Speak Out December 2018

Narrative approach worksheet

What is the current story? What are the client’s concerns and goals? What are the roles and responsibilities of other people who are part of the client’s life? What options do interdisciplinary health professionals bring to the story?

Nia presents with significant communication difficulties and other, as yet undiagnosed, areas of concern relating to her development. Tarri is aware that Nia would benefit from assessment and intervention from a range of health professionals, however the mother is not willing to consider that at present. Nia’s mother is wanting speech pathology intervention to help Nia ‘speak more’ and has no other goals to address Nia’s difficulties beyond that. Tarri has begun to develop a trusting relationship with Nia’s mother, and will work towards developing a positive relationship with Nia’s father. Tarris considers that, if the parents’ trust in her as a health professional can develop further, the parents are more likely to consider and agree to her suggestions that Nia receive further assessment and intervention. Tarri is aware of her responsibility to develop her knowledge and awareness of the cultural influences on the family. She is aware that the parents may disengage from therapy altogether if she takes a firm stance on insisting that other health professionals are consulted at this time. With the parent’s consent, Tarri intends to continue to collaborate with the teacher, who may be able to support Nia’s parents’ understanding of the benefit of further assessment from other health professionals. She will maintain appropriate records of all therapy sessions, meetings and discussions in Nia’s clinical file, and accurately record all decisions made by the parents. Tarri is also aware of her responsibility to make sure she has sufficient knowledge to provide benefit to Nia in her therapy sessions, particularly if she is the only health practitioner the family will engage with at present. She identifies that she needs to learn more about interventions that are beneficial for the level of disability Nia is displaying – up to now she has only worked with children displaying mild autistic features. Tarri downloads and reads the SPA clinical guideline: Evidence Based Speech Pathology Practice for Individuals with Autism Spectrum Disorder. She searches for any CPD events coming up in the next few months on this topic, and looks at the SPA library for recorded webinars that she can view, then consults with the SPA online community for ideas of key resources to support interventions for this population. She also offers to present Nia as a deidentified case study at the next network event in two weeks, to learn from discussion with her peers. How can the client’s choices be incorporated into planning future management? How can I actively support the client to achieve his/her most positive future story? How can I retell the client’s story in a coherent and respectful way so that members of the health care team provide intervention consistent with the client’s goals? Through the ongoing development of the parents trust in her, Tarri will hopefully engage the parents in understanding Nia’s difficulties, and support them to develop an understanding and acceptance of how further assessment and intervention from other professionals will be of benefit to Nia. There is a risk that if Tarri is not sensitive to the factors influencing the parent’s decisions, a worse outcome will be realised, i.e. the parents will withdraw from accessing any support. By working collaboratively with the family, understanding the cultural and personal influences on their decisions and developing her own knowledge of those influences, Tarri will demonstrate her respect for their story and how their experiences impact on their choices for their daughter. Tarri will continue to seek professional support to develop her own knowledge and skills to ensure she can provide appropriate interventions for Nia. If she achieves her goal of supporting the parents to seek further professional input, Tarri will endeavour to pass on objective information to those health professionals to assist them to be aware of and consider the cultural influences in this situation. Tarri will also seek out family-based culturally responsive services in the local area, that may assist and support the family during the current time and into the future. What is the future story? What are the possible outcomes for the client?

Trish Johnson Senior Advisor, Ethics and Professional Issues

30

December 2018 www.speechpathologyaustralia.org.au

Speak Out