Exploring the complexity of engagement with families in early speech-language pathology intervention

Abstract

Despite being an important factor for the delivery of best practice early intervention services, ‘engagement’ has been inconsistently defined in paediatric healthcare. While recent research in other settings has identified that engagement is complex and multifaceted, the nature of engagement in early speech-language pathology intervention has never specifically been defined. There remain substantial gaps in understanding what engagement means, and how engagement can be supported in early speech-language pathology intervention. Therefore, the aims of this thesis were to: (1) describe the nature of engagement in earlyspeech-language pathologyintervention according to the existing literature;(2) identify the characteristics of families who are engaged in early speech-language pathologyintervention according to speech-language pathologists (SLPs) in this setting;(3) explore the complexity of how different families are engaged;(4) identify the factors that underpin the way a family engages in early speech-language pathologyintervention across their intervention journey;(5) identify what SLPsdo to support families to be actively involved in intervention inside and outside sessions; and (6) explore the perspectives of families regarding how their SLP supported them to be actively involved. Following a background literature review presented in Chapter 1, the aim of the systematised review presented in Chapter 2 was to provide a description of engagement in early speech-language pathology intervention, as represented in existing literature. Thematic synthesis was used to analyse qualitative data from 28 peer-reviewed articles. Results suggested that engagement could be conceptualised as (1) a complex, multifaceted state of ‘being engaged’, where parents are ready and empowered to take an active role in intervention; and (2) a relational, co-constructed process where many families need time and support from SLPs to ‘become engaged’. The purpose of Chapter 3 was to explore SLPs’ perceptions of the characteristics that describe families who are ‘engaged’; and the characteristics they consider most important for engagement. Using a participatory mixed-methods research approach called Group Concept Mapping, Australian SLPs brainstormed statements in response to a focus question about engagement (n = 58), grouped statements into categories (n = 34), and rated the importance of each statement (n = 29). Results indicated that engaged families: (1) are reliable and ready for therapy; (2) have an open, honest relationship with their SLP; (3) actively participate and take initiative; (4) work in partnership to plan and set goals together; (5) see and celebrate progress; (6) invest in intervention at home; and (7) understand intervention and advocate for their child. All aspects of engagement were considered important, with the family-SLP relationship and families’ investment in intervention at home rated most highly. Findings of Chapters 2 and 3 informed the design of a series of studies contained in Chapters 4 to 6 of this thesis. A collaborative visual methodology called video-reflexive ethnography was used to explore engagement from the perspective of both SLPs (n = 8) and families (n = 21) working together in early intervention. Up to three intervention appointments for each SLP-family dyad were video-recorded. During individual, semi-structured interviews, participants were shown selected video segments from their appointments and invited to reflect on aspects of engagement. The first study in this series is presented in Chapter 4. Findings highlighted that families have different levels of engagement in various aspects of intervention, which contribute to their unique profile of engagement. For example, families engage differently with respect to: attending sessions and coming into the room; actively participating in sessions; actively participating outside sessions; and having open and honest communication with their SLP. The second study in this series, which explored the factors that underpin families’ engagement in intervention across their intervention journey, is presented in Chapter 5. Findings provide a better understanding of factors that impact the establishment of engagement; maintenance of engagement; and families’ ownership of an active role in engagement. Opportunities for SLPs to provide proactive and responsive support as they work with families over time are discussed.Chapter 6 explored what SLPs do to support families to be actively involved in intervention, and families’ experiences of being actively involved. SLPs supported involvement in sessions by planning ahead, setting expectations, modelling strategies, inviting families to ‘have a go’, providing feedback, and problem-solving with families. Families’ continued involvement was supported when SLPs provided opportunities to practice in sessions, made home practice achievable, asked about home practice, highlighted progress, and involved other family members. Results from the aforementioned studies contribute to a more complete understanding of engagement in early speech-language pathology intervention. Engagement is presented as (1) a complex and multifaceted state of ‘being engaged’, which looks different for different families; and (2) a dynamic, co-constructed process which is influenced by multiple factors over time. As SLPs and families are considered ‘co-constructors’ of engagement, SLPs have an important role in working with families to support their engagement in various aspects of intervention, inside and outside sessions.