Striving for shared understandings: therapists' perspectives of the benefits and dilemmas of using a child self-assessment.

Pediatric client-centered intervention planning is particularly complex because children, parents, and professionals must form a "tridactic" partnership and reach a shared understanding for therapy. Therapists may use child self-reports to facilitate children's involvement in this process. The purpose of this study was to understand how therapists used and interpreted a child self-report to achieve a shared understanding in the context of a tridactic relationship, using the Children's Occupational Self-Assessment (COSA) as an exemplar. Thirty-three pediatric therapists participated in five focus groups and qualitative analysis was conducted in four iterative phases. Therapists' decision to use the COSA led to either "good" responses or unexpected tensions between the therapist's, child's, and parent's perspectives. Therapists used demonstration, negotiation, or reflection to shift beliefs to achieve a shared understanding for therapy. Findings suggest that although therapists valued children's voices, professional knowledge usually took precedence over child and parent self-knowledge during intervention planning.