Counselor
The anchor question: who counsels this patient before and after the test, and who helps carry the weight of a diagnosis, a risk result or a long search? Every care map has a counseling step: genetic counseling around testing, depression and anxiety screening, pain psychology, support for telling the family. This roster covers genetic counselors and the psychologists, psychiatrists and mental-health counselors the maps refer to.
What the care maps need
| Service | Serves | What the care maps ask for |
|---|---|---|
| Pre- and post-test genetic counseling | Hereditary cancer risk, comprehensive genetic risk, preconception carrier screening, polygenic risk score, specific signs, transthyretin amyloidosis, connective tissue, management and surveillance | Counseling before and after testing, in person or by telehealth, including preconception visits with the option to decline, cash-pay disclosure of polygenic results, and reproductive counseling in the management and surveillance map. On 18 curated family histories, genetic counselors matched hereditary cancer referral guidelines 82.2% of the time, oncologists 66.0% and primary care 60.6%.1 In a randomized trial of 669 women, telephone BRCA counseling was noninferior to in-person on knowledge, distress, decision conflict and satisfaction; test uptake was lower (84.2% against 90.1%), and it saved $114 per patient.2 |
| Cascade testing, family communication and reproductive planning | Hereditary cancer risk, transthyretin amyloidosis, comprehensive genetic risk, inherited metabolic disease | A family letter the proband can send, and a counselor who will see relatives, including the carriers and families facing a hereditary diagnosis in the ATTR map. The inherited metabolic map adds cascade testing of at-risk siblings before symptoms and reproductive planning, maternal PKU among it. |
| Depression and anxiety: where a positive screen goes | Connective tissue, nonspecific symptoms, neurogenetic, transthyretin amyloidosis, progressive monogenic disease, lysosomal storage disorders, hypophosphatasia, inherited metabolic disease | The maps screen; this roster is the referral. The USPSTF recommends depression screening for all adults (grade B).3 In the nonspecific symptoms map a positive screen doesn't end the medical search, and the clinician on this roster is comfortable working alongside that search. |
| Pain psychology and CBT | Connective tissue, nonspecific symptoms | Part of the plan, not a replacement for it, as the nonspecific symptoms map puts it. |
| Health anxiety and risk information | Comprehensive genetic risk, polygenic risk score | Pre-test counseling on the psychological side of risk, and a referral when a result lands hard. |
| Caregiver strain and adjustment to progressive disease | Neurogenetic, progressive monogenic disease | Both maps ask about caregiver strain. The progressive monogenic map also screens for apathy and daytime sleepiness, and considers behavioral therapy or CBT for apathy in DM1. |
| Psychiatry | Management and surveillance, inherited metabolic disease, neurogenetic, nonspecific symptoms, connective tissue | The management and surveillance map asks for psychiatric review at every visit in 22q11.2 deletion syndrome, with a low threshold to refer; in the inherited metabolic map, new psychiatric symptoms in Wilson disease or a urea cycle disorder get a metabolic look. A psychiatrist who reads the medical record and talks to the anchor. |
Vetting criteria
Every entry is checked against these before listing and reviewed yearly.
- Genetic counselors hold the Certified Genetic Counselor credential from the American Board of Genetic Counseling,4 and a state license wherever the state requires one.
- Psychologists, psychiatrists and mental-health counselors hold an active license where the patient is seen; psychiatrists are board-certified.
- Founded or co-founded the practice, and more than half of its revenue comes from patients rather than payers. A counselor who also works for a testing laboratory says so on the entry.
- Publishes a cash price and offers telehealth.
- Comfortable with a genetic diagnosis, with chronic illness that has no label yet, and with the care map's plan. Writes back to the anchor.
How the roster is built
- Year one: two or three genetic counselors who take cash-pay pre- and post-test visits by telehealth, since the hereditary cancer and comprehensive genetic risk maps need them first; one pain psychologist; one psychiatrist.
- Year two: genetic counselors with cardiovascular, neurologic and reproductive focus for the newer maps; psychologists with chronic-illness experience; a group option for families after a hereditary diagnosis.
- Year three: track time to first visit, whether notes reach the anchor, and cascade testing uptake in families. Prune and add.
Roster
No entries yet. The convener drafted this roster and it's looking for a member to lead it. Members propose counselors in the cohort channel; the convener and one member check the criteria before listing, and nobody is listed without their consent. Each entry will show the clinician, credential, practice, the services they cover from the table above, cash price, telehealth availability, states licensed, and the member who vouched for them.
References
- Ritchie JB, Welch BM, Allen CG, et al. Comparison of a cancer family history collection and risk assessment tool, ItRunsInMyFamily, with risk assessment by health-care professionals. Public Health Genomics. 2022;25(3-4):80-88. doi:10.1159/000520001
- Schwartz MD, Valdimarsdottir HB, Peshkin BN, et al. Randomized noninferiority trial of telephone versus in-person genetic counseling for hereditary breast and ovarian cancer. J Clin Oncol. 2014;32(7):618-626. doi:10.1200/JCO.2013.51.3226
- US Preventive Services Task Force; Barry MJ, Nicholson WK, Silverstein M, et al. Screening for depression and suicide risk in adults: US Preventive Services Task Force recommendation statement. JAMA. 2023;329(23):2057-2067. doi:10.1001/jama.2023.9297
- Hoskovec JM, Bennett RL, Carey ME, et al. Projecting the supply and demand for certified genetic counselors: a workforce study. J Genet Couns. 2018;27(1):16-20. doi:10.1007/s10897-017-0158-8
References retrieved from PubMed on 2026-10-30. Rosters are reviewed at each yearly cycle.
Colorado Care Network. Counselor. Version 2026-10-30.