Sep 2, 2019 | Volume 9 - Issue 3
Gulsah Kemer, Jeffry Moe, Kaprea F. Johnson, Emily Goodman-Scott, Zahide Sunal, Chi Li
We conducted a confirmatory factor analysis (CFA) to obtain validity support for the Consultation Skills Scale (CSS) in a sample of 369 counseling professionals and interns. Upon obtaining a poor model fit from an initial CFA, we utilized modification indices and removed nine items from the CSS. As a result, we achieved a better model fit for the shorter 8-item instrument (CSS-S). To further examine validity of the CSS-S, we also explored the relationships between counselors’ consultation skills and two related professional activities, ability to foster supervisory working alliance and ability to engage in interprofessional collaboration. We discuss the results along with the implications for further practice and research as well as limitations to the current study.
Keywords: consultation skills, confirmatory factor analysis, counseling professionals, supervisory working alliance, interprofessional collaboration
As an important component of counselors’ scope of practice (Kurpius & Fuqua, 1993; Scott, Royal, & Kissinger, 2015), consultation is included in the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2015) standards, referenced in the American Counseling Association (ACA) Code of Ethics (2014), and supported as a best practice for helping counselors resolve ethical dilemmas (Sangganjanavanich & Lenz, 2012). Literature on consultation encompasses diverse professional perspectives, models, and theoretical frameworks (Brown, Pryzwansky, & Schulte, 2011; Goodman-Scott, 2015; Moe, Perera-Diltz, & Sepulveda, 2010). In an attempt to define consultation for professional counselors, Scott et al. (2015) proposed that consultation is a professional helping relationship in which a consultant seeks to foster growth and change to benefit the consultee, the consultee’s clients, and the organizational context in which the consultee provides services. Both mental health and school counselors utilize consultation to enhance practice and support recognized standards of care. As a distinct mode of intervention, consultation is recognized as a key component of the Multicultural and Social Justice Counseling Competencies (Ratts, Singh, Nassar-McMillan, Butler, & McCullough, 2015), in which counselors are strongly encouraged to act outside of the counselor–client dyad to advocate for the competent provision of services to marginalized groups.
Consultation as a Distinct Area of Practice
In the consultation literature, scholars tend to conflate consultation with other related practices, such as supervision and interprofessional collaboration. The practice of consultation does overlap in some areas with both supervision and interprofessional collaboration, while differing in how the duty of care toward identified clients and students is shared between professional stakeholders. In supervision, the relationship rests on a de facto hierarchy in which supervisors take on ultimate responsibility for ensuring the standard of care is being met and utilize consultation as one of their supervisory roles (Bernard & Goodyear, 2018). In interprofessional collaboration, the duty of care is co-equal across the specific roles and functions of the collaborating care providers. In consultation, on the other hand, the duty of care rests with the primary provider, though consultants are obligated to act ethically within the consultation relationship. These general comparisons between consultation, supervision, and collaboration, however, are not rigid and the skill sets, responsibilities, and best practice guidelines governing a specific relationship between two professionals may share elements of each depending on context. Developing competency in each area appears to share a common theme, though counselors and other helping professionals should be intentional about practicing through the lens of a coherent, guiding framework when engaging in supervision, consultation, or interprofessional collaboration with other professionals and on behalf of the clients and students being served. Although recent scholarship on supervision and collaboration can be found supporting the efficacy of each intervention, recent scholarship on consultation in the professional counseling literature is largely conceptual and continues to lack robust empirical grounding. In our study, we addressed these gaps by obtaining further validation of a consultation skills instrument, the Consultation Skills Scale (CSS; Moe, Perera-Diltz, & Sparkman-Key, 2018).
The Need for Counseling-Specific Consultation Research
Given the commonality of peer consultation and collaboration across the various health care and allied fields (Newman & Ingraham, 2017), it is imperative to consider the research base on the apparent efficacy of consultation as an adjunctive practice. Research on consultation is similar to research on clinical supervision in counseling, with outcome-based research focusing on the effect consultation has on the consultee as opposed to clients or organizational contexts. The main evidence-based outcome of consultation appears to be improvement in treatment integrity or fidelity, with this effect being documented with consultees working with both youth (Brennan, Bradley, Allen, & Perry, 2008) and adults (Collier-Meek & Sanetti, 2014). The improvement of practitioners’ treatment fidelity attributable to the effect of consultation has been documented in manualized, experimental research (Ruble et al., 2018), and with single-subject design research (Smith, Eichler, Norman, & Smith, 2015). As supervision is only mandated for counselors during distinct periods early in their training, Ruble et al. (2018) suggested that consultation as a mode of intervention is ideal for diffusing innovation and evidence-based practice throughout counselors’ career development. For example, promising results have been generated in the critical area of child and adolescent behavioral and mental health consultation, in which consultants are viewed as enhancing the standard of care being provided by another primary therapist (Vuyk, Sprague-Jones, & Reed, 2016). The ability to diffuse affirmation of lesbian, gay, bisexual, transgender, and other gender- and sexuality-diverse people as the standard of care in mental health work also appears to be supported through consultation practice (Moe et al., 2018).
In a comprehensive meta-synthesis of qualitative studies sharing a focus on consultation processes, five cross-cutting themes were identified related to best practice in consultation implementation (Newman et al., 2017). The five themes were: (a) taking system-level factors into consideration;
(b) providing consultation in a coherent and consistent manner; (c) creating space for consultee voice, social-emotional support, and learning; (d) striving for ecologically valid and culturally competent consultation practice; and (e) obtaining sufficient training to apply relational process skills before engaging in consultation (Newman et al., 2017). These themes are echoed within both classic and recent scholarship on consultation and underscore the need for training in consultation as a distinct intervention. What training is needed specifically, and how to assess training in consultation, is an overlooked area in the professional counseling and counselor education literature base. As an under-researched area of scholarship (Guiney, Harris, Zusho, & Cancelli, 2014; Sangganjanavanich & Lenz, 2012), the dearth of counseling-specific consultation research may exist because of the lack of a valid measure specifically designed to assess counselors’ consultation skills and proficiencies. Guiney et al. (2014) developed the Consultation Self-Efficacy Scale (CSES) to assess school psychologists’ relative self-efficacy for implementing consultation. Presenting a complex framework, the CSES defined consultation self-efficacy as comprised of six interconnected domains that overlap substantially with common professional helping skills (e.g., communication ability, multicultural sensitivity). This conceptual foundation for the CSES is more aligned with the profession of school psychology as opposed to counseling, limiting our ability to use it for assessing counselors’ general skills and proficiency in consultation.
Moe et al. (2018) developed the theory-based CSS, focusing on counselors’ perceived knowledge of consultation models and frameworks and related consultation skills as a distinct practice modality akin to group counseling, clinical supervision, and crisis response (Brown et al., 2011). Rather than practicing consultation as an adjunct or supplement to their preferred mode of counseling, the CSS incorporated awareness of models, interventions, and dispositions identified in the literature base as distinguishing consultation from other modes of professional helping. The items for the CSS were created using a rational-empirical approach, with the aim of developing a construct that would assess respondents’ awareness of consultation theory, process, and skills, and relative adherence to the idea that consultation is a distinct area of practice as opposed to an ad hoc one. In a study specifically examining counseling professionals’ lesbian, gay, and bisexual counseling competence in relation to their consultation skills, Moe et al. established the initial construct validity for the CSS through an exploratory factor analysis (EFA). However, Moe et al. stated that the targeted sample and sample size in the study were limited, requiring further collection of validity evidence for the CSS.
Purpose of the Study
In our study, we aimed at further examining the validity and reliability properties of the CSS to advance our knowledge base regarding consultation skills and proficiency among counselors. Thus, our research questions were: (1) Is the unidimensional structure of the CSS confirmed with a cross-validation sample? (2) Does the CSS demonstrate different types of validity (i.e., convergent, divergent, concurrent, incremental)? and (3) Is the derived factor internally consistent and stable? We explored validity evidence for the CSS by testing the factorial structure through a confirmatory factor analysis (CFA). We also further tested validity evidence for the instrument by assessing the relationships between participants’ scores on the CSS and two related constructs: supervisory working alliance and interprofessional collaboration. Finally, we explored the reliability properties of the CSS.
Methodology
Participants
Demographics for participant (N = 369) cultural background, gender identity, age, years of experience, counseling specialty, training in consultation, and highest degree earned are reported in Table 1. Only participants who completed all measures plus the demographic information were included in the present study.
Table 1
Self-Reported Participant Demographics (N = 369)
Gender Identity Number % Total
Male 101 27.4
Female 245 66.4
Choose Not to Respond 23 6.2
Cultural Heritage
White, Non-Hispanic 298 81.0
Black/African American 9 2.4
Latinx/Hispanic 15 4.1
Asian/Asian American 10 2.7
Native American 4 1.1
Multiple Heritage 15 4.1
Other Background 5 1.4
Choose Not to Respond 12 3.2
Highest Earned Degree
Bachelor’s 80 22.0
Master’s 265 72.0
EdS 11 2.5
Doctorate 13 3.5
Counseling Specialty
School Counseling 41 11.1
Clinical Mental Health Counseling 219 59.3
Counselor Education 25 6.8
College Counseling 12 3.3
Addictions Counseling 7 2.0
Rehabilitation Counseling 47 12.7
Other 18 4.8
Training in Consultationa
No Training 89 24.1
Required Course 181 49.0
Elective Course 54 14.7
CEUs 135 36.5
Supervised Practice 115 31.2
Age
Range 24 to 79
Mean 51.6
SD 13.9
Practice Experience
Range 6 months to 48 years
Mean 17.5
SD 11.8
aTraining in consultation percentage not cumulative; participants could report more than one type of training.
Data Collection Procedure
We recruited participants via direct email and posting announcements to professional counselor-focused listservs such as CESNET and COUNSGRADS. We accessed emails through the purchase of a member email list from the American Mental Health Counselors Association, whose membership is comprised of self-identified mental health counselors, and the publicly available contact information for practicing school counselors in Virginia, as well as members of national and state school counselor professional associations. Because of the use of the web-based survey method for recruiting participants via the internet, we could not calculate a rate of response. Although we knew the total number of available emails in advance, the number of non-working emails and the presence of email firewalls prevented the assessment of how many potential respondents received the recruitment notice. Potential respondents were emailed five times over a period of three months. Of the people reached, 610 began the web-based survey but only 369 (60%) completed the study measures and demographic information to a sufficient extent for inclusion as a participant. We used this particular sampling method to identify practicing counselors affiliated with ACA and its divisions and branches. We aimed to generalize results of the current study to the ACA community, comprised of a diverse national and international group of practicing counselors and very similar groups. We also used an incentive raffle to encourage participation, and participants had the opportunity to win one of two $25 electronic gift cards.
Instruments
Demographic information form. The demographic information form was administered to obtain information about the participants’ ethnicity, age, gender, educational background, years of counseling experience, specialty area, current position, consultation training, supervision training, and experiences of consultation and supervision.
CSS. Moe et al. (2018) developed the CSS to assess counselors’ awareness of consultation theory and related consultation skills. In the CSS, Moe et al. aimed at differentiating consultation from other areas of practice, while keeping the focus applicable across counseling specialties. The CSS’s specific focus on consultation practice supports the evaluation of training and practice in consultation as a distinct modality relative to other professional counseling practice domains. With a sample of 145 counseling professionals and interns, Moe et al. conducted an EFA on the 19-item CSS using a maximum likelihood extraction with direct oblimin rotation. In the preliminary analysis, the unrotated solution for the EFA revealed two factors; however, a single-factor structure with 17 items appeared as the most robust solution for the CSS. Indicating validity, the CSS was positively associated with counseling experience and sexual orientation competence, and the Cronbach’s alpha coefficient for the total scale was reported as .97. The CSS utilizes a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). In the present study, the Cronbach’s alpha coefficient for the 17-item CSS was .98.
Supervisory Working Alliance Inventory – Supervisor (SWAI-S). Participants’ perceptions of being able to establish a working alliance in counselor supervision were assessed with the Supervisory Working Alliance Inventory – Supervisor Scale (SWAI-S; Efstation, Patton, & Kardash, 1990). The SWAI-S is a 23-item, 7-point Likert scale ranging from 1 (almost never) to 7 (almost always). Client Focus, Rapport, and Identification are the three domains that comprise the overall items on the SWAI-S. The Client Focus domain emphasizes the supervisor’s contribution to the supervisee’s perception of the client. Rapport stresses the supervisor’s effort in the supervisory rapport-building process, and Identification draws attention to the supervisor’s view of the supervisee’s identification in the supervision process. Efstation et al. (1990) reported alpha coefficients for SWAI-S subscales as .71 for Client Focus, .73 for Rapport, and .77 for Identification. In the current study, we found alpha coefficients for SWAI-S subscales as .98 for Client Focus, .99 for Rapport, and .99 for Identification. Convergent and divergent validity of the scales were established through intercorrelations with the Supervisory Styles Inventory (Efstation et al., 1990). For the purposes of the current study, participants were asked to indicate the extent to which SWAI-S items were characteristic of their work with trainees during their supervision.
Modified Index for Interdisciplinary Collaboration (MIIC). Participants’ perceptions of collaboration on interdisciplinary teams were measured with the Modified Index for Interdisciplinary Collaboration (MIIC; Oliver, Wittenberg-Lyles, & Day, 2007). The MIIC is a 42-item self-report questionnaire with a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Including four subscales of Interdependence and Flexibility, Newly Created Professional Activities, Collective Ownership of Goals, and Reflection on Process, the MIIC’s conceptual framework is based on the original instrument, the Index for Interdisciplinary Collaboration (IIC; Bronstein, 2002); therefore, it is expected to have the same face validity with the IIC (Oliver et al., 2007). The internal consistency estimate of the MIIC, calculated as Cronbach’s alpha, was found to be .94 for the present study. The subscale internal consistency estimates were found to be .87 for Interdependence and Flexibility, .77 for Newly Created Professional Activities, .80 for Collective Ownership of Goals, and .79 for Reflection on Process (Oliver et al., 2007). For the purposes of our current study, participants were asked to specify their agreement on the MIIC statements with regards to their current primary work setting and organization.
Data Screening and Analyses
Confirmatory Factor Analysis (CFA). To examine the fit for the single-factor solution of the CSS in our sample, we utilized Mplus 6 to run a CFA. Prior to conducting the analysis, we initially examined the necessary assumptions for the CFA (i.e., multivariate normality; Kline, 2011). We observed 26 cases as multivariate outliers in our sample. Upon the examination of these cases’ influence on our results with and without them, we decided to remove these outliers from the final analysis. To have a robust understanding of our CFA results, we observed multiple fit indices for the single-factor model from Moe et al.’s (2018) EFA (i.e., chi-square test, root mean square error of approximation [RMSEA], confirmatory fit index [CFI], and standardized root mean square residual [SRMSR]), as recommended by Lent, Lopez, Brown, and Gore (1996).
Other validity analyses. We also examined convergent, divergent, concurrent, and incremental validity psychometrics of the CSS. We first explored the correlations between the CSS and the subscales of the SWAI, namely Client Focus (CF), Rapport (R), and Identification (I), for the convergent validity—as they measured similar, but not identical concepts. To explore divergent validity, we checked the correlations between the CSS, the MIIC, gender (identifying as male), and ethnicity (identifying as European American)—as all measured different concepts. Next, concurrent validity of the CSS was investigated through the examination of mean differences between participants without consultation training, those with one to two consultation training experiences, and those with three or more consultation training experiences. Finally, we tested incremental validity of the CSS via a hierarchical regression analysis in which predictive ability of the CSS was examined to predict participants’ MIIC scores beyond the variables of age, gender, and years of experience.
Reliability analyses. Finally, we examined Cronbach’s alpha coefficient as well as split-half reliability properties of the CSS for internal reliability.
Results
CFA
In our sample, the CFA fit indices for the single-factor model yielded a poor model fit for single-factor solution. Specifically, although non-significance is desirable (Tabachnick & Fidell, 2013), we obtained a significant result for the chi-square test of model fit. This test is known as sensitive to sample size (Lent et al., 1996), and to account for this, we continued with examining other criteria for our model fit. We also obtained initial values for RMSEA (.12) and CFI (.90) outside the recommended criteria for fit (RMSEA < .06, CFI > .95; Hu & Bentler, 1999). The SRMSR was the only index meeting the recommended fit criteria (.04 < .08; Hu & Bentler, 1999). After this initial review, we followed Cole and Maxwell’s (2003) recommendations on examining modification indices. As a result of conducting necessary modifications, we removed nine items from the CSS, and the CFA results revealed a better fit for an 8-item version of the instrument the authors called the Consultation Skills Scale-Short Form (CSS-S; χ2(28) = 86.21, p = .00, CFI = .98, RMSEA = .075, 90% CI [.06, .90], SRMSR = .02). See Table 2 for means, standard deviations, and factor loadings of the eight items.
Table 2
Means, Standard Deviations, and Factor Loadings of the Items of the CSS-Short Form
Item # |
Item labels |
Ma |
SD |
Factor Loadings |
1 |
I know how to help consultees improve programming issues for work with identified clients. |
4.31 |
1.63 |
.86 |
2 |
I know how to develop a consultation contract. |
3.71 |
2.21 |
.83 |
3 |
I know how to apply established problem-solving models to address consultee concerns. |
4.23 |
1.76 |
.89 |
4 |
I am familiar with systems consultation. |
3.77 |
2.10 |
.87 |
5 |
I know how to operate as an external consultant. |
3.97 |
2.05 |
.87 |
6 |
I know how to operate as an internal consultant. |
4.16 |
1.85 |
.87 |
7 |
I know how to assess the culture and climate of consultee organizations. |
3.97 |
1.92 |
.85 |
8 |
I can address theme interference effectively with consultees. |
3.88 |
1.98 |
.85 |
|
|
|
|
|
|
a Means are based on a scale of 1 to 5.
Validity Analysis
We obtained initial evidence for the construct validity of the CSS-S through our CFA results. Convergent validity of the CSS-S was established through the obtained significant correlation coefficients between the CSS-S and SWAI-CF (r = .50), SWAI-R (r = .46), and SWAI-I (r = .46). Indicating divergent validity for the CSS-S, the correlation coefficients between the CSS and the MIIC, gender, and ethnicity were .34, .05, and -.03, respectively. The results of a one-way ANOVA indicated concurrent validity for the CSS-S with significant differences between the three groups of participants without consultation training, those with one to two consultation training experiences, and those with three or more consultation training experiences: [F(2,368) = 28.27, p = .00]. Participants with three or more consultation training experiences reported significantly higher consultation practice proficiency perceptions (M = 38.39, SD = 6.40) when compared to participants without consultation training (M = 26.47, SD = 8.96) or with one to two consultation training experiences (M = 32.62, SD = 9.67). Finally, showing incremental validity, the CSS-S also explained an additional 7% of the variance in participants’ MIIC scores (R2 = .132, p = .000), above and beyond the independent variables in the first (i.e., age, gender, and years of experience; R2 = .004, p > .05) and second (i.e., SWAI; R2 = .058, p = .000) blocks.
Reliability Analyses
The reliability analyses results showed satisfactory support for the CSS-S. For the present study, Cronbach’s alpha coefficient for the CSS was .96; no items appeared to reduce the reliability coefficient of the scale. We also examined the Spearman-Brown coefficient for the split-half reliability and obtained .96.
Discussion
In this study, we obtained strong results for the single-factor structure as well as validity and reliability properties for a shorter version of the CSS-S in a sample of counselors. Our results also revealed further validation for consultation as a distinct area of practice.
Psychometric Qualities of the CSS-S
CFA results revealed that the CSS-S is a psychometrically sound unidimensional instrument, measuring counselors’ consultation skills as a distinct modality relative to other professional counseling practice domains. In the current sample, upon poor fit of the initial single-factor solution, we further utilized modification indices and eliminated items. As a result, different than the original 17-item instrument (Moe et al., 2018), we obtained a shorter version of the CSS with eight items indicating a good CFA solution fit.
We further obtained significant results for the CSS-S via convergent, divergent, concurrent, and incremental validity procedures. For convergent validity, we found that counselors’ CSS-S scores were moderately related to the subscales of the SWAI (i.e., Client Focus, Rapport, and Identification). These relationships revealed that the CSS-S measured a similar but different competency area compared to the area of supervision. We also found that counselors’ CSS-S scores were unrelated to gender or ethno-cultural identification and were weakly related to the MIIC, establishing divergent validity. In other words, counselors’ consultation skills were distinctly different than their gender or ethno-cultural identification and separate from their interdisciplinary collaboration ability. Supporting concurrent validity, counselors’ CSS-S scores got higher as they had more consultation training (i.e., three or more consultation training experiences vs. one to two or no consultation training experiences). Beyond other variables (i.e., years of experience and supervisory working alliance), counselors’ consultation skills significantly contributed to their interdisciplinary collaboration ability, indicating incremental validity of the CSS-S.
