"We're All Time Poor": Experienced Clinicians' and Students' Perceptions of Challenges Related to Patient Communication.

PHENOMENON: Communication is a complex and essential element of clinical practice. It is widely accepted that communication skills can be taught and learned, but challenges remain for clinicians in achieving effective communication with patients. This study explored the patient-communication challenges faced by both medical students and experienced clinicians. APPROACH: Semi-structured interviews were conducted with twenty medical students and nineteen experienced clinicians from a range of medical disciplines. Interviews were recorded and transcribed, and transcriptions subjected to thematic analysis and coding to quantify the challenges discussed. FINDINGS: There was remarkable consistency in the challenges described by both groups of participants, with eight predominant challenges identified: time constraints and chaotic environments, rapport building, patient characteristics, reluctance, omissions, assumptions, decision-making, and keeping conversations focused. INSIGHTS: Medical curricula often focus on communication challenges associated with complex or sensitive clinical situations, but many of the challenges identified occur in routine consultations. Both pre-service and post-graduate medical training should adopt strategies to help build students' and clinicians' skills in managing these challenges from the outset of training.

The ability of adults with limited expressive language to engage in open-ended interviews about personal experiences.

This study examines how adults with limited expressive language (with average sentences of five words or less) respond to open-ended questions. Participants (n = 49) completed a baseline measure and were then interviewed about a personal experience using exclusively open-ended questions, followed by open-ended and directive questions about a staged event. Their interviews were coded for mean length of utterance (MLU), number of different words and six dimensions of the Narrative Assessment Profile. Descriptively, the participants were able to give some event-related detail in their narratives, but there was wide variability in narrative quality. Correlational and regression analyses indicate that their MLU was stable across contexts. The findings suggest that adults with limited expressive language can provide informative responses to open-ended questions about their experiences, and that their expressive language is likely to show stability across introductory and substantive interview phases.

Information Gathering in Investigative and Medical Interviewing: Drawing Parallels Across Contexts.

Information gleaned from a patients' medical history is a core determinant of a medical diagnosis. Accurate and effective history-taking is, therefore, a foundational skill for medical practitioners and is introduced early in medical training. Recognizing and developing the skills of effective medical interviewing is an ongoing challenge for medical students and experienced clinicians alike. Important parallels exist between the information gathering skills required in medicine and health, and those required in investigative interviewing. Qualitative interviews were conducted with 19 experienced medical professionals from a range of specialty areas. They were asked about the role of the medical interview in their discipline, and about challenges they experience when gathering information from patients. Both theory-driven and grounded-theory approaches were used in combination to identify common themes. The interviews were rich with themes including approaches to introductory phases of the interview, eliciting a narrative account, and several topics that specifically paralleled issues in interviewing of vulnerable witnesses. We explore these themes through a lens of investigative interviewing by applying the knowledge of effective interviewing skills and structures to the data gained from the medical context. In general, themes indicated that there are numerous parallels to information gathering approaches in both contexts. As such, there may be scope for medical education to adopt some of the training techniques employed in the investigative interviewing field. Further, it is hoped that the present findings be used to spark an interdisciplinary conversation about communication from which both sides can learn.

Assessing the training needs of medical students in patient information gathering.

BACKGROUND: Effective communication is at the heart of good medical practice but rates of error, patient complaints, and poor clinician job satisfaction are suggestive of room for improvement in this component of medical practice and education. METHODS: We conducted semi-structured interviews with experienced clinicians (n = 19) and medical students (n = 20) to explore their experiences associated with teaching and learning clinical communication skills and identify targets for improvements to addressing these skills in medical curricula. RESULTS: Interviews were thematically analysed and four key themes emerged; the importance of experience, the value of role-models, the structure of a consultation, and confidence. CONCLUSIONS: The findings reinforce the need for improvement in teaching and learning communication skills in medicine, with particular opportunity to target approaches to teaching foundational skills which can establish a strong grounding before moving into more complex situations, thus preparing students for the flexibility required in medical interviewing. A second area of opportunity and need is in the engagement and training of clinicians as mentors and teachers, with the findings from both groups indicating that preparation for teaching and feedback is lacking. Medical programs can improve their teaching of communication skills and could learn from other fields s to identify applicable innovative approaches.

