Counseling provides individuals, families/caregivers, and other relevant persons with information and support about communication and/or swallowing disorders to develop problem-solving strategies that enhance the (re)habilitation process.

Counseling is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Counseling is conducted by appropriately credentialed and trained speech-language pathologists.

Speech-language pathologists may provide these services individually or as members of collaborative teams that may include the individual, family/caregivers, and other relevant persons (e.g., educators, psychologists, social workers, physicians).

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, counseling is designed to--

• assist individuals to develop appropriate goals related to a communication or swallowing disorder that capitalize on strengths and address weaknesses related to underlying structures and functions that affect communication/swallowing;
• facilitate the individual's activities and participation by assisting the person to increase autonomy, self-direction, and responsibility for acquiring and utilizing new skills and strategies that are related to their goals to communicate or swallow more effectively;
• assist individuals in understanding how to modify contextual factors to reduce barriers and enhance facilitators of successful communication/swallowing and participation.

Counseling is expected to result in improved abilities, functioning, participation, and contextual facilitators. Counseling also may result in recommendations for speech-language or swallowing reassessment or follow-up, or in a referral for other services.

Clinical Indications

Counseling is prompted by referral and/or by the results of a communication or swallowing assessment. Individuals of all ages may receive counseling as part of intervention and/or consultation services when their ability to communicate or swallow effectively is impaired and when there is a reasonable expectation of benefit to the individual in body structure/function and/or activity/participation. Counseling may be warranted even if the prognosis for improved body structure/function is limited.

Clinical Process

Counseling involves providing timely information and guidance to patients/clients, families/caregivers, and other relevant persons about the nature of communication or swallowing disorders, the course of intervention, ways to enhance outcomes, coping with disorders, and prognosis. Services are sensitive to cultural and linguistic diversity.

Depending on assessment results, counseling addresses the following:

• Assessment of counseling needs.
• Provision of information.
• Use of strategies to modify behavior and/or the individual's environment.
• Development of coping mechanisms and systems for emotional support.
• Development and coordination of individual and family self-help and support groups.

Speech-language pathologists are responsible for ensuring that individuals, families/caregivers, and other relevant persons receive counseling about communication and swallowing issues. Referrals to and consultation with mental health professionals may be an integral component of counseling.

Counseling extends long enough to accomplish stated objectives/predicted outcomes. The counseling period does not continue past the point at which there is no longer any expectation for further benefit.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Counseling is conducted in clinical and educational settings and other natural environments that are conducive to individual and family comfort, confidentiality, and uninterrupted privacy. Settings are selected with consideration for the social, academic, and/or vocational activities that are relevant to or desired by the individual. In any setting, counseling addresses the personal and environmental factors that are barriers to or facilitators of the patient's/client's communication or swallowing.

Equipment Specifications: All equipment is used and maintained in accordance with the manufacturer's specifications.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes the following:

• Written record of the dates, length, and type of counseling services that were provided.
• Progress toward stated goals, updated prognosis, and specific recommendations.
• Evaluation of counseling outcomes and effectiveness within the WHO framework of body structures/functions, activities/participation, and contextual factors.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA), Family Education Rights and Privacy Act (FERPA), and other state and federal laws.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (2000). Guidelines for the roles and responsibilities of the school-based speech-language pathologist. In Rockville, MD: Author.

American Speech-Language-Hearing Association. (2004). Knowledge and skills needed by speech-language pathologists providing services to infants and families in the NICU environment. ASHA Supplement 24, 159-165.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Guidelines. Available from http://www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Position statement. ASHA Supplement 24, 60-61.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Technical report. ASHA Supplement 24, 121-130.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.