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					              Workshop:    Talking with parents
               Sally Hind and Lindsay Kimm

       Avoiding unintentionally misleading parents

A scenario was ‘acted’ out to represent a clinic appointment. The participants
represented a clinician and a parent whose baby had been diagnosed with a
severe hearing impairment 75dB HL. A conversation was taking place about
the likelihood of the baby developing spoken language. The mother used the
pronoun ‘it’ in several places which, following accepted rules of English
grammar, appeared to refer to the child’s future spoken language skills.
However, in reality the mother was referring to the child’s hearing impairment.
Consequent on this, the clinician unwittingly affirmed the mother’s hopes by
agreeing that it was possible, reiterating each time that it was still much too
early to be certain, that ‘it’ (meaning spoken language but being
misunderstood as hearing impairment) might improve over time.

PLEASE NOTE. THE MOTHER IN THIS SCENARIO WAS AN ARTICULATE
WHITE CAUCASIAN WITH ENGLISH AS HER FIRST LANGUAGE. I.E. THIS
IS NOT JUST AN ISSUE FOR PEOPLE WHOSE FIRST LANGUAGE IS
OTHER THAN ENGLISH OR WHO ARE NOT VERY ARTICULATE

Workshop participants were invited to rate the scenario on (1) Family-
Friendliness, (2) Accessibility, and (3) Content. They were then informed that
the main interest was on the content and they were invited to offer
suggestions about possible problems with the content. Only 1 participant out
of 60+ recognised the ‘trap’ which had been set.

The participants were debriefed, and much useful discussion followed.
Several participants offered scenarios where they now realise they too could
be using unintentional misleading information. For example, using the
expression ‘We’ve managed to get good results today’ meaning the child
cooperated and a test with clear outcomes was achieved. For many parents,
‘good results’ would be translated as – better hearing.

There was ecological validity behind this workshop. Sally Hind explained that
she had interviewed several parents of children with severe-profound hearing
loss who reported the clinician had told them their child’s hearing might
improve as they get older. Clearly this is unlikely to have happened so it is
highly probable something such as discussed in this workshop occurred, and
planted the erroneous idea in the parent’s mind.

Participants were then invited to discuss the issue further and generate ideas
to help minimise such misunderstandings. Their ideas have been categorised
below.
                                  Verbal information
   Minimise use of potentially ambiguous words like ‘it’.
    This is difficult given the usefulness of the pronoun but try to listen out for it
    and reiterate what is being substituted by ‘it’
   Try to avoid using expressions like ‘get/getting better’ even when referring
    to something/anything unrelated to the HL. The intended message (e.g.
    parent’s understanding of HL which should ‘get better’ with time/clinic moving to a new
    building will mean the facilities will ‘get better’) could be forgotten and substituted
    with the expression ‘hearing loss will get better’.
   Take care when categorising information, especially with language use of
    words which have different meanings in lay terms from the ones you are
    using professionally
   Avoid using expressions like ‘good result/s today’ if you’re only referring to
    the traces/audiogram etc and not to the child’s actual hearing level – can
    be misunderstood to mean the hearing is better than last time
   Provide only bite-sized chunks of information
   Don’t try to ‘soften’ message for parents – can lead to more
    disquiet/discomfort if misunderstood
   Only talk in facts and be honest. Don’t be afraid of ‘telling it as it is’
   Be cautious if defining hearing loss in terms of ability to develop language
    – this can be a useful method of describing outcome but can be
    misleading
   Clarify every point made
   Keep remembering to check if your language and content is appropriate
    for the parents before you
   Clearly state if it is a permanent hearing loss and reiterate what is meant
    by permanent
   Don’t say too much
                           Supporting information

   Use diagrams to consolidate verbal information
   Use written information to support verbal or diagrammatical information
   Produce a FAQs booklet with appropriate responses
   Provide a written definition of audiological terms and commonly used
    phrases which can have different meanings outside the profession
   Provide phone numbers for key contacts and encourage parents to call
    them with their questions. Explain that these people will be very pleased to
    hear from them – it is part of their job (some parents feel uncomfortable
    about asking for help from busy people)
   Provide a clinic letter to parents which states in easy non-technical terms
    the exact state of affairs




                   Enhancing understanding on all sides
   Check parent’s knowledge and understanding of hearing loss
   Use a check list with appropriate lay expressions to guide you
   Listen to parent’s questions before responding
   Check understanding of question raised, speaking out aloud so they can
    correct any misunderstandings on your part – encourage them to do this
   Reiterate and check questions and understanding of information proffered
   Allow parents time to express their fears etc
   Ensure you reduce ambiguity by careful use of body language
   Make sure parents understand that hearing aids/CIs are not a ‘cure all’
   Ideally have Health and Education representatives together during such
    appointments – multidisciplinary team may spot misunderstandings
   All professionals need detailed training in how to give information and not
    just how to break bad news
   Get the parent to seek more information on hearing loss and advise on
    how to go about it