A few days ago, we took our daughter to see a health professional for an initial assessment. As someone who sees families regularly to take a case history and assess a child, it was interesting being on the other side of the process. I should point out before I start that we were really happy with both the assessment and the health professional, and none of what I have listed below is in any way a criticism of anything that happened. The person we saw did all of these things really well; they are just things I thought about afterwards.
Elizabeth posted this really useful post a few months ago giving advice to parents about what to tell your therapist at the assessment session and beyond. Here are a few thoughts for therapists that were highlighted to me again about carrying out initial assessments.
- It’s really important to make people feel relaxed and comfortable with you. This is even more true if you’re in a clinic room or somewhere that is unfamiliar to the family. Not only was my daughter distracted and a little overwhelmed to begin with in the new environment, but I found myself distracted for the first couple of minutes as I took in my surroundings and got comfortable in my chair etc.
- Ask open questions and give people time to explain their concerns. As a parent, it can be really difficult to remember everything you wanted to say, and all the significant things about your child’s development. We are very fortunate, in that our daughter’s developmental and medical history are pretty straightforward, but I still found it hard to remember when particular things happened. As a therapist, I try to encourage people to bring any baby books they have, or their red Child Health Record book with them to an appointment to help them remember developmental milestones. As well as this specific information however, I think the general conversation that takes place about a child is often just as important. Often a parent will mention something in passing which turns out to be really relevant, and giving them space to talk helps me to see what is concerning them the most (which may not be the same as what is concerning me the most).
- Remember that you are only seeing the child in one (fairly unnatural) situation. Children will frequently behave differently in an assessment session to how they do the rest of the time. This can go either way; sometimes children will be overwhelmed or shy and reluctant to do things the parents know they can do. Other times, they will choose that moment to show a new skill for the first time! I have frequently had both of these things happen in assessment sessions that I have conducted. As a parent watching it, there is a natural feeling of frustration and worry that the professional is not getting to see your child as they usually are. When I do initial assessments, after playing with the child and carrying out any specific assessment tasks, I always ask the parent directly if their child responded the way they expected them to. I think it’s really important for me to make people aware that I do understand that what I see in the assessment session may be unusual, and respond to what I am being told as well as what I see. Both are important, and play a part in getting a full assessment of a child.
- Explain conclusions and follow up activities clearly and (if appropriate) give or send parents something written down to take away. It is easy to hear and understand things at the time, but forget them later. We were fortunate to discover that there was no reason for major concern about our daughter. However, we have been given things to practise at home with her. This is a very common outcome of SLT appointments, and home practice is a brilliant way of helping many children. However, it’s important that I am really clear about exactly how to do what I am asking parents to do. I found it very helpful to be shown each exercise so that I could see how it should be done, and to have it explained to me how and why it was going to help. We were also given a written sheet with diagrams to take away. I am sure that without this, I would have forgotten what had been said as soon as we left the room! Sometimes, as an SLT, I need to suggest practising something that does not seem to directly relate to what a family are concerned about. For example, for some late talkers, I may recommend working on attention and listening skills before working directly on speech. It’s important that I explain why the skill I am targeting is going to help. Home practice is also hard work. It’s hard to keep a child motivated to carry on doing something. It’s important that I acknowledge that as a therapist, and do everything I can to help the family work out how they can fit the practice into their lives and to give ideas about how to keep the activities fresh and interesting.
- Don’t overwhelm people with information but direct them to where to find more if and when they want it. The internet can be both a blessing and a curse! It was fantastic to be able to come home with greater knowledge about what is causing the difficulty and “google” it to find out more. However, anyone can publish anything they like on the internet, and it’s hard to know what is good information and what is not. It’s important that we help people to find what is useful, without being distracted by misinformation. With most medical things, you can very easily find a worst case scenario on the internet, which can be scary when you only have a little knowledge and are searching for answers. Knowing a good book or website to start with can be really handy.
SLTs – have you ever been on the other side of the assessment process? What did you take away from the experience to help you in your work? Parents – what do you think is important for professionals to do when assessing a child? It’s something I’m constantly trying to get better at and would love to hear what you think!…