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Introduction
In this paper I would like to present the findings of my research (1995) into the satisfaction of parents about the Early Intervention service, offered by the Theofaan Institute in the Netherlands.
The results are based on
the information of 88 questionairres, which were completed by the parents
(=57%). Besides using structured categories for their answers, parents
were also asked to give additional information to illustrate their answers.
The usefulness of a satisfaction
survey lies not so much in establishing the level of satisfaction, but
more in detecting areas of dissatisfaction which can be the basis for improving
the quality of the service.
First of all, I am happy to inform you that the final conclusion was that most of the parents were very satisfied about the EI service provided by Theofaan. They were satisfied in general as wel as regarding specific aspects of EI. Such as organisation, methods and objectives, cooperation with parents and evaluation.
I could give you a large amount of figures and data to illustrate this. But I won't. In my opinion the additional information parents has given are more important. I will use some of these answers to illustrate my lecture
So: Parents are satisfied,
but still ......
On the following sheet you can see how I have structured this lecture:
SHEET
- introduction
- account
- study - objectives
- formulation of the question
- subjects
- method
- conclusions and recommandations
- general comments
- data on child and family
- social work and assessment
- support provision in different
situations
- points of attention and
activities in EI
- general
INTRODUCTION.
In general, when the period
of intervention has been concluded, Theofaan in conjunction with the parents
evaluates the service.
Although this type of service
provision to visually impaired children and their parents has existed for
a considerable time (in the Netherlands for over 20 years), parent satisfaction
with the service has never been systematically studied.
I felt it was important to carry out a satisfaction survey, despite the methodological snags involved, especially now since the number of children in EI has risen sharply over the past 15 years. I will show you some figures.
SHEET
Early Intervention: chidren in care
1983 70 children
1986 99 children
1989 145 children
1992 279 children
(Source; 10 jaar Theofaan, Dr. H.Gresnigt)
1994 279 children
1995 302 children
(Source: Theofaan annual report 1995)
This increase has led to an enormous expension of the EI-service. As a result, the quality and the improvement of the service may have somewhat receded into the background. I therefor felt it would be important to gain a better insight into the quality of the service by means of this survey.
STUDY
The purpose of this study was therefore to find out whether the format and the contents of the EI service provided by Theofaan meet the parents' needs and questions.
The main question of the study was:
To what extent are parents satisfied with the orthopaedag ogical intervention provided by the Theofaan EI department?
We can distinguish different aspects in the EI process, which in practice intersect, but for the study a number of aspects were artificially singled out. Different aspects were adressed, e.g. intake, assessment, role and activities of the educational home visitor, etc.
SUBJECTS
The subjects of the survey
were parents of visually impaired and multiple visually impaired children
under the age of 10 years.
The support may have been
provided at home and/or in various institutions or primary schools. The
support was finished and these contacts were terminated up to 3 years before
the survey was carried out. There was no longer a direct relationship between
the parents and the EI-team. This would as much as possible help overcome
the problem of socially desirable answers.
METHOD
The survey was based on a
structured questionaire. With the majority of the questions parents were
asked to express their level of satisfaction about different aspects of
the EI service. They could give 3 different answers
- satisfied
- not satisfied/not dissatisfied
- dissatisfied
Furthermore, with a large
number of questions the parents were asked to explain their answers. This
would possibly benefit the reliability and validity of the parents statements.
Most parents amply complied with the request for additional information.
CONCLUSIONS AND RECOMMENDATIONS
Comments
In a satisfaction survey
similar opinions expressed by different parents may have very different
meanings . Therefore the overall opinion of all the parents has limited
value. We should therefore be cautious in drawing conclusions from such
a survey. By combining all the results of the questionaire a lot of important
information would be lost.
In particular the explanations
provided by the parents on various aspects in combination with their rating
of these aspects, in my view, yield more usable information. On the basis
of these explanations and ratings it is easier to draw objective conclusions
and to make recommendations that assign more valua to the parents' experiences
with the Theofaan EI service.
The survey shows that the
group of parents studied were satisfied with their contacts with the Theofaan
EI.
However, we should bear
in mind that this survey did not examine whether this group of parents
(88= 57%) was representative of the entire group of parents approached
(154).
Conclusions can therefore
only be made on the basis of the data that these 88 parent have supplied.
As most of the parents indicated
that the were satisfied with the early intervention, both in general and
with regard to the individual aspects of the service, there was not much
point in statistically examining the relations between different variables
and the level of satisfaction. We can conclude that detecting dissatisfaction
has proved to be difficult.
How can this overall satisfaction be explained?
The most obvious answer is, of course, that all the parents have really been satisfied with the Theofaan EI service. From the large number of explanations that parents gave to the different questions such a conclusion perhaps could be justified. As far as the reliability of the parents' statements is concerned, these explanations have proven their value in this survey.
