Connecting With Caregivers A speech-language pathologist improves outcomes for early-intervention clients by changing the way she relates with parents. Make It Work
Free
Make It Work  |   July 01, 2017
Connecting With Caregivers
Author Notes
  • Rachel Harvey, MS, CCC-SLP, is a clinician in the Child and Family Support Program at the Kennedy Krieger Institute in Baltimore. She is an affiliate of ASHA Special Interest Group 11, Administration and Supervision. harveyr@kennedykrieger.org
    Rachel Harvey, MS, CCC-SLP, is a clinician in the Child and Family Support Program at the Kennedy Krieger Institute in Baltimore. She is an affiliate of ASHA Special Interest Group 11, Administration and Supervision. harveyr@kennedykrieger.org×
Article Information
Special Populations / Early Identification & Intervention / Make It Work
Make It Work   |   July 01, 2017
Connecting With Caregivers
The ASHA Leader, July 2017, Vol. 22, 34-36. doi:10.1044/leader.MIW.22072017.34
The ASHA Leader, July 2017, Vol. 22, 34-36. doi:10.1044/leader.MIW.22072017.34
I arrive at Billy’s home, as I do every Tuesday morning. I see my 2-year-old friend coming down the stairs in his diaper with a big drooling smile. His mother has a change of clothes and a fresh diaper and quickly gets him ready for the day. Billy brings me one of his new toys and demonstrates how it works. His mother sits on the couch, interested and attentive, though quiet. She shares a few updates: “He said ‘hot’ yesterday” and “He can bring me his shoes when I ask him to now.”
We celebrate with smiles and applause for Billy, who has a receptive-expressive language delay and who is now pulling books from a shelf. His mother looks exhausted as she describes other appointments scheduled for herself and her son. I carry out my planned treatment activities, address Billy’s goals, do my best to involve mom and provide my parent training. But as I approach the door to leave, there is an overwhelming feeling that I’ve missed something. And on one of those Tuesday mornings, I realized exactly what “something” was: a true connection with this parent.
In 2015, I did a two-day training in the Fussy Baby Network’s Facilitated Attuned Interaction (FAN), followed by nine months of supervision from a FAN-trained social worker. FAN was developed by Linda Gilkerson to increase engagement/connection between the service provider and the parent, and to support parents of fussy babies and—in this project—parents of infants and toddlers with special needs.
It was a pivotal year for me professionally. I never realized the true importance of connecting with the caregivers of my clients. Not “training” or “educating” them, but connecting, empathizing and seeing their child the way they see them. With this new practice, I’ve seen measurable change in my patient outcomes and productivity.

I never realized the true importance of connecting with the caregivers of my clients. Not “training” or “educating” them, but connecting, empathizing and seeing their child the way they see them.

Today’s urgent concern
Here’s something key that I’ve learned: Build each treatment session around a caregiver’s urgent concern. That’s the foundation from which to genuinely provide support. Identifying that urgent concern is not always easy—it may not be immediately obvious to the provider or even to the caregiver. That’s where three easy questions from FAN come in handy. I now ask them in every appointment and the responses continue to provide insight and surprise:
  • How have things been for you since we last met?

  • Are we getting to what you had hoped today?

  • What would you like to remember from our time together today?

These questions, when asked at the beginning, middle and end of a session, create the arc of the visit. The arc provides a structure upon which a provider can provide treatment and connect with the caregiver simultaneously. The questions are not about the child, but about the caregiver’s experience.
Many times my urgent concern matches the caregiver’s. But many times they do not match, and this is where providers can really change their practice. Once it is identified, the urgent concern provides common ground for building a treatment session.
Mindfulness and empathy
Mindful self-regulation and empathic inquiry are two parts of the FAN approach. Mindfulness and empathy are not “new-age” practices, but they do require practice! In one instance, they helped me to support a worried parent, who was then able to make an important—though scary—decision about her child’s care.
Mike, another 2-year-old, had an expressive language delay complicated by his complex medical history: He had been a micro-preemie, experienced traumatic intubations, and had an extended stay in the neonatal intensive care unit.
At one visit, Mike was scheduled for an outpatient surgery the next day. I began my visit by asking his mother my usual question: “How have things been for you since we last met?” In an exasperated and somewhat panicked tone she said she would likely not take Mike for his surgery the next day. She paced the room, describing in incomplete sentences that she “just wasn’t sure about it.”
In that moment my mind started to reel. I thought to myself, “Are you kidding me? He needs that surgery, you went to all the pre-op appointments, you’re just telling me this now? You’re clearly overreacting.”
After recognizing this feeling—and without offering a response—I used a mindfulness practice. I took a breath, tried to quiet my judgments about this mother, and forgave myself for jumping to those responses (a little kindness for myself!). Here was my chance to respond, rather than to react. It took every ounce of my self-control not to tell her all the reasons why this surgery was a good thing, but instead of offering advice or direction, I offered empathy.
In a carefully crafted response, I said, “It sounds like you are having strong feelings about this.” Emotions can be heavy (like bricks) or just difficult to contain if there are too many (like holding on to 15 inflated balloons with no strings), and empathic statements help “hold” emotions, making them easier for the caregiver to manage. The session continued with more descriptions of this mother’s apprehension and more supportive statements from me. I was trying to help hold these strong emotions for this mother, so they wouldn’t weigh so heavily on her, at least during our hour together.
My responses appeared to help and we did our typical language treatment that day. When I left, I knew I had supported this mother, though I was worried that Mike would not get the surgery he needed, at least not that week.
Much to my surprise, the next day I received a photo of Mike, in recovery at the hospital, with a text message that said, “I couldn’t have done it without you.”

The foundation upon which we practice needs to be attunement and connectedness. Without them, all the therapeutic pieces won’t stay in place.

Attuned and connected
The foundation upon which we practice needs to be attunement and connectedness. Without them, all the therapeutic pieces won’t stay in place. Attending to that foundation often means staying in the “hard places” longer: an upsetting diagnosis, a family crisis, an impending surgery. It also requires leaving personal beliefs, opinions and judgments at home—easier said than done.
I use the FAN tool for communication as a guide to stay present and connect with caregivers. When a provider can recognize their own feelings of dysregulation (judging or becoming frustrated with a parent, for example) and use mindfulness to manage these moments, they can stay present with a parent to provide support and make change.
Just as a child with secure attachment to caregivers is more likely to confidently explore the world, a parent with strong connectedness and support from providers is more confident to care for their complex child. Empathy is not feeling for a caregiver, it is feeling with them, and it is almost medicinal.
And Billy’s mother? I began to check in with her using the “arc” questions, and I would receive typical responses: “I’m fine” or “Yes, I want you to work on this.” One day, I asked mid-session if we were getting to what she’d hoped today. She responded, “Do you think he’ll ever really talk?” I had been happily playing Potato Head with Billy while his mother was worrying about his future. It was a great way to find attunement, offer support (“I can tell you’re worried about him”) and explore (“What do you think?”).
Ever since that visit, I’ve wondered if she would have asked me that question if I had never “checked in.”
Tips for connecting with caregivers
  • Pay attention to your reactions and feelings toward patients and families.

  • Keep empathic inquiries and statements short—something that can be said in one breath.

  • Use the arc questions to determine the “urgent concern.”

  • Ask the caregiver their theory of the problem (“Why do you think he isn’t talking?”). They’ve undoubtedly spent a lot of time considering this. Value and validate their response.

  • Be kind to yourself! It’s impossible to be attuned with caregivers and patients 100 percent of the time. Improving your connectedness, even if just a little, can improve outcomes.

0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
July 2017
Volume 22, Issue 7