Speak Out December 2018

Narrative approach worksheet

Who are the important characters in this dilemma? Who needs to tell their story (e.g., client, carer, health care professional, and employer)? What are the different perspectives that each character may bring to this dilemma? Nia is a six-year-old with significant developmental and communication needs; she is reliant on her parents to access services that will benefit her development and participation in social and educational contexts. Nia’s mother and father emigrated to Australia two years ago and come from a non Anglo-Saxon culture. They have just separated. These are significant factors in the parents’ understanding of, and ability to respond to, their daughter’s needs. They have a difference of opinion about getting help for Nia. Tarri is the first health professional that has been consulted to provide help to Nia. Until recently, Tarri has had limited professional collaboration with other services in her local community, and the speech pathology profession in general. She is building her confidence to access information and supports to work with children with autism. What strategies will facilitate important stakeholders to have a ‘voice’ in this dilemma? Are there any sociocultural, communication, or physical barriers that must be addressed? Is the setting appropriate for hearing and sharing stories? How can ‘open’ communication be maintained? What verbal and non-verbal messages must be attended to during interactions? How can I check that I have ‘heard’ each character’s story? Tarri is aware that the family has come from a cultural background which has different perceptions of disability to the majority of her other clients, but she is not sure exactly what the cultural expectations are for this family. The mother has indicated that she feels she will be blamed for having a child with a disability so does not want Nia to be seen by any other professional or diagnosed with anything other than ‘difficulty talking’. Tarri decides to investigate the cultural attitudes towards disability for the family’s culture, to gain a greater understanding that may guide her interactions with the parents. Tarri is aware that she should allow the father to attend the next therapy session and wants to provide an environment where both parents can contribute to a positive discussion. However, as the father has been so angry on the phone, Tarri is not sure how he will conduct himself during the session. She has concerns that she may be drawn into the conflict between the parents due to their disagreement about what Nia needs. Tarri begins to plan the session: • She needs to make sure that the mother knows that the father will be there; • Tarri thinks about the layout of the waiting room and therapy room to make sure there is space and positioning to support positive interactions and no one feels overwhelmed; • Tarri develops a plan for the session to allow time to demonstrate to the father how speech therapy can benefit Nia, as well as allow time for discussion; • She plans some activities that Nia has shown some interest in, to demonstrate that Nia can participate in therapy and benefit from the intervention provided; • Tarri allocates time for each parent to speak and ask questions, and plans to use reflective listening to verify and clarify comments made by both parents, to support consideration of both viewpoints. She considers how she will identify if the father is becoming annoyed and have flexibility in her plan to respond at that time, if needed; • Tarri considers advising both parents by email what the plan for the session will be, including that there will be expectations for appropriate behaviour and communication between all parties, and that any angry outbursts will not be tolerated, and the person will be asked to calm down or leave; and • She also plans to tell the parents that she will be emailing them both after each session, with an record of the session and home practice activities to continue with, so that both parents know they are receiving the same information and not being left out. What is the background story? What do the characters perceive as important factors in their history? Apart from medical history, what other past factors may influence a client’s current values and choices? The mother is willing to seek help from a speech pathologist, as Nia is ‘not talking very much’, but she is not willing to consider that Nia may have other significant needs or consult with any other health professional at this time. The mother has reported that the father does not think anything is ‘wrong’ and during their phone conversation the father indicated to Tarri that he is angry that Nia has been seen by a speech pathologist, which would support the mother’s comments. Tarri considers that the parents’ reactions to Nia’s difficulties are influenced by their cultural background but may also be influenced at present by the tension due to the recent separation. She is aware that she should not jump to any conclusions regarding the influence of either factor but needs to be open to understanding their influence on the decisions the parents will make regarding gaining help for Nia. Tarri has found a local community support group for immigrants from the family’s country. A brief initial discussion with the support worker has identified that cultural attitudes towards disability are strong and may restrict the parents’ acceptance of significant diagnoses and their willingness to seek support.

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December 2018 www.speechpathologyaustralia.org.au

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