Gail Teachman

Children and Youth With Disabilities Innovative Methods for Single Qualitative Interviews

There is a paucity of explicit literature outlining methods for single-interview studies with children, and almost none have focused on engaging children with disabilities. Drawing from a pilot study, we address these gaps by describing innovative techniques, strategies, and methods for engaging children and youth with disabilities in a single qualitative interview. In the study, we explored the beliefs, assumptions, and experiences of children and youth with cerebral palsy and their parents regarding the importance of walking. We describe three key aspects of our child-interview methodological approach: collaboration with parents, a toolkit of customizable interview techniques, and strategies to consider the power differential inherent in child–researcher interactions. Examples from our research illustrate what worked well and what was less successful. Researchers can optimize single interviews with children with disabilities by collaborating with family members and by preparing a toolkit of customizable interview techniques.

Critical approaches in physical therapy research: Investigating the symbolic value of walking

Research using a critical social science perspective is uncommon in physiotherapy (PT) despite its potential advantages for investigating questions other approaches cannot address. Critical approaches can be used to expose ideas and concepts that are dominant, given, or taken-for-granted in practice in order to reflect on how “things could be otherwise.” The purpose of this paper is to use an example of research examining the symbolic value of walking to outline the key features of critical research and its application to PT. The study drew from Pierre Bourdieus sociology of practice to illuminate how socially ingrained notions of normality and disability are reflected in rehabilitation practices and affect parents and children with cerebral palsy. Dominant social assumptions about the value of walking are shown to shape individual choices and contribute to parental feelings of angst and doubt, and negative self-identities for children. The example reveals how critical approaches to research can be used to reveal the socio-political dimension of rehabilitation practice and address important research questions that have been largely neglected.

An integrated methods study of the experiences of youth with severe disabilities in leisure activity settings: the importance of belonging, fun, and control and choice.

Abstract Purpose: The aim was to examine the leisure activity setting experiences of two groups of youth with severe disabilities – those with complex continuing care (CCC) needs and those who have little functional speech and communicate using augmentative and alternative communication (AAC). Method: Twelve youth took part in a mixed methods study, in which their experiences were ascertained using qualitative methods (observations, photo elicitation and interviews) and the measure of Self-Reported Experiences of Activity Settings (SEAS). Data integration occurred using a “following a thread” technique and case-by-case analysis. Results: The analysis revealed several highly valued aspects of leisure activity setting experiences for youth, including engagement with others, enjoying the moment, and control and choice in selection and participation in activity settings. Conclusions: The findings provide preliminary insights into the nature of optimal activity settings for youth with severe disabilities, and the mediators of these experiences. Compared to other youth, the data illustrate both the commonalities of experiences and differences in the ways in which these experiences are attained. Implications for research concern the utility of mixed methods approaches in understanding the complex nature of participation experiences. Implications for clinical practice concern the importance of not assuming the nature of youths’ experiences. Implications for Rehabilitation Service providers can lose sight of the importance of broader concepts of belonging, fun, and control and choice when providing interventions that focus on “participating” in an “activity” to build specific skills. In addition to the skill-based outcomes for youth with disabilities that are valued by the rehabilitation system, we suggest that consideration needs to be given to other types of outcomes that matter to youth, such as participating in a leisure activity for the sake of belonging or having fun. It is important not to assume that youth with severe disabilities are not enjoying their participation or are not benefiting from their leisure experiences. It is important not to “over-therapize” youth with disabilities and promote a balanced approach to therapy and leisure participation, by discussing with youth and families the beneficial developmental outcomes that can accrue from leisure activities.

Expanding beyond individualism: Engaging critical perspectives on occupation

Abstract Background: Perspectives that individualize occupation are poorly aligned with socially responsive and transformative occupation-focused research, education, and practice. Their predominant use in occupational therapy risks the perpetuation, rather than resolution, of occupational inequities. Aim: In this paper, we problematize taken-for-granted individualistic analyses of occupation and illustrate how critical theoretical perspectives can reveal the ways in which structural factors beyond an individual’s immediate control and environment shape occupational possibilities and occupational engagement. Method: Using a critically reflexive approach, we draw on three distinct qualitative research studies to examine the potential of critical theorizing for expanding beyond a reliance on individualistic analyses and practices. Results: Our studies highlight the importance of addressing the socio-historical and political contexts of occupation and demonstrate the contribution of critical perspectives to socially responsive occupational therapy. Conclusion and significance: In expanding beyond individualistic analyses of occupation, critical perspectives advance research and practices towards addressing socio-political mediators of occupational engagement and equity.

Thinking critically about client-centred practice and occupational possibilities across the life-span

Abstract Background: Client-centred occupational therapy practice is tacitly guided by prevailing social values and beliefs about what are “normal” occupational possibilities. These values and beliefs privilege some occupations and negate others. Aim: This study aims to identify and problematize assumptions regarding the value of approximating normal occupational possibilities, showing how these assumptions influence and may diminish client-centred practice. Methods: Using empirical research examples it demonstrates how occupational therapists and clients are immersed in contexts that shape values and beliefs about what are considered “normal” occupations and how these taken-for-granted values structure occupational therapy practice. Conclusion: Critique of client-centred practice requires conscious reflexivity, interrogating our own and our clients’ predispositions to value some occupations over others. Engaging in critical reflexivity can help therapists develop new perspectives of how client-centred practice can be applied that includes enabling possibilities for occupations that would be missed altogether in the pursuit of “normal’.

