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It's Not What You Say, It's How You Say It (Family-Centered Practice & Teaming)

It's Not What You Say, It's How You Say It (Family-Centered Practice & Teaming)
Tara Warwick, MS, OTR/L
December 26, 2018

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Editor’s note: This text-based course is an edited transcript of the webinar, It's Not What You Say, It's How You Say It, presented by Tara Warwick, MS, OTR/L.

Learning Outcomes

As a result of this course, participants will be able to:

  • List two tips for family-centered practice.
  • Explain one way to approach a family about a difficult topic.
  • List four steps for having a difficult conversation with your team.

Introduction and Overview

Thank you for having me today to discuss the importance of good communication. As providers, teachers, and counselors, one of the most important tools that we can use is good communication strategies. Over the years that I have practiced as an OT, I have learned that often it's not what you say but how you say it. Knowing proper strategies and interventions is key, but you also need to be able to effectively convey information to parents and teachers and team members. Otherwise, those thoughts will remain inside your brain. I do a lot of work in both schools and homes environments. Specifically, when I'm in school settings, I work with students who have challenging behaviors, and I share strategies and ideas and work with school teachers and staff. On many occasions, I've had to use my communication strategies in difficult situations. I'm constantly honing my communication skills. I'm not a perfect communicator, but I am going to share some tips and strategies that have helped me to engage in difficult conversations and to be able to work with teams in challenging situations.

Common Difficult Situations

As a therapist, I have encountered a variety of difficult situations working with families, as well as when working in team situations. One challenging situation I have experienced is when I observe signs of autism in a child. Autism is a difficult topic to bring up with families. Challenging behavior is another hard thing to discuss, especially if the family has experienced a lot of challenging behavior and now we're having difficult situations in the school setting. In addition, if you're a teacher, perhaps you need to convey to the parents that the student is not completing their homework. Moreover, in very young children, there might not be follow through with toilet training. If you're working on toilet training at school and the child goes home, and the next day they come back wearing a Pull-up, clearly, there is a lack of communication. Maybe you're working on teaching the child how to use pictures or an iPad to communicate and you're not seeing any follow through from home. Another issue I often see is the number of services on an IEP. A lot of times, we have difficult conversations with schools and with families about how many services are needed (e.g., if a child needs more speech therapy or more occupational therapy).

When working with teams, you might encounter a lack of consistency, where everyone is using the correct strategies with a child except one person. Or, you might have put this great plan in place and then maybe the assistant isn't implementing it like she's supposed to. You might have different types of management styles. Perhaps you went from having a supervisor or an administrator who was laid-back, to one who micromanages you. There are some administrators who are onboard with special education services, and others don't see the value in it. Some teams have trouble getting schedules down, especially at the beginning of the year. Communication can also become a problem with teams. As a related service provider, I often arrive at a school and they neglected to tell me in advance that there is an IEP meeting that day. In those cases, the lack of communication did not allow me adequate time to prepare my goals. 

Family-Centered Practice

Family-centered practice has a lot of evidence behind it. The notion of family-centered began in the medical world with people thinking about the best way to incorporate families. This can be hard to achieve in the school setting, due to time constraints. I'm going to share some strategies on how to make the most of your time with families and children. The literature indicates that half of parents agree that family-centered practices are not occurring as frequently as would be ideal (Crais, 2006). Half of the families that we work with feel that we're not providing enough family-centered services. In addition, families value interventions that emphasize interaction between the child and parent, and they believe those types of interventions helped them to be more successful parents (Stahmer, 2011). When we look at our interactions with families and children, are we doing interventions and focusing on things that are meaningful to families? As a therapist, I have often seen that families don't really know what their child does in therapy (e.g., speech therapy). They aren't fully aware of what their child is working on. That's not family-centered practice. That's not working on things that are important to families and important to their everyday lives.

What Does It Mean to be Family-Centered?

