealed two latent factors (attitudes and skills/knowledge) consistent with the 2013 SOCCS and the theoretical constructs of cultural competency. The BDSM Counselor Competency Scale (BDSM-CCS) can help clinicians, practices, agencies, and training programs track self-reported cultural competence with the BDSM population. Future research directions for scale development and clinical and training applications are discussed.

Genetic counselors' utilization of ChatGPT in professional practice: A cross-sectional study

PURPOSE

The precision medicine era has seen increased utilization of artificial intelligence (AI) in the field of genetics. We sought to explore the ways that genetic counselors (GCs) currently use the publicly accessible AI tool Chat Generative Pre-trained Transformer (ChatGPT) in their work.

METHODS

GCs in North America were surveyed about how ChatGPT is used in different aspects of their work. Descriptive statistics were reported through frequencies and means.

RESULTS

Of 118 GCs who completed the survey, 33.8% (40) reported using ChatGPT in their work; 47.5% (19) use it in clinical practice, 35% (14) use it in education, and 32.5% (13) use it in research. Most GCs (62.7%; 74) felt that it saves time on administrative tasks but the majority (82.2%; 97) felt that a paramount challenge was the risk of obtaining incorrect information. The majority of GCs not using ChatGPT (58.9%; 46) felt it was not necessary for their work.

CONCLUSION

A considerable number of GCs in the field are using ChatGPT in different ways, but it is primarily helpful with tasks that involve writing. It has potential to streamline workflow issues encountered in clinical genetics, but practitioners need to be informed and uniformly trained about its limitations.

Exploring the evolving roles of clinical geneticists and genetic counselors in the era of genomic medicine

The increased utilization of clinical genomic sequencing in the past decade has ushered in the era of genomic medicine, requiring genetics providers to acquire new skills and adapt their practices. The change in workplace responsibilities of clinical/medical geneticists (CMGs) and genetic counselors (GCs) in North America, due to the evolution of genetic testing, has not been studied. We surveyed CMGs (n = 80) and GCs (n = 127) with experience in general/pediatric genetics to describe their current practice of clinical tasks and the change in regularity of performing these tasks over the past 5-10 years. Currently, complementarity of responsibilities between CMGs and GCs clearly exists but providers who have been in the field for longer have noted role changes. Trends indicate that fewer experienced CMGs perform physical exams and select genetic tests than before and fewer experienced GCs complete requisitions and write result letters. The frequency of CMGs and GCs who investigate genetic test results, however, has increased. This study provides insight into the changing landscape of clinical genetics practice. Our findings suggest that the roles and responsibilities of CMGs and GCs have shifted in the past decade.

Sexualized substance use among gbMSM: Their perspectives on their intervention needs and counsellor competencies

INTRODUCTION

Treatments for problematic substance use by gay, bisexual and other men who have sex with men (gbMSM) in sexualized contexts must be adapted to take sociocultural aspects of these sexual practices into account. When treatment programs factor in sexuality, they most commonly address it from a biological perspective (STTBIs, HIV). This article sets out to identify intervention needs related to sexualized substance use (SSU) from the perspective of gbMSM, taking into consideration different dimensions of sexuality to offer more effective support.

METHODS

Twenty adult gbMSM, each of whom had previously participated in addiction-related treatment programs, took part in this study. We recruited through medical clinics, community organizations, social media advertising and word of mouth. Through one-on-one semi-structured interviews, participants shared their perspectives on the treatment they had received, how their sexuality had been addressed during treatment, and their perceptions of their treatment-related needs and requirements. The study analyzed and interpreted the data gathered during these interviews using a conceptual framework of sexual health combined with The Competencies, a model for addiction counselling training.

RESULTS

When the study asked participants what they would consider beneficial in terms of SSU-related treatment, they identified certain key competencies. These can be broken down into three categories - knowledge, skills and attitudes - that, together, participants perceived as critical to the development of adequate programs and services. While participants reported addiction-related knowledge was important, so too was an understanding of sexuality (e.g., sexual practices, gbMSM communities, sociocultural norms). With regard to attitudes, the study identified respect, non-judgment, acceptance and empathy as themes for most participants. Lastly, the desired skills were those permitting counsellors and other treatment providers to better align programs and services with each individual's singular reality within the context of their substance use.

CONCLUSIONS

The results of this study suggest that, to provide treatment programs adapted to the needs of gbMSM in a context of SSU, knowledge must be consolidated and new skills developed. Furthermore, both knowledge and skills need to be placed within an overarching perspective of cultural humility. Overall, improving these various competencies should improve the continuum of care in addiction treatment.

Mobile health intervention to address chronic pain among those who engage in hazardous drinking: A pilot study

BACKGROUND

Hazardous drinking has been associated with chronic pain in community and medical samples. The purpose of this study was to develop a novel, integrated mobile health intervention that improves pain management and reduces hazardous drinking that may be implemented in primary care settings.

METHODS

Forty-eight participants with moderate or greater chronic pain and hazardous drinking were recruited from primary care clinics and through social media sites. Following baseline assessment, participants were randomized to a counselor-supported smartphone app intervention (INTV) or a counselor delivered treatment-as-usual control condition (CTL).

RESULTS

Results supported the feasibility and acceptability of the smartphone app intervention. Participants found it easy to use, reported high levels of satisfaction, and showed high levels of engagement with the app. Between-group effect size estimates at follow-up showed small effects for the intervention on pain ratings. However, using clinically meaningful change thresholds of 30% and 50% improvement in pain scores, 38% and 25% respectively of those in the INTV condition showed reductions compared to 20% and 12.5% respectively in the CTL condition. Effect size estimates did not indicate intervention superiority on alcohol outcomes as participants in both conditions showed considerable reductions in drinking over the course of the study.

CONCLUSIONS

Results supported the view that a mobile health intervention delivered via smartphone with electronic coaching is a feasible and acceptable method of addressing chronic pain among those who engage in hazardous drinking. Future work should test the efficacy of this approach in a fully powered trial.

Role of Institutional Support for Evidence-Based Psychotherapy in Satisfaction and Burnout Among Veterans Affairs Therapists

OBJECTIVE

Burnout is widespread among psychotherapists and leads to negative mental and other health outcomes, absenteeism, and turnover. Job resources, including institutional support for evidence-based practices, can buffer against burnout and may improve satisfaction among therapists. The Veterans Health Administration (VHA) is the nation's largest integrated health system and employs 23,000 therapists, including psychologists, social workers, and counselors. The authors assessed associations between perceived institutional support for evidence-based treatment and satisfaction and burnout among VHA therapists.

METHODS

This analysis used data from the VHA's national 2018 Mental Health Provider Survey. Responding therapists (N=5,341) answered questions about the quality of mental health care and job satisfaction. Multilevel logistic regression models were used to predict burnout and satisfaction. The authors tested availability of evidence-based treatment and measurement-based care (MBC) as predictors; analyses were adjusted for therapist workload, demographic characteristics, and potential clustering by facility.

RESULTS

VHA therapists had less burnout and more job satisfaction when they perceived receiving institutional support for evidence-based psychotherapy (EBP) and MBC, irrespective of whether the analyses were adjusted for workload. Less difficulty in scheduling EBP was significantly associated with decreased likelihood of burnout (OR=0.83, p<0.001) and increased satisfaction (OR=1.09, p=0.008). Less difficulty ending psychotherapy was significantly associated with decreased likelihood of burnout (OR=0.89, p=0.002) and increased satisfaction (OR=1.12, p=0.004).

