We think of our work in stages. How these stages manifest differs for different children and families, but the journey that results from this sequence of stages is generally the same.

Stage 1. Concerns to questions

When parents first present, they bring a set of concerns. Listening to these, the first stage in the journey is to map these onto answerable questions, then determine the best way to find answers.

We begin with the consideration of whether there is likely to be a significant, or genuine problem, something that would benefit from further understanding and attention.

Presuming the answer is YES, then;

  1. Function: What areas of the child's life are impacted (e.g. language, learning, behavioural self control, social development), and what is the nature of impact in each area. Is it a delay (normal developmental track, but slower), or is there something more unusual going on?
  2. Impact: What is the severity of struggle in each affected area - e.g. how far behind?
  3. The child's experience: what is it like for the child? How they feel about what is going on? What is their understanding and belief about the issue? How well are they able to manage what is going on for them?
  4. Cause: is there an identifiable cause for this profile of problems? Specifically, is there a medical (biological) process, or is there something else going on? If we cannot be sure about cause, what do we presume is going on?
  5. Developmental / Category diagnosis:  Does the situation meet necessary criteria for a developmental diagnosis (e.g. ADHD, Learning Disability, ASD)? If so, what are the advantages and disadvantages of formally making this diagnosis?
  6. Future: based on the presumption of cause, what is likely to happen into the future? Is your child, for example, likely to 'grow out' of the problem over time, or is it likely to worsen?
  7. Contextual influences: Are there factors that make the problem better or worse? Bullying at school is likely to make it worse, whilst an excellent school teacher is likely to make the problem easier to live with for your child. Are there relevant issues in the family?
  8. Associated (comorbid) problems: What else is going on? If there are several issues, how do they fit together? How do they influence each other?
  9. Capacity for change: Based on our best understanding of what is going on, how amenable is this to change? What is the likely response to intervention? What strategic approaches are likely to work best?
  10. Resilience:  What is going on that makes the future more likely to be successful? For example, does your child have strengths, passions, and other qualities that will help them get through successfully?

Once the questions are clear, it is then possible to explore how best to answer them.

Stage 2. An agreed, shared hypothesis

Even after doing our best to answer the questions, there is often uncertainty: complexity and imprecision. 

We manage this uncertainty with the concept of a hypothesis. This is the best understanding of what is going on, based on the current evidence. As new information emerges, however, this explanation may change.

A hypothesis needs to be sufficiently accurate as to begin the discussion around what to do. It is the foundation for planning of treatment and management.

Stage 3. Plan before action

Before deciding what to do, we choose to prepare a plan. It doesn't need to be complicated, but it does need to have a sense of direction, or purpose. Otherwise, it becomes very difficult to know whether the actions taken are working.

Our plans generally include:

  1. A definition of purpose, or goals, or intended outcomes. These are defined in time, and defined also but the evidence that will be used (at that time) to determine whether they have been achieved. We think of these in simultaneous timeframes:
    • Immediate - what is important right now
    • Short term - what is important for the next planning period, e.g. 6 months
    • Long term - what is important for when the child becomes and adult
  2. Consideration of the Team - who is involved in each of these agendas?
  3. Strategy - how will the goal be achieved?
  4. Communication - how will information be shared amongst the team during this time?
  5. Review - when and how will the situation be formally reviewed?

Stage 4. Review cycles

This stage repeats itself. It involves reviewing the existing plan, learning, resetting and re-planning. It evolves and adapts the plan. It revises the hypothesis if necessary. It continues to focus on the immediate and short term, but without losing the balance of considering and working towards the long term.

At DMC, we structure our consulting formally to work through these stages in a formal manner.