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Counseling

Counseling. Counseling is a vital part of the aural rehab process. Effectiveness of counseling is correlated to compliance with recommendations. Why Effective Counseling is Important. Because there are challenges in attaining the goal of infants using their hearing aids full time:

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Counseling

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  1. Counseling • Counseling is a vital part of the aural rehab process. • Effectiveness of counseling is correlated to compliance with recommendations.

  2. Why Effective Counseling is Important Because there are challenges in attaining the goal of infants using their hearing aids full time: • Parents need to understand how important hearing is to brain development • Parents need to provide auditory stimulation during all waking hours (and know why this is important) • Keeping hearing aids on an active toddler‘s head can be a challenge

  3. Why Effective Counseling is Important Goal: full time hearing aid use (12+ hrs per day) • BUT studies show that 40% of children wear their hearing aids 4 hours or less per day • Only 10% achieve full-time hearing aid use

  4. Why Effective Counseling is Important If a baby only wears hearing aids for 4 hours per day, then it will take 6 years for his or her brain to receive as much auditory stimulation as a normal hearing child gets in one year.

  5. Source: Achieving Effective Hearing Aid Use in Early Childhood

  6. Counseling Counseling starts when you are explaining the results of the hearing assessment to the child’s parents.

  7. Breaking Bad News It helps if you can break the news gently – i.e. over 2 sessions. • 1st session: I have a suspicion, we’re going to have you come back for further testing… • 2nd session: The results are consistent with the first…

  8. Breaking Bad News It helps if you can break the news gently – i.e. over 2 sessions. • 1st session: I have a suspicion, we’re going to have you come back for further testing… • 2nd session: The results are consistent with the first… • This instills more confidence

  9. Breaking Bad News It helps if you can break the news gently – i.e. over 2 sessions. • 1st session: I have a suspicion, we’re going to have you come back for further testing… • 2nd session: The results are consistent with the first… • This instills more confidence • May soften the blow

  10. Confidence • You have to be confident in your test results to project confidence during counseling. • Avoid messages like “Our test results suggest hearing loss” or “I think your child might have a hearing loss”. Don’t hedge. • It's OK to bring a patient back for a 2nd or 3rd ABR if that's what you need to be confident in your results.

  11. Giving the Results Prepare the room. • Make sure tissues are handy. • Parents should be seated comfortably. • You should be at the same eye level as the parents or lower – never higher. • Try to make sure that there will be no interruptions.

  12. Giving the Results • Make and maintain eye contact with both parents.

  13. Giving the Results • Make and maintain eye contact with both parents. • Announce that you are going to explain the test results – get parents spoken or unspoken permission to do so.

  14. Giving the Results • Make and maintain eye contact with both parents. • Announce that you are going to explain the test results – get parents spoken or unspoken permission to do so. • PREFACE “I’m sorry to have to be the one to give you this news, but...” or “I know this is not the news you were hoping for, but..” or “I have some difficult news”.

  15. Giving the Results • Make and maintain eye contact with both parents. • Announce that you are going to explain the test results – get parents spoken or unspoken permission to do so. • PREFACE “I’m sorry to have to be the one to give you this news, but...” or “I know this is not the news you were hoping for, but..” (empathy) or “I have some difficult news”. • Give your diagnosis. For example “___ has a severe hearing loss in both ears. This is a permanent hearing loss and he/she is going to need hearing aids”.

  16. Giving the Results • Make and maintain eye contact with both parents. • Announce that you are going to explain the test results – get parents spoken or unspoken permission to do so. • PREFACE “I’m sorry to have to be the one to give you this news, but...” or “I know this is not the news you were hoping for, but..” (empathy) or “I have some difficult news”. • Give your diagnosis. For example “___ has a severe hearing loss in both ears. This is a permanent hearing loss and he/she is going to need hearing aids”. Stop there! That is a lot of information to absorb. Give the parents much time as they need to absorb this. Let them dictate the next step.

  17. Silence • We are conditioned that silence is awkward/uncomfortable in social situations. This is not so when delivering bad news !

  18. Silence • We are conditioned that silence is awkward/uncomfortable in social situations. This is not so when delivering bad news ! • The parents don’t experience silence this way.

  19. Silence • We are conditioned that silence is awkward/uncomfortable in social situations. This is not so when delivering bad news ! • The parents don’t experience silence this way. It is not silent in their heads. • Talking too much is the biggest mistake that clinicians make when delivering news about a diagnosis.

  20. Silence You will find this odd at first, but when you get used to it, it will seem very natural.

  21. Respect • The family is allowing you, a stranger, into their lives at this very vulnerable time.

  22. Respect • The family is allowing you, a stranger, into their lives at this very vulnerable time. • This is a privilege

  23. Respect • Respect is a 2-way street.

  24. Respect • Respect is a 2-way street. • “Positive, unconditional regard. Assume good will.” (English, 2008, Oticon Pediatric Symposium)

  25. Respect • Respect is a 2-way street. • “Positive, unconditional regard. Assume good will.” (English, 2008, Oticon Pediatric Symposium) • How might you seem like you’re looking down on a family ? • By not listening to what they have to say (interrupting them). • By invalidating their concerns “It could be worse”. • By commenting negatively about something (such as the child’s behavior – now is not the time!).

  26. Crying Expect one or both parents to cry, even if you thought they already expected the diagnosis

  27. Crying “Audiologists need to be prepared to deal with the emotional ramifications of the news they deliver” (parent of deaf/hard of hearing child)

  28. Crying • Crying is a natural reaction and is not to be discouraged. It is a way for the parents to release their stress/emotions. • Offering a tissue is an unspoken way of saying you’re OK with them crying.

  29. Crying What about the clinician. Should you cry ?

  30. Crying It’s normal to feel a bit sad, but there is also optimism because you know you are doing what is best for the child, and that this is something they can overcome.

  31. Being Positive Jane Madell: “We need to be optimistic about what is possible for hearing loss and believe it! Today, everything IS possible for children with hearing loss.” Source: Audiology Online, 2013.

  32. Breaking Bad News • We tend to feel that we have to give parents all the answers and solve the problem.

  33. Breaking Bad News • We tend to feel that we have to give parents all the answers and solve the problem. • You will not be good at counseling if you put this kind of pressure on yourself. You may find that you will actually get better at counseling when you try to do less.

  34. Breaking Bad News • We tend to feel that we have to give parents all the answers and solve the problem. • You will not be good at counseling if you put this kind of pressure on yourself. You may find that you will actually get better at counseling when you try to do less. • Avoid being the rescuer.

  35. Breaking Bad News • We tend to feel that we have to give parents all the answers and solve the problem. • You will not be good at counseling if you put this kind of pressure on yourself. You may find that you will actually get better at counseling when you try to do less. • Avoid being the rescuer. • Encourage parents to talk about their feelings, fears and emotions.

  36. Grief The 5 stages of grief (Elisabeth Kübler-Ross): • Denial • Anger • Bargaining • Depression • Acceptance For audiology, I would add guilt.

  37. Grief “Welcome to Holland” by Emily Perl Kingsley

  38. Parent’s Concerns(even if unspoken) • Are you sure? J Am Acad Audiol. 2007 Sep;18(8):675-87. Development of an instrument to evaluate audiologic counseling skills. English K, Naeve-Velguth S, Rall E, Uyehara-Isono J, Pittman A.

  39. Parent’s Concerns(even if unspoken) • Are you sure? • Did I cause this somehow? J Am Acad Audiol. 2007 Sep;18(8):675-87. Development of an instrument to evaluate audiologic counseling skills. English K, Naeve-Velguth S, Rall E, Uyehara-Isono J, Pittman A.

