The Importance of Small Talk

By Monica Morela, behavioral aide with Connecting Dots

Lynne-McHale and Deatrick (2000) describe trust as being, “the cornerstone of helping relationships” (p. 211). This statement is also corroborated in Reeder and Morris’s (2018) qualitative study regarding the importance of trust in therapeutic relationships. They found that in some cases a positive therapeutic relationship was more strongly correlated with positive treatment outcomes than the choice of what treatments to use (Reeder & Morris, 2018). Reeder and Morris (2018) also found that although professionals are aware of the importance of trusting relationships, they were not always clear on how to achieve a positive trusting relationship with families. So how do we as practitioners and behavioural aides authentically gain the trust of the families we work with? The answer might be more attainable than we think! Francis et al. (2016) examined parent perceptions of best practices for building trust in professional relationships. They found that one of the most important skills for building trusting family-professional partnerships was communication (Francis et al., 2016). More specifically, engaging frequently with clients in casual and positive conversations has been described by parents as one of the best ways to build trust (Francis et al., 2016). This means that our beginning of session chats about the weather and our weekends might be more important than we think! Edwards et al. (2018) provide more detail regarding key communication skills that can help us as service providers build positive working relationships. Taking the time to listen, using proper eye contact, remaining attentive, and being clear are all communication skills that can aid us in building a positive therapeutic relationship.

I think that we can treat building rapport and trust as a skill. Taking an intentional, conscious, and conscientious approach to providing care will be beneficial for us as practitioners but also for the families we work with. The next time you are working with your clients maybe take some time before the session to chat with parents about their day. Taking this time to build a positive relationship might go farther than you think!

 

References

Edwards, M., Parmenter, T., O’Brien, P., & Brown, R. (2018). FAMILY QUALITY OF LIFE AND THE BUILDING OF SOCIAL CONNECTIONS: PRACTICAL SUGGESTIONS FOR PRACTICE AND POLICY. International Journal of Child, Youth and Family Studies9(4), 88–106. https://doi.org/10.18357/ijcyfs94201818642

Francis, G. L., Blue-Banning, M., Haines, S. J., Turnbull, A. P., & Gross, J. M. (2016). Building “Our School”: Parental Perspectives for Building Trusting Family–Professional Partnerships. Preventing School Failure: Alternative Education for Children and Youth60(4), 329–336. https://doi.org/10.1080/1045988x.2016.1164115

Lynn-McHale, D. J., & Deatrick, J. A. (2000). Trust Between Family and Health Care Provider. Journal of Family Nursing6(3), 210–230. https://doi.org/10.1177/107484070000600302

Reeder, J., & Morris, J. (2018). The importance of the therapeutic relationship when providing information to parents of children with long-term disabilities: The views and experiences of UK paediatric therapists. Journal of Child Health Care22(3), 371–381. https://doi.org/10.1177/1367493518759239

Getting the Cooperation of the Uncooperative Child Part 1

By Christine Marchant

I have been a mother for over 30 years and I ran a private day home for 20 years. I was also a nanny, a child development facilitator for 6 years, and worked one to one with many therapists on many specialized teams for helping children. I have observed that there are many ways a child will show you that he doesn’t want to cooperate. There are many reasons the child isn’t cooperating. In this post, I will list a few ways the child may behave, and a few reasons why he may be using this tactic.

Sometimes an uncooperative attitude or behaviour is anxiety, attention seeking, stress, or previously learned behaviour. We don’t know what is happening inside the child, so we do need to be sensitive to the “why” and not just assume our own reasons for this behaviour. Too often, I hear adults say things like, “oh he’s being bad,” “He doesn’t like me,” “That kid is a BRAT!” or “He’s spoiled!” When an adult thinks these thoughts at the onset of the activity, it taints their approach and reaction to the child. These children tend to get a bad reputation because it’s very hard to work with a child who refuses to cooperate, especially when he is VERY LOUD and negative in this refusal. Some of their behaviours may include yelling, screaming, throwing things, hitting, running away, climbing railings, darting away, knocking things over, hiding, kicking, swearing, or being very passive and just laying there and staring at nothing, or closing his eyes, humming, reading a book, playing with toys and not acknowledging your existence. This is a child’s way of saying that they want you gone.

The child is a child, and he doesn’t even know that he is resisting to cooperate. Often his mouth is being disagreeable, while his brain is saying “What is happening?” This is the vital turning point of the session. When you find yourself locked into a battle with the child, you are at the critical point where it will calm down and go positive or it will completely fall apart. The way you handle the situation will set the tone not only for the session, but actually for the rest of the time you work with that child. You need to take control of the situation and set the tone right away. If you are finding yourself in this battle, drop all expectations. Put your lesson plan away, look at the child, stop talking and just wait. If you have just walked in, just stand silently at the door. If you are in the living room or at the kitchen table, just stop. Don’t put anything away, because this may be a trigger and set the child off. Just slow your breathing, and stand silent. Your body should be prepared for anything, but on the outside, you look calm and passive. Count to thirty and keep your eyes on him! He may throw a toy at you, or dash up, kick you or run away. Answer any questions the child may ask, in a calm quiet voice. Do not use an overly sweet voice because kids see right through it. Just answer normally with as few words as possible. It sounds silly and wrong, but just spend as long as needed in that spot. One day, I spent the whole session standing at the front door. The child threw a fit and ran away screaming every time I showed up. I just stood there, the mom chased the child, scolding and threatening and cajoling, and bribing etc, which just made it worse. When he didn’t get attention from me doing this, he’d greet me with a disdainful “what are you doing here?” This moved into a blatant swearing fest, and saying “I hate you”. I would just sit silent, and he would try to flip the table and throw toys. I continued to remain calm no matter what happened.

Eventually, he would desire my attention. When he reached this point, I knew he was ready for my input. I then printed out my expectations for the session. I also printed out the consequences for the ‘unexpected’ behaviours. This was an older child. He understood natural consequences and the token system. The approach I took with this child is not the same one I use with another child. When working with these children, we must ALWAYS remember that this is a child. A child is a child, and we should not put our life stories onto them. They are not inherently bad or bratty. We stay calm, and allow them to come to us. I honestly don’t know why these children behave this way. I’ve had many of these children in my day home, because these are children that were kicked out of all the other day homes, and the parents hear through word of mouth that Christine takes on the difficult kids. I took in every child, with every type of issue, and I just accepted each one the way they were, an each one was an amazing child. I was also a nanny for years. Now that’s a job! I’ve had a child who sat at the dinner table, looked me in the eyes and put her feet on the table and said “so, you’re the new nanny. I’ll tell you right now, you will not make it to the end of the month, we’ve had 4 nannies fired before you, DON’T unpack your bags” this was said by a beautiful, blond, blue eyed 9 year old girl.  I worked there for a long time!

The point that I am making, is to meet the child at their level. This does not mean, that if the child swears, we swear, if he hits, we hit, or if he glares at us, we glare at him. It means that we put our lesson plans to the side, smile, and remain quiet and passive. I tend to do something while I wait. That one session I spent at the door, I literally did nothing. During another session with the same child, I sat at the table taking notes the whole session. I did not chase, follow, or try in any way to engage the child. I did not play with his toys in the hope that he would get curious and join me.

In the next post, I will share with you how I get the younger children who run away to cooperate. The one I described in this post was an older child, who was very volatile, verbally explosive, and aggressive. It took a long time but, my patience won the day. The child was such a little darling and sweetheart once he pushed through his block. The last time I saw him, he was a thoughtful, kind, and polite little boy. I was sad to move on.

Teaching the 5-W-H Questions: Part 4

By Christine Marchant

If you have read my previous posts, you’ll notice that I have a system for teaching 5-W-H questions.  Levels one through three deal with concrete who, what, where, when, why, and how questions, while level four is concerned with asking the child about what can happen in the future.  It’s quite easy to teach the first two levels.  When the child becomes more aware of their world, and isn’t easily entertained by the simple flash cards or photos, the teaching becomes more challenging.  I find that they are now more interested in the games.  I like to try plenty of new games to test the child’s interest and to see if the game will match the goal.  We play the game at least three times with no target goals.  This is how I build the interest and desire to play the game.  The goal here is to create a strong desire to play the game.  At this level, it’s the game and the interactions with the people that keep the child involved and wanting to cooperate.  It doesn’t matter what the game is, as long as you explain to the child that the reason you are doing the sessions is to help the child achieve the targets.  Hopefully, at this level, you’ve already created a relationship of trust and honesty.  This is my favorite level of the relationship with the child because they are opened enough to actually understand why you are spending the time with them.  They are usually enthusiastic about achieving their goals.  I explain to the child that we play the game with no targets and then when we really enjoy the game we add the targets.

While playing the games, I use a LOT of WE, US, OUR, and TEAM WORK language to motivate the child and let her know that we are working together.  The language you use will determine the attitude of the child.  They LOVE to take ownership of their learning.  By this level, they seldom resist doing their “work.”  The games are now a fun way to make the sessions go faster.  They may MOAN and GROAN or ROLL their eyes, and declare “you’re the meanest aide EVER!!” BUT, it’s all said in laughter and good cheer.  If you have a good relationship with them, you play along, then say, “OK! Let’s get down to business, and get it done. ” If you don’t have a relationship with the child and are just jumping in, don’t start at this level!!  If I were to start teaching the 5-W-H without knowing the child, I would ALWAYS start at a lower level and see where the child is, then move up the levels, in the same order,  at the speed that matches the child.  This level is based entirely on trust and a relationship with the child.

Teaching what happens after is the trickiest part for children because it requires abstract thinking.  It’s been proven that we can envision the past easier than the future.  The future is difficult because it can be any possibility.  The past now seems more concrete than the future because it’s easier to prove.  If you have one of those children that LOVE to argue and declare that a dragon has super powers and can possibly run for government in the future, LET IT GO!!!!  Don’t argue with the child, but try to remember the goal!  At this point, the goal is opening their minds to future possibilities, not to debate what the future actually can be (natural consequences will take care of that).  Here is my method:

1) Find books and tons of photos that show a ton of details.  I use books, flash cards, random photos, even advertisement photos.

2) Bring out their favorite game and lay the photos beside the game.

3) At this level, the child already knows the expectations.

4) Start the game.  The first player looks at the picture and describes what she sees.  This is important because this gives the story as they see it.  It’s concrete, so use concrete language like “the people are in the boat”, “the dog is in the water”, or “the waves are huge”.

5) All the players look at the picture, then agree or disagree with the player’s description.

6) The player then says what the possible future may be.  Using the language, “I think the waves will push the boat over”, “I think they will rescue the dog”, or “I think the people in the boat will be beamed up by aliens”.  It doesn’t matter what the child says.  The goal is not to correct the child’s idea of the future.  The goal is to have the child be flexible in their thinking.  If it’s dark, you can leave it, or have your version of the future when it’s your turn.  Do NOT correct the child during their turn.  It’s their turn and you can damage the relationship if you are constantly correcting the child on their turn.  Save that for another goal, at another time.

7) When the child is finished predicting, the turn is over and they take their turn playing the game. Often by this level, the interest can be more into the predicting than playing the game.  If the child wants to go on and on with their predictions, let them because the game is not the goal.  This does not go on for hours.  Whenever you choose to teach a target, you choose the system and how long it will last.  You can set the expectation as an open ended game, which is with a timer, or closed ended one, which is with the number of turns.

8) I alternate between the open and closed ended.  We seldom ever finish the game at this level, which is not a big deal.

9) Never let the game go for more than ten minutes for the very young, and fifteen for the older children.  Put on the timer, and when it goes off, you say, “Do you want the game to be over?” or “Do you want to play for another ten or fifteen minutes?”.

10) If they choose game over, you can smile and say it was a fun game.  If they choose to play, set the timer.  If they want more, you tell them that you will play it at the next session, and then keep your word.

This is the end of sharing how I teach 5-W-H questions.  In the future, I will share the different approaches I take.  The system always stays the same, but the approach and materials change.  As I said in earlier posts, I’m not a therapist or have formal education in teaching.  I am a mom for thirty-one years and have lots of experience with children from parenting and running a private day home for twenty years.  I was also a nanny in between and during doing those jobs.  I have also been a child development facilitator for five years.  I hope you enjoyed my posts, and found at least one tip to help you teach the 5-W-H questions!

 

 

Connecting with a Multidisciplinary Approach

By: Stephanie Magnussen

Although it may seem apparent that a child needs specific help, there usually are many layers to an individual’s needs.  For example, if a child has a speech delay, the parent may request that he sees a speech pathologist.  But why does this child have a speech delay?  Is there is a sensory need that is not being met, or are there developmental delays or behavioral issues at work?  Kids are complicated little people, and it’s important to remember that what we see is only the tip of the iceberg.  It’s really beneficial for a group of therapists to explore what lies beneath the surface to give the child the most effective strategies to thrive academically, socially, and mentally.

Perhaps the short term goals for a child with Autism Spectrum Disorder are maintaining eye contact and increased vocabulary, and the long term goals are independence and integration into a typical classroom.  The speech pathologist will develop activities that increase vocabulary, while the occupational therapist creates drills for promoting eye contact, and the psychologist may make social stories that build confidence and promote more appropriate social behavior.  Just having one therapist would not be the most advantageous for the child and family in this case.  The parents are also part of the multidisciplinary team.  They must be on board with practicing what the therapists are working on and provide a supportive environment for the child to thrive under this team approach.

At Connecting Dots, all of the therapists are registered health care professionals with Master’s level education.  They all work together and share ideas on how to set a child up for success by using each of their expertise.  If a child is exhibiting disfluent speech or a stutter, and therefore struggling socially at school, of course we want to promote smooth speech, but there may be other issues to address.  The child may have motor planning deficits which result in disfluent speech.  The speech pathologist can work on an action plan for smooth speech, while the occupational therapist develops a plan to promote increased ability for the muscles to make the correct movements for speech.  Psychologists are also a key part of this multidisciplinary approach.  Communication is not just the words that we speak, but also our ability to interact with those around us.  Any disability can be stressful for a child, and may result in anxiety and social isolation.  A psychologist can identify activities and games that will help a child excel socially.

As an aide at Connecting Dots, I have been fortunate to work with speech pathologists, occupational therapists, and psychologists and have seen the gains my clients are making by working on each piece of their puzzle.   Every child’s background and needs are so diverse, and an individualized plan with input from different types of therapists allows the team to work on gains for the child in a holistic manner.  It is truly a team approach between the therapists, aides, and family members.