Colleen Willoughby

Turning Points and Protective Processes in the Lives of People With Chronic Disabilities

In this qualitative study, the authors examined the nature of resilience in people with chronic disabilities. Fifteen people with disabilities identified the factors that helped or hindered them at major turning points, and the triggers and resolutions to these turning points. Turning points were emotionally compelling experiences and realizations that involved meaning acquired through the routes of belonging, doing, or understanding the self or the world. The major protective factors were social support, traits such as perseverance and determination, and spiritual beliefs. Three new protective processes were identified: replacing a loss with a gain (transcending), recognizing new things about oneself (self-understanding), and making decisions about relinquishing something in life (accommodating). These protective factors, processes, and ways in which people with disabilities draw sense and meaning in life have important implications for service delivery.

The development of expertise in pediatric rehabilitation therapists: Changes in approach, self-knowledge, and use of enabling and customizing strategies

Purpose: To examine the clinical decision making of novice, intermediate, and expert pediatric rehabilitation therapists from various disciplines. Methods: Two qualitative studies were conducted. Thirteen therapists took part in a study using the critical incident interview technique and 11 therapists took part in a study using the ‘think aloud’ technique. Therapists were classified as novice, intermediate, or expert in developmental level based on a cluster analysis of data collected using a multifaceted battery of assessment tools. Data were analyzed using a grounded theory approach. Results: Expert and intermediate therapists differed from novices with respect to content, self-, and procedural knowledge. Conclusion: With increasing expertise, therapists use a supportive, educational, holistic, functional, and strengths-based approach; have heightened humility yet increased self-confidence; and understand how to facilitate and support client change and adaptation by using principles of engagement, coherence, and manageability. Expert therapists use enabling and customizing strategies to ensure a successful therapeutic session, optimize the childs functioning in the mid-term, and ensure child and family adaptation and accommodation over the longer-term.

Social Support Processes and the Adaptation of Individuals With Chronic Disabilities

In a qualitative study examining turning points in life, 15 adults with chronic disabilities (cerebral palsy, spina bifida, or attention deficit disorder) provided information about the nature and meaning of their social support experiences. The study revealed three types of psychological support linked to self-perceptions and enabling beliefs: (a) emotional support (valuing and acceptance leading to perceptions of “being believed in” and a sense of self-esteem), (b) instrumental support (guidance and provision of strategies leading to self-efficacy), and (c) cognitive support (affirmation, confirmation, and new perspectives leading to coherence in self-concept and worldview). The findings have important implications for service delivery with respect to understanding client needs for different kinds of support, especially at periods of transition, and for providing optimal experiences and creating supportive environments. In particular, the role of cognitive support deserves more attention in understanding the adaptation of individuals with chronic disabilities.

Measuring the Expertise of Paediatric Rehabilitation Therapists

This article describes the development of a classification system to measure the expertise levels of practicing paediatric rehabilitation therapists. Seventy‐five therapists from five disciplines (physical, occupational, speech‐language, behaviour, and recreational therapy) were involved, along with 170 peers, and 188 parents of children with disabilities. A cluster analysis of 10 indicators of expertise (derived from a battery of self‐completed, peer‐completed, and parent‐completed measures) indicated three levels of therapist expertise—novice, intermediate, and expert. Expertise level was related to various aspects of experience but not to therapy discipline. The classification system will be useful for the education and professional development of paediatric therapists, and for research on expertise in paediatric rehabilitation.

Development of a measure to assess effective listening and interactive communication skills in the delivery of children’s rehabilitation services

Purpose: Therapists’ listening and communication skills are fundamental to the delivery of children’s rehabilitation services but few measures comprehensively assess these skills. The 24-item Effective Listening and Interactive Communication Scale (ELICS) was developed to reflect a multifaceted conceptualization based on evidence in the literature. Method: Data from 41 pediatric rehabilitation therapists (occupational, physical, speech-language, recreation, and behavioural therapists; psychologists and social workers) were used to determine the factor structure, internal consistency, and construct validity of the subscales. Results: The measure contains four subscales with very good to excellent reliability: Consensus-oriented, Exploratory, Receptive, and Action-oriented Listening. Content validity was ensured by the development process. Conclusions: The ELICS portrays listening as a purposeful, goal-oriented, and relational activity. The measure allows clinicians to assess and reflect on their listening/communication skills, and can be used to evaluate professional development activities and interventions geared to improving these skills. Implications for Rehabilitation Therapists’ listening and effective communication skills are essential to the successful delivery of children’s rehabilitation services, but few measures comprehensively assess these skills. Clinical encounters in pediatric rehabilitation involve various types of listening/communication skills: receptive listening, exploratory listening, consensus-oriented listening, and action-oriented listening. The ELICS is a valid and context-appropriate tool for the self-assessment of listening and communication skills in the context of pediatric rehabilitation practice. The ELICS allows clinicians (e.g., occupational, physical, and speech-language therapists) to assess and reflect on their listening/communication skills and may enhance the relationship-based practice of clinicians who provide therapy services to children with disabilities and their families.

Clinical Scenario Discussions of Listening in Interprofessional Health Care Teams

There are benefits of engaging health care professionals in interprofessional groups to discuss clinical scenarios with a focus on listening and communication. Three focus groups (n = 16) highlighted the utility of carefully crafted clinical scenarios relevant to paediatric health care to explore the thought processes of interprofessional groups about listening. Scenario discussion was valuable to clinical learning and assisted professional development by broadening perspectives, providing a safe environment, and offering opportunities to learn and share. Participants reflected on listening in the therapy process, in groups versus individually; discussed listening barriers; and highlighted awareness of being family-centered and building relationships.

A listening skill educational intervention for pediatric rehabilitation clinicians: A mixed-methods pilot study

Abstract Objective: To prepare for an RCT by examining the effects of an educational intervention on the listening skills of pediatric rehabilitation clinicians, piloting study procedures, and investigating participants’ learning experiences. Methods: Six experienced clinicians received the intervention, consisting of video simulations and solution-focused coaching regarding personal listening goals. Self- and observer-rated measures of listening skill were completed and qualitative information was gathered in interviews and a member checking session. Results: Significant change on self-reported listening skills was found from pre- to post-test and/or follow-up. The pilot provided useful information to improve the study protocol, including the addition of an initial orientation to listening skills. Participants found the intervention to be a highly valuable and intense learning experience, and reported immediate changes to their clinical and interprofessional practice. Conclusion: The educational intervention has the potential to be an effective means to enhance the listening skills of practicing pediatric rehabilitation clinicians.

Developing authentic clinical simulations for effective listening and communication in pediatric rehabilitation service delivery

Abstract Purpose: To describe the creation and validation of six simulations concerned with effective listening and interpersonal communication in pediatric rehabilitation. Methods and findings: The simulations involved clinicians from various disciplines, were based on clinical scenarios related to client issues, and reflected core aspects of listening/communication. Each simulation had a key learning objective, thus focusing clinicians on specific listening skills. The article outlines the process used to turn written scenarios into digital video simulations, including steps taken to establish content validity and authenticity, and to establish a series of videos based on the complexity of their learning objectives, given contextual factors and associated macrocognitive processes that influence the ability to listen. A complexity rating scale was developed and used to establish a gradient of easy/simple, intermediate, and hard/complex simulations. Conclusions: The development process exemplifies an evidence-based, integrated knowledge translation approach to the teaching and learning of listening and communication skills.