A multi-method approach to studying activity setting participation: integrating standardized questionnaires, qualitative methods and physiological measures

Abstract Purpose: This study investigated the feasibility of integrating three diverse methods for studying disabled youth’s experiences of activity settings: standardized questionnaires, qualitative methods and physiological measures. The article describes a case study of data collection in a real-life setting to outline the opportunities, challenges and lessons learned for future research. Methods: The methods included (a) two newly developed quantitative measures of qualities of home and community activity settings (MEQAS) and youth experiences (SEAS); (b) youth-friendly qualitative methods, including photo-elicitation, observations, electronic interviews and face-to-face interviews; and (c) an innovative system to collect physiological data (the HEART system) that provided insight into the experiences of youth beyond other methods. Results: The study demonstrated that these diverse methods measures can be practically combined to study activity setting participation experiences. The measures provided different types of data that informed one other and allowed a rich interpretation and deep understanding of the participant’s experiences. We discuss practical lessons concerning the joint use of the three methods, lessons specific to each method, and lessons concerning next steps for integrating the data. Conclusions: Combined methodologies hold great promise for investigations of the participation experiences of disabled youth in future research. Implications for Rehabilitation This feasibility study demonstrated that standardized questionnaires, qualitative methods, and physiological measures can be practically combined to study the real-world activity setting participation experiences of disabled youth. Combined methodologies hold great promise for investigations of the participation experiences of “hard to study” disabled youth in future research. Clinically it is important to look at youth-based experiences and priorities when planning interventions rather than focusing on specific skills or inclusion for its own sake.

Assembling activity/setting participation with disabled young people

Abstract Rehabilitation research investigating activity participation has been largely conducted in a realist tradition that under‐theorises the relationship between persons, technologies, and socio‐material places. In this Canadian study we used a post‐critical approach to explore activity/setting participation with 19 young people aged 14 to 23 years with complex communication and/or mobility impairments. Methods included integrated photo‐elicitation, interviews, and participant observations of community‐based activities. We present our results using the conceptual lens of assemblages to surface how different combinations of bodies, social meanings, and technologies enabled or constrained particular activities. Assemblages were analysed in terms of how they organised what was possible and practical for participants and their families in different contexts. The results illuminate how young people negotiated activity needs and desires in particular ‘spacings’ each with its own material, temporal, and social constraints and affordances. The focus on assemblages provides a dynamic analysis of how dis/abilities are enacted in and across geotemporal spaces, and avoids a reductive focus on evaluating the accessibility of static environmental features. In doing so the study reveals possible ‘lines of flight’ for healthcare, rehabilitation, and social care practices.

A Relational Ethics Framework for Advancing Practice with Children with Complex Health Care Needs and Their Parents

ABSTRACT Children with complex health care needs are an emerging population that commonly requires long-term supportive services. A growing body of evidence has highlighted that these children and their families experience significant challenges. Many of these challenges involve ethical concerns that have been under-recognized. In this article, we (a) outline ethical concerns that arise in clinical practice with children with complex health care needs and their families (e.g.: exclusion of children’s voices in discussions and decisions that affect them; difficulties in defining their best interests; clashes across the array of social roles that parents manage; limited recognition of the ethical significance of parents’ and other family members’ interests) and (b) propose a relational ethics framework for addressing these concerns. Our framework draws on hermeneutical interpretation and moral experience as foundational orientations, recognizing children with complex health care needs as relationally embedded agents, who while dependent and entitled to protection, are simultaneously agential. Children’s and parents’ interests are relationally intertwined and interdependent. Families are recognized as significant social microcosms for the cultivation and transmission of intergenerational cultural heritage, narratives, and outlooks. We describe strategies for (a) conducting a relational ethics inquiry and (b) reconciliation of identified ethical concerns through a process of rapprochement. A relational ethics framework can promote clinical practices that are ethically attuned to the complexity of this population’s needs.

A Critical Dialogical Methodology for Conducting Research With Disabled Youth Who Use Augmentative and Alternative Communication

In this article, we present a theoretical examination of communication difference in the context of a critical qualitative study that explored “inclusion” with disabled youth who use augmentative and alternative communication (AAC). Drawing on Mikhail Bakhtin’s dialogism, we articulate a novel critical dialogical methodology developed to rethink dominant understandings of voice, authenticity, and the autonomous participant. Case examples illustrate how the methodology surfaced normative value judgments that tacitly deem some kinds of interview talk more valid than others. The approach helped recognize the agency of disabled youth as they worked to make sense of inclusion and its effects.

Integrating Visual Methods With Dialogical Interviews in Research With Youth Who Use Augmentative and Alternative Communication

Scant information is available to guide the selection and modification of methods for doing research with people with communication impairments. In this article, we describe and illustrate a novel combination of methods used to optimize data generation in research with 13 disabled youth who use augmentative and alternative communication (AAC). Using a critical dialogical methodology developed for the study, we explored links between dominant calls for social inclusion, disabled youths’ social relations and life circumstances, and their position-takings in relation to inclusion. Building on emergent methodologies, we selected and integrated complementary methods: photo-elicitation, a graphic elicitation method termed “Belonging Circles,” observations, and interviews. The interview methods were modified to recognize all AAC modes used by participants and to acknowledge the relational, situated and thus, dialogical nature of all communication in interviews. Each method is described, and rationales for their selection and modification are discussed. Processes used to combine the methods, generate data, and guide analysis are illustrated using a case example from the study. The integrated methods helped illuminate the lives and practices of youth who use AAC and the strategies they used to negotiate inclusion across the social spaces that they traversed. We conclude with reflections on the strengths and limitations of our approach, future directions for development of the methodology, and its potential use in research with a broad range of persons experiencing communication impairments.