CONCLUSIONS

Support for evidence-based practices, including EBP and MBC, was closely linked to VHA therapists' satisfaction and burnout. Expanding support for therapists to provide evidence-based treatment may benefit therapists, patients, and the health care system.

Slice Testing-Considerations from Ordering to Reporting: A Joint Report of the Association for Molecular Pathology, College of American Pathologists, and National Society of Genetic Counselors

As the number of genes associated with various germline disorders continues to grow, it is becoming more difficult for clinical laboratories to maintain separate assays for interrogating disease-focused gene panels. One solution to this challenge is termed slice testing, where capture backbone is used to analyze data specific to a set of genes, and for this article, we will focus on exome. A key advantage to this strategy is greater flexibility by adding genes as they become associated with disease or the ability to accommodate specific provider requests. Here, we provide expert consensus recommendations and results from an Association for Molecular Pathology-sponsored survey of clinical laboratories performing exome sequencing to compare a slice testing approach with traditional static gene panels and comprehensive exome analysis. We explore specific considerations for slices, including gene selection, analytic performance, coverage, quality, and interpretation. Our goal is to provide comprehensive guidance for clinical laboratories interested in designing and using slice tests as a diagnostic.

PrEP and Behavioral Health Treatment Referral Among HIV Test Counselors in Miami-Dade County: A Rapid Qualitative Study Using the Consolidated Framework for Implementation Research

HIV test counselors are well positioned to refer individuals to pre-exposure prophylaxis (PrEP) and behavioral health treatments. HIV test counselors in Miami-Dade County (N = 20), a priority jurisdiction for Ending the HIV Epidemic, completed interviews to assess determinants of PrEP and behavioral health treatment referrals. To identify determinants, we used a rapid deductive qualitative analysis approach and the Consolidated Framework for Implementation Research (CFIR). Identified determinants sometimes served as facilitators (e.g., relative priority, leadership importance) and sometimes as barriers (e.g., lack of access to knowledge and information, available resources for referrals) to making referrals. We also observed differences in determinants between PrEP and behavioral health referrals. For example, complexity (perceived difficulty of the referral) was a barrier to behavioral health more often than PrEP referral. Our findings suggest that determinants across many CFIR domains affect referral implementation, and the corresponding need for multiple implementation strategies to improve implementation of PrEP and behavioral health referrals in the context of HIV testing.

Experiences of breastfeeding peer counseling among women with low incomes in the US: a qualitative evaluation

BACKGROUND

Person-centered breastfeeding counseling is a key but often overlooked aspect of high-quality services. We explored women's experiences of the Breastfeeding Heritage and Pride™ program, an evidence-based breastfeeding peer counseling program serving women with low incomes in the United States.

METHODS

This study was conducted through an equitable community-clinical-academic partnership and guided by the World Health Organization (WHO) quality of care framework for maternal and newborn health, which highlights three domains of positive experiences of care: effective communication; respect and dignity; and emotional support. In-depth interviews were conducted with a purposive sample of women participating in the Breastfeeding Heritage and Pride™ program. Women were asked to describe their experiences with the program including examples of when good quality counseling was or was not provided. Each interview was conducted in English or Spanish, audio-recorded, and transcribed verbatim. Data were analyzed using reflexive thematic analysis. Once themes were generated, they were organized according to the three care experience domains in the WHO quality of care framework.

RESULTS

Twenty-eight in-depth interviews were conducted with a racially/ethnically and socio-economically diverse sample of women. Three themes described effective communication practices of peer counselors: tailoring communication to meet women's individual needs; offering comprehensive and honest information about infant feeding; and being timely, proactive, and responsive in all communications across the maternity care continuum. Two themes captured why women felt respected. First, peer counselors were respectful in their interactions with women; they were courteous, patient, and non-judgmental and respected women's infant feeding decisions. Second, peer counselors showed genuine interest in the well-being of women and their families, beyond breastfeeding. The key theme related to emotional support explored ways in which peer counselors offered encouragement to women, namely by affirming women's efforts to breastfeed and by providing reassurance that alleviated their worries about breastfeeding. These positive experiences of counseling were appreciated by women.

CONCLUSIONS

Women described having and valuing positive experiences in their interactions with peer counselors. Efforts to expand access to high-quality, person-centered breastfeeding counseling should, as part of quality assurance, include women's feedback on their experiences of these services.

Processing the process: Reflections on genetic counselor-led student supervision groups and practical tips for future facilitators

Genetic counseling graduate students face growth and challenges across a variety of axes both personally and professionally throughout their training. The formation of leader-led supervision groups for second-year genetic counseling students has created a safe space for students to give and receive feedback, process their positionality in complex clinical scenarios and the medical system at large, dissect psychosocial counseling theory, and share personal and professional experiences with the overall aim of supporting their growth. This work requires faculty facilitators who are invested in student growth and operate from a framework of empathy, humanism, curiosity, and vulnerability. The authors share their reflections on stepping into the facilitator role with no prior experience other than their work in clinical genetic counseling in varied practice settings. Common themes across four cohorts of students are presented along with reflections on facilitator growth, consideration of student developmental stages, and the parallel process between providing clinical services to clients and educating students. The authors hope to highlight the value of processing cases, inspire other genetic counselors to engage in this work, and normalize the experiences of those already running genetic counseling student process groups.

A cross-professional competency framework for communicating genomic results

To ensure genomic medicine is delivered safely and effectively, it is crucial that healthcare professionals are able to understand and communicate genomic results. This Education Innovation describes a nationally agreed, cross-professional competency framework outlining the knowledge, skills and behaviors required to communicate genomic results. Using principles of the nominal group technique, consensus meetings with clinical, scientific and educational experts identified six stages in the return of results process, drafted and iterated competencies. Competencies were then mapped across three levels to acknowledge different degrees of experiences and scopes of practice. The framework was open for consultation with healthcare professionals and patient communities before being published. The finalized framework includes six core competency statements required to communicate genomic results. This framework is designed to be a guide for best practice and a developmental tool to support individuals and organizations. It can be used by healthcare professionals, such as genetic counselors, to identify individual learning needs or to structure the development of training for other healthcare professionals who are increasingly involved in requesting and returning results for genomic tests.

Development of a flipped learning course to deliver and scale molecular variant evaluation education: A quality improvement initiative

Over the past several decades, molecular genetic testing volumes have grown and testing has expanded from single-gene assays to multigene panels, exome sequencing, and genome sequencing. The number of molecular genetic variants that require manual interpretation has grown simultaneously, resulting in an increased demand for education on molecular variant evaluation (MVE). To meet this growing need, a team of genetic counselors and educational experts undertook a quality improvement (QI) initiative with the objectives of assessing, standardizing, and scaling access to MVE education, without increasing instructor time to deliver the education. Using the Six Sigma define-measure-analyze-improve-control (DMAIC) framework, a flipped learning course with a series of standardized online modules was developed to deliver MVE education in an enduring and accessible format for a diverse group of learners. Outcome measures included the number of online modules developed, the number of individual learners and unique learner groups accessing MVE education, and direct instruction time required to deliver MVE education. Countermeasures to ensure maintenance of educational quality included post-course learner satisfaction scores and performance on competency assessments. Both the total number of learners and the number of unique learner groups accessing MVE education increased, while instructor time required to deliver content per learner decreased. Learner satisfaction scores remained constant and performance on competency assessments improved. The QI initiative successfully scaled MVE education to a diverse group of learners without decreasing learner outcomes or satisfaction. The flipped learning format provides a scalable and flexible educational model for instructors and learners in a rapidly changing environment that often includes remote work and education.