The effects of episode similarity on children's reports of a repeated event.

Much research has tested techniques to improve children's reporting of episodes from a repeated event by interviewing children after they have experienced multiple episodes of a scripted event. However, these studies have not considered any effects of the similarity shared between event episodes on children's reports. In the current study, 5- to 9-year-olds experienced four episodes of a scripted repeated event that shared a high (n = 76) or low (n = 76) degree of similarity, and were subsequently interviewed about individual episodes. The proportional amount and accuracy of children's reported details were tallied. Children reported proportionally more details and more script deviations after experiencing the high, compared to low, similarity event. Conversely, children were more accurate in their episodic reports when they experienced the low, compared to high, similarity event. The current findings have implications for the generalisability and comparability of past results across laboratory studies.

Effects of interviewer familiarity and supportiveness on children's recall across repeated interviews.

OBJECTIVES: Child witnesses often describe their experiences across multiple interviews. It is unknown whether talking with a familiar interviewer increases disclosures, however, or whether any benefits of a familiar interviewer could be achieved by ensuring that interviewers (regardless of familiarity) behave in socially supportive ways. This study tested the effects of interviewer familiarity and social support on children's reports of an adult's transgressions. HYPOTHESES: We predicted that familiarity and supportiveness would increase transgression reports at a second interview and that children who spoke with familiar, supportive interviewers would disclose the most transgressions. METHOD: Children (N = 160, 5 to 9 years) participated in a science event involving 6 transgressions. Across 2 interviews, they spoke with the same trained university student interviewer or different interviewers, and these interviewers engaged in supportive or neutral behaviors. Interviews were coded for overall information reported, number of transgressions, and confabulations. RESULTS: There were no effects of support in the first interview or on total details reported in either interview. Children reported more transgressions to supportive than neutral interviewers in the second interview (IRR = 1.19), even during open-ended prompting (IRR = 1.26), and they omitted fewer transgressions that had been reported in the first interview (IRR = 0.69). Confabulations were infrequent. There were no condition differences in the total number of confabulations reported across interviews, but these errors occurred more often in the second interview in the supportive condition. CONCLUSIONS: Interviewer support may play a greater role than familiarity in facilitating children's testimony. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Prosecutors' Perceptions on Questioning Children about Repeated Abuse.

The purpose of this study is to elicit guidance from prosecutors across Australia on questioning children about repeated events. Two focus groups were conducted. The first sought broad feedback concerning questioning children about repeated events. The second focused more specifically on eliciting feedback about techniques for aiding children in describing specific instances of repeated events. The techniques used are derived from a combination of empirical research and best practice interview guidelines. Data from both focus groups were compiled because themes were highly similar. Thematic analysis of the focus group discussions revealed three broad themes in prosecutors' perceptions about questioning children about repeated abuse: a) permitting children to provide a full generic account before describing individual episodes of abuse, b) using the information obtained during the generic account to create episode labels, and c) probing incidences of abuse chronologically. These themes are discussed within the context of the child development and mnemonic literature, and implications for interviewing protocols are drawn.

Investigative Interviewing of Aboriginal Children in Cases of Suspected Sexual Abuse.

This study examined the investigative interviewing of Australian Aboriginal children in cases of alleged sexual abuse, with a focus on three commonly included components of interview protocols: ground rules, practice narrative, and substantive phase. Analysis of 70 field transcripts revealed that the overall delivery and practice of ground rules at the beginning of the interview was positively associated with the spontaneous usage of rules in children's narratives of abuse. When specifically examining the "don't know" rule, however, only practice had an effect of children's usage of the rule (as opposed to simple delivery or no delivery at all). Children spoke more words overall, and interviewers used more open-ended prompts during the substantive phase when the interviews contained a practice narrative. Children most often disclosed sexual abuse in response to an open-ended prompt; however, they produced the most words in response to suggestive prompts. This article concludes with a discussion of the effectiveness of ground rules, practice narratives, and questioning with Aboriginal children.

