MC-2 Helping Relationships
Summative Assessment Example: Helper Skills
Assignment Instructions
Students should read the provided example verbatim script of a brief counseling session and complete the provided worksheet to identify the helper skills from the script and provide a brief rationale for each answer. See grading rubric for expectations on the degree of completion and accuracy. The helper skills in the verbatim are: Open-ended questions, close-ended questions, clarification, paraphrase, reflection, and summarization.
Definitions
- Close-ended questions are used sparingly and helpful in making immediate decisions with a patient.
- Clarification is characterized by an open-ended question that verifies accuracy of a client statement and encourages the patient to elaborate on their story.
- A paraphrase is a rephrase of the content that describes a person, situation, event, or idea with the goal of highlighting a patient’s message.
- A reflection mirrors the identified affect or feeling stated by the client. In the motivational interviewing literature, a reflection may be simple (mirroring the feeling someone is experiencing) or complex (mirroring the feeling and the circumstances attached to the feeling).
- A summary is an extension of paraphrase and reflection tying themes together and usually used sparingly or at the end of a counseling session.
Guidance for Instructor
This summative assignment assesses students’ ability to identify basic listening skills by reading a verbatim of a brief counseling session. This assignment could be replicated by observing a brief counseling video, watching a counseling session in a pop culture media format, or by observing a live session. If using a live session, it is recommended the instructor record the session to assist in recall of skills demonstrated. For the assessment to be valid, the listening skills being assessed need to be demonstrated in the verbatim, recorded, or live session. An instructor may also choose to use open-ended questions, affirmations, reflective listening, and summaries (OARS), part of the motivational interviewing listening skillset. The verbatim adapts easily to OARS. One or more BHSS responses would need to be modified to resemble an affirmation.
Grading Rubric
| Skill being assessed | Criteria | Score | Comments | |||
| 1 Needs Work | 2 Beginning | 3 Developing Proficiency | 4 Proficient (for a BHSS student) | |||
| 6 or more errors | 4-6 errors | 1-3 errors | No errors | |||
| Identify example(s) of a close-ended questions. | Accurately identified close-ended questions in all instances. | |||||
| Identify example(s) of a clarification and provide rationale. | Accurately identified clarification in all instances. | |||||
| Identify example(s) of paraphrase and provide rationale. | Accurately identified paraphrase in all instances. | |||||
| Identify example(s) of reflection (s) and provide rationale. | Accurately identified reflection of feeling in all instances. | |||||
| Identify example(s) of summarization. | Accurately identified summary statement(s). | |||||
Sample Verbatim
BHSS=Behavioral Health Support Specialist
C=Client or patient
BHSS-1: Hello Jasmine, my name is Tyra and I am a behavioral health support specialist. I work closely with your primary care provider (PCP) to help you attend to your whole health which includes your emotional and psychological health. Thank you for reviewing and signing the disclosure form. Do you have any questions about the disclosure?
C-1: No, it was straightforward.
BHSS-2: Jasmine, we have ten minutes together. I would like to understand your situation a bit and see if I can help you before you leave for your next appointment. Do you have time to talk for fifteen minutes?
C-2: Yes, that is fine.
BHSS-3: Jasmine, I spoke briefly with your Dr. Kang about the concerns you shared related to your overall wellbeing. Based on the conversation, it is my understanding that you have reported feeling more sad than usual and that you are struggling to take care of yourself and your family. Dr. Kang mentioned she has known you for five years, and that she is concerned for you and how you will balance all of your responsibilities.
C-3: Yes, the doctor gave you the correct information.
BHSS-4: What does it mean for you to be more sad than usual?
C-4: Well, I have just had a hard time falling asleep. I have all these thoughts running through my mind, and I can’t shake them before I go to bed. So, I lay awake at night, and maybe fall asleep for a couple of hours, but then I have to start my day exhausted and tired. I am a caregiver for seniors at a rehabilitation facility. On the weekends and I help my mother take care of my father who is partially disabled from a stroke.
BHSS-5: You must be exhausted!