Finally, we examined the reliability of the CSS-S by observing the internal consistency across the items. Both Cronbach’s alpha and split-half reliability results were strong, demonstrating satisfactory results for the CSS-S. The CSS-S appears to possess useful validity and reliability characteristics for assessing counselors’ perceptions of their own abilities to practice consultation and may help scholars develop more empirically grounded scholarship on consultation as a distinct mode of practice.
Consultation and Supervision as Related and Distinct Areas of Practice
In addition to validation of the CSS-S, our findings also point out other significant information. The domains of consultation and supervision have long been conceptually linked in the literature, primarily in terms of both serving as modalities for senior clinicians to provide support and mentorship to their colleagues (Truneckova, Viney, Maitland, & Seaborn, 2010). The consultation paradigm of consultee-based mental health consultation (Newman & Ingraham, 2017) shares similarities to clinical supervision in terms of a shared focus on promoting skill development in consultees or supervisees to work with an identified client population or presenting problem. In the Discrimination Model, consultation is presented as one of the roles of clinical supervisors while training professional counselors (Bernard & Goodyear, 2018). According to the Discrimination Model, supervisors’ engagement in a consultative, collaborative relationship is seen as a hallmark of supervisee development, in which the supervisee is invited to contribute as a peer and fellow professional expert (Bernard & Goodyear, 2018). From their phenomenological study of the supervisory relationship between female supervisors and supervisees, Mangione, Mears, Vincent, and Hawes (2011) also reported that consultation emerged as an important theme when participants reflected on how to create a collaborative environment during the supervision process. Adopting the role of consultant may enhance the supervision process for counselors-in-training (Sangganjanavanich & Lenz, 2012). For example, Granello, Kindsvatter, Granello, Underfer-Babalis, and Moorhead (2008) identified peer consultation as an intervention for promoting perspective taking and overall cognitive development in supervisees. The relationships between the counselors’ perceptions of their consultation skills and supervisory working alliance in the current study were indications of the complementary relationship between counseling professionals’ consultation and supervision roles. Our findings appear to promote the understanding that although consultation skills and different dimensions of supervisory work are intertwined, they are also distinct concepts, and expertise in one modality does not necessarily ensure expertise in the other.
Limitations
The current study involved limitations that need to be reported. First, we specifically targeted counseling professionals in this study and did not include participants from other fields. Another group of counselors or participants from other fields (e.g., social work, nursing) may have yielded different results than the ones we obtained in this study. Second, we did not examine some of the specific demographic variables (e.g., specialty areas, position) within our data set. Those variables may have influenced the results of the current study. Lastly, despite being part of a master list of licensed counselors, self-selection of our participants in this study could indicate participants’ interest in consultation as an area of practice. The authors may not have reached out to enough participants who lacked knowledge and experience of consultation, or had sufficient participants with experience as a supervisor to effectively complete the SWAI-S.
Implications for Future Research and Practice
Our results supporting the psychometric qualities of the CSS-S have both research and practical implications, many of which are connected to one another. The lack of a psychometrically sound measure of counselors’ consultation skills has limited research on consultation efficacy in the counseling literature and the research base of other helping fields (Dougherty, 2013). Assessing counselors’ perceptions of their consultation skills with the CSS-S can help to clarify and contribute to consultation efficacy research in counseling and counselor education. The small number of items on the CSS-S also offers researchers the convenience of a brief measure for participants to self-assess their consultation skills and can help clarify how this construct influences other areas of counseling practice. For example, the CSS-S may be used with participants from different specialty areas of counseling (e.g., school counseling, mental health counseling) and different professional development levels (e.g., counseling interns, counselors working toward licensure, licensed counselors) to understand the participants’ consultation skills perceptions and their potential needs. Researchers also could utilize the CSS-S to address the need for examinations of consultants’ relative competence to practice consultation from a theory-based foundation. The CSS-S could address the gap between consultation training, practice, and research. Particularly, as counselors and counselor educators prepare to operate in a modern clinical environment, where behavioral and physical health care professionals are encouraged and expected to collaborate effectively, assessing counselors’ consultation abilities could help support development of the skills necessary to operate within the integrated care paradigm. Similarly, because of the generic language of the instrument, researchers could establish the validity and reliability properties of the CSS-S with samples from other fields (e.g., social work, nursing). In these efforts, researchers also could compare professionals from different fields (e.g., counseling vs. nursing) to examine similarities and differences among the participants’ consultation skills perceptions as well as other variables (e.g., consultation training and practice experiences), and explore the discipline-specific factors that may influence how consultation is practiced and when it is considered to be an effective intervention.
Researchers have identified the process nature of consultation as an impediment to establishing the efficacy of consultation (Erchul & Sheridan, 2014). Consultants’ ability to practice consultation as a distinct helping intervention is both a process and outcome variable, and a valid measure of this construct can help to establish baseline levels of consultant ability or serve to identify when during the consultation relationship a consultant feels most capable. In tandem, counselor education programs could use the CSS-S as a baseline instrument to identify relative levels of familiarity with the consultation paradigm and tailor their consultation-related pedagogy to the needs and expectations of counselor trainees with different levels of consultation proficiency. Being able to assess consultation proficiency also can help to clarify when and what types of training are most effective. Questions related to where in the curriculum this domain should be introduced, what methods are optimal for ensuring retention and mastery, and what benchmarks exist for the development of consultation skills can be explored empirically with the measure presented in this study.
Conclusion
We presented the results of a psychometric investigation of the CSS-S, a derived measure assessing participants’ perceptions of their skills to practice consultation as a distinct modality based on specific knowledge and skills. The preliminary findings demonstrate support for continued use of the CSS-S in research on consultation and support previous conceptual scholarship identifying consultation as complementary to but also distinct from clinical supervision and interprofessional collaboration. Training in consultation (i.e., coursework, supervised experience, postgraduate workshop attendance) appeared to increase participants’ perceptions of consultation skills as measured with the CSS-S. Consultation is a distinct mode of counseling and behavioral health practice, and being able to assess consultants’ perceptions of their own abilities is an important step in advancing the research base on consultation theory and how this domain can be employed to promote better outcomes for clients, students, and communities, not only in educational and clinical settings, but also in integrated health care settings.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
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Gulsah Kemer, NCC, is an assistant professor and graduate program director at Old Dominion University. Jeffry Moe, NCC, is an associate professor at Old Dominion University. Kaprea F. Johnson is an associate professor at Virginia Commonwealth University. Emily Goodman-Scott, NCC, is an associate professor and graduate program director at Old Dominion University. Zahide Sunal is a doctoral student at Old Dominion University. Chi Li, NCC, is an assistant professor at the University of Memphis. Correspondence can be addressed to Jeff Moe, ODU Counseling and Human Services, 2106 New Education Building, Norfolk, VA 23529, jmoe@odu.edu.
Sep 1, 2019 | Volume 9 - Issue 3
Malti Tuttle, Lacey Ricks, Margie Taylor
School counselors experience various emotions, such as anxiety, when in the role of mandated reporter of child abuse. This manuscript addresses how early career school counselors might experience distress because of the lack of established child abuse reporting procedures, fear of repercussions for the school counselor or student, and limited training in identifying types of abuse. Based on the previous literature, the authors discuss the imperative role early career school counselors have as mandated reporters and provide a framework to assist in the child abuse reporting process. The framework, specifically designed for school counselors, is collaborative in nature and emphasizes maintaining ethical and legal standards, obtaining continual professional development, and following best practices for mandated child abuse reporting.
Keywords: child abuse, mandated reporter, early career, school counselors, framework
School counselors often experience anxiousness regarding child abuse reporting (Lambie, 2005; Sikes, 2008). Early career school counselors in particular can experience this because of the lack of established reporting procedures (Lambie, 2005), fear of repercussions for the school counselor or student (Bryant & Milsom, 2005; Kenny, 2001), and limited training on identifying types of abuse (Alvarez, Kenny, Donohue, & Carpin, 2004; Kenny, 2001). Because of these factors, early career school counselors seek and request support to assist them with the child abuse reporting process and clarification on these procedures (Bryant & Baldwin, 2010; Ricks, Tuttle, Land, & Chibbaro, 2019). Therefore, we propose a child abuse reporting framework designed to assist early career school counselors, who are ethically and legally mandated to report child abuse, in the child abuse reporting process (American School Counselor Association, 2016; Sikes, Remley, & Hays, 2010). This manuscript is different from previous literature (e.g., Alvarez et al., 2004; Bryant & Milsom, 2005; Kenny, 2001; Lambie, 2005; Sikes, 2008) because it focuses specifically on the concerns and needs of early career school counselors, as well as expands on previous literature. For the purpose of this article, child abuse and neglect are defined by the Child Abuse Prevention and Treatment Act Reauthorization Act of 2010 (2010) as “any recent act or failure to act on the part of a parent or caretaker which results in death, serious harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm” (p. 6).
Child maltreatment can have lasting harmful effects on victims. Maltreatment includes “medical neglect, neglect or deprivation of necessities, physical abuse, psychological or emotional maltreatment, sexual abuse, and other forms included in state law” (U.S. Department of Health & Human Services [USDHHS], Administration for Children, Youth and Families, & Children’s Bureau, 2019, p. 108). Minimum standards for what constitutes child abuse are defined by federal law and further stipulated under state law (ASCA, 2015; Stone, 2013). Laws and definitions of child abuse can vary across each state, and ASCA (2019b) provides information on Child Protective Services (CPS), laws, and statutes for different states. Furthermore, ASCA’s (2015) position statement, The School Counselor and Child Abuse and Neglect Prevention, states: “It is the school counselor’s legal, ethical and moral responsibility to report suspected cases of child abuse and neglect to the proper authorities” (p. 7).
Mandated reporting is among the many responsibilities school counselors perform within the school setting. School counselors are required by the Child Abuse Prevention and Treatment Act (CAPTA) of 1974 to report suspected cases of child abuse to the appropriate authorities. School counselors need to become familiar with federal guidelines, their state laws, and school policies regarding child abuse and mandated reporting laws and procedures. ASCA (2016) speaks to the role of the school counselor in child abuse reporting by stating that school counselors are ethically and legally responsible for reporting suspected cases of child abuse to appropriate agencies. These agencies include, but are not limited to, CPS, law enforcement agencies, attorneys, social workers, and case managers assigned to open cases (Bryant, 2009; Hinkelman & Bruno, 2008).
It is essential for school counselors to have knowledge and an understanding of the ethical standards and legal statutes that apply to child abuse reporting (Corey, Corey, & Callanan, 2011). Two sections from the ASCA Ethical Standards for School Counselors (2016) specifically address child abuse reporting. The “Serious and Foreseeable Harm to Self and Others” (A.9.) section speaks to ensuring the welfare and safety of students by making appropriate reports to CPS, parents and guardians, and agencies and authorities regarding the abuse. The “Bullying, Harassment and Child Abuse” section (A.11.) highlights the ethical mandates school counselors must follow when reporting suspected child abuse (ASCA, 2016).
Froeschle and Crews (2010) echoed the vital role ethics and legalities play as well as the challenges presented in working with students. Because school counselors serve as an integral part of protecting the health and well-being of children by performing in the role of responsible mandated reporters, it is imperative that school counselors recognize the importance of maintaining student welfare when making decisions pertaining to suspected child abuse. Research regarding school counselors’ ethical and legal competency is limited; however, it has been noted that knowledge of ethical and legal parameters around child abuse reporting has increased in coursework and trainings (Lambie, Ieva, & Mullen, 2013). This necessitates the call for school counselors to have additional knowledge and training in detecting signs and symptoms of abuse and a general understanding of how to report child abuse.
Although the ethical and legal responsibilities of school counselors in the role of reporting child abuse and maltreatment has been recognized (Kenny & Abreu, 2016), counselors might not have received adequate training in identifying and reporting child abuse. Therefore, the authors of this article further recognized the dutiful call to provide a framework for early career school counselors to assist with the process of reporting child abuse. The purpose of this manuscript is to develop an effective mandated reporting framework for school counselors. The development of the framework within this manuscript was guided by the ASCA Ethical Standards for School Counselors (2016), recommendations by early career school counselors (Ricks et al., 2019), previous literature and research studies (Bryant & Baldwin, 2010; Lambie, 2005; Sikes, 2008), and current mandated reporter procedures (Hogelin, 2013). However, it is imperative to acknowledge that within any such framework, state and school policy must be followed and considered.
Child Abuse Trends
Mandated reporting is increasingly needed because of the extent of child abuse and neglect in the United States. In 2015, CPS agencies received approximately 4.1 million referrals for potential child abuse or neglect, which involved roughly 7.5 million children (USDHSS et al., 2019). Gullatt (1999) published a manuscript that reported the number of abused children to be astonishing. Despite decades passing since the 1990s, the number of children abused today is still considered shocking. In 2017 it was reported that 674,000 children were victims of abuse and neglect (USDHHS et al., 2019). The number of children abused increased by 2.7% from 2013 to 2017, and it is estimated that 1,720 children died from abuse and neglect in 2017, a rate of 2.32 per 100,000 children (USDHSS et al., 2019). These staggering statistics attest to the need for school counselors to become more educated and confident in reporting child abuse.
“Abuse is encountered in all socioeconomic groups, races, and religions” (Lambie, 2005, p. 250). The racial distribution for all children within the United States who experience abuse is 50.7% Caucasian, 13.7% African American, and 25.2% Hispanic (USDHHS et al., 2019). The percentages of victims are similar for both boys (48.6%) and girls (51.0%; USDHHS et al, 2019); however, rates of abuse seem to vary by socioeconomic status. According to Sedlak et al. (2010), children from households of low socioeconomic status experience some type of maltreatment at a rate more than five times higher than other children; they also were more than three times as likely to experience abuse and about seven times more likely to experience neglect. Bias has been suggested as a cause of differentiation in demographics of reported child abuse cases. When looking at school counseling reporting trends, a recent study specifically examining school counselors’ decisions found school counselors were not statistically more likely to report students based on race but were more likely to suspect abuse when students were from a middle or lower socioeconomic class (Tillman et al., 2015). However, research data suggest that the variation in the overrepresentation of low-income children is driven by the presence of increased risk factors among this population (Jonson-Reid, Drake, & Kohl, 2009).
Despite the increased need for school counselors to be proficiently trained in mandated reporting, many school counselors experience challenges with the reporting process. School counselors are frontline workers who develop trusting relationships with children, which in turn leaves school counselors with a much higher reporting rate than other professionals within the school (Bryant, 2009). A study by Bryant and Milsom (2005) found the second most reported legal issue experienced by school counselors was whether to report alleged sexual abuse. However, there are some laws that no longer give school counselors the choice. Furthermore, according to Davis (1995) and Sikes (2008), the reporting of child and sexual abuse cases are the second highest reasons for school counselors to attend court. The increase in reports of child abuse, legal issues experienced by school counselors, and the frequency of court appearances by school counselors also are valid reasons for developing a better, more effective, and easily understood framework for mandated reporting.
Challenges in Reporting Child Abuse
Reporting child abuse and neglect can often be a challenging and stressful experience for school counselors. This might be due to difficulty in collaborating with reporting agencies; the lack of training in child abuse symptomology (Alvarez et al., 2004; Kenny, 2001); unclear guidelines for reporting child abuse (Lambie, 2005), including what defines reasonable suspicion to report (Levi & Brown, 2005); and the fear of repercussions from parents and school officials (Bryant & Milsom, 2005; Kenny, 2001). A recent research study (Ricks et al., 2019) identified challenges faced by early career school counselors, which provided the impetus to further consult the literature to seek what circumstances led to these challenges and how to mitigate potential barriers to reporting child abuse. Each of these challenges are discussed in further detail.
Collaboration with reporting agencies. A review of literature on school counselors’ relationships with reporting agencies found that the relationships are disconnected and misunderstood (Bryant & Baldwin, 2010). A study conducted by Sikes et al. (2010) indicated most school counselors had negative experiences when making reports to reporting agencies. Participants in the study reported high levels of anxiety because of the concern that the report would not be investigated. Consistent with findings from the research study conducted by Ricks et al. (2019), Bryant and Baldwin (2010) found that school counselors experience frustration and irritation when the school counselor’s report did not result in an investigation from CPS. Furthermore, a study conducted by Behun, Cerrito, Delmonico, and Kolbert (2019) found that school counselors chose not to report suspected child abuse because of the belief CPS would not intervene effectively.
Furthermore, school counselors experience concern when CPS does not provide follow-up information regarding the report of alleged abuse. A study conducted by Bryant (2009) found school counselors reported 77% of alleged cases of child abuse to CPS, and only 66% of those cases were investigated by CPS. Some school counselors believe they are entitled to information about the ongoing investigation of the report made; however, because of confidentiality, CPS is not legally obligated to provide school counselors with detailed information about an ongoing investigation (Child Welfare Information Gateway, 2003; Minnesota Department of Human Services, 2016). After the initial assessment, the CPS caseworker will determine the disposition of the reported case based on state laws, agency guidelines, and gathered information (Child Welfare Information Gateway, 2003).
According to the Child Welfare Information Gateway (2003), CPS agencies use different terminology for this decision. Most states use a two-tiered system of substantiated–unsubstantiated or founded–unfounded. Some states use a three-tiered system of substantiated, indicated, or unsubstantiated. The indicated classification means evidence of abuse has been found, but not enough to substantiate the case. A school counselor can be provided information on whether the case was indicated or not indicated by CPS (Minnesota Department of Human Services, 2016; Washington State Department of Social & Health Services, 2018).
To resolve this issue, further education and collaboration with CPS and other agencies can aid school counselors’ understanding of policies, leading to less frustration for school counselors. Bryant (2009) recommended CPS provide additional training for school counselors on mandated reporting and recognition of child abuse. This training conducted by CPS with schools can improve the working relationship between CPS and school counselors.
Likewise, Hinkelman and Bruno (2008) recommended attorneys, CPS, and mental health professionals gather to discuss child abuse through in-service trainings. During such time, school administrators can review their written policies to be certain they correspond with state laws, ensuring the reporting process is both ethical and legal for school counselors. This practice would mitigate challenges to communication, consultation, and collaboration between school counselors and reporting agencies, which would be helpful.
School counselors’ knowledge of child abuse symptomology. Previous research studies indicated the most significant hindrance to reporting child abuse is the lack of knowledge in recognizing signs of child maltreatment (Kenny & Abreu, 2016). A study conducted by Bryant (2009) evaluated school counselors’ perceived ability to recognize different types of child abuse. Generally, most school counselors felt confident in their knowledge to recognize physical abuse; however, fewer counselors reported certainty in identifying sexual as well as emotional abuse (Bryant, 2009; Bryant & Baldwin, 2010; Bryant & Milsom, 2005; Kenny & Abreu, 2016).
More experienced counselors believe themselves to be competent in recognizing and reporting child abuse, while beginning school counselors with less experience perceive themselves to be less knowledgeable and in need of additional training (Tillman et al., 2015). Bryant and Baldwin (2010) also found most experienced school counselors reported more confidence in recognizing signs of physical abuse in children. Certain physical and behavioral concerns in children can serve as indicators of physical abuse (Mayo Clinic, 2015; Sikes, 2008). Behavioral changes can include isolation, change in school performance, depressed affect, sudden weight loss or gain, or inability to control emotions (Lambie, 2005; Mayo Clinic, 2015; Minnesota Department of Human Services, 2016; Sikes, 2008). School counselors spend a significant amount of time with children and can be alert to the changes in behavior of a student, or teachers can notify the school counselor of their concerns for a child (Brown, Brack, & Mullis, 2008).
Conversely, certain forms of abuse, such as sexual and emotional abuse, are not as easily recognized by school counselors (Bryant & Baldwin, 2010). Emotional abuse can be defined as the continuous use of abusive language that hurts the child’s self-esteem or well-being (Mayo Clinic, 2015). Emotional abuse includes verbal and emotional assault, and isolating, ignoring, or rejecting a child (Mayo Clinic, 2015). Lack of empathy, warmth, and understanding also are associated with emotional abuse (McEachern, Aluede, & Kenny, 2008). A study conducted by Bryant and Milsom (2005) stated three-quarters of school counselors in the study felt sure of their ability to identify child physical abuse, but less so in their ability to recognize sexual and emotional abuse. The difficulty in determining emotional abuse can lead to school counselors feeling less qualified to make a report of suspected child abuse (Valkyrie, Creamer, & Vaughn, 2008).
Further training and education on the signs and symptoms of different types of abuse are necessary for school counselors to feel more confident in making a report of suspected child abuse (Herlihy & Corey, 2015). Awareness and instruction on the symptomology of the various forms of child abuse can increase early reporting from school counselors, resulting in improved chances of children recovering from the negative effects of child abuse (Valkyrie et al., 2008).
Unclear guidelines for reporting child abuse. Although school counselors are in the role to report suspected child abuse, many still struggle to determine if a report is warranted. School counselors have voiced the issue of needing evidence to make a report of child abuse (Valkyrie et al., 2008). Past studies indicated school counselors felt more comfortable reporting abuse when they had solid evidence the abuse occurred and were more likely to hesitate to report if less evidence was present in the case (Bryant & Milsom, 2005; Tillman et al., 2015). Moreover, a study conducted by Bryant (2009) indicated that the lack of evidence was the main reason school counselors decided not to report the suspicion of abuse.
