Question #1. What are the strengths and drawbacks of the team approach?
The team approach is critical, including engaging the student’s family as part of the team. The team approach facilitates the contribution of each team member’s knowledge and experience, via a collaborative, consensus building process, towards the AT decision-making and developing the best strategies to support the student. Occupational therapists contribute knowledge about positioning and physical capabilities; speech pathologists contribute knowledge regarding communication capabilities; teachers contribute knowledge about curriculum and the classroom environment; AT professional contribute knowledge about the capabilities of AT; students and their families contributed knowledge regarding contextual factors, such as home routine, cultural perspectives, support outside the school, desires and objectives. This diversity of experience and knowledge that each team member brings is an important strength. A team approach maximizes the capacity for the involved professionals and the family to serve as resources for each other through the decision-making and implementation process.
For instance, engaging the family may allow for the contribution of important insights regarding training preferences and needs, as well as contextual factors that may be potential barriers to training and AT acceptance.
A team approach that employs systematic support structures in its assessment activities is more effective at selecting and implementing AT. (Parette, et al., 2000).
Zabala’s SETT framework encompasses/facilitates a team approach, comprising the interconnected areas of student, environment, team and technology. Interconnectedness is the key point here; i.e. the interconnectedness of these four areas, and the interconnectedness of the multidisciplinary team as it works through the consensus building process effectively guided by the SETT framework. (Parette, et al., 2000)
The consensus building process – an ideal aspect of the team approach – would embody equity in terms of team members’ contributions and participation in the decision-making process. Consensus building provides a mechanism for empowering the user and family as active participants, rather than imposing/adopting passive participation. It would also empower other team members who may have limited or no experience or knowledge regarding AT. A process such as SETT can help to prioritize non-technical knowledge and consideration that impact AT decision-making and implementation.
Engaging families equitably in the team approach may help families to feel greater confident regarding the value of their knowledge and experience, which may encourage them to contribute to information resources such as the QIAT listserv and other internet/multimedia resources. Since families generally prefer receiving information and training from other families, (Parette, et al., 2000) the engagement of families as contributors to information resources may not only enhance what resources are available, but may also enhance the perceived credibility of the resources which could result in families’ increased usage of those resources. It may also increase the effectiveness of these as resources for use by professionals, as it could enhance professionals’ understanding of family perspectives. (Parette, et al., 2000)
Each team member has their own knowledge, expertise, experience, values and cultural perspectives. While this can be a rich resource to draw upon, there is also a risk that there may be miscommunication between team members, especially between family members and other team members with respect to decision-making. Team members need to be open-minded, and the team approach must facilitate two-way communication flow. For instance, consistent with their cultural practices, a family may defer to the preferences of an AT professional in the decision-making process, rather than advocating their own values, perspectives and preferences. (Parette, et al., 2000)
Team members who are professionals may not work towards facilitating meaningful engagement of the family as part of the team, which may serve to impose a passive role on the family. For instance, completing questionnaires does not represent meaningful engagement. (Parette, et al., 2000) Lack of cultural sensitivity on the part of team members can undermine the consensus-building process and impose passive roles on certain team members. Lack of cultural sensitivity can also prevent contextual barriers to AT success from being identified and addressed; i.e. the professionals on the team may not understanding the contextual factors that influence the family in the AT decision-making and implementation processes. (Parette, et al., 2000)
I would also add that literacy and language issues could pose a significant risk.
Question #2. To what extent should the family be involved?
Families are experts with respect to daily routines, available supports outside the school environment, intimate knowledge regarding the student’s capabilities, desires and life goals, and potential social, cultural and environmental factors that may influence the successful implementation of an AT for the student. Regardless of the expertise of the AT professionals on the team, this contextual knowledge that can only be contributed by the family is critical to the team’s overarching goal of findings identifying an AT that best meets the needs and supports the student. Therefore, family involvement on the team, with equity in terms of contributing knowledge and participating in the decision-making, is imperative.
The student/user should be considered as being embedded within the context of his/her family (as well as the broader social environment). Contextual factors relating to the family environment and culture are critical influences that either support or undermine the successful implementation of AT. By understanding and taking into consideration family issues that are not generally included in the AT assessment process, it may be possible to identify critical loci for family support or lack of support. For instance, if the family lacks capacity of time for AT programming at home, then AT that requires frequent programming updates would be likely to fail. However, AT that requires little programming maintenance would better match the family’s capacity, and would therefore successful adoption would be more likely. In terms of the influences of culture, for instance, individual achievement and independence may not be prioritized as a value, and therefore that student’s/family’s AT objectives may differ from those of professionals who may hold individual achievement and independence as a high priority; by not engaging the family in a meaningful way in the decision-making process, this difference in perspectives may result in an AT choice that does not fit within the student’s/family’s cultural context, and may therefore fail. (Beigel, 2000; Parette, et al., 2000). Cultural difference may also impact training needs and preferences, and engaging families within the team approach will help identify these and facilitate them being addressed. (Parette, et al., 2000)
Since families tend to prefer receiving information and training from other families, families who have experienced the decision-making and implementation process can serve as peer trainers for other families or can contribute to other resources such as online forums, etc. (Parette, et al., 2000) This is a peripheral but an important outcome of meaningfully engaging families.