What does it mean to be family-centered? The definition of family-centered is that all people are treated the same, with respect and dignity, regardless of their background or their socioeconomic status. In addition, providers communicate and share complete and unbiased information with children and families that is affirming and useful. I see people struggling a lot with sharing unbiased information. Often, parents picking up their children will hear reports from the teacher that their child "had a horrible day today" or "they had a great day." In both of those statements, the teacher has infused their judgment about the child's day. Sometimes, the information is more about how the teacher dealt with the behaviors than it is about how that child behaved. Instead, the teacher can share unbiased information, focusing on what happened without judging or labeling it as good or bad. For example, "When it was math time, Jimmy went under the table..."

Another characteristic of family-centered practice is that children and families are encouraged and supported for participation in care and decision making at the level they choose. We're encouraging families to be a part of the decision making. We're not just saying, "Here's the IEP. Sign off on it." We want families to be a part of the process and involved in the conversation around how much related service is required to help the child be successful. We're finding ways to incorporate them in that decision making, versus just telling them what we're going to do. Furthermore, with family-centered practice, collaboration among children, families, and providers occurs in policy and program development and professional education, as well in the delivery of care. How are we incorporating families across the board to make sure that we're providing family-based services? Are we including families in professional education? This is the definition of what it means to be family-centered.

How do we include families? We're going to highlight two strategies that were developed by Dathan Rush and M'Lisa Shelden, two of the most well-known early intervention specialists in the country. For the purposes of this presentation, we will briefly touch on these strategies. If you are interested in obtaining more information, please refer to my resource list and you can explore this further at your leisure. 

Natural Learning Environment Practices

Whether you are in an early childhood setting or in a home setting, think about how you can incorporate as much natural learning as possible. With natural learning environment practices, I'm going to start with the everyday activities and opportunities that the child is interested in. We need to think about how we can help the family and help the child incorporate things within their daily routines because people are more likely to practice something that falls in line with their routine. There are many different ways that you can find out what their routines are like. In fact, there are some routines inventories that you can use. As an example, maybe the child works with an SLP and we're working on certain sounds. Instead of telling the parents, "I want you to work on these sounds with your child once every day for 15 minutes," show them ways to practice those sounds during part of their normal routine, like bath time. When we do that, they're more likely to practice it, and it's going to be more important to them because it's part of their daily routine.

With natural learning environment practices, we're also going to look at caregiver responsiveness. What do we do when caregivers respond different ways and how can we respond with affirmative (not evaluative) feedback? It's not about whether they did it right or wrong; it's about giving them affirmative feedback.


How do we implement these practices? By identifying the child's interests and everyday family and community activities. There are reinforcer assessments and preference assessments that you can use, along with other tools to help find things the children are interested in. When we can incorporate and build on their interests, they're more likely to participate in the activity.

What are their everyday family and community activities? The first thing that you might want to do is talk with families about their routine. Ask them to tell you about a typical Monday for their family, or a typical weekend. We're not going to ask them yes/no questions; we're going to ask open-ended questions. As they're telling you about their weekend, you're starting to see what their routines are. Then, as a teacher, therapist, or provider, we're going to start thinking about ways they can build onto things that we're targeting into those daily routines. For example, you might discover that they go to the park every Saturday. Knowing that I'm going to give them some ideas of things that they can do at the park to work on their social skills because it's already a part of their routine.

Select activities that provide opportunities for interest-based learning. Once again, it's building on those things that are important to them, things that they're interested in. Use interaction styles that support and encourage child competence, exploration, and mastery of activities. I'm going to use interaction styles that make sure that we're supporting them to explore things, that they're mastering tasks, and that we're helping them be successful. Finally, evaluate the effectiveness of parent-mediated child learning opportunities. I'm going to make sure that within the activities we're doing, there are learning opportunities happening across the board for the parent and for the child, and that changes are occurring, based on these strategies that I'm using.

Goal of Intervention

Rush and Shelden determined that the goal of intervention is to "increase the breadth and depth of child participation in everyday family, community, and early childhood programs" (Rush & Shelden, 2017). As such, this is what our goal needs to be. We need to help families and children play more of a part in their routines, in their community, and in their early childhood programs. That is the goal. When we can do that, we've done our job.


Next, we are going to discuss coaching. It is safe to assume that we all got into our professions because we enjoy working with children. However, if we're doing it right, we are not only working with the child, but also with the adult. We are coaching families on having this goal in mind.

