Solution-Focused Coaching to Support Clinicians' Professional Development: An Analysis of Relational Strategies and Co-constructed Outcomes.

PURPOSE: To explore solution-focused coaching (SFC) as a means to enhance pediatric rehabilitation practitioners' development of listening skills. METHODS: Six clinicians each participated in two SFC sessions with an experienced coach who used a practice model developed for pediatric rehabilitation (SFC-peds). The transcribed interviews were analyzed by inductive content analysis to identify the coach's use of relational strategies and the nature of what was being co-constructed in the sessions. RESULTS: The coach used six relational strategies (e.g., supporting reflective and critical thinking). Through dialogue and reflection, the coach and clinician co-constructed four important outcomes, including shared meaning, awareness and discovery of strengths and values, discovery of strategies and opportunities, and forward movement. CONCLUSIONS: The study informs our understanding of the relational processes and benefits of SFC conversations. These conversations appear to provide an optimal learning space to enhance professional development, by facilitating the co-creation of meaning, awareness, and intentionality.

Exploring Relational Dialogue in Solution-Focused Coaching Sessions: An Analysis of Co-Construction and Reflection.

Purpose: To examine solution-focused coaching (SFC) as a means to enhance clinicians' professional development. Methods: Six pediatric rehabilitation clinicians (three physical, two occupational, and one behavior therapist) each received two SFC sessions targeting clinical listening goals. Conversational intervals were noted in session transcriptions. Frequencies of relational strategies and conversational intervals were calculated. The meaning of intervals > 10 s was examined. Results: The most frequent relational strategies indicated that SFC facilitates reflection and critical thinking, and encourages action. An appreciable number of long intervals (>10 s) occurred, indicating substantial reflection by participants. These were embedded in relational dialogue sequences involving coach questions and formulations, and participant pauses. Conclusions: The findings support the use of SFC as a professional development tool and substantiate the view that SFC 'works' through the coach's use of relational strategies designed to facilitate collaborative conversations that build solutions through an emphasis on reflection and action.

A Solution-Focused Coaching Intervention with Children and Youth with Cerebral Palsy to Achieve Participation-Oriented Goals.

Background: The ultimate goal of therapeutic intervention is meaningful participation in one's world. For people with Cerebral Palsy (CP), limitations can often become a focus of care.Aim: Our purpose was to investigate the impact of a Solution-Focused Coaching intervention designed for pediatric rehabilitation (SFC-peds) on the attainment of participation goals for children/youth with CP.Method: Twelve participants participated in a repeated measures quantitative study and in qualitative interviews. Children and youth (ages 6-19) and their families participated in three to five coaching sessions, including an initial baseline goal setting session, with one additional follow-up session as well as the qualitative interviews. The Canadian Occupational Performance Measure and Goal Attainment Scaling were incorporated into initial coaching sessions and then re-administered by a blind assessor within one month post-intervention. Qualitative interviews were conducted at this time.Results: Statistically significant improvements were found in goal performance, satisfaction, and attainment. Interview data included consideration of both the content of the intervention (what the practitioner is doing) and the unique SFC-peds process (how the client feels about the intervention).Conclusions: SFC-peds may present an effective approach for working with children/youth with CP to achieve self-selected participation-oriented goals in a relatively short time-period.

Solution-Focused Coaching in Pediatric Rehabilitation: Perceived Therapist Impact.

Aims: This qualitative descriptive study explored perceived impacts of solution-focused coaching in pediatric rehabilitation (SFC-peds) from the viewpoint of experienced therapists.Methods: Semi-structured in-depth interviews were conducted with six participants (four occupational therapists and two physical therapists) who had incorporated SFC-peds into their practice for three years or longer. Participants were asked to describe perceived differences SFC-peds has made to their clinical practice, service provision, and relationships with clients and families. Interview transcripts were analyzed using the method of thematic analysis.Results: Three major themes, each with subthemes, were identified: 1) changes in therapists' perception of their roles; 2) increased service effectiveness; and 3) enhanced client capacity. Through long-term engagement with SFC-peds, participants have experienced a role shift from an expert adviser to a collaborative facilitator who assists clients and families with capacity building and self-discovery of solutions for their everyday environments.Conclusions: The findings suggest that SFC-peds can help participants reframe professional expertise and integrate principles of family-centred care into their day-to-day practice. Individual- and system-level support, along with flexibility in service structures and processes, may be needed to further the implementation of SFC-peds in service delivery.

