S48 Copyright © American Occupational Therapy Foundation Striving for Shared Understandings: Therapists ’ Perspectives of the Benefits and Dilemmas of Using a Child Self-Assessment

key words: client-centered practice, family-centered practice, health communication Pediatric client-centered intervention planning is particularly complex because children, par-ents, 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 thera-pists 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 ten-sions 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 too