Sylvie Tétreault

The needs of spouses caring for severely aphasic persons

This qualitative research aimed to identify and describe the needs perceived by spouses of persons with severe aphasia. The analyses revealed different categories of needs: (1) information, (2) need to acquire an effective mode of communication with the aphasic partner, (3) better interpersonal relationships, (4) need to be considered as a partner in the caring process, (5) support, (6) respite. These needs were not static but in interaction with one another. Moreover, they varied within a temporal axis and appeared at different time periods: within the acute hospitalisation phase, rehabilitation phase, and after the aphasic person returned home. Taking into consideration the needs of spouses of persons with severe aphasia requires an eco-systemic and interdisciplinary approach aiming for the social reintegration of the person with aphasia. Services should be developed in order to respond to the unique and individual experiences and needs of people affected by aphasia. Speech language pathologists play a pivotal role within this approach because communication problems are central to the consequences of severe aphasia.

The roles of effective communication and client engagement in delivering culturally sensitive care to immigrant parents of children with disabilities.

Abstract Purpose: Delivering pediatric rehabilitation services to immigrant parents of children with disabilities requires the practice of culturally sensitive care. Few studies have examined the specific nature of culturally sensitive care in pediatric rehabilitation, especially the notions of effective communication and client engagement. Method: Interviews were held with 42 therapists (10 social workers, 16 occupational therapists and 16 speech language pathologists) from two locations in Canada (Toronto and Quebec City). Data were analyzed using an inductive content analysis approach. Results: Study themes included the importance and nature of effective communication and client engagement in service delivery involving immigrant parents. Participants discussed using four main types of strategies to engage immigrant parents, including understanding the family situation, building a collaborative relationship, tailoring practice to the client’s situation and ensuring parents’ understanding of therapy procedures. Conclusions: The findings illuminate the importance of effective, two-way communication in providing the mutual understanding needed by therapists to engage parents in the intervention process. The findings also richly describe the engagement strategies used by therapists. Clinical implications include recommendations for strategies for therapists to employ to engage this group of parents. Furthermore, the findings are applicable to service provision in general, as engaging families in a collaborative relationship through attention to their specific situation is a general principle of good quality, family-centered care. Implications for Rehabilitation Effective communication permeates the delivery of culturally sensitive care and provides mutual understanding, which is fundamental to client engagement. The findings illuminate the nature of “partnership” by indicating the role of collaborative therapist strategies in facilitating engagement. Four main strategies facilitate effective communication and client engagement, including understanding the family situation, building a collaborative relationship, tailoring practice to the client’s situation and ensuring parents’ understanding of therapy procedures. Engaging families in a collaborative relationship through attention to their specific situation is a general principle of good quality, family-centered care.

SWOT analysis of a pediatric rehabilitation programme: A participatory evaluation fostering quality improvement

Purpose. To present the results of a strengths, weaknesses, opportunities and threats (SWOT) analysis used as part of a process aimed at reorganising services provided within a pediatric rehabilitation programme (PRP) in Quebec, Canada and to report the perceptions of the planning committee members regarding the usefulness of the SWOT in this process. Method. Thirty-six service providers working in the PRP completed a SWOT questionnaire and reported what they felt worked and what did not work in the existing model of care. Their responses were used by a planning committee over a 12-month period to assist in the development of a new service delivery model. Committee members shared their thoughts about the usefulness of the SWOT. Results. Current programme strengths included favourable organisational climate and interdisciplinary work whereas weaknesses included lack of psychosocial support to families and long waiting times for children. Opportunities included working with community partners, whereas fear of losing professional autonomy with the new service model was a threat. The SWOT results helped the planning committee redefine the programme goals and make decisions to improve service coordination. SWOT analysis was deemed as a very useful tool to help guide service reorganisation. Conclusions. SWOT analysis appears to be an interesting evaluation tool to promote awareness among service providers regarding the current functioning of a rehabilitation programme. It fosters their active participation in the reorganisation of a new service delivery model for pediatric rehabilitation.

Increasing the Use of Group Interventions in a Pediatric Rehabilitation Program: Perceptions of Administrators, Therapists, and Parents

ABSTRACT Objectives. To explore perceptions related to increased utilization of group interventions as a part of the service reorganization within a pediatric rehabilitation program. Methods. Individual interviews with program administrators (n = 13) and focus groups with therapists (n = 19) and parents of children with disabilities (n = 5) were conducted. Data were analyzed using a coding grid inspired by the organized action systems theory. Results. Administrators and therapists identified several issues including the need to improve the referral process for groups and the coordination across services. Groups considerably modified practice and required substantial efforts from therapists. Administrators felt groups contributed to increased service accessibility. Although therapists had some doubts about service quality in groups, especially in regard to the reduced attention to individual needs, they reported positive benefits on childrens social participation. Generally, parents were satisfied with group interventions. Conclusion. Groups appear to be a promising method of service delivery, but organizational-related issues should be considered.

Going beyond the identification of change facilitators to effectively implement a new model of services: lessons learned from a case example in paediatric rehabilitation

Purpose: To identify facilitators and barriers to service reorganization, how they evolved and interacted to influence change during the implementation of a new service delivery model of paediatric rehabilitation. Methods: Over 3 years, different stakeholders responded to SWOT questionnaires (n = 139) and participated in focus groups (n = 19) and telephone interviews (n = 13). A framework based on socio constructivist theories made sense of the data. Results: Facilitators related to the programmes structure (e.g. funding), the actors (e.g. willingness to test the new service model) and the change management process (e.g. participative approach). Some initial facilitators became barriers (e.g. leadership lacked at the end), while other barriers emerged (e.g. lack of tools). Understanding factor interactions requires examining the multiple actors’ intentions, actions and consequences and their relations with structural elements. Conclusions: Analysing facilitators and barriers helped better understand the change processes, but this must be followed by concrete actions to successfully implement new paediatric rehabilitation models.

Development, Implementation, and Evaluation of the Apollo Model of Pediatric Rehabilitation Service Delivery

ABSTRACT This article presents the experience of a rehabilitation program that undertook the challenge to reorganize its services to address accessibility issues and improve service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to improve the quality of services provided to children with disabilities, their families, and their communities.

Analyse qualitative des difficultés rencontrées par les mères d'enfants ayant une incapacité motrice:

Une étude qualitative portant sur la réalité des mères ayant un enfant avec une incapacité motrice (spina-bifida ou infirmité motrice cérébrale) a été menée auprès de 67 femmes de la région de Québec. Une analyse de contenu thématique des difficultés rencontrées par ces femmes a été réalisée. Les femmes interviewées affirmaient que le contact initial avec les membres du corps médical (particulièrement les médecins) représentait une source importante de frustration et de mécontentement. De plus, elles indiquaient que les caractéristiques physiques et psychologiques propres à. leurs enfants engendraient de nombreuses difficultés. Il est ressorti que les réactions du conjoint tout comme celles de la famille rendaient leur vie quotidienne encore plus ardue. À la lumière des commentaires des participantes, des recommandations pour les ergothérapeutes sont énoncées afin de mieux guider les interventions auprès de ces femmes.

Social circus program (Cirque du Soleil) promoting social participation of young people living with physical disabilities in transition to adulthood: a qualitative pilot study

ABSTRACT Purpose: To explore the perceived impact of a social circus program on the participation level of young adults’ living with physical disabilities from their own and their parents’ perspective. Method: Exploratory phenomenological qualitative design. A social circus program was offered for nine months. Perceived participation level was documented through pre and post semi-structured interviews. A pretested interview guide was used. Interviews were transcribed and coded by two independent researchers. Results: The average age of the participants (n = 9) was 20.0 ± 1.4 years with 2/9 being female. Participation was perceived as being improved after the intervention from both perspectives (participants and parents) mainly for communication, mobility, relationships, community life and responsibilities. The intervention was perceived as strengthening self-perception and self-efficacy, which in turn enhanced participation level and decreased parents’ bounding. Conclusion: The results show promises for social circus as a new approach in adult physical rehabilitation for this population in transition.

Ecosystemic Needs Assessment for Children with Developmental Coordination Disorder in Elementary School: Multiple Case Studies

ABSTRACT This study explored the needs of children with developmental coordination disorder (DCD) from an ecosystemic viewpoint as part of a theory-driven program evaluation process. A multiple case study needs assessment was conducted. Participants included ten children with DCD, their parents (n = 12), teachers (n = 9), and service providers (n = 6). Data collection involved semi-structured interviews, validated questionnaires, and a review of the childrens records. The results support the relevance of using an ecosystemic model to assess the needs of children with DCD in their life and social contexts. More specifically, the results highlight the need to provide additional services at school, such as occupational therapy and special education, as well as information and training regarding DCD for parents and teachers. The results also point to the relevant variables to consider in an intervention program based on theory-driven evaluations. This study shows how employing an ecosystemic frame of reference provides a better understanding of the needs of children with DCD. Future research should document the ecosystemic profiles and evolution of the needs of children with DCD with a larger sample from diverse socioeconomic backgrounds using a longitudinal study design.

Participation and needs of children with developmental coordination disorder at home and in the community: Perceptions of children and parents

BACKGROUND The existing literature provides only a partial understanding of the viewpoints of elementary school-aged children with developmental coordination disorder (DCD) regarding their participation and needs. In order to plan and develop health and social services driven by a personalized approach, it is essential to further document their perceptions with those of their parents. AIMS The aim of the study was to explore the participation and needs of school-aged children with DCD at home and in the community, as perceived by children and parents. METHODS Participants were ten school-aged children with DCD, from 6 to 13 years old, and their parents, including one couple (n=11). Individual semi-structured interviews were conducted with each participant, except the couple who were interviewed together. RESULTS Most children and all parents perceived some difficulties at home but few in the community. However, participation and needs varied for each child. Children rarely expressed the same expectations as their parents. While most children did not want more support, parents requested training on DCD. CONCLUSIONS When planning health and social services for children with DCD, it is recommended to consult all stakeholders, including children, as well as offer indirect interventions, such as training and coaching for parents.