The Effects of Practice on Children's Ability to Apply Ground Rules in a Narrative Interview.

Despite the widespread use of ground rules in forensic interview guidelines, it is unknown whether children retain and apply these rules throughout narrative interviews. We evaluated the capacity of 260 five- to nine-year-olds to utilize three ground rules. At the beginning of the interview all children heard the rules; half also practiced them. Children then responded to open-ended prompts about a repeated laboratory event and were assessed for their application of the rules. Logistic regressions revealed that practice only benefitted the use of the "don't know" rule. Although the children accurately answered "don't understand" and "correct me" practice questions, practice appeared to give no greater benefit than just hearing the rules. Results suggest that the current format of ground rule practice in interview guidelines is appropriate for the "don't know" rule, but the other rules may require more extensive practice with this age group.

Children's performance on ground rules questions: implications for forensic interviewing.

Ground rules, also called interview instructions, are included in investigative interviews with children around the world. These rules aim to manage the expectations of children who are typically unaccustomed to being questioned by adults who are naïve to the children's experiences. Although analog research has examined the efficacy of ground rules instruction, a systematic analysis of children's ability to respond appropriately to each of the rules has not been reported. In the current study, we scored the accuracy of children's (N = 501, 4 to 12 years) responses to 5 ground rules practice questions (e.g., "What is my dog's name?") and 2 questions that asked whether they would follow the rules, and then assigned inaccurate responses to 1 of several error categories. Few children answered every question correctly, but their performance on individual questions was encouraging. As expected, there were marked differences in children's understanding across ground rules questions (especially among the younger children), with "Don't guess" and "Tell the truth" rules being the easiest to comprehend. Together with evidence that ground rules instruction takes little time to deliver (typically 2 to 4 min) and is associated with improved accuracy in previous research, these findings support the use of ground rules in investigative interviews of children 4 years and older.

Deficient cognitive control fuels children's exuberant false allegations.

In eyewitness studies as in actual investigations, a minority of children generate numerous false (and sometimes incredulous) allegations. To explore the characteristics of these children, we reinterviewed and administered a battery of tasks to 61 children (ages 4-9 years) who had previously participated in an eyewitness study where a man broke a "germ rule" twice when he tried to touch them. Performance on utilization, response conflict (Luria tapping), and theory of mind tasks predicted the number of false reports of touching (with age and time since the event controlled) and correctly classified 90.16% of the children as typical witnesses or exuberant (more than 3) false reporters. Results of a factor analysis pointed to a common process underlying performance on these tasks that accounted for 49% of the variability in false reports. Relations between task performance and testimony confirmed that the mechanisms underlying occasional intrusions are different from those that drive persistent confabulation and that deficient cognitive control fuels young children's exuberant false reports.

An examination of "don't know" responses in forensic interviews with children.

Most experimental studies examining the use of pre-interview instructions (ground rules) show that children say "I don't know" more often when they have been encouraged to do so when appropriate. However, children's "don't know" responses have not been studied in more applied contexts, such as in investigative interviews. In the present study, 76 transcripts of investigative interviews with allegedly abused children revealed patterns of "don't know" responding, as well as interviewers' reactions to these responses. Instructions to say "I don't know" when appropriate did not affect the frequency with which children gave these responses. Interviewers rejected "don't know" responses nearly 30% of the time, and typically continued to ask about the same topic using more risky questions. Children often answered these follow-up questions even though they had previously indicated that they lacked the requested information. There was no evidence that "don't know" responses indicated reluctance to talk about abuse. Implications for forensic interviewers are discussed.

Gaze, goals and growing up: Effects on imitative grasping.

