Braun Matthew J, Dunn Winnie, Tomchek Scott D
University of Kansas Medical Center, Center for Child Health and Development, Kansas City.
University of Kansas Medical Center, Department of Occupational Therapy Education, Kansas City.
Am J Speech Lang Pathol. 2017 Aug 15;26(3):972-981. doi: 10.1044/2017_AJSLP-16-0117.
There is growing evidence supporting the use of strengths-based practices when serving families. The purpose of this study was to examine the use of strengths-based approaches in the context of written professional documentation. We specifically explored whether or not interdisciplinary clinicians in one university-based medical center clinic write from a strengths perspective (e.g., writing focuses on abilities rather than on deficits) when documenting child behavior in autism diagnostic clinics.
We gathered narrative-based writing samples (a total of 299 phrases) from 20 patient reports. Using a coding system developed by the research team (intraclass correlation coefficient = .801 on final definitions and coding system), we analyzed the extent to which interdisciplinary clinicians included strengths-based language (e.g., language that emphasizes a person's strengths rather than limitations) in their written documentation. An independent researcher coded a random sample (20% of entire sample) of the data to document reliability of the coded data (97% interrater agreement).
Our findings indicated that clinicians in our study used deficit-based language significantly more than neutral and strengths-based language in written documentation.
This preliminary evidence suggests a need to reflect upon our own understanding of strengths-based practices and the way professionals write about children in clinical documentation.
越来越多的证据支持在为家庭提供服务时采用基于优势的做法。本研究的目的是考察在书面专业记录的背景下基于优势的方法的使用情况。我们特别探讨了一所大学医学中心诊所的跨学科临床医生在自闭症诊断诊所记录儿童行为时是否从优势视角进行书写（例如，书写聚焦于能力而非缺陷）。
我们从20份患者报告中收集了基于叙述的书写样本（共299个短语）。使用研究团队开发的编码系统（最终定义和编码系统的组内相关系数为0.801），我们分析了跨学科临床医生在其书面记录中纳入基于优势语言（例如，强调个人优势而非局限的语言）的程度。一名独立研究人员对数据的随机样本（占整个样本的20%）进行编码，以记录编码数据的可靠性（评分者间一致性为97%）。
我们的研究结果表明，在我们的研究中，临床医生在书面记录中使用基于缺陷的语言显著多于中性语言和基于优势的语言。
这一初步证据表明，有必要反思我们自己对基于优势做法的理解以及专业人员在临床记录中描述儿童的方式。