Despite these findings, it is important that school counselors recognize that it is not their responsibility to investigate the case or determine the truth of the allegation of abuse. In fact, it is not in the best interest of the child for school counselors to investigate the alleged abuse because they do not have the proper resources and it could lead to further issues for the child (Hinkelman & Bruno, 2008; Lambie, 2005; Miller, Dove, & Miller, 2007). The school counselor’s responsibility is to follow legal and ethical obligations as a mandated reporter (ASCA, 2016) by reporting all suspected child abuse. It is important for school counselors to be aware of their state laws because it can be a felony if child abuse is not reported (Child Welfare Information Gateway, 2019).
Additional education on the school counselor’s role in reporting child abuse could elevate their understanding of their role in mandated reporting. Being aware that the law does not require school counselors to investigate cases and that they will not be held liable if a report is false (Hinkelman & Bruno, 2008) may increase the reports made by school counselors. It is important for school counselors to report suspected child abuse to the appropriate agencies and authorities by following state laws and school district protocol to ensure the safety of all children.
Fear of Repercussions. Numerous studies have suggested school counselors fear the repercussions that can result from reporting suspected child abuse (Bryant, 2009; Bryant & Baldwin, 2010; Bryant & Milsom, 2005; Sikes et al., 2010). These repercussions may originate from school administration, colleagues (Bell & Singh, 2017; Kenny, 2001; Sikes et al., 2010), or the family of the student (Bryant & Baldwin, 2010; Kenny, 2001; Valkyrie et al., 2008), or impact the relationship with the student (Alvarez et al., 2004; Bryant & Baldwin, 2010; Sikes et al., 2010). Moreover, school counselors may be afraid the family of the child will file a lawsuit against the school and the counselor for making a report of suspected child abuse (Valkyrie et al., 2008). Conversely, a study conducted by Kenny, Abreu, Helpingstine, Lopez, and Mathews (2018) found that all 50 states give immunity to professionals who report alleged child abuse. The purpose of the immunity is to encourage professionals to report suspected abuse, knowing they do not have to fear the repercussions of disgruntled family members (Kenny et al., 2018). Further exposure to the law of mandated reporting can in fact reduce the anxiety of reporting and encourage more reporting of alleged abuse.
Additional education on mandated reporting and a specific plan for mandated reporting can help to alleviate the fears school counselors have when reporting abuse. If the school policy includes a specific model for mandated reporting, then school counselors may be less likely to fear repercussions and follow appropriate guidelines (Committee for Children, 2014; Oloumi-Johnson, 2016; Sinanan, 2011). If faced with disgruntled parents, school counselors can refer to their school policy within the mandated reporting model to verify to the concerned individual that school policy and procedures were followed.
Challenges of the Early Career School Counselor
Early career school counselors are often faced with tremendous challenges as they enter their new work environment. These challenges include differing expectations from site to site and district to district (Hatch, 2008). Although school counselors are designated as mandated reporters, many may struggle with identifying different types of abuse, understanding reporting procedures, and understanding their district and state policies (Bryant, 2009; Ricks et al., 2019). New school counselors may be especially vulnerable to challenges because they are still defining their roles within their new school system and learning what the expectations are for their site. Past research also has shown that school counselors’ understanding of child abuse reporting is related to past professional experiences (Bryant, 2009), and early career school counselors can be deficient in this knowledge. Additional training in child abuse reporting is needed to help school counselors become more proficient and knowledgeable in these procedures (Tillman et al., 2015). Currently, there is a lack of research and resources for early career school counselors on child abuse reporting. This proposed framework aims to aid early career school counselors in developing their understanding of child abuse reporting procedures and expectations.
Framework Foundation
The purpose of this article is to develop an effective mandated reporting framework for school counselors based on the ASCA Ethical Standards for School Counselors (2016), the research from Ricks et al. (2019), and previous literature reviews and research studies. Even though previous recommendations for collaboration have been made, we recognized the need for school counselors to have a specific framework for reporting child abuse that is collaborative and specific to school counseling.
Ricks et al. (2019) examined the experiences of child abuse reporting by early career school counselors (0 to 5 years of experience as a school counselor) in the Southeastern United States. Early career school counselors were targeted because they can be confused and frustrated regarding their roles within the school as mandated reporters (Slaten, Scalise, Gutting, & Baskin, 2013). Participants responded to a survey allowing them to share their experiences and suggestions regarding child abuse reporting using two open-ended questions (Ricks et al., 2019). The two open-ended questions asked: (1) What types of additional training do you need regarding child abuse reporting? and (2) What challenges did you or are you facing as a new SC (0–5 years) regarding mandated reporting? (Ricks et al., 2019). Findings revealed the need for help identifying types and signs of abuse; staff and faculty training; information on reporting procedures; and additional mandated report training. Additionally, the findings found challenges with mandated reporting including fear of repercussions, agency concern and collaboration, reporting policies, identifying types of abuse, and school counselor responsibilities. The responses to the open-ended questions informed the direction and development of this framework to assist early career school counselors as they navigate the child abuse reporting process.
Child Abuse Reporting Framework for Early Career School Counselors
The purpose of this framework is to provide steps for early career school counselors to ensure their school counseling program is following best practices in mandated reporting. The steps are designed based on the recommendations by the participants in the study by Ricks et al. (2019) to provide clarity in the informed decision-making process when child abuse is suspected. School counselors should adhere to all the steps identified to ensure they are knowledgeable of current research and best practices on child abuse reporting. This information is considered vital for reviewing mandated reporter guidelines and identifying resources to assist students. Additionally, early career school counselors are encouraged to continuously review guidelines and procedures to ensure execution of streamlined services; however, keeping resources is not enough. School counselors should continually update their collected information by participating in ongoing professional development to ensure they remain abreast of changes in laws, policies, agencies, and personnel.
The authors recognize that reporting child abuse is a collaborative effort within the school setting, which includes faculty, administrators, school counselors, and other mandated reporters. Therefore, a collaborative approach was deemed appropriate, especially when seeking support and understanding the gravity of reporting child abuse to the appropriate agencies and authorities. A collaborative approach is substantiated based on previous literature by Gullatt (1999), Bell and Singh (2017), and Ricks et al. (2019). Gullatt called for a collaborative approach to child abuse reporting and recommended school principals be aware and know how to identify child abuse as well as the laws for reporting.
Eight steps have been outlined in the Child Abuse Reporting Framework for Early Career School Counselors to guide early career school counselors in their role as mandated reporters: (1) become familiar with and follow state laws and district/school child abuse reporting policies, (2) become familiar with and follow the ASCA ethical standards, (3) obtain training to identify and recognize signs of child abuse, (4) identify stakeholders, (5) build collaborative partnerships, (6) provide school-based training, (7) report child abuse, and (8) perform post-reporting procedures. Each of these steps includes recommendations and considerations to assist in increasing self-efficacy for early career school counselors in the child abuse reporting process.
Step I: Become Familiar With and Follow State Laws and District/School Child Abuse Reporting Policies
State laws define the role of community members, helpers, and school officials as mandated reporters. Therefore, it is in the best interest of early career school counselors to review the laws on mandated reporting within their state of employment to understand what is expected for mandated reporters, the timeframe to report, and contact information. Knowledge and awareness of state laws is particularly imperative because state requirements to report child abuse vary for each state (Hogelin, 2013; Lambie, 2005). Not only do state laws differ, but schools within the same district can vary in their child abuse reporting policies. Early career school counselors must make familiarizing themselves with state laws and district/school child abuse reporting policies a priority. This should be done during the pre-planning period and first days on the job in order to be knowledgeable and aware of what the laws and policies state. Areas in particular to be aware of include who is to be contacted when knowledge of suspected child abuse has been identified; who officially makes the report; what the procedures are; how to make a report (e.g., electronically, phone call, in person, website); where and how to file documentation of the report; and who to inform once the report has been made.
Some schools and states require everyone who has knowledge of suspected child abuse to file a report. This would include school counselors, administrators, teachers, and school personnel. In some school districts, a designated school official is the individual to make the report. This generally is the school counselor. Therefore, it is incumbent on early career school counselors to be aware of what their role is and how it meets the legal and ethical requirements. School counselors should be aware that if the school has designated only a specific individual to file a report, this may go against the law and possibly jeopardize the school counselor’s licensure and certification. Therefore, it is important that all stakeholders in the school setting be aware of their respective state’s laws.
Step II: Become Familiar With and Follow the 2016 ASCA Ethical Standards
ASCA ethical standards A.9. and A.11. highlight the responsibilities school counselors have in reporting child abuse (ASCA, 2016). Early career school counselors have received training in their master’s programs regarding ethics; however, it is especially imperative to review the ethical standards pertaining to child abuse reporting on a regular basis. This will aid in maintaining ethical dispositions at the forefront, while leveraging the ASCA ethical decision-making process as a guide (ASCA, 2016). Additionally, the ASCA ethical standards can be used as a tool to advocate for school counseling services in reporting child abuse. This is especially useful in circumstances when there might be role confusion by administrators, school personnel, authorities, and agencies. By referencing the ethical standards, school counselors can advocate for their role in reporting child abuse and working to keep students safe.
Step III. Obtain Training to Identify and Recognize Signs of Child Abuse
It is recommended that educators consistently receive training to identify and recognize signs of child abuse (Hogelin, 2013). Kenny and Abreu (2016) recommended counselors seek continued education on child abuse reporting by attending workshops that will help them remain abreast of the changes to reporting laws and requirements. Therefore, school counselors should advocate to receive opportunities to attend professional development conferences and trainings by the district and/or local agencies (Hogelin, 2013). Advocacy is considered an integral component of the ASCA National Model (ASCA, 2012; 2019a). Although regular training is recommended, it is not guaranteed this practice occurs across states and school districts. Furthermore, it would be beneficial for early career school counselors to seek and participate in professional development because of varying types of training they have or have not received on identifying and reporting child abuse during their master’s-level school counseling programs.
Laws, protocols, procedures, and staff are continuously changing; therefore, early career school counselors should remain cognizant and aware of these changes. In order for knowledge to remain relevant, school counselors should engage in continued professional development on recognizing child abuse indicators and child abuse reporting. This practice allows the school counselor to remain informed while increasing their self-efficacy in reporting suspected child abuse. Additionally, each year school counselors must continue to update administration and school personnel on procedures and protocol for identifying and reporting child abuse.
Step IV. Identify Stakeholders
School counselors who seek to strengthen partnerships with administrators (e.g., principals and assistant principals) are in a position to initiate discussion on child abuse reporting procedures and protocols to ensure an understanding of the role of the school counselor as a mandated reporter. Particularly building a partnership with principals is vital to identify the key role school counselors play in the school setting. A study conducted by Bringman, Mueller, and Lee (2010) shed light on the perception principals have on the role of the school counselor. This research indicated that principals have not received prior education on the role of the school counselor; therefore, it would be beneficial to discuss the role of the school counselor with administration. This step is deemed significant because school counselors generally see themselves as more informed in recognizing and reporting child abuse than principals (Tillman et al., 2015).
Nevertheless, a study conducted by Kenny and McEachern (2002) mentioned that both school counselors and school principals report child abuse, although school counselors reported child abuse at a higher percentage than school principals. Still, it is imperative to recognize that both professions—school counselors and administrators—share the common goal of protecting children by reporting suspected child abuse (Kenny & McEachern, 2002; Tillman et al., 2015).
Early career school counselors can leverage this insight by approaching their administrators through a collaborative stance, highlighting this shared goal, and discussing how to ethically and legally report suspected child abuse. This discussion can include, but is not limited to, state laws, district policies, and district/school child abuse reporting procedures. Furthermore, school counselors and school principals who keep the safety of students at the forefront and work together need to reduce role confusion.
Step V. Build Collaborative Partnerships
CPS. This step has been included to encourage partnerships between school counselors and CPS. District school counseling supervisors can support this endeavor by extending an invitation to CPS supervisors to attend a meeting with school counselors. This meeting would be utilized as a rapport-building opportunity as well as a way to share each other’s roles, challenges, and strengths. Additionally, this would be an opportunity for CPS to provide updates, contact information, and any other pertinent information.
It also has been recommended that joint training be done with local CPS members and school counselors (Bryant & Baldwin, 2010) to ensure collaboration between agencies and to ensure all participants are exposed to consistent training. Additionally, CPS may be able to provide training to the school system and not only school counselors. “When school counselors understand the limitations inherent in receiving a report, they might, in turn, be more efficacious in their reporting of child abuse” (Bryant & Milsom, 2005, p. 70). This training should include information on the reporting process, but also on the investigative process so that school counselors develop an understanding of the reactions and behaviors of the investigators (Bryant & Baldwin, 2010). Other stakeholders, such as school psychologists, social workers, and nurses, would benefit from this training as well.
Law enforcement. Public safety is the mission of law enforcement officers. Within the school system, police officers and especially school resource officers (SROs) engage in numerous activities and perform numerous duties. One of the duties can include being a member of the school’s crisis response team (Cowan, Vaillancourt, Rossen, & Pollitt, 2013). School counselors should work to build a positive working relationship with their SRO and local law enforcement. These individuals can help assist school counselors in providing services when students are a danger to themselves or when the student is in danger. Additionally, SROs have been provided specific training on “student needs and characteristics, and the educational and custodial interests of school personnel” (Cowan et al., 2013, p. 10). Law enforcement and SROs also can help ensure the safety of everyone in the building when a threat arises.
Attorneys. School counselors should consider consulting with the school district’s attorney to ensure that their rights and the rights of their students and others are being maintained. Most schools have a school attorney that school counselors can communicate with when issues or questions arise. School counselors also must make sure they are aware of legal and ethical guidelines on confidentiality and privacy of student information. Nonetheless, if school counselors find themselves in situations where discrepancies arise, they should call their local department of children’s services or attorney (Mitchell & Rogers, 2003). Participants from a study conducted by DeCino, Waalkes, and Matos (2017) reported positive experiences with legal counsel. An attorney not only provides guidance on ethical dilemmas but also legal advice for potential court hearings.
Step VI. Provide School-Based Training
Stakeholders in the school setting, such as teachers, school nurses, coaches, paraprofessionals, custodians, lunchroom staff, and other support staff in the building, should be provided with training to identify and report child abuse (Hogelin, 2013; Lambie, 2005). It is recommended that training on child abuse identification and reporting procedures be conducted each year; this is mandatory in some states. These individuals interact with students daily and are able to recognize if a student is in distress. Despite their daily interactions with students, many teachers struggle to identify signs of abuse and have a lack of knowledge of reporting procedures (Greytak, 2009). Therefore, school counselors are in the position to schedule dates and times at the beginning of the school year, such as during pre-planning, and mid-year as a refresher to provide school personnel with the training to identify and recognize child abuse as well as inform them of their mandated reporter obligations. This involves addressing state laws, ethical requirements, and district/school policies for child abuse reporting as well as providing the procedures and contact information to make a report.
Step VII. Report Child Abuse
Child abuse reporting involves several crucial details. These details include, but are not limited to, the name of the child, name of family members (e.g., parents, siblings), individuals who reside in the home, phone number, address, previous history of abuse, academic performance, child dispositions, and concern leading to the report (Sikes, 2008). It would behoove early career school counselors to determine if their school districts have a specific form to complete while filing an abuse report. This resource would guide the process of obtaining all the details for filing a complete report. If no such resource is available, school counselors should work with key personnel to create a standardized form for abuse reporting. Furthermore, knowledge of the method to make a report is necessary. Reporting procedures for CPS vary by state. Most states prefer an oral report be made to CPS; however, some states require a written report be completed after the oral report has been made (Child Information Gateway, 2017). Because there may be a timeframe in which to call according to state policy, early career school counselors who are aware of the specific method to report will not only report in a timely manner but be more prepared and self-efficacious in their reporting skills and capabilities.
Step VIII. Perform Post-Reporting Procedures
After the child abuse report has been made, questions often arise about how to support the student who needs to be aware of the child abuse report, and how to respond to parents who inquire about the report. Early career school counselors can reach out to the caseworker to inquire as to what supports might be provided at the school, check in with the student to ensure they are safe, and seek what procedures the district has in place to address parents. When approached by parents, early career school counselors can maintain the disposition of informing parents that all child abuse reports are confidential and that they may contact the caseworker with their questions. Additionally, pamphlets on the role of mandated reporting and resources can be made available in the school counselor’s office to provide the parents with assistance in identifying supports. School counselors also can provide parents with referrals to outside agencies, such as counseling or family supports, when asked by parents who are seeking interventions.
Conclusion
Reporting child abuse is recognized as a crucial element in the role of a school counselor. Early career school counselors often are anxious about reporting child abuse because of the fear of repercussions from parents, lack of self-efficacy in identifying abuse, limited knowledge of child abuse reporting procedures, unclear reporting procedures for school counselors, and lack of collaboration with outside agencies. This article has addressed the challenges faced by early career school counselors and provides a framework to alleviate their anxiety while increasing their self-efficacy as mandated reporters.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest or funding contributions for the development of this manuscript.
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Malti Tuttle is an assistant professor and School Counseling Program Coordinator at Auburn University. Lacey Ricks is an assistant professor at Liberty University. Margie Taylor is a visiting assistant professor at Auburn University. Correspondence can be addressed to Malti Tuttle, 2084 Haley Center, Auburn, AL 36849, mst0022@auburn.edu.
Sep 1, 2019 | Volume 9 - Issue 3
Anna Elliott, Lynn Bohecker, Gregory M. Elliott, Bethany Jean Townsend, Veronica Johnson, Anna Lopez, Elizabeth D. Horn, Ken Roach
Counseling licensure portability is in a state of crisis. The collaborative 20/20 initiative made headway in establishing the profession’s objectives toward consistent licensure standards across states; however, inconsistencies and significant barriers persist. The authors conducted a qualitative content analysis to understand the logistics associated with interstate portability of counseling licenses in the Rocky Mountain Region of the Association for Counselor Education and Supervision (Colorado, Idaho, Montana, New Mexico, Utah, and Wyoming). Results describe participants’ experiences in fulfilling licensure requirements and the barriers encountered because of discrepancies in practice standards. Recommendations for counselors, supervisors, and state licensing boards are described.
Keywords: license portability, interstate portability, licensing boards, licensure requirements, qualitative analysis
The American Counseling Association (ACA) was originally formed in 1952 in part to develop consistency among practice and ethical standards for the counseling profession (Simmons, 2002). Since then, counselors have gone through various phases of seeking professional unity, complicated by and arising from the joining of four different specialty areas (Kaplan, 2002; McKinney, West, Fye, Bradley, & Storlie, 2018). Historically, there have been different opinions on counselor professional title, scope of practice, and educational requirements (Burns & Cruikshanks, 2018; Gale & Austin, 2003). This disparity has been presented as evidence of a young, fragmented profession searching for a solid professional identity (Calley & Hawley, 2008; Cashwell, Kleist, & Scofield, 2009; McKinney et al., 2018). Counselor professional identity consists of understanding the profession’s historical context, the scope of a counselor’s practice, associated laws and ethics, and pride and engagement in counseling professional organizations (Remley & Herlihy, 2007).
Even with attempts within the counseling profession to develop consistent expectations and requirements related to educational standards, national examinations, and state licensing criteria, barriers remain (Kaplan & Kraus, 2018). Licensed professional counselors moving from state to state experience difficulties maintaining their licensed status, resulting in a “licensure portability crisis” (Kaplan & Kraus, 2018, p. 223). There is movement in the counseling profession toward established licensure portability practices as clinicians report significant barriers moving from one state to another (Kaplan & Kraus, 2018). However, as it stands, each state develops its own laws and statutes and is not bound to align with other states or recognize licenses issued in another state. These inconsistent regulations create barriers for licensed professional counselors looking to relocate and raise issues for counselors working near state borders who must be licensed in both states.
Recent Portability Efforts in the Counseling Profession
In order to unify the counseling profession under a single professional identity, 20/20: A Vision for the Future of Counseling was developed through collaboration between ACA and the American Association of State Counseling Boards (AASCB; Kaplan & Gladding, 2011; Kaplan, Tarvydas, & Gladding, 2014). This initiative focused on the importance of defining a professional identity and promoting licensure portability (Kaplan & Gladding, 2011; Kaplan & Kraus, 2018). By 2010, a consensus was reached on the definition of counseling and the importance of strengthening professional identity (Kaplan & Kraus, 2018). Establishing these two areas of agreement was a step forward; however, the counseling profession remained divided on criteria for educational programs and accreditation, which contribute significantly to licensure portability (Kaplan & Kraus, 2018). The 20/20 initiative’s final achievement before disbanding was the formation of the Building Blocks to Portability Project, designed to address issues of portability such as education requirements and number of supervised hours (Kaplan & Kraus, 2018). A consensus was obtained for the title of Licensed Professional Counselor (LPC) and scope of practice, and recommendations were made to state licensing boards (Kaplan & Kraus, 2018).