Developmental differences in the use of social-attention cues to imitation were examined among children aged 3 and 6 years old (n = 58) and adults (n = 29). In each of 20 trials, participants watched a model grasp two objects simultaneously and move them together. On every trial, the model directed her gaze towards only one of the objects. Some object pairs were related and had a clear functional relationship (e.g., flower, vase), while others were functionally unrelated (e.g., cardboard square, ladybug). Owing to attentional effects of eye gaze, it was expected that all participants would more faithfully imitate the grasp on the gazed-at object than the object not gazed-at. Children were expected to imitate less faithfully on trials with functionally related objects than those without, due to goal-hierarchy effects. Results support effects of eye gaze on imitation of grasping. Children's grasping accuracy on functionally related and functionally unrelated trials was similar, but they were more likely to only use one hand on trials where the object pairs were functionally related than unrelated. Implications for theories of imitation are discussed.

Perceptions of Allegations of Repeated Victimization: The Roles of Event Frequency, Language Specificity, and Disclosure Delay.

Although many forms of victimization are repeated (e.g., domestic violence), we know relatively little about the perceived credibility of adult claimants who allege repeated maltreatment. We examined the effects of Event Frequency (Single vs. Repeated), Language Specificity (Episodic vs. Generic), and Disclosure Delay (Immediate vs. Delayed) on laypersons' perceptions of claimant credibility. Participants (N = 649) read a mock interview transcript and provided subjective ratings (e.g., credibility, likelihood of suspect guilt, claimant responsibility). When the alleged abuse occurred a single time (vs. repeatedly), participants rated the interviewee as less blameworthy but no more (or less) credible. Exploratory findings indicated that female participants viewed the interviewee as more credible and less responsible than did male participants.

Induced power changes the sense of agency.

Power differentials are a ubiquitous feature of social interactions and power has been conceptualised as an interpersonal construct. Here we show that priming power changes the sense of agency, indexed by intentional binding. Specifically, participants wrote about episodes in which they had power over others, or in which others had power over them. After priming, participants completed an interval estimation task in which they judged the interval between a voluntary action and a visual effect. After low-power priming, participants judged intervals to be significantly longer than judgments after high-power or no priming. Thus, intentional binding was significantly changed by low-power, suggesting that power reduces the sense of agency for action outcomes. Our results demonstrate a clear intrapersonal effect of power. We suggest that intentional binding could be employed to assess agency in individuals suffering from anxiety and depression, both of which are characterised by reduced feelings of personal control.

An overview of mock interviews as a training tool for interviewers of children.

Mock (simulated) interviews can be used as a safe context for trainee interviewers to learn and practice questioning skills. When mock interviews are designed to reflect the body of scientific evidence on how questioning skills are best learned, research has demonstrated that interviewers acquire relevant and enduring skills. Despite the importance of this exercise in learning interview skill and its prevalence as a learning tool in other fields such as medicine and allied health, there has been relatively little discussion about mock interviews from an educational perspective in investigative interview training. This paper addresses that gap by providing the first comprehensive overview of the way mock interviews have been used in training interviewers of children. We describe the research that supports their utility, and the various ways they can be implemented in training: providing insight to learners; allowing opportunities for practice, feedback, and discussion; and as a standardized way to assess skill change over time. The paper also includes an overview of the cutting-edge use of avatars in mock interviews to enhance efficiency, provide unique learning experiences, and ultimately reduce training costs. We explain why avatars may be particularly useful in basic training, freeing up human trainers to facilitate mock interviews around advanced topics and discussion.

International perspective on guidelines and policies for child custody and child maltreatment risk evaluations: A preliminary comparative analysis across selected countries in Europe and North America.

