Clinical reasoning and intervention strategies: simulated interviews with psychoactive substance-using mothers who monitored by youth protection services
Professionals who work with parents presenting a double problem of negligence towards their children and of problematic psychoactive substance use are confronted with complex decision-making on a daily basis. Before determining what best practices are recommended in this field, it seems important to better understand the various types of clinical reasoning and intervention strategies used by professionals to resolve issues and make decisions. Therefore, a research project was conducted to identify the types of clinical reasoning (pragmatic, procedural, interactive and conditional) and the response strategies most often used by counselors working alongside this clientele, as well as to illustrate the clustering between these reasoning processes and the response strategies associated to them. To that end, the use of the explicitation interviewing technique (Vermersch, 2006) allowed us to access the implicit knowledge of eight counselors, who were met after a simulated clinical interview with an actress playing a mother. Although all types of reasoning processes are found in the practice of counselors, interactive reasoning predominates and is particularly present in the context of clinical evaluation (for example, when evaluating fact recognition) and relational (for example, when reinforcing the confidence of parents) strategies. A better understanding of clinical reasoning processes and of intervention strategies used during clinical decision-making among negligent, psychoactive substance users, represents a first step in improving the support offered to counselors and managers in terms of training and clinical supervision.