Beyond the Clinic and Classroom A Tennessee program adds video and live-panel exercises to help students develop patient counseling skills. Academic Edge
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Academic Edge  |   October 01, 2016
Beyond the Clinic and Classroom
Author Notes
  • Emily Clark Noss, MA, CCC-SLP, is a clinical assistant professor at the University of Tennessee Health Science Center in the Department of Audiology and Speech Pathology, specializing in pediatric aural habilitation. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood. eclark1@uthsc.edu
    Emily Clark Noss, MA, CCC-SLP, is a clinical assistant professor at the University of Tennessee Health Science Center in the Department of Audiology and Speech Pathology, specializing in pediatric aural habilitation. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood. eclark1@uthsc.edu×
  • Kelly R. Yeager, AuD, CCC-A, is a clinical associate professor at the University of Tennessee Health Science Center in the Department of Audiology and Speech pathology, specializing in pediatric audiology. She is an affiliate of SIG 9, Hearing and Hearing Disorders in Childhood. kyeager@uthsc.edu
    Kelly R. Yeager, AuD, CCC-A, is a clinical associate professor at the University of Tennessee Health Science Center in the Department of Audiology and Speech pathology, specializing in pediatric audiology. She is an affiliate of SIG 9, Hearing and Hearing Disorders in Childhood. kyeager@uthsc.edu×
Article Information
School-Based Settings / Academic Edge
Academic Edge   |   October 01, 2016
Beyond the Clinic and Classroom
The ASHA Leader, October 2016, Vol. 21, 36-37. doi:10.1044/leader.AE.21102016.36
The ASHA Leader, October 2016, Vol. 21, 36-37. doi:10.1044/leader.AE.21102016.36
The scenario was all too familiar.
Our AuD students were well-prepared to see a newly identified infant who had been referred for amplification and audiological rehabilitation. Our speech-language pathology students were ready to meet the new family, administer communication assessments, and initiate audiologic habilitation services.
The students were ready to counsel the parents of the baby with a bilateral sensorineural hearing loss. They had a plan and visual aids such as the “audiogram of familiar sounds.” The hearing aid and earmold colors were ready to “show and tell” and the audiogram was entered into the Verifit to simulate hearing loss. They knew how to teach beginning strategies to increase communication and had information showing typical auditory, speech and language development. They were primed for informational counseling!
But the parents’ emotional comments took the students out of their comfort zone:
  • “I don’t know why I am even here. I should have canceled the appointment. I know my baby hears, and I just do not think the test results are accurate.”

  • “This is all my fault. What did I do wrong? How did I cause this to happen to my baby?”

  • “I dreamed of my baby for years and now this. How do I begin to dream new dreams?”

As clinical faculty serving the pediatric population, we were trained to diagnose hearing loss, assess communication, assist families and guide parents as they begin the process of intervention. As clinicians, we collaborated, referred and provided what we were certain families needed. As educators, we prepared students, provided resources and modeled.
But we realized that students needed additional formal training in the clinic on the grief process and on counseling families through the associated emotions of hearing loss. We recognized that we had gained much of our own professional knowledge related to counseling families primarily through our experiences, and conveying this knowledge to students was challenging. Although we thought we did a stellar job at this mission, we sought further training as professionals and for our graduate students. This new insight was long overdue.
Filling the gap
In addition to our academic counseling courses at the University of Tennessee Health Science Center, we have implemented further experiences outside the classroom and clinic to give students the practical knowledge, skills and self-confidence they need when they face these emotional scenarios. Our clinical program has used various materials to help ensure that we, as professionals, are providing the best possible care for our families, while implementing more specific training with our first-year graduate students in audiology and speech-language pathology.
Our objective was to build a strong foundation in our students for counseling families who are beginning their journey with hearing loss. Using tools from David Luterman, Elizabeth Kübler-Ross, Kris English and the CARE Project (Counseling, Aural Rehabilitation and Education) as resource guides (see sources), we implemented two approaches to teach and equip students: video documentary reflections and live parent panel reflections.

Our objective was to build a strong foundation in our students for counseling families who are beginning their journey with hearing loss.

Video reflections
The CARE Project focuses on helping families and professionals understand the importance of the grief process. We gave a two-hour presentation in the weekly clinical education series for AuD and speech-language pathology graduate students completing practica in aural re/habilitation. The presentation described the stages of grief in detail and coached students through specific counseling strategies.
Using CARE training materials, we asked students to reflect on the experiences of parents and families in the video. The students identified the stages of grief as people in the video shared their journey with hearing loss. The students took notes on the various ways that grieving influences the journey to resilience and advocacy. We administered pre- and post-surveys to document the students’ perceptions of the CARE Project.
As a whole, students noted that prior to this training, their own comfort level with counseling parents and children regarding hearing loss was relatively low. The students also felt less confident about counseling children than parents. Post-training surveys indicated that students’ individual ability to counsel families on the acceptance of hearing loss improved.
Parent stories
The following semester, students listened to an in-person panel of five parents whose children had received cochlear implants. Using a model by Kübler-Ross as a guide, the students were assigned to take notes on the stages of grief. As each parent shared their personal stories with hearing loss, the students noted the journey of each through the “cycle of acceptance” to a “state of normal existence.” Students considered the amount of informational counseling each parent might be able to handle at each stage.
After the panel, students wrote a reflection paper sharing how this awareness might change their clinical approach. The students realized the need to share information during all stages of grief, recognizing that it takes time to empower families and guide them through informed decisions.
As one student commented, “I have learned new insights into how to counsel parents; what to say and not say and what information they want to hear. The panels’ viewpoints will allow me to become a better pediatric audiologist.”
Sources
English, K. M. (2002). Counseling children with hearing impairment and their families. Boston: Allyn and Bacon.
English, K. M. (2002). Counseling children with hearing impairment and their families. Boston: Allyn and Bacon.×
Kübler-Ross, E. (1969). On death and dying, the cycle of acceptance. New York: Macmillan.
Kübler-Ross, E. (1969). On death and dying, the cycle of acceptance. New York: Macmillan.×
Luterman, D. (2006). The counseling relationship. >The ASHA Leader, 11(4).
Luterman, D. (2006). The counseling relationship. >The ASHA Leader, 11(4).×
Luterman, D. (2008). Counseling persons with communication disorders and their families (5th ed.). Austin, TX: Pro-Ed, Inc.
Luterman, D. (2008). Counseling persons with communication disorders and their families (5th ed.). Austin, TX: Pro-Ed, Inc.×
Sexton, J. (2011). The Care Project, Inc..
Sexton, J. (2011). The Care Project, Inc..×
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October 2016
Volume 21, Issue 10