{"@context":{"@language":"en","Affiliation":"http:\/\/vivoweb.org\/ontology\/core#departmentOrSchool","AggregatedSourceRepository":"http:\/\/www.europeana.eu\/schemas\/edm\/dataProvider","Campus":"https:\/\/open.library.ubc.ca\/terms#degreeCampus","Creator":"http:\/\/purl.org\/dc\/terms\/creator","DateAvailable":"http:\/\/purl.org\/dc\/terms\/issued","DateIssued":"http:\/\/purl.org\/dc\/terms\/issued","Degree":"http:\/\/vivoweb.org\/ontology\/core#relatedDegree","DegreeGrantor":"https:\/\/open.library.ubc.ca\/terms#degreeGrantor","Description":"http:\/\/purl.org\/dc\/terms\/description","DigitalResourceOriginalRecord":"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO","FullText":"http:\/\/www.w3.org\/2009\/08\/skos-reference\/skos.html#note","Genre":"http:\/\/www.europeana.eu\/schemas\/edm\/hasType","GraduationDate":"http:\/\/vivoweb.org\/ontology\/core#dateIssued","IsShownAt":"http:\/\/www.europeana.eu\/schemas\/edm\/isShownAt","Language":"http:\/\/purl.org\/dc\/terms\/language","Program":"https:\/\/open.library.ubc.ca\/terms#degreeDiscipline","Provider":"http:\/\/www.europeana.eu\/schemas\/edm\/provider","Publisher":"http:\/\/purl.org\/dc\/terms\/publisher","Rights":"http:\/\/purl.org\/dc\/terms\/rights","RightsURI":"https:\/\/open.library.ubc.ca\/terms#rightsURI","ScholarlyLevel":"https:\/\/open.library.ubc.ca\/terms#scholarLevel","Supervisor":"http:\/\/purl.org\/dc\/terms\/contributor","Title":"http:\/\/purl.org\/dc\/terms\/title","Type":"http:\/\/purl.org\/dc\/terms\/type","URI":"https:\/\/open.library.ubc.ca\/terms#identifierURI","SortDate":"http:\/\/purl.org\/dc\/terms\/date"},"Affiliation":[{"@value":"Education, Faculty of","@language":"en"},{"@value":"Educational and Counselling Psychology, and Special Education (ECPS), Department of","@language":"en"}],"AggregatedSourceRepository":[{"@value":"DSpace","@language":"en"}],"Campus":[{"@value":"UBCV","@language":"en"}],"Creator":[{"@value":"Nasseri, Anisa","@language":"en"}],"DateAvailable":[{"@value":"2025-04-25T18:49:15Z","@language":"en"}],"DateIssued":[{"@value":"2025","@language":"en"}],"Degree":[{"@value":"Master of Arts - MA","@language":"en"}],"DegreeGrantor":[{"@value":"University of British Columbia","@language":"en"}],"Description":[{"@value":"In this study the researcher sought to investigate the experiences of immigrant parents upon finding out their child\u2019s diagnosis within the psychoeducational feedback meeting. Once a psychoeducational assessment is complete, the student\u2019s parents participate in a feedback meeting with the assessing psychologist where the assessment results, including any diagnosis, is communicated. These meetings can be emotional, challenging, and meaningful to families. How the psychologist communicates the results of an assessment can directly impact parents understanding of the assessment results and their child\u2019s needs, which consequently impacts the child\u2019s access to supports. Although a small body of existing research examines the characteristics of successful feedback meetings, little research has been done on the experience of immigrant families in these feedback sessions. Immigrants may face challenges when accessing care and communicating with professionals due to structural barriers and linguistic and cultural differences. Thus, in the present study, 10 immigrant parents whose child had undergone a psychoeducational assessment in Canada were interviewed. The lived experiences of these participants within the feedback meeting and upon hearing news of their child\u2019s diagnosis were explored using interpretative phenomenological analysis. Five group-level superordinate themes and 19 subordinate themes emerged from the data. The group-level themes included Positive Experiences, Challenges and Doubts, Impact of Culture and Language, Emotional Reactions, and Journey Beyond the Feedback Meeting. Through highlighting the voices of immigrant parents, implications for school psychologists\u2019 practice are explored in order to offer suggestions for improving communication and service provision for immigrant families in the feedback meeting.","@language":"en"}],"DigitalResourceOriginalRecord":[{"@value":"https:\/\/circle.library.ubc.ca\/rest\/handle\/2429\/90808?expand=metadata","@language":"en"}],"FullText":[{"@value":"  IMMIGRANT PARENT EXPERIENCES OF RECEIVING THEIR CHILD\u2019S PSYCHOEDUCATIONAL DIAGNOSIS: INFORMING SCHOOL PSYCHOLOGISTS\u2019 PRACTICE  by   Anisa Nasseri   B.A., The University of Victoria, 2021    A THESIS SUBMITTED IN PARTIAL FUFILLMENT OF  THE REQUIREMENTS FOR THE DEGREE OF    MASTER OF ARTS   in   The Faculty of Graduate and Postdoctoral Studies   (School and Applied Child Psychology)     THE UNIVERISTY OF BRITISH COLUMBIA  (Vancouver)  April 2025  \u00a9 Anisa Nasseri, 2025     ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, the thesis entitled:  Immigrant Parent Experiences of Receiving their Child\u2019s Psychoeducational Diagnosis: Informing School Psychologists\u2019 Practice   Submitted by:   Anisa Nasseri                 in partial fulfillment of the requirements for the degree of:                    Master of Arts  in:                   School and Applied Child Psychology   Examining Committee: Dr. Laurie Ford, Associate Professor, Educational and Counselling Psychology and Special Education, UBC Supervisor  Dr. Melanie T. Nelson, Assistant Professor, Educational and Counselling Psychology and Special Education, UBC Supervisory Committee Member   Dr. Thomas Schanding, Associate Professor, Educational and Counselling Psychology and Special Education, UBC Supervisory Committee Member       iii Abstract In this study the researcher sought to investigate the experiences of immigrant parents upon finding out their child\u2019s diagnosis within the psychoeducational feedback meeting. Once a psychoeducational assessment is complete, the student\u2019s parents participate in a feedback meeting with the assessing psychologist where the assessment results, including any diagnosis, is communicated. These meetings can be emotional, challenging, and meaningful to families. How the psychologist communicates the results of an assessment can directly impact parents understanding of the assessment results and their child\u2019s needs, which consequently impacts the child\u2019s access to supports. Although a small body of existing research examines the characteristics of successful feedback meetings, little research has been done on the experience of immigrant families in these feedback sessions. Immigrants may face challenges when accessing care and communicating with professionals due to structural barriers and linguistic and cultural differences. Thus, in the present study, 10 immigrant parents whose child had undergone a psychoeducational assessment in Canada were interviewed. The lived experiences of these participants within the feedback meeting and upon hearing news of their child\u2019s diagnosis were explored using interpretative phenomenological analysis. Five group-level superordinate themes and 19 subordinate themes emerged from the data. The group-level themes included Positive Experiences, Challenges and Doubts, Impact of Culture and Language, Emotional Reactions, and Journey Beyond the Feedback Meeting. Through highlighting the voices of immigrant parents, implications for school psychologists\u2019 practice are explored in order to offer suggestions for improving communication and service provision for immigrant families in the feedback meeting.         iv Lay Abstract When students struggle significantly in school, they are often referred for a psychoeducational assessment. When the assessment is complete, a psychologist typically shares the results, including the diagnosis, with the parents in a feedback meeting. Despite feedback meetings being a very important part of the assessment process, research on the subject is scarce. The purpose of this study was to explore the experiences of immigrant parents when told their child\u2019s psychoeducational diagnosis in the feedback meeting. Five key themes and 19 subthemes were identified from interviews conducted with 10 immigrant parents. Parents spoke about their positive and challenging experiences within the feedback meeting, how culture and language impacted the meeting, the complex emotions they experienced when hearing news of their child\u2019s diagnosis, and their journey beyond the feedback meeting. These themes are explored and recommendations for improving services for immigrant parents are discussed.       v Preface This thesis is the original, independent, intellectual and unpublished work by the author, Anisa Nasseri. Dr. Laurie Ford supervised this project, including data collection and data analysis. The study, which involved human participants, was reviewed and approved by the University of British Columbia Ethics Board (BREB), with the certification approval number H23-00813. One out of the 20 interviews completed for this thesis was part of a larger study and was conducted in collaboration with Dr. Dorna Rahimi as part of her doctoral dissertation. Harresh Thayakaanthan and Abby Dalmacio were research assistants and aided with the transcription of interviews. Generative AI, including Grammarly (2025) and ChatGPT (OpenAI, 2025), were used to check the grammar and punctuation of the document. The author reviewed each suggestion and made changes where appropriate on a case-by-case basis. Additionally, ChatGPT was used to translate some semi-structured interview questions into Arabic during one of the interviews, to ensure the participant understood what was being asked.      vi Table of Contents Abstract .......................................................................................................................................... iii Lay Abstract ................................................................................................................................... iv Preface............................................................................................................................................. v Table of Contents ........................................................................................................................... vi Acknowledgements ........................................................................................................................ xi Chapter One: Introduction .............................................................................................................. 1 Chapter One Overview ............................................................................................................... 1 Brief Background ........................................................................................................................ 1 Positionality ................................................................................................................................ 3 Key Terms ................................................................................................................................... 5 Psychoeducational Assessment ............................................................................................... 5 Feedback Meeting ................................................................................................................... 5 Diagnosis................................................................................................................................. 