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Families' experience of a single session therapy framework in advanced allied health practice for children with neurodevelopmental and behavioural disabilities: A thematic analysis of qualitative data

Families' experience of a single session therapy framework in advanced allied health practice for... Key pointsSingle session therapy assists health services in providing targeted, timely care whilst maintaining service efficiencies.There are many complexities in the relationship between a clinician, parent, child, and the health organisation that influence a patient's experience of health‐care services, and ultimately health‐related outcomes.Many parents and children described the therapeutic change that occurred during one targeted therapy session that focused on their identified needs.Parents and children valued the interpersonal connections established with clinicians pertaining to creating an atmosphere of being present, understanding, valuing time, and facilitating confidence in actions.Short‐term therapy models provided at a time of need can improve a parent's and child's understanding and perspective of developmental needs.INTRODUCTIONDemands on health services globally are exceeding current capacity, requiring organisations to create efficiencies whilst delivering care to larger populations within finite budgets (Creen, Kennedy‐Behr, Gee, et al., 2021; Creen, Kennedy‐Behr, Verdonck, & Donkin, 2021; Johannessen & Alexandersen, 2018). Maintaining long‐term follow‐up care under traditional ongoing therapy models is no longer sustainable with poor patient engagement and unsustainable economic impacts (Huang et al., 2017). As a result of these ongoing service provision challenges health services are constantly evaluating and researching methods of service optimisation whilst improving patient care and enhancing patient experience (Creen, Kennedy‐Behr, Gee, et al., 2021; Creen, Kennedy‐Behr, Verdonck, & Donkin, 2021; Johannessen & Alexandersen, 2018).Single session therapy (SST) emerged in the field of mental health services over 40 years ago, as an approach to assist with providing targeted care to mental health users, within a shorter time frame, rather than ongoing regular follow‐up therapy (Hoyt et al., 2021; Talmon & Hoyt, 2015; Young, 2020). It was identified that following a single‐session approach, patients could receive meaningful therapeutic change during one consult, and did not always need to attend ongoing follow‐up consultations (Hoyt et al., 2021; Lee & Tratner, 2021; Talmon & Hoyt, 2015). Therefore, a shift in therapeutic service delivery began with a focus on maximising every single session with a patient, with the understanding that they may only need a small number of appointments, as little as one, to facilitate the process of personal change towards improved health.Neurodevelopmental challenges present unique needs for each family that are multifaceted and complex (Rosenbaum & Novak‐Pavlic, 2021). Within paediatric health care, child developmental and behavioural challenges have been steadily increasing, currently consuming more than 50% of paediatric caseloads within Australia (Hiscock et al., 2017). Traditionally, children and families are involved in long‐term therapies and review appointments to check progress, often set at a time that suits the service. However, this is not sustainable and does not always meet the family's needs at the point in time that they require help. By utilising session frameworks, such as SST, families and clinicians can address the family's needs at that point in time in a complete therapeutic session (Hoyt et al., 2021). Furthermore, the impact of one SST can lead to sufficient change to mitigate the need for further appointments (Lee & Tratner, 2021; Young, 2020). SST differs from other approaches as the core principle is that the family is the driver for the session, and the clinician draws on the family's capabilities to facilitate change and develop actions to occur out of the consult (Hoyt et al., 2021). Essentially, the family retains autonomy, and the allied health professional is a facilitator using their clinical capabilities to ensure the session stays on track and is completed.In Australia, the Bouverie Centre SST framework has gained traction with increasing implementation across a variety of public health services (Talmon & Hoyt, 2015; Young, 2020). The Bouverie Centre SST framework incorporates key phases to the therapeutic session and guides clinicians in how to conduct a complete clinical session with an underlying principle that clinical change can occur within that one encounter (Hoyt et al., 2021; Talmon & Hoyt, 2015). Within each session, patients identify the focus for the session and delve into that issue with agreed actions for change to occur after the consultation (Le Gros et al., 2019; Lee & Tratner, 2021; Talmon & Hoyt, 2015). Since 2014, a modified SST approach particular to developmental and behavioural paediatrics has been implemented in an Australian regional public hospital outpatient department. Research into the impact on service delivery has shown improved patient flow with earlier time to being seen, receiving a diagnosis, and being linked in with community support (Creen, Kennedy‐Behr, Gee, et al., 2021; Creen, Kennedy‐Behr, Verdonck, & Donkin, 2021).Research has been emerging on the effectiveness of single‐session work within various psychotherapy fields, such as mental health, chronic conditions, and sports psychology (Harper‐Jaques & Foucault, 2014; Perkins, 2006; Pitt et al., 2020). Short‐ and long‐term improvements have been reported in patients for a variety of health needs across various settings including but not limited to acute hospital stays, emergency departments, community health settings, and mental health programs (Hoyt et al., 2021; Hymmen et al., 2013; Lee & Tratner, 2021; Pitt et al., 2020), In addition, research has started to explore the characteristics of the consultation that lead to successful implementation of SST (Courtnage, 2020). However, there is limited research on the framework, experience, and effectiveness of this intervention particularly in the field of developmental and behavioural paediatrics.This study aimed to explore and describe the parent or caregiver and child experience with the advanced allied health practitioner (AAHP) clinic utilising an SST approach as routine service delivery, by understanding key characteristics of the consultation that influenced experiences and therapeutic change.METHODSSingle session therapy model implementationThis study took place in a regional health service district on the east coast of Australia. Clinics involve a multidisciplinary team utilising AAHP as the first point of contact for families. The AAHP role was shared by an occupational therapist, psychologist, and speech pathologist who each had over 15 years of clinical experience with postgraduate qualifications and training specific to child development and behaviour. The AAHP utilised a customised developmental and behavioural family SST model (Figure 1). The developmental and behavioural SST approach is family‐centred with a solution focus, and can occur within a single session.1FIGURESingle session therapy framework for child development and behaviour.Study designThis study utilised a qualitative research design to understand and explore families' experiences. Qualitative research is a thorough method for exploring complex topics and understanding experiences (Borell et al., 2014; Creswell & Creswell, 2018). The qualitative research team consisted of four professionals with a background in occupational therapy (n = 3) and medical science (n = 1). The team had content experience with SST, qualitative research, client experience, and engagement in health care.The study was conducted in accordance with the National Health and Medical Research Council of Australia and was approved by the (Queensland Children's Health Human Research Ethics Committee (HREC/18/QCRH) and the University of the Sunshine Coast Human Research Ethics Committee (S181182). Written consent was obtained from parents or legal guardians for data collection and publication of the results.Participants and recruitmentParents of children with developmental and/or behavioural concerns who attended AAHP outpatient consultations were invited by an independent research assistant to participate in interviews regarding their experiences. Children between the ages of 8 and 18 were invited to participate with both child and parent consent. Convenience and purposeful sampling were adopted to include families and children with varying diagnoses, household compositions, parent education levels and ages, as well as a gender balance. Parents and children were excluded if they were unable to complete the interview in English or had cognitive difficulties impacting participation as assessed by the research team.In total, there were 50 participants, 38 parents and 12 children, from 37 different families. Families participated in one to four SST consultations around their identified areas of need. Demographic and service data details of the participants are provided in Table 1. Most parents were female (n = 35), with one paternal grandmother being the carer. Parents ranged in age from 26 to 62, with most parents having achieved high school or trade certificates as their highest level of education. A majority of parents and children lived in a dual‐parent household (n = 25) with many parents working or studying (n = 29). Children