Little knowledge exists on how evaluators in child custody and child maltreatment cases are informed by guidelines, the kinds of qualifications required and the types of training provided in different countries. The purpose of this paper is to provide an international preliminary comparison on how child custody and child maltreatment risk assessments are conducted in selected Western countries, and how the assessments are informed by best practice guidelines. Another aim is to increase knowledge on how the guidelines and best-practice standards could be developed further to reflect recent research findings. A total number of 18 guidelines were included in the analyses: four from Canada, five from the United States, three from the United Kingdom, three from the Netherlands, two from Finland, and one from Germany. We conducted a content analysis of the included guidelines in the database, focusing on how the guidelines address the best interest of the child criteria, guidelines for conducting the assessments, considerations for evaluative criteria, and specific guidance for conducting specific assessment procedures (e.g., interviews and observations). Findings show that the qualifications of and training provided to evaluators in child custody and child maltreatment risk evaluations are largely heterogeneous across the countries represented. Guidelines differ in whether and how they highlight the importance of evidence-based practices and scientifically validated assessment measures. Implications are drawn from the review and contextualized by international expert authors in the fields of forensic psychology, and family law. After the content analysis, discussion sessions within the expert group were held. The authors provide both commentaries and suggestions to improve the development of standard methods for conducting both child custody and child maltreatment risk evaluations and to consider a more transparent and judicious use of social science research to guide methods and the recommendations offered within these assessments.

Responding to orphanage trafficking from an information gathering perspective.

Estimates suggest that close to 3 million institutionalized children internationally have some family to whom they could go home. A proportion of these children is recruited from their communities under false pretenses and has false documentation that describes them as legal orphans. The orphanages where they live exploit them on the basis of their orphanhood. These children are known as paper orphans. The aim of the current article is to provide a profile of their origins and networks based on current available evidence, from an investigative interviewing perspective. Increased discussion and research of this problem will assist in supporting efforts towards reunification of children with families, investigations by law enforcement into orphanages, and successful prosecution of orphanage trafficking. The article provides an overview of the orphanage trafficking context, followed by a comparison of orphanage trafficking victims with other child trafficking victims from the perspective of investigative needs. Investigative needs are outlined with respect to two primary groups who would interview paper orphans and other involved parties (e.g., birth parents, orphanage staff)-law enforcement and reunification officers. In the final section of the article, we encourage further research on orphanage trafficking and provide initial guidance for interviewing in this unique context. This paper serves as a step to raise further awareness of paper orphans, orphanage trafficking, and the specific characteristics of their cases that affect research and planning into how to identify and interview them and others involved.

Forensic interviewers' perceptions of the utility of mock interviews with trained actors as a training tool for child interviewing.

BACKGROUND: The use of mock interviews (also known as role play), particularly using trained actors as interviewees, has demonstrated positive effects on communication training but little is known about how learners engage with these practice activities. OBJECTIVE: The current study was conducted to determine what perceptions forensic interviewers hold about mock interviews as a learning exercise for developing skills for child interviewing, and whether there are negative perceptions that could potentially have an impact on the helpfulness of the exercise. PARTICIPANTS: Written reflections were obtained from 35 US forensic interviewing professionals who were enrolled in an online child interviewer training program. METHODS: Common themes were extracted from the reflections to establish forensic interviewers' perceptions of aspects of the mock interview. Extraction of themes assisted in the determination of whether perceptions impacted the manner and degree to which interviewers engaged in the mock interview process. RESULTS: Results suggest that regardless of potential anxiety, learners experience multiple benefits from the mock interview. CONCLUSIONS: Findings from the present study suggests suggest most trainees perceive mock interviews favourably, and they are useful in child interview training programs.

"She Wanted to Know the Full Story": Children's Perceptions of Open Versus Closed Questions.

The current study explored children's perceptions of open and closed questions in an interview setting. Children aged 7-12 ( n = 83) years watched a short film and were questioned about it by an interviewer who asked only open questions and an interviewer who asked only closed questions (counterbalanced). A third interviewer subsequently invited perceptions of each interview by asking children to compare the interviews on 10 attributes (e.g., length, perceived interviewer interest). Children's comparisons on each of the 10 attributes were analyzed quantitatively and their responses to the follow-up questions underwent thematic analysis. Overall, children tended to find closed questions easier than open questions because they required less thought to answer but felt more listened to and better able to give their stories in response to open questions. Their perceptions frequently matched findings in the literature about the utility of open versus closed questions. The research has implications for interviews with child victims.