Karen Davies Manchester Metropolitan University September 2012 Transforming partnerships between parents and SLTs

Literature review of models of partnership practice 1. Rationale for studying roles of parents and SLTs Parents’ experiences Policy imperative Lack of consensus 2. Reviewing the evidence: models of practice from a range of disciplines 3. Building the evidence 4. Challenges

Rationale

Parents’ experience Most depressing aspect is that your child is treated as a ‘case’ or ‘object of analysis’ Bercow 2008 When seeking professional support: ‘I was like a blank canvas-I wilfully suspended my instinct’ Parent 2012

Parents’ experience-suspending instinct “because they see professionals as a source of expertise that could help them to interpret and understand aspects of their children’s behaviour.” (Hodge and Runswick-Cole 2008)

Parents’ experience-where does the power lie? ‘...the ideal of partnership with professionals is brought into question by the realities of the power equation’ (Band et al., 2002)

Policy imperative (DfE 2011) ‘Include parents in the assessment process and introduce a legal right, by 2014, to give them control of funding for the support of their child needs ’.…so that parents are at the heart of any discussions or decisions about their child give parents more control

Lack of consensus about the purpose of partnerships and envisaged roles of partners within it (Pinkus 2003) Speech and language therapist Parent

Reviewing the evidence

Models of practice Describe and explain the different roles and relationships that exist between parents and professionals.

Models of practice: what informs what we do? The challenges of working with parents The challenges of working with therapists

What informs parents’ practice? Want Know Do

Reviewing the literature using realist synthesis (Pawson 2006) Features: 1. Identifies the theories that underlie health interventions 2. Systematically evaluates the evidence to test and refine the theory 3. Emphasises context 4. Draws on wide sources of evidence often omitted by tight criteria used for systematic reviews 5. Iterative process

3 models of practice

Professional as decision maker Parent and professional negotiate decisions Parent as decision maker Paternalistic Shared decision making Informed choice

Professional as decision maker Professional and parent negotiate Parent as decision maker How is the SLC problem identified How is the intervention decided Who is responsible for implementing the intervention Who is responsible for monitoring progress? Variation in decision making roles over assessment and intervention phases

Shared decision making Negotiated decisions Relationship centred Building alliance

Reviewing the evidence-the tensions

Tensions emerging from the evidence SLTs assume the decision making role, but believe they provide family centred care (Watts Pappas 2009) Mismatch between expectations of parents and SLTs More experienced SLT clinicians give less choice to parents as decision makers Parental satisfaction in SLT not related to parental participation in choosing therapy goals (Australia)

Some patients have prefer the professional to be decision maker Expert led, child focused assessment is recommended professional practice-who is the decision maker? Expertise plays an important part in advice seekers adapting their behaviour-expertise invests power and encourages trust

Building the evidence

Exploring the implications for SLT The perception- practice gap in involving parents in decision making Gap in knowing what parents want-what roles they want during intervention Research questions Conception of roles? How do these change? How are they linked to actions? Influence of service characteristics?

Phase 1: First SLT appointment Interview 12 parent-SLTs dyads Interviews take place separately Follow up at 6 and 24 weeks Phase 2: Survey based on findings of phase 1 Questionnaire: 80 parents and 40 SLT Study design: longitudinal qualitative study

The challenges  Ethical and research governance approval  Overlapping and confusing terminology  Scope, relevance and quality of the literature  Limitations of self reporting

Models of practice

Acknowledgements Thanks to parents and professionals who have provided insight and advice in planning the research Thanks also to the supervisory team at MMU: Julie Marshall, Juliet Goldbart and Laura Brown Child Talk-What Works presents independent research commissioned by National Institute of Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG )