Communication
Situation
I was with my supervisor conducting a home visit to one of the disabled children the practice provides services to. It was after school and the childs mother had just gotten home from work herself. The appointment time was the only one available given the other commitments of both parties. We arrived at the home, and the husband who works on a mine in the far north, was home at the time. He has a fly in fly out roster of two weeks on, one week off. It was clear from when we arrived that there was some tension in the family household. The mother answered the door flustered and somewhat perturbed. The mother, father, disabled child, and her sibling were all at home, along with myself, my supervisor, and the occupational therapist. The family had not long moved from Perth, and were temporarily living in a small unit, until the building of their specially built home in a nearby area was completed. The two and a half year old sibling seemed to be agitated and wanting attention from his mum, who’d not been home long herself. The visit was limited in time due to the OT needing to be back at the office within a restricted time frame (own childs appt).
Task
Our objective of the visit was to alter parts of the wheelchair foam which required replacing, check the childs AFO’s, and problem solve what other requirements the child may need in her new (temporary) home. I was to assist in the measuring of the wheelchair and childs dimensions, but also observe, given it was my first week, and it being the first meeting of the family with the full allied health team. I was keen to observe what sort of questions were asked, and begin to familiarise myself with the different needs disabled children have, and the various services available to families eg funding organisations for specialist equipment.
Action
Because the unit was so small with the number of people present, and the obvious tension between the mother and father at the time, I made sure I kept myself well clear of being in the way, and attempted to subtley distract the younger sibling by flicking through one of his nearby books etc, to allow the mother to discuss with the OT and physio what her concerns are currently. The OT and my supervisor clearly revised their aims of the session (as discussed in the car on the way), and spent some time listening to the mother and generally allowing her vent her frustrations.
Result
Because the mother was primarily the one looking after the child, many of the concerns came from her. She mentioned a number of pieces of the childs specialist equipment from her last school in Perth, did not come down to her new school as it was meant to. This was a great frustration to the mother and it appeared that numerous of her own phone calls were unable to locate the “missing” equipment. The result of that concern was that the OT would seek out where exactly the equipment had found itself, and update the mother as soon as possible. Another concern was that the mother was still manually lifting her child from her chair into the shower. This was causing her some physical stress, yet upon assessment, the bathroom was not large enough to allow a hoist to assist with transfers. My supervisor stressed to the mother the importance of looking after her own back, and offered a refresher on manual handling skills, which she agreed to. One of her concerns also included the small size of the unit. This was obviously temporary, and not something that OT or physio could address, but she mentioned it and it was subsequently acknowledged.
Evaluation
It was clear in this situation the importance of the “family-centred approach” and the “biopsychosocial” model in assisting this family. Emotional stressors were a large part of this situation, some of which could be addressed with the allied team help, others could not be. The team had to adapt as to what would be achieved during this visit. It was more important to connect with the mother and family and listen to her/their needs. Rapport building is so important in situations such as this, as a negative experience with therapists inadvertently affects the child who really needs the help. After listening and discussing with the mother, she became more relaxed, and expressed her apologies in her regard on our entering the house. I saw the team really working with the mother. Had they gone in guns blazing with solutions and advice without listening, I’m sure it would have been a different outcome.
Strategies
While I had minimal input in this situation (I couldn't have done anything more really), I certainly took note of how this situation was managed, and how it could well have turned out differently. Listening skills were utilised here, as you would in most situations, but I think it really was effective listening. Allowing the mother to vent her concerns, without being interrupted by therapists with obvious solutions allowed the mother to feel acknowledged. Being supportive throughout the visit (without being false or patronising) appeared to appease the mother and soften her mood. I think keeping in mind that any tension felt from the mother, may in fact have nothing to do with you, as they have their own lives and all of it’s variables is also important. I saw non verbal communication ie open body language, being used in this instance, and it being reciprocated by the mother (after some time). Being adaptable to a changing situation was vital also. The foam was replaced on the childs chair and AFOs checked, which was enough achieved given the situation. Apart from seeing the above unfold, I myself kept the younger sibling entertained during the visit. This was one minor contribution I could actually make, and I think it did in fact help with the mothers space and ability to chat freely, without him all over her. Overall the importance of appropriate and effective communication was clear in this instance.
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