Table 1:

Applying Genomic Concepts in Competent Social Work

CASE: Valerie and Jacob, a mixed-race heterosexual couple, present for counseling due to disagreement about whether to have children. Since the death of Jacob’s Jewish mother when he was six, he has been adamant that he does not want children. Valerie desperately wants a child, despite feeling fearful and preemptively guilty a child might “get sickle cell like my sister has.” Valerie is not worried about the possibility that their child might develop breast cancer as she believes that the fact that it is on the child’s paternal side would eliminate breast cancer risk. Jacob’s reluctance and Valerie’s excited ambivalence have led to a rift in their marriage.
SCENARIO 1	SCENARIO 2
Focus on exploring the couple’s thoughts and experiences around parenthood and parenting. Social worker does not address ambivalence about parenting. She explores Jacob’s memories of his mother and complicated grief involving the culture of silence around her illness and death. Social worker explores Valerie’s experience of her sister’s condition without awareness of inheritance patterns or current reprogenetic technologies available for family planning. Social worker tells Jacob, “One in three Americans get cancer, so you can’t predict anything.” She refers them to a perinatologist for help with getting pregnant.	Focus on patterns of illness and child bearing in both families. Social worker explicitly asks Jacob whether he would be interested in children if health issues were not present, putting the abandonment hypotheses aside. Social worker reviews rudimentary genetics information and lets the couple know about reprogenetic treatments and the possibility of adoption. Social worker refers them to a perinatal geneticist to explore options. She works with the couple as they identify their tolerance of health risks, make decisions, and manage their grief about family illness and death as well as the loss of innocence about child bearing.