Communicating with families from a strengths-based perspective

"In writing from a strengths and abilities perspective, we write in a manner that is neutral and positive, limiting the extent to which we emphasize deficits in our interpretation of observed behaviors."

Many of us have been taught to write our evaluation and progress reports from a strengths-based perspective.The purpose of using strengths-based report writing is not only to be respectful and kind to the child and family (though that’s certainly enough!), but also because research has shown it improves the therapy process (e.g. clinician­–parent relationship) and outcomes (e.g. behavioral, academic); see article background for literature review. The authors state, “… documentation may be the anchor for how families have and share information…” and “…it’s important that … services occur in a way that leaves families with hope rather than despair.”

The purpose of this study was to evaluate current clinical practices. To do this, the researchers pulled 20 patient reports from an autism diagnostic clinic, collaboratively written by SLPs, OTs, and psychologists. They then analyzed 299 phrases from these reports, coding each as:

  • descriptive (e.g. “The child’s mother and stepfather accompanied him to the appointment.”
  • interpretive, positive (e.g. “Julie was easily redirected to tasks.”)
  • interpretive, negative (e.g. “Emily was generally unable to follow simple directions.”)
  • interpretive, neutral (e.g. “He exhibited a partial smile during the balloon activity.”)

Findings from the study demonstrated that, “…interdisciplinary providers… used phrases that were interpretive and negative significantly more often than other types of statements in their written diagnostic reports.” The authors state, “… clinicians may identify strengths and resources during a diagnostic evaluation, yet make intervention and programming recommendations around a specified diagnosis with little consideration for the identified strengths or family priorities.”

So, we may not be using strengths-based writing nearly enough. Now, an initial reaction from a clinician reflecting on his/her own writing may be, “Yeah, I use negative interpretive language. But it’s because I’m trying to get this kid the services he/she needs, and school districts and insurance companies don’t exactly pony up easily.” And the authors acknowledge this barrier—that reimbursement and service provision is deeply rooted in a deficits model. But does it have to be? Is there any data to indicate that negative interpretive language is more likely to result in service provision and reimbursement? Regardless, when the client, family, and intervention outcomes are the focus, writing from a strengths-based perspective has strong supportive evidence.

So, how can clinicians improve their skills? First, the authors suggest that some version of “active learning strategies”, with practice, coaching, feedback are likely to work better than passively listening to a brief CE course, for example. They also suggest clinicians may audit their own work by using Figure 1 from the article (which is basically a flow chart to figure out what type of language you’re using). Also, Table 5 in the article gives example of what strengths-based writing does and doesn’t look like, such as:

  • YES: “He hit his sister twice…” (descriptive)
  • YES: “He used happy and sad facial expressions on several occasions.” (neutral interpretive)
  • YES: “He maintained good eye contact…” (positive interpretive)
  • NO: “Social interactions were difficult.” (negative interpretive)
  • NO: “He was very impulsive in the waiting area.” (negative interpretive)

As can be seen, the use of descriptive, positive interpretive, and neutral interpretive is encouraged, and the use of negative interpretive is discouraged.

The authors state, “Providers are considered a guide or agent to the family, and their role is to assist them in identifying their own strengths and resources and help them realize their potential.” Also, “By focusing on strengths, we shift the starting point of care from problems (or deficits) to strengths and abilities.”

Braun, M.J., Dunn, W., Tomcheck, S.D. (2017). A pilot study on professional documentation: do we write from a strengths perspective? American Journal of Speech­–Language Pathology. Advance online publication. doi:10.1044/2017_AJSLP-16-0117