  40. Parent’s Concerns(even if unspoken) • Are you sure? • Did I cause this somehow • Will my child talk? J Am Acad Audiol. 2007 Sep;18(8):675-87. Development of an instrument to evaluate audiologic counseling skills. English K, Naeve-Velguth S, Rall E, Uyehara-Isono J, Pittman A.

  41. Parent’s Concerns(even if unspoken) • Are you sure? • Did I cause this somehow? • Will my child talk? • What do I do now? J Am Acad Audiol. 2007 Sep;18(8):675-87. Development of an instrument to evaluate audiologic counseling skills. English K, Naeve-Velguth S, Rall E, Uyehara-Isono J, Pittman A.

  42. Parent’s Concerns(even if unspoken) • Are you sure? (show ABR waveforms as you’re doing test) • Did I cause this somehow? (can’t choose our genes; only preventable hearing loss is NIHL) • Will my child talk? • What do I do now? • Shouldn’t I get a second opinion? J Am Acad Audiol. 2007 Sep;18(8):675-87. Development of an instrument to evaluate audiologic counseling skills. English K, Naeve-Velguth S, Rall E, Uyehara-Isono J, Pittman A.

  43. Parent’s Concerns(even if unspoken) • Are you sure? • Did I cause this somehow? • Will my child talk? • What do I do now? • Shouldn’t I get a second opinion? • How many children have you tested? J Am Acad Audiol. 2007 Sep;18(8):675-87. Development of an instrument to evaluate audiologic counseling skills. English K, Naeve-Velguth S, Rall E, Uyehara-Isono J, Pittman A.

  44. Parent’s Concerns(even if unspoken) • Are you sure? • Did I cause this somehow? • Will my child talk? • What do I do now? • Shouldn’t I get a second opinion? • How many children have you tested? • Can this be fixed? Is there a surgery or medicine to fix this problem? J Am Acad Audiol. 2007 Sep;18(8):675-87. Development of an instrument to evaluate audiologic counseling skills. English K, Naeve-Velguth S, Rall E, Uyehara-Isono J, Pittman A.

  45. Parent’s Concerns(even if unspoken) • Are you sure? • Did I cause this somehow? • Will my child talk? • What do I do now? • Shouldn’t I get a second opinion? • How many children have you tested? • Can this be fixed? Is there a surgery or medicine to fix this problem? • Will my baby have to wear a hearing aid? J Am Acad Audiol. 2007 Sep;18(8):675-87. Development of an instrument to evaluate audiologic counseling skills. English K, Naeve-Velguth S, Rall E, Uyehara-Isono J, Pittman A.

  46. Parent’s Concerns(even if unspoken) • Are you sure? • Did I cause this somehow? • Will my child talk? • What do I do now? • Shouldn’t I get a second opinion? • How many children have you tested? • Can this be fixed? Is there a surgery or medicine to fix this problem? • Will my baby have to wear a hearing aid? • Will my other / future children also have hearing loss? J Am Acad Audiol. 2007 Sep;18(8):675-87. Development of an instrument to evaluate audiologic counseling skills. English K, Naeve-Velguth S, Rall E, Uyehara-Isono J, Pittman A.

  47. Parent’s Concerns(even if unspoken) • Are you sure? • Did I cause this somehow? • Will my child talk? • What do I do now? • Shouldn’t I get a second opinion? • How many children have you tested? • Can this be fixed? Is there a surgery or medicine to fix this problem? • Will my baby have to wear a hearing aid? • Will my other / future children also have hearing loss? • How will I communicate with him/her? J Am Acad Audiol. 2007 Sep;18(8):675-87. Development of an instrument to evaluate audiologic counseling skills. English K, Naeve-Velguth S, Rall E, Uyehara-Isono J, Pittman A.

  48. Relationships Having a child diagnosed with hearing loss can be a strain on a marriage.

  49. Non-Compliant Parents • "I try to put the hearing aids in but he or she does not want to keep them on“

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