The article for this week’s forum describes a number of computer-based resources for training, information, etc., which can be especially useful for families, and for team members who have lesser experience with AT, because these resources can allow for user-set preferences, such a speed. For the more the team members more experienced with AT, these resources can deliver cultural awareness training, sensitivity towards the family’s perspectives, etc., which will ultimately inform the AT decision-making process. (Parette, et al., 2000)
Engaging families as team members may also serve to provide access to resources vis-a-vis the team network. The resources may not otherwise be available. For instance, Parette et al. (2000) describe how access to computer-based resources can be facilitated for families by allowing them access to school computers.(Parette, et al., 2000)
A team environment can help to identify needs and appropriate ways they can be addressed, and can facilitate resource sharing such as families accessing resources via school computers.
Engaging families as team members provides opportunities for communication of family needs, preferences, etc., and exposed the other team members to the family’ culture and other contextual factors. Working through the processes of consensus building via the team approach confers an onus on the professionals / more experienced team members to engage in activities such as cultural awareness training (ex. via the resources described by Parette et al. ), to gain a better understanding of the family’s perspective, with the goal of enhancing AT outcomes for the student.
The most appropriate way to ensure contextual factors are effectively identified, considered and addressed is to meaningfully engage the family in the team approach.
Question #3. Is the family-centred team approach consistent with what you’ve experienced in your practice?
I have not yet had experience with AT decision-making for students who have special needs. However, I was involved with the case of a young child who required support that involved administering medications and the monitoring of certain health indicators on a schedule throughout the school day. The child was to attend a new school in a rural area, and a team approach was used to help the school develop the capacity needed to support the child. The team included the child’s family, the school district, principal, teacher, educational assistant, school kitchen staff, as well as a nurse and dietitian from the community’s health centre. A specialist doctor from Edmonton was also consulted. The family and nurse were able to contribute knowledge with respect to what the teacher and educational assistant could expect in terms of daily routine. The child was consulted, and helped in the process by demonstrating self-care capabilities (i.e. what aspects of the daily routine could be undertaken independently). The nurse and dietitian provided the educational assistant with training for administering the medication and monitoring health indicators, and provided training to the kitchen staff with respect to providing appropriate nutrition for the child. This process didn’t involve consensus building amongst team members with respect to what devices and care were required. Rather, it was a process that facilitated the two-way flow of information and support, and the contribution of knowledge from a number of experts, towards building capacity within the school for supporting this child. Engaging the family was not only critical to providing information and training, but also to providing the school with a sense that they could rely on the family as an ongoing resource. The willingness of the family to be involved helped to increase the school’s confidence in its capacity to support the student. So, yes, I see many similarities between the processes I experienced and those described in this week’s forum.
Much of my research current activities involve collaborating with First Nations communities. Project development is informed by the Tri-Council Policy Statement (TCPS-2) regarding research involving Aboriginal peoples in Canada. (CIHR, NSERC & SSHRC, 2010) I see many similarities between this collaboration process and the processes described in this week’s forum. In particular, the facilitation of meaningful engagement, sharing of perspectives and reconciling differences. Through the collaboration / consensus building process, the stakeholders strive towards the creation of “ethical space”, which is the point where stakeholders’ perspectives and viewpoints overlap (i.e. share commonalities in terms of values, goals, etc.) but do not undermine or defer to each other. (Ralph-Campbell, et al., 2012; Garvey, et al., 2004; Turner, 1999) The process involves a two-way flow of communication whereby each stakeholder shares its values, objectives, needs, etc., and commonalities are identified, then a plan is developed incorporating these.
Beigel, A. R. (2000). Assistive technology: More than the device. Intervention in School and Clinic, 35(5), 237-243. Retrieved from http://web.archive.org/web/20050308113347/http://www.ldonline.org/ld_indepth/technology/at_assessment.html
Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada, (2010). Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Retrieved from http://www.pre.ethics.gc.ca/pdf/eng/tcps2/TCPS_2_FINAL_Web.pdf
Garvey, G., Towney, P., McPhee, J.R., Little, M., and Kerridge, I.H. (2004). Is there an Aboriginal bioethics? Journal of Medical Ethics, 30, 570–575.
Parette, P., VanBiervliet, A., & Hourcade, J. J. (2000). Family-centred decision making in assistive technology. Journal of Special Education Technology, 15(1), 45-55.
Ralph-Campbell, K., Oster, R. T., Supernault Kaler, S., Kaler, N., & Toth, E. L. (2011). Screening for undiagnosed type 2 diabetes in Aboriginal communities: Weighing the advantages and disadvantages. Pimatisiwin: A Journal of Aboriginal and indigenous Community Health, 9(2), 399-422. Retrieved from http://www.pimatisiwin.com/uploads/jan_20112/08RalphCampbellOster.pdf
Turner, D.H. (1999). Genesis Regained: Aboriginal Forms of Renunciation in Judeo- Christian Scriptures and other Major Traditions. Toronto studies in religion, vol. 25. New York: Peter Lang.