5 Parent ...................................................................................................................................... 6 Immigrant ................................................................................................................................ 6 Chapter One Summary ................................................................................................................ 6 Chapter Two: Review of the Literature .......................................................................................... 8 Chapter Two Overview ............................................................................................................... 8 The Purpose of Psychoeducational Assessments ........................................................................ 8 The Feedback Meeting .............................................................................................................. 10 Models and Guidelines for Feedback Meetings........................................................................ 13 Successful Feedback Meetings ................................................................................................. 17 Successful Disclosures of Specific Diagnoses .......................................................................... 20 Feedback Meetings with Culturally and Linguistically Diverse Populations ........................... 22 Immigrants in Canada and Barriers to Accessing Care ............................................................ 26 Rationale for the Proposed Study ............................................................................................. 30 Chapter Two Summary ............................................................................................................. 31 Chapter Three: Methodology and Methods .................................................................................. 33 Chapter Three Overview ........................................................................................................... 33 Purpose of the Study ................................................................................................................. 33 Research Question .................................................................................................................... 33 Epistemology and Theoretical Orientation ............................................................................... 33 Methodology: Interpretive Phenomenological Analysis .......................................................... 34    vii Procedures ................................................................................................................................. 37 Ethics and Consent ................................................................................................................ 37 Participant Recruitment ........................................................................................................ 38 Participant Inclusion Criteria ................................................................................................ 39 Participant Characteristics .................................................................................................... 39 Methods..................................................................................................................................... 45 Demographic Questionnaire ................................................................................................. 45 Semi-Structured Interviews .................................................................................................. 45 First Interview. .................................................................................................................. 46 Second Interview. ............................................................................................................. 47 Interview Technique. ........................................................................................................ 47 Member Reflections .............................................................................................................. 49 Data Analysis ............................................................................................................................ 49 Transcription ......................................................................................................................... 49 Seven-Step Analysis Framework .......................................................................................... 50 Step 1: Reading and Re-reading ....................................................................................... 50 Step 2: Exploratory Noting ............................................................................................... 50 Step 3: Constructing Experiential Statements................................................................... 50 Step 4: Searching for Connections Across Experiential Statements ................................ 50 Step 5: Naming the Personal Experiential Themes and Consolidating ............................ 51 Step 6: Continuing the Individual Analysis of Other Cases ............................................. 51 Step 7: Working with Personal Experiential Themes to Develop Group Experiential Themes Across Cases ....................................................................................................... 51 Ensuring Scientific Rigor .......................................................................................................... 52 Reflexivity............................................................................................................................. 52 Thick Description.................................................................................................................. 53 Contextualization .................................................................................................................. 53 Member Reflections .............................................................................................................. 54 Audit Trail ............................................................................................................................. 55 External Audit ....................................................................................................................... 55 Chapter Three Summary ........................................................................................................... 56 Chapter Four: Findings ................................................................................................................. 57 Chapter Four Overview............................................................................................................. 57 Theme 1: Positive Experiences ................................................................................................. 58 Clear and Detailed Explanations. .......................................................................................... 58    viii Care Demonstrated Through Action ..................................................................................... 61 Guided Next Steps ................................................................................................................ 63 Personal Characteristics Established Trust and Comfort ...................................................... 64 Theme Two: Challenges and Doubts ........................................................................................ 67 Overwhelming and\/or Inadequate Explanation .................................................................... 67 Doubts, Differences, Discontent ........................................................................................... 71 Uncertainty Around Prognosis .............................................................................................. 74 Theme Three: Impact of Culture and Language ....................................................................... 76 Intersectional Barriers to Support ......................................................................................... 76 Navigating Cultural Differences ........................................................................................... 80 Lack of Cultural Consideration ............................................................................................. 83 Language Barriers ................................................................................................................. 85 Theme Four: Emotional Reactions ........................................................................................... 87 Anxiety and Uncertainty ....................................................................................................... 87 Relief and Understanding ..................................................................................................... 90 Overwhelm and Upset........................................................................................................... 91 Shocked only by the Unexpected .......................................................................................... 92 Theme Five: Journey Beyond the Feedback Meeting............................................................... 94 Benefits of Diagnosis ............................................................................................................ 94 Insufficient Support Navigating Next Steps ......................................................................... 95 Strength and Hope in the Face of Ongoing Challenges ........................................................ 98 Evolving Perceptions .......................................................................................................... 103 Chapter Four Summary ........................................................................................................... 107 Chapter Five: Discussion ............................................................................................................ 109 Chapter Two Overview ........................................................................................................... 109 Discussion of the Results in the Context of the Literature ..................................................... 109 Overview ............................................................................................................................. 109 Discussion of Positive Experiences .................................................................................... 109 Discussion of Challenges and Doubts................................................................................. 111 Discussion of the Impact of Culture and Language ............................................................ 113 Discussion of Emotional Reactions .................................................................................... 117 Discussion of the Journey Beyond the Feedback Meeting ................................................. 118 Summary of Thematic Discussion ...................................................................................... 120 Implications for School Psychologists .................................................................................... 120    ix Limitations and Strengths ....................................................................................................... 124 Future Directions .................................................................................................................... 