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How Can We Improve The “Quality” Of Health Care Services?

Written by: Jessica Earle, Executive Contributor

Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.


What would quality services look like for a family seeking therapy support for their child?

Families would want to be able to tell their story openly and without judgment, feel reassured that they are seeking the right services, be able to ask questions and walk away with “next steps” in place, and have a sense that their child is feeling “taken care of”. We seek quality in our health care services however often we may feel like we are simply part of the quantity. Our families often a number on a waitlist? I’ve come to realize that “quantity” or lack, thereof, is a common issue for most families. Since moving to a new location with young children, I have felt the message of “quantity” over quality in health care. Minimal health care practitioners, limited resources, the overwhelming message of “there are not enough” so just be ok with what you get. COVID-19 has certainly added more layers to an existing issue.

As a mother of three young children and a pediatric occupational therapist, I am feeling the message loud and clear from both sides. You may have heard of an “occupational therapist” or know someone who has received services from an occupational therapist. We work in so many environments such as hospitals, nursing homes, schools, child development centers, offices, home health services, workplace & safety positions, teachers at universities, etc. We are everywhere because our profession allows us the opportunity to explore and diversify to enable those who need it.

As a clinician in pediatrics, my training has purposefully led me to focus on the quality of services. When you are working in the public sector, you often find yourself under the microscope of “quantity” and feeling overwhelmed with long waitlists, the pressure to see as many clients as you can, etc. In my experience, quality was always pushed forward even when you have felt overworked and overwhelmed with the constant lists of items needing to be crossed off. Quality always began with speaking to families and getting a sense of their “story”. This story unfolded like a book that allowed me to understand the family “past, present and future”.

The “past, present & future” concepts are the backbone of therapy services. A holistic approach to understanding your child’s needs is to fully understand your client’s story.

Some families might ask, “Why do I need to discuss all my child's developmental history for a quick fine motor assessment?” or “Why do you need a full history when I’m asking for ideas on how to improve my child’s ability to focus in the classroom? “Why a full history when I’m asking for ideas on how to expand my child's diet?” etc.

The detailed story gives room for quality care. When I sometimes got entangled with “quantity” care, it often felt like a “Band-Aid” approach. As a parent and professional, you seek quality over quantity solutions.

What does the “past” look like in someone’s story? A detailed interview allows the therapist to obtain vital information on how a child responded to various sensory inputs, how a child transitioned through developmental milestones, recognize the context of a child and the relationship with their own family, and understand any past traumas that a child and family might have experienced, etc.

These discussions open a whole new dialogue between parent and therapist because the story is beginning to unfold. You have a chance to understand a parent’s history/experiences from their perspective and delve into their past to possibly reveal triggers, emotional key points, and provide a parent a “soundboard” to freely discuss what is on their minds and what is in their hearts. The “past” discussion is hugely important for a therapist to grasp because it will help guide the therapeutic process with a child.

We arrive at the "present". This "present" looks like a formal assessment, observation session at a child’s home, daycare, or school, gaining insight into a child’s behavior in session. This "present" is a gift because a therapist gets a chance to meet their client and discover all their strengths, get a sense of their personality, interests, and likes/dislikes.

The “future” of the story is when parents/caregivers and the therapist obtain a sense of “where” we are headed. Family identified goals are developed and “next steps” are planned. If the family presents a concern that is not within the realm of the therapist, a discussion on who might be helpful to help the family can be discussed. When families can walk out of a session, knowing “where” they are going and “how” their concerns are being met, quality care is set in motion.

While in sessions, we might often get focused on finding the “right” answers for the family when I’ve discovered that providing support in terms of regulation to the “whole” family first is the most valuable. In therapy terms, this is understood as “co-regulation”. Parents/caregivers who are stressed and seek your expert opinion will begin this therapeutic journey in a much better space when they feel regulated. We all understand that once a parent/caregiver is regulated, they can support and regulate their child. This is referred to as “co-regulation”. Co-regulation is a wonderful concept because it isn’t something you buy, it’s in us and can be sourced anytime, anywhere. Self-regulation is a lifelong skill and so is co-regulation. We need to be regulated before we can co-regulate.

How can a health care professional co-regulate? First, that professional needs to be present and determine if they are feeling dysregulated. If so, completing calming activities that support your nervous system is the first step.

What regulates you? Meditation? A warm cup of coffee in the morning? Exercise? Deep belly breathing? Listening to music?

Once your nervous system is in a “just right” state, you then can co-regulate. Co-regulation is simple, listen with intention, be empathic, ask questions to understand the many layers to their concerns, and simply “be present” or “being with” when they are struggling emotionally with a sensitive topic. This approach of “being with” highlights how we can use our presence to support families in need. “Being with” is not only about verbal communication, it's important to consider non-verbal communication. Is your body language calm or disruptive? Our gestures, tone of voice, and facial expressions impact our experiences with developing a secure attachment. We can imagine how masks (reduce facial expressions), limited resources for staff feeling overwhelmed/overworked, and additional layers of stress can impact the quality of care that we desperately want for ourselves and our children.

If we can practice self-regulation and make steps towards co-regulation, we can then create more quality in a bigger and more compassionate way.

Co-regulation and regulation topics are to be explored in my follow-up article.

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Jessica Earle, Executive Contributor Braiinz Magazine

Jessica Earle, is a pediatric Occupational Therapist with a focus in early intervention and school age therapy services. After working in various pediatric settings across Canada, Jessica owns a private practice in Halifax, Nova Scotia, Canada. Her practice focuses on providing quality therapy services to bilingual families needing support around feeding, sensory integration, and attachment-based therapy. She offers a blog that combines common parenting struggles with helpful therapeutic tips for families. Jessica will be launching an online course for therapists seeking support in assessing children’s feeding skills in the community. She values a family centered approach and encourages an inter-professional collaboration between health professionals to meet the therapeutic needs of each family.



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