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:
- Gathering personal and psychosocial data
- Competency in interviewing skills
- 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.