126 Conclusion .............................................................................................................................. 128 References ................................................................................................................................... 129 Appendix A: Screening Questions .............................................................................................. 139 Appendix B: Initial Interview Consent Form ............................................................................. 140 Appendix C: Consent Form A for Present Study........................................................................ 142 Appendix D: Consent Form B for Present Study........................................................................ 145 Appendix E: Introductory Script A ............................................................................................. 148 Appendix F: Introductory Script B ............................................................................................. 150 Appendix G: Demographic Questionnaire for Parents ............................................................... 152 Appendix H: Semi Structured Interview Guiding Questions ..................................................... 153 Appendix I: Recruitment Poster for Larger Study ...................................................................... 156 Appendix J: Recruitment Poster for Current Study .................................................................... 157 Appendix K: Example Personal Experiential Themes and Subthemes ...................................... 158 Appendix L: Group Level Superordinate and Subordinate Themes ........................................... 159       x List of Tables Table 1. Demographic Characteristics of Participants (N =10) \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026....\u2026\u202640 Table 2. Superordinate and Subordinate Themes\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.\u2026\u2026\u2026\u2026\u2026\u2026.\u2026\u202658     xi Acknowledgements  There are several people I wish to thank, without whom this research would not be possible. First and foremost, I would like to thank the ten parents who took time out of their days to share their stories with me. I am so grateful for your input and for sharing your journeys. Next, I would like to thank my supervisor, Dr. Laurie Ford. This research would not be possible without you. Thank you for always being so encouraging, lifting up my ideas, and pushing me when I needed it. I will be forever grateful for your mentorship and support. A big thank you to Dr. Melanie Nelson for being on my committee and providing thoughtful feedback and guidance along the way. I would also like to thank Dr. Thomas Schanding for being the arms-length examiner on my committee. Thank you to my wonderful cohort. You are always so encouraging and supportive, and it means a lot to be on this journey together. A special thank you to Antonia for completing the external audit and reviewing long pages of documents. To my research assistants, Harresh and Abby, thank you so much for helping with transcriptions.   Finally, I would like to thank my family. To my partner Nishant, thank you for always cheering me on, pushing me forward, and believing in me when I needed it most. Lastly to my parents, Azin and Shelly, thank you for instilling in me a love for education, learning, and service to humanity. I would not be where I am today without your constant love and support.  Chapter One: Introduction Chapter One Overview  The purpose of this chapter is to provide a synopsis of the topic of this thesis. I begin with providing brief literature highlights on the topic, introduce my positionality as a researcher conducting this study, and define key terms used in the study.  Brief Background  The first time you are told your child\u2019s psychoeducational diagnosis can be an incredibly emotional, difficult, and significant moment (Makino et al., 2021; Merkel 2010; Seligman & Darling 2007). Psychologists conducting psychoeducational assessments often impart this potentially life changing news, and the way they communicate this information can directly impact the family\u2019s experience, perception, and subsequent actions. Some research has found that parent experiences within the feedback meeting may facilitate or limit the child\u2019s access to support, given the association between parent understanding of the assessment results and adherence to the psychologists\u2019 recommendations (Human & Teglasi 1993; Merkel, 2010; 1993; Scipioni, 2014).  Despite the importance of the feedback session where psychoeducational assessment results are shared with families, relatively little research has been conducted in this area. A handful of researchers have published articles or suggested models for conducting successful feedback meetings, which has provided guidance to practitioners within the field (Dematteo, 2021; Glazer 2014; Pollack 1988; Tharinger et al., 2008). A number of studies have explored parent experiences within the feedback session, providing insights into what may be helpful and unhelpful within these meetings (Davey et al., 2022; Hasnat & Graves, 2000; Merkel, 2010; Scipioni, 2014); however, the populations with whom studies were conducted is limited.    2 Although there is some research about the communication between culturally and linguistically diverse parents and their child\u2019s practitioners (Jegatheesan, 2009; Lopez et al., 2018; Park & Turnbull, 2001; Sheets et al., 2012), there is a gap in examining the experiences of immigrant parents in these critical feedback meetings.  In 2016, 37.5% of children in Canada had at least one immigrant parent, with forecasts predicting that between 39%-49% of children in Canada will have an immigrant background (i.e., be first or second generation immigrants) by 2036 (Statistics Canada, 2017). Immigrant parents often deal with intersectional stressors that can cause the assessment process and feedback session to be more challenging (Khanlou et al., 2015b; Khanlou et al., 2017). Immigrants often face barriers related to culture and language when navigating new health care systems (Brown et al., 2020; Kalich et al., 2016), including limited access to culturally responsive care and systemic issues that can increase financial challenges (Khanlou et al., 2017). Additionally, differing cultural perspectives on mental health, learning, and psychoeducational assessments have the potential to make feedback meetings that much more challenging and miscommunications more likely (Jegatheesan, 2009; Khanlou et al., 2015b). In Canada, psychologists follow the Code of Ethics for Psychologists (Canadian Psychological Association [CPA], 2017), which includes four principles: Respect for the Dignity of Persons, Responsible Caring, Integrity in Relationships, and Responsibility to Society. The principle of Responsible Caring mandates that every psychologist minimize harm and maximize benefits for their clients. Therefore, it follows that providing culturally appropriate services is an ethical obligation for every psychologist. Indeed, the National Association for School Psychologists (NASP, 2020) states that school psychologists working with immigrant families have the responsibility to provide culturally competent and responsive care to their clients, no matter their background.    3 Thus, research regarding immigrant parent experiences within the feedback session is vitally important to ensure their needs are being met when first finding out their child\u2019s diagnosis.  Positionality   Being a child of a refugee and having worked with immigrant populations, I am well positioned to do this work. Through my personal experience of volunteering with newcomers at a local non-profit organization and through my work as a behavioural interventionist, I have seen first-hand the modern-day struggles of immigrants and newcomers to Canada, and the intersectional challenges they face when their children have psychoeducational concerns. I have also been an immigrant myself when I lived in Shanghai, China during my adolescent years. Although I had many privileges when I lived in Shanghai, I can understand the challenges that come with not understanding the language or local systems, and feeling as though you cannot fit into the mainstream culture. This experience helped develop empathy and understanding for others who are going through similar situations. I have a particular interest in working with immigrants because many of my loved ones are, or once were, newcomers in Canada.  Despite having close personal ties and lived experience with this population, I need to consider how participants may perceive me. Although I have mixed Iranian and Dutch heritage, many people perceive me as White, which may cause immigrant participants to see me as an outgroup member or feel as though I will not understand their experience. Because I am not a visible minority and I have a Canadian accent, I have privilege in our society and need to be aware that my experiences will differ from visible minorities or racialized groups. Although I may empathize and somewhat identify with my participants\u2019 experiences, I cannot truly understand and thus need to adopt a humble posture of learning. Additionally, I do not have children of my own, which may limit the extent to which participants believe I can understand    4 their experience as parents. Furthermore, I am presenting myself as a school psychology graduate student, so I must consider how this role may be perceived by people from different cultural backgrounds. Some cultures and individuals may view my position with distrust, while others may have immense respect and feel wary to inadvertently offend or criticize the profession. It will be vital to build trust with my participants and ensure they feel comfortable to share their genuine feelings and experiences.  I am currently located in the lower mainland of British Columbia which is an area with a large immigrant population (NewToBC, 2018). As graduate student in School and Applied Child Psychology, a primary focus of my training is psychoeducational assessment and effectively communicating these results with families and schools. However, I need to be aware of how my professional experiences may influence my perceptions of parents\u2019 accounts of the feedback meetings. I may unconsciously empathize with the psychologist since I know how challenging this job can be, or alternatively, I may pass harsh judgements on psychologists since I am familiar with evidence-based practices. It will be important to continually reflect on my perceptions and actively work to ensure my internal reactions are not influencing participants\u2019 ability to freely express themselves. To facilitate reflections, I will kept a reflexive journal, which is explained in the methods section.  This study has implications for school psychologists\u2019 practice and contribute to the social science field by helping to ensure all families from all backgrounds are receiving appropriate, thoughtful, and evidence-based care. This project will conclude with a number of knowledge translation efforts including submission as a master\u2019s thesis, posters presented at professional conferences including the Canadian Psychological Association (CPA), the American Psychological Association (APA), and the National Association of School Psychologists    5 (NASP), in-service presentations for school psychologists, and workshops and infographics for immigrant families with children receiving psychoeducational assessments.   