Rush and Shelden define coaching as "an adult learning strategy in which the coach promotes the learner's ability to reflect on his or her actions as a means to determine the effectiveness of an action or practice and develop a plan for refinement and use of the action in immediate and future situations" (Rush & Shelden, 2011). Coaching is an adult learning strategy; their definition doesn't mention anything about the child. We are teaching parents and families on how to reflect on their actions. Not just to reflect, but also to help them develop a plan that makes it better the next time. 

The act of coaching includes several characteristics: 

  • Joint planning (i.e., brainstorming)
  • Observation
  • Action/practice
  • Reflection
  • Feedback

As you're thinking about working with a child or with a family, these are the steps that you're going to go through when you're coaching. Maybe you're coaching a family. Perhaps you're coaching another teacher. You might be coaching a therapist. In any case, these are the steps to go through as we're coaching. Keep in mind that coaching is not just modeling and then letting them do it. There's a process for helping them reflect on it, giving them feedback, and planning.

Joint Planning/Brainstorming

The first step in coaching is joint planning or brainstorming. The purpose is to build the family's capacity to solve problems. We are only there for a short time. In the majority of cases, families are permanent. Families are constant. Family members are with the child all the time. Our job is to teach families how to problem solve when we're not there.

With joint planning and brainstorming, we are helping the family to think about what else they have done, and what they have thought about. Discuss the disadvantages and advantages of each type of strategy they have tried. Perhaps we're working with a family on toilet training. It may be that their toilet training has not been going well, so we're going to plan for it. We're going to ask, "What have you tried with regard to toilet training? What other options can you think of?" They may answer, "We tried doing it this way, where we just set a timer." In return, we can ask them what they think is the advantage of using a timer versus not using one? Maybe they could just take the child to the bathroom when he asks. Ask them if it would be okay for you to offer some other suggestions and strategies for toilet training. Request their permission to share your information, instead of just telling them what to do. Joint planning and brainstorming is our first step with the people we're coaching, with the end goal of teaching them how to problem solve (Rush & Shelden, 2011).


Next, we use observation. Observation can be either intentional or hopeful. Many times, when we observe, we are using hopeful observation. The mindset is that we are going to model it in front of them in hopes that they're going to do what I do when I'm not there. We know that hopeful observation is not effective. We need to be more intentional about observation. Intentional observation can occur with a parent, a teacher, or a paraprofessional.

With intentional observation, I'm first going to explain what and why. For example: "I'm going to try this visual schedule for toilet training because I want to see how Jimmy does when he can see pictures of the steps for the process." I'm also going to demonstrate. I'm going to give the parent a job to do while I'm demonstrating. "While I'm going through this schedule, I want you to observe and I want you to look to see if the child needs my help or doesn't. I want you to write down every time he needs my help." After demonstrating, and after the parent does their job, I'm going to reflect. I'm going to say, "Okay, we did that. This is where I thought he needed more or less help. I think we might need to add one more picture to the visual schedule." I'm going to reflect on how I felt it went. I'm then going to invite the parent to try. After they try, we're going to reflect again. I'm going to ask them to tell us how they think it went, where they feel change is needed, and what we should do about it. That's where your planning comes into place. "What are we going to plan for next time? What do you think we need to do differently?" We may need to change the order of some of the pictures on the schedule. Maybe we need to do less talking and use more physical cues. Whatever the case, we need to reflect on the outcome, and plan for the next time (Rush & Shelden, 2011).


Ask the parent to show you what they've tried. Maybe they're struggling with getting their child to try new foods. Ask them what they have tried so far. Provide opportunities for them to practice. Use verbal prompting or teaching or direct teaching to support the parent (or paraprofessional). I'm going to prompt them verbally by saying, "Okay, now you can try doing it this way. Maybe if you give a little cue on his elbow, he might try it this way." Then I'm going to identify how the parent will continue with the new skill. "You've practiced using a visual schedule with Jimmy. Tell me how you can try this again tomorrow. We're going to start looking at how you can continue with that new skill." I wouldn't say, "You need to try this tomorrow during bathing." I'm going to say, "When you used the visual schedule, he was more independent. Tell me another time that you might be able to use that visual schedule." In this way, we can start teaching them this process for problem-solving through these issues (Rush & Shelden, 2011).


