A listening skill educational intervention for pediatric rehabilitation clinicians: A mixed-methods pilot study.

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.

Developing authentic clinical simulations for effective listening and communication in pediatric rehabilitation service delivery.

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.

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.

The development of expertise in paediatric rehabilitation therapists: the roles of motivation, openness to experience, and types of caseload experience.

BACKGROUND/AIM: A transdisciplinary approach was taken to study the nature of variables associated with the development of expertise in 71 paediatric rehabilitation therapists (i.e. physical, occupational, speech, behavioural, and recreational therapists). METHODS: Six groups of practising therapists were identified based on expertise status (novice, intermediate, and expert, as determined by a multifaceted assessment battery), and their level of clinical experience (10 years or less, more than 10 years). Scores for these six therapist groups were examined on three variables generally considered to be associated with the development of expertise--motivation, openness to experience (as defined by the critical-thinking dispositions of truth-seeking, open-mindedness, and cognitive maturity), and features of their clinical caseload experience (i.e. breadth of experience as measured by number of different client age groups worked with, the complexity of clients' needs, and experience in delivering services to adolescents, school-age children, preschoolers, and infants). RESULTS: Low-experience experts ('young stars') had the highest motivation, truth-seeking, and open-mindedness scores of all groups, the highest percentage of clients with complex service needs, and were more likely to work with adolescents. CONCLUSIONS: The major differences between therapists who attain expertise quickly versus those who remain novices after many years of experience appear to be motivation and complexity of work experiences. Implications for supporting the development of expertise in practising therapists are discussed.

The development of expertise in pediatric rehabilitation therapists: changes in approach, self-knowledge, and use of enabling and customizing strategies.

PURPOSE: To examine the clinical decision making of novice, intermediate, and expert pediatric rehabilitation therapists from various disciplines. METHODS: Two qualitative studies were conducted. Thirteen therapists took part in a study using the critical incident interview technique and 11 therapists took part in a study using the 'think aloud' technique. Therapists were classified as novice, intermediate, or expert in developmental level based on a cluster analysis of data collected using a multifaceted battery of assessment tools. Data were analyzed using a grounded theory approach. RESULTS: Expert and intermediate therapists differed from novices with respect to content, self-, and procedural knowledge. CONCLUSION: With increasing expertise, therapists use a supportive, educational, holistic, functional, and strengths-based approach; have heightened humility yet increased self-confidence; and understand how to facilitate and support client change and adaptation by using principles of engagement, coherence, and manageability. Expert therapists use enabling and customizing strategies to ensure a successful therapeutic session, optimize the child's functioning in the mid-term, and ensure child and family adaptation and accommodation over the longer-term.

Social support processes and the adaptation of individuals with chronic disabilities.

In a qualitative study examining turning points in life, 15 adults with chronic disabilities (cerebral palsy, spina bifida, or attention deficit disorder) provided information about the nature and meaning of their social support experiences. The study revealed three types of psychological support linked to self-perceptions and enabling beliefs: (a) emotional support (valuing and acceptance leading to perceptions of "being believed in" and a sense of self-esteem), (b) instrumental support (guidance and provision of strategies leading to self-efficacy), and (c) cognitive support (affirmation, confirmation, and new perspectives leading to coherence in self-concept and worldview). The findings have important implications for service delivery with respect to understanding client needs for different kinds of support, especially at periods of transition, and for providing optimal experiences and creating supportive environments. In particular, the role of cognitive support deserves more attention in understanding the adaptation of individuals with chronic disabilities.

Turning points and protective processes in the lives of people with chronic disabilities.

In this qualitative study, the authors examined the nature of resilience in people with chronic disabilities. Fifteen people with disabilities identified the factors that helped or hindered them at major turning points, and the triggers and resolutions to these turning points. Turning points were emotionally compelling experiences and realizations that involved meaning acquired through the routes of belonging, doing, or understanding the self or the world. The major protective factors were social support, traits such as perseverance and determination, and spiritual beliefs. Three new protective processes were identified: replacing a loss with a gain (transcending), recognizing new things about oneself (self-understanding), and making decisions about relinquishing something in life (accommodating). These protective factors, processes, and ways in which people with disabilities draw sense and meaning in life have important implications for service delivery.