Key Terms Psychoeducational Assessment  A psychoeducational assessment is the assessment of an individual\u2019s cognitive, academic, social, emotional, behavioural, communicative, and adaptive functioning in an educational context (Dombrowski, 2020). Also referred to as psychoeducational evaluations, these assessments are typically conducted by school psychologists and collect information from multiple sources (i.e., standardized testing, interviews, file reviews, and observations) to describe relevant areas of functioning, understand a student\u2019s challenges and strengths, and propose interventions to enhance overall functioning (Lichtenstein & Ecker, 2019). Psychoeducational assessments often result in a diagnosis and\/or ministry\/state designation in order to assist with program planning and to facilitate access to funding and resources (Levin & Olfert, 2011).   Feedback Meeting  The feedback meeting (also referred to as the feedback session, feedback conference, report-out, or results meeting) is a meeting where the psychologist who conducted the psychoeducational assessment shares the results and findings with the individual being assessed, their caregivers (in the case of a child or youth) and\/or relevant professionals. For the purpose of this study, the feedback meeting refers exclusively to the meeting between the psychologist conducting the assessment and the primary caregivers of the student who was assessed.  Diagnosis  A diagnosis is the categorization of a specific academic, cognitive, social, emotional, behavioural, communicative, or adaptive condition that an individual meets criterion for.    6 Diagnoses and criteria used in North America are listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) (American Psychiatric Association, 2022), but for the purpose of this study, diagnosis will also include ministry designations, which are the official classifications provided by Ministries of Education in Canada (or State Departments of Education in the United States). For example, in British Columbia, the Inclusive Education Services Manual of Policies, Procedures and Guidelines delineates designations used in the province (Province of British Columbia, 2024). Designations may be assigned to students with special learning needs or exceptionalities based on the results of the psychoeducational assessment. Eligibility criteria for designations may be slightly different from the DSM-5-TR and designation categories are often broader than specific diagnoses. Designations often facilitate access to student funding for services and additional resources. It is important to contextualize the construct of disability and process of diagnosis as Western ideologies (Pewewardy & Fitzpatrick, 2009), which may not have meaning for people brought up in a culture not centered on Euro-western thought.  Parent   For the purpose of this study, a parent is defined as an individual who is a primary caregiver to the student who received a psychoeducational assessment.   Immigrant  An immigrant is someone who has permanently settled in another country (Canadian Council for Refugees, 2010). In the context of this study, immigrant will refer to any individual who was born outside of Canada, moved to Canada from another country, and now permanently resides in Canada.  Chapter One Summary    7 In this chapter the topic being studied, my positionality, and key terms used in the study are introduced. The study topic, understanding immigrant parents' experiences of finding out their child's psychoeducational diagnosis, is important to examine because the feedback meeting where this disclosure takes place can be incredibly impactful on the family. Notably, there is little research on immigrant families' experiences during this potentially pivotal moment. Thus, it is vital to understand immigrant parent experiences when receiving news of their child's psychoeducational diagnosis in the feedback meeting where the disclosure takes place. My positionality includes personal connections to working with immigrant populations, the context of my physical location and educational background, and considerations for how my position may influence the participants and the study as a whole. Definitions are provided above to provide clarity on key ideas that will be discussed throughout this paper.       8 Chapter Two: Review of the Literature Chapter Two Overview  The purpose of this chapter is to review the literature on feedback meetings and the experiences of immigrant parent when receiving their child\u2019s psychoeducational diagnosis. First, I explore the nature and purpose of the psychoeducational assessment process and feedback meetings. The literature on the determinants of successful feedback meetings is then reviewed, looking specifically at several studies that examine parent experiences with feedback meetings. I then overview the literature on conducting feedback meetings with culturally and linguistically diverse families and explore the experiences of immigrant families in Canada with a child who qualifies for special education services. The barriers in care for immigrant families in Canada, and particularly those relevant to services offered by school psychologists are then examined. To conclude this chapter, gaps in the literature are identified and I explain the rationale and need for the proposed study.  The Purpose of Psychoeducational Assessments  Psychoeducational assessment is \u201ca type of assessment that is used to understand an individual\u2019s cognitive, academic, social, emotional, behavioural, communicative and adaptive functioning within an educational setting\u201d (Dombrowski, 2020, p. 4). More simply, it has also been defined as \u201can opportunity to enlighten, to collaborate, and to plan\u201d (Lichtenstein & Ecker, 2019, p.1). Unlike broader psychological assessments, psychoeducational assessments typically focus on the functioning of individuals in kindergarten through grade 12 and focus on the client\u2019s functioning in educational settings (Dombrowski, 2020). Psychoeducational assessments are most commonly conducted by school psychologists working in schools or school districts, although, licensed\/registered psychologists may also complete them in private practice, in the    9 community, or in hospital settings (Dombrowski, 2020). The purpose of these assessments is to use the referral question to guide an exploration of a client\u2019s functioning, identify strengths and opportunities for growth, and make relevant recommendations to support them (Lichtenstein & Ecker, 2019). Based on a review of over 125 metanalyses, psychological assessments are found to have test validity that is strong and comparable to medical test validity (Meyer et al., 2001). To ensure a thorough and holistic assessment, multimethod, multisource, and multi-setting approaches should be employed, which should include record reviews, observations, interviews, and formal and informal testing (NASP, 2009). School psychologists conducting psychoeducational assessments should adhere to relevant ethical and legal guidelines and use data-driven, evidence-based practices (NASP, 2009). The National Association of School Psychologists (2009) highlight that assessment is a tool that school psychologists use to promote academic competence and positive mental health for students.  Canada does not have a nationally agreed upon definition of a psychoeducational assessment that specifies psychoeducational assessment practice, so school psychologists in Canada may derive their definition from multiple sources, including NASP, the Canadian Psychological Association (CPA), provincial guidelines and codes, institutional guidelines, and educational law. In 2007, the CPA published Professional Practice Guidelines for School Psychologists in Canada. These guidelines do not use the words psychoeducational assessment but define psychological assessment as a key activity for school psychologists, and state that this typically includes standardized testing, file review, observations, interviews, questionnaires, and behavioural data (CPA, 2007). In Canada, psychologists are regulated at the provincial level, so specific guidelines for assessment may vary from province to province. For instance, in British Columbia, psychologists are beholden to the Code of Conduct (College of Psychologists of    10 British Columbia, 2014). While the Code does not specifically define psychoeducational assessments, it includes general standards and ethical obligations for the psychologists who conduct assessment activities. Furthermore, school psychologists working in BC schools use the Inclusive Educational Services Manual of Policies Procedures and Guidelines (2024) to guide their work and provide appropriate designations to students. The guidelines for what constitutes a psychoeducational assessment are not clearly laid out in the manual; however, it states that psychoeducational assessments serve a diagnostic and planning function, may include an assessment of cognitive functioning, and aim to better understand the student\u2019s disability (or diverse ability) and the implications for the student\u2019s educational, social, and emotional functioning.  While the exact definition may vary slightly, the overall the process of psychoeducational assessment serves a vital function in education by identifying possible explanations for a student\u2019s struggles, revealing student strengths and needs, assessing current levels of student functioning, determining progress towards defined goals, recommending services and interventions to enhance learning, and evaluating the effectiveness of educational programs (Ysseldyke et al., 2007). An assessment may result in a formal diagnosis or designation (e.g., designation from the BC Ministry of Education and Child Care), which may provide a child with access to services, resources, and associated financial supports (Province of British Columbia, 2024; Levin & Olfert, 2011).   The Feedback Meeting The feedback meeting that follows a psychoeducational assessment involves the psychologist conveying the results to the child\u2019s primary caregivers. Clearly interpreting the data of a psychoeducational assessment to the parents is a key component of the process (NASP,    11 2009; Pollack, 1988). Dombrowski (2020) outlines two general ways that feedback meetings are structured; the first being between psychologists and caregivers, and the second being between caregivers, psychologists, and a multidisciplinary team. Depending on the structure of the organization conducting the assessment, this team may include case managers, directors of programming, educational aids, therapists, teachers, or attorneys (Dombrowski, 2020). However, in both meeting structures, the psychologist is primarily responsible for discussing and interpreting the results of the psychoeducational report (Dombrowski, 2020).  