Reflection is intended to assist the parent in that deeper understanding of what they directly know. For example, "We used a visual schedule today and we saw that it helped him be more independent. Tell me about why you think that worked. Why do you think he was more independent with that schedule?" We want to make sure the parent understands the reason why things work, because if they understand the why, that will help them use it the next time in maybe a different situation.

Help them reflect on what modifications are needed. "That visual schedule worked really well, however, Jimmy had a hard time manipulating the pictures. What modifications do you think we could make in order to help him manipulate those pictures better?" They may suggest putting the pictures on foam or making them bigger. Take into consideration and implement whatever they might suggest.

Finally, reflecting involves helping them with the new skills. For instance, "If we're going to work on a new skill like getting dressed in the morning, how could you see that visual schedule helping him learn a new skill?"

Tips for reflection. When reflecting with the parent, the following tips are useful:

  • Ask only one question at a time.
  • Be okay with silence. We often feel like we need to keep asking the question or stating it in a different way. 
  • Avoid big, vague questions like, "How are things going?"
  • Reflect before giving feedback. Have them tell you about things before you give them feedback about it.
  • Yes/no questions should be only used to ask permission or not to make an assumption (e.g., "Would you like to try this?"). If you ask a parent a question such as, "Did you use that schedule this week?" chances are they may have a tendency to lie to you and respond "Yes." Instead, we should ask open-ended questions, like "How did you feel about using the schedule?"  
  • If someone says, "I don't know," rephrase for understanding and provide feedback about an observation you made in the past. "What did you think how he did with that visual schedule?" "Well, I don't know." You could say, "I know it can be hard to see how visual schedule works. Last week, I saw that when I had those pictures, I didn't need to tell him as many things and he did it a little bit more on his own. That's what I observed when I watched him."

Types of reflective questions. Some reflective questions that you could ask include:

  • Questions that relate to awareness. "What have you tried? Tell me more about that."
  • Questions that involve analysis. "How well did that work? What would the ideal situation look like?"
  • Questions that suggest alternatives. "What other ideas do you have? What else could you try?"
  • Questions that involve action. "What is your plan/decision? What is your first step?"

All these are questions that you can ask that helps the parent problem solve versus just telling them the answer. We need to get away from simply telling them what to do. We want to teach them how to think through these things. Again, it's not just with parents; it's with any adult that we're trying to coach through situations (Rush & Shelden, 2011).

Types of Feedback

The way that we give feedback is critical. There are three main types of feedback:

  1. Affirmative feedback: These are statements that describe, restate, or acknowledge what the learner has said. For example, "Yes, I see what you mean."
  2. Evaluative feedback: Statements that evaluate or judge the actions of others. Evaluative feedback should be used with caution, as they can be misinterpreted or taken personally.
  3. Informative feedback: This type of feedback occurs when the coach is sharing new information with the learner. That's when we're giving our information. For example, "Four-year-olds often act independently just the way you described. It is normal for her age." 

Let's Practice

Let's practice what we have learned using the following scenario:

You're working with a child learning how to use a visual schedule for getting ready in the morning. Go through the steps for intentional observation.

First, work with the parents and do some joint planning. Talk with families about ideas that we could implement to help get ready in the morning. Ask parents about their child's biggest struggles. For example, if they have a hard time getting dressed in the morning and require constant verbal reminders to stay on task, perhaps a dressing schedule might be effective.

Next, we're going to engage in intentional observation. I might try taking this schedule for dressing and I'm going to practice it with them. We are giving them the opportunity for action and practice. Afterward, we're going to reflect on what happened and talk about how the child did with the schedule. Find out what things worked well and what didn't work well. Finally, we're going to give feedback and have a conversation about what we could do next. We're making the family a part of this process the entire time.


When we work with children who have disabilities, we need to be aware that parents and families may be experiencing a sense of grief. Families don't plan on having a child with a disability. As such, they may suffer from grief because it's not what they expected. It's not that they don't love their child. They love their child just as much as they would if they didn't have a disability. Knowing this, we need to take care when handling situations and consider this grief cycle.

Empathy vs. Sympathy

Brene Brown is one of my favorite authors. She has written an extremely astute explanation as to how we can distinguish between empathy and sympathy. For example, think about a family who is in a bad situation, or who is "stuck in a hole." Empathy is when you get in the hole with them. Empathy is when you understand that this isn't my hole, but I'm going to be here with this family and I'm going to help them find ways to get out of the hole. You're not saying that you know how they are feeling, but you are willing to be there with them work through it together. Sympathy is when you're looking down at them in the hole and you think, "Wow, that must be a difficult situation. I'm sad for you, but I don't know how to help you." Empathy is really about jumping into that hole with them (Brown, 2013). 

Grief Stages

Parents of children with disabilities go through different stages of grief. Grief is not something that you experience and then it is finished. It is a circular, constant feeling that comes and goes. You might see families experiencing denial, anxiety, fear, guilt, depression, and/or anger. All those things can be different stages of grief. I've also seen families experience grief where it hits them at different moments. For example, I work with one mom of a child with autism. The mom seemed to be doing well, and then all of a sudden, her son lost his first tooth -- a milestone which all children experience. Other children without autism become excited when they lose their first tooth, in anticipation of the Tooth Fairy. However, the Tooth Fairy came to their house and her son didn't seem to care. To him, it was just another day. That was difficult for her, and her cycle changed where she went back into that grief stage. We need to remember that sometimes, everyday things can trigger those grief stages and it looks different in every family (Moses, 1987). 

Dealing with Difficult Situations and Change

Sometimes, difficult conversations arise when we are trying to make a change or deal with challenging behavior. Maybe there is a behavior, such as hitting or biting, that we would like to change. Perhaps we are trying to work on a new skill. When working with families, they may be at different stages in their willingness to accept change. The difficulty level of the conversation depends on which stage they are in. 

Stages of Change 

There are five different stages of change:

Pre-contemplation. In the pre-contemplation stage, there is no intent to change behavior. The person is unaware or under-aware of any problems. They're perfectly content with where they are. Our goal is to help them see that there's a problem, remembering that we must be sensitive and approach the situation with care.

Contemplation. The person is aware of the problem, and seriously considering a change, but they have made no commitment to take action. The goal is to raise awareness of the problem by observation of behavior.

Preparation. The person intends to change and makes small behavioral changes. The goal is to encourage these steps and support the change process.

Action. In the action stage, the person chooses to take decisive action to change. The goal here is to make an action plan, give suggestions, reinforce changes, and provide support and guidance.

Maintenance. In the maintenance phase, we're working to prevent relapse and consolidate gains. We don't want to slide backward. We're going to continually reevaluate so we don't go back to where we were. 

These stages of change apply to everyone, not just children. It is difficult for any of us to change one small habit. Think about how difficult it is to change a major habit or behavior.

Motivational Interviewing (MI)

Motivational interviewing comes from addiction research and looking at how hard it is for people to change. Change doesn't happen by simply telling a person, "You need to stop doing this." Change occurs through the process of motivational interviewing which is a strategy for helping people through change. I use motivational interviewing a lot when I'm going into schools to help with children who are having challenging behaviors. It all comes down to change and seeing where they're at in this cycle of change.

Motivational interviewing is a collaborative, person-centered form of guiding to elicit and strengthen motivation for change. We're working together to strengthen that reason to want to change. It doesn't come from you saying, "You need to do this." It has to come through a process. For the purposes of this presentation, and due to time constraints, I'm going to provide you with the highlights of motivational interviewing.

There are four core principles to motivational interviewing.

  1. Express empathy -- build rapport.
  2. Develop discrepancy -- elicit the pros and cons of continuing the behavior.
  3. Roll with resistance -- respect the person's autonomy. This can be a hard pill to swallow, but we have to respect the fact that they can still make their own decisions, even if you don't agree with their decision. We have to respect that a parent or a teacher has the autonomy to make their own decisions and we have to roll with it because we're not going to get people to change by just telling them that they need to change.
  4. Support self-efficacy -- communicate that their child is capable of change and that they have all the skills needed to be successful. We can work together. We're building that confidence.