interviewed ranged in age from 8 to 15, with the majority being male (n = 9). The length of time for interviews ranged from 12 to 41 min, with the median length of time being 15 min for children and 26 min for parents.Data collectionData were collected through qualitative semi‐structured interviews conducted within 1 month of the families attending consultations. The interview guide was developed by the research team utilising an iterative approach following a literature review (Creen, Kennedy‐Behr, Gee, et al., 2021; Creen, Kennedy‐Behr, Verdonck, & Donkin, 2021; Creswell & Creswell, 2018) and incorporation of concepts from key theories around experience and engagement in health care (Table 2). The topic guide was trialled with parents (n = 4) and reviewed by an expert panel consisting of consumers and experts in the field (n = 8). On the basis of the trial, no changes were made to the topic guide. De‐identifiable clinical, demographic, and service provision data were collected by survey and hospital record review at the time of interview.1TABLEDemographic and service data details for interview participants.Demographic and service dataN (%)Child participants (n = 12)Child ageMean and range10; 8–15Child genderMale9 (75)Female3 (25)Child ethnicityIndigenous (Aboriginal or Torres Strait Islander)1 (8)DiagnosisaAttention deficit hyperactivity disorder (ADHD)5 (42)Autism spectrum disorder (ASD)3 (25)Anxiety1 (8)Speech and/or language disorder1 (8)Specific learning disability1 (8)Intellectual disability2 (17)Anxiety1 (8)Developmental coordination disorder (DCD)2 (17)Mental health1 (8)Parent participants (n = 38)Parent ageMean and range41; 26–62Parent genderMale3 (8)Female35 (92)Parent ethnicityIndigenous (Aboriginal or Torres Strait Islander)3 (8)Culturally and linguistically diverse (CALD)3 (8)Child of parent ageMean and range9; 5–15Child of parent genderMale24 (63)Female14 (37)Child of parent ethnicityIndigenous (Aboriginal or Torres Strait Islander)2 (5)Child's diagnosisaAttention deficit hyperactivity disorder (ADHD)18 (47)Autism spectrum disorder (ASD)9 (24)Speech and/or language disorder6 (16)Specific learning disability5 (13)Intellectual disability4 (11)Anxiety3 (8)Developmental coordination disorder (DCD)3 (8)Mental health4 (11)Trauma2 (5)Parent educationDid not complete senior high school4 (11)High school15 (39)Trade, certificate, or diploma training11 (29)University bachelor or higher8 (21)Household compositionChild attending clinic is first child of parent27 (71)Number of children in the house (average and range)2.4; 1–5Dual‐parent house28 (74)Single‐parent house10 (26)Shared care parenting arrangement8 (21)Parent employmentStudent2 (5)Homemaker8 (21)Part‐time10 (26)Full‐time17 (45)aChildren were able to be classified into multiple diagnostic categories to reflect a combination of conditions.2TABLESemi‐structure interview topic guides.Parent/caregiver interview topic guideFirstly, tell me about your previous times here with (AAHP name). Can you describe your experience? Can you tell me what happened?While you were here, do you remember what you were thinking? Do you remember how you felt? Tell me more.Were there things that were good? Not so good? Difficult?How was your child involved during the appointments? How do you think they felt? What do you think their experience was like?The last time you were here you developed some strategies along with (AAHP name). Are these useful?After you left, how did you feel? What did you remember? Can you describe any benefits?How do you think the experience was for your child? What do you think the benefits are for your child, if any? Is there anything that challenged your child?How would you describe this service to someone else?Is there anything else you would like to say about the appointment? Any other thoughts you would like us to know?Child/adolescent interview topic guideDid you know why you were coming to see (AAHP name)? How did you feel about coming?When you were last here to see (AAHP name), can you tell me what happened?While you were here, do you remember what you were thinking? Do you remember how you felt? Tell me more.Were there things that were good? Not so good? Difficult?How was your mum/dad during the time with (AAHP name)? How do you think they felt?After you left, how did you feel? What did you remember?Can you remember any suggestions that were given to you and your parents while you were here seeing (AAHP name)? Can you tell me about them? Are these useful?Has anything changed for you or your parents since you came in to see (AAHP name)? Tell me more.Is there anything else you would like to say about the appointment?Interviews took place via phone or video conferencing and were conducted by the lead researcher (JC) and two research assistants with prior interviewing experience and backgrounds in occupational therapy. The initial plan was to conduct interviews face to face, but due to COVID‐19 restrictions during 2020 at the time of the study, interviews were changed to phone and video‐conferencing platforms. Interviews were recorded and transcribed verbatim by a professional transcription service. Transcripts were de‐identified and transported into NVivo12 (QSR International, Melbourne, Australia) (NVivo, 2020).Data analysisThematic analysis was utilised, examining patterns and themes in qualitative data through a reflexive approach (Braun & Clarke, 2019; Clarke & Braun, 2017). The research team discussed preconceived assumptions prior to data analysis. The team viewed experiences as highly individual being related to the families' and health professionals' level of engagement, competence, motivation, and determination. The research team initially read through raw transcripts and became familiar with the data. Preliminary coding of the data was conducted by JC using a reflexive thematic coding scheme leading to the development of an initial coding template (Braun & Clarke, 2019). The research team reviewed the coding template and collaboratively made further developments. This process was applied to further interview transcripts and the coding template was discussed and modified as necessary. Final coding templates were reviewed with the research team to facilitate a rich, nuanced understanding of the data (Braun & Clarke, 2019).Interrater reliability was conducted between two authors (JC and RD) who independently reviewed 20% of the interviews against the coding template. A Cohen's kappa of 0.78 indicated good inter‐rater reliability (McHugh, 2012).RESULTSThe findings revealed four key themes: (1) mutual presence, (2) value of time, (3) power of understanding, and (4) confidence (or trust) in actions. These four themes were influenced by two common threads, firstly interpersonal skills and connections between the AAHP, parents, and child; and secondly the organisational factors to provide clinical care and service delivery. Connections established at the interpersonal and organisation level created presence, time, understanding, and action in positive outcomes as represented in Figure 2.2FIGUREThemes of parent and child experience.Mutual presenceMutual presence relates to what happens in the space between the clinician, parent, and child. It is centred around the ability of all individuals in a session to process thoughts, feelings, and values in the moment, to create meaningful presence and connection. This is fostered through the AAHP manner, general likeability, and professional skills, as well as families’ feelings, thoughts, and behaviours.I just really liked her [AAHP] and I found it easy to open up to her and talk to her. (P19)Interpersonal characteristics of the AAHP that contributed to the experience of mutual presence included ease of communication, particularly listening skills, openness, honestly, and the ability to engage and relate with children. The professional skills of the AAHP, with the level of knowledge, helpfulness, and family focus was also valued by parents. For example:[The AAHP was] easy to talk to, it was just like having a conversation with somebody else, but it was professional at the same time. (P14)Children emphasised the importance of AAHP being caring and helpful whilst focusing on them.I knew I was finally getting someone who actually cared. After the incident I really felt like no one really wanted to help me because I have issues with my decisions. (C3 aged 14)The personal characteristics of parents, particularly the change in their thoughts and feelings from nervousness to relief and hope as the consultation progressed, was highlighted. Parents reported being willing and open to learning about their child and valued the AAHP validating their concerns and respecting their role as a parent.There are people out there willing to help you. And the people that I’ve been involved with … not only listen but do actually hear what you say and don’t judge you. You know, everyone thinks they are failing as a parent and the people that I’ve dealt with have made you feel like no, you’re not. You’re not failing as a parent. (P29)There were several challenges raised with achieving mutual presence. At times when members of the family unit had different perspectives, objectives, and values, achieving mutual meaningful connection respecting all parties was challenging. One parent reported frustration around not being listened to in the consult and the AAHP not appearing to be focused on their needs or validating their views of their child.I just didn't feel heard … You've got to listen to the parents. (P10)Value of timeTime was perceived as an attribute when it was valued