In Canadian schools, a common feedback approach is for the school psychologist to first meet with the parents, then have a separate feedback meeting to convey the results to the school. The school psychologist may then also participate in the individual education plan (IEP) meeting, which typically involves the caregivers, school-based team, and often the student themselves (Lo, 2012). The IEP meeting utilizes the results of the psychoeducational assessment to create a plan to best support the student and set them up for success. The school psychologist should always aim to meet with the parents before the IEP meeting to help them process potentially challenging information, give them the opportunity to ask questions, and allow them to participate more meaningfully in the IEP meeting (Parkin & Tyre, 2021). In many states and provinces, parents have a legal right to receive the results of the assessment before they are provided to the school (Parkin & Tyre, 2021). Some suggest that it is not only parents who should be present in this initial feedback meeting, but also any adult family members who play a significant role in the child\u2019s life (Pollack, 1988).  Pollack (1988) outlines that the goals of the feedback session with parents are to a) ensure parents understand their child\u2019s developmental needs and status, b) assist in facilitating adaptive coping to new and potentially challenging information, and c) to encourage and discuss    12 potential interventions. Dombrowski (2020) highlights that the purpose is to discuss the report\u2019s findings clearly and concisely and Flanagan (2011) states that the practitioner should use the referral question to structure their communication of the child\u2019s strengths, weaknesses, and needs within this meeting. The feedback session is a key process in parental understanding, processing, and decision making. Indeed, the feedback meeting directly effects the parent\u2019s understanding of their child\u2019s needs and their motivation to follow through with suggested recommendations (Selig, 1983). In a study of 77 parents of children who had received psychoeducational assessments, Human and Teglasi (1993) found that parent understanding of their child\u2019s learning and behavioural challenges was associated with improved parent-child relationships, communication, and self-esteem for the child. In another study, 8 mothers were interviewed about their experience of the psychoeducational feedback meeting and following through with the recommendations made during the assessment (Merkel, 2010). Their interviews were transcribed then analyzed using interpretive phenomenological analysis (IPA). Analysis of the interviews revealed that when mothers understood the value and purpose of a particular recommendation, they seemed more likely to pursue the recommendations (Merkel, 2010). Conversely, in their study including 93 parents whose child was referred to an outpatient unit for psychological assessments or treatment, MacNaughton and Rodrique (2001) found that satisfaction with the psychological assessment was uncorrelated to adherence to recommendations, but rather that the perceived number of barriers was the main predictor of compliance to recommendations. Interestingly, Merkel (2010) found that warmth, openness, and availability seemed to increase parents\u2019 satisfaction with their experience in the feedback meeting and also facilitated adherence to the psychologist\u2019s recommendations. Thus, the specific    13 mechanisms by which parent satisfaction and adherence to recommendations is attained warrants further investigation. However, research indicates the way in which psychologists communicate the client\u2019s needs and suggest recommendations in the feedback meeting can influence the family\u2019s understanding and adherence to the recommendations (Human & Teglasi, 1993; Merkel, 2010; Scipioni, 2014) and, therefore, impact the child\u2019s access to support.  Models and Guidelines for Feedback Meetings  There are several models created to provide assessment feedback to parents (Dematteo, 2021; Glazer 2014; Pollack 1988; Tharinger et al., 2008). Pollack (1988) provides guidelines for conducting feedback meetings in both clinical and school settings. He states that meetings should be flexible and include adults who are significant in the child\u2019s life. There should be a clear time limit and active participation should be encouraged. Initiating the conversation with positive remarks about the child and discussing the child\u2019s engagement with the assessment process is recommended. Next, the clinician should review the reason for referral and describe the assessment process and the multiple sources of data used to draw conclusions such as background history, interviews, and diagnostic tests. The feedback should be tailored to the parent\u2019s background, educational level, and familiarity with assessment practices, and Pollack (1988) suggests providing a package of basic information about psychometric concepts and common misconceptions to parents. He mentions that technical language should be minimized, and results should be linked to real life experience. The psychologist should be empathetic and gentle while remaining honest and transparent. Additionally, psychologists should exercise their discretion to determine the content of the feedback session, as providing comprehensive accounts of everything learned is neither feasible nor beneficial, thus the clinician should stick to information relevant to the referral question and discuss key interpretations and    14 recommendations. When disclosing a diagnosis or potentially challenging results, it is suggested to start with the least anxiety-inducing content and then move onto more challenging findings, and to emphasize how the child is similar to other children (i.e., especially in terms of their challenges) to prevent parents from feeling isolated (Pollack, 1988).  Tharinger and colleagues (2008) outline the Collaborative Approach Model for providing feedback to parents and children. The Collaborative Approach focuses on compassionately understanding the parents\u2019 stories of their child and then tailoring feedback to the families existing narratives. Within the Collaborative Approach, there are three consecutive levels of feedback, which are based on Finn\u2019s (1996) method. Level 1 involves providing information that fits within the parents\u2019 narrative and understanding of their child and the family as a whole. Level 2 involves presenting findings that may challenge or modify the family\u2019s notions about their child but are unlikely to threaten self-esteem or core beliefs. Level 3 involves communicating information that is discrepant to the family\u2019s beliefs or ways of thinking about their child. These are more likely to be anxiety provoking and may enact defense mechanisms. The ability for a parent to accept third-level findings depends on their relationship with the psychologist and level of support and understanding they feel from the clinician; therefore, relationship building is central to Tharinger\u2019s approach (Tharinger et al., 2008). Similarly, in Parkin and Tyre\u2019s (2021) book on effective communication within school-based meetings, the authors state that clinicians must build trust during meetings by understanding the perspectives and beliefs of participants and should demonstrate understanding of these values to further develop trust and foster acceptance and collaboration.  More recently, DeMatteo (2021) created the Feedback Model as a means to deliver psychoeducational feedback to parents, which involves 16 steps derived from basic learning    15 principles and effective communication techniques. Within these steps, the clinician aims to re-establish rapport, acknowledge positive attributes of the child, give the parent the chance to speak and ask questions, establish the purpose and agenda for the meeting, provide an in-depth understanding of the child\u2019s abilities in a way that the parent can understand, and communicate the diagnosis\/designation and recommendations. In DeMatteo\u2019s (2021) model, the school psychologist seeks to educate the parent regarding interpretation of results and explain each domain of functioning in a way the parent can comprehend.  While not specific to providing psychoeducational feedback, the SPIKES protocol, originally developed for breaking bad news to cancer patients (Baile et al., 2000), is reported to be used by some neuropsychologists during the feedback meeting (Longley et al., 2022). The SPIKES protocol includes six steps: setting up the environment, assessing the patient\u2019s perception and needs, obtaining the patient\u2019s invitation while indicating that the information may be challenging, giving knowledge and information to the patient, addressing the patient\u2019s emotions with empathetic responses, and providing a summary and discussing next steps (Baile et al., 2000). While no research was found about school psychologists using this model, it remains a potential model for psychologists to use when delivering difficult news. Although not specific to the feedback meeting, Lichtenstein and Ecker (2019) propose a Consumer-Responsive Approach, which encourages putting the needs of the consumer first and thereby simplifying report writing to be easily understood and interpreted. These authors report the psychoeducational assessment process is highly flawed due to the unnecessary complexity of psychoeducational reports that make them inaccessible, and therefore less useful, to the individuals who use them most: parents and teachers. Within their book, they dedicate a chapter to the oral communication of findings. They explain that the extent to which teachers, parents,    16 and administrators comprehend report findings and follow through with recommendations depends on the communication and interactions with the assessor (Lichtenstein & Ecker, 2019). They emphasize that creating positive connections with the consumers is of vital importance. When communicating with parents, Lichtenstein & Ecker (2019) discuss the need for plain language and non-judgemental responses to questions and concerns. Furthermore, they view the feedback meeting as part of a continuous process that does not end with the conclusion of the meeting. Additionally, understanding the parents\u2019 beliefs and preconceptions about a diagnosis and explaining disabilities in adequate depth is stressed (Lichtenstein & Ecker, 2019).  Glazer (2014) emphasizes the significance of providing effective communication of assessment results within the feedback meeting. The article outlines both the importance of what is communicated and how it is communicated. Organization and preparation are vital. Prior to the meeting, the school psychologist should prepare key messages and talking points, using important themes and strengths and weaknesses. They should avoid reading verbatim from the report, but rather briefly review all its components (observations, background information, interviews, testing etc.). While tasks and standardized testing should be explained adequately, the focus should not be on scores, nor should the meeting be overly technical. Glazer (2014) recommends using visual charts and qualitative descriptors of scores to aid the description of results. Additionally, communication skills such as eye contact, alert body posture, using clear and concise language, and responding to the parents\u2019 engagement levels are all important. The school psychologist should exhibit positive qualities such as empathy, genuineness, and respect. Cultural and contextual factors that may have impacted the assessment results should be openly discussed during the meeting, and ample time should be given for questions and consolidation of    17 information. During this interaction, Glazer (2014) also emphasizes the importance of discussing the child\u2019s strengths, resilience, and positive characteristics.  Successful Feedback Meetings Highlighted by the models and guidelines in the previous section, there are various suggestions for how to conduct a successful feedback meeting. Central to the success of a feedback meeting is presenting the results of the assessment in a way that is clear and understandable to the parents (Dombrowski, 2020; Glazer 2014; Lichtenstein & Ecker, 2019; Pollack, 1988; Scipioni, 2014; Sleig, 1983). This includes eliminating jargon and technical language (Dombrowski, 2020; Glazer 2014; Lichtenstein & Ecker, 2019; Scipioni, 2014) and speaking in a manner that is tailored to the parents\u2019 capabilities such as their educational background (Pollock, 1988). Some authors suggest avoiding discussions of numbers and figures, but rather encourage interpretation using real life examples (Drombowski, 2020; Lichtenstein & Ecker, 2019; Scipioni, 2014). Another important determinant of successful feedback meetings is finding the balance between being direct and honest while remaining gentle and empathetic (Drombowski, 2020; Lichtenstein & Ecker, 2019; Pollock, 1988).  Throughout the feedback meeting it is important to hold space for the parents and allow them ample time to process their emotions and ask questions (Drombowski, 2020; Glazer 2014; Pollock, 1988; Scipioni, 2014). Some suggest taking a therapeutic approach to support the parents through the meeting (Flanagan, 2011; Lichtenstein & Ecker, 2019). Specifically, Flanagan (2011) positions the school psychologist\u2019s role as a joint-problem solver and suggests that they may utilize elements of cognitive behavioural psychotherapy to help the parents process the results and plan ahead. A flexible approach is necessary in the feedback meeting, while maintaining structure and a clear outline for the goals of the meeting (Lichtenstein & Ecker,    18 2019; Pollock, 1988). Furthermore, many parents value acknowledging the child\u2019s strengths and positive qualities as an important part of the feedback meeting (Glazer, 2014; Merkel, 2010; Scipioni, 2014). Finally, understanding the parents\u2019 values and beliefs about their child and the diagnosis is important in order to gauge how to best communicate information (Lichtenstein & Ecker, 2019; Pollock, 1988; Tharinger et al., 2008).   In a study by Hasnat and Graves (2000), 23 parents of children with developmental disabilities were interviewed about their experiences of receiving their child\u2019s diagnosis. Participants were asked questions about their experience and to rate various experiences on a 5-point Likert-like scale. A total of 86% of parents indicated they were satisfied with the disclosure. Chi-squared analysis was used to determine relationships between various determinants of satisfaction and revealed that parents who received more (rather than less) information were more likely to be satisfied. Additionally, the evaluator\u2019s communication skills, ability to be direct, and their understanding of the parents\u2019 concerns were all associated with higher satisfaction (Hasnat & Graves, 2000). In a broader study looking at satisfaction from psychological assessment feedback practices, Smith and colleagues (2007) found that in a sample of 719 psychologists, 71% of clinicians provided in-person feedback to their clients, and 72% believed their clients found this information to be helpful and positive.  In Scipioni\u2019s (2014) study, 11 parents were interviewed about their experience in the feedback meeting with a school psychologist. These interviews were transcribed and coded into various themes that were used to create recommendations for school psychologists using a grounded theory methodology. Parents reported that complex language and jargon made the results difficult to understand and wished for a jargon-free summary to really understand the report. Many parents felt that overemphasizing numbers was not a helpful practice and    19 sometimes made them feel worse about their child's functioning. Additionally, parents wanted the school psychologist to put their child's needs first rather than the school\u2019s. Many parents reported concerns about the future and felt as though they were left with unanswered questions and a lack of guidance about the next steps and available support. Although some parents reported feeling hopeful after the feedback meeting, others felt hopeless and lost. Parents appreciated the incorporation of multiple sources of data and the use of empathy within the feedback session. Based on the parents' experiences, Scipioni (2014) created practice guidelines for school psychologists to include within their assessment practice and feedback sessions, including a) knowing the referral question, b) explaining the evaluation process to the parents, c) being mindful of language and avoiding jargon, d) giving a \"bottom line\" summary (p. 107), e) discussing what the child can do and highlighting the child's strengths, f) giving time for questions and being empathetic, g) providing resources, h) ensuring they are not alone, i) providing a sense of hope, and j) developing a system (Scipioni, 2014, pp. 105-110). In another similar study, IPA was used to analyze eight interviews with mothers about their experience in the psychoeducational feedback meeting with a psychologist (Merkel, 2010). Out of the interview data, three broad themes and 11 subthemes emerged. The three broad themes included experiences of satisfaction, experiences of finding out, and emotional experiences. Within the first theme of experiences of satisfaction, parents conveyed that the psychologist highlighted their child\u2019s strengths. Additionally, parents expressed positive interactions with the psychologist as well as a desire to have a second meeting. For the second theme of experiences of finding out, parents came into the feedback meeting with an expectation of being told their child\u2019s diagnosis, of better understanding their child\u2019s challenges, and of acquiring information about how they could better support their child. For the theme of    20 emotional experiences, parents reported 5 common emotions during the feedback session: shock\/overwhelm, upset\/sadness, guilt, uncertainty\/worry, and validation\/pride. Based on these findings, the vital importance of understanding parents\u2019 expectations throughout the assessment process was noted. Furthermore, it is important to be clear about what parents should expect from the assessment process to avoid disappointment or a discrepancy between expectations and reality (Merkel, 2010). Additionally, psychologists\u2019 warmth, empathy, and openness toward the family and child is critically important to communicate within the feedback meeting (Merkel, 2010).  Successful Disclosures of Specific Diagnoses Some studies have looked at disclosures of specific diagnoses. Research on disclosures of autism spectrum disorder (ASD) has drawn particular attention in the literature. In a recent scoping review of parents\u2019 experiences with ASD diagnoses, roughly a third of the 122 articles examined reported some experience of the feedback session (Makino et al., 2021). They found that finding out about the diagnosis was a very important moment for caregivers. Parents wanted professionals to be empathetic and to highlight their child\u2019s strengths. Optimistic statements about the diagnosis and possible interventions were appreciated and having the opportunity to ask questions and discuss the prognosis was important. Some parents, however, felt that the feedback session was confusing and overwhelming due to an information overload. Additionally, when diagnoses were unclear (e.g., \u201csuspected\u201d or \u201cprobably\u201d), parents tended to be more confused (Makino et al., 2021, p. 274). Having information about interventions and recommendations that were tailored for their child was very important to parents and some families also wished to be connected with other parents whose children were also on the spectrum. Emotions around the time of diagnosis was another theme identified in the scoping    21 review. Many parents found the disclosure emotionally intense, and parents reported a range of primarily negative emotions such as shock, sadness, isolation, and guilt, but the most commonly experienced emotion was relief (Makino et al., 2021).   Many similar findings are present in the handful of studies that examine disclosures of other diagnoses. For example, in the study by Hasnat and Graves (2000) looking at determinants of satisfaction for parents whose children were diagnosed with a developmental disability also found parents were more satisfied when practitioners clearly communicated and were direct yet understanding. Interestingly, parents were more satisfied with disclosures when they received more, rather than less information, even when they initially found the information to be overwhelming (Hasnat & Graves, 2000). Davey and colleagues (2022) conducted a study on parent\u2019s experiences of receiving their child\u2019s anxiety disorder diagnosis and found similar themes. For example, a non-judgemental attitude and a good relationship between families and practitioners was important and parents also reported appreciating clear and detailed information in face-to-face meetings. However, some parents did feel that they had an information overload within the feedback session. Parents also had mixed reactions to the diagnosis itself; some felt relieved and validated whereas other parents felt guilty, sad, or upset. Nonetheless, most parents viewed the diagnosis as a step towards receiving support for their child (Davey et al., 2022). Based on the results of these studies we see common elements in terms of successful disclosures of different diagnoses (Davey et al., 2022; Hasnat & Graves 2000; Makino et al., 2021), including gentle yet direct communication, finding a balance between enough information and information overload, and facilitating a supportive environment to deal with potentially challenging emotions. It is important to consider these studies mainly took place in North America, Australia, or Europe with participants that were predominantly White (Davey et al.,    22 2022) and predominantly mothers (Davey et al., 2022; Hasnat & Graves, 2000); therefore, the findings regarding successful feedback meetings may not be applicable to more diverse populations. Additional research is needed to identify the elements of successful feedback meetings with culturally and linguistically diverse populations.  Feedback Meetings with Culturally and Linguistically Diverse Populations  Few studies have examined feedback meetings with culturally and linguistically diverse populations emphasizing the need for research in this area. Sleig (1983) asserts that people process communication through the lens of their own personal experience and associations. New information that differs from existing beliefs may facilitate new ways of thinking but may also heighten anxiety and thus hinder capacity to listen objectively (Sleig, 1983). Immigrants and newcomers may have perspectives regarding mental health and diagnoses which differ from the traditional Western approach, thus it is unclear how information shared at the feedback meeting may clash or meld with existing world views and beliefs. For example, different cultures may interpret disability or diagnoses in different ways (Rogers-Adkinson et al., 2003), which can lead to miscommunications between families and school psychologists.  Returning to the model put forward for collaborative communication by Tharinger and colleagues (2008), it is possible that information shared during the feedback meeting may be considered Level 3 in that it may be at odds with parent beliefs about their child, and thus more anxiety inducing. For example, in a study of 44 Latina mothers and 52 White mothers living in Midwestern United States (Lopez et al., 2018), it was found that after receiving their child\u2019s diagnosis of ASD, White mothers tended to feel relieved, while Latina mothers reported increased guilt. Latina mothers also reported less knowledge about ASD, which may have been one factor impacting the way they perceived the diagnosis. Additionally, only Latina mothers    23 reported feelings of injustice or unfairness about the diagnosis (Lopez et al., 2018). A significant proportion (84%) of the Latina mothers in this study were immigrants, highlighting how diagnosis disclosures may be experienced by cultural groups in different ways. Important to note are the various contextual factors that may have influenced the Latina mothers\u2019 perceptions and experiences of the diagnosis disclosure, including the fact that the Latina mothers were younger, less educated, and earned less compared to the White mothers in the study (Lopez et al., 2018).  A recent study examined the experiences of 11 Korean immigrant mothers in their journey with their child\u2019s ASD diagnosis and accessing services in the United States (Kim et al., 2023). Transcripts from semi-structured interviews were analyzed using thematic analysis, which resulted in five main factors that interacted to influence the diagnostic process and access to treatment: a) cultural beliefs and values, b) language barriers, c) complex emotions, d) immigration and navigating systems, and e) facilitators and assets. The authors noted that culture played an important role in the diagnostic process. For many Korean parents, autism was seen as a severe disorder, which in some cases delayed the diagnosis because mothers did not think their child could be autistic. Additionally, parents tended to use medical terminology and described autism as an illness that could be cured with appropriate treatment or medical advancements. Language barriers made processing information and accessing resources more challenging. Furthermore, parents received mixed messages about whether to continue bilingual instruction within the household, or to focus on one language with their autistic child. Strong emotions were also noted, which arose from both internal perceptions as well as social interactions with family and community members. Challenging emotions, such as shock and despair, seemed to spur mothers into action to access services and best support their child.    24 Finally, parents faced delays in accessing services when their child was previously diagnosed in Korea, and the diagnosis was not accepted in the United States (Kim et al., 2023).   Another study interviewed 14 Latina mothers who were first generation immigrants and who had children with Down syndrome to learn about their experience finding out their child\u2019s diagnosis from physicians (Sheets et al., 2012). One of the six organizing themes identified from interviews was cultural belief systems. Specifically, Latina mothers often initially believed they or their partners were to blame for their child\u2019s diagnosis and often perceived their child\u2019s condition to be linked with religious causes (e.g., God\u2019s will, punishment, or a blessing). Mothers also expressed differences in the way Down syndrome was perceived in the United States versus their country of origin. Communication was another broad theme identified. Parents wished doctors had explained their child\u2019s diagnosis better, used less technical jargon, went through the information at a slower pace, and included more positive information about the diagnosis (Sheets et al., 2012). Another study of 19 Hispanic Families and 16 White families compared the experiences of White and Hispanic families obtaining an ASD diagnosis and found 4 key similarities: a) doctor response to parent concerns, b) family support, c) family and friend\u2019s lack of awareness of ASD, and d) treatment of child when friends and family are aware of the child\u2019s diagnosis (Ferguson & Vigil, 2019). There were also 4 differences identified: a) religion, b) acceptance of the diagnosis, c) lack of knowledge of developmental milestones, and d) challenges finding resources and being an advocate. A greater proportion of Hispanic families were religious than White families (i.e., seven out of 10 Hispanic families and three out of 10 White families indicated they were religious) and tended to use religion as a means to understand their child\u2019s diagnosis. Based on the authors interpretations of the interview data, both White and Hispanic    25 families experienced some difficulty accepting the diagnosis, but the Hispanic families tended to have more difficulty accepting it and felt more responsible for their child\u2019s diagnosis. Additionally, the researchers shared that Hispanic families had a harder time finding resources and reported language barriers prevented them for accessing services (Ferguson & Vigil, 2019). Additional reasons for these difficulties are not explored in the study. It is possible that challenges finding resources may not have been due only to language barriers; it may also be the case that Hispanic families faced other barriers, such as a lack of culturally responsive services, proximity to services, or challenges obtaining affordable services. These studies further demonstrate how culture can impact the experience of hearing difficult news of a life-changing diagnosis.   Although not specific to the feedback meeting, communication with professionals was a common theme that arose from a study examining the perceptions and experiences of eight Korean immigrant parents who had children with special needs in the United States (Park & Turnbull, 2001). Language barriers and cultural differences made it challenging for parents to advocate for themselves when they did not understand something and several parents made suggestions for how professionals could adapt meetings to be informative and effective, such as: providing written information ahead of time, checking with parents for understanding, writing down key words and numbers while talking, and using videos (Park & Turnbull, 2001). Similarly, in a study examining perceptions of 23 first-generation Asian American mothers of children with developmental disabilities, communication and cultural differences were found to be major barriers when accessing care, and English proficiency and acculturation also impacted how parents viewed interactions with professionals (Jegatheesan, 2009). When these parents were asked to share how parent-professional relationships could be improved, they emphasized    26 the need for high quality interpreters, an understanding of Asian culture, norms, and values, and the consistent use of strong interpersonal skills such as respect, patience, and compassion (Jegatheesan, 2009). These studies demonstrate how listening to the experience of parents is an important step towards understanding and adapting communication between immigrant parents and mental health professionals. Moreover, in Scoponi\u2019s study (2014) on parent experiences of the feedback meeting, she recommended that future studies on parent experiences should specifically explore culture and the influence of culture on experiences within the feedback meeting.  Immigrants in Canada and Barriers to Accessing Care  First-generation immigrants comprise almost a quarter of the Canadian population (Statistics Canada, 2022) and their experiences are important to examine. Immigrants are vitally important to the country of Canada and bring diverse cultures, beliefs, customs, and traditions with them. Immigration can be a challenging process, and immigrants can face numerous barriers that result in inequitable service provision. For example, in a scoping review it was found that immigrants in Canada face barriers to care that result in unmet health care needs (Kalich et al., 2016). Specifically, cultural differences, language barriers, and challenges with accessing relevant information and navigating systems were the most common barriers to accessing care. These researchers recommend \u201csolution focused research\u201d that determines best practices for working with immigrant populations (Kalich et al., 2016, p. 707). In another scoping review, the experiences of newcomer families with programs and services to support early childhood development in Canada was explored (Brown et al., 2020). From the 34 articles synthesized in the review, three common themes were identified: a) effective intercultural understanding, responsiveness, and communication are critical to ensuring full access to    27 meaningful programs and services, b) some newcomer families face systemic barriers exacerbated by their immigrant status and c) feelings and perceptions of families and service providers, as well as social supports, networks, and relationships influence how programs and services are accessed and experienced. This review calls for more conversations and collaboration between newcomers and professionals and research that highlights the voices of newcomer families in order to understand newcomers needs and thus evolve services and programs effectively (Brown et al., 2020).   A handful of studies have examined the experiences of immigrant parents in Canada whose children have learning differences or developmental disabilities (Khanlou et al., 2015; Khanlou et al., 2017). In a study that examined the experiences of 21 Canadian immigrant mothers who had children with ASD, several unique barriers to service provision were identified. The first was delay in diagnosis, with almost all mothers in the study wishing their child\u2019s diagnosis was confirmed at an earlier age. The second theme was navigating the system, where several mothers reported communication barriers and trouble with complex language and jargon, while others identified a lack of available resources and information on how to seek out services. The third theme was fragmented and dispersed services, where mothers explained that services were physically far apart. They also identified the need for coordinated support from social services, schools, and other institutions, as many experienced confusion and delays in assessment and accessing resources. The fourth theme was a long wait time and excessive paperwork, which again led to delays and sometimes a loss of services. The fifth theme was lack of awareness of client needs by service providers. Some mothers were dissatisfied with the care and explanations they received from their family doctors, highlighting the requirement for research on the needs of immigrant families. The sixth theme was poorly funded services and financial barriers. The    28 seventh was social isolation since many mothers felt isolated due to their child\u2019s disability. Lastly, were the themes of emotional support and perceptive support. Many immigrant mothers faced a loss of social networks and a lack of emotional support. Some mothers perceived they were not receiving enough support and that they often did not have access to, or knowledge about, the supports when they needed them (Khanlou et al., 2017).  A narrative review completed by Khanlou and colleagues (2015b) specifically examined the barriers and stressors that immigrant fathers faced when raising children with developmental disabilities. Through the examination of 39 articles, the researchers found that fathers faced unique stressors and barriers due to their intersectional identity as an immigrant (i.e., often a visible minority) and a parent of a child with a disability. The most common stressors were financial, and immigrant fathers often saw themselves as responsible for the family\u2019s financial needs. Additionally, language and culture were frequently reported stressors, with examples including miscommunication, differences in culture, values, norms, and traditions, as well as a fear of western medicine. Finally, other stressors involved social isolation, stigma and perceptions (e.g., the child\u2019s disability or gender roles), discrimination, legal status, practical barriers, and gender.  The recommendations that resulted from the study by Khanlou and colleagues (2015b) included addressing income inequality, making access to health care and social\/developmental services more equitable, improving the cultural sensitivity of professionals and services, and increasing the participation of fathers in making decisions about their child (e.g., encourage to participate in family therapy activities and be present for disclosures from service providers). Another study examined the experiences of South Asian Immigrant families in accessing programs and support for ASD (Shafi et al., 2024). The study found that parents faced barriers to    29 support at the individual, service provider, community, and structural levels. At the individual level, many parents reported language barriers as well as a lack of knowledge about Western diagnoses such as ASD. A lack of interpreter services, use of technical language, and limited reflexivity to client needs were examples of service-level barriers. At the community level, understanding of ASD was limited, resulting in limited support. For example, one parent explained that there was no word for autism in Urdu, which made the diagnosis hard to explain to family and community members. Lastly, at the structural level, parents discussed challenges with long wait times, expensive services, and a lack of information about accessing appropriate services (Shafi et al., 2024).  The studies conducted by Khanlou and colleagues (2015b), Khanlou and colleagues (2017), and Shafi and colleagues (2024) illustrate the additional barriers that immigrant families who have children with disabilities face to accessing care as compared to non-immigrant populations. Research regarding immigrant parents of children with disabilities is an under-studied area that warrants further investigation (Jennings et al., 2014). Developing competency to work with immigrant populations is vitally important, especially within the Canadian context where a large proportion of the population are immigrants (Statistics Canada, 2022). Having cultural competence and knowledge of different cultures is vitally important for practitioners when communicating with immigrant parents and building healthy relationships with families (Jegatheesan, 2009).  School psychologists have a duty to effectively serve all families, which includes learning about the experiences and perceptions of immigrant families. Principle I in the National Association for School Psychologists (NASP, 2020) Standards is Respecting the Dignity and Rights of all Persons. This includes Guiding Principle I.3 of Fairness, Equity and Justice, which    30 states that regardless of individuals\u2019 actual or perceived characteristics, school psychologists will use their knowledge to create safe, inclusive, and equitable school climates (NASP, 2020). Standard I.3.2 states that \u201cschool psychologists strive to ensure that [\u2026] all students and families have access to and can benefit from school psychological services,\u201d (NASP, 2020, p. 44). Furthermore, Standard II.3.13 states that school psychologists will encourage parental participation in designing interventions and take into consideration the ethnic and cultural values of the family when relevant (NASP, 2020). These standards all indicate that school psychologists have an ethical duty to understand and adapt to meet the needs of immigrant families. In order to do this well, we must become thoroughly acquainted with the experiences, and consequently, the needs of this population within specific contexts.   Rationale for the Proposed Study  Psychoeducational assessments inform educators and families about a child\u2019s functioning and needs, as well as determine if they are eligible for services (Dombrowski, 2020). The feedback meeting and initial disclosure of a diagnosis can be a challenging and emotional experience for the family and thus requires care and understanding on the part of the assessor (Makino et al., 2021; Merkel 2010; Seligman & Darling 2007). Effective feedback meetings provide accurate information about the child\u2019s diagnosis and needs (Hasnat & Graves, 2000; Meyer et al., 2001) and lead to the family seeking support and treatment (Selig, 1983). Parent experiences in the feedback meeting determine the family\u2019s understanding and adherence to the psychologists\u2019 recommendations (Lichtenstein & Ecker, 2019; Merkel 2010; Human & Teglasi, 1993) and, therefore, impact the child\u2019s access to support.  Currently, few studies have examined the process of school psychologists providing feedback for psychoeducational assessments despite assessment being a major focus in the field    31 (DeMatteo, 2021). Nevertheless, several authors have created useful models and made suggestions for effectively providing feedback to parents about their child\u2019s psychoeducational assessment (DeMatteo, 2021; Glazer 2014; Lichtenstein & Ecker, 2019; Pollack 1988; Tharinger et al., 2008). Some studies have directly examined parent experiences of the feedback meeting (Merkel, 2010; Scoponi, 2014), with many focusing on receiving a specific diagnosis such as anxiety (Davey et al., 2022) or autism spectrum disorder (Makino et al., 2021; Kim et al., 2023). There is a need, however, to examine the experience of immigrant parents when receiving their child\u2019s psychoeducational diagnosis specifically. First-generation immigrants comprise almost a quarter of the Canadian population (Statistics Canada, 2022) and their unique lived experiences are important to consider. Immigrants and newcomers may face barriers to accessing care due to cultural and language differences, structural barriers in navigating systems, and psychosocial challenges (Brown et al., 2020; Kalich et al., 2016; Shafi et al., 2024). Researchers have called for immigrant voices to be highlighted and for increased communication between practitioners and immigrant families to improve services (Brown et al., 2020; Kalich et al., 2016; Scoponi, 2014); therefore, examining immigrant parents\u2019 experiences is necessary to determine if their needs are being adequately met when their child\u2019s psychoeducational diagnosis is disclosed. Chapter Two Summary  In this chapter the relevant literature and the need for the study is reviewed. Psychoeducational assessments, which often result in a diagnosis, are conducted to understand an individual's abilities and needs, and to suggest interventions that assist with learning and functioning. Some models exist for conducting successful feedback meetings with parents, and various studies have identified determinants of success within these meetings, including clear communication, empathy, honesty, elimination of jargon, using clear examples, highlighting    32 strengths, allowing time to ask questions, and providing resources and support. Upon finding out their child's diagnosis, parents often experience intense emotions ranging from guilt and sadness to relief and validation. Culturally and linguistically diverse families often have unique reactions within these meetings due to cultural, linguistic, and intersectional contexts. Given the limited understanding of immigrant parent experiences in feedback meetings and upon discovering their child\u2019s diagnosis, this study sought to gain insights into the experiences of this group.         33 Chapter Three: Methodology and Methods Chapter Three Overview  The objective of this study was to examine the experiences of immigrant parents when receiving their child\u2019s diagnosis in the psychoeducational assessment feedback meeting. Interpretative phenomenological analysis (IPA) was used to examine the individual experiences of 10 participants regarding the feedback meeting where a diagnosis was shared through the use of semi-structured interviews. IPA is a well-established methodology when seeking to understand the unique experience, or lifeworld, of each participant (Smith et al., 2022). Due to a history of marginalization, highlighting immigrant voices is particularly important. A series of personal and group level themes and sub-themes were created from transcribed interviews using the IPA framework from Smith, Flower & Larkin (2022). In this chapter the conceptual framework of IPA, ethics and consent, participant recruitment and characteristics, methods, data analysis, and ensuring rigour is overviewed. Purpose of the Study  The purpose of the present study was to better understand the experience of immigrant parents when receiving news of their child\u2019s psychoeducational diagnosis during the feedback meeting following an assessment. Research Question What are immigrant parent experiences of receiving their child\u2019s diagnosis within the psychoeducational feedback meeting?  Epistemology and Theoretical Orientation  As a researcher, I approached this research through a constructionist epistemological lens. Constructivists posit that knowledge and meaning is created through our interactions in the    34 world (Moon & Blackman, 2014). Moreover, a constructionist epistemology asserts that different individuals may experience the same phenomenon in diverse ways, as the meanings they construct are dependent on their cultural, historical, and social perspectives (Moon & Blackman, 2014). Aligning with this epistemological stance, I take an interpretivist theoretical perspective. Research rooted in this perspective views reality as socially constructed and thus seeks to understand phenomena through examining individual cases while also acknowledging the ways in which the researcher\u2019s position and beliefs influence data collection and analysis (Crotty, 1998; Moon & Blackman, 2014; Patton, 2002). The primary focus of interpretivist research is to understand rather than to explain. Guided by my epistemological and theoretical perspectives, I chose a coherent methodology, interpretive phenomenological analysis, to understand immigrant parents\u2019 experiences of finding out their child\u2019s psychoeducational diagnosis.  Methodology: Interpretive Phenomenological Analysis  Interpretive phenomenological analysis (IPA) is an interpretative methodology that is used as a means to understand the subjective lived experiences of individuals (Eