A presentation entitled “Integrating strength-focused approaches into the FASD assessment process” is presented by:
- Dr Natasha Reid, research fellow at the University of Queensland and clinical psychologist; and
- Ms Maree Maloney, occupational therapist and clinical educator at the University of Queensland
NATASHA: OK, good morning.
MAREE: Good morning.
NATASHA: I'm Natasha Reid, I'm a research fellow and clinical psychologist here at the University of Queensland.
MAREE: And I'm Maree Maloney, an occupational therapist and clinical educator at the School of Health and Rehabilitation Sciences, and I work in the clinics at the University of Queensland.
NATASHA: So we're going to give you a quick run through of a couple of practical things that we do in our clinic to help to bring in strengths-focused approaches into the assessment, feedback and report writing. We've only got five minutes so it's going to be a really quick whip through of a couple of ideas for you - and by no means do we think that these are perfect - and then we're going to have a video from one of our parents and one of our young people, so they're the real stars of the show, and then we'll be online to answer any questions for you.
OK, so the first thing we'll tell you a little bit about is the assessment process. So, in the assessment process we bring in a number of different activities to try and highlight some of the strengths that our children and young people have, but also to really acknowledge and bring in their preferences and interests and likes - and learn about their dislikes as well.
So a couple of ideas for you, one of the tools that we use is this adolescent goal-setting tool which is actually a tool developed by Autism Queensland. So we take out any of the cards that are not relevant and we use that with the young people to help give them a voice and hear things from their perspective and it talks you through, you know, what are the things that you can do at the moment, what are the things that you'd like to be able to do more of, and it usually brings up opportunities to say what are the things that you don't want to do, so that's something that gets quite highlighted for us, and as you can see there the picture is a resource from that, and they're really beautiful resources.
Some of the other things that we bring in- there is more of a standardised tool if you're wanting to use something like that - so that's the CAPE and the PAC, so that is a tool that we've also trialled in the clinic, and then we also have a range of resources which our wonderful OT colleagues have developed.
MAREE: Well mainly the students did the card sorting, yeah.
NATASHA: Yeah, so they have some really nice card sorting activities particularly that we've been using with younger kids to again bring in those opportunities to hear from the child's perspective. And then we also have a range of functional tasks that we integrate into our assessment process, so some of these things might be like lunch making tasks, the OT students do some really cool activities – and in these tasks the children don't know that they're actually getting assessed, and it's really fun – so I think that's the other thing that I love about what we get to do, is the kids don't realise they're doing assessments and at the end of the assessment process they don't want to leave.
MAREE: No, they do want to come back, they build really nice relationships with the team.
NATASHA: It's really cool. So, some of the things that the OTs might do are things like recently, last week they were doing slime making.
MAREE: We've also done some community access with some of the older ones.
NATASHA: Catching public transport nearby and things like that.
MAREE: Ordering food.
NATASHA: Ordering food, yeah, in public. Yeah, so all sorts of different activities where they could be looking at their real-life abilities, you know, in terms of executive functioning, looking at planning, organising, tapping into some of those everyday sort of life skills and this gives us really rich information for their NDIS reports as well, so also looking at strengths, but then it also enables us to get some really rich observations that are helping us with our NDIS reporting.
MAREE: And I think the functional tasks really complement sometimes the more standardised assessments, it makes it clearer what it actually looks like.
NATASHA: Yeah.
MAREE: All right, so this is our feedback process, I'll talk about that. So what you're seeing is our strengths tree which was actually done by one of our young children, I think she was about 10 or 11, and craft was her thing, that's what she really enjoyed doing.
