Communication in research, evaluation, or audit

Tania Hart and Gillian Eccles

Introduction

There is a wealth of evidence highlighting the importance of research that aims to get a better understanding of children and young people’s life experiences, perspectives, values, standpoints, developmental needs, and life trajectories. All of this is supported by the United Nations Convention on the Rights of the Child, 1989 (Office of the United Nations High Commissioner for Human Rights), which stipulates, children globally have the right to express their views on matters that impact their lives. Often the broader goal of conducting a child-centred research enquiry is to seek new or more accurate information about children and their experiences, as they themselves perceive them. Such knowledge has the potential to inform a wide array of child-centred local, national, and global policies and practices because it enables adults to better understand, engage, and support the needs of children.

It is fair to say that in health and social care it is now common practice to involve children and young people in research, as well as other forms of enquiry, such as service evaluations and clinical audits. This information has important value because it can potentially make a difference to children’s lives by, for instance, helping to develop health related policy or cutting- edge clinical interventions and therapies as well as improving and assuring the quality of everyday intervention and practice. A classic example of an historical piece of research having great influential power on national policy, even today, is Bowlby and Robertson’s (1952) child-focused investigation, whereby the findings underpin the rationale for parental open visitation rights to visit their sick child in hospital. This recommendation being derived from their films, whereby they observed the potentially detrimental effects of hospital stays on young children.

Carrying out research with children and young people does, however, have challenges; a major one being effectively engaging with the young person on an interpersonal level and getting the communication right, especially considering the imposed generation gap between child and adult. It is therefore imperative, in order to maximize the research time spent with young people, that great attention is paid to one’s own interpersonal skills, how you communicate and the language you use (O’Reilly and Parker, 2014). This applies to both quantitative and qualitative researchers, auditors, and those involved in service evaluation activity. This is because communication in research is often all encompassing, involving written or verbal communication which often seeks to engage communities, as well as individuals. It is also fair to say communication is needed at every stage in the research process, whether it be in the preliminary stages of data collecting or at closing when disseminating the research findings. Furthermore, sensitive, in-depth, qualitative enquiry also requires the researcher to possess more advanced communication skills as it is crucial to engage with a vulnerable young person effectively and safely.

This chapter aims to provide those interested in child-focussed enquiry with some helpful engagement and communication tips. We first distinguish research communication from everyday professional communication. Then we introduce the reader to some commonly adopted child research communication strategies. We then highlight the benefits of improving our research communications by consulting and involving children and young people more proactively in our research projects as well as highlight the importance of using creative mediums to promote research engagement and communication. Throughout this chapter we detail and share some of our own research experiences, when carrying out different forms of child- focussed research.

How research-focussed communication differs from other forms of professional communication

Before we move onto discuss communications in research, it is useful at this point to outline the similarities as well as the major differences between other forms of professional communication, that maybe, clinical, recovery-, or formulation-focussed communication, or conversations that take place in the teaching arena, whereby they revolve around pedagogic or pastoral supports. The communication approaches used when carrying out these differing types of professional communications, to some degree, like research communication, all share a common objective, which is to sensitively enquire and evoke information, whereby the young person feels able to share their personal information. To gain an individual’s trust just like all other professional communication, research communication is also underpinned by Rogerian principles of congruence (being genuine and real) and unconditional positive regard (being non-judgmental, respectful, and accepting) (McLeod, 2019).

Despite the similarities of research and other enquiring professional conversations and communications, they do however differ. Very importantly, research-based conversations aim in the main (not in all cases) to remain neutral as the goal is to gather new or more up-to-date information without making judgements or without influencing the data or outcome. Very often there is no emphasis (except for research methods like clinical trial interventions) on striving for therapeutic benefit (Targum, 2011).

Those professionals trained in differing forms of interviewing will need to separate clearly their routine professional roles from their research role. Remembering that the objective of research-focussed conversation is in the majority of cases, not to offer therapy, support, or help, but to ensure, within the parameters of the research project, the young person(s) have their say about the issues that are important to them. Upholding this neutral stance can pose the researcher, who is more accustomed to facilitating therapeutic or supportive interventions, with a challenge. As senior CAMHS professionals we have frequently found ourselves shuffling our clinical and researcher hats and so over the years have found ways of compartmentalizing our differing roles and maintaining neutrality. Below we outline some of our tips and reflect on how we partition our roles:

• • Think carefully prior to conducting your research about the action process and signposting you will do if a child becomes distressed or needs further assistance during your research activity. This is also an ethical consideration and ensures you partition your roles.
• • In your initial introductory conversation and participant information sheet, remember to outline briefly the parameters of what you can and cannot do in your role as a researcher.
• • Refrain from advice giving during the interview so as not to be sidetracked away from your topic of enquiry, however, allow time following your research activity to give advice or therapeutic support or signpost information to alternative help if needed.

Gillians reflection below outlines the importance of separating out clinical and researcher roles

It is now common and statutory practice within CAMHS services and other agencies to evaluate clinical practice by gathering outcome information. Such practice is driven by the Child Outcomes Research Consortium (CORC) whose business it is to collate via specially developed, age appropriate measures, information from young people about their mental health service support. What I have found, over the years, is it is important to assertively boundary my psychotherapy role from my evaluator role. This ensures children can then be supported in their own transition from taking part in therapy, to being in a more objective enabling frame of mind whereby they feel selfconfident enough to autonomously fill out an evaluation questionnaire.

Segregating one’s clinical responsibilities, can however be a personal challenge. What I have found helps, is having a demarcation between therapy and evaluation activity. I do this by introducing the measures to the child before therapy begins and letting them know what I will be asking them to do in the end 5 minutes of our time together. I will then explain why the measures are needed and how they will be used.

I always ensure I finish as promised. I then inform the child the therapy session is over and it is now their time to fill in the measure. I provide some explanation of how the measure will be used to inform service improvement and give instruction as to how it needs to be filled in, and always provide a caveat to the child emphasizing there is no right or wrong response to the questions. I give them the opportunity to ask any questions about the measure and if they reject the request to fill it in or are demonstrating signs of uncertainty, I then take time to explore with them the use of outcome measures and how this helps develop service provision. In most the cases the child responds well once they have an understanding of the purpose of the activity. If a child still refuses to take part in any clinical evaluation it is important to honour their decision, reassuring them that it is OK not to participate whilst being mindful of the child adult power imbalance.

As an Art Therapist I also encourage the children to decorate and personalize their questionnaires with drawing or stickers. This provides them with a degree of ownership promoting their autonomy and free thinking. I have found I sometimes have to guide the child when they ask, “How do I answer this?” I also prepare to explain and reframe any questions that the child may not understand. It is during this time, very importantly, I also need to remain cognizant of the importance of remaining neutral in my stance, avoiding influencing the answers the child provides. I have always found this purposeful partitioning of time, along with clear explanation encourages child autonomy helps me to remain neutral in my stance.