Coffee and conversation: A genuine dialogue on authentic professional learning between genetic counselor educators

Lifelong learning is a term frequently referred to in the training and continuing professional development of genetic counselors. It implies the ability to continuously engage in self-motivated reflection to identify knowledge gaps and develop a learning plan to address identified needs or interests. In contrast to this definition, the path to continuing professional development for most genetic counselors involves attendance at conferences; yet much data suggest that other forms of learning are more effective at leading to practice change and improved patient or quality outcomes. These conflicting ideas beg the question: what is professional learning? A dialogue between two genetic counselor educators, both with advanced training in health professional education, shares personal beliefs regarding lifelong learning in the genetic counseling profession. This discourse represents an authentic conversation that was audio-recorded and transcribed with minimal editing to improve clarity and readability. The views presented in this dialogue are highly personal, yet grounded in educational theory. References are provided to those that desire further reading on the topics discussed. Several authentic learning strategies are described, including communities of practice, peer supervision, and personal learning projects. The authors consider ways to increase knowledge acquisition from conference attendance and discuss how learning on the job becomes embedded in practice. As a result of this discourse, the authors hope to inspire genetic counselors to reflect over their continuing professional development and consider their job as a learning environment that presents rich, ongoing, and unique opportunities for growth. The authors invite and challenge readers to identify learning needs and set goals for themselves to address those needs. For those with interest in education, it is hoped that the conversation sparks new or invigorated interest that will lead to novel or more effective learning opportunities with improved outcomes for patients, students, and colleagues alike.

Poor recall of genetics curriculum by medical students highlights barriers to use in clinical practice

Many current and upcoming healthcare providers do not feel comfortable ordering or discussing genetic tests and using genetic information in medicine. Nationally, a little over a quarter of medical students indicate that they do not feel prepared to use genetic information in clinical rotations, despite attempts at many schools to remodel the genetics curriculum. This study was conducted at Emory University School of Medicine to identify gaps within the medical curriculum that may contribute to student reports that they feel underprepared to apply genetic knowledge in clinical practice. The analysis included a comprehensive curriculum inventory of genetic content that was then compared to the responses from focus groups of randomly selected second- and fourth-year medical students without a prior genetics degree or background. This joint analysis of precisely what was taught and how it was perceived by students was informative in the development of targeted interventions in our curriculum, and it highlighted the important role of genetic counselors in the education of medical students. Our curriculum has a structure similar to that at many other schools, in which core genetics concepts are concentrated in a brief segment in the first year. We believe our results will be useful for other medical schools to address the perception by medical students that they are underprepared to use genetic information and other basic sciences clinically.

Integrating nutrition and genetic counseling: A case study approach to interprofessional learning

Interprofessional collaboration is an increasingly important skillset for practicing healthcare professionals including genetic counselors and registered dietitian nutritionists. A multi-part interactive case study activity was created to develop interprofessional skills for graduate students within genetic counseling and medical nutrition training programs at an academic medical center. Feedback from learners who participated in this activity highlights its effect on their post-graduation clinical practice. Additionally, since the implementation of this activity, collaboration between students and faculty members of each program has occurred in other scholarly pursuits, fostering longstanding interprofessional relationships. Similar approaches to interprofessional education could be considered with other healthcare professions or at other institutions as another tool to strengthen practice upon graduation.

Creation and beta testing of a "choose your own adventure" digital simulation to reinforce motivational interviewing skills in genetic counseling

Standardized patients and/or role-playing are commonly used for practicing genetic counseling (GC) skills. Use of digital simulation, incorporating gamification elements, would require fewer resources to sustain than standardized patients. This manuscript reports steps taken and the lessons learned from creating a digital "Choose your own adventure" simulation in which students select preferred dialog for a genetic counselor who is seeing an adult patient to discuss genetic testing for the known pathogenic variant that caused familial adenomatous polyposis (FAP) in their father. The case has three endings, one of which is attained by selecting options that are mostly consistent with motivational interviewing counseling techniques. We conducted a preliminary evaluation of our beta version among nine GC students and one educator using a survey to assess acceptability and appropriateness as well as to elicit open-ended feedback. All participants agreed or strongly agreed with statements indicating the case was acceptable, appropriate, and fun. Users particularly appreciated the immediate feedback given throughout the case simulation. Many users wanted more options to select from and listed various other recommendations, including several which would require substantial resources to implement.

Promoting the integration of genetic counseling education and research across the spectrum of learners at a large academic institution

Genetic counselors are valuable members of research teams and are increasingly taking leadership roles in major research trials. While the field of genetic counseling has explored a doctoral degree several times, the terminal degree is still a master's level. Genetic counseling training programs provide research training, but many genetic counselors desire additional opportunities to develop expertise. To address the gaps in the availability of research training before and after obtaining genetic counseling degrees, we applied for and received a grant centered around three aims: (1) develop an undergraduate minor in genomics and human health with a research component, (2) promote a rigorous genetic counseling research program for training to practice genetic counselors, and (3) initiate a combined PhD program in Molecular, Cellular, Developmental Biology, and Genetics (MCDB&G) with a track in genetic counseling. We describe each of these components and early progress toward these aims. As each individual aim is bearing fruit, the next challenges are implementing more crossover between people in each aim and distilling the lessons learned to see if this program could be replicated at other sites.

What next for "counseling" in genetic counseling training: A co-production workshop exploring how CBT and ACT approaches can contribute to the genetic counseling toolkit

Counseling techniques are an important part of genetic counseling, and teaching of the humanistic person-centered philosophy has been central to genetic counselor (GC) training. However, other psychotherapeutic approaches, especially cognitive approaches, may also be beneficial for the GC to have in their toolkit. This paper reports on a co-production workshop with newly qualified GCs where the potential for adopting more cognitive approaches informed by cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) was explored. Attendees were taught about the approaches and the rationale for their use in genetic counseling and had a chance to discuss their reactions and ideas for application. The attendees saw great potential for the approaches within their practice, feeling that these short interventions can have a wide impact, including engaging patients who do not want to discuss feelings, helping people to make sense of information (not just gain knowledge), and helping people to change the relationship they have with their thoughts. They were able to identify when they already use some cognitive approaches in their practice, and to see how they could build on this to provide better patient care. The paper advocates for an introduction to CBT and ACT to be incorporated into pre-qualification training, and for more advanced training to be available to post-qualification GCs.

Massive open online courses (MOOCs) in genomic variant interpretation: An innovative education strategy for the growing genetic counselor workforce

The growth in genomic testing in healthcare requires a highly trained specialist workforce to ensure evidence based clinical germline variant interpretation. Genetic counselors form a core part of the clinical genomics multidisciplinary team (MDT) and represent a growing workforce participating in variant interpretation from data analysis to the patient consultation. Standardized, high-quality variant interpretation training for Genetic Counselors has historically been ad hoc and variable, with existing programs lacking capacity to reach the entire workforce. To address the requirement for scalable variant interpretation training for genomics healthcare professionals (HCPs), two Massive Open Online Courses (MOOCs) were developed. We analyzed the data from 17 Genetic counselors, as part of an evaluation cohort completing the first run of these MOOCs. Overall genetic counselors enjoyed the courses, felt they were clinically relevant and would recommend them to colleagues. Common challenges amongst the genetic counseling workforces included utilizing relevant databases and finding time in the workday to complete training. These findings suggest MOOCs could be an acceptable option to ensure a consistent and transferrable high standard of training, complimentary to existing curricula. They also hold the potential to facilitate large-scale education to update the genetic counseling workforce when changes in variant interpretation guidance occur.

