JCPSLP Vol 17 No 3 2015

Australia, participated in this study. Upon receiving ethical approval, educators were recruited to the study through purposive sampling. Purposive sampling was employed to ensure participants recruited could share meaningful data on the research topic (Creswell, 2014). The eligibility criteria based on the research objective were (a) educators who were working in a childcare centre, (b) educators who had worked directly with children and families at the centre, and (c) educators who had developmental concerns about a child in their care. Upon receiving consent to participate, pseudonyms were allocated to participants to ensure confidentiality. A predetermined sample size was not established for this research. This allowed for gradual selection of participants to the study (i.e., recruiting educators who met eligibility criteria while continuing the preliminary analysis as per established qualitative methods). Gradual selection of participants occurred until saturation of data was reached. Guidelines and descriptions relating to how saturation may be determined in qualitative methods of inquiry other than grounded theory are not consistently documented in the literature (Guest, Bunce, & Johnson, 2006). Data saturation in this study was defined as the point when participants raised no new themes/topics in interviews (Guest, Bunce, & Johnson, 2006) and at this point data collection ceased. Procedure Participating educators each identified a child for whom they had developmental concerns. Educators approached families to consent to involvement in the study and families were informed that their participation would involve 1) completing the developmental milestone sections of latest CHR (2013 version) and 2) a discussion with the educator around their child’s development, progress, and concerns. Consenting families received a copy of the latest CHR from their educator and were given time to provide developmental information in the My Health and Development section of the South Australia CHR about their child (e.g., talking and connecting skills, movement and activity skills, fine motor skills, problem solving skills, socialisation skills). Families returned the CHR to the educator. Educators used the information in the completed section of the CHR in preparation for a conversation with parents to communicate their concerns regarding the child’s development. Educators each organised a time with their participating family to discuss the information provided in the CHR regarding the child’s development and their concerns. Staff were encouraged to adopt their own professional approach when engaging in the conversations with parents regarding the child’s development. Concerns raised with parents by the educators were primarily regarding communication skills/development. Following the conversation with each family, each educator participated in a face-to-face interview with the first author, exploring the utility of the South Australia CHR when conveying developmental concerns to parents. A semi-structured format with interview guide was used (see Appendix). Interview length ranged from 11 to 31 minutes. Interview duration varied with each educator, depending on the depth of information each educator provided and their experience with identifying concerns. Interviews were audio-recorded on a Sony ICD-AX412F portable digital recorder and transcribed orthographically by the first author. Analysis Interview data were analysed using Braun and Clarke’s (2006) framework for thematic analysis. This qualitative analytic technique establishes description and understanding of the

topic under investigation through the development of categories and the emergence of themes from the data (Braun & Clarke, 2006). The following steps were undertaken to produce a thematic analysis: 1) coding the interview transcripts (labelling the features of the interview data related to the research question), 2) grouping similar codes in categories, and 3) collating categories with a shared central concept into themes. Interview transcripts were coded inductively and categorised using NVivo 10 (QSR International, 2012). To ensure robust analysis and that participant experiences were represented accurately (Creswell, 2014), the first and second authors completed dual coding and cross-checked themes with the third author. Discrepancies were discussed and consensus reached. Results and discussion Thematic analysis revealed two themes related to the research question: Supporting difficult conversations and Challenges . Supporting difficult conversations The educators in the study reported the CHR to be a valuable support for conversations with parents in a variety of ways. Four categories, examined below, emerged from the data, outlining how educators were supported in these situations (see Figure 1). First, the participating educators reported experiencing positive feelings associated with having the CHR available as a resource to refer to during conversations with the parents. In comparison to previous experiences communicating concerns to parents they reported feeling supported and more confident to engage in conversations with the CHR present. I get quite a bit of anxiety before speaking to parents so this way I just had the reassurance myself of what I was doing and what I am trying to achieve... it just gave me a little bit of confidence or more confidence going up to the parent. (Carly) Other benefits reported by the educators included being “on the same page as parents” due to referring to the same resource and information, allowing gaps in development to be easily identified by both parties, and that the information and examples in the CHR facilitated parents’ understanding of their message(s). They described the CHR as allowing the focus of the conversation to gradually reach their concerns. This contributed to having more successful and constructive conversations as well as feeling supported. Having the book 1 with me when we were having the conversation ... was a good sort of talking point. (Sally) Participating educators recognised the CHR content as being useful, particularly the parent-friendly, shared language that facilitated understanding and enhanced interactions. I think having the blue book as a tool to start with really helped break down barriers, so we had something in common to look at to share the information and I think Supporting difficult conversations Educator feelings Conversation CHR content Experience with parents Figure 1. Theme 1 – Categories within the theme Supporting difficult conversations

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JCPSLP Volume 17, Number 3 2015

Journal of Clinical Practice in Speech-Language Pathology