In addition to portability, license through endorsement is a term that has been used in some states to better facilitate obtaining a license in a new state. Endorsement means a license may be granted reciprocally to a professional counselor who has been licensed by another state. More recently, in 2013, the CACREP Board adopted a position statement on licensure portability for professional counselors, and then in 2015 endorsed portability standards proposed by the Association for Counselor Education and Supervision (ACES), the American Mental Health Counselors Association (AMHCA), and the National Board for Certified Counselors (NBCC; CACREP, 2018). In 2016, ACA developed and proposed a different aspirational licensure portability model (ACA, 2017). AASCB, ACES, AMHCA, and NBCC together released a joint statement, the Joint Statement on a National Counselor Licensure Endorsement Process (AMHCA, 2017; NBCC, 2017). The CACREP Board voted to publicly endorse the joint position statements later that same year (CACREP, 2018).
The consistent standards needed in order to establish licensure through an endorsement process were summarized by Olson, Brown-Rice, and Gerodias (2018). These criteria were: (a) no disciplinary sanctions for at least 5 years; (b) possess the highest tiered license; (c) completion of a jurisprudence exam if necessary; and (d) complies with one of the following: meets all academic, exam, and postgraduate supervised experience standards as adopted by the state counseling licensure board; holds the National Certified Counselor (NCC) credential; or holds a CACREP-accredited graduate degree (NBCC, 2019; Olson et al., 2018). However, most states still require a detailed application to demonstrate that the specific educational, experiential, supervision, and exam requirements of licensure have been met for that state (ACA, 2019).
In addition to licensure portability and licensure endorsement, licensure reciprocity is one mechanism of portability that states employ to grant full recognition for a license from another state. Reciprocity includes an expedited type of application process for LPCs. One example is a signed reciprocity agreement between Tennessee and Kentucky (Tennessee Department of Health, 2015). In general, to apply for licensure in another state, the license earned in another jurisdiction must be in good standing with no unresolved legal or ethical issues and have equivalent or higher requirements. Exam scores must meet the current state’s passing score and there may be additional specific state examinations. Other states do not have specific provisions for reciprocity or endorsement and require the full application process. The lack of uniformity between states can significantly increase the time and effort to provide documentation and evidence of competence to be issued a full license in another state. The exact definitions of these terms differ from state to state, further highlighing the lack of clarity and consistency counselors encounter when navigating this process.
The counseling profession continues to be divided on the topics of educational requirements for number of credit hours, accreditation, number of supervised experience hours, number of supervision hours, and examinations. Even though there has been work toward solidifying a professional identity and addressing licensing issues, jurisdiction of issuing a counseling license resides within each state. Consistency between state licensure requirements would facilitate counselor mobility to support career and family options and increase client access to care.
Specific Issues in Licensure Portability
Each state is responsible for determining its own licensure laws, and as a result of this differentiation significant differences exist (ACA, 2016). A licensed counselor’s move from one state to another is often met with difficulties. Kaplan (2012) stated, “We have a real crisis in counseling licensure. Counselors are trapped in their own states” (p. 1). There remains a wide range of educational requirements, accreditation, number of hours of supervised experience, number of hours of supervision, and examinations. For example, a majority of states in the United States (n = 37) require 60 educational credit hours (ACA, 2016). However, some states require specific coursework, such as family counseling, human sexuality, and addictions. Therefore, counselors who graduate from an accredited program still may not meet the educational requirements for licensure in a second state. Regarding accreditation, 29 states explicitly identify CACREP, CACREP/Council on Rehabilitation Education (CORE), or NCC certification for licensure. Other states do not specify accreditation or simply use the word “accredited.”
Across the United States, there are vastly different requirements for supervision, specifically who can supervise, types of supervisor, frequency of supervision, number of supervisees per supervisor, and supervisor requirements (Henriksen, Henderson, Liang, Watts, & Marks, 2019). Henriksen et al. (2019) conducted an analysis of supervision rules and laws. The number of clinical hours of experience required for master’s-level prelicensure counselors varied from 500 to 7,000 if the program of study did not meet CACREP (2015) standards.
There are differences in the frequency of prelicensure supervision and variations in how requirements are described (e.g., not defined, based on client hours, a specific number of hours or sessions, weekly and special rules). Sometimes additional postgraduate supervision hours are required. These range from not specified to 200, with many states (n = 28) requiring 100 hours of supervision. The minimum exam requirements for the majority of states (n = 42) is a passing score on the National Counselor Examination (NCE). Other states require the National Clinical Mental Health Counseling Examination (NCMHCE) or Certified Rehabilitation Counselor Exam (CRCE). Alternatively, a state may require more than one exam, a higher minimum score, or a different or additional exam (ACA, 2016).
In addition to the burden of already possessing a license and having to complete another application in a different state with varied requirements, there are logistical and economic barriers as well. Finding a clinical supervisor, syllabi to support coursework verification, and a clinical agency that will hire a professional counselor without a valid state license are just a few of the issues that need to be navigated. Many of the state licensing differences can result in financial stress, with practitioners having to wait extended periods of time without income, as well as possibly incurring extra costs related to taking another exam, obtaining licensure documentation, additional coursework, supervision, and unpaid client contact hours. The counseling profession will clearly benefit from a consensus on licensure requirements, resulting in fewer barriers to licensure portability (Burns & Cruikshanks, 2018). In an attempt to explore these issues in one area of the United States, the authors established a regional licensing committee.
The Interstate Licensing Agreement Committee
In 2015, the Rocky Mountain Association for Counselor Education and Supervision (RMACES) board authorized the formation of the Interstate Licensing Agreement Committee. The committee members were comprised of counselor educators and clinicians who represented the six states in the RMACES region: Colorado (CO), Idaho (ID), Montana (MT), New Mexico (NM), Utah (UT), and Wyoming (WY). The goal of the committee was to have representatives from each state in the RMACES region work together and with their respective state licensing boards to develop an interstate agreement for counseling licensure reciprocity.
Table 1 shows the similarities and differences between the state licensing requirements in the Rocky Mountain region (ACA, 2016). The first column identifies the state, and the second column contains the acronym for the top tier title for a counseling license. The next two columns contain the educational requirements, including type of programmatic accreditation and the minimum number of credit hours. The next four columns are experiential requirements, which include the required number of hours of clinical supervision, the number of direct client hours, the minimum number of years of post-graduation experience, and the total number of overall counseling-related hours.
Many attempts to find common licensing ground and facilitate discussions between even two of the state boards was met with resistance from licensure board members. The committee hoped to open dialogue regarding the possibility of establishing greater alignment between a minimum of two states. The attempts of collaboration between state boards became futile so the committee then turned their efforts toward engaging in research on topics related to counselor licensure and portability. The Interstate Licensing Agreement Committee representatives are the researchers in this study and the authors of this manuscript.
Table 1
Summary of State Licensing Requirements in the RMACES Region
State |
Top Tier Title |
Educational Requirements |
Experiential Requirements |
Exams |
Accreditation |
Credit
Hours |
Supervision
Hours |
Direct
Hours |
Years |
Total
Hours |
CO |
LPC |
CACREP |
60 |
100 |
NS |
2 |
2,000 |
NCE + CO Exam |
ID |
LCPC |
Accredited |
60 |
80 |
2,400 |
2 |
3,400 |
NCE + NCMHCE |
MT |
LCPC |
Accredited |
60 |
1:20a |
1,000 |
NS |
3,000 |
NCE |
NM |
LPCC |
Accredited |
48 |
100 |
3,000 |
2 |
NS |
NCE + NCMHCE |
UT |
LCMHC |
CACREP |
60 |
100 |
NS |
NS |
4,000 |
NCE + NCMHCE + UT Exam |
WY |
LPC |
CACREP/CORE |
60 |
100 |
1,200 |
NS |
3,000 |
NCE or NCMHCE or CRCE |
Note. NS = Not specified. Table adapted from data in Licensure Requirements for Professional Counselors: A State-By-State Report (2016 Edition). Copyright 2016 by the American Counseling Association.
aRequires 1 hour of supervision for every 20 clinical hours.
Although research exists examining aspects of counselor licensure portability, there appears to be a gap in the literature of studies conducted that address the experiences and challenges counselors face when relocating. We were aware of some logistical and economic barriers counselors experienced when attempting to obtain an additional counseling license (Kaplan, 2012). Therefore, the purpose of this study was to increase understanding of counselors’ experiences of obtaining licensure in another state. We interviewed 12 licensed counselors who sought licensure in one of the RMACES region states of CO, ID, MT, NM, UT, and WY, after obtaining licensure in any other state throughout the country. We sought to answer the following research question: What are the experiences of obtaining clinical licensure in counseling after moving from one state to another within the RMACES region of the United States?
Researcher Positionality
Because the researchers each held a state-issued license to provide mental health services, we brought our individual experiences into the development of this research. Some of the authors had personal experiences of obtaining a license in more than one state, ranging from a fairly simple process to one that took over a year to complete. The researchers were all trained counselor educators ranging from a doctoral candidate to assistant, associate, and full professors. The researchers were intentional to rely on the participants’ views of their experiences obtaining a counseling license and not their own anecdotal stances on the issue.
Method
We sought to understand licensed counselors’ experiences of obtaining a counseling license after moving to one of the RMACES states. We wished to focus on participants’ perspectives to understand the logistics and challenges associated with the interstate portability of counseling licenses. The constructivist approach of qualitative research provides opportunities for participants to report meaningful experiences and allows for multiple perspectives and participant realities (Hays & Wood, 2011). Qualitative content analysis is a method based on naturalistic inquiry with rigorous coding to systematically categorize data to describe “the meaning of qualitative material” (Schreier, 2012, p. 1). Data were collected from recollections of personal experiences obtaining a state counseling license. We used both a deductive and an inductive content analysis approach to draw themes directly from the data and analyzed experiences using qualitative content analysis to classify data into categories of experiences with similar meanings (Cho & Lee, 2014; Schreier, 2012).
Participants
We obtained the required human participants research approval from the institutional review boards of our respective institutions. We used purposeful and snowball sampling to recruit subjects who were licensed counselors in one state and then obtained an additional license in the states of CO, ID, MT, NM, UT, and WY. We looked for people who met the criteria of involvement and had a willingness to describe their experiences. Each state has different procedures and qualifications for licensure; therefore, we wanted to include at least two participants’ experiences from each RMACES state. The involvement inclusion criteria were people who (1) have been licensed as a professional counselor or equivalent in another state in the United States, (2) have subsequently moved into an RMACES state and applied for a counseling license, and (3) were granted the counseling license. The resulting sample consisted of 12 participants (seven women and five men). Participants ranged in age from 33 to 68 years and all identified as Caucasian.
Data Collection
Participants were asked to take part in an interview lasting between 15 and 40 minutes based on the length of participant responses. Participants were asked questions specifically related to their experience obtaining a license in the RMACES region, beginning with the overarching question: “What is your experience of obtaining clinical licensure, transitioning from one state to another?” The authors recruited participants from their own state and conducted at least one of the interviews, which were audio- or video-recorded. In addition to the initial research question, participants were asked, “What factors/elements have influenced your experience of licensure portability?” “What has been positive and what has been challenging or created a barrier?” “What have your interactions with the state’s licensure board been and how has this impacted your experience?” and “Can you briefly describe the step-by-step process that you had to go through to obtain licensure and how long the overall process took to complete?” The researchers attempted to meet the criteria of thematic saturation, or the continual sampling of the data collected from the participants until repetition was achieved and no new information was obtained (Bowen, 2008; Strauss & Corbin, 1990).
Data Analysis
Analysis consisted of engaging in the systematic nature of qualitative content analysis (Schreier, 2012). This helped set the stage for approaching the data with a beginner’s mind. First, we collected and transcribed interview data (n = 12). Next, two members of the research team read through the collection to get a sense of the whole experience. The next step consisted of these two researchers individually reading the interview transcriptions and engaging in open coding to identify the most common and analytically rich essential themes from which to base a more selective coding scheme or category (Schreier, 2012). The researchers then engaged in selective coding to determine the units of analysis, categories, and themes (Cho & Lee, 2014; Schreier, 2012). In this case, the unit of analysis was related to the licensing process. The researchers engaged in the use of deductive and inductive analysis. The two approaches differ on how initial codes or categories are developed. The deductive approach starts with preconceived codes or categories derived from prior relevant theory, research, or literature, while in the inductive approach, codes and categories are directly drawn from the data (Cho & Lee, 2014). The initial codes were developed from a deductive approach using the categories of title, education, experience, and exam, identified previously in Table 1. Every unit of analysis was placed into a mutually exclusive category, meaning that no data fell between two categories or was placed into more than one category (Crowley & Delfico, 1996).
Next the researchers engaged in inductive coding based on the aspects of the participants’ experiences that were not captured by the a priori deductive codes (Schreier, 2012). Inductive categories were developed as a means to compress the large amount of individual text into fewer content-related groups with similar meanings and connotations (Schreier, 2012; Weber, 1990). This also is known as a data reduction process in qualitative content analysis and is achieved through limiting “analysis to those aspects that are relevant with a view to your research question” (Schreier, 2012, p. 7). Next, two researchers compared codes and where discrepancies existed, we described our coding process (Cho & Lee, 2014; Saldaña, 2016). A third researcher triangulated the coding by the first two researchers. Discrepant data and negative cases were discussed among the three coding researchers, and we decided collectively on categories that best represented and explained the data (Cho & Lee, 2014; Saldaña, 2016). We formed a final codebook of the categories and descriptions. Each category contained the name, a description of meaning, examples, and inclusion and exclusion decision rules. The identification of categories and themes continued until no new themes were identified within the data and redundancy occurred (Guest, Bunce, & Johnson, 2006; Strauss & Corbin, 1990). Theoretical saturation was obtained meeting this “critical methodological concept in qualitative research” (Walker, 2012, p. 37). The last step consisted of a review of the codes conjointly to discuss refinement of categories, impressions of the themes, and interpretation of the meanings (Schreier, 2012). Based on this analysis, the content of the interviews fit into six categories: professional title; graduate education; clinical hours; licensure exams; barriers to licensure; and recommendations for counselors, counselor educators, supervisors, and state boards.
Trustworthiness
In qualitative research, trustworthiness is used to acknowledge the subjectivity of experience while also engaging in rigorous methods to establish meaning. We embraced Corbin and Strauss’s (2008) assertion that in qualitative research, “findings are trustworthy and believable in that they reflect participants’, researchers’, and readers’ experiences with a phenomenon” (p. 302). To establish trustworthiness of the data, we used Creswell’s (2014) methods. Two researchers coded the comments separately and met to preserve congruence in coding definitions and check the trustworthiness of the process (Creswell, 2014). Coding was triangulated with a third researcher to add to the trustworthiness. Because all data in qualitative research pass and are filtered through the researchers’ lens, how we were positioned in this study is stated in the conceptual framework and authors’ positions. All of the authors identify as counselor educators or doctoral students in counselor education, and each author holds a professional counseling or marriage and family therapist license. Trustworthiness was deepened through participants as they were asked to take part in a member check at the conclusion of data analysis. The authors shared the categories and themes with participants to assess whether the conclusions were congruent with the participants’ experiences.
Results

Figure 1. Inductive and Deductive Categories
The categories were derived from deductive (professional title, graduate education, licensure exams, and clinical hours) and inductive (barriers to licensure and recommendations for counselors, counselor educators, supervisors, and state boards) approaches to data analysis. Overall, the researchers concluded that the categories reflected the participants’ experiences upon receiving a license in another state (see Figure 1). Each category is individually described with “sentences that elaborate on the researcher’s interpretations of the participants’ meanings in more nuanced and/or complex ways,” supported with quotations from the data (Saldaña, 2016, p. 204).
Professional Title
Professional counseling licenses are available today in all 50 states and three jurisdictions (Washington, D.C., Guam, and Puerto Rico). The title of this license is not consistent across all states, or even between the RMACES states. Some states have two tiers, meaning counselors are first awarded a provisional license before obtaining full licensure, while other states have one tier, and a clinician cannot describe himself or herself as a licensed counselor until the license is obtained. This can cause confusion when the top-tier or full license title in one state is the same as the bottom-tier title or conditional license in another state.
This deductive category was established with the description applying for an additional license involves understanding the differences in tiers, titles, and equivalencies. Participants described the necessary investigation and discovery of the differences in titles across states, and in some cases how the same title meant different things in each state. Table 1 illustrates the differences between top-tier licensure titles for counselors in each state within the RMACES region, and even more variations and inconsistencies exist outside of the RMACES region. Most participants’ confusion related to the inconsistencies among these licensure titles. For example, Ann described how in Indiana the full license is called a Licensed Mental Health Counselor (LMHC) and in New Mexico, the conditional license is called an LMHC and the full license title is an LPC. This caused confusion when she was trying to obtain full licensure in New Mexico and board members assumed she only held the conditional license. Other participants described similar experiences of frustration and confusion related to navigating differences in licensure titles, including one participant who did not “understand why there isn’t just one name for what we do?” Having one title for a full counseling license would clarify scope of practice for practitioners, state licensing boards, and clients, regardless of jurisdiction.
Graduate Education
A second significant discrepancy between state licensure requirements was related to whether participants graduated from an accredited master’s program. Even though it was clear that a master’s degree in some form of counseling is required to obtain a counseling license in any state, participants described different ways in which their master’s education affected their ability to obtain licensure when switching states. It is important to note that CACREP-accredited programs require 60 credit hours, as do many programs, while some school counseling specializations within CACREP-accredited programs are only 48 credit hours, as licensure is not required (Table 1 documents the differences in requirements in the RMACES states). Some non-accredited programs only require 48 credits, which can create a barrier for obtaining licensure in some states. Many states are implementing educational requirements based on CACREP standards; therefore, it is useful for graduate students to attend a CACREP-accredited program, potentially facilitating ease of the licensure process.
Education was established as a category with the description applying for an additional license is continuing to prove a master’s degree was conferred, unless the program was CACREP-accredited. Consistently, participants who graduated from CACREP-accredited programs described how their process was made easier because their program was CACREP-accredited. Graduating from a CACREP-accredited program meant that the state board required less documentation of their academic curriculum. Participants who did not graduate from CACREP-accredited programs described how needing to provide extra documentation as proof of the legitimacy of their graduate program compounded their experiences. Echoing other participants, Kathy, for example, reflected on how when a counselor graduates from a CACREP-accredited program “you check a box here instead of having to go through and fill out all this [extra paperwork] . . . so that was a positive that saved me a lot of steps.” Conversely, Amy described having to jump through a lot of hoops when first licensed in Colorado because she did not attend a CACREP-accredited program and had to send all her syllabi to an organization in North Carolina to evaluate her education. Although graduating from a CACREP-accredited program did not entirely prevent participants from facing challenges during the licensing process, it appears that graduating from a CACREP-accredited program positively impacted their portability experiences. Participants reported graduating from a CACREP-accredited program reduced the volume and time required to complete the process. Participants from non–CACREP-accredited programs needed to submit course syllabi and, in some cases, take extra classes required by the state.
Clinical Hours
All counseling licenses require the completion of a certain number of clinical hours, both during the master’s program and following graduation. The requirements can vary widely from state to state, as depicted in Table 1. Direct hour requirements for states in this study ranged from 1,000 to 3,000, and overall hours varied between 2,000 and 4,000. Participants described the issues encountered based on differences in state requirements.
The deductive category of clinical hours was further defined as applying for an additional license is tracking hours of client contact and supervision with varying requirements. Participants described a variety of logistical issues related to required clinical hours, such as needing to complete additional supervised hours in their new state because the state they moved from required fewer hours. Some participants highlighted that the additional hours were required despite having been endorsed and “fully” licensed in the previous state. Multiple participants indicated that differences in clinical hours and years needed to practice led to challenges when relocating. Aside from the challenge of having to complete additional clinical hours, multiple participants described difficulty with obtaining verification of hours from previous supervisors. Challenges getting documentation completed included difficulty accessing supervisors, time that had passed since they had been supervised by these individuals, and overall inconvenience of tracking down previous supervisors and asking for verification.
Licensure Exams
All states require a licensure exam as part of the requirements for obtaining a counseling license. Participants described the ease or difficulty this caused in the process of obtaining a counseling license in a second state. Table 1 illustrates the different exam requirements among the RMACES states, where some accept either the NCE or the NCMHCE, some require both exams, and others additionally require their own state-specific counselor exam. For example, the exam requirements differ between states without expectation that the exam be reliable and valid according to state law, but rather applicants need to have passed “an equivalent exam” that is subjectively determined by current members of a state board (ACA, 2016, p. 108).
The deductive category of licensure exams included the description applying for an additional license is sending the scores to each state board and potentially taking another exam. Participants described the logistical difficulties of moving to another state and in addition to having to fill out the application for licensure, having to take another exam in order to be eligible. Participants reported a lack of uniformity between states regarding the required licensure exam, which further complicated their ability to obtain a counseling license in another state. Both Colorado participants described the burden created by the state’s jurisprudence examination that is required in addition to the NCE. Veda elaborated that taking the state exam was a “huge hindrance” and the test information was not applicable to her practice as a counselor.