Perspectives of genetic counseling supervisors regarding genetic counseling students' attainment of practice-based competencies in clinical care through remote supervision

There are limited studies regarding the attainment of the Accreditation Council for Genetic Counseling Practice-Based Competencies by genetic counseling students who complete clinical rotations in an in-person setting versus in a remote setting that incudes telephone and/or video patient encounters. This study explored the perceptions of 17 patient-facing genetic counselors who had served as supervisors for genetic counseling students regarding student attainment of practice-based competencies in in-person compared to remote rotations. Participants were recruited through an American Board of Genetic Counseling eblast and were required to have at least 2 years of clinical experience and experience providing genetic counseling supervision for at least one in-person rotation and one remote rotation. Four focus groups were created comprising genetic counselors from various practice disciplines. Discussion focused on potential differences and similarities in supervisor perceptions of student attainment of each clinical practice-based competency, and whether there were any concerns about students being able to attain each competency in remote rotations. Overall, participants discussed that genetic counseling students' attainment of clinical competencies through remote rotations was comparable to in-person rotations; however, 15 themes were identified illustrating differences reported by participants in how they observed these skills being performed by students in in-person versus remote clinical settings. The findings of this study highlight important considerations when developing a remote rotation, as well as ways in which certain clinical skills may be further enhanced through a combination of both in-person and remote clinical experiences. A noted limitation of remote rotations is that students have less of an opportunity to interact with other providers, and so may require other opportunities for interprofessionalism and to understand their role as part of a larger organization. Further study is required to elucidate differences between telephone and video clinics, as well as potential differences pertaining to various specialty areas of practice.

Exploring the training needs of inherited cardiac conditions (ICC) nurses: Elucidating role boundaries and competencies for practice in the genomics era

Nurses represent the largest professional group within the National Health Service (NHS) and are therefore central to the successful integration of mainstreaming genomics into routine healthcare. Inherited cardiac conditions (ICC) nurse roles have been developed in recent years to streamline the care for patients and families affected by an ICC. Like many nurse specialists, ICC nurses' prior exposure to genomics and the wider implications surrounding inherited conditions is limited. The aim of the study was to explore the education needs and support required for ICC nurses to fulfill their role within the genomic medicine era. A convenience sampling approach was adopted to invite ICC nurses working within various NHS Trusts across the United Kingdom to take part. Semi-structured interviews were conducted with ICC nurses (n = 8), which were recorded, transcribed, coded, and analyzed using an inductive thematic analysis approach. Analysis of interview data highlighted four core themes, which were transferrable core competencies; managing genomic information; mixed-modality learning; defining multidisciplinary team boundaries. The study highlights areas for further training and demonstrates the importance of defining competencies and role boundaries within ICC services. The ICC nurses identified the limits of their practice and the complementary role of genetic counselors, indicating the need for both professions within the ICC service and proposing implications for practice.

Non-Adherence to Anti-Retroviral Therapy Among Adult People Living with HIV in Ethiopia: Systematic Review and Meta-Analysis

Human immunodeficiency virus remains a global public health problem. Despite efforts to determine the prevalence of non-adherence to ART and its predictors in Ethiopia, various primary studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of non-adherence to ART and identify its predictors. We have searched PubMed, Google Scholar and Web of Science databases extensively for all available studies. A weighted inverse-variance random-effects model was used to compute the overall non-adherence to ART. The pooled prevalence of non-adherence to ART was 20.68% (95% CI: 17.74, 23.61); I2 = 98.40%; p < 0.001). Educational level of primary school and lower [AOR = 3.5, 95%CI: 1.7, 7.4], taking co-medications [AOR = 0.45, 95%CI: 0.35, 0.59], not using memory aids [AOR = 0.30, 95%CI: 0.13, 0.71], depression [AOR = 2.0, 95%CI: 1.05, 3.79], comorbidity [AOR = 2.12, 95%CI: 1.16, 3.09), under-nutrition [AOR = 2.02, 95%CI: 1.20, 3.43], not believing on ART can control HIV [AOR = 2.31, 95%CI: 1.92, 2.77], lack of access to health facilities [AOR = 3.86, 95%CI: 1.10, 13.51] and taking ART pills uncomfortably while others looking [AOR = 5.21, 95%CI: 2.56, 10.53] were significantly associated with non-adherence to anti-retroviral therapy. The overall pooled prevalence of non-adherence to ART was considerably high in Ethiopia. Educational status, taking co-medications, not using memory aids, depression, comorbidity, under nutrition, not believing on anti-retroviral therapy controls HIV, lack of access to health facilities and taking ART pills uncomfortably were independent predictors of non-adherence to ART in Ethiopia. Therefore, healthcare providers, adherence counselors and supporters should detect non-adherence behaviors and patients' difficulties with ART early, and provide intensive counseling to promote adherence.

Efficacy of ChatGPT in Cantonese Sentiment Analysis: Comparative Study

BACKGROUND

Sentiment analysis is a significant yet difficult task in natural language processing. The linguistic peculiarities of Cantonese, including its high similarity with Standard Chinese, its grammatical and lexical uniqueness, and its colloquialism and multilingualism, make it different from other languages and pose additional challenges to sentiment analysis. Recent advances in models such as ChatGPT offer potential viable solutions.

OBJECTIVE

This study investigated the efficacy of GPT-3.5 and GPT-4 in Cantonese sentiment analysis in the context of web-based counseling and compared their performance with other mainstream methods, including lexicon-based methods and machine learning approaches.

METHODS

We analyzed transcripts from a web-based, text-based counseling service in Hong Kong, including a total of 131 individual counseling sessions and 6169 messages between counselors and help-seekers. First, a codebook was developed for human annotation. A simple prompt ("Is the sentiment of this Cantonese text positive, neutral, or negative? Respond with the sentiment label only.") was then given to GPT-3.5 and GPT-4 to label each message's sentiment. GPT-3.5 and GPT-4's performance was compared with a lexicon-based method and 3 state-of-the-art models, including linear regression, support vector machines, and long short-term memory neural networks.

RESULTS

Our findings revealed ChatGPT's remarkable accuracy in sentiment classification, with GPT-3.5 and GPT-4, respectively, achieving 92.1% (5682/6169) and 95.3% (5880/6169) accuracy in identifying positive, neutral, and negative sentiment, thereby outperforming the traditional lexicon-based method, which had an accuracy of 37.2% (2295/6169), and the 3 machine learning models, which had accuracies ranging from 66% (4072/6169) to 70.9% (4374/6169).

CONCLUSIONS

Among many text analysis techniques, ChatGPT demonstrates superior accuracy and emerges as a promising tool for Cantonese sentiment analysis. This study also highlights ChatGPT's applicability in real-world scenarios, such as monitoring the quality of text-based counseling services and detecting message-level sentiments in vivo. The insights derived from this study pave the way for further exploration into the capabilities of ChatGPT in the context of underresourced languages and specialized domains like psychotherapy and natural language processing.

Direct-to-Consumer Genetic Tests and Canadian Genetic Counselors: A Pilot Exploration of Professional Roles in Response to Novel Biotechnologies

The role of genetic counselors is evolving in response to health-related direct-to-consumer genetic tests (DTC-GT). While there is consensus in the literature that pre- and post-DTC-GT genetic counseling would benefit consumers, genetic counselors have reservations about DTC-GTs, and there is a paucity of research on providing DTC-GT counseling. This pilot quantitative survey is the first study to examine Canadian genetic counselors' views on DTC-GTs and how this disruptive biotechnology affects their role, and consumer informed consent and privacy. Canadian genetic counselors are cognizant of the harm to informed consent and privacy associated with DTC-GT, but are hesitant to engage directly, wary of misusing clinical time and resources. However, counselors are open to producing educational materials on DTC-GTs and collaborating with other stakeholders and the DTC-GT industry to support consumers. In this study, practical considerations for DTC-GT counseling sessions are discussed, including the unique needs of DTC-GT patients and the challenges posed by DTC-GTs to the genetic counseling duty to inform. This research benefits genetic counselors and physicians by examining how best to utilize genetic counselors' skills in the DTC-GT context, to minimize burdens on the healthcare system and support DTC-GT consumers.

Co-design of patient information leaflets for germline predisposition to cancer: recommendations for clinical practice from the UK Cancer Genetics Group (UKCGG), Cancer Research UK (CRUK) funded CanGene-CanVar Programme and the Association of Genetic Nurse Counsellors (AGNC)

BACKGROUND

Testing for germline pathogenic variants (GPVs) in cancer predisposition genes is increasingly offered as part of routine care for patients with cancer. This is often urgent in oncology clinics due to potential implications on treatment and surgical decisions. This also allows identification of family members who should be offered predictive genetic testing. In the UK, it is common practice for healthcare professionals to provide a patient information leaflet (PIL) at point of care for diagnostic genetic testing in patients with cancer, after results disclosure when a GPV is identified, and for predictive testing of at-risk relatives. Services usually create their own PIL, resulting in duplication of effort and wide variability regarding format, content, signposting and patient input in co-design and evaluation.

METHODS

Representatives from UK Cancer Genetics Group (UKCGG), Cancer Research UK (CRUK) funded CanGene-CanVar programme and Association of Genetic Nurse Counsellors (AGNC) held a 2-day meeting with the aim of making recommendations for clinical practice regarding co-design of PIL for germline cancer susceptibility genetic testing. Lynch syndrome and haematological malignancies were chosen as exemplar conditions.

RESULTS

Meeting participants included patient representatives including as co-chair, multidisciplinary clinicians and other experts from across the UK. High-level consensus for UK recommendations for clinical practice was reached on several aspects of PIL using digital polling, including that PIL should be offered, accessible, co-designed and evaluated with patients.

CONCLUSIONS

Recommendations from the meeting are likely to be applicable for PIL co-design for a wide range of germline genetic testing scenarios.

Basic counseling skills in psychology and teaching: validation of a short version of the counselor activity self-efficacy scales

BACKGROUND

Counseling self-efficacy is a relevant measure to examine trainees' beliefs about their counseling skills. This study aimed to validate three scales of the revised German version of the Counselor Activity Self-Efficacy Scales (CASES-R) measuring basic counseling skills. To ascertain the scales' sensitivity to change, counseling self-efficacy was assessed before and after specific training.

METHOD

The sample comprised 163 university students enrolled either in psychology or education. Students were examined before and after participating in training focusing on basic counseling skills. We applied confirmatory factor analysis and tested internal consistency, convergent validity, and criterion validity.

RESULTS

Confirmatory factor analysis supported the three-factor structure of the CASES-R scales for basic counseling skills. The scales provided acceptable to good internal consistency (α = 0.77 - 0.87). Significant relations with general self-efficacy (r =.23, p <.01) provided first indication for convergent validity. We also found a significant correlation of the CASES-R with positive affect (r =.22), and significant correlations of some subscales with empathetic concern (r =.16 -.21) and mastery goal orientation (r =.16), overall supporting criterion validity. The CASES-R scales proved to be sensitive to change, as participants' scores were higher after (M = 6.18, SD = 1.05) than before (M = 5.37, SD = 1.16) counseling training (F(1, 309) = 42.27, p <.001).

CONCLUSION

We found support for the proposed factor structure and reliability of the German version of the three CASES-R scales, indicating its suitability for use in basic counseling settings. Future research should further examine the scales' validity.

Improving counseling effectiveness with virtual counselors through nonverbal compassion involving eye contact, facial mimicry, and head-nodding

An effective way to reduce emotional distress is by sharing negative emotions with others. This is why counseling with a virtual counselor is an emerging methodology, where the sharer can consult freely anytime and anywhere without having to fear being judged. To improve counseling effectiveness, most studies so far have focused on designing verbal compassion for virtual counselors. However, recent studies showed that virtual counselors' nonverbal compassion through eye contact, facial mimicry, and head-nodding also have significant impact on the overall counseling experience. To verify this, we designed the virtual counselor's nonverbal compassion and examined its effects on counseling effectiveness (i.e., reduce the intensity of anger and improve general affect). A total of 40 participants were recruited from the university community. Participants were then randomly assigned to one of two virtual counselor conditions: a neutral virtual counselor condition without nonverbal compassion and a compassionate virtual counselor condition with nonverbal compassion (i.e., eye contact, facial mimicry, and head-nodding). Participants shared their anger-inducing episodes with the virtual counselor for an average of 16.30 min. Note that the virtual counselor was operated by the Wizard-of-Oz method without actually being technically implemented. Results showed that counseling with a compassionate virtual counselor reduced the intensity of anger significantly more than counseling with a neutral virtual counselor (F(1, 37) = 30.822, p < 0.001, ηp2 = 0.454). In addition, participants who counseled with a compassionate virtual counselor responded that they experienced higher empathy than those who counseled with a neutral virtual counselor (p < 0.001). These findings suggest that nonverbal compassion through eye contact, facial mimicry, and head-nodding of the virtual counselor makes the participants feel more empathy, which contributes to improving the counseling effectiveness by reducing the intensity of anger.

Survey of genetic counselors identifies a knowledge gap discerning properly regulated cell and gene therapy trials

BACKGROUND AND AIMS

As cell and gene therapy (CGT) has grown in availability and scope, more unapproved regenerative medicine is being marketed to the public. It is essential that health care providers have sufficient knowledge and comfort to determine whether treatments are properly regulated and address these topics with patients. Due to the applicability of CGT to genetic disease, genetic counselors could be key in providing education and answering patients' questions about these topics. However, previous studies have focused only on physicians' knowledge and comfort with CGT and unapproved regenerative medicine. The purpose of this study was to assess genetic counselors' self-reported knowledge and comfort discussing these topics with patients and to explore what factors predict increased knowledge and comfort.

METHODS

The authors designed an online survey distributed to genetic counselors who were part of the National Society of Genetic Counselors Student Research Program e-mail list. The survey addressed genetic counselors' demographics, practice experience with CGT, education about CGT, knowledge and comfort.

RESULTS

The survey was completed by 144 genetic counselors. The best predictor of increased knowledge and comfort was experience discussing CGT in practice. In addition, those who worked at an institution at which CGT trials were offered had greater knowledge and comfort. However, most genetic counselors reported their knowledge was not sufficient to address questions from patients, and most had little-to-no knowledge or comfort determining whether a trial was properly regulated. There was no correlation between education and either knowledge or comfort; however, most participants desired more education about these topics.