C-5: Yes, I go through cycles of insomnia every so often and it weighs me down. I start to wonder if I will ever get a good night’s sleep. My supervisor at work is understanding, but seems frustrated with me because it takes me longer to do my rounds with the patients, and I haven’t been particularly cheerful. So apparently, some patients have complained about my attitude. That makes me angry. I take pride in my work, and I feel like I am being judged unfairly.
BHSS-6: You feel angry at times.
C-6: I mean, I try to do all the right things for my health. I don’t smoke cigarettes. I don’t smoke weed or do drugs. I do have some wine every once in a while, but not much. I asked the doctor for some sleeping pills, and they won’t give me any saying they are addictive. I just need some help to get my sleep back on track.
BHSS-7: You try to take care of yourself, and you want some help getting your sleep on the right track.
C-7: Exactly, do you think you could get the doctor to prescribe me some Ambien? I heard that is great for getting a good night’s sleep. I think my sister gave me some Ambien once and I really slept well.
BHSS-8: You think that a good night’s sleep would put you on the right track, and you are hopeful that can happen if you take sleep medication.
C-8: Listen, I get it that the doctor needs to be careful prescribing medications for sleep. She explained why she doesn’t prescribe Ambien. I work in healthcare and I understand what those medications can do to older people. I am in my early 30’s, so I don’t feel I am at risk. The doctor also asked me to talk with you about other ways to improve my sleep besides taking medication (client laughs). I am here to tell you-yes I sleep with my earbuds, and yes I am listening to political podcasts that upset me, and yes, I don’t take them (the earbuds) out at night, and I don’t plan to change.
Pause (silence)
C-9: I will talk with you about other ideas though.
BHSS-9: What do you know about sleep hygiene or ways to improve sleep?
C-10: Well, I know I shouldn’t be keeping my earbuds in with noise blaring, but it is a habit I find hard to kick. Once I get off work, I usually just come home, eat dinner, watch programs and then try to go to bed. I really should be doing something else. I just haven’t felt like it lately.
BHSS-10: Are you saying you have some ideas about what you could be doing?
C-11: Well, I could go for a walk with a friend, go to a gym, join a group, visit my church, call my mom, take up a new hobby…all kinds of things.
BHSS-11: You have been struggling with both sleep, and mood, you are anxious to get a good night’s sleep and you are thinking about ways you could change up your routine that might help you. One thing you are thinking about is to meet a friend for a walk in the evening.
C-12: I guess so. Something else I am dealing with is the anniversary of my friend’s death. It is coming up soon and his mom is calling me asking if I want to go to the cemetery with her. It brings up a lot of intense emotions for me and I really don’t want to keep revisiting that point in my life.
BHSS-12: Remembering your friend’s death is really challenging for you at this point in your life.
C-13: I wonder sometimes if that is what is bothering me most and keeping me awake and the reason I am avoiding other people, but it was five years ago, and I don’t feel as attached to the grief or the sadness of it all. At the same time, his mom wants to keep including me in her rituals, which might seem nice on the surface, but her mood and the whole thing brings me down.
BHSS-13: With the anniversary of your friend’s death, you feel both grief and guilt. Part of you wants to move on.
C-14: Yes, and one thing I want to do is tell his mom I don’t want to be her grief counselor every year. She cries and cries and I listen and wonder “what am I doing here?” She isn’t my mother. I wasn’t really close to her. She just sees me as a reminder of him.
BHSS-14: You have been invited to join her for an annual remembrance and you are not looking forward to it. In fact, it is very upsetting to you.
C-15: I am so confused sometimes-there are so many things on my mind.
BHSS-15: Jasmine, we have a few minutes left, may I pull together some ideas about what I have heard so far?
C-16: Sure.
BHSS-16: I have heard you talk about a demanding schedule including a full-time job as a caregiver at a senior rehabilitation facility and a caregiver on weekends to your father who had a stroke. To do all of this, you need consistent, sound sleep to rest and restore your energy. Unfortunately, you are not sleeping well and you feel tired most of the time. There may be many factors contributing to poor sleep, one of those factors being stress, including feelings of sadness, anger and guilt related to the anniversary of your boyfriend’s death and his mother’s invitation for you to join an annual ceremony. Something you mentioned doing differently was inviting a friend to take a walk with you.
C-17: That is all pretty accurate.
BHSS-17: It may be helpful for us to talk again for a bit longer to continue to discuss how you might address your sleep, your sadness, and decisions you need to make for your future. In the meantime, how likely are you to call the friend you mentioned after we finish talking?
C-18: She has texted me for the last week and I have only replied half the time. I can see myself calling and talking on the phone. I am not sure if I am ready to go for a long walk and talk.
BHSS-18: One thing you might do is call her.
C-19: Yes.
BHSS-19: How likely are you to call her today?
C-20: Very likely
BHSS-20: You are very likely to call your friend today. Are you open to returning in a few days for 30 minutes to follow up and continue the conversation?
C-21: Yes, I would like that.
BHSS-21: Ok, let’s schedule that appointment and you can be on your way.
Student Response Table
| BHSS Response # | Helper Response | Rationale |
| BHSS-1 | ||
| BHSS-2 | ||
| BHSS-3 | ||
| BHSS-4 | ||
| BHSS-5 | ||
| BHSS-6 | ||
| BHSS-7 | ||
| BHSS-8 | ||
| BHSS-9 | ||
| BHSS-10 | ||
| BHSS-11 | ||
| BHSS-12 | ||
| BHSS-13 | ||
| BHSS-14 | ||
| BHSS-15 | ||
| BHSS-16 | ||
| BHSS-17 | ||
| BHSS-18 | ||
| BHSS-19 | ||
| BHSS-20 | ||
| BHSS-21 | Not assessed | Not assessed |
Answer Sheet
| BHSS Response # | Helper Response | Rationale |
| BHSS-1 | Closed ended question | Verifies whether patient does or does not have questions about disclosure. Does not seek elaboration. |
| BHSS-2 | Closed ended question | Verifies patient has the time to talk with BHSS. Does not seek elaboration. |
| BHSS-3 | Summary | Statement summarizes the themes shared by the PCP with the BHSS. |
| BHSS-4 | Clarification | A question that seeks to check out the meaning of the patient’s previous statement to the PCP. |
| BHSS-5 | Reflection | Reflects the affect shared by the patient when she reported being tired in addition to work and responsibilities to family. |
| BHSS-6 | Reflection | The patient stated she felt angry and the BHSS mirrored this back to her. |
| BHSS-7 | Paraphrase | Rephrased the client’s message to focus on her wants/needs. |
| BHSS-8 | Reflection | A complex reflection that acknowledged the patient’s situation and a feeling the patient implied. |
| BHSS-9 | Open ended question | Invited the patient to elaborate on a topic area with the goal of informing the BHSS about patient knowledge. |
| BHSS-10 | Clarification | Started with “are you saying…” and seeks to check out patient’s ideas for addressing sleep. |
| BHSS-11 | Reflection | Statement that addresses affect, situation and a possible goal. |
| BHSS-12 | Paraphrase | Restates important message from patient. |
| BHSS-13 | Reflection | Statement that addresses affect, situation and direction. |
| BHSS-14 | Reflection | Statement that addresses affect and situation. |
| BHSS-15 | Closed ended question | Asks for yes or no response. Seeks permission for next step. |
| BHSS-16 | Summary | Ties together themes, combination of paraphrases and reflections. Intent is to bring session to a close. |
| BHSS-17 | Open ended question or clarification | Specifically, this is a scaling question. Both open ended question and clarification would be appropriate categories. |
| BHSS-18 | Paraphrase | Restates important message from patient. |
| BHSS-19 | Open ended question or clarification | Specifically, this is a scaling question. Both open ended question and clarification would be appropriate categories. |
| BHSS-20 | Closed ended question | Intended to end the session. |
| BHSS-21 | Not assessed | Not assessed |