So we have four key components to feedback - we have the child or the young person actually receiving feedback, and this is done, for this example [using] the strengths tree, but there are other ways in which we can do it depending on the child's interest, or their age, or their culture. So this one was a craft, it's a collage, we've got the flowers, as you can see there's a purple and a green and I think a pink - they are actually the child's supports or who they identify as someone who helps them; and then we have different colour leaves, and again it's open to the child's choices, so the green leaves are usually things they see that they do really well, they're the ones that are being nurtured quite well, and the ones that are yellow are the ones we're still working on, we're still trying to develop. We don't see them as deficits, but we just try and identify some of the things that we might have picked up in our observations that's actually relevant and meaningful to the child. As you can see there's fluffy clouds up at the top and there's a sun - and there's some extra things that have been added to the flowers - and that's to distinguish the different people, so it's like hair and characteristics of that person, so that was very successful. Then the child actually uses this tool to explain to their caregiver what they can see is their strengths and what they can see that they're still developing and they still need help from all their supports.
We also give caregiver feedback, and that's usually done without the child or the young person in the room, and we go through a little bit of an outcome table and we talk about all the different neurodevelopmental domains that we have assessed, and we talk about the strengths around those areas, as well as what we've found that might be areas to consider for further intervention or NDIS funding, so we talk about that. So this process can take quite a long time, but we find it is really, really beneficial; and it's very useful for understanding and also shifting our thinking about the child's behaviour within the family and the school. We also do school and other key stakeholder feedback, sometimes that can happen with the caregiver, most of the time it actually happens outside of that process of the child feedback.
I think that's usually by phone call or Zoom, of course we're in COVID at the moment so a lot of things are being done by Zoom or online.
NATASHA: OK, so just to give you an example of one of the resources that we use with the caregiver and the child - so this was developed by Jacob and it's a beautiful resource that he put together for us. So you can see in the middle there is actually – so it's actually a card, I've just cut it so you can see each part of it – so on the front there is a photo that he's taken, and on the right there is a message that he's written for children and families and then we also have a little bit about Jacob and his story, and so we put that inside the card and we give this to all the children and the parents when they do get a diagnosis, and we explain about Jacob and that he has FASD, but that hasn't stopped him from being able to do the things that he's really passionate about. And this has been a really big thing for families and a lot of caregivers have said to us afterwards, what a big difference, having this as part of the feedback process made for them and their child. So we really are grateful to Jacob for putting these resources together and it's been a wonderful thing we've been able to include.
MAREE: Though sometimes it can be quite emotional, but...
NATASHA: Yeah.
MAREE: It is quite nice especially if the children read out the card themselves.
NATASHA: Yeah depending on their age, if they're a bit older and they're very capable with their reading we've had the child read it out and then nearly everyone in the room gets quite emotional and – yeah -
MAREE: Yeah, it's a great resource.
NATASHA: It's been powerful.
MAREE: It's a nice shared experience I think, when they receive their diagnosis and then to have this to back it up.
NATASHA: Yeah.
MAREE: OK, our last little one for you is our report process, so I'll be talking to this one. So we have two reports [that] we provide. This is a student-led clinic as well so we supervise students, so there's a lot of teaching and learning happening as well. But we do [a] strengths-focused, family-friendly report, so we try to use language that is positive and strength-based, we try and not use any psychobabble or anything that is going to be too difficult for people who are reading the report to understand. We don't put numbers, scores, or anything in there, and what we're trying to do is put practical recommendations, we're trying to highlight the child's strengths to start with and how they actually do tasks, then we may talk about areas that need further development and recommendations. Very specific for day-to-day tasks but also for ongoing intervention and planning.
So from the strengths-focused one we do our NDIS report, and due to it being for funding we are required to look at deficits, so we do really focus on that as well, we do it within the domains of functioning that NDIS has recognised and how they like the information to be presented. So we talk about their impairments and then the functional impacts of those impairments, and what supports we would consider, and this is very collaborative, it's not just with the psychs and me but it's also with the other stakeholders and the parents and the family. So we look at what the child has had in the past or is currently receiving, what is being beneficial, what we may see or talk about which may help, so that might be other allied health professionals or just some more support within the home just to get through the day.
NATASHA: OK, that's all we have for you!
MAREE: That's right.