CONCLUSIONS

This study suggests that genetic counselors who (i) have experience with CGT in practice or (ii) work at institutions at which CGT trials are offered may have better knowledge regarding CGT. These results may help identify individuals and/or institutions in whom increasing knowledge regarding CGT could be beneficial. This is crucial as CGT becomes mainstream, leading to more widely marketed unapproved regenerative medicine. Several gaps in knowledge and comfort were identified, including participants' ability to determine whether a treatment is properly regulated. Further research is needed to better characterize the educational needs of genetic counselors surrounding these topics to address these gaps.

Eye Donation Counsellor Skill Evaluation Tool (EDC-SET): A step toward improved eye donation counseling

PURPOSE

The expansion of the Hospital Corneal Retrieval Programme (HCRP) and the role of Eye Donation Counsellors (EDCs) have shown promising results in increasing donor cornea availability. To further enhance EDC competency and improve cornea availability for transplantation, the study proposes the Eye Donation Counsellor Skill Evaluation Tool (EDC-SET). Key words: Competency assessment, corneal blindness, Eye Donation Counsellors (EDCs), eye health, Hospital Corneal Retrieval Programme (HCRP), skill evaluation.

METHODS

A competency framework for EDCs and a tool for evaluation of the competency level (EDC-SET) was designed, along with scripts for emulating realistic counselling scenarios. Independent assessors were trained on using EDC-SET and evaluated EDCs participating in role-plays based on the pre-designed scripts. EDCs were briefed a priori on the EDC-SET but not on the role play scripts which were used during evaluation.

RESULTS

We piloted the tool at a tertiary eye hospital, and it was found to capture EDC competency reliably. The study evaluated seven EDCs each assessed by two independent assessors. Conformity, kappa, and intraclass correlation coefficient (ICC) values were calculated to estimate the parameter-wise reliability of the EDC-SET. The results suggest that the scores from both assessors closely matched for most of the parameters, and overall, their ratings showed moderate agreement. The difficulty level of each parameter as assessed by the two assessors was also calculated. It was observed that most participants found "Initiation of the Case" and "Empathy and Emotional Support" challenging. However, "Body Language," "Cultural Awareness," and "Attentiveness to Family Dynamics" were perceived as relatively easy or not difficult by participants.

CONCLUSION

Evaluation of EDCs using EDC-SET revealed the varying competency levels of EDCs and showed agreement on the evaluation between the assessors. Implementing the EDC-SET could help standardise the mapping and measurement of the skill set of EDCs, thereby enhancing their performance and reducing corneal blindness in India.

Who is providing HIV testing services? The profile of lay counsellors providing HIV testing services in Johannesburg, South Africa in the treat-all era

BACKGROUND

Lay counsellors are critical in sustaining access to HIV testing services (HTS) and psychosocial support for persons living with HIV (PLHIV). We aimed to describe the professional and psychosocial profiles of lay counsellors in primary healthcare (PHC) clinics in Johannesburg, South Africa under the universal-test-and-treat (UTT) policy context.

METHODS

We conducted a descriptive analysis of a cross-sectional survey among adult (≥ 18 years) lay counsellors from 20 PHC facilities (2-3/ clinic) in Johannesburg, South Africa. Consenting counsellors were interviewed between June 2018 and March 2019. We report on counsellors' demographic profiles, training, work experience, and mental and emotional well-being.

RESULTS

Overall, 55 consenting adult (≥ 18 years) lay counsellors (92.7% female, median age 37 years, interquartile range [IQR]: 33-44, and 27.3% HIV diagnosed) were surveyed. Most (85.5%) were Department of Health lay counsellors receiving a volunteer stipend at the time. Overall, 56.4% had been working as counsellors for five years or longer. The majority (87%) had completed the National HIV Testing Services Policy Guidelines-recommended 10-day basic counselling training, but 45.2% had not completed refresher training within the guideline's required 24 months. Reported operational barriers include lack of designated space for counselling (56.4%), inadequate professional supervision and support (40.7%) and insufficient emotional support (over 56.4%), and 60% were overwhelmed by their workload. A total of 18.2% had major depressive symptoms, and the same proportion scored low for psychological well-being. While most (87.3%) reported moderate job satisfaction, 50.9% actively sought alternative employment.

CONCLUSION

Despite lay counsellors' significant role in delivering HIV care in South Africa, there has been minimal investment in their skills development, emotional support, and integration into the formal health workforce. Counsellors' persisting unmet psychosocial, training, and professional needs could impact their efficacy in the UTT era.

The GC Immersive: Patching the pipeline with genetic counseling experiences for all

Genetic counseling graduate programs largely recommend that prospective applicants shadow or gain exposure to genetic counselors (GC) as a means of developing insight into the profession. However, prospective students have cited this need to shadow genetic counselors as harder to access in comparison to other prerequisites. The GC Immersive (GCI) at Color was created as a no-cost, remote, self-paced professional exploration program designed to provide resources and live interaction with a team of genetic counselors to increase accessibility to GC exposure and enhance the competitiveness of underrepresented GC candidates. The program design and curriculum were developed by a team of certified genetic counselors and a GC student in 2021 and is marketed to those who have one or more identities underrepresented in the GC field. In total, 287 individuals enrolled in the program in the first and second cycles, with 115 providing demographic information. The majority of enrollees identified as an underrepresented minority in GC in one or more identities, with individuals who are ethnic and/or racial minority (70%), first-generation college student (44%), lesbian, gay, transgender, queer, intersex, and/or asexual (LGBTQIA+) (27%), and disabled community (16%) reported as the most common identities. Most participants had never shadowed a GC (55%) prior to this course. Twenty-two percent of enrollees resided outside of the United States, representing 15 different countries. Of the 287 enrolled participants, 21 (7%) have completed the program, with the remaining participants having between 5 and 11 months to complete. All individuals who completed the program reported they felt better prepared to apply for a GC program. The general structure of this program can be replicated by any institution, as the program consists primarily of recorded content. Ongoing effort by genetic counselors is minimal and has the ability to provide GC experience to prospective applicants at great scale.

Incorporating telehealth education into the genetic counseling curriculum

As the provision of telehealth genetic counseling (THGC) services continues to expand, it is imperative that genetic counseling students gain proficiency in telehealth service delivery. To prepare students to provide THGC services, the MSGC program at the University of Pennsylvania has included didactic sessions on THGC, THGC role plays, THGC standardized patient sessions, and THGC fieldwork experiences and clinical rotations. This article highlights best practices in THGC and guidance for Master of Science in Genetic Counseling (MSGC) programs training the next generation of genetic counselors providing THGC services.

Future Frontiers: Exploration of practices, challenges, and educational needs of genetic counselors in emerging subspecialties

The augmented use of genomic testing across different medical subspecialties has led to increased involvement of genetic counselors (GCs) in specialized areas of medicine. However, the lack of educational infrastructure required for changing scholastic needs of GCs entering new subspecialties lends to the burden of self-directed learning and inconsistent knowledge. We conducted a cross-sectional study surveying GCs with experience in the emerging genetic subspecialties of Immunology, Dermatology, Endocrinology, and Pulmonology (abbreviated as "IDEP") on current practices, clinical challenges, and educational strategies undertaken while working in these settings. We compared knowledge and confidence in skills related to IDEP patient care between GCs who do (experienced cohort) and do not (control cohort) practice in these settings to assess their comfort with working in subspecialties. Participants were recruited from the National Society of Genetic Counselors membership. A total of 304 GCs (178 experienced and 126 control) completed the survey. Most GCs in the experienced cohort saw IDEP patients by themselves (n = 104; 58.4%) or with a geneticist (n = 97; 54.4%) and almost all (n = 176; 99%) cited GeneReviews as a primary informational source for IDEP genetics but half (n = 91; 51.1%) agreed that a dedicated online course would be the best way to learn about a specific subspecialty. The experienced cohort scored higher on confidence in all skills (p < 0.001, z = 7.32) and knowledge (p < 0.001, z = 5.68) related to IDEP genetics than the control cohort. Previous exposure to IDEP through graduate school coursework and rotations positively correlated with better self-confidence in skills (p = 0.02, z = -2.19; p < 0.001, z = -5.25) and genetic knowledge (p = 0.03, z = -2.09; p < 0.001, z = -2.81) related to IDEP patient care. Years of experience working as a GC did not correlate with better confidence in skills (p = 0.53) or better IDEP genetic knowledge (p = 0.15). Our findings show that provision of opportunities for increased exposure to subspecialties could help maximize GCs' ability to work in emerging niche fields.