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

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 client's 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.

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.

Quality of Life and Self-Determination: Youth with Chronic Health Conditions Make the Connection.

While optimizing quality of life (QOL) is a key goal of rehabilitation care, no previous study has reported on what 'QOL' means to youth with chronic health conditions. In addition, no qualitative studies have explored the relationship between QOL and self-determination (SD). Objectives of this qualitative study were to examine: what the terms 'quality of life' and 'self-determination' mean to youth with chronic conditions; the factors these youth think are linked with these concepts; the relationship they see between concepts, the types of future goals youth have and how they view the connection between their SD and these goals. A descriptive methodology was used. A purposive sample of 15 youth aged 15 to 20 years was obtained. Youth had cerebral palsy, a central nervous system disorder, or autism spectrum disorder. Semi-structured interviews were conducted first, followed by a focus group. Line-by-line coding of transcripts was completed, codes were collapsed into categories, and themes identified. Participants viewed QOL as an overarching personal evaluation of their life, and used terms such as satisfaction and happiness to describe the concept. Factors related to QOL included: 'relationships', 'supportive environments', 'doing things', 'personal growth and moving forward', and 'understanding of self/acceptance of disability'. Participants described SD in such terms as confidence and motivation. Contributors to SD were: 'personal strengths', 'interdependence', and 'functional independence'. SD was considered important to QOL. Youth goals were reflective of the goals of most adolescents. They identified the importance of having key goals that were of personal interest to them. This study adds consumer-based information to the debate over the meaning of QOL. Service providers and decision makers should be aware of the factors that youth feel impact their QOL and SD, the importance of SD to youth QOL, and of SD to future goals, and consider this information when tailoring therapeutic interventions.

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.

Solution-focused coaching in pediatric rehabilitation: an integrated model for practice.

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.

The value of oncology nursing certification.

The attainment of oncology nursing certification indicates that a nurse has the knowledge and expertise to competently care for patients with an actual or potential diagnosis of cancer. Research regarding the value nurses associate with certification is lacking; therefore, the Oncology Nursing Certification Corporation participated in a national study led by the American Board of Nursing Specialties Research Committee to explore the value of certification in a sample of certified and noncertified nurses and nurse managers. A total of 940 oncology nurses participated and completed a demographic survey and the Perceived Value of Certification Tool. Most were Caucasian women, with a mean age of 54 years; 36% were staff nurses, 19% were nurse managers, and 10% were advanced practice nurses. A high value of certification was reported. Barriers to certification included cost issues and lack of institutional reward and support. Benefits included institutional reimbursement and listing certification credentials on name badges or business cards. Both certified and noncertified nurses value certification. Increasing institutional recognition and financial support could improve nurse certification rates and ultimately may result in improved patient care.

Employing the International Classification of Functioning, Disability and Health to enhance services for children and youth with chronic physical health conditions and disabilities.

PURPOSE: In 2001, the World Health Organization published the International Classification of Functioning, Disability and Health (ICF). The ICF is just beginning to be used in a variety of clinical and research settings in Canada and worldwide. The purpose of the present article is to describe the initial use of the ICF at an Ontario children's rehabilitation centre, and to consider further uses both within and outside the centre for enhancing services for children and youth with chronic physical health conditions and disabilities, as well as for their families. METHOD: A description is provided on how the ICF has been used at the centre to guide clinical thinking and practice, and to justify and steer research directions. Plans underway to use the ICF to collect and record functional data at the centre are also described. Finally, recommendations for the use of the ICF to enhance communication among child health professionals across service settings are provided. CONCLUSIONS: Used in conjunction with the International Classification of Diseases - Tenth Revision, the ICF's conceptual framework and classification system shows great promise for enhancing the quality of services for children with chronic conditions and their families. This information may assist paediatric specialists, other child health professionals, researchers and administrators to use the ICF in similar settings. It may also stimulate exploration of the use of the ICF for general paediatricians and other service providers in the larger community.

An evaluation of the "Youth en Route" program.

Youth En Route (YER) is a transition program for youth and young adults with multiple disabilities. It offers a multifaceted approach that includes self-discovery, skill development, and community experience. Underlying the service delivery model is a philosophy of self-determination. This program evaluation measured the self-determination skills, sense of personal control over life choices, and community participation of 34 youth prior to and one year following their involvement with YER. Youth reported statistically and clinically significant improvement from pretest to posttest with respect to both self-determination and sense of personal control. Moreover, youth reported spending significantly more time at posttest than at pretest engaged in volunteer/work activities and community leisure activities. On average, youth reported high satisfaction with YER services. Practical and research implications are discussed.

Bringing the Life Needs Model to life: implementing a service delivery model for pediatric rehabilitation.

This article describes the use and utility of the Life Needs Model of Pediatric Service Delivery at a regional children's rehabilitation center. The model is a transdisciplinary, evidence-based model that guides pediatric service delivery to meet the long-range goals of community participation and quality of life for children and youth with disabilities. The article describes the use of the model as a tool to assist with the development of organizational culture, strategic and operational planning, the development of therapists' expertise, and the development of community partnerships. The model also has influenced human resources practices, community relations activities, and research. The model provides needed direction to service planners about the types of services that are important to provide in a geographical region, and fills a gap in outlining the nature of services that can be encompassed in pediatric rehabilitation.

Interstitial lung disease following erlotinib (Tarceva) in a patient who previously tolerated gefitinib (Iressa).

OBJECTIVE: To report a case of who a patient developed clinical and radiographical evidence of interstitial lung disease (ILD) on erlotinib after having tolerated gefitinib therapy. CASE SUMMARY: A 58-year-old man with stage IV non-small-cell lung cancer (NSCLC) failed first and second line chemotherapy. He then received gefitinib, a small molecule epidermal growth factor receptor (EGFR) inhibitor, a therapy which was well tolerated, but did cause a grade 1 rash. On gefitinib, the patient's disease remained stable for seven months. Subsequent disease progression was treated with the newer EGFR inhibitor, erlotinib. After 5 days of erlotinib therapy, the patient presented with a sore throat and dyspnea, followed by a grade 2 rash and significant hemoptysis. Erlotinib was discontinued for three days, during which time his symptoms abated. Erlotinib was restarted and the patient again developed sore throat, dyspnea and severe hemotpysis, with progression of the rash to grade 3. Erlotinib therapy was discontinued and the patient recevied prednisone and supplemental oxygen. A CT scan of the chest demonstrated new areas of patchy ground glass opacity bilaterally and increased interstitial markings consistent with ILD. DISCUSSION: The case demonstrates that clinical ILD can occur following erlotinib therapy, even in patients who previously tolerated gefitinib. ILD has not been reported to occur more frequently with erlotinib than with gefitinib. However, the dose of erlotinib employed clinically is the maximum tolerated dose identified in phase 1 trials, and is associated with an increased incidence of grade 3-4 rash and diarrhea, as compared to gefitinib. Thus, the observation of clinical ILD following erlotinib, but not gefitinib, may be the consequence of increased potency of erlotinib 150 mg/day compared to gefitinib 250 mg/day. CONCLUSION: Clinical ILD can occur following erlotinib even in patients who previously tolerated gefitinib. IT is important to carefully monitor pulmonary symptoms in all patients who are receiving erlotinib, as early diagnosis and timely intervention are critical in managing drug-induced ILD.

A life needs model of pediatric service delivery: services to support community participation and quality of life for children and youth with disabilities.

This article presents a life needs model of pediatric service delivery that is based on the values of the intrinsic worth, dignity, and strengths of individuals. This developmental, socio-ecological model outlines the major types of service delivery needs of children and youth with disabilities, their families, and their communities within three spheres of life (the personal, interpersonal, and external spheres). The model legitimizes the concept of need, emphasizes the values of family-centered services, and recognizes child and family strengths and capacities. We discuss the utility of this transdisciplinary model in guiding pediatric service delivery to meet the long-range goals of community participation and quality of life of children and youth with disabilities.