Strategies for Successful Collaboration

In order to achieve successful collaboration using motivational interviewing, the following strategies are highly effective:

  • Ask open-ended questions. Example: "Tell me about the behaviors you're seeing at home." Open-ended questions elicit a lot more conversation than "yes" or "no" questions.
  • Listen reflectively.
  • Affirm. I'll often say affirmative statements, such as, "I hear you telling me that your weekends are really busy" to make sure that they know I'm listening. Or, "You were very successful in teaching him how to get dressed using that visual schedule. That might be something you could use to teach him other things."
  • Summarize. Reiterate and reflect on what they have told you. 

Assumptions to avoid. We want to avoid making the following assumptions:

  • That the family/child (individual) ought to or wants to change. They might be perfectly fine with what's going on. Remember you can't force someone to change.
  • Child’s health/diagnosis is the prime motivator. It might not be that just because they have autism, they're motivated. There might be other motivations in play.
  • If the individual does not want to change, that is considered a failure. Just because they don't want to change right now does not mean they're a failure. It means that they can't right now. That doesn't mean it's forever. Maybe next week they'll be ready to put something different in place. 
  • Individuals are motivated to change or not.
  • Now is the right time to change. They may not be ready right now, and we can't force them. They need to be ready.
  • A tough approach is best. We need to be mindful that all parents feel guilt, especially parents of children with autism or other disabilities. Sometimes the tough approach results in feelings of guilt, which is not a good motivator.
  • I’m the expert…he/she must follow my advice. You might be the expert in occupational therapy or speech therapy, but remember, they are the expert in their child. They know their child more than you will ever know their child and they're the ones that are going to be with them for the long haul. 

Signs of resistance. You might encounter resistance, such as:

  • Arguing (e.g., "They don't behave that way here.")
  • Interrupting
  • Denying (e.g., "We never had him do that." or "He never acts that way when he's at home.")
  • Ignoring (e.g., ignoring your phone calls and text messages, not returning the communication binder). 


Scenario #1. You are working with a child with autism at the early childhood center. The child is having challenging behavior and you approach the dad. The dad states, "He never acts this way for me."

How would you begin your interaction with the dad? If he is not exhibiting the behaviors at home, you might start by asking the dad what he does at home. For example: "Tell me about your day, because I would love to learn what's working at home. Maybe could you come and spend some time at school and show me some things that are working for you at home. Tell me what you think we need to do in order to not have any behaviors at school."

Scenario #2. You're working on toilet training with your student at school, but the family is putting diapers on the student when he gets home. Every Monday and after a break, you feel like you're starting all over again.

This family might not be at the point where they're ready for toilet training. Instead of saying, "Did you work on toilet training? I see that he's here in diapers." I'd want to say, "Tell me about your weekend." You might find out that the mom is working two jobs, the dad is taking care of the child and three other children at home and they're in survival mode. Maybe the only thing they can do is put diapers on him at this time because they're not at that point in change. Using some of those open-ended questions can give you a lot more information.

Communicating on Teams During Conflicts

When we work on teams, whether in a school or a rehab/therapy setting, sometimes we see conflicts related to:

  • Someone on the team not following through
  • Disagreements in service delivery
  • Scheduling disagreements

Having Difficult Conversations

There are several key things to consider before you engage in some of these difficult conversations:

  1. What is the purpose for having the conversation? What do you hope to accomplish? It's so easy in these conversations to get sidetracked, but we want to make sure we have a clear reason for the conversation.
  2. What assumptions are you making about this person's intentions? Are we assuming that they are just not following through the plan because they're lazy or because they are just trying to get under your skin? We need to think about what our assumptions are.
  3. What buttons of yours are being pushed? Are you much more emotional than the situation warrants? Are you getting overly upset because they're not taking them to P.E. when they need to, or they're late to get to P.E.? Be aware of the emotional energy that you're bringing to this conversation.
  4. How is your attitude toward the conversation influencing your perception of it?
  5. Who is the opponent? Who are you going to have this conversation with and what are their needs? What solutions do you think they would want to discuss? Maybe it's about P.E. and the para's not taking the child to P.E. Think about their side of the argument. Why would they not be taking them to P.E.?
  6. What are your needs and fears?
  7. How have you contributed to the problem? How have they? Maybe you've contributed to the problem by never having tried to take the child to P.E. You have never tried to give the para any strategies to take the child to P.E. You've just asked why she hasn't taken him to P.E. How have they contributed? "You know what? She's never asked me to try."

Four Steps

The majority of the work in any conflict conversation is the work you do on yourself before you have the conversation. That is what's going to make the conversation go one way or the other. Each conversation should occur using the following four steps:

  1. Inquiry
  2. Knowledge
  3. Advocacy
  4. Problem-solving

Inquiry. In the inquiry phase, when you are having a conversation, pretend you don't know anything about what's going on. Some sample questions/sentences might be: "Tell me about what goes on in P.E." or "What do you do when you don't take him to P.E.?" The intent is to try and obtain as much information as you can about the situation.

Acknowledgment. In the acknowledgment phase, show that you have heard and understood. Try to understand them so well that you can make their argument for them. Sample statements may be: "You're telling me that he seems to not like P.E. He seems really overwhelmed when he goes to P.E. You think that if you don't take him to P.E., it's helping him the rest of the day." Show that you're trying to understand their perspective.

Advocacy. When you see that they have expressed their opinions on the topic, it's your turn. At that point, you're going to advocate for your perspective. Sample statements may be: "I see this is your perspective of not taking him to P.E.; however, as I am the teacher of record, on his IEP it says that he's supposed to go to P.E. Therefore, it's my responsibility to make sure that he's going to P.E., and if he's not, that we figure out how we can make P.E. successful." I'm not going to minimize their perspective, but I want to make sure that they can see it from my perspective as well. You can say, "It seems like it's challenging to get him to P.E.," but you're also going to make sure you advocate for your side of it too.

Problem-solving. Finally, we're going to brainstorm about ways to make P.E. more successful. For example: "Tell me what you think would make P.E. better. Would it help if I came and did P.E. and you stayed in here?" Whatever they say, find something you can build on and turn it around. They might say that the child doesn't like a specific student named Johnny in P.E. If he doesn't like Johnny, that's a good observation. How about we find someone he does like in P.E., and we will talk to the P.E. instructor about not pairing him up with Johnny? We have to find something and build off of there.


The following tips and guidelines are helpful in having difficult conversations:

  • The conversation depends on two things: how you are and what you say. You have to take your emotions out of it and you have to think clearly about what you're going to say.
  • Acknowledge that emotional energy: yours and theirs. I know this is a hard, emotional thing for you, and it's hard emotionally for me. 
  • Know and return to your purpose at difficult moments. If the conversation goes off topic, make sure you come back to your original purpose for the meeting. 
  • Don't take verbal attacks personally. In these meetings, sometimes people are blunt and very direct. Make sure you're not taking it personally. It might just be the way that they're responding to a difficult situation.
  • Don't assume they can see things from your point of view. Maybe they can't see things as the certified teacher. If they've never been a teacher, they might not know the responsibilities that you have. They may just need to realize that. You might need to explain that to them.
  • Practice it ahead of time. The more you can role play about that conversation before you're in front of the other person, the less emotional energy that you're going to exert.

How to Begin

It can be difficult to think of what to say when starting a conversation. Keep these opening sentences in mind to help you begin a conversation:

  • I have something I’d like to discuss with you that I think will help us work together more effectively.
  • I’d like to talk about _____ with you, but first I’d like to get your point of view.
  • I need your help with what just happened. Do you have a few minutes to talk?
  • I think we have different perceptions about ______. I’d like to hear your thinking on this. 

You might not want to address it at the moment, but say something to acknowledge what happened and set up a time to talk about it later. That way, you can both plan and prepare for that conversation.



Scenario #1. You know your student needs a way to communicate, but you're getting resistance from the speech therapist. The speech therapist states that she cannot work on speech or communication until his behavior is better. You've tried pictures with him and seen success, but cannot get the speech therapist on board.

What do you do to get the speech therapist on board? You are going to use the four steps to help you engage in conversation: inquiry, acknowledgment, advocacy, and problem-solving.

  • Inquiry: Tell me about what goes on in speech. You're the expert in speech. Tell me some things. Can we problem solve through some things that might help him communicate? I've seen these pictures work, but I need your help.
  • Acknowledgment: I know as a speech path, you don't typically work on behavior. I know that's hard when they don't behave, but I really am struggling here.
  • Advocacy: I really feel like the behavior is because of communication. I really need someone who's a communication expert to help me.
  • Problem-solving: Are there ways that we could work together to help with behavior and help to increase his communication?

Scenario #2. You are a special education teacher. You put a plan in place but the paraprofessional is not implementing the program like you set it up. She will do her own thing and seems to make up things as things as she goes. Meanwhile, the student's challenging behavior's increasing.

What do you do in this scenario? You could approach the para and say, "I'd really like to talk about his behavior. Do you have time to talk on Friday?" In preparation for your conversation, use the four steps: inquiry, acknowledgment, advocacy, and problem-solving.

  • Inquiry: "Tell me about how you think his behavior is going at school. When is he doing the best and when is he having the most difficulty?"
  • Acknowledgment: "I know you have a tough job. Being a para, you're with him all the time and that can be hard. It seems as though you need more breaks or you need more support."
  • Advocacy: "From a teacher perspective, we put this plan in place and it's my legal responsibility to follow through with this plan or I'm going to get in trouble. Let's work together on how we can either change the plan or make sure we all know how to consistently implement that plan."
  • Problem-solving: "What are ways that we can better work together? How can I better support you so that you can implement that plan consistently?"

I appreciate you joining me for today's webinar on communication. These are some strategies that I have learned over the past 17 years and that have made a big difference for me. As stated in the title of this course, it's not what you say, it's how you say it. I'm hoping that you will find some relief in knowing some strategies on how to communicate in those difficult situations. Thank you and have a great day.


Brown, B. (2013, December 10). Brené Brown on Empathy [Video file]. Retrieved from

Crais, E. R., Roy, V. P., & Free, K. (2006). Parents' and professionals' perceptions of the implementation of family-centered practices in child assessments. American Journal of Speech-Language Pathology15(4), 365-377.

Moses, K. (1987). The impact of childhood disability: The parent's struggle. WAYS magazine, 1, 6-10.

Rush, D.D., & Sheldon, M.L. (2011). The early childhood coaching handbook. Baltimore, MD: Brookes Publishing Company.

Stahmer, A. C., Brookman-Frazee, L., Lee, E., Searcy, M. K., & Reed, M. S. (2011). Parent and multidisciplinary provider perspectives on earliest intervention for children at risk for autism spectrum disorders. Infants and young children24(4), 344.

Wagner, C. (2017, August 10). Motivational Interviewing. Retrieved from



Warwick, T. (2018). It's Not What You Say, It's How You Say It (Family Centered Practice & Teaming). – Early Childhood Education, Article 22819. Retrieved from

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tara warwick

Tara Warwick, MS, OTR/L

Tara Warwick, MS, OTR/L, is a graduate of the University of Oklahoma, obtaining her Bachelor’s degree in occupational therapy in 2000 and completing her Master’s degree in rehabilitation sciences with an emphasis in pediatrics in 2005. She has spent her entire career focusing on improving the quality of services for children, primarily targeting children with autism.  She currently co-owns a pediatric therapy practice called Today’s Therapy Solutions and is a consultant for the Oklahoma Autism Center through the University of Oklahoma Health Sciences Center – Child Study Center. Tara’s specialties include working with children with autism and challenging behavior. She has extensive experience and expertise in behavior management, sensory processing, self-care training (potty training, eating/feeding, dressing, play, etc.), and assistive technology.  She has conducted trainings and provided consultations for schools, parents and health and child care professionals all across the state.

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