A Qualitative Examination of School Counselors' Experiences of Sextortion Cases of Female Students in Israel

Sextortion (a portmanteau of "sexual" and "extortion") is a relatively new phenomenon of sexual exploitation, which occurs when a person threatens another with the distribution of sexual content on the Internet, to obtain more pictures or videos, money, or have some other demand met. The current study examined how school counselors in Israel perceive the phenomenon of online sextortion. To this end, we conducted a qualitative study based on 20 semi-structured in-depth interviews with school counselors working in middle schools and high schools in Israel, who treated adolescent girls blackmailed over the Internet on sexual grounds. Findings indicate that the school counselors had difficulty in identifying and defining the cases they treated as instances of sextortion, and that in their view the harm was slight. Findings also indicate that school counselors associated the causes of sextortion with the victims and their backgrounds. We found differences between the Arab and secular and national-religious state education in the way Jewish counselors treated the victims and involved additional actors such as the victim's parents and the police. This underscores the importance of providing educational staff with adequate knowledge and tools that are culturally suited to the victims.

Unlocking learner potential: A course director's experience building an Educational Escape Room for Cancer Risk Assessment

Using a traditional lecture format alone often limits students' opportunities to engage with and apply the concepts taught in a classroom. This report describes the design, curricular implementation, and application of an innovative educational escape room as an active learning tool for genetic counselor educators to teach cancer risk assessment skills. A Cancer Risk Assessment Escape Room is a novel way to offer experiential learning and to assess a learner's critical thinking and ability to apply cancer risk assessment models to evolving clinical scenarios. This successful implementation of an interactive escape room can be adapted to other genetic counseling competencies. The use of an escape room allows learners to actively engage in and apply content taught in lectures before entering clinical internships.

A qualitative study of LGBTQIA+ genetic counselors' experiences while applying to graduate school

Research has shown that lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexual and gender minority (LGBTQIA+) healthcare students experience discrimination during admissions and training. While several studies have examined the experiences of racial and ethnic minorities within the genetic counseling field, the admissions experiences of LGBTQIA+ individuals have not been explored. Through semi-structured interviews, this qualitative study investigated the experiences of ten LGBTQIA+ genetic counselors and genetic counseling students during graduate school admissions. Interview questions focused on participants' perceptions of the genetic counseling field prior to applying, important factors in choosing and ranking programs, decisions surrounding disclosure of LGBTQIA+ identities, interview experiences related to their identities, and the impacts, if any, of their identities on their overall admissions journey. Transcripts were coded and analyzed utilizing a constructivist grounded theory approach, resulting in the emergence of themes regarding factors that influenced participants' decisions to disclose their identity and how their LGBTQIA+ identity factored into their selection of a training program. This study adds new perspectives to the conversations around diversity, equity, and inclusion within the genetic counseling field. Further, it provides genetic counselors and genetic counseling programs insight into inclusive admissions processes and suggests ways to improve inclusivity in graduate admissions.

Population-Based Estimates and Predictors of Child and Adolescent Linkage to HIV Care or Death in Western Kenya

BACKGROUND

Population-level estimates of linkage to HIV care among children and adolescents (CAs) can facilitate progress toward 95-95-95 goals.

SETTING

This study was conducted in Bunyala, Chulaimbo, and Teso North subcounties, Western Kenya.

METHODS

Linkage to care was defined among CAs diagnosed with HIV through Academic Model Providing Access to Healthcare (AMPATH)'s home-based counseling and testing initiative (HBCT) by merging HBCT and AMPATH Medical Record System data. Using follow-up data from Bunyala, we examined factors associated with linkage or death, using weighted multinomial logistic regression to account for selection bias from double-sampled visits. Based on the estimated model, we imputed the trajectory for each person in 3 subcounties until a simulated linkage or death occurred or until the end of 8 years when an individual was simulated to be censored.

RESULTS

Of 720 CAs in the analytic sample, 68% were between 0 and 9 years and 59% were female. Probability of linkage among CAs in the combined 3 subcounties was 48%-49% at 2 years and 64%-78% at 8 years while probability of death was 13% at 2 years and 19% at 8 years. Single or double orphanhood predicted linkage (adjusted odds ratio [aOR]: 2.66, 95% confidence interval [CI]: 1.33 to 5.32) and death (aOR: 9.85 [95% CI: 2.21 to 44.01]). Having a mother known to be HIV-positive also predicted linkage (aOR = 1.94, 95% CI: 0.97 to 3.86) and death (aOR: 14.49, 95% CI: 3.32 to 63.19).

CONCLUSION

HIV testers/counselors should continue to ensure linkage among orphans and CAs with mothers known to be HIV-positive and also to support other CAs to link to HIV care.

Pivotal Role of Genetic Counselors in the Uptake of Germline Genetic Testing in Non-Metastatic Breast Cancer and the Impact of Testing on Surgical Decision Making

BACKGROUND

Genetic testing is increasingly utilized in breast cancer patients; however, testing rates remain low. We aimed to evaluate the rate of genetic testing at a tertiary academic medical center utilizing a multidisciplinary clinic model including genetic counselor.

METHODS

A single-center retrospective chart review was performed on a cohort of newly diagnosed breast cancer patients from January 2018 through February 2019. Patients were reviewed for genetic screening eligibility, consultation with a genetic counselor, and test results.

RESULTS

Final analysis included 426 patients. 261 (61.3%) were found to meet National Comprehensive Cancer Network guidelines for genetic testing, of which 178 patient (68.2%) underwent testing and 32 patients (12.3%) declined testing. Of the 165 not eligible for testing, 5 patients were tested. A total of 183 patients underwent testing and 116 (63.4%) had a negative result, 17 (9.3%) were positive for at least one gene mutation and 50 (27.3%) were identified to have a variant of unknown significance (VUS). There was a positive association between those patients who met with a genetic counselor and eligibility for testing (OR 31.1, 95% CI 16.0-60.5).

CONCLUSIONS

Genetic testing result has become an increasingly important factor when defining optimal surgical treatment for breast cancer patients. Increasing the availability of genetic consultation for breast cancer patients can improve testing rates and patient selection.

A coping model for school psychological counsellors: A qualitative study

This study analyzed the coping processes of psychological counsellors working in high schools in Turkey in the face of the challenges experienced in counselling sessions. The study used a qualitative research design: grounded theory. Semistructured interviews conducted with 33 high school counsellors were analyzed following Strauss and Corbin's analysis guidelines to create a coping model. The core category in the model was 'coping' while 'actions/reactions' explained what counsellors do to cope. Finally, 'environmental factors' and 'personal factors' influenced their coping processes. The findings are discussed in light of the existing literature to provide suggestions for school counsellors to develop self-care/coping strategies, increase their resilience and decrease their burnout.