Barriers to Licensure
This inductive category was established by researchers based on the overwhelming amount of data that related to descriptions of barriers that participants experienced while trying to obtain counseling licensure in a Rocky Mountain state. The category of barriers to licensure is described as encountering unexpected barriers and challenges when applying for an additional license. This data went beyond the specific deductive categories that defined required aspects of the licensure application to describe significant flaws in the overall logistics of the licensure process. This category encompassed the largest amount of data from interviews and was further divided into four themes: interacting with a state licensing board, gathering materials, impacting ability to practice, and paying additional fees.
Interacting with a state licensing board. The most salient theme across interviews captured the difficulties and barriers created by interactions with the state licensing boards. All participants described some degree of confusion experienced when seeking licensure requirement information on the state board website. They reported that then when calling the board directly, they would encounter additional points of confusion. They dealt with state board staff who provided vague or confusing information, who were unable to answer detail-specific questions, and who were unwilling to refer the counselor to someone who was capable of answering their questions. Participants also lamented the additional barrier of often being unable to get the same staff member on the phone, and therefore having to repeat their questions and explanations of specific circumstances each time they called. State board staff answering the phones also often had no counseling background and therefore had no context for the questions being asked by applicants. A final significant barrier identified by participants was that submitted paperwork would be lost by the state board, therefore delaying the application process further and even preventing counselors from getting licensed before arriving in the new state.
Some participants described not obtaining a full license in a new state even though they maintained one in the first state. They indicated sometimes this was because they did not meet the requirement in the second state, but also because the verification process was too convoluted when they attempted to verify their qualifications for full licensure with the new board. George described how he had been licensed for over five years in Washington and attempted to acquire a full license in Idaho. He opted to pursue the conditional license, even though he should have qualified for the full license, because of the lack of clarity from the state board about what was required of him. Other participants described conflicting answers regarding what was needed in their application, but that their experience was positively influenced by pleasant interactions with board or administrative members they called. Dorothy expressed gratitude for the ability to get someone on the phone who was able to answer specific questions, even though the information on the website was difficult to decipher.
Gathering materials. Participants from all six states described multiple barriers that slowed down their ability to become licensed related to gathering applications materials. This included the time required to gather documents and find required documents that were not readily available or clearly described as required on state board websites, having to provide notarized documents, tracking down former supervisors, having to document continuing education for multiple states, and requesting letters from other state boards. Idaho, for instance, requires licensure documents to be notarized, and both Idaho participants described the additional barrier this created. George shared how it felt like a burden to ask former supervisors to “go out of their way to find a notary or even pay for it.”
Impacting ability to practice. Participants described the hardship associated with not being able to practice in the new state. Barriers included waiting for the application to be received, processed, and approved, which sometimes took months; needing to have an address in the new state in order to apply; not being able to supervise in the new state when that is a required part of their new job; and not being able to provide client care. Participants described the process as taking between six weeks and six months to obtain their new license, preventing them from seeing clients and earning an income. One participant described having a spouse with a career requiring him to move states periodically and how much additional stress this created, as she had to endure the licensure portability process each time her husband was transferred.
Paying additional fees. In addition to potential income barriers, participants described the burden of paying multiple fees that occurred simultaneously with relocating to a new state and not yet being able to practice counseling. Brian described the tedium of his application process and how it took about six months to complete, and in addition, “it was very costly . . . all-in-all it came out to close to $800 to get licensed here.” Rosie echoed this experience: “By the time everything was done, I spent $600 to get my license transferred . . . that’s a substantial amount of money before I can even start working.” Because of having to pay additional fees, participants lost money and were unable to work for prolonged periods while waiting until they were licensed in their new state.
Recommendations for Counselors, Counselor Educators, Supervisors, and State Boards
The category of recommendations emerged from participants offering their perspective on what could have potentially made their experiences easier and less burdensome. Recommendations were designated as a category with the description making recommendations to facilitate or improve the process of obtaining an additional license. Recommendations were divided into three themes of recommendations for counselors, programs, and state licensing boards. The recommendations will be briefly described here and expanded upon in the implications section.
Recommendations for counselors. All participants emphasized the importance of strict documentation of all hours, supervision, and training, and keeping copies of all paperwork submitted to the state boards. This recommendation was based on supervisors later being unavailable to verify hours (e.g., lack of available contact information or death); state boards not accepting documentation or verification from other states; or in some cases the board losing the applicant’s paperwork, compelling the applicant to complete the paperwork a second time. Multiple participants described how the licensure process was generally easier after having been fully licensed for five years because certain states allow for licensure reciprocity if that time frame has been met (e.g., ID and NM). Participants therefore recommended trying to maintain licensure in one state for at least five years, even if one left the state, so that they would have access to licensure reciprocity if they decided to relocate to another state. Participants also recommended saving copies of course syllabi, particularly if they graduated from a non–CACREP-accredited program, as it was difficult to find syllabi retroactively.
Recommendations for counselor educators and supervisors. Participants recommended counselor educators and supervisors be clear on the expectations of licensure to assist their students and supervisees. Participants believed that facilitating students’ preparation for the licensure process may help them avoid the barriers that many described.
Recommendations for state boards. All participants described the lack of clarity they experienced in accessing information about licensure either from the state board websites or calling and talking to a board member or administrator. Therefore, the most poignant recommendation for state boards was to work to provide clearer information on their website and to ensure that staff who answered questions over the phone were well-versed in licensure requirements and application procedures. One participant’s recommendation was for state boards to create a flow chart detailing the paperwork required for licensure applications based on the variety of contexts from where counselors might be operating.
Discussion
Our exploration began with the understanding that despite initiatives and calls for consistency among licensure standards, the counseling profession continues to struggle to establish a unified identity. Participants’ narratives supported previous researchers who emphasized the need for a unified counselor identity, accomplished in part through consistent licensing criteria (Eissenstat & Bohecker, 2018; Mascari & Webber, 2013; Mellin, Hunt, & Nichols, 2011; Myers, Sweeney, & White, 2002). Participants described confusion related to licensure titles and licensing categories across states. Within the RMACES region, the highest level of licensure for professional counselors has four different titles. In addition to making the application process more confusing and tedious, this inconsistency contributes to the deeper problem of counselors not having a clear professional identity.
The results of this study support both the objectives and the proposed outline for the national counselor licensure endorsement process. This initiative was prompted by calls from within the profession to establish greater consistency between state licensure requirements (AASCB, 2019; Kaplan & Gladding, 2011; Kaplan & Kraus, 2018; Kaplan, Tarvydas, & Gladding, 2014). In response, AASCB, ACES, AMHCA, CACREP, and NBCC have all agreed upon a national process for counselor licensure by endorsement. The joint statement’s proposal for licensure reciprocity demonstrates key governing organizations within the counseling profession are aligned on this issue and if enacted would eliminate the majority of issues participants described. Counselors can work to effect systemic change through advocacy at the state level. The more states that adopt this joint process for licensure endorsement, the easier the licensure reciprocity process will be for professional counselors who move to a new state. Professional counselors who directly serve on their state licensing boards also may be able to influence their state in moving toward this standard.
Although we expected to hear narratives of frustration related to the licensure portability process, we were surprised by how pervasive this frustration was across everyone’s experience, to varying degrees. Our call for participants simply sought out licensed counselors who obtained a second license in a Rocky Mountain state, so it seems indicative of a larger issue of inefficiency across states that all participants described a system that does not function well. Specifically, we were surprised by how many different types of barriers applicants could encounter. Interactions with the state boards overwhelmingly contributed to the struggle to obtain clear instructions on how to manage typical and also unique circumstances. We were surprised that no participants spoke about the benefits of the NCC endorsement through NBCC. In addition to access to clinical resources, designation as an NCC voluntarily demonstrates to the public that a counselor has met high national standards (NBCC, 2019). Participants either did not address this certification or described it as irrelevant toward helping them with their licensure process.
Until greater consistency between state licensure requirements can be enacted, the authors recommend counselors keep documentation of everything related to their clinical training, remain in a state for five years prior to relocating, and communicate with the board of the state that one is moving to ahead of time in order to promote understanding of requirements needed in order to obtain licensure. All of these suggestions reduced the barriers experienced in the licensure process. State boards are encouraged to develop a flow chart outlining the licensing process. The authors suggest counselors organize their application materials behind a detailed cover letter to the board which delineates each enclosed item, and ensure the following are included: (1) previous license verification, (2) contact information for previous state board, (3) unofficial transcript with official one ordered to be sent directly to board, (4) CV or résumé, (5) the appropriate state application, and (6) application fees. Highlighting discrepancies that exist between state requirements or titles that might confuse board members also can help applicants successfully achieve licensure.
Limitations and Future Research
Participants were selected for the study based on acquiring an additional counseling license within an RMACES state. Although our participants ranged in gender, age, and number of years licensed, we offer a generally small, homogenous sample, who all identified as Caucasian. It would be advantageous to understand if there are different experiences with this process across other regions of the United States and for counselors from other cultural demographics. Explicit interview questions were established for this study; however, six different interviewers conducted the interviews. Variances in follow-up questions were noted during the analysis. This might have impacted the depth of the participant experiences captured by the interview process, representing our second limitation.
Future research should include qualitative examinations of other regions’ challenges to licensure portability, as well as larger-scale quantitative surveys of licensure issues across the country. What remains to be addressed is the vast difficulty of states interacting with one another—getting state legislatures and governing organizations to coordinate activities. For example, ACA has not yet endorsed the joint portability statement. Greater than the need for describing the problem, as a profession we need to continue moving toward a unified solution. This requires collaboration and proactivity on the part of leaders within counseling. A more resounding message needs to reach the state boards regarding their role in the effectiveness of the current system. The joint portability statement is a step in the right direction; however, the profession needs to determine what specific actions come next.
Conclusion
Unification of the licensure process is imperative, and we see this research as illustrating the importance of prioritizing licensure portability. We have outlined the spectrum of challenges counselors face when obtaining an additional counseling license and offered recommendations for how to mitigate the inconsistent standards. Counselors should continue to advocate locally and nationally for unification of licensure standards across state lines in order to promote uniformity and consistency, and enhance counselor practice and well-being.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
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Anna Elliott is an assistant professor at Montana State University. Lynn Bohecker is an associate professor at Liberty University. Gregory M. Elliott is an assistant professor at Colorado Christian University. Bethany Jean Townsend is an assistant professor at Northwest Nazarene University. Veronica Johnson is an associate professor at the University of Montana. Anna Lopez is an assistant professor at New Mexico State University. Elizabeth D. Horn is a professor at Idaho State University. Ken Roach is a clinic director at the University of Phoenix—Utah. Correspondence can be addressed to Anna Elliott, PO Box 173540, Bozeman, MT 59718, anna.elliott@montana.edu.
Jun 7, 2019 | Volume 9 - Issue 2
Hilary Dack, Clare Merlin-Knoblich
Although the American School Counselor Association National Model reflects the importance of high-quality school counseling core curriculum, or classroom guidance, as part of a comprehensive school counseling program, school counselors are often challenged by the complexities of designing an effective classroom guidance curriculum. This conceptual paper addresses these challenges by proposing the use of Understanding by Design, a research-based approach to curriculum design used widely in K–12 classrooms across the United States and internationally, to strengthen classroom guidance planning. We offer principles for developing a classroom guidance curriculum that yields more meaningful and powerful lessons, makes instruction more cohesive, and focuses on what is critical for student success.
Keywords: school counseling, school counselor, classroom guidance, school counseling core curriculum, Understanding by Design
In comprehensive school counseling programs, school counselors use a range of approaches to support students’ academic achievement, social and emotional growth, and career development (American School Counselor Association [ASCA], 2012). Classroom guidance is one delivery method of such supportive approaches, advantageous in part because it allows school counselors to reach all students in their schools (ASCA, 2012; Lopez & Mason, 2018). This curriculum is ideally “a planned, written instructional program that is comprehensive in scope, preventative in nature, and developmental in design” (ASCA, 2012, p. 85). In systematically delivering classroom guidance, school counselors use planned lessons crafted to ensure students acquire the desired knowledge, skills, and attitudes suited to their developmental levels (ASCA, 2012). These lessons comprise critical time school counselors spend in direct service to students. ASCA (2012) recommends school counselors spend 15%–45% of their time (depending on school level) delivering classroom guidance; thus, development of classroom guidance curriculum warrants careful consideration and intentionality (Lopez & Mason, 2018; Vernon, 2010).
Researchers have highlighted the value of classroom guidance for student outcomes (Bardhoshi, Duncan, & Erford, 2018; Villalba & Myers, 2008). For example, Villalba and Myers (2008) found that student wellness scores were significantly higher after a three-session classroom guidance unit on wellness. Similarly, Bardhoshi et al. (2018) found that teacher ratings of student self-efficacy were significantly higher after a 12-lesson classroom guidance unit on self-efficacy. In a causal-comparative study of 150 elementary schools, Sink and Stroh (2003) found that after accounting for socioeconomic differences, schools with comprehensive school counseling programs including classroom guidance had higher academic achievement than schools without such interventions.
The ASCA National Model (2012) reflects the importance of classroom guidance in a comprehensive school counseling program. For instance, designing a curriculum action plan is a key task in the management quadrant of the model. ASCA recommends school counselors develop a curriculum for classroom guidance that aligns with both student needs and prescribed standards. (Although ASCA [2012] refers to delivering a school counseling core curriculum, we use the term classroom guidance because of its familiarity among school counselors and counselor educators.) Once school counselors identify these student needs and prescribed standards, they meaningfully design corresponding lesson plans. ASCA (2012) asserts, “The importance of lesson planning cannot be overstated. . . . It is imperative to give enough time and thought about what will be delivered, to whom it will be delivered, how it will be delivered, and how student[s] . . . will be evaluated” (p. 55).
Despite these recommendations, school counselors appear hindered in designing highly effective lessons because of their limited training in curriculum design (Desmond, West, & Bubenzer, 2007; Lopez & Mason, 2018). This may occur in part because counselor educators do not consistently teach methods of developing a classroom guidance curriculum (Lopez & Mason, 2018). Standards of the Council for the Accreditation of Counseling and Related Educational Programs (CACREP, 2015) reflect this lack of emphasis. Of the 33 CACREP school counseling specialty-area standards, only one standard (G.3.c.) relates to the topic of curriculum development. Indeed, after reviewing classroom guidance lesson plans on the ASCA SCENE website (ASCA, 2016), Lopez and Mason (2018) noted a need for better instruction on lesson design, concluding, “school counselors need further training in incorporating standards and developing learning objectives” (p. 9). We seek to address this need by introducing Understanding by Design (UbD; Wiggins & McTighe, 2005, 2011), a research-based approach to curriculum development used widely in K–12 classrooms across the United States, to strengthen the classroom guidance planning process. In doing so, we offer a framework for redesigning curriculum in response to three common questions from school counselors: How can I make student experiences in my classroom guidance lessons more meaningful, relevant, rigorous, and powerful? Because I see each class infrequently, how can I make my lessons more cohesive, rather than a series of disconnected activities? and How can I connect my lessons more directly to what I want my students to apply to their daily lives and accomplish after they leave my program?
Applying UbD to Classroom Guidance Curriculum Development
UbD presents a curriculum design framework for purposeful planning for teaching. The goal of this framework is teaching for understanding (Wiggins & McTighe, 2005, 2011). Understanding goes beyond simply recalling facts or information. It involves a student coming to own an idea by deeply grasping how and why something works. Those who teach for understanding give students opportunities to make meaning of content through “big ideas” and transfer understanding of these ideas to new situations (Wiggins & McTighe, 2011). UbD presents a structured system for (a) distinguishing between what is essential for students to know, understand, and be able to do, and what would be nice to learn if more time were available; and (b) considering the big ideas of the curriculum at the unit level rather than the individual lesson level (Wiggins & McTighe, 2005, 2011).
The UbD framework advocates the “backward design” of a unit through a three-stage sequence of clarifying desired results or goals of learning, determining needed evidence of learning, and planning learning experiences (Wiggins & McTighe, 2005, 2011). Beginning the unit design process with the end—or learning result—in mind helps prevent “activity-oriented design.” This problem occurs when planning does not begin with identifying clear and rigorous goals, but instead begins with creating activities that are “‘hands-on without being minds-on’—activities [that], though fun and interesting, do not lead anywhere intellectually” (Wiggins & McTighe, 2005, p. 16). Activity-oriented design is a common problem in more traditional curriculum design approaches. Other problems in traditional approaches include: (a) a pattern of teaching in which the teacher directly transmits shallow factual content to students who passively receive information, making lessons more teacher-centered than student-centered; or (b) failing to ask students to practice skills or create products that have real-world applications (Wiggins & McTighe, 2005, 2011).
UbD offers a way of thinking about curriculum design, not a recipe, a prescription, or a mere series of boxes on a template to be filled in (Wiggins & McTighe, 2011). It presents guiding principles about planning for teaching that apply to teaching any topic from any field to any learner. Although these principles are commonly used by teachers, their application is not limited to general education lessons in core subjects. Because existing research has examined the effects of teaching for understanding in diverse content areas with diverse learners, its application to classroom guidance is a logical extension of an approach that is widely accepted as best practice in K–12 schools. Because classroom guidance targets big ideas of healthy student development and important skills with immediate real-world applications, its curriculum is a particularly strong fit for UbD.
Theoretical and Empirical Foundations of UbD
Although the UbD framework was developed over the last 20 years, the ideas of designing a curriculum that targets understanding and planning a curriculum backward from desired results are not new. Leading curriculum theorists have advocated these principles for the last century. Almost 90 years ago, for example, Dewey (1933) championed the importance of teaching for understanding, describing understanding as occurring when inert facts gain meaning for the learner through connection-making. Taba (1962) also maintained that specific facts and skills serve “as the means to the end of gaining an understanding of concepts and principles” (p. 177), and that the curriculum should therefore target student understanding of broader transferable ideas, rather than individual facts and discrete skills. Additionally, major theorists have promoted backward design as an effective planning process for many decades (Gagné, 1977; Mager, 1988; Spady, 1994; Tyler, 1948). UbD outlines a clear and structured process for designing curriculum that reflects these long-standing ideas. In addition to deep theoretical foundations, UbD also has strong empirical support. Specifically, its principles are supported by research from the fields of cognitive psychology and neuroscience and by research conducted in K–12 schools.
In the seminal summary, How People Learn, the National Research Council (2000) presented a comprehensive overview of psychology research on learning. This research indicates meaningful learning results from teaching that centers on broad concepts and principles that promote deep understanding of important ideas, rather than on narrow facts; emphasizes application of understanding, rather than drill or rote memorization; and prompts students to authentically perform complex skills to show they know when, how, and why to use skills in new contexts. Recent neuroscience research also indicates long-term memory storage and retrieval is more likely to be successful when students use knowledge in authentic contexts; engage in active, experiential learning; and discern relationships among conceptual ideas (Willingham, 2009; Willis, 2006).
Although no large-scale studies of the effects of curriculum developed using the UbD framework on K–12 student outcomes have been published to date, a second body of research has examined the effects of understanding-focused curriculum and instruction on student achievement more broadly (McTighe & Seif, 2003). For instance, Hattie’s (2009) seminal synthesis of meta-analyses of more than 50,000 studies of more than 80 million students suggested learning outcomes across content areas are positively influenced by curriculum that achieves an effective balance between surface versus deep understanding leading to conceptual clarity. Additionally, in large-scale studies of data from the Third International Mathematics and Science Study (TIMSS), a cross-national comparative study of the education systems of 42 countries and their outputs, American eighth graders’ proficiency was found to be approximately average compared to other participating countries, while scores of 12th graders in advanced classes were at the bottom of the international distribution (Schmidt, Houang, & Cogan, 2004). When researchers sought to explain this relatively low performance of American students through analysis of TIMSS data, they painted a bleak picture of U.S. curriculum (e.g., Schmidt et al., 2004; Schmidt, McKnight, & Raizen, 1997), characterizing it as unfocused, lacking a coherent vision reflecting recognition of which ideas in a discipline are most important (Schmidt et al., 1997), and being “a mile wide and an inch deep” (Schmidt et al., 2004). A second series of studies on the influence of varied math curriculum on student outcomes indicated that teaching with a focus on understanding allowed students to both learn basic skills and develop more complex reasoning compared to more traditional curriculum (Senk & Thompson, 2003). The principles of UbD respond directly to the curricular problems outlined in these studies of K–12 learner outcomes.
Although research suggests students exposed to curriculum emphasizing understanding may experience improved outcomes compared to those who experience traditional curriculum, it also suggests that understanding-focused curriculum design is not widespread. For example, Weiss, Pasley, Smith, Banilower, and Heck (2003) conducted a large-scale observational study of K–12 classrooms selected to be representative of the nation. Researchers evaluated observed lesson quality using criteria that included lesson design. Almost 60% of lessons were categorized as low quality. When identifying common weaknesses of lesson design, Weiss et al. (2003) reported many lessons lacked structures to encourage understanding and intellectual rigor, while high-quality lessons were distinguished by “a commitment to . . . understanding through . . . application” (p. xi).
