Providing Feedback and Involving Stakeholders in the Research Process: TRIAGE

1. Providing Feedback and Involving Stakeholders in the Research Process: TRIAGE Monique Carrière PhD, Sylvie Tétreault PhD, Eve-Line Bussières MPs, & Martine Giroux, MA Rehabilitation Department, Laval University, Quebec City Monique.Carriere@rea.ulaval.ca

2. Abstract Stakeholders are the first actors concerned by the results of evaluation and research. In a perspective of transparency and exchange, it is important to involve participants in the reflection process and to give them feedback. This study focusing on managers’ contribution to partnership between families and rehabilitation therapists illustrates this process in two phases : 1° managers are interviewed individually 2° the actions proposed by managers during the individual interviews are examined by managers in group sessions conducted with TRIAGE The purpose of TRIAGE is to provide feedback and allow managers to select which actions are compatible with their context. TRIAGE facilitates interactions between researchers and participants, which in turn favors transparency.

3. Illustration of the Process “Contribution of managers to partnership between families and rehabilitation therapists” • Granted by the FQRSC (2001-2003) • Qualitative and exploratory study in six rehabilitation centers in Quebec province • Theoretical approach : Structuration Theory (Giddens, 1987) • A dialectic and constructivist approach

4. Main Research Goal Better understanding of managers’ perceptions and contribution to partnership between families and rehabilitation therapists Specific Objectives 1) To describe and explain managers’ intentions and actions regarding the families and the therapists’ partnership 2) To determine contextual elements that facilitate or limit managers’ actions 3) To highlight self-evaluation of managers’ influence on collaboration

5. Methodology Phase I:Data collection • Individual interviews with participants Phase II:Data treatment by participants • TRIAGE : Technique for Research of Information by Animation of a Group of Experts (Plante & Côté, 1993)

6. Participants Phase I(N=48)Participation rate ~ 52% Phase II (N=26) Participation rate ~ 65% (5 meetings for TRIAGE) Top Managers n=13 Middle managers n=16 Board members n=15 Professional advisors n= 4 29 women / 19 men Top managers n=3 Middle managers n=23 21 women / 5 men

7. Phase I • Themes for the Individual Interviews (individual production of TRIAGE) •   Contextual data •   Managers’ experience •   Perceptions of collaboration between families and therapists •   Managers’ intentions •   Managers’ actions and resources •   Reflections

8. Between Phase I and Phase II • Interviews’ analysis (n=48) • Development of 100 statements and more from individual interviews. • Extraction of 20 statements from scientific literature and previous research (St-Onge, Tétreault, & Carrière, 2002)

9. RESULTS Phase I = MEMORY Phase II Action propositions of managers toward: Partners n=39 Parents n=18 Therapists n=54 Associations Committees n=12 Parents and Therapists Propositions Literature Recommendations Pull

10. Examples of Managers’ Actions RegardingParents • “ Meet with parents whocomplain ” • “ Give resource information ” • “ Survey parents’ opinions ” • “ Support parents ” • “ Consult parents about servicesoffered ”

11. Examples of Managers’ Actions RegardingTherapists • “ Meet with therapists who • complain ” • “ Give resources to therapists ” • “ Supervise therapists (coaching) ” • “ Recall the center’s philosophy ” • “ Support therapists ”

12. Examples of Managers’ ActionsRegardingPartners and Other Managers • “ Simplify administrative procedures ” • “ Promote partnership ” • “ Evaluate programs ” • “ Hire people who are willing to work in • partnership ” • “ Maintain coherence between the center’s • orientations and the rehabilitation • objectives ”

13. Examples of Managers’ Actions RegardingParents’ Associations • “ Clarify problems and find a solution” • “ Help and support parents’ • associations” • “ Defend parents’ associations” • “ Promote exchanges between • associations and rehabilitation centers”

14. Examples ofParents and Therapists propositions • “ Hire more staff ” • “ Maintain a rehabilitation team stability ” • “ Consider parents’ preoccupations ” • “ Support parents ” • “ Share rehabilitation approach with • school setting ” • “ Develop interventions at school, • kindergarten and home ”

15. Examples ofLiterature Recommendations • “ Consider parents as experts ” • “ Form therapists with the family • centered approach” • “ Support families ” • “ Let families take part of the decision • making process ” • “ Develop a communication and • information system ”

16. Phase II: Preparation Participants receive a package containing : - the TRIAGE process description - the questions that will be examined in TRIAGE - the statements taken from the six rehabilitation centers

17. Phase II : TRIAGE • Realization of TRIAGE groups (between 3 and 10 participants) in participating rehabilitation centers • Collective and interactive production • Continuous visual support • Consensus-focused technique • 3-step process : • Validation of statements • Regrouping and reformulation of statements (if necessary) • Selection of statements (priorities) • Involves participants and gives them feedback

18. Phase II : TRIAGE FRIDGE : Statements to be discussed later GROUPING / REFORMULATION / SELECTION MEMORY TRASH : Statements not relevant VETO : Statements to be treated later by external experts

19. TRIAGE Follow-up • Feedback to participants by sending them the list of priorities established in TRIAGE sessions • Evaluation of TRIAGE by the participants • Results’ analysis of TRIAGE by the researchers • for each center in its context •  for all the centers • Report writing and its distribution Pull

20. Some Priorities of the Managers in RC #1 Regarding… Therapists 1. Recall center’s vision 2. Give resources (training in family intervention) Parents 1. Support families (information on resources and tips) Parents’ Associations 1. Make alliance with parents’ groups Partners 1. Simplify administrative procedures 2. Promote partnership

21. Some Priorities of the Managers in RC #2 Regarding… Therapists 1: Give therapists working tools (to help families) 2: Be available to guide therapists (especially new ones) Parents 1: Develop interaction tools for the families 2: Evaluate parents’ satisfaction (surveys) Parents’ Associations: 1: Find a solution when there is a problem Partners 1: Build partnership 2: Take action to promote social participation

22. Some Priorities of the Managers inRC #3Regarding… Therapists 1: Give therapists appropriate work conditions 2: Facilitate communication in every way Parents 1: Organize structures to give a place to parents 2: Examine the waiting lists’ issue Parents’ Associations 1: Give information, promote parents’ participation Partners 1: Promote partnership 2: Promote coherence between center’s functioning and rehabilitation goals

23. Ultimate Feedback • Diffusion of the final report in rehabilitation centers, rehabilitation center associations, and government offices • Presentations and discussions in each rehabilitation center • Presentations in scientific and professional conferences • Continuous education and university training

24. Participants ’ Feedback about TRIAGE Main contributions - Reflexive activity about managers’ contribution to collaboration between parents and therapists - Creative problem solving - Better understanding of organizational values - Development of an overall picture of parents’ position in rehabilitation centers Main difficulties - Time-consuming process - Treating statements coming from other centers - Scheduling a meeting with several managers - Make consensus

25. Researchers ’ Feedback about TRIAGE Strengths - Flexible (different contexts, group sizes and questions) - Production of valid material - Easy to use (visual support, usual animation technique) - Gives feedback while involving participants Pitfalls - Challenges of animation - Time-consuming process

26. Résumé Les acteurs sur le terrain sont les premiers concernés par les résultats des évaluations et de la recherche. Dans une perspective de transparence et d’échanges, il s’avère important d’impliquer les participants dans un processus de réflexion et de leur fournir des rétroactions. Cette étude portant sur la contribution des gestionnaires à la collaboration entre les familles et les intervenants en réadaptation illustre ce processus composé de deux étapes : 1° entrevues individuelles avec les gestionnaires 2° les actions proposées par les gestionnaires lors des entrevues individuelles sont examinées par les gestionnaires lors de sessions de groupe animées avec TRIAGE L’utilisation de TRIAGE fournit des rétroactions aux gestionnaires et leur permet de déterminer des actions qui sont compatibles avec leur contexte. TRIAGE facilite les interactions entre les chercheurs et les participants et favorise la transparence.