by both the AAHP and the family. This included the use of time within the consult, the timing of services throughout the family's journey including before, during, and after the consultation, and the accessibility of the service, being able to provide intervention at the right time for the family's needs.Parents valued the structure of the appointment with the dedicated time within the consult to explore in depth their primary concerns. When AAHP valued the time with families by providing a comprehensive and productive service, parents felt they were able to move forward at their own pace, were not rushed into decisions, and were provided adequate time to process the situation.The actual appointment was great. It was very detailed. There was no rush or ushering out the door. (P16)The consultation time was perceived as valuable when it was maximised in a single session, rather than attending multiple appointments to achieve a similar outcome.We only have seen her [AAHP] the once and … we are moving forward. (P29)Families commented on the long wait to get into the services initially, and the impact that this length of time to be seen had on the family unit. Parents frequently reported that long delays to be seen negatively impacted their initial perceptions of the service, leading to feelings of frustration and desperation prior to being seen. Several families reported the need to have a service that they could access when they needed support, rather than being offered appointments at a time that suited the service. Parents reported some challenges with taking time off school and work to attend appointments. The benefit of parents being able to book appointments at a time that suited them when they needed the service was raised by several families.Power of understandingUnderstanding was experienced as a mutual process, where parents and children were offered understanding about their situation and need from the AAHP, but this was integrated with the AAHP being open to understanding the parent and child through effective therapeutic connection. Positive mutual connections and interactions between the AAHP, parent, and child led to improved understanding and empowerment for both the parents and their child. This was particularly true when the parent and child could connect with each other through the facilitation of the AAHP to understand their emotions and behaviours.We [child and parent] understood some of the problems we were having, why we were having them and that made it a little bit easier. (P7)Families valued that their thoughts and concerns were listened to, understood, and subsequently validated with appropriate responses to their concerns.I felt very understood. So, I did cry quite a few times while I was there, but it wasn't crying because I was frustrated or anything like that. It was relief that someone was listening and giving us some suggestions. (P28)Most parents reported AAHP single sessions were thorough and answered specific queries and concerns that either the parent or child presented with. If questions and needs were met, the single sessions improved the parents' understanding of their child, their challenges, strengths, and family dynamics. One parent explained that she:Felt a sense of relief with sort of being listened to and having a better understanding of [child]. (P21)Children reported feeling relieved at improved understanding of themselves and feeling validated for their individuality. Parents acknowledged the child's improvement, understanding of self, and the impact this had on their ability to respond to their child's needs. Whilst fostering understanding of development and behaviour was powerful for some, a small number of parents reported being overwhelmed trying to grasp their child's neurodevelopmental profile.I am myself a bit confused of all the different diagnoses that you can get someone diagnosed with … because it makes it harder to figure out what to do, or which way to go. (P20)Overall perception of a positive experience was also impacted by the parents' understanding and expectations of the service prior to the single session consultation. If the families understood the process, they perceived the experience to be better than those who did not. Providing parents with an understanding of the clinic's process and clarifying parents' expectations for the service was appreciated by most parents. Parents reported the level of understanding, validation, and communication provided by AAHP was comprehensive and they requested this level of support to continue for other paediatric appointments. One parent felt the process wasn't explained well which in turn created some stress around ongoing support.Confidence in actionPerceived actions of AAHP and family members prior to, during, and following the consult directly impacted parental confidence to take actions following the consult. Parents respected the actions of the AAHP prior to consultations, reporting that AAHP appeared prepared and were ready to support the family. Actions of the AAHP during SST that were reported as relevant and appropriate included physical mannerisms such as eye contact and body language, intentional focus on the family, and being open and honest with the family. Additionally, parents reported a strong confidence and trust that the AAHP will take effective action following consultations including liaising with external parties and the team on their behalf.The significance of the AAHP actions of intentional effort to make the child comfortable and engaged, and the positive impact this had on the entire family during the consultation was frequently mentioned. When the child felt comfortable, safe, and calm in the consultation, parental stress and anxiety reportedly reduced.Following an AAHP single‐session consultation, most parents reported that they had confidently engaged in further actions to facilitate their child's development and their own management of their child. This ranged from engaging in other community services; meeting with schools and advocating for support; changing routines at home; and working on parenting practices with a greater understanding of the child's needs and capabilities. Parents commented on the actions their children engaged in following consultations, which led to improvements in their child's skills, such as:Just little behaviours that we [now do] with him. We kind of altered … [found] ways to make everyone's life easier (P7)Another parent described that:It gave us the confidence to continue doing what we're doing … and [child] has changed, has managed much better. She's a child you can talk to and she can understand what you're trying to do with her … It's been really beneficial … My husband and I decided that at this stage we didn't need to go any further, because we just thought we'd gotten enough out of [the single‐session] at this stage. (P34)Overall parents felt confident in the direction of the service provision and the management plans that were discussed for moving forward. Parents were confident in engaging in new actions or adopting small changes which allowed them and their child to manage and change for the better. Parents described the ability to change their perspective and mindset which facilitated a fresh perspective to their family's situation.It is about mindset and taking a different mindset, and I think sometimes you do need to reset, or maybe just have another go at it at a different phase. (P13)Due to the impact of COVID‐19, families expressed challenges that occurred with following up with private and community services. These included financial difficulties in accessing support services and the impact of restrictions to resources due to COVID‐19.DISCUSSIONThe results of this study provide an in‐depth insight into the experience of parents and children participating in SST during AAHP consultations for developmental and behavioural paediatric conditions. Exploring the experience of parents and children has led to an understanding of the characteristics of the consultation that led to therapeutic change. The themes derived from this study relate to facilitating mutual presence, valued time, and improved understanding and confidence to engage in meaningful actions both within and following consultation.Parents reported that a meaningful experience during SST was achieved through the AAHP intentional focus, ‘being in the moment’, and their desire to understand the child and the family. This is facilitated by utilising the time within the consult effectively, focusing on the family's needs and priorities, avoiding distractions, attending to the family's stories, and using reflective listening skills. This work builds on other research in the field highlighting the complexity of interpersonal and professional factors that contribute to positive therapeutic experience during consultations (Brown‐Johnson et al., 2019; Courtnage, 2020; Macaulay et al., 2008; Pitt et al., 2020). Families constantly reported on the mutual development of shared presence, understanding, and confidence between clinician, parent, and/or child. This mutual connection between the clinician and parent was pivotal to a positive experience and perceived positive outcomes of the consultation reported by families. This interpersonal complexity is consistent with research in the field demonstrating that clinician characteristics such as empathy, compassion, and providing hope are vital to the success of therapy (Courtnage, 2020; Macaulay et al., 2008).Families in this study reported high levels of satisfaction with the AAHP consultations due to the complete nature of the SST appointment approach. Parents identified that after one consultation they had improved understanding of their situation, and confidence moving forward in managing their child's needs. Parents identified that their child's needs were still present, however with increased understanding of their child they were able to adopt their own parenting practices and could have meaningful discussions with other services (e.g., schools) with positive outcomes for their child. This is consistent with studies in other health fields that have identified SST as being able to empower and support patients to utilise internal strengths to address health challenges (Hymmen et al., 2013; Lee & Tratner, 2021). This highlights that the SST approach can be utilised in paediatric development and behavioural caseloads, facilitating change in parental capacity, understanding, and the ability to action outcomes after only one consultation.Research has demonstrated that there are challenges to clinicians in being able to consistently and efficiently achieve therapeutic connection with patients (Brown‐Johnson et al., 2019). These challenges are linked to individual professional capabilities as well as organisational support (Brown‐Johnson et al., 2019; Johannessen & Alexandersen, 2018; Ventres & Frankel, 2015). Research into health‐care burnout and compassion fatigue is substantial, and a current priority of organisations (Zhang et al., 2018). Utilising structured frameworks such as SST may be one way to assist health‐care workers to be mindful of the emotions and feelings of both family, child, and AAHP within the consult, and assist with rituals to help with personal self‐care and prevention of burnout.Family experience of SST within AAHP clinics was improved when expectations of the service were met. This is consistent with studies that identify satisfaction is correlated to being accurately aware of the service (Hale et al., 2016). This study revealed that expectations were met when parents were informed of the SST clinic process (including wait times) and had prior knowledge of the health service that aligned with their values.ImplicationsFollowing the outcomes of this study, further consideration for the utilisation of SST approaches in other outpatient and paediatric caseloads is recommended. The framework proposed for SST within developmental and behavioural paediatrics may be a useful direction for other child developmental services to consider. This supports a cultural therapeutic shift from providing long‐term therapeutic input, to providing targeted short‐term input at times of need.This study highlights the need for concentrated AAHP presence, expertise, time, and intuition to reflect on and be aligned with the family's identified needs. Maintaining this level of professional conduct is exhausting and emotionally draining. Implementing organisational processes to provide the AAHP with time to process information and emotions and be able to remain intentionally focused throughout consult is necessary to prevent AAHP burnout and enhance patient outcomes (Brown‐Johnson et al., 2019; Haverfield et al., 2020). Further exploration of service efficiencies that improve experience and clinical outcomes, whilst enhancing professional fulfilment, without reducing time for AAHP well‐being is recommended.Results from this research have identified the need for further exploration of factors underpinning the family experience of SST. These concepts were beyond the scope of this study but warrant attention. Further research is recommended to explore the longitudinal impacts of parent and child actions following SST consults, and the clinical outcomes. This study utilised a qualitative methodology through semi‐structured interviews. Researching clinical outcomes through more standardised measures and clinical markers would be beneficial to understand the perceived short‐ and long‐term impact in more detail. Additionally, research into the specific constructs of interpersonal connection and engagement in the SST process would be beneficial to help guide clinicians in understanding the necessary training and clinical skills required to effectively implement SST. Further research into which particular developmental and behavioural paediatric patient cohorts benefit most from an SST approach and those that require other therapeutic consultation frameworks is needed.LimitationsThis study aimed to include children's experiences. However, conducting phone or video conferencing interviews with children with neurodevelopmental and behavioural conditions was challenging. Despite a small sample size, thematic saturation was reached which provided depth to the study. This study was limited to one location and health service. Future studies should be broadened to include a variety of health services.During the time of this study, initial COVID‐19 societal limitations were in situ, with many families conducting schooling from home. This was a challenging time for families. However, as most families reported positive experiences, providing an SST approach during this highly challenging time appeared beneficial. The SST approach was able to be adapted to telehealth mediums when required to suit families and societal needs.CONCLUSIONThis study makes an important contribution to the field of SST research by understanding the experience of families with children with developmental and behavioural conditions, which to our knowledge has not been explored before. Findings from this study describe an understanding of the characteristics of an SST approach, particularly the AAHP interpersonal skills, actions, and shared presence which led to families being valued, understood, and respected. The importance of the organisational clinic process such as being seen at a time of need was highlighted. Through this families described a therapeutic shift within themselves including a change in their understanding, improved knowledge, confidence, and trust in actions to support their child at home and in the community.ACKNOWLEDGEMENTSThis work was partially supported by the Allied Health Professionals Office of Queensland Research Scheme. The lead researcher, JC, contributed to the study design, obtained funding, data collection, and data analysis and wrote the manuscript draft. AKB provided feedback on the study design, contributed to the grant application and data collection, and reviewed the manuscript. MV contributed to study design, data analysis, and manuscript reviewing and editing. RD contributed to data analysis, and manuscript reviewing and editing. Open access publishing facilitated by University of the Sunshine Coast, as part of the Wiley ‐ University of the Sunshine Coast agreement via the Council of Australian University Librarians.CONFLICT OF INTEREST STATEMENTThe authors report there are no competing interests to declare.REFERENCESBorell, L., Nygård, L., Asaba, E., Gustavsson, A. & Hemmingsson, H. (2014) Qualitative approaches in occupational therapy research. Scandinavian Journal of Occupational Therapy, 21(suppl 1), 80–88. Available from: https://doi.org/10.3109/11038128.2014.952910Braun, V. & Clarke, V. (2019) Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. Available from: https://doi.org/10.1080/2159676x.2019.1628806Brown‐Johnson, C., Schwartz, R., Maitra, A., Haverfield, M.C., Tierney, A., Shaw, J.G. et al. (2019) What is clinician presence? A qualitative interview study comparing physician and non‐physician insights about practices of human connection. 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(2006) The effectiveness of one session of therapy using a single‐session therapy approach for children and adolescents with mental health problems. Psychology and Psychotherapy, 79(2), 215–227. Available from: https://doi.org/10.1348/147608305X60523Pitt, T., Thomas, O., Lindsay, P., Hanton, S. & Bawden, M. (2020) A framework of single‐session problem‐solving in elite sport: a longitudinal, multi‐study investigation [original research]. Frontiers in Psychology, 11, 1–22. Available from: https://doi.org/10.3389/fpsyg.2020.566721Rosenbaum, P.L. & Novak‐Pavlic, M. (2021) Parenting a child with a neurodevelopmental disorder. Current Developmental Disorders Reports, 8(4), 212–218. Available from: https://doi.org/10.1007/s40474‐021‐00240‐2Talmon, M. & Hoyt, M. (2015) Capturing the moment: single session therapy and walk‐in services. Beaverton, OR: Ringgold, Inc.Ventres, W.B. & Frankel, R.M. (2015) Shared presence in physician–patient communication: a graphic representation. Families, Systems & Health, 33(3), 270–279. Available from: https://doi.org/10.1037/fsh0000123Young, J. (2020) Putting single session thinking to work: conceptual, practical, training, and implementation ideas. Australian and New Zealand Journal of Family Therapy, 41(3), 231–248. Available from: https://doi.org/10.1002/anzf.1426Zhang, Y.Y., Han, W.L., Qin, W., Yin, H.X., Zhang, C.F., Kong, C. et al. (2018) Extent of compassion satisfaction, compassion fatigue and burnout in nursing: a meta‐analysis. Journal of Nursing Management, 26(7), 810–819. Available from: https://doi.org/10.1111/jonm.12589 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Family Therapy Wiley

Families' experience of a single session therapy framework in advanced allied health practice for children with neurodevelopmental and behavioural disabilities: A thematic analysis of qualitative data

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Copyright © 2023 Australian Association of Family Therapy.
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Abstract

Key pointsSingle session therapy assists health services in providing targeted, timely care whilst maintaining service efficiencies.There are many complexities in the relationship between a clinician, parent, child, and the health organisation that influence a patient's experience of health‐care services, and ultimately health‐related outcomes.Many parents and children described the therapeutic change that occurred during one targeted therapy session that focused on their identified needs.Parents and children valued the interpersonal connections established with clinicians pertaining to creating an atmosphere of being present, understanding, valuing time, and facilitating confidence in actions.Short‐term therapy models provided at a time of need can improve a parent's and child's understanding and perspective of developmental needs.INTRODUCTIONDemands on health services globally are exceeding current capacity, requiring organisations to create efficiencies whilst delivering care to larger populations within finite budgets (Creen, Kennedy‐Behr, Gee, et al., 2021; Creen, Kennedy‐Behr, Verdonck, & Donkin, 2021; Johannessen & Alexandersen, 2018). Maintaining long‐term follow‐up care under traditional ongoing therapy models is no longer sustainable with poor patient engagement and unsustainable economic impacts (Huang et al., 2017). As a result of these ongoing service provision challenges health services are constantly evaluating and researching methods of service optimisation whilst improving patient care and enhancing patient experience (Creen, Kennedy‐Behr, Gee, et al., 2021; Creen, Kennedy‐Behr, Verdonck, & Donkin, 2021; Johannessen & Alexandersen, 2018).Single session therapy (SST) emerged in the field of mental health services over 40 years ago, as an approach to assist with providing targeted care to mental health users, within a shorter time frame, rather than ongoing regular follow‐up therapy (Hoyt et al., 2021; Talmon & Hoyt, 2015; Young, 2020). It was identified that following a single‐session approach, patients could receive meaningful therapeutic change during one consult, and did not always need to attend ongoing follow‐up consultations (Hoyt et al., 2021; Lee & Tratner, 2021; Talmon & Hoyt, 2015). Therefore, a shift in therapeutic service delivery began with a focus on maximising every single session with a patient, with the understanding that they may only need a small number of appointments, as little as one, to facilitate the process of personal change towards improved health.Neurodevelopmental challenges present unique needs for each family that are multifaceted and complex (Rosenbaum & Novak‐Pavlic, 2021). Within paediatric health care, child developmental and behavioural challenges have been steadily increasing, currently consuming more than 50% of paediatric caseloads within Australia (Hiscock et al., 2017). Traditionally, children and families are involved in long‐term therapies and review appointments to check progress, often set at a time that suits the service. However, this is not sustainable and does not always meet the family's needs at the point in time that they require help. By utilising session frameworks, such as SST, families and clinicians can address the family's needs at that point in time in a complete therapeutic session (Hoyt et al., 2021). Furthermore, the impact of one SST can lead to sufficient change to mitigate the need for further appointments (Lee & Tratner, 2021; Young, 2020). SST differs from other approaches as the core principle is that the family is the driver for the session, and the clinician draws on the family's capabilities to facilitate change and develop actions to occur out of the consult (Hoyt et al., 2021). Essentially, the family retains autonomy, and the allied health professional is a facilitator using their clinical capabilities to ensure the session stays on track and is completed.In Australia, the Bouverie Centre SST framework has gained traction with increasing implementation across a variety of public health services (Talmon & Hoyt, 2015; Young, 2020). The Bouverie Centre SST framework incorporates key phases to the therapeutic session and guides clinicians in how to conduct a complete clinical session with an underlying principle that clinical change can occur within that one encounter (Hoyt et al., 2021; Talmon & Hoyt, 2015). Within each session, patients identify the focus for the session and delve into that issue with agreed actions for change to occur after the consultation (Le Gros et al., 2019; Lee & Tratner, 2021; Talmon & Hoyt, 2015). Since 2014, a modified SST approach particular to developmental and behavioural paediatrics has been implemented in an Australian regional public hospital outpatient department. Research into the impact on service delivery has shown improved patient flow with earlier time to being seen, receiving a diagnosis, and being linked in with community support (Creen, Kennedy‐Behr, Gee, et al., 2021; Creen, Kennedy‐Behr, Verdonck, & Donkin, 2021).Research has been emerging on the effectiveness of single‐session work within various psychotherapy fields, such as mental health, chronic conditions, and sports psychology (Harper‐Jaques & Foucault, 2014; Perkins, 2006; Pitt et al., 2020). Short‐ and long‐term improvements have been reported in patients for a variety of health needs across various settings including but not limited to acute hospital stays, emergency departments, community health settings, and mental health programs (Hoyt et al., 2021; Hymmen et al., 2013; Lee & Tratner, 2021; Pitt et al., 2020), In addition, research has started to explore the characteristics of the consultation that lead to successful implementation of SST (Courtnage, 2020). However, there is limited research on the framework, experience, and effectiveness of this intervention particularly in the field of developmental and behavioural paediatrics.This study aimed to explore and describe the parent or caregiver and child experience with the advanced allied health practitioner (AAHP) clinic utilising an SST approach as routine service delivery, by understanding key characteristics of the consultation that influenced experiences and therapeutic change.METHODSSingle session therapy model implementationThis study took place in a regional health service district on the east coast of Australia. Clinics involve a multidisciplinary team utilising AAHP as the first point of contact for families. The AAHP role was shared by an occupational therapist, psychologist, and speech pathologist who each had over 15 years of clinical experience with postgraduate qualifications and training specific to child development and behaviour. The AAHP utilised a customised developmental and behavioural family SST model (Figure 1). The developmental and behavioural SST approach is family‐centred with a solution focus, and can occur within a single session.1FIGURESingle session therapy framework for child development and behaviour.Study designThis study utilised a qualitative research design to understand and explore families' experiences. Qualitative research is a thorough method for exploring complex topics and understanding experiences (Borell et al., 2014; Creswell & Creswell, 2018). The qualitative research team consisted of four professionals with a background in occupational therapy (n = 3) and medical science (n = 1). The team had content experience with SST, qualitative research, client experience, and engagement in health care.The study was conducted in accordance with the National Health and Medical Research Council of Australia and was approved by the (Queensland Children's Health Human Research Ethics Committee (HREC/18/QCRH) and the University of the Sunshine Coast Human Research Ethics Committee (S181182). Written consent was obtained from parents or legal guardians for data collection and publication of the results.Participants and recruitmentParents of children with developmental and/or behavioural concerns who attended AAHP outpatient consultations were invited by an independent research assistant to participate in interviews regarding their experiences. Children between the ages of 8 and 18 were invited to participate with both child and parent consent. Convenience and purposeful sampling were adopted to include families and children with varying diagnoses, household compositions, parent education levels and ages, as well as a gender balance. Parents and children were excluded if they were unable to complete the interview in English or had cognitive difficulties impacting participation as assessed by the research team.In total, there were 50 participants, 38 parents and 12 children, from 37 different families. Families participated in one to four SST consultations around their identified areas of need. Demographic and service data details of the participants are provided in Table 1. Most parents were female (n = 35), with one paternal grandmother being the carer. Parents ranged in age from 26 to 62, with most parents having achieved high school or trade certificates as their highest level of education. A majority of parents and children lived in a dual‐parent household (n = 25) with many parents working or studying (n = 29). Children interviewed ranged in age from 8 to 15, with the majority being male (n = 9). The length of time for interviews ranged from 12 to 41 min, with the median length of time being 15 min for children and 26 min for parents.Data collectionData were collected through qualitative semi‐structured interviews conducted within 1 month of the families attending consultations. The interview guide was developed by the research team utilising an iterative approach following a literature review (Creen, Kennedy‐Behr, Gee, et al., 2021; Creen, Kennedy‐Behr, Verdonck, & Donkin, 2021; Creswell & Creswell, 2018) and incorporation of concepts from key theories around experience and engagement in health care (Table 2). The topic guide was trialled with parents (n = 4) and reviewed by an expert panel consisting of consumers and experts in the field (n = 8). On the basis of the trial, no changes were made to the topic guide. De‐identifiable clinical, demographic, and service provision data were collected by survey and hospital record review at the time of interview.1TABLEDemographic and service data details for interview participants.Demographic and service dataN (%)Child participants (n = 12)Child ageMean and range10; 8–15Child genderMale9 (75)Female3 (25)Child ethnicityIndigenous (Aboriginal or Torres Strait Islander)1 (8)DiagnosisaAttention deficit hyperactivity disorder (ADHD)5 (42)Autism spectrum disorder (ASD)3 (25)Anxiety1 (8)Speech and/or language disorder1 (8)Specific learning disability1 (8)Intellectual disability2 (17)Anxiety1 (8)Developmental coordination disorder (DCD)2 (17)Mental health1 (8)Parent participants (n = 38)Parent ageMean and range41; 26–62Parent genderMale3 (8)Female35 (92)Parent ethnicityIndigenous (Aboriginal or Torres Strait Islander)3 (8)Culturally and linguistically diverse (CALD)3 (8)Child of parent ageMean and range9; 5–15Child of parent genderMale24 (63)Female14 (37)Child of parent ethnicityIndigenous (Aboriginal or Torres Strait Islander)2 (5)Child's diagnosisaAttention deficit hyperactivity disorder (ADHD)18 (47)Autism spectrum disorder (ASD)9 (24)Speech and/or language disorder6 (16)Specific learning disability5 (13)Intellectual disability4 (11)Anxiety3 (8)Developmental coordination disorder (DCD)3 (8)Mental health4 (11)Trauma2 (5)Parent educationDid not complete senior high school4 (11)High school15 (39)Trade, certificate, or diploma training11 (29)University bachelor or higher8 (21)Household compositionChild attending clinic is first child of parent27 (71)Number of children in the house (average and range)2.4; 1–5Dual‐parent house28 (74)Single‐parent house10 (26)Shared care parenting arrangement8 (21)Parent employmentStudent2 (5)Homemaker8 (21)Part‐time10 (26)Full‐time17 (45)aChildren were able to be classified into multiple diagnostic categories to reflect a combination of conditions.2TABLESemi‐structure interview topic guides.Parent/caregiver interview topic guideFirstly, tell me about your previous times here with (AAHP name). Can you describe your experience? Can you tell me what happened?While you were here, do you remember what you were thinking? Do you remember how you felt? Tell me more.Were there things that were good? Not so good? Difficult?How was your child involved during the appointments? How do you think they felt? What do you think their experience was like?The last time you were here you developed some strategies along with (AAHP name). Are these useful?After you left, how did you feel? What did you remember? Can you describe any benefits?How do you think the experience was for your child? What do you think the benefits are for your child, if any? Is there anything that challenged your child?How would you describe this service to someone else?Is there anything else you would like to say about the appointment? Any other thoughts you would like us to know?Child/adolescent interview topic guideDid you know why you were coming to see (AAHP name)? How did you feel about coming?When you were last here to see (AAHP name), can you tell me what happened?While you were here, do you remember what you were thinking? Do you remember how you felt? Tell me more.Were there things that were good? Not so good? Difficult?How was your mum/dad during the time with (AAHP name)? How do you think they felt?After you left, how did you feel? What did you remember?Can you remember any suggestions that were given to you and your parents while you were here seeing (AAHP name)? Can you tell me about them? Are these useful?Has anything changed for you or your parents since you came in to see (AAHP name)? Tell me more.Is there anything else you would like to say about the appointment?Interviews took place via phone or video conferencing and were conducted by the lead researcher (JC) and two research assistants with prior interviewing experience and backgrounds in occupational therapy. The initial plan was to conduct interviews face to face, but due to COVID‐19 restrictions during 2020 at the time of the study, interviews were changed to phone and video‐conferencing platforms. Interviews were recorded and transcribed verbatim by a professional transcription service. Transcripts were de‐identified and transported into NVivo12 (QSR International, Melbourne, Australia) (NVivo, 2020).Data analysisThematic analysis was utilised, examining patterns and themes in qualitative data through a reflexive approach (Braun & Clarke, 2019; Clarke & Braun, 2017). The research team discussed preconceived assumptions prior to data analysis. The team viewed experiences as highly individual being related to the families' and health professionals' level of engagement, competence, motivation, and determination. The research team initially read through raw transcripts and became familiar with the data. Preliminary coding of the data was conducted by JC using a reflexive thematic coding scheme leading to the development of an initial coding template (Braun & Clarke, 2019). The research team reviewed the coding template and collaboratively made further developments. This process was applied to further interview transcripts and the coding template was discussed and modified as necessary. Final coding templates were reviewed with the research team to facilitate a rich, nuanced understanding of the data (Braun & Clarke, 2019).Interrater reliability was conducted between two authors (JC and RD) who independently reviewed 20% of the interviews against the coding template. A Cohen's kappa of 0.78 indicated good inter‐rater reliability (McHugh, 2012).RESULTSThe findings revealed four key themes: (1) mutual presence, (2) value of time, (3) power of understanding, and (4) confidence (or trust) in actions. These four themes were influenced by two common threads, firstly interpersonal skills and connections between the AAHP, parents, and child; and secondly the organisational factors to provide clinical care and service delivery. Connections established at the interpersonal and organisation level created presence, time, understanding, and action in positive outcomes as represented in Figure 2.2FIGUREThemes of parent and child experience.Mutual presenceMutual presence relates to what happens in the space between the clinician, parent, and child. It is centred around the ability of all individuals in a session to process thoughts, feelings, and values in the moment, to create meaningful presence and connection. This is fostered through the AAHP manner, general likeability, and professional skills, as well as families’ feelings, thoughts, and behaviours.I just really liked her [AAHP] and I found it easy to open up to her and talk to her. (P19)Interpersonal characteristics of the AAHP that contributed to the experience of mutual presence included ease of communication, particularly listening skills, openness, honestly, and the ability to engage and relate with children. The professional skills of the AAHP, with the level of knowledge, helpfulness, and family focus was also valued by parents. For example:[The AAHP was] easy to talk to, it was just like having a conversation with somebody else, but it was professional at the same time. (P14)Children emphasised the importance of AAHP being caring and helpful whilst focusing on them.I knew I was finally getting someone who actually cared. After the incident I really felt like no one really wanted to help me because I have issues with my decisions. (C3 aged 14)The personal characteristics of parents, particularly the change in their thoughts and feelings from nervousness to relief and hope as the consultation progressed, was highlighted. Parents reported being willing and open to learning about their child and valued the AAHP validating their concerns and respecting their role as a parent.There are people out there willing to help you. And the people that I’ve been involved with … not only listen but do actually hear what you say and don’t judge you. You know, everyone thinks they are failing as a parent and the people that I’ve dealt with have made you feel like no, you’re not. You’re not failing as a parent. (P29)There were several challenges raised with achieving mutual presence. At times when members of the family unit had different perspectives, objectives, and values, achieving mutual meaningful connection respecting all parties was challenging. One parent reported frustration around not being listened to in the consult and the AAHP not appearing to be focused on their needs or validating their views of their child.I just didn't feel heard … You've got to listen to the parents. (P10)Value of timeTime was perceived as an attribute when it was valued by both the AAHP and the family. This included the use of time within the consult, the timing of services throughout the family's journey including before, during, and after the consultation, and the accessibility of the service, being able to provide intervention at the right time for the family's needs.Parents valued the structure of the appointment with the dedicated time within the consult to explore in depth their primary concerns. When AAHP valued the time with families by providing a comprehensive and productive service, parents felt they were able to move forward at their own pace, were not rushed into decisions, and were provided adequate time to process the situation.The actual appointment was great. It was very detailed. There was no rush or ushering out the door. (P16)The consultation time was perceived as valuable when it was maximised in a single session, rather than attending multiple appointments to achieve a similar outcome.We only have seen her [AAHP] the once and … we are moving forward. (P29)Families commented on the long wait to get into the services initially, and the impact that this length of time to be seen had on the family unit. Parents frequently reported that long delays to be seen negatively impacted their initial perceptions of the service, leading to feelings of frustration and desperation prior to being seen. Several families reported the need to have a service that they could access when they needed support, rather than being offered appointments at a time that suited the service. Parents reported some challenges with taking time off school and work to attend appointments. The benefit of parents being able to book appointments at a time that suited them when they needed the service was raised by several families.Power of understandingUnderstanding was experienced as a mutual process, where parents and children were offered understanding about their situation and need from the AAHP, but this was integrated with the AAHP being open to understanding the parent and child through effective therapeutic connection. Positive mutual connections and interactions between the AAHP, parent, and child led to improved understanding and empowerment for both the parents and their child. This was particularly true when the parent and child could connect with each other through the facilitation of the AAHP to understand their emotions and behaviours.We [child and parent] understood some of the problems we were having, why we were having them and that made it a little bit easier. (P7)Families valued that their thoughts and concerns were listened to, understood, and subsequently validated with appropriate responses to their concerns.I felt very understood. So, I did cry quite a few times while I was there, but it wasn't crying because I was frustrated or anything like that. It was relief that someone was listening and giving us some suggestions. (P28)Most parents reported AAHP single sessions were thorough and answered specific queries and concerns that either the parent or child presented with. If questions and needs were met, the single sessions improved the parents' understanding of their child, their challenges, strengths, and family dynamics. One parent explained that she:Felt a sense of relief with sort of being listened to and having a better understanding of [child]. (P21)Children reported feeling relieved at improved understanding of themselves and feeling validated for their individuality. Parents acknowledged the child's improvement, understanding of self, and the impact this had on their ability to respond to their child's needs. Whilst fostering understanding of development and behaviour was powerful for some, a small number of parents reported being overwhelmed trying to grasp their child's neurodevelopmental profile.I am myself a bit confused of all the different diagnoses that you can get someone diagnosed with … because it makes it harder to figure out what to do, or which way to go. (P20)Overall perception of a positive experience was also impacted by the parents' understanding and expectations of the service prior to the single session consultation. If the families understood the process, they perceived the experience to be better than those who did not. Providing parents with an understanding of the clinic's process and clarifying parents' expectations for the service was appreciated by most parents. Parents reported the level of understanding, validation, and communication provided by AAHP was comprehensive and they requested this level of support to continue for other paediatric appointments. One parent felt the process wasn't explained well which in turn created some stress around ongoing support.Confidence in actionPerceived actions of AAHP and family members prior to, during, and following the consult directly impacted parental confidence to take actions following the consult. Parents respected the actions of the AAHP prior to consultations, reporting that AAHP appeared prepared and were ready to support the family. Actions of the AAHP during SST that were reported as relevant and appropriate included physical mannerisms such as eye contact and body language, intentional focus on the family, and being open and honest with the family. Additionally, parents reported a strong confidence and trust that the AAHP will take effective action following consultations including liaising with external parties and the team on their behalf.The significance of the AAHP actions of intentional effort to make the child comfortable and engaged, and the positive impact this had on the entire family during the consultation was frequently mentioned. When the child felt comfortable, safe, and calm in the consultation, parental stress and anxiety reportedly reduced.Following an AAHP single‐session consultation, most parents reported that they had confidently engaged in further actions to facilitate their child's development and their own management of their child. This ranged from engaging in other community services; meeting with schools and advocating for support; changing routines at home; and working on parenting practices with a greater understanding of the child's needs and capabilities. Parents commented on the actions their children engaged in following consultations, which led to improvements in their child's skills, such as:Just little behaviours that we [now do] with him. We kind of altered … [found] ways to make everyone's life easier (P7)Another parent described that:It gave us the confidence to continue doing what we're doing … and [child] has changed, has managed much better. She's a child you can talk to and she can understand what you're trying to do with her … It's been really beneficial … My husband and I decided that at this stage we didn't need to go any further, because we just thought we'd gotten enough out of [the single‐session] at this stage. (P34)Overall parents felt confident in the direction of the service provision and the management plans that were discussed for moving forward. Parents were confident in engaging in new actions or adopting small changes which allowed them and their child to manage and change for the better. Parents described the ability to change their perspective and mindset which facilitated a fresh perspective to their family's situation.It is about mindset and taking a different mindset, and I think sometimes you do need to reset, or maybe just have another go at it at a different phase. (P13)Due to the impact of COVID‐19, families expressed challenges that occurred with following up with private and community services. These included financial difficulties in accessing support services and the impact of restrictions to resources due to COVID‐19.DISCUSSIONThe results of this study provide an in‐depth insight into the experience of parents and children participating in SST during AAHP consultations for developmental and behavioural paediatric conditions. Exploring the experience of parents and children has led to an understanding of the characteristics of the consultation that led to therapeutic change. The themes derived from this study relate to facilitating mutual presence, valued time, and improved understanding and confidence to engage in meaningful actions both within and following consultation.Parents reported that a meaningful experience during SST was achieved through the AAHP intentional focus, ‘being in the moment’, and their desire to understand the child and the family. This is facilitated by utilising the time within the consult effectively, focusing on the family's needs and priorities, avoiding distractions, attending to the family's stories, and using reflective listening skills. This work builds on other research in the field highlighting the complexity of interpersonal and professional factors that contribute to positive therapeutic experience during consultations (Brown‐Johnson et al., 2019; Courtnage, 2020; Macaulay et al., 2008; Pitt et al., 2020). Families constantly reported on the mutual development of shared presence, understanding, and confidence between clinician, parent, and/or child. This mutual connection between the clinician and parent was pivotal to a positive experience and perceived positive outcomes of the consultation reported by families. This interpersonal complexity is consistent with research in the field demonstrating that clinician characteristics such as empathy, compassion, and providing hope are vital to the success of therapy (Courtnage, 2020; Macaulay et al., 2008).Families in this study reported high levels of satisfaction with the AAHP consultations due to the complete nature of the SST appointment approach. Parents identified that after one consultation they had improved understanding of their situation, and confidence moving forward in managing their child's needs. Parents identified that their child's needs were still present, however with increased understanding of their child they were able to adopt their own parenting practices and could have meaningful discussions with other services (e.g., schools) with positive outcomes for their child. This is consistent with studies in other health fields that have identified SST as being able to empower and support patients to utilise internal strengths to address health challenges (Hymmen et al., 2013; Lee & Tratner, 2021). This highlights that the SST approach can be utilised in paediatric development and behavioural caseloads, facilitating change in parental capacity, understanding, and the ability to action outcomes after only one consultation.Research has demonstrated that there are challenges to clinicians in being able to consistently and efficiently achieve therapeutic connection with patients (Brown‐Johnson et al., 2019). These challenges are linked to individual professional capabilities as well as organisational support (Brown‐Johnson et al., 2019; Johannessen & Alexandersen, 2018; Ventres & Frankel, 2015). Research into health‐care burnout and compassion fatigue is substantial, and a current priority of organisations (Zhang et al., 2018). Utilising structured frameworks such as SST may be one way to assist health‐care workers to be mindful of the emotions and feelings of both family, child, and AAHP within the consult, and assist with rituals to help with personal self‐care and prevention of burnout.Family experience of SST within AAHP clinics was improved when expectations of the service were met. This is consistent with studies that identify satisfaction is correlated to being accurately aware of the service (Hale et al., 2016). This study revealed that expectations were met when parents were informed of the SST clinic process (including wait times) and had prior knowledge of the health service that aligned with their values.ImplicationsFollowing the outcomes of this study, further consideration for the utilisation of SST approaches in other outpatient and paediatric caseloads is recommended. The framework proposed for SST within developmental and behavioural paediatrics may be a useful direction for other child developmental services to consider. This supports a cultural therapeutic shift from providing long‐term therapeutic input, to providing targeted short‐term input at times of need.This study highlights the need for concentrated AAHP presence, expertise, time, and intuition to reflect on and be aligned with the family's identified needs. Maintaining this level of professional conduct is exhausting and emotionally draining. Implementing organisational processes to provide the AAHP with time to process information and emotions and be able to remain intentionally focused throughout consult is necessary to prevent AAHP burnout and enhance patient outcomes (Brown‐Johnson et al., 2019; Haverfield et al., 2020). Further exploration of service efficiencies that improve experience and clinical outcomes, whilst enhancing professional fulfilment, without reducing time for AAHP well‐being is recommended.Results from this research have identified the need for further exploration of factors underpinning the family experience of SST. These concepts were beyond the scope of this study but warrant attention. Further research is recommended to explore the longitudinal impacts of parent and child actions following SST consults, and the clinical outcomes. This study utilised a qualitative methodology through semi‐structured interviews. Researching clinical outcomes through more standardised measures and clinical markers would be beneficial to understand the perceived short‐ and long‐term impact in more detail. Additionally, research into the specific constructs of interpersonal connection and engagement in the SST process would be beneficial to help guide clinicians in understanding the necessary training and clinical skills required to effectively implement SST. Further research into which particular developmental and behavioural paediatric patient cohorts benefit most from an SST approach and those that require other therapeutic consultation frameworks is needed.LimitationsThis study aimed to include children's experiences. However, conducting phone or video conferencing interviews with children with neurodevelopmental and behavioural conditions was challenging. Despite a small sample size, thematic saturation was reached which provided depth to the study. This study was limited to one location and health service. Future studies should be broadened to include a variety of health services.During the time of this study, initial COVID‐19 societal limitations were in situ, with many families conducting schooling from home. This was a challenging time for families. However, as most families reported positive experiences, providing an SST approach during this highly challenging time appeared beneficial. The SST approach was able to be adapted to telehealth mediums when required to suit families and societal needs.CONCLUSIONThis study makes an important contribution to the field of SST research by understanding the experience of families with children with developmental and behavioural conditions, which to our knowledge has not been explored before. Findings from this study describe an understanding of the characteristics of an SST approach, particularly the AAHP interpersonal skills, actions, and shared presence which led to families being valued, understood, and respected. The importance of the organisational clinic process such as being seen at a time of need was highlighted. Through this families described a therapeutic shift within themselves including a change in their understanding, improved knowledge, confidence, and trust in actions to support their child at home and in the community.ACKNOWLEDGEMENTSThis work was partially supported by the Allied Health Professionals Office of Queensland Research Scheme. The lead researcher, JC, contributed to the study design, obtained funding, data collection, and data analysis and wrote the manuscript draft. AKB provided feedback on the study design, contributed to the grant application and data collection, and reviewed the manuscript. MV contributed to study design, data analysis, and manuscript reviewing and editing. RD contributed to data analysis, and manuscript reviewing and editing. 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Journal

Australian and New Zealand Journal of Family Therapy – Wiley

Published: Sep 1, 2023

Keywords: behaviour; child; neurodevelopment; occupational therapy; psychology; single session therapy

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