Case History

Things To Avoid

When collecting a written case history;

• Patient must be given enough time to complete filling out his history form.

• Patient must be communicated with in their preferred language

When conducting the interview

• Asking one question at the time

• Do not ask priming questions that require specific response

• Do not use WHY questions because they sound judgmental

• Always adapt patient-oriented tone and encouraging patient to take part in making important decisions

• Always refrain from judgements and assumptions

• Never interrupt patient

Initial evaluation

• Initial assessment should be clear and simple structure

• Always take into consideration individual/ cultural differences

• Be aware of your own Bias

When Providing Information/home assignments

• Do not use technical jargon

• Do not create premature clinical prognosis

• Always emphasize the positives, strengths and progress made

• Always encourage the patient to partake in decision making about his own life

• Always be creative when conveying information

• Always be aware of the way information is conveyed; watch out for tone, prosody, gestures

• Always continue to collaborate with other professionals to improve/enhance linguistic communication with individuals who have communication challenges

Information Giving

• When providing information to a patient or a caregiver, always pay attention to your linguistic delivery.

• Tone must be empathetic and must use understandable terminology

• Always emphasize the positive, strengths, and improvements made

• Always encourage patient to partake in the decision making process

• Obey the ethical codes pertaining to confidentiality

• Consider all cultural differences when providing information

• Always implement creative thinking

• Be very aware of your own word choice, prosody, gestures, and body language

• Always continue to collaborate with other professionals to improve or enhance linguistic communication with individuals who have communicative challenges

Role of Counseling

Key Issues in Counseling for Speech

Roles and Responsibilities

"As indicated in the Code of Ethics (ASHA, 2016), speech and language pathologists should be specifically educated and appropriately trained to provide the services that they offer, should engage in only those aspects of the professions that they are within the scope of their practice and competence, and should use every resource, including referral to ensure that quality service is provided"

Counseling for Professional Service Delivery

Preferred Practice Patterns

Expected Outcomes

• Enhancement of client and family/caregiver understanding of, acceptance of, and adjustment to communication, swallowing, vestibular, tinnitus, or related conditions;

• Increased engagement in management of disorder;

• Increased autonomy, self-direction, and responsibility for acquiring and utilizing new skills and strategies related to their goals;

• Enhanced physical and psychosocial well-being and quality of life;

• Improved understanding of how to modify contextual factors to reduce barriers, enhance participation, facilitate successful communication, and manage related disorders;

• Enhanced compliance with treatment recommendations; and

• Enhanced benefit from and satisfaction with treatment

Counseling Addresses

• Evaluation procedures

• Diagnoses and results of evaluations

• Problems experienced secondary to communication, vestibular, swallowing, tinnitus, and related conditions

• Effects of the disorder on psychosocial and behavioral adjustment, including interpersonal relationships, social activities, and occupational options and performance

• Affective/emotional reactions to communication/swallowing/balance disorders

• Development of coping mechanisms, problem-solving skills, compensatory behaviors, and systems for emotional support

• Development and coordination of individual and family/caregiver self-help and support groups

Counseling Theories and Approaches

Considerations in Service Delivery

Health Literacy: The degree to which an individual can obtain, communicate, process and understand basic health information nd serviced needed to make appropriate health decisions and follow instructions for treatment (Patient Protection and Affordable Care Act of 2010).

• Monitor the rate of delivery and take adequate time to communicate

• Use common language and limited technical terms

• Include pictures to clarify concepts and emphasize key points

• Provide manageable amounts of information and repeat what was communicated

• Encourage questions to facilitate comprehension of information

• Ask open-ended questions using the words "what" and "how"

• Use an interpreter when working with an individual who has limited English proficiency.

U.S. Department of Health and Human Services

Family Involvement: Family therapy and counseling by using the family systems approach.

• Leverage family strengths into the therapy regimen to firmly involve the family in addressing the issues at hand

• Have family present during explanations of the diagnosis and proposed treatment

• May alleviate some of the stress that the individual is experiencing.

Therapeutic Relationship: Building a good therapeutic relationship can help alleviate distress and lay a foundation of trust and cooperation between the clinician and the client and family/caregiver (Flasher & Fogle, 2012). The development of the therapeutic relationship is a reciprocal process during which the behaviors of each person in the ever-changing dynamic influence the others involved.

• Show consideration for the individual and family/caregivers

• Engage in joint decision making

• Motivate

• Facilitate identification of barriers

• Trust your intuition

• Address resistance

• Consider transference

• Consider countertransference

• Avoid blaming language

• Consider tone of voice

• Consider nonverbal communication

• Know when to refer an individual to mental health professionals

https://www.asha.org/practice-portal/professional-issues/counseling-for-professional-service-delivery/#collapse_1

Microskills for Counseling

Referral

*SLP's should refer out to a mental health professional when the patients issue is outside the knowledge or comfort level of the licensed SLP such as:

• Topic of death is raised in multiple instances.

• Person reports recurrent thoughts of death.

• Person reports suicidal thoughts.

• Person shows signs of persistent depression.

• Person shows signs of physical abuse of either themselves or a family member/caregiver (this behavior also warrants alerting law enforcement).

• Person shows signs of self-inflicted abuse.

• Person has a drug and alcohol addiction.

• Person reports behaviors consistent with persistent and/or severe social and/or emotional withdrawal.

• Person indicates a deterioration in family relationships.

• Person reports behaviors/thoughts consistent with personality and character disorders.

https://www.asha.org/practice-portal/professional-issues/counseling-for-professional-service-delivery/#collapse_1

Disorder-Specific Considerations

Clinicians should listen for the following information that can affect therapy progress and related counseling when engaging with a person and their family/caregiver:

• Is the disorder chronic, acute, congenital, or progressive?

• How much time post-onset is the individual? What impact does this have on their perspective?

• How might this affect the individual's self-image and self-concept?

• What feelings of anxiety, guilt, embarrassment, and so forth, might this disorder instill in the person and their family/caregiver?

• How does the disorder affect socialization and relationships with peers?

• How does the disorder affect academic performance and perceptions of teachers, employers, colleagues, and so forth?

• Is there any cultural stigma associated with the person's communication impairment that could affect how they are treated by others?

• How does the severity of the communication impairment affect the individual and family/caregiver?

• What kinds of situations may be challenging for the person and family/caregiver?

Intake/Case History Forms for Pediatrics and Adults