Research has not yet examined the effects of a classroom guidance curriculum designed in accordance with UbD principles. However, recent research (Lopez & Mason, 2018) has suggested that, as in the general education contexts studied by Weiss et al. (2003), high-quality curriculum reflecting these principles may not be common in classroom guidance either. Lopez and Mason (2018) conducted a content analysis of 139 classroom guidance lesson plans posted on the ASCA SCENE website (ASCA, 2016), using a 12-category rubric to identify each lesson plan as ineffective, developing, effective, or highly effective. Lopez and Mason’s criteria for a highly effective lesson plan included: introducing a “new concept or skill” (p. 6), not just rote information; developing clear and concise objectives for the lesson that reflected “at least one higher-order thinking skill” (p. 6); providing “an opportunity for active student participation” (p. 6) and “application of skill” (p. 8); and tightly aligning all phases of the lesson to the lesson objectives (p. 7). These criteria reflected an emphasis on teaching for understanding, not simple factual acquisition. Notably, the researchers classified no lesson plans as highly effective and only 28% as effective. Thus, the majority of the lesson plans were found to be developing or ineffective (Lopez & Mason, 2018). Although the lesson plans reviewed for this study were not representative of all classroom guidance curriculum, it is noteworthy that these plans were publicly posted by school counselors as model curriculum, suggesting they believed the plans were effective. Our paper responds directly to Lopez and Mason’s pressing call for school counselors to “strengthen” their “skill set” (p. 9) by borrowing methods of lesson design and curriculum development from K–12 general education practices and applying them to the special context of classroom guidance.
In the sections that follow, we briefly outline UbD’s three design stages as applied to the development of a classroom guidance unit. We then offer an example of a school counselor’s application of the UbD framework to the revision of his classroom guidance curriculum at the program, grade, unit, and lesson levels. In keeping with UbD principles, we advocate that school counselors should treat consecutive classroom guidance lessons as one unit when they address similar topics or themes, even if school counselors present the lessons several weeks apart. We encourage school counselors to focus on designing cohesive units of a curriculum, rather than treating each lesson as an isolated learning experience.
“Backward Design” of a Curricular Unit
Stage 1. When applied to classroom guidance curriculum development, the first stage of backward design tasks school counselors with stating the learning goals, or desired results of a unit, with clarity and specificity. Although other curricular frameworks may refer to these statements of curricular aims as learning objectives, UbD uses the term learning goals to emphasize their purpose as a destination or end-point for student learning.
Stage 1 includes six components (Wiggins & McTighe, 2011). The first component prompts school counselors to identify pre-established goals for the program, such as national and state standards. The other five components are different types of learning goals to be written by the school counselor: transfer, understanding, essential question, knowledge, and skill goals. School counselors develop these goals through a combined process of “unpacking” standards into clearer or more specific learning outcomes, deciding which aspects of content are essential to emphasize in their context, and adding big ideas not suggested by the standards (see Table 1).
Table 1
Type of
Learning Goal |
Definition of Learning Goal |
Stem That Begins
Learning Goal |
Transfer |
Statements of what students should be able to accomplish independently in the long-term by using what they have learned (after completing the program/grade)
|
Students will be able to independently use their learning to…
|
Understanding
|
Statements of big ideas reflecting an important and connective generalization that helps students see themes or patterns across different content topics
|
Students will understand that…
|
Essential Question |
Thought-provoking big idea questions that foster inquiry, meaning-making, and application
|
Students will keep considering… |
Knowledge |
Statements of specific facts that students should know and recall (such as vocabulary words and their definitions)
|
Students will know…
|
Skill |
Statements of discrete skills that students should be able to do or use (starting with an active verb) |
Students will be able to… |
Note. Adapted from Wiggins and McTighe (2005, pp. 58–59) and Wiggins and McTighe (2011, p. 16). Examples of each type of learning goal from a classroom guidance curriculum are provided in Table 2 and Appendix A, and discussed in depth in the sections that follow.
Transfer, understanding, and essential question goals reflect long-term aims of education. Transfer goals describe desired long-term independent accomplishments, or what we want students to carry forward and apply in their academic, career, or personal achievements after they finish their last learning experience with their school counselor. Understanding and essential question goals reflect the “big ideas” of which we want students to actively make meaning for themselves through examination and inquiry. In contrast, knowledge and skill goals reflect short-term acquisition goals; they serve as means to the ends of exploration and application of big ideas (Wiggins & McTighe, 2005, 2011).
In planning a classroom guidance curriculum, school counselors must think broadly about what students will learn in classroom guidance at the program level (everything learned throughout three years of middle school) and throughout a particular grade level (everything learned in sixth grade). They also must think more narrowly about what students will learn from classroom guidance in a particular unit (everything learned in a sequence of three sixth-grade lessons about similar topics) and in a specific lesson (everything learned on Tuesday). School counselors often write transfer goals, understanding goals, and essential question goals to apply to classroom guidance across their whole program or across a whole grade because these goals are broad and reflect long-term aims. When developing a single unit, school counselors might target one or two transfer goals out of all the transfer goals for the program or grade and one or two understandings and essential questions out of all the understandings and essential questions for the program or grade. In contrast, knowledge and skill goals are usually written to reflect new content that will be explicitly taught and assessed in just one unit (McTighe & Wiggins, 2015). Although the knowledge and skill may be used or practiced in future units, they would only be targeted as goals in one unit. After identifying a unit’s desired learning results in Stage 1, the school counselor then considers what specific evidence will be required to demonstrate whether those results have been achieved.
Stage 2. In Stage 2, the school counselor’s focus shifts to the particular products or performances that will provide evidence of proficiency with the learning goals identified in Stage 1. Tight alignment is needed between unit goals and unit assessments, meaning all key goals should be explicitly assessed through tasks or prompts thoughtfully crafted to reveal the student’s current proximity to each goal (Wiggins & McTighe, 2005, 2011). Many school counselors may feel more comfortable assessing acquisition-focused goals like knowledge, because assessing through direct questioning for factual recall often seems familiar or straightforward. However, if a unit targets complex, authentic skills and big ideas, then the unit’s major assessments need to show the extent of learner understanding by asking students to (a) explain in their own words how they have drawn conclusions and inferences about understandings and essential questions and (b) apply their learning to new, real-world situations (Wiggins & McTighe, 2011). After the school counselor has identified both the desired unit results and the evidence needed to demonstrate whether results have been achieved, the focus shifts to developing learning experiences for the unit.
Stage 3. The learning plan created in Stage 3 includes the key learning activities students will complete in each lesson and the ongoing assessment embedded in those activities to monitor progress and provide students with feedback. Before planning individual lessons in detail, in Stage 3 the school counselor considers the unit’s big picture while determining the most effective learning experiences. Because tight alignment between learning activities and unit goals is needed, school counselors must purposefully select learning activities to provide direct opportunities for students to gain proficiency with targeted learning goals.
In sum, the three stages of backward design provide a sequenced structure designed to prompt deep thinking about powerful long- and short-term learning outcomes; how to elicit the best evidence of how well learners have achieved those outcomes; and which learning experiences will best lead to the desired outcomes.
ASCA Mindsets and Behaviors
Because ASCA’s (2014) Mindsets & Behaviors for Student Success: K–12 College- and Career-Readiness Standards for Every Student offers school counselors clear statements of the long-term aims of school counseling programs, they are an effective starting point for designing a classroom guidance curriculum. ASCA explains that the standards prioritize what students should be able to demonstrate as a result of their experiences in a school counseling program. The standards should be used by school counselors to “assess student growth and development” and “guide the development of strategies and activities” (p. 1). The six mindset standards are “related to the psycho-social attitudes or beliefs students have about themselves in relation to academic work” (p. 1). The 29 behavior standards “include behaviors commonly associated with being a successful student. These behaviors are visible, outward signs that a student is engaged and putting forth effort to learn” (p. 2). UbD’s approach to developing a curriculum that targets the understanding and transfer of big ideas aligns with the thrust of ASCA’s standards to deepen student understanding of key mindset ideas and transfer that understanding to new contexts through successful behaviors.
The following example demonstrates how one school counselor, Mr. Mendez, strengthened his classroom guidance curriculum by applying UbD principles. It describes the intentional work involved in making student experiences more meaningful, relevant, rigorous, powerful, and connected to the ASCA mindsets and behaviors. There is no single “right way” to develop a classroom guidance curriculum. We have worked with many school counselors and other educators in varied settings who have successfully applied UbD principles to their curriculum in different ways that match their own contexts. Mr. Mendez is a composite of these dedicated professionals, presented here as a single school counselor to offer the most illuminating example possible. We offer Mr. Mendez’s story as a model of the thought processes a school counselor uses in applying UbD to classroom guidance curriculum design, recognizing that the specific mission or structure of school counseling programs may vary in diverse contexts.
Case Study of Classroom Guidance Curriculum Development
Mr. Mendez is the only school counselor at his middle school. When he described his interest in strengthening his classroom guidance curriculum to another teacher, his colleague shared an article on UbD with him. He decided to use its principles to revise his curriculum. Mr. Mendez sees each class in his school once per month (nine times per year) for a 60-minute block. Because he only delivers classroom guidance lessons to each class nine times, he designates three lessons for each of the three domains – social and emotional, academic, and career development (ASCA, 2012). He considers each set of three lessons in the same domain to be one unit. In the past, the three lessons in each unit were not cohesive, or not tied together with common ideas and related skills. Instead, he taught lessons on topics he thought would interest the students. These lessons were usually based on exercises he learned in his counselor education program, a few lesson plans his predecessor left behind, and activities he found on the internet.
Strengthening the Curriculum Across a Whole Program and Whole Grade Level
Mr. Mendez decided to begin the revision process by looking at ASCA’s (2014) Mindsets & Behaviors for Student Success: K–12 College- and Career-Readiness Standards for Every Student and broadly considering how the mindsets and behaviors apply to his classroom guidance curriculum across all three grade levels. In the past, Mr. Mendez had always listed mindsets and behaviors from this document at the top of his lesson plans. However, he had added this information to the lesson plan after he wrote it based on what students were doing in that day’s activity, rather than using the standards as starting points and considering them to be destinations for student learning. As he read over the document, he first considered whether the standards sounded like any form of UbD learning goals (see Table 1). He noticed the mindsets reflected some “big ideas” of school counseling programs, while the behaviors sounded more like broad transfer goals.
Unpacking the mindsets. Mr. Mendez had copied and pasted the mindsets into lesson plans many times, but he decided to deconstruct or “unpack” them now in greater depth. He began by looking for the key concepts reflected in each mindset. Although he noted several concepts in every mindset, he decided to focus on the concept he felt was the most critical for middle schoolers in each one. He listed out: balance (M1), self-confidence (M2), belonging (M3), life-long learning (M4), fullest potential (M5), and attitude (M6; ASCA, 2014). Next, he noted how frequently the concept of success was reflected in these mindsets. As he thought about his school counseling program’s mission, he recognized that supporting students’ short- and long-term success, which has many different definitions, was his program’s overarching goal.
Concept mapping. After identifying these six key concepts of success, Mr. Mendez decided to draw a concept map to think more deeply about the connections among them (see Figure 1). He wrote the concept of success on one side of the map and then considered the relationships between that idea and the other key concepts he identified. After he drew arrows between them, he wrote phrases related to the language of the mindsets along each of the arrows to explain the connections between the ideas. Although Mr. Mendez had previously held a general idea of these connections, making the ideas explicit through this exercise forced him to think more clearly about how each of the mindsets led students directly toward success. Although he found this process to be a bit mentally taxing, he spurred this work on by asking himself, If I can’t articulate these connections clearly for myself, how can I expect my instruction to reflect them clearly—or my students to really understand them? This process of concept mapping led Mr. Mendez directly to writing understandings that applied to all grade levels of his classroom guidance program. He crafted an understanding for each of the six mindsets and then added a seventh understanding because he wanted one that focused specifically on the individualized meanings of success. After he had written the understandings, he wrote essential questions to go along with each one (see Table 2).
Big idea design principles. In writing understandings and essential questions for his whole program, Mr. Mendez kept three design principles in mind by asking himself a series of questions: Who are my students? Which ideas are relevant to all of my diverse students at this developmental level in the context of my school? How can these ideas be worded in student-friendly language, so that students will understand and internalize these statements? Do the understandings and essential questions work together as matching pairs? and Do they include the same key concepts and reflect similar ideas?
Mr. Mendez then shifted his focus from thinking about his classroom guidance program as a whole to thinking about what students learned at each grade level. He used the ASCA Mindsets & Behaviors: Program Planning Tool (ASCA, 2003) to clarify which mindsets (with corresponding understandings and essential questions) he would target at which grade level. For example, he confirmed that the sixth-grade classroom guidance curriculum would focus on M3/U3/EQ3 in the social and emotional development unit, M2/U2/EQ2 in the academic development unit, and M4/U4/EQ4 in the careers unit (see Table 2).
Figure 1.
Note. Adapted from template developed by McTighe and Wiggins (2004, pp. 112–113). Although the word “potential” did not appear in mindset 5 (ASCA, 2014), Mr. Mendez added this word to “fullest,” because it was a phrase he used often with students, and it seemed to be implied in M5.
Unpacking the behaviors. Mr. Mendez turned his attention next to the behaviors outlined in ASCA’s (2014) Mindsets & Behaviors for Student Success: K–12 College- and Career-Readiness Standards for Every Student. As he reviewed the learning strategies, self-management skills, and social skills and compared them to the definitions of different types of UbD learning goals, he recognized these behaviors sounded like long-term transfer goals (Wiggins & McTighe, 2011). He noted that for students to learn and ultimately enact them, the behaviors would need to be further broken down into specific, assessable skills to practice.
For example, as he considered “Demonstrate ability to overcome barriers to learning (B-SMS 6)” (ASCA, 2014, p. 2), he broke this transfer goal down into five skills. To accomplish this broader behavior, students must be able to: identify a specific barrier to learning; access resources with information on strategies for overcoming the barrier; develop a plan of action to overcome the barrier based on gathered information; use strategies from a plan of action to overcome the barrier; and evaluate progress on overcoming the barrier and adjust strategies as needed.
Mr. Mendez recognized that he often unpacked the behavior standards into more specific skills during conversations with students in individual and group counseling about how to achieve a behavior, but he had never thought through how students might practice these skills in classroom guidance. He decided he would unpack each of the behaviors into more specific skills later and would shift his focus from thinking broadly about the whole sixth-grade curriculum to redesigning individual units.
Table 2
ASCA Mindset Standards |
Understandings |
Essential Questions |
M1: Belief in development of whole self, including a healthy balance of mental, social/emotional, and physical well-being |
U1: Success demands that I grow every part of myself by making choices that balance my mental, social/emotional, and physical well-being.
|
EQ1: How do I make choices to balance different parts of my well-being at the same time?
|
M2: Self-confidence in ability to succeed
|
U2: I work to maintain my self-confidence in my ability to succeed.
|
EQ2: How do I keep my self-confidence up when I fail? |
M3: Sense of belonging in the school environment |
U3: I belong in this school, which is here to help me succeed.
|
EQ3: How do I help myself and my classmates feel like we belong here? |
M4: Understanding that postsecondary education and life-long learning are necessary for long-term career success |
U4: I must be a life-long learner to succeed in a career. |
EQ4: Why doesn’t learning end when school ends?
|
M5: Belief in using abilities to their fullest to achieve high-quality results and outcomes
|
U5: Success requires me to use my abilities to their fullest potential. |
EQ5: How can I stay motivated to use my abilities to their fullest potential, even when I don’t feel like it? |
M6: Positive attitude toward work and learning |
U6: A positive attitude toward my work and my learning supports my success.
|
EQ6: How does my attitude affect my success in obvious and in hidden ways?
|
|
U7: I am capable of deciding what my own success will look like—and of achieving that success. |
EQ7: What does success mean to me—today? Throughout school? Throughout life? |
Note. Mindset standards are quoted directly from ASCA Mindsets & Behaviors for Student Success: K–12 College- and Career-Readiness Standards for Every Student, by the American School Counselor Association, p. 1. Copyright 2014 by the American School Counselor Association. Mr. Mendez bolded the key concepts in each understanding and essential question to remind himself of the focus of every statement.
Next, Mr. Mendez returned to the ASCA Mindsets & Behaviors: Program Planning Tool (ASCA, 2003) to clarify which behaviors, or transfer goals, he would target in different domains at which grade level. During this process, he kept in mind which mindsets (with corresponding understandings and essential questions) he had already decided to target at each grade level, and he selected behaviors for that grade level to go along with those mindsets. For example, because he had selected M3/U3/EQ3 (see Table 2) to target in his sixth-grade social/emotional unit, he selected related behaviors such as “B-SS 2: Create positive and supportive relationships with other students” and “B-SS 4: Demonstrate empathy” (ASCA, 2014, p. 2) to teach in sixth grade as well.
Strengthening the Curriculum at the Unit Level
At this stage, Mr. Mendez turned his attention to redesigning one unit. He picked his first unit in sixth grade—the social and emotional unit—for this work. He called the unit “Belonging in Middle School.” This was the first classroom guidance unit students would experience in middle school, and he wanted it to offer support for their transition from elementary school. Mr. Mendez felt that, in the past, the three lessons he had taught for this unit did not reflect a cohesive big idea, and he had picked activities because students might enjoy them, not because they were aligned to strong learning goals. He decided to use the three-stage backward design process to strengthen the unit by writing a one-page “unit plan.” He also decided to mentally put aside the activities he had used in this unit in the past as he did this redesign work. He thought this might help him avoid the problem of activity-oriented design and not be constrained by what he had done previously.
Stage 1. Mr. Mendez began by documenting the six components of Stage 1 in his unit plan (see Appendix A). He had already identified most of the learning goals when thinking through his whole sixth-grade curriculum. He knew this unit would focus on ASCA standards M3, B-SS 2, and B-SS 4. He considered the behavior standards to be transfer goals, and he had already written an understanding and essential question corresponding to M3. This meant he only needed to identify the specific knowledge and skill goals for this unit that would help students explore the big ideas developed from the mindset standard and achieve the transfer goals from the behavior standards.
Skills. To begin this process, Mr. Mendez decided to write his skill goals. He looked again at the transfer goal presented in B-SS 2: “Create positive and supportive relationships with other students” (ASCA, 2014, p. 2) and asked himself: Which specific skills must students be able to do to accomplish this? He decided the first skill underlying this transfer goal was classifying relationships with others as positive and supportive or negative and unsupportive (D1 in Appendix A). He reasoned that, before working on creating positive relationships, students needed to distinguish between such relationships and those that would not be supportive of success in middle school. Mr. Mendez then identified additional skills related to creating such relationships with peers: listening actively, interpreting others’ verbal and non-verbal cues about their feelings, and communicating one’s own feelings verbally and non-verbally (D2, D3, D4).
Next, Mr. Mendez considered the meaning of B-SS 4: “Demonstrate empathy” (ASCA, 2014, p. 2). He decided a key related skill was being able to analyze others’ perspectives to understand their feelings and actions (D5). Additionally, he noted that three skills he wrote with B-SS 2 in mind—D2, D3, and D4—also applied to this transfer goal about demonstrating empathy.
At the end of this process, Mr. Mendez had described five clear and specific skills students would need to practice in this unit to ultimately achieve the transfer goals, and these skills also connected to the unit’s understanding and essential question about belonging in middle school. He recognized that when he taught this unit in the past, students had not practiced these specific skills as ways to increase a sense of belonging in themselves and their peers through creating positive relationships. Similarly, he had not assessed these skills to determine whether his lessons were actually moving students closer to the goals of the ASCA standards.
Knowledge. Last, Mr. Mendez identified several pieces of factual knowledge students would need to know in the unit. To decide this, he asked himself: What knowledge must students have to do the skills and to meaningfully explore the understanding and essential question? For example, he recognized that students would not be able to classify a given relationship as supportive or unsupportive (D1) if they did not already know the characteristics of supportive and unsupportive relationships (K1, K2 in Appendix A). Likewise, students could not meaningfully analyze others’ perspectives (D5) if they did not know the meaning of the word perspective (K3).
One challenge Mr. Mendez faced in developing knowledge and skill goals was that he could think of a long list of facts or skills students might encounter or use at some point during the unit. Rather than capturing all of these as unit goals, he used two questions to keep his thinking focused: Does this knowledge or skill reflect new learning that I will explicitly teach and assess in this unit (McTighe & Wiggins, 2015)? and Does this knowledge or skill reflect what is essential for students to learn to support my program’s transfer goals and big ideas, not just what would be nice to learn if we had no time constraints (Wiggins & McTighe, 2005)? If the answer to either question was no, he did not include that knowledge or skill as a unit goal.
Stage 2. To develop Stage 2, Mr. Mendez reflected on the most illuminating evidence he could collect from students to determine their proficiency with the unit goals after they completed the key learning experiences (see Appendix A). He decided the best way for students to demonstrate their proficiency with skills like active listening (D2), interpreting others’ verbal and non-verbal cues about their feelings (D3), and communicating feelings to others verbally and non-verbally (D4) was to enact conversations through role plays in which they practiced the skills. He decided students would do this as the key learning activity in Lesson 3, and they would then complete a written reflection as his main unit assessment. Specific reflection questions would prompt students to reveal their understanding of the unit’s big ideas, recall of the unit’s knowledge, and proficiency with the unit’s skills. Mr. Mendez would have students answer similar questions on a pre-assessment so he could evaluate student growth over time.
