Table 3.

Counseling Micro Skills

Micro Skill	Brief Description	Examples
Core Skills Used Throughout Session
Listens to parents	Listens for emotional, factual and inferred content of parents’ communications. Uses verbal and non-verbal responses to indicate that they are listening to parents.	“Mm hmm.” Or “Tell me more about that.” Or quietly nods head.
Makes eye contact during discussion	Uses culturally appropriate eye contact with parents to facilitate conversation.
Shows range of affect	Facial expressions suggest empathy, interest, and concern in response to parents’ needs.
Tone of voice communicates sincerity	Shows range of intonation to communicate sincerity, warmth, interest and concern in response to parents’ needs.
Uses attentive body language	Uses culturally appropriate facilitative posture and hand gestures to communicate interest and encourage parent participation.
Shares talk time	Engages both parents to become active participants in the session so that parents and counselor contribute to conversation.	“So (mother’s name) described what she would like to know more about; (father’s name), I’m wondering about you. What questions do you have?”
Uses open-ended questions	Uses non-directed and semi-directed questions that prompt parents to share their thoughts, feelings, questions, or concerns.	Non-directed: “How can I best help you today?” Semi-directed: “What did your doctor tell you about (infant’s name) NBS test results?”
Uses closed-ended questions	Uses questions that have one or two word responses when brevity is called for.	“How many children do you have?” “Are you interested in information about carrier testing?
Prompts questions	Uses verbal and non-verbal prompts to facilitate dialogue. Counselor remains alert for changes in parent’s facial expression, pauses, and check to see if parents have questions.	“What questions do you have?” “Please feel free to ask questions.” “I’m wondering if you have some questions about what we just discussed.”
Uses minimal encouragers	Uses verbal and non-verbal prompts to reinforce and promote parents’ contribution to the conversation	Nodding head “Uh ha,” “mm”
Paraphrases comments	Uses parents’ key words and/or summarizes. Comments confirm that counselor understands parent’s perspective.	“It sounds like you learned from your primary physician what CF is and that it affects the lungs and digestive system. That’s a great start for our discussion today.”
Minimizes major disruptions	Stops counseling session during major disruptions.	“I’m just going to stop right now and let the technician collect the sweat pads from (baby’s name).”
Minimizes minor and moderate disruptions	Uses pauses and other methods to address minor and moderate disruptions and does not amplify them.	“I apologize for that interruption; let’s go back to where we were before the knock on the door. We were talking about…”
Skills Associated with Emotional Support
Supports parents’ story-telling	Encourages parents to share stories about their experience with the NBS process and other relevant life experience.	“How was (infant’s name) birth?” “What has the wait for the sweat test appointment been like for you?” “What do you know about CF?”
Assesses parents emotional needs	Asks parents if they have worries about their infant; explores specific sources of concerns including but not limited to the NBS results. Uses worry scale.	“On a scale of 0 to 10 with 0 meaning not worried at all and10 being the most worried ever, I’m wondering how you are feeling at this time.”
Reflects parents’ feelings	Labels feeling(s) that parents appear to be expressing verbally or non-verbally.	“You seem very worried.” “It sounds like you’re feeling pretty optimistic about how the sweat test will turn out today.”
Shows empathy	Uses words, tone of voice, and facial expressions to communicate an appreciation for parents’ emotions.	Mirrors parents’ facial expressions of smiling or seriousness. “Given your past experiences, I can understand why you might feel…”
Normalizes parents’ reported experience	Explains that many parents share similar feelings, concerns, responses or behaviors when in this, or similar, situations.	“Many parents come to the sweat test appointment with reactions much like yours.” “The majority of parents that we see are not familiar with CF.”
Uses silence effectively	Monitor’s parents non-verbal language for cues that they need a moment to gather their thoughts.	Stops talking to allow parents time to formulate questions and express their feelings.
Clarifies meaning	Checks with parents to be sure that the counselor and parents share the same meaning and understanding of comments or questions.	“You said that you think your baby has been making odd noises during sleep. I’m wondering if you think it might be related to CF?”
Instills sense of hopefulness	Identifies contextual factors that offer reasons for optimism regarding infant’s future.	“Although we still need the test results, everything that you have described about your baby sounds typical for a healthy newborn.”
Skills associated with Parent Education
Foreshadows events	Outlines sequence of events that will occur during and/or after the session.	“While the technician is working on the sweat test analysis, I’d like to answer your questions and discuss the newborn screening process.” Or “I will call you before 4:00 this afternoon with the sweat test results.”
Gathers pertinent family information (brief pedigree)	Gathers family history related to CF, health of children, date and place of other children’s births and Family history of CF or CF-related symptoms.	“Has anybody in your families ever been diagnosed with CF or needed to have a sweat test?”
Assesses parents’ learning style	Asks parents how they learn best, e.g. visual, verbal, combination.	“I’m wondering how you learn new information best, such as reading, listening, or looking at visual aids.”
Matches teaching method to parents’ learning style	Uses visual aids, verbal explanations and/or hands-on activities to best fit the parents’ needs.	“As you can see here in this diagram…” “I’m going to illustrate the genetics of CF in a drawing.”
Matches language to parents’ understanding	Defines technical terms, offers basic background information about genetics, and avoids medical jargon unless parents demonstrate clear understanding.	“A mutation is a change or ‘misspelling’ in a gene.” “The sweat test was normal.”
Provides verbal explanations	Provides clear, organized, and easily understandable verbal information.	“Today’s sweat test will measure the amount of chloride or salt in (baby’s name) sweat. Babies with CF have about 5 times more chloride in their sweat than babies that don’t have CF.
Scaffolds information	Builds on parents’ previous knowledge.	“So you read that the risk of having a child with CF is 1 in 4, if both parents are CF carriers. That’s right. CF is a recessive disorder. That means that a baby must receive one changed CF gene from each parent in order to have the condition we call CF.
Normalizes carrier status	Explains how common genetic variations are and that being a CF carrier creates no health concerns.	“One in twenty-nine people whose ancestors came from Northern Europe is a CF carrier.” or “At least one parent is a carrier and he or she is healthy.”
Uses examples or metaphors	Uses illustrations or comparisons from everyday life to explain concepts to aid parents’ understanding.	“Chromosomes are like our body’s cookbooks. Genes are the individual recipes in those cookbooks.”
Uses non-examples appropriately	States what something is not to aid the parents’ understanding.	“CF carriers have one defective gene, but they do not have the disease” “Newborn screening is not designed to pick up all carriers of CF.”
Conducts a teach back	Asks parents to explain their understanding of information using their own words. If misunderstanding is noted, a teach-to-goal is used, restating the information and the parent is again questioned to confirm comprehension.	“I’d like to ask you a few questions to be sure that I adequately explained all the information we just discussed.”
Summarizes information	Captures key points of the discussion in a clear and concise synopsis.	“Your baby’s sweat test was normal. He does not have CF, but we know he is a carrier. This will not affect his health in any way.”
Takes a non-directive approach	Remains neutral when presenting parents options for further carrier testing.	“Think about whether having carrier testing might be helpful for you and your future decisions” or “Some people choose to have carrier testing, and some choose not to. The decision is individual and I encourage you to think about what is best for you.”