Posted in Eleanor Cawley, M.S., OTR/L

All About Me- The Student Interview & Patient-Centered Interview

Dr. Anne Zachary recently posted “6 Ways Your Child with Special Needs Can Get the Most out of Occupational Therapy.”  She is so right on to suggest an “All About Me” binder that a parent creates for his or her child.  This binder, as suggested by Dr. Zachary, should include relevant information, service providers, favorite toys, and any other info that the parent feels appropriate.  Dr. Zachary calls this the “Ice Breaker!”  This binder is the beginning of a patient-centered interview.  It is the initial collection of psychosocial data that is so important to improving clinical outcomes.

As parents and clinicians, we are charged with encouraging our children to be assertive and responsible.  As school-based therapists, we evaluate, collect data and make many of our judgments through standardized testing and analysis of work samples.  All of this data that we collect has little to do with the feelings or actual function of our students. In my opinion, we need to go a step further.  Our students need guidance to initiate conversation that will lead to information gathering specifically related to a student’s needs.  “The Student Interview” becomes my “ice breaker.”

I recently read an article, Evidence-Based Patient-Centered Interviewing, by Swiss Lyles, et al.  This article describes the basis for Patient-Centered Interview which includes: The Student Interview CoverA

  1. Gathering personal and psychosocial data
  2. Competency in interviewing skills
  3. Relationship building skills that nurture confidence and human understanding

In essence, being in the moment with the patient, focusing on his or her needs which is the basis for ‘therapeutic use of self.’ As therapists, one of the first terms that we learn is ‘therapeutic use of self.’ This term refers to using yourself as a therapeutic tool in the evaluation and treatment process.  It includes being focused in the moment and on your patient.  As a school-based therapist, this is not often easy to do.  There are so many students, assessments, reports and evaluations to conduct that we can easily fail to concentrate our focus on the student.

Interviewing a student may not always be an easy task.  Providing a student the freedom to discuss whatever they choose may actually be a luxury.  So how do we get to a patient-centered interview?  Since our students are still quite young, we still need to guide them through the interview process.  We must encourage them to discuss their needs but guide them to discuss their needs within the realm of occupational therapy.  As some one who has worked in middle and high schools, my focus has been to meet the student’s needs and discharge.  I have sat in many meetings where someone says, “but he has so many deficits.”  It has often been the result of a committee decision to continue therapy and not my opinion. Often, the student has had no input at all.  It is my belief that I need to train my students to be appropriately assertive and give him or her a voice in the process.  My students are emerging into adulthood.

Research has indicated that when physicians encourage a patient to participate in his or her care by asking questions during appointments showed improvement in blood pressure, blood glucose levels and functional status. It is this giving and receiving of information that shapes how a patient feels about their disease or disability giving them control over how their disability impacts on their lives. This creates a sense of commitment to the treatment process. The “Ice Breaker” becomes a tool to promote familiarity and engagement.  I created “The Student Interview” to have the very same effect with my students.  Using “The Student Interview” allows me to learn about a student’s likes/dislikes, what worked or has not worked, what they feel comfortable with, leisure activities, self-care activities, what they think their abilities are.  It is a guided interview with checklists leading to open-ended questions which my students can use to focus attention on their treatment needs.  In my opinion, The Student Interview not only provides a structure to help a student express their opinions and needs but helps to train them to become assertive and not feel as if they have no control.  Using a patient-centered interview has been shown to increase patient satisfaction and compliance with treatment.

I began using The Student Interview a few years ago.  Yes, I did start to develop this resource out of frustration due to numerous challenges brought by unhappy parents. I know that all they really wanted was to focus on their child’s specific needs. What I saw was an over tested and overwhelmed student becoming increasingly frustrated because no one asked them what was important and what worked for them. They did not know how to respond or how to contribute. They were frightened to raise their voices to be heard. The Student Interview allows a student to do just that.

 

Posted in Eleanor Cawley, M.S., OTR/L

How do we get to Client-Centered Practice 2

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This graphic is based on the writings of Turnbull, A. P., Turbiville, V., & Turnbull, H. R. (2000). Evolution of Family-Professional Partnerships. In J. P. Shonkoff, & S. J. Meisels (Eds.), Handbook of Early Childhood Intervention 2nd Edition (pp. 630-650). Cambridge, U.K.: The Cambridge University Press.

When writing the initial blog post “How to we get to Client-Centered Practice,” I fully intended to include something on the evolution of the client-therapist partnership.  Unfortunately, I did not so I felt that it was important to write a second post.  I had read this book, oh so long ago, when I was working in early intervention home care.  I felt that the evolution of the therapeutic relationship was as important then as it is now. I feel that in many ways, doctors and therapists are still vacillating between levels of power, decision making and communication.  I personally feel that all doctors and therapists need to get to the level of shared decision making with insightful, caring and dynamic decision making.  Two words come to mind:  Authoritarian and Authoritative.

When a therapist acts in an authoritarian manner, the therapist is in total control of the session with no input from the client. The phrase, “My way or the highway” comes to mind. When a therapist acts in an authoritative manner, the therapist imparts his or her knowledge with input and feedback from the client.  It does allow for the sharing of knowledge and resources for both the therapist and the client.  So from the 1950’s to the 1960’s, professionals tended to exert control over clients.  This was when doctors and therapists were ‘gods’ which still remains today in older patients.  Moving into the 1960’s through the 1970’s, the client patient relationship became somewhat more collaborative. Professionals became more candid and courteous with some changes to the level of jargon in documentation and conversation, although in my opinion, professionals remained authoritarian.  As we come into the 1980’s, authoritarian was still the rule but there was more family involvement.  The family became a resource to help the client and began being involved in the treatment process.  From the 1990’s to today, authoritarian has become authoritative, with professionals finding new and innovative ways to manage patient care.  P4s were developed to help the physician become more in tune with the needs of the client and involve the client in leading changes to effect better healthcare management.

So while there are changes happening, we are still stuck in the mindset that we grew up with and inherited from our parents.  I believe that it is this mindset that effects how patients perceive physicians and therapists.  It is our duty to help change the ways in which we deliver therapy services; change the way that we interact with clients; the ways in which they perceive us; in having responsibility for progress; and engage our clients in advocating for themselves.