Stage 3. For the last stage of the unit plan (see Appendix A), Mr. Mendez thought broadly about how students could (a) gain proficiency with the unit goals in Stage 1 and (b) prepare to participate meaningfully in the role play and respond comprehensively to the written reflection prompts in Stage 2. He was particularly keen to ensure each of the Stage 1 unit goals would be taught and practiced in depth in at least one lesson’s learning activities. To avoid the problem of activity-oriented design, Mr. Mendez asked himself, What experiences do my students need to have in this unit to achieve my goals? rather than What activities would be fun?
As he reviewed his unit goals again, he decided that the most effective learning plan would include a sequence of experiences involving student self-analysis, case study analysis, and role play. To ensure every unit goal would be targeted in at least one lesson, he identified in Stage 3 the goals to which each lesson aligned (see Appendix A). He also considered the methods of assessment he would use to gather data about student learning during or after each learning experience, such as collecting completed handouts, listening to student comments, and giving short exit cards.
Mr. Mendez found it useful to think about the learning experiences of all three lessons in this unit at the same time when he designed the unit plan. He knew he would develop these ideas further in individual lesson plans, but it was beneficial to consider at the unit level how key learning experiences across the three lessons all aligned to his learning goals and comprised a cohesive, purposeful learning sequence.
Strengthening the Curriculum at the Lesson Level
After he had completed the unit plan for Belonging in Middle School and understood how his lessons would work together to achieve the unit goals, Mr. Mendez revised his three individual lesson plans. He liked using the ASCA (n.d.) Lesson Plan Template and decided that from now on, when he listed learning goals on lesson plans, he would simply copy and paste the goals from his unit plan that he was targeting in that lesson as the learning objectives. He would also copy goal labels (e.g., U1, EQ1, K2, D3) to remind himself which type of UbD goal each one reflected. As Mr. Mendez considered the learning activities he had previously used in this unit, he realized he would still be able to use many of those activities with minor revisions.
Lesson 1. In Lesson 1, Mr. Mendez could still have students complete an activity from past years in which they worked in small groups to generate lists of characteristics of positive and supportive versus negative and unsupportive relationships with peers. However, in the past, he had not connected that activity to any big ideas about the concept of belonging.
This year, Mr. Mendez would begin the lesson by posing the essential question to students as a critical question they would be answering for themselves during the first three months of school. As a warm-up, he would ask them to independently consider answers to the essential question, reflect on the challenges of building feelings of belonging in a new school, and identify a few strategies for helping themselves feel that they belong in middle school. Next, students would complete a brief activity to identify characteristics of supportive or unsupportive peer relationships in small groups. Mr. Mendez would then lead a short whole-class discussion in which he described typical sixth-grade peer relationships and asked students to classify them as supportive or unsupportive based on the characteristics their group listed. He also would discuss how building positive and supportive relationships with peers can be a key strategy for encouraging your own feelings of belonging. At the end of the lesson, students would work in small groups to develop a one-page handout for next year’s incoming sixth graders with strategies for helping them feel like they belong in the middle school, including building supportive peer relationships.
Lesson 2. For Lesson 2, Mr. Mendez decided he would continue to use activities he had used in the past. He would begin the lesson by teaching students the definition of the term empathy and asking students to share with a partner an example of a time they felt empathy for a peer. He would then explain they were going to watch Life Vest Inside’s (2011) “Kindness Boomerang” video in which a series of people are kind to others out of empathy. Next students would work in small groups to identify their three favorite examples of empathy in the video, the feelings of each receiver of empathy, and possible reasons the receiver felt that way.
Mr. Mendez would segue into the main activity by reminding students of the unit’s essential question and explaining that demonstrating empathy is a key way to help classmates feel like they belong. He would explain that at the core of empathy is the ability to see others’ perspectives to understand their feelings and actions, and that students would practice this skill through two case studies of fictional incoming sixth graders. After defining the term perspective, he would then show two brief videos to introduce the case studies: Daniel, a boy with a prosthetic arm (Siemens, 2012), and Amira, a Muslim girl who planned to join the girls’ basketball team and wear a different uniform that accommodated her religious beliefs (Associated Press, 2015).
Students would then work in small groups to identify Daniel’s and Amira’s perspectives as students who might appear different from their peers, including how they might feel about coming to a new school and act in response to those feelings. Next, Mr. Mendez would lead a group discussion about how feelings of empathy might arise in ourselves from understanding Daniel’s and Amira’s perspectives, and how empathy is different from pity. Last, each small group would create a list of verbal and non-verbal ways a supportive peer could communicate their empathy and a list of verbal and non-verbal ways an unsupportive peer might communicate a lack of empathy.
Lesson 3. Mr. Mendez did not plan to incorporate any activities he had used before into Lesson 3. This was because, after developing four specific skill goals based on B-SS 4: “Demonstrate empathy,” he realized he had not actually provided opportunities in the past for students to practice the skills that underlie demonstrating empathy. Now that he had these skill goals (D2, D3, D4, D5) clearly in mind, he wanted this unit to prompt students to use them authentically. Because students practiced D5 directly in Lesson 2, he focused on D2, D3, and D4 in Lesson 3—listening actively, interpreting others’ verbal and non-verbal cues about their feelings, and communicating one’s own feelings verbally and non-verbally. It seemed the best way to do this was through role play (see Appendix B for lesson plan).
Because Mr. Mendez only sees each class once a month, he planned to begin this lesson by showing the videos of Daniel and Amira again. However, this time, he would prompt the students to look for four “cues” about how their new classmates were feeling: (a) the words they used, (b) their tone of voice, (c) their body language, and (d) their facial expressions. He would pause the videos when Daniel describes “stuff I can’t do” and Amira says “I don’t want to look weird” so students could examine cues and jot down notes about what they see. Mr. Mendez would encourage students to hunt for more subtle cues and to focus on recording what they actually observed without judgment or criticism. He would then have students share what they observed in their same small groups from Lesson 2 and have each group share their common conclusions with the class.
Next, Mr. Mendez would ask each small group to review the lists they made in Lesson 2 of the ways a supportive peer would communicate empathy appropriately and the ways an unsupportive peer might communicate a lack of empathy. He would explain that they would be doing a role play with a partner in which one person would be Daniel (or Daniela) and the second would be himself or herself. Then, the partners would switch; the second person would be Amira (or Amir) and the first would be himself or herself. During the role play, the person playing Daniel or Amira would repeat what was said in the videos. The person playing themselves would listen actively, interpret verbal and non-verbal cues, and communicate empathy verbally and non-verbally.
After explaining these instructions, in preparation for the role play, Mr. Mendez would have students brainstorm ideas about what it means to listen actively. Then students would watch the videos of Daniel and Amira again—imagining these new classmates were present in the room—and practice active listening. Last, Mr. Mendez would lead a brief discussion about how, just as others give cues about their feelings through their words, tone of voice, body language, and facial expressions, we also communicate our own feelings like empathy in those four ways.
Students would then break into pairs and role play. After completing the role play, students would give each other feedback. In the round in which they played themselves, students would tell their partner how they interpreted the cues they saw in their partner’s word choice, tone of voice, body language, or facial expressions that let them know how their partner was feeling. In the round in which they played Daniel or Amira, students would tell their partner how they saw them actively listening and communicating empathy. Mr. Mendez would then lead a short whole-class discussion about how communicating empathy to Daniel and Amira could help these students feel they belonged at school. He would re-pose the essential question of the unit and ask students to reflect individually on how their answers to the question had changed from Lesson 1.
Overall, Mr. Mendez was pleased with his curriculum redesign process guided by UbD. He felt he now had strong clarity, not only about the purpose of individual lessons he taught, but also about the larger purpose of his classroom guidance program.
Conclusion
Although this article presented extensive detail about one school counselor’s curriculum development process, we must repeat that Mr. Mendez’s process—and UbD in general—should not be considered a recipe or prescription. A key strength of this model is that it provides a clear, step-by-step structure for curriculum design, while still offering flexibility in how it is applied. UbD should feel like a helpful set of guiding principles, not a straightjacket. We acknowledge that reading about Mr. Mendez’s work may raise concerns for school counselors who feel they do not have adequate time to redesign their classroom guidance curriculum at the “big picture” level in light of the competing demands of their schedules, or who feel overwhelmed by the decision-making involved in this process if they are the only school counselor for their school or grade level. We offer three suggestions in response to these challenges.
First, we suggest setting manageable goals for curriculum design work if fully redesigning a classroom guidance program at one time is not feasible. For example, one elementary school counselor we know developed a 3-year plan for redesigning her curriculum using UbD. She spent one summer unpacking the ASCA mindsets and behaviors, identifying the big ideas for her program, and identifying which big ideas, mindsets, and behaviors would be addressed at each grade level. For the following three school years, she then worked on revising the classroom guidance curriculum for two grade levels each year. In doing so, she kept most of the lessons she already used in each grade, but added new elements to those lessons so that learning activities would better align with the larger goals of her program, such as revisiting essential questions during lesson introductions and conclusions.
Our second and third suggestions come from the work of Lopez and Mason (2018), whose recent study identified the elements of highly effective classroom guidance lessons and suggested such lessons may not be common. The authors recommended that school counselors attend their school’s or district’s professional development trainings for teachers on best practices in lesson design and curriculum development. They also noted that school counselors who have previous experience as teachers may be “ideal resources” (Lopez & Mason, 2018, p. 9) for school counselors without this experience; identifying such colleagues who can answer questions and provide guidance on curriculum redesign work may provide constructive support during this process.
We suggest that future research should qualitatively examine the experiences of school counselors who work to strengthen their classroom guidance curriculum. In addition, quasi-experimental research might compare outcomes for students who have experienced a classroom guidance curriculum designed with UbD versus more traditional approaches. Such research could inform those who offer professional development on these topics, as well as counselor educators who seek to prepare school counselors effectively for this component of their future work.
We conclude with several parting thoughts about how this article’s contents might apply to different contexts. Mr. Mendez’s redesign work should not be interpreted as a call for school counselors to scrap curriculum that is working and start over. Rather, we encourage school counselors to further strengthen what is already effective in their classroom guidance curriculum by applying UbD principles and redesigning components that are not aligned to clear, robust goals. School counselors should also recognize that they do not need to follow the curriculum development steps in the same order as Mr. Mendez. If they prefer retaining an existing activity with the potential to build mindsets and behaviors, school counselors can unpack the big ideas underlying the activity or the knowledge and skills the activity teaches. However, school counselors should not be so tied to existing activities that they are unwilling to discard activities that are not aligned to powerful learning goals or will not lead to meaningful long-term transfer.
School counselors can use Mr. Mendez’s process with any state standards in addition to the national ASCA standards explored here; they would use the same process of identifying the key concepts in state standards and writing specific statements about the big ideas that underlie them. The ASCA standards also can be unpacked into understandings and essential questions other than the ones Mr. Mendez wrote. They may vary depending on the concepts the school counselor focuses on, whether the big ideas must capture ideas presented in other standards or a school’s mission statement, and who the students are, including their developmental levels.
Last, we emphasize that developing a classroom guidance curriculum is about the long-term outcomes school counselors want for their students. Mr. Mendez identified the concept of success as the unifying concept for his long-term goals. He therefore used that concept as a lens through which he made all curricular decisions, and he connected all of his transfer goals and big ideas to his program’s broader goal of making his students successful in school and careers. But other school counselors might see their programs’ long-term goals through different lenses. What matters is that a school counselor has clarity about those long-term outcomes and develops goals that match them. As counselor and teacher educators guiding our own students through this work, we often ask: If you don’t know where you’re going, how can you know if you’ve arrived? The key to high-quality classroom guidance is knowing the desired destination for students and making strategic curricular decisions to move students forward to that clear destination.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
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Hilary Dack is an assistant professor at the University of North Carolina at Charlotte. Clare Merlin-Knoblich, NCC, is an assistant professor at the University of North Carolina at Charlotte. Correspondence can be addressed to Hilary Dack, Department of MDSK, Cato College of Education, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223, hdack@uncc.edu.
Appendix A
Unit Plan for “Belonging in Middle School”
(Template adapted from McTighe & Wiggins, 2004, p. 13; Wiggins & McTighe, 2011 pp. 16–17)
Stage 1—Unit Learning Goals (Desired Results of Unit) |
PRE-ESTABLISHED GOALS (ASCA, 2014)
M3: Sense of belonging in the school environment
B-SS 2: Create positive and supportive relationships with other students
B-SS 4: Demonstrate empathy |
TRANSFER
In the long-term, students will be able to independently use their learning to…
create positive and supportive relationships with other students. (B-SS2)
demonstrate empathy. (B-SS4) |
UNDERSTANDINGS (Us)
Students will understand that…
U3: I belong in this school, which is here to help me succeed. (M3) |
ESSENTIAL QUESTIONS (EQs)
Students will keep considering…
EQ3: how do I help myself and my classmates feel like we belong here? |
KNOWLEDGE (Ks)
Students will know…
K1: characteristics of positive/supportive relationships
K2: characteristics of negative/unsupportive relationships
K3: definitions of vocabulary terms: perspective and empathy |
SKILLS (Ds—what students must be able to Do)
Students will be able to…
D1: classify relationships with others as positive/supportive or negative/unsupportive based on their characteristics (B-SS 2)
D2: listen actively to show respect and gain information about others (B-SS 2, B-SS 4)
D3: interpret cues such as word choice, tone of voice, body language, and facial expressions to identify feelings of others (B-SS 2, B-SS 4)
D4: communicate feelings to others using word choice, tone of voice, body language, and facial expressions (B-SS 2, B-SS 4)
D5: analyze others’ perspectives to understand their feelings and actions (B-SS 4) |
Stage 2—Unit Assessment Evidence |
Role play in Lesson 3 followed by written reflection with questions prompting students to explain:
New strategies learned in unit for helping themselves feel like they belong (U1, EQ1)
New strategies learned in unit for helping others feel like they belong (U1, EQ1)
Examples of positive/supportive and negative/unsupportive peer relationships based on the relationships’ characteristics (K1, K2, D1)
Examples of how they listened actively, interpreted cues, communicated feelings, and analyzed another’s perspective in role play—and possible effects of those approaches on their partner’s sense of belonging (K3, D2, D3, D4, D5) |
Stage 3—Unit Learning Plan |
Lesson 1: Self-analysis—past examples of: belonging and not belonging; positive and negative relationships; building feelings of belonging in new context through positive peer relationships (U1, EQ1, K1, K2, D1)
Lesson 2: Case studies—analyze two new classmates’ perspectives, reflect on strategies for building and expressing empathy for classmates (U1, EQ1, K3, D4, D5)
Lesson 3: Role play—take turns portraying fictional classmate from one case study and building positive relationship with classmate to support sense of belonging (U1, EQ1, D2, D3, D4) |
Appendix B
Lesson Plan for Lesson 3 in “Belonging in Middle School” Unit
(Template from ASCA, 2018)
Lesson Plan Template
Activity: Belonging Role Play
Grade(s): 6
ASCA Mindsets & Behaviors:
M3: Sense of belonging in the school environment
B-SS 2: Create positive and supportive relationships with other students
Learning Goal(s):
U3: I belong in this school, which is here to help me succeed.
EQ3: How do I help myself and my classmates feel like they belong here?
D2: Listen actively to show respect and gain information
D3: Interpret cues such as word choice, tone of voice, body language, and facial expressions to identify feelings of others
D4: Communicate feelings to others using word choice, tone of voice, body language, and facial expressions
Materials:
Small white board and marker for each small group
Helping Hand video (Daniel) at https://www.youtube.com/watch?v=9X-_EEIhurg (play 0:00–3:10)
Muslim Girls Design Modest Sportswear video (Amira) at https://www.youtube.com/watch?time_
continue=63&v=pA7JQonL-TE (play 0:00–1:00)
Procedure:
Show videos of Daniel and Amira. Students jot down notes on “cues” about how each is feeling: words, tone, body language, facial expressions. Students share what they found in same small groups from Lesson 2. Each group shares common conclusions with class.
Each group reviews lists made in Lesson 2 of verbal and non-verbal ways in which supportive or unsupportive peers communicate empathy or lack of empathy.
Explain instructions for Daniel and Amira role plays. (Student playing themselves must listen actively, interpret verbal and non-verbal cues, communicate empathy verbally and non-verbally.)
To prepare for role play, each group brainstorms ideas on white board about what it means to listen actively, and students watch videos of Daniel and Amira again to practice active listening.
Students break into pairs and role play a discussion as Daniel/a or Amir/a.
Partners give each other feedback on three key skills they practiced.
Lead whole-class discussion about how communicating empathy to Daniel and Amira as new students could help them feel they belong in the school.
Re-pose essential question. Ask students to reflect individually on how their answers changed from beginning of Lesson 1.
(Students complete written reflection as end-of-unit assessment.)
Plan for Evaluation: How will each of the following be collected?
Process Data: Document the number of times this lesson is delivered to sixth-grade classes and how many students receive the lesson in each class.
Perception Data: At the end of Lesson 3, distribute written reflection prompts assessing what students learned in the “Belonging in Middle School” unit:
Identify all the new strategies you learned in this unit for helping yourself feel like you belong at our school. (U1, EQ1)
Identify all the new strategies you learned in this unit for helping others feel like they belong at our school. (U1, EQ1)
In this unit, you learned that positive peer relationships can be supportive and negative peer relationships can be unsupportive for different reasons. (K1, K2, D1)
Give three examples of positive peer relationships that are supportive for different reasons. Explain why each one is supportive.
Give three examples of negative peer relationships that are unsupportive for different reasons. Explain why each one is unsupportive.
Think about your work in today’s role play when you played yourself (not Daniel or Amira). Give 4 specific examples of how you showed empathy by 1) actively listening, 2) interpreting your partner’s “cues”, 3) communicating your feelings, 4) analyzing your partner’s perspective. Next to each example, explain how that part of showing empathy helped Daniel or Amira feel like they belong at our school. (K3, D2, D3, D4, D5)
(At the beginning of Lesson 1, ask students similar questions to gather pre-assessment data. Compare pre-assessment responses to responses on end-of-unit written reflection.)
Outcome Data: Track student attendance, grades, and the number of behavioral referrals one month before this lesson, the month of the lesson, and in the three subsequent months to determine if the lesson’s impact on students’ sense of self-belonging is reflected in attendance, grades, and behavior.
Follow-Up: Check in with teachers to see if they observe any changes in student behaviors surrounding creating positive and supportive relationships with other students (B-SS 2) and demonstrating empathy (B-SS 4). Examine all assessment data from end-of-unit written reflections and determine if any concepts remained unclear to students. Schedule any necessary follow-up “mini-lessons” if some students lacked clarity about any concepts.
Jun 7, 2019 | Volume 9 - Issue 2
Jennifer Katz
Abortion is common, yet stigmatized. In some cases, abortion patients may experience feelings of sadness, guilt, anger, and other signs of emotional distress after their pregnancy is terminated. This article offers guidance for counselors seeking to provide nonjudgmental support to promote adaptation and recovery among abortion patients experiencing emotional distress. A brief summary of different ways to conceptualize emotional distress after abortion is provided. Next, a general cognitive behavioral framework is introduced, and common thought and behavioral patterns that may contribute to unresolved distress are explored. The article concludes with general recommendations to promote a respectful, collaborative alliance.
Keywords: abortion, abortion counseling, stigma, emotional distress, pregnancy
Abortion is a common medical procedure. An estimated one in four women in the United States will have an abortion by age 45 (Jones & Jerman, 2017). Although prevalent, abortion is highly stigmatized and politicized. Many people understand abortion in terms of the competing rights of the fetus (to live) and the person who is pregnant (to retain autonomy over one’s body and life). As such, legal abortion challenges conceptions of the nonviable embryo or fetus as having independent rights (Solinger, 2013). In the United States, abortion is more strictly regulated than any other medical procedure (Sanger, 2017), and these regulations contribute to a misperception that legal abortion is more medically dangerous than childbirth. Depending on state-specific regulations, abortion patients may be required to wait a certain amount of time after their initial clinic visit, to receive information about fetal development, or to observe fetal imagery before they are permitted to make final abortion care decisions (Sanger, 2017). Requirements like these imply that potential abortion patients are unlikely to make sound decisions without outside assistance (Norris et al., 2011), and also create different types of potential stressors depending on where a patient seeks abortion care.
Because abortion is so stigmatized, counselors and community members across many different settings (e.g., clinic volunteers, talk-line counselors) may encounter abortion patients experiencing distress after their procedures. This article offers guidance for both professional and paraprofessional counselors who are approached by a woman seeking support. The focus here is specifically on supporting a patient who has had a legal abortion procedure by a licensed health professional. Women seeking illegal abortions from unlicensed providers face additional physical and psychological risks that are beyond the scope of the current article.
