[Robyn Tacon]

#89409

although this example is not from my experience in palliative care, I feel it can definitely be applied. (and on thinking about it now – some big self-reflection happening!)

in our paediatric practice we have a number of discipline including physio, to, speech, ed psych, dietician, paed, homeopath, chiro. usually when we have a new patient referred, and especially if they need more than one discipline (this doesn’t usually involve the doctors) we start our process with a completely separate intake interview with the parents/caregivers. Personally I tell whoever made first contact that they may bring or invite anyone who plays an active role in childcare, eg child spends every afternoon with granny, less bring her.
during this we discuss all the medical, developmental, schooling, etc history. their concerns and goals. we then explain the basics of what we do, how muscles work, and whatever is appropriate for that situation. eg. I’m not going to talk the GMFCS scaled with the parents of a child diagnosed with EDS. we also go through things the child likes/dislikes etc and what sort of praise/enouragement works best for them, so that we can use that too.

in this meeting the parents are made to feelheard (hopefully) and the start of relationship forms. if its an online meeting sometimes the child will pop in and meet us too so they know they are involved. if its in person, I ask the parents to show them a photo of me so they are prepared for who they will be meeting with for assessment.

during the assessment the parent/careiver can sit in, but we actively ignore them! unless the child brings them into the activity. the child has our utmost attention. i usually try to video the entire thing and make as few notes as possible so that the child really feels connected with. i can go back later and analyse video, write notes on it etc. if I’m measuring angles or something I will talk them out load so that the video captures it :) I have found that the kids are so much more engaged, want to take part, and want to come back!! if the parent asks questions during I politely tell them that we will discuss it at a later stage and once I’ve put it all together. (they were told in first meeting that the were going to ignored during assessment session :) ) if the child is old enough and has understanding of the need for therapy intervention, we chat about their difficulties and their goals, and set a plan together on how we are going to get there.

following later we have a feedback session, revisit the gals of the parents and structured new or teaked (or the same) goals for the whole team going forward. Depending on the age and needs of the child, we also set these goals with them, and encourage parents to have discussion with them around it.

sadly I note that in hospital settings, I don’t find myself doing this !! and I’ve just caught myself out on that! we go to the bedside following referral and off we go. Yes we have some discussion etc with child and family along the way, but the start off is never as good. I am determined now to work on being better!!

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