Training activity information
Details
Assess individuals psychological state and their social support and mental health needs and refer appropriately
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Exploring individuals’ psychological needs in genetic counselling consultations
- Identifying individual patients at psychological risk for early intervention and/or referral to other agencies as appropriate
- Referral pathways for appropriate agencies, such as mental health services
- Safeguarding children, young people and vulnerable adults
- Mental capacity
- Exploring individuals’ social support needs in genetic counselling consultations
- Appropriate social support resources
- Consideration of patient consent for referral
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify how you will assess an individual’s psychological state, social support, and mental health needs during a consultation.
- Consider how the learning outcomes apply, specifically in relation to the criteria that indicate you have made an appropriate decision regarding referral, if necessary.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the appropriate depth of assessment and the triggers that mandate referral or discussion with a senior colleague
What is your prior experience of this activity?
- Think about what you already know about assessing psychological status in a clinical setting.
- Consider possible challenges you might face during the activity, such as sensitively exploring a patient’s mental health or social support network, or negotiating breaking confidentiality in a patient who discloses significant risk to self or others
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if the patient discloses significant suicidal ideation or a severe mental health crisis that requires immediate intervention outside your counselling scope.
- Acknowledge how you feel about initiating discussions about a patient’s psychological state or potential mental health needs.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as specific assessment techniques or questioning approaches to refine, drawing upon previous experiences of the activity.
- Identify the specific insights you hope to gain into identifying signs that warrant further assessment or referral.
What additional considerations do you need to make?
- Consider your previous experiences of psychosocial assessment or referral. Check whether your department has a specific protocol for managing patients with suicidal ideation.
- Identify what information you need to consider before embarking on the activity, such as the appropriate referral pathways available for mental health or social support in your clinical setting. You should also review any specific ethical considerations regarding discussing mental health.
- Identify what resources are available for patients, including primary care, relevant charities and self-referral options to support wellbeing.
- Consider any specific factors that might influence communication on this topic, including cultural attitudes to mental health, neurodivergence, disability or a patient’s prior experiences of mental health care.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst actively assessing the individual’s psychological state or needs?
- Are you encountering situations such as:
- The patient discloses severe suicidal ideation or a severe mental health condition that you did not anticipate from the referral?
- Their reaction to routine psychological screening questions (e.g., about support networks) is unexpectedly wary or defensive?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you changing your approach to assess the level of psychological risk or distress? Are you able to explain to the patient the reason for your questions and put them at ease?
- Consider the steps you are taking in the moment, such as: Adapting your approach to focus on the patient’s present moment comfort and safety, as well as any relevant risk assessment protocols; or, pausing the assessment to document the disclosure accurately while maintaining rapport.
- How are you feeling in that moment? For instance, are you finding it difficult to maintain composure while managing the patient’s psychological distress? Is it affecting your confidence in accurately assessing the best course of action?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, were you able to complete a sufficient risk assessment and make an appropriate preliminary plan? Or are you needing support because the level of acute psychological distress requires immediate senior input and crisis management protocol activation?
- What are you learning as a result of the unexpected development? For example, are you mastering real-time risk assessment strategies in genetic counselling o learning to support yourself and a patient so that the therapeutic alliance is maintained despite emotional distress?
On action
What happened?
- Begin by summarising the key steps you took when assessing the individual’s psychological state, social support, and mental health needs.
- Consider specific events, actions, or interactions which felt important, such as the moment the patient disclosed severe suicidal ideation or a highly sensitive social support issue.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, safely exploring the level of psychological risk or distress using immediate risk assessment protocols.
- How did you feel during this experience, e.g., did you feel confident in your assessment but challenged by the unexpected intensity of the topic, or was it hard to get your patient to open up?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding assessing complex needs. What strengths did you demonstrate, e.g., effective approach to sensitive topics?
- What skills and/or knowledge gaps were evident, e.g., difficulty identifying potential acute mental health issues or appropriate local crisis referral pathways?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in assessing these complex needs in the context of genetic counselling?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding an acute disclosure that required immediate intervention outside your routine counselling role, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving skills in identifying potential mental health issues or appropriate referral pathways.
- What will you do differently next time you approach assessing psychological state, for instance, by proactively exploring additional resources or practicing specific questioning techniques for mental health referral?
- Do you need to practise any aspect of the activity further, such as applying specific psychological screening tools or communicating with patients about mental health?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of assessing psychological state since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how subsequent learning, supervision, or challenging cases prompted you to re-evaluate your method of inquiry regarding psychological state and sensitivity to subtle cues during your first attempt at this training activity.
- Considering what you understand about psychological assessment, social needs, and appropriate referral pathways now, how have you since improved your psychological assessment technique? For example, proactively reviewing specific protocols for acute mental health risk, or incorporating strategies that support this process in patients with additional needs.
- Has discussing past assessment experiences (such as the impact of missing subtle psychological or social needs) with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, hearing a senior colleague talk about a patient whose coping mechanism masked acute distress may have refined your understanding of the importance of attending to subtle cues, or using counselling skills such as challenge during assessment.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent psychological assessment experiences, contributed to your overall confidence and ability in supporting vulnerable patients, particularly in preparing for assessments? For example, has your accumulated ability in psychological assessment influenced your confidence in helping patients safely adjust to difficult news or weigh up complex decisions that might impact their psychological health.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to psychological assessment? Looking holistically at your training journey, how has this initial psychological assessment experience, revisited with your current perspective, contributed to your development in supporting vulnerable patients? For example, how this foundational experience provides the necessary ongoing learning or supervision essential to maintain and enhance ability in this area.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Lead on establishing the patient agenda and psychosocial needs in complex genetic and genomic counselling consultations, under the supervision of a GCRB registered Genetic Counsellor. |
| # 2 |
Outcome
Employ counselling skills to facilitate complex decision making during genetic and genomic counselling consultations. |
| # 3 |
Outcome
Apply communication skills to provide complex genomic test results in an empathic manner. |
| # 4 |
Outcome
Use counselling supervision and multidisciplinary meetings to work through ethical and cultural issues in genomic counselling practice. |