Michelle Servais

Solution-Focused Coaching in Pediatric Rehabilitation: An Integrated Model for Practice

ABSTRACT This article describes the conceptual basis and key elements of a transdisciplinary model for solution-focused coaching in pediatric rehabilitation (SFC-peds). The model exemplifies a strengths-based, relational, and goal-oriented approach to clinical practice. It provides a distinct shift from a problem-oriented, therapist-directed approach to a possibilities-oriented approach where client empowerment takes precedence. The model facilitates client change through a method of working with client strengths and resources that involves the use of strategic questions to co-construct therapy intervention. Through client–therapist collaboration, therapy goals and plans are developed that align with client hopes, priorities, and readiness for change. SFC supports client self-determination and capacity for change through customized therapy goals and plans that are meaningful for the child and family. Implications for therapists include the need for relational expertise, practical coaching skills, and expertise in facilitating change. The need for research on the effectiveness of this approach in pediatric rehabilitation is discussed.

An evaluation of the paediatric acquired brain injury community outreach programme (PABICOP)

Primary objective: To examine the utility of a coordinated, family/community-focused programme (PABICOP) vs. a standard approach for improving outcomes for children with ABI and their families. Research design: Pre-test–post-test design, with comparison group and follow-up. Methods and procedures: Ninety-six children (64 children receiving PABICOP services and 32 children receiving standard care) participated in the study. Measures were completed at baseline and 3 and 12 months later. Main outcomes and results: Parents/caregivers with more than 10 contacts with PABICOP scored significantly higher on an ABI knowledge quiz than either parents/caregivers with 10 contacts or less or the comparison group at post-test and follow-up. Parents/caregivers with 10 contacts or less with PABICOP reported significantly greater improvements in childrens school and total competence on the CBCL than either parents/caregivers with more than 10 contacts or the comparison group at post-test and follow-up. Conclusions: PABICOP may be more useful for enhancing knowledge of ABI for parents/caregivers and for integrating children into the community over a 1-year period than a standard approach. The amount of service received appears to influence outcomes.

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.

Evaluation of an Occupational Therapy Mentorship Program: Effects on Therapists’ Skills and Family-Centered Behavior

ABSTRACT There is growing interest in understanding the usefulness of mentorship programs for childrens rehabilitation service providers. This evaluation study examined the effects of an occupational therapy mentorship program on the skills and behaviors of 8 new and 17 experienced occupational therapists practicing at a regional childrens rehabilitation center. Self- and peer-report measures of family-centered behavior, critical thinking ability, listening/interactive communication skill, and clinical behavior were collected before and after an 11-month facilitated, collaborative group mentorship intervention. Significant pre–post changes associated with intervention were found on 9 of 12 outcome measures, including information provision, respectful treatment, self-confidence, and listening and clinical skill. Changes were not found on the more trait-like variables of open-mindedness, interpersonal sensitivity, and interpersonal skill. Experienced therapists had higher scores than new therapists on most variables, including family-centered behavior, listening skill, and clinical skill. Implications regarding the utility of mentorship programs in childrens rehabilitation centers are discussed.

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.

Solution-Focused Coaching in Pediatric Rehabilitation: Investigating Transformative Experiences and Outcomes for Families

ABSTRACT Aims: A qualitative study was conducted to investigate family experiences and outcomes of Solution-Focused Coaching in pediatric rehabilitation (SFC-peds). Methods: Two interviews (5 months apart) were conducted with nine sets of family members who had received SFC-peds, within the past 6 months, from therapists with 3–10 years of experience using the approach. Transcripts were analyzed using thematic analysis and a phenomenological approach. Results: Participants experienced a goal-oriented collaborative process, high engagement, enhanced capacity and community participation, and empowered mindsets. The therapy process was seen as a collaborative solution-focused conversation, situated in the clients world, and involving individualized and co-created goals and plans. SFC-peds provided families with a supportive, structured, and paced goal-setting process. Reported enhancements to capacity included child/youth skill development, enhanced parent skills, enhanced parent knowledge of their child and options, and changes in parenting. Increased community participation was also reported. Empowered mindsets involved increased confidence, increased self-efficacy and self-determination, and broadened perspectives and expectations. Conclusions: The study provides evidence for the utility of SFC-peds and the importance of engaging families in a goal-oriented collaborative process. Implications concern greater understanding of transactional dynamics in therapy and real-world client change, and the need to develop measures of client/family resiliency.

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.

The development of expertise in children’s mental health therapists and teachers: changes in perspective and approach

Background: There is growing interest in identifying changes in ways of practice associated with the growth of professional expertise. Research on highly experienced or expert teachers and therapists (i.e. occupational, physical and behavioural therapists) can provide insights into how they approach practice, providing guidance for new practitioners. Purpose: The objective was to compare and contrast children’s mental health therapists’ and elementary/secondary schoolteachers’ perceptions of changes in perspectives and approaches related to the development of expertise. Sample: Nine children’s mental health therapists and five teachers/principals took part. Design and methods: Using a nested sampling design, therapists and teachers/principals were selected based on years of experience and peer reputation, and participated in two separate focus groups. Similarities and differences between the practice groups were examined qualitatively, using cross-group analysis. Results: Common reported changes in perspective included the development of open, broad, flexible and relational perspectives. Changes in approach included a focus on children’s needs/desires, psychosocial issues/outcomes and realistic goals. Conclusions: The findings indicated how expert practitioners viewed their practice as changing over time, contributing to a better understanding of the nature and development of expertise in children’s service practitioners. The findings suggest the importance of paying attention to children’s needs/desires, cultivating awareness of their motivation and psychosocial issues, and setting realistic goals. Practitioners linked these changes in perspective and approach to more positive life and learning outcomes for children, which may have implications for guiding the practice of more novice teachers and therapists.