Although different abortion patients will have different concerns, there are at least five general recommended aspects of after-abortion counseling (Needle & Walker, 2008). First, patients tend to disclose what happened, under what circumstances, and their broader social, medical, and family history. Second, a patient’s decision-making process and knowledge about the abortion procedure before and after it occurred warrant full exploration. Third, counselors can support emotional stability by accepting and exploring a patient’s feelings, including ambivalence as experienced both in the past and in the present. Fourth, spiritual and cultural issues can be addressed; these may include religious and familial values about abortion, parenting, and the concept of forgiveness. Finally, counselors can promote client self-care, potentially by identifying “safe” people to whom patients can disclose. When working within this broader framework, and while drawing upon best practices for pregnancy loss (e.g., Wenzel, 2017), a cognitive behavioral therapy (CBT) framework may help foster recovery. This article discusses (a) different ways to understand abortion-related distress, (b) concepts and methods from CBT that may help counselors support abortion patients, and (c) general recommendations for the respectful use of questions and language.
Understanding Emotional Distress After Abortion
Counselors may draw upon vastly different ways of understanding how and why abortion patients experience emotional distress after abortion. In the early 1990s, Vincent Rue proposed the existence of post-abortion syndrome (PAS), a variant of post-traumatic stress disorder. According to Speckhard and Rue (1993), “the trauma involved in being both attached to and responsible for the death of one’s fetal child can be emotionally overwhelming, and cause a range of symptoms” (p. 5). Symptoms of distress may manifest as guilt, self-directed blame and anger, sadness, intrusive thoughts about fetal death, and problematic family relationships, among others. Speckhard and Rue suggested that in some cases, distress may fluctuate with the menstrual cycle. In other cases, distress may remain dormant until patients experience subsequent reproductive events such as childbirth or menopause. Although some find PAS to be useful in conceptualizing cases, there have been longstanding debates about its validity (e.g., Dadlez & Andrews, 2010; Edwards, 2009). PAS has not been recognized as a formal medical or psychiatric diagnosis. Furthermore, PAS is often used in political contexts to argue against abortion rights and access (Dadlez & Andrews, 2010; Kelly, 2014). That is, “pro-life” activists use PAS to argue that potential abortion patients are likely to be emotionally harmed by abortion and therefore should be protected from making the decision to seek abortion.
In contrast, British “pro-choice” activist Ann Furedi (2016) argued that abortion-related distress may be more strongly related to the circumstances that led to pregnancy and the need for abortion than the actual abortion procedure itself. Although not all abortions occur after an unwanted pregnancy, Furedi wrote that “one of the few generalizations we can make about women seeking to end an unwanted pregnancy is that they are in a place they would rather not be. An abortion is no woman’s ambition, and an unwanted pregnancy is often (although not always) a marker of a lot of unwanted things in her life” (p. 52). Furedi also posited that the right to self-determination is key to psychological well-being, and for individuals who may become pregnant, self-determination involves the ability to plan when and how pregnancy is resolved. According to Furedi, access to family planning services, including abortion, is required for individuals to live as full citizens of society as well as to provide responsibly for their families. As such, restricting access to abortion is emotionally harmful because it denies those who are pregnant autonomy over both their bodies and their lives. This position is supported by research showing that patients who are denied an abortion show greater psychological distress than those who receive an abortion (Biggs, Upadhyay, McCulloch, & Foster, 2017). Importantly, both groups showed either stable or improved symptoms after a 5-year follow-up, indicating that initial distress did not generally lead to long-term or diagnosable conditions.
Abortion-related distress also can be conceptualized within a stress and coping framework (Major et al., 2009). Most abortions occur following an unintended pregnancy, and unintended pregnancy itself is a stressor that may increase risk for both short-term distress and longer-term mental health problems (Herd, Higgins, Sicinski, & Merkurieva, 2016). Individuals experience abortion as more or less stressful depending on a number of factors, including the timing of their abortion, their reasons for the decision, the type of procedure, their personal appraisals of abortion and other options, others’ social reactions, and the broader social and cultural context (Major et al., 2009). Overall, evidence from rigorous empirical studies indicates that legal first-trimester abortion does not increase risk for mental health problems. In addition, patients who have a later abortion for a wanted pregnancy due to fetal abnormality experience similar mental health outcomes compared to patients who miscarry, experience stillbirth, or experience newborn death (Horvath & Schreiber, 2017; Major et al., 2009).
Although research data do not suggest that legal abortion typically causes mental health problems (Horvath & Schreiber, 2017), many abortion patients experience symptoms of emotional distress, and in some cases, prolonged distress. Less commonly, some abortion patients experience mental health problems after their abortion procedures. In general, patients with a history of emotional disorders such as depression and those with low social support are at greater risk for mental health problems after a pregnancy resolves either by abortion or childbirth (Major et al., 2009; Russo, 2014). Abortion-specific risk factors for emotional distress include terminating a wanted pregnancy, feeling pressured into abortion by other people, perceiving the need for secrecy, and participating in or identifying with a cultural or religious group that teaches the idea that abortion is wrong (Major et al., 2009). These abortion-specific risk factors for distress warrant attention by counselors who are seeking to support abortion patients. Assessment of these factors may help inform how the counselor understands the sources of evident distress.
A Cognitive Behavioral Framework
Counselors who rely on a CBT framework help patients to become more aware of their thoughts, to differentiate between thoughts and facts, to objectively evaluate the evidence for their thoughts, and to consider making changes when warranted. For example, patients may change their thoughts after reflecting on the ways in which their thinking is incomplete or inaccurate. Alternatively, patients may change their behaviors or circumstances after reflecting on evidence that shows behaviors or circumstances to be problematic.
From a CBT perspective, emotional distress following abortion may be conceptualized as emotions that are linked to thoughts and behaviors related to the abortion experience. Identifying and talking about thoughts and behaviors that are related to strong negative emotional states can help patients who are feeling stuck and not able to move forward. Abortion patients in distress may benefit from becoming more aware of and talking through thoughts that elicit emotional distress and exploring these with a supportive listener. Cognitive behavioral therapists often use an ABC (activating event, belief, consequence) model in working with patients to collaboratively understand how patients are experiencing their lives. To illustrate, an activating event (A) might be scheduling a follow-up appointment after an abortion procedure. A thought or belief (B) might be, “I shouldn’t have had sex if I wasn’t ready to be a mother,” and the consequences (C) of that belief may be emotional (guilt, low self-esteem), behavioral (keeping the abortion a secret), and interpersonal (feeling disconnected from loved ones after an abortion).
Behavioral avoidance is another common target of CBT interventions. It can be useful to ask about situations or events that a person has avoided since her abortion. To illustrate, attending a baby shower, interacting with young children, or going to the doctor might all be situations that a distressed abortion patient avoids. Such situations might elicit thoughts and beliefs about having had an abortion that, in turn, elicit aversive feelings. In some cases, avoidance might not be sustainable or healthy in the long-term. For instance, some abortion patients avoid sex because they worry about pregnancy and making another abortion decision. Such patients may benefit from discussing barriers to contraception use. They additionally may benefit from discussing the use of more effective methods of contraception. Examining the evidence for ease of use and effectiveness could help prevent a future unintended pregnancy. In other cases, avoidance may be adaptive. In particular, it may be wise to avoid telling certain people about having had an abortion when the costs of disclosure are likely to outweigh the benefits. Genuine collaboration with the abortion patient is necessary to weigh the benefits of maintaining current thoughts and behaviors against the benefits of potential changes.
CBT counselors often differentiate between primary (basic) and secondary (manufactured) emotions (Resick, Monson, & Chard, 2017). Primary emotions occur as a direct result of an event. For example, an unintended pregnancy may lead to feelings of shock. The end of a pregnancy may lead to feelings of loss. Being insulted by protestors or denied access to medical care may lead to anger. Primary emotions tend to fade in intensity over time. Secondary emotions, in contrast, arise as an indirect result of an event, based on thoughts about the event. In particular, when an abortion patient thinks about having made the wrong decision, this thought could elicit guilt. When a patient thinks about how others may respond negatively to learning about her abortion, this thought could elicit worry. If different types of abortion-related thoughts are habitual or persistent, these associated emotions also will tend to persist, and the abortion patient may thus feel stuck in negative feelings. Thoughts that may not be fully accurate, constructive, or conducive to recovery, such as those described below, may be potential targets for intervention.
Some abortion patients find themselves stuck between multiple conflicting thoughts (and associated feelings). For example, an abortion patient might think, “It hurts to know I’ll never be forgiven by my Lord, but there’s no way that my family could manage another child,” or “I’m a feminist, so there’s no reason for me to feel sad.” In the former case, the patient switches the focus of her thinking between her religious tradition and her perceived family obligations. In the latter case, the patient switches between thoughts about her political views and her actual experience. Regardless of their content, experiencing conflicting thoughts can be confusing and disorienting, which may add to the overall experience of emotional distress. In addition, when thoughts are in conflict, one type of thought can be used to invalidate the other, preventing a full awareness and acceptance of each. Helping the patient acknowledge and accept the existence of conflicting thoughts may reduce confusion and distress. Furthermore, considering the evidence for each thought independently may allow the patient to consider which thoughts are worth holding onto and which might be less accurate, reasonable, or conducive to healing.
Common Thought Patterns Associated With Abortion-Related Distress
From a CBT approach, several specific patterns of thought may be associated with abortion-related distress. Hindsight bias is the tendency to use knowledge from the current situation to re-interpret past situations. Patients who exhibit hindsight bias believe they knew then what they know now, and they may assume that they have failed in some way by making the decision that they did. One approach to hindsight bias is to ask for more detail about the patient’s life context and specifics of the decision-making process at the time of the pregnancy. Counselors might ask questions such as: “How did you find out you were pregnant? What were your initial reactions? Who did you tell, and why? How did they respond?” Counselors might specifically ask what the patient perceived at the time as the reasons to consider abortion versus the reasons not to. “If you can try to remember during that time of your life, I’m curious, what seemed like good reasons for the decision? What seemed like good reasons not to make this decision?” In making the decision to end a pregnancy, abortion patients tend to consider the impact of pregnancy, childbirth, and parenting on their current and future lives, health, obligations, and goals (Finer, Frohwirth, Dauphinee, Singh, & Moore, 2005). Given that many abortion patients have already given birth, many also consider the impact of pregnancy, childbirth, and parenting on children already in the home (Jones, Frohwirth, & Moore, 2008). When this reflection is accurate, counselors could comment that the abortion patient seemed to put a lot of thought into the decision, or they might reflect hearing that the patient had considered multiple important factors. A counselor might observe that it sounds like the patient made the best decision based on the available information at hand, although some important information may not have been accessible at the time. Some patients who are not parenting children might appreciate hearing that this type of thoughtfulness seems like a quality that would allow them to be a loving and effective parent in the future, when they are ready.
Another type of thought that may be related to abortion-related distress is belief in a just world. Many people hold the simple belief that good things happen to good people, and thus bad things happen to bad people. For some abortion patients, an unintended pregnancy is bad, an unhealthy pregnancy or fetal anomaly is bad, or an abortion is bad; thus, the self is bad. When an abortion patient terminates a pregnancy because of outside pressures, such as when parents, a partner, or a workplace would not accept a pregnancy, childbirth, or parenting, this lack of acceptance can also lead to self-blaming thoughts. A patient may perceive herself as having made bad decisions about relationships or workplaces that do not offer her support. An important corollary of belief in a just world is that a person who is bad does not deserve to feel better or to receive support. Some abortion patients feel that they deserve to be punished, and they deprive themselves of intimacy with others. Others may believe they do not deserve to participate in self-care activities or to “indulge” in interventions such as relaxation training, mindfulness meditation, or distress tolerance.
To address belief in a just world, it can be helpful to explore how the patient developed this belief as well as to explore both supportive and disconfirming evidence. Upon reflection, many patients are likely to acknowledge that belief in a just world is a common theme in fairy tales and other lessons imparted to very young children. Likewise, patients are likely to acknowledge that accidents sometimes happen, people can make mistakes and still be good and moral, and that sometimes bad things happen to good people. Inquiring about other people who they perceive as deserving and not deserving of distress and hardship may be helpful. For example, counselors might ask patients to identify others who have “gotten away with” crimes without punishment or censure and to identify good, deserving people who have faced unfair experiences or mistreatment. In addition to these explorations, a counselor might empathize with the wish that people would get what they deserve, even if the world does not always work that way.
Outcome-based reasoning, a tendency to assume that emotional distress is the natural result of a bad decision, is closely related to belief in a just world. As applied to an abortion patient in distress, the end result (distress) may be thought of as reflecting the quality of the decision to terminate the pregnancy (bad). Outcome-based reasoning reflects an interest in a world that is predictable and orderly. As with belief in a just world, asking questions about the evidence for outcome-based reasoning may be helpful. Counselors could wonder aloud about times that the patient has seen good intentions lead to problematic outcomes, good behavior lead to punishment, or bad behavior lead to reward. In addition, patients using outcome-based reasoning often assume that they would feel better if they had made a different prior decision. As such, the counselor might explore with the abortion patient the possible consequences of decisions other than abortion. Useful questions might include: “What were the other options that you considered? If you instead decided to become a single parent, or to make an adoption plan, what would that look like now? What would be the consequences of these different decisions, emotionally and otherwise?” Thinking through the available options and considering all the different consequences of each may allow patients to consider the possibility that alternative prior decisions also might have been distressing, and perhaps even more so. Patients might conclude that each possible option was likely to lead to different types of stress and challenges, some in the short term, and some in the long term.
The final type of thought pattern addressed here involves all or none thinking. Some abortion patients hold themselves singularly responsible for becoming pregnant, for experiencing a complicated or unhealthy pregnancy, for making an abortion decision based on reasons that now seem suspect (such as trying to please their parents or a partner, or not having enough money), or for causing the circumstances that led them to decide that abortion was the best option. One approach to this type of thought pattern is to explore what seems to be a reasonable amount of responsibility rather than hyper-responsibility. Some apparently hyper-responsible patients might appreciate hearing a reflection along the lines of, “It sounds like you played a role in the unintended pregnancy, which makes you feel badly, and it sounds like other people and circumstances also played a role.”
In other cases, abortion patients assign complete responsibility for the abortion decision to other people who urged them to end their pregnancies. Careful exploration of this thought pattern is needed. Some financially or emotionally dependent abortion patients, particularly younger ones, may have faced strong pressure from parents or a partner to seek an abortion. In addition, pressuring someone into an abortion may be part of a larger pattern of coercive control or intimate violence. If an abortion patient describes being compelled by another person to abort a pregnancy, it may be helpful to screen for intimate violence specifically as well as to ask about other ways in which they feel constrained within their close relationships.
In the absence of coercive control or violence, some patients still may blame their abortion decisions on the wishes of other people. Other abortion patients may regret taking the advice of others and may hold extreme negative thoughts about themselves as well as others who influenced their decisions. In both types of cases, counselors might ask questions to help explore boundaries and assertiveness within an abortion patient’s intimate relationships. It could be useful to ask when and under what conditions the patient believes it is useful to take others’ feelings into account when making important decisions. It may be appropriate to reflect that it can be challenging to balance different sources of influence. Abortion patients who feel like they should have stood up for themselves or for their unborn child might benefit from considering what barriers to assertiveness they experienced and what degree of influence they want others to have over their lives. Patients might also develop a plan for acting differently in the future when they are making a personal decision that affects others in their social networks. Collaborative work with a counselor may help to promote assertiveness while also conveying to the patient that she is deserving of respect.
Conveying Respect for Abortion Patients
This article has focused on ways of understanding abortion-related distress, thoughts that may be associated with abortion-related distress, and topics of conversations that might help promote recovery. Suggestions have been offered about what to listen for, possible questions to ask, and thoughts and feelings that might be reflected. This final section offers suggestions about methods of asking questions and general use of language in order to promote rapport and the patient’s sense of feeling respected, understood, and validated. Most broadly, rapport between the counselor and the abortion patient is essential, and the goal should be for the abortion patient to feel both the presence of unconditional positive regard and the absence of negative judgment on the part of the counselor (e.g., Kimport, Foster, & Weitz, 2011).
Socratic dialogue. Socratic dialogue involves asking questions that help others come to new understandings about their thoughts, behaviors, and experiences (Padesky, 1993). Questions may allow the patient to consider new or different information that has not been considered. When an abortion patient describes patterns of thoughts that sound distressing, a counselor might ask for more information in a way that gently challenges those thoughts. At the same time, answers to the questions may reveal that the counselor had an incomplete understanding of important aspects of the situation. Because no counselor can know the unknown, questions should be asked in the spirit of mutual inquiry, with constructive curiosity, and with compassion. Questions should not be asked to interrogate or to imply that the counselor knows the correct way to think and feel. Likewise, questions should not be asked to try to elicit a specific right answer. Rather, questions are asked in a genuinely open way with the goal of eliciting more information about the events that occurred and how those events may be perceived at present. In the process of reflecting on answers to open questions, the abortion patient has the opportunity to explore whether there are alternative ways to think about an experience that are accurate, balanced, and reasonable, and that lend themselves to self-compassion and healing.
Language related to gender, social roles, and pregnancy. In general, to be accurate and validating, counselors are advised to use the terms that patients themselves use to describe themselves, others, and their experiences. This means listening carefully and asking open questions to learn about a person’s situation and about how the patient identifies. It is advisable to listen for how the abortion patient describes their gender identity, and if they are in a partnered relationship, how the patient describes their partner’s gender, because not all people who seek abortion identify as women and not all are involved in heterosexual relationships.
It is useful to listen for words that refer to the different social roles that a patient or others may occupy, including mother, father, baby, child, or fetus. Some couples immediately identify themselves as mothers or fathers when one person is pregnant. Others only identify themselves in these ways after a certain point in the pregnancy or after birth. When individuals are already parenting children, they are likely to identify themselves as mothers or parents independent of the pregnancy that ended in abortion. Reflecting the patient’s own words shows respect and validation. For example, consider an abortion patient who asks, “What kind of a person fails to protect her child and instead selfishly decides to end her child’s life?” In response, it is advisable for the counselor to use the word “child” (not “fetus”) and to ask for more information about the decision-making process to better understand the circumstances. Additionally, it might be helpful to reflect feelings of guilt or shame and to ask about the thoughts the patient is having that connect to those feelings.
Counselors should be aware that the language that they use may reflect assumptions about whether the pregnancy was wanted or contraception was used. Although most (but not all) pregnancies that end in abortion are unintended, some unintended pregnancies are happy accidents. Additionally, some intended pregnancies become unwanted after life circumstances change, such as when a relationship ends or health problems emerge. Regarding contraception, some people who are sexually active do not use contraception or do not use it correctly, but sometimes contraception fails, and in cases of reproductive or sexual coercion, a patient may be blocked from effective contraceptive use (Chamberlain & Levenson, 2012). As such, until hearing how the patient describes the situation and how conception occurred, it is recommended to avoid referring either to the “father” of the pregnancy or to the “partner.” In some cases, abortion patients who seem to feel singularly responsible for becoming pregnant make no mention of anyone else. Questions that might help identify others involved in conception could include, “Who else knows about the pregnancy?” or “Tell me about the episode that led to you becoming pregnant.” If a patient says that the pregnancy happened because her boyfriend’s condom broke, it is validating for the counselor to refer to her “boyfriend,” but if the patient discloses that she was raped, the counselor can refer to the “perpetrator” or the “rapist.”
Language related to politics and medicine. Counselors are advised to avoid language that may have direct or implied connections to politics, including either “pro-choice” or “pro-life” activism. In discussing the abortion decision-making process, the term “choice” can imply connotations of being “pro-choice.” Instead, the terms “decision” and “option” can be substituted with ease. For example, “Can you tell me about how you decided to terminate your pregnancy?” or “It sounds like you picked the option that made the most sense to you at the time.” Similarly, although it is often important to explore different types of thoughts and feelings that occurred at different times, such as before and after an abortion procedure, it is best to avoid the term “post-abortion.” Because of connections between “pro-life” activism and PAS, the phrase “after abortion” can be substituted as a politically neutral and factually accurate alternative. Finally, to work effectively with abortion patients who have safely and legally terminated pregnancies, it is recommended that counselors develop a basic understanding of abortion and its terminology (Grimes & Stuart, 2010), including the difference between surgical abortion (removing the contents of the uterus with instruments, without incision) and medical abortion (ingesting pills to expel the products of conception from the uterus).
Conclusion
Abortion patients who are in distress can be coping with stigma as well as a variety of realistic stressors and concerns. At the same time, abortion patients might be experiencing patterns of thought or behavioral avoidance that are contributing to intense or prolonged emotional distress. By applying concepts and methods from CBT, both professional and paraprofessional counselors across a variety of community settings may participate in constructive conversations with patients that foster adaptation and recovery. Counselors may collaborate with patients to help them become more aware of their thoughts and how these thoughts are related to feelings and behaviors. Conversations with supportive, nonjudgmental individuals who serve in a counseling role may allow abortion patients to reflect honestly and realistically on their past experiences and current lives. Such reflections may give way to self-compassion and may help to transform distress into feelings of acceptance and peace.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
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doi:10.1037/pst0000132
Jennifer Katz is a professor of psychology at SUNY Geneseo. Correspondence can be addressed to Jennifer Katz, Bailey Hall, 1 College Circle, Geneseo, NY 14454, katz@genesco.edu.