Lay counsellors' experiences of administering the AUDIT-C as a brief screening tool in a South African township

BACKGROUND

South Africa presents one of the riskiest patterns of alcohol consumption, with per capita consumption above the African regional average. Globally, there has been an increased focus on the potential of appointing lay counsellors to administer alcohol intervention strategies in resource-limited contexts. Given the increasing need for relevant and efficient intervention strategies in response to high-risk alcohol consumption, screening instruments such as the AUDIT-C have gained increased attention.

METHODS

This paper explores the experiences of 15 lay counsellors in response to the training received on how to administer the AUDIT-C instrument, as well as provide interventions such as brief advice or an appropriate referral, in the resource-limited South African township of Alexandra, Johannesburg. A focus group was facilitated for this purpose and, thereafter, a thematic content analysis was applied to identify the themes most central to the lay counsellors' experiences.

RESULTS

The research findings suggest that the lay counsellors perceived the training to be adequate in preparing them for administrating the AUDIT-C and for providing any relevant interventions, and that their confidence in administering the instrument developed as the project progressed. However, recruitment and administration challenges were experienced in primary healthcare and community settings, and lay counsellors perceived home visits to be more appropriate with respect to issues related to confidentiality and stigmatisation.

CONCLUSION

Overall, while lay counsellors feel that the training they received on the tool and the tool itself is useful for effectively implementing the AUDIT-C in low-resource communities, the availability and efficiency of alcohol treatment services in Alexandra Township need to be improved.

Experiences of peer counsellors in supporting exclusive breastfeeding in southern India: An exploratory qualitative study

OBJECTIVE

Peer counsellors are effective in addressing a variety of health challenges, including exclusive breastfeeding (EBF). Providing education and support from a person of similar background and experience has been an important adjunct to the practice of health workers for the past 50 years.

DESIGN

It is an exploratory qualitative study.

POPULATION OR SAMPLE

Twenty-two peer counsellors.

SETTING

In-depth Interview in the community.

METHODS

To better understand the experiences of these important health workers, we conducted qualitative interviews with 22 peer counsellors who participated in a research study in Belagavi District, Karnataka, India. Transcripts of the interviews were organised and assigned codes by the research team.

MAIN OUTCOME MEASURES

Experience of Peer counsellor's role in the community to improve breastfeeding practices.

RESULTS

Peer counsellors had a good understanding of the larger study and of their role. Analysis of the transcripts identified three themes: personal satisfaction; the effect on the larger circle of family and community; and ideas for future programming. The positive experiences and the ability of peers to be trained in counselling women around EBF support their use in breastfeeding support and other areas of health education.

CONCLUSIONS

The women from the community who served as peer counsellors were enthusiastic and satisfied about their work, which provided them with opportunities to do meaningful community work outside of their household routines. Use of the peer counsellor model to deliver a specific objective like improvement in EBF rates, immunisation or mental health in integration with healthcare providers can help in achieving desired goals.

Evaluating the effectiveness of concurrent sessions and counselors' attention allocation in online counseling

OBJECTIVE

With its anonymity and accessibility, text-based online counseling has shown great potential in reaching people with mental health needs. One strategy adopted to meet the service gap is concurrent counseling, that is, each counselor attending to more than one client at a time. To date, there is no reported evidence supporting its rationality and effectiveness. This study investigated the potential opportunities, effectiveness, and caveats in concurrent service delivery and identified the optimal cutoff number of concurrent sessions while maintaining the quality of service at or above a set threshold.

METHOD

We analyzed the transcript of 54,716 online counseling sessions from Open Up, a free, 24/7 text-based counseling service, to develop an attention score that measures the attention allocation of counselors and examined the impact of the counselor's attention allocation on client satisfaction and service outcomes.

RESULTS

On average, compared to nonconcurrent sessions, concurrent sessions were longer, more likely to end prematurely, and had lower client satisfaction. We also identified an optimal attention score of approximately 0.4 (out of 1.0, which denotes full attention), which translates to two to three concurrent sessions.

CONCLUSIONS

This study provides empirical evidence for the feasibility of conducting multiple text-based sessions concurrently without compromising service quality and client experience. Our method of measuring the counselor attention allocation offers a way to systematically assess and evaluate concurrent sessions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Experiences of genetic counselors in referring young and metastatic breast cancer patients to support services: A needs assessment

OBJECTIVE

Conduct a needs assessment to explore the experiences, barriers, and needs of genetic counselors (GCs), who counsel and refer young and metastatic breast cancer (BC) patients to support services, in order to develop resources to address any noticeable gaps.

METHODS

GCs providing care to BC patients were eligible to complete the survey. Support services were defined as resources to address patient-centered healthcare, emotional, and quality-of-life needs.

RESULTS

Most participants (n = 117) reported familiarity with cancer prevention services (93%); fewer were familiar with services secondary to a BC diagnosis (e.g., fatigue=16% and sexual health=24%). The volume of GCs indicating familiarity with support services increased significantly as work experience increased for seven services. Many (>50%) never referred patients to most (9/12) support services, excluding cancer prevention, mental health, and financial issues. Open-ended responses highlighted that GCs considered referrals to be outside their scope of practice or that healthcare systems prevent GCs from making referrals.

CONCLUSION

GCs may benefit from curated resources and materials, especially for support services secondary to a BC diagnosis, to better support their patients.

PRACTICAL IMPLICATIONS

Collaboration of GCs with other health professionals through integrative care programs may decrease burdens to accessing support services.

Variation in rates of sexual assault crisis counsellor usage during forensic examination in California: an observational study

OBJECTIVES

A critical asset to post-assault care of survivors is support from sexual assault crisis counsellors (SACCs). We sought to elucidate variation in implementation between California counties in SACC accompaniment during Sexual Assault Forensic Examination (SAFE).

METHODS

SACC attendance data from 2019 was obtained from the California Governor's Office of Emergency Services (CalOES). To assess SACC attendance rates during SAFEs, we requested SAFE quantity data from sheriffs and public health departments, the State Forensic Bureau, and the California Department of Justice (DOJ), but all requests were unanswered or denied. We also sought SAFE data from District Attorneys (DAs) in each county, and received responses from Marin and Contra Costa Counties. To estimate numbers of SAFEs per county, we gathered crime statistics from the Federal Bureau of Investigation's (FBI's) Uniform Crime Reporting Program and OpenJustice, a transparency initiative by the California DOJ. For each data source, we compared SACC attendance to SAFE quantities and incidences of sexual assault statewide.

RESULTS

At the state level, data on SACC attendance per CalOES and DOJ archival data on sexual assault were used to approximate relative rates of SACC accompaniment at SAFEs; 83% (30 of 36) of counties had values <50%. The joint sexual assault crisis centre for Contra Costa and Marin Counties reported that 140 SACCs were dispatched in 2019, while DAs in Contra Costa and Marin reported completion of 87 SAFEs in 2019, for a calculated SACC accompaniment rate of 161%. Proxy data sourced from FBI and DOJ crime statistics displayed significant inconsistencies, and DOJ data was internally inconsistent.

CONCLUSIONS

SACC accompaniment at SAFEs appears to be low in most California counties, however, limited data accessibility and data discrepancies and inaccuracies (e.g., rates over 100%) prevented reliable determination of SACC accompaniment rates during SAFEs. Substantial improvements in data accuracy and transparency are needed to ensure survivors' adequate access to resources.