However, a number of alternative
explanations should also be given. It may well be that the parents have
given socially desirable answers, both with regard to the answer (satisfied/dissatisfied)
and ther explanations. This despite the fact that there is no longer a
relationship between the group of parents approached and the Theofaan EI
team.
Another explanation could
be that parents, in general, have been satisfied with the service without
differentiating. Whether there has been a question of parents having forgotten
less positive experiences unfortunately cannot be established.
A 5-point scale, rather
than the 3-point scale that was used, would possibly have yielded a more
differentiated picture.
Another point is whether the outcomes would have been the same if all the parents approached had returned the questionnaire. It cannot be excluded that the number of dissatisfied parents in this group (N=50 = 33%) is higher than in the group that responded.
On the basis of the survey
results it can be concluded that the parents are satisfied with the format
and contents of the Theofaan EI service. A further deepening and improvement
of the service, however, could result in an even higher level of satisfaction
among parents.
Despite this general satisfaction
a number of aspects are noticeable because in relation to the other aspects
a lower level of satisfaction was expressed. These relatively lower rated
items will be addressed in more detail later in addition to other conclusions
and recommendations.
At the moment the Theofaan EI department does not use standard evaluation forms to be completed on the conclusion on the support. However, we recommend that a standard evaluation form be used. It would give parents the opportunity to express their expectations, ideas and experiences with regard to the service. By means of a standardised form all aspects could be addressed. It would provide the department with data concerning the format and contents of this service.
DATA CONCERNING THE CHILD AND ITS FAMILY
First of all, some information
that came out of the survey. In most cases the families concerned were
"complete", i.e. consisted of a father, a mother and a child or children
(91%).
In 42 of the families (48%)
the visually impaired child is the only child in the family. In 86% of
the families there are additional children. The number of boys represented
in the survey is nearly twice as high as the number of girls (66% vs 34%).
Under the section "the nature
of the impairment" partial sightedness was mentioned the most (60%). The
group of multiple handicapped children is about half of this (33%) while
the number of blind children is 7%. Whether these figures are representative
of the children of all the parents approached in this survey has not been
established.
The group of parents with
multiple handicapped children with a visual impairment represented 33%
of the respondents, whereas currently over 50% of the service users fall
under this category. Possibly, for whatever reason, less parents of this
group of children responded to the survey.
Secondly, it could be that
this number of multiple handicapped children is representative of the period
concerned. In particular over the past few years this group has increasec
significantly. It will be clear to everyone that is fact affects the nature
and contents of the service provided by Theofaan and will require gaining
more in-depth knowledge about this issue.
44% of the parents indicated that they received a lot of support from their family, friends and acquaintances. 16 parents indicated that they received little support from their social environment (18%).
In my view, the number of parents who received "not much/not little support" and "little support" from their family, friends and acquaintances (38% and 18% respectively) is remarkable and significant. Possibly the parents of visually impaired children are often alone in fulfilling their educational task. Their family may be relatively isolated from their environment.
38% of the parents foun it easy to appeal to service institutions for help. The majority of the parents indicated that they found this not difficult/not easy (46%). 15% found this difficult to do. Possibly ther is too high a threshold for parents to use these institutions.
The average age of enrolment for early intervention was between 1 and 4 years. 19% of the children were enroled during their first year.
Early recognition of the
handicap and familiarity with Theofaan appears to work well.
Nevertheless, a childs visual
impairment may become more evident as the child grows older. Placement
in a day care center or a special school that can pay more attention to
the visual functioning may lead to questions about the childs vision.
The majority of these children (53%) subsequently received support for 2 to 4 years, while 27% received support for 4 to 6 years.
34% of the parents indicated that during the Theofaan early intervention they als worked with other support agencies.
SOCIAL WORK AND ASSESSMENT
*From the survey data it
also becomes clear that the opportunity to have supportive discussions
with social workers (depending on the parents needs) forms an important
part of the support Theofaan offers to families with visually impaired
children. 43% of the families have used this opportunity to their full
satisfaction.
In particular the way in
which social workers approached the parents appealed to the respondents.
Parents characterised this aspect of the service with phrases such as they
have all the time in the world, listening, supportive, helps them to reflect
on their own feelings.
*Assessment
The data show that both
the assessment and the support (which are mentioned together under one
category) were the main reasons for parents turning to Theofaan (51%).
20% of the parents did not
know this before they contacted Theofaan. 18% of the parents indicated
that the assessment was the main reason, whereas only 10% stated that the
actual support was the main reason for using Theofaan.
The parents indicated that the assessments (ophthalmological, psychological and physical) were important in forming and keeping a good overall picture of the childs development and potential and guiding the support at home and/or in other situations. In their explanations the parents emphasised the calm and relaxed approach and that they sensed great involvement of the people concerned. The parents felt that a thourough, expert and extensive assessment had been carried out.
PROVIDING SUPPORT IN DIFFERENT SITUATIONS
The frequency of home visits must be determined by the parents wishes and needs. The survey results indicate that the educational support department has to handle more carefully the arrangements (like visits) made with parents.
Children who attended a primary
school where they were supported by Theofaan were amply represented in
this survey.
The survey also shows that
it is important to involve the parents (more) in the support provided at
primary school, but possibly also in other institutions. The function and
the contents of the support should be discussed explicitly with the group
teacher and should be more concrete and clearly defined in terms of content.
The cooperation between parents and the educational home visitor forms an important part of the support Theofaan provides. Parents experience this support as being child-oriented as well as parent-oriented.
A considerable number of
parents mentioned staff changes in educational support. These changes should
be avoided as much as possible. More attention should be given to a clear
working method and support structure, as well as honouring agreements
Issues concerning the termination
of the service and the handing over the EI also require attention. Greater
care is required here. A standardised questionairre/evaluation form would
be useful in clarifying matters not only with regard to the parents but
also at the institutions and primary schools.
POINTS OF ATTENTION AND ACTIVITIES DURING THE SUPPORT
Under this section parents
were asked questions about the attention that was paid to the various aspects
of the development and education of visually impaired children during the
EI.
The different items were
taken from the so-called Bielefelder- questionaires (Prof. Brambring, 1989).
In addition to the level
of satisfaction , the categorie "not applicable" was included as possible
answer.
A number of more general observations can be made with regard to this issue. Firsly, it is remarkable that the number of parents that were "not satisfied/not dissatisfied" with the amount of attention paid to the various aspects of the support is relativly large (an average of 21% for all the sections). Parents appear to have taken a fairly neutral standpoint.
Possibly the educational
home-visitor should pay more attention to developing methods and deepening
theorie and treating a range of educational problems as these are adressed
in the different sections.
It is important that educational
home-visitors continually and sensitivily involves the parents in the work
they do. It is necessary to be explicit about the working methods and objectives,
and to always take account of the questions parents have.
Another noticable point under
this section was that many parents gave the respons "not applicable". This
particular answer was chosen most often for a considerable number of sub-questions:
for example - how to deal with unusual behavioural patterns, - stimulate
learning to walk, - orientation and mobility indoors, - independance general
dailly living skills. Maybe the parents found it difficult to recall what
exactly had been the focal points of the EI. It is obvious that the parents
did not consider these items to be urgent issues in the EI.
provided by Theofaan. And/or
maybe the parents did not experience these items as points of attention/objectives
in the support. In the latter case it becomes clear once more that it is
important that the working method and the objectives are clearly expained
and discussed with the parents.
As a result of above , it
is recommended that at the beginning, but also periodically during the
EI/support provision a detailed inventory should be made of the issues
that are important to the parents which would then be translated into support
objectives.
The combination of data
provided by all clients over the years will eventually provide a thourough
inventory of all the needs of the parents of visually impaired children.
By further developing the the methods used, these methods can be sensitivily
addressed.
Aspects that come out most
favourable, with a satisfaction level of 85% or over, include
- problems concerning vision
(92%, N=85)
- developmental steps achieved
(88%, N= 81)
- use of vision and how
to stimulate this (88%, N=72)
- reaching for toys and
material (93%, N=..)
Finally, a number of items
under this section that score a relatively lower level of satisfaction
are striking. These concern (in my view) aspects related to educational
problems that are more serious than the average problems we are dealing
with.
For example: behavioural
problems (66%, N=47), unusual behavioural problems (57%, N=25), and sleeping
disorders (50%, N=18). This means, that when faced with these problems,
we probably failed to adequatly address these.
A possible recommendation
here would be futher deepening of the theory and treatment of varios more
serious educational problems.
GENERAL
Parents experience the Theofaan
EI service as being both child - and parent oriented. Child-oriented activities,
carried out by the educational home-visitor, were mainly aimed at different
aspects of the child's development. These had an effect on the development,
self-confidence and contact with others.
Parent-oriented activities
were described as " providing better insight to.. ", advices/tips and adressing
parents' questions, interaction with the child and confirmation of the
parents' abilities and potential.
Finally some last words.
I'm happy to inform you
that within the Theofaan EI service, the needs and questions of parents
becoming more and more important, a starting point by translating them
into support objectives.
Besides that, we put a lot
of energy and time in developing the method and theory of our EI service.
We're still in that process.
The needs and questions
of families with a visually impaired child, specially those with other
disabilities, address often also other social services. Close cooperation
with these services is necessary and needed, and we give this constant
attention, on behalf of the families involved.
Thus, Theofaan keeps pace with the times