OARS is a framework for gathering information about a child’s mental health and their family’s stories. OARS stands for:
- Open-ended questions
OARS are a core group of conversation strategies within motivational interviewing, an evidence-based engagement technique (Lundahl, Kunz, Brownell, Tollefson, & Burke, 2010; Miller & Rollnick, 2013). They can also be used to build a parent’s motivation to act or change, which is an important part of working with parents whose child has a mental health concern. It is likely that parents are going to have to do something different in order to address their child’s mental health difficulties. Their motivation will often be the driving force behind any change that parents make.
Open-ended questions are questions that invite the parent to provide a longer answer (e.g. ‘What are your thoughts about all of this?’), rather than a simple ‘yes’ or ‘no’ (e.g. ‘Do you think it’s a good idea?’). They are intended to seek out what is on the parent’s mind, rather than what’s on your mind.
Open-ended questions build initial engagement and empathy, but also invite more opportunities for reflective listening (see below). They allow you to focus on what the parent thinks and feels about a particular issue. These thoughts and feelings are crucial for you to understand how a parenting is thinking about any parenting challenges or concerns regarding their child’s mental health.
- ‘How does your baby respond to you when you try to soothe/settle them?’
- ‘What does this look like?’
- ‘What’s this experience like for you and your family?’
- ‘When Jelesha runs off after you have asked her to do something, what happens next?’
- ‘Who are your main supports?’
- ‘I noticed when you are talking to Mohammed, he doesn’t look at your face. Have you noticed that? What do you make of that?’
- ‘What would you like to do next?’
Affirmations are supportive comments or statements about a parents’ behaviour in relation to:
- values (e.g. ‘…I can tell you take Liam’s learning seriously…’)
- strengths (e.g. ‘You’re good at letting people know what you need.’)
- effort (e.g. ‘You’ve really had a good crack at trying to solve this problem.’); or
- intentions (e.g. ‘Sounds like you’re really keen to see this through.’).
They help build self-confidence, which is linked to motivation. These simple affirmations are also great for general engagement and can be used during first appointments (and beyond).
Complicated affirmations are an extension of simple affirmations; the only difference is that they are aimed at a particular behaviour in which a parent wants to/is contemplating change. For example, if a parent has mentioned they feel bad when they yell at their child for hitting their siblings, you can affirm their intention to try some other strategies.
- ‘You regret yelling at the kids, and you are keen to find another way to respond when this happens.’
- ‘It’s really important to you that your child knows that you’re here, and you won’t leave them.’
- ‘You’ve been trying a bunch of things to solve this issue.’
- ‘You’re good at setting boundaries with…’
- ‘You’re not really sure of the next steps, but you’re eager to find a way for Sara to learn how to settle herself to sleep without you.’
Reflections are the most important aspect of OARS. They are statements you make to show that you understand what a parent is thinking and feeling.
Reflections can be simple. For example, when a parent says they’re annoyed, you can reflect that you recognise the emotion:
- Parent: ‘I just don’t understand why the kids won’t just listen to me … when we’re in a rush, I just get so annoyed at them…’
- Nurse: ‘It’s frustrating when the twins don’t do what you asked – in fact, it sounds like it’s wearing really thin at the moment.’
These simple reflections are designed for general engagement and aim to build empathy by letting the parent know you are listening.
Complex reflections involve inferring what a parent may have meant (by what was said), without them directly saying it. When these reflections are directed towards a parent’s thoughts or feelings about making a change, it can be powerful to emphasise the reasons for change and motivate the person to make the change:
- Parent: ‘I just don’t know why they do what my partner says, but not what I say. Why is that?!’
- Nurse: ‘It sounds like you’d like to work out a way to communicate with the kids so that they follow important instructions.’
- ‘You aren’t worried that Lily has tantrums at home, but it’s really hard to manage when she does this in the supermarket and other public places. Is that right?’
- ‘It sounds like, while you’re feeling unsure about how best to handle this, you’re seeking support from trusted friends.’
Summaries are a way of consolidating the main points from a larger or complex conversation. They build engagement by letting the parent know you’re listening carefully to them.
- ‘Let me see if I’ve understood it all. One, you and your partner are struggling to pay the rent; two, you’re fighting with your mother, and she looks after your kids while you and your partner work; and three, the early learning centre educators are saying that Mohammed is hitting the other kids a lot. Have I covered everything? Is there anything else?’
- ‘At first you thought Declan was relating OK with others, just like other kids, but now you’re not so sure. You’ve noticed that he prefers to be by himself, and rarely smiles when other kids come to play with him.’
- ‘While things are feeling chaotic at home at the moment, you feel like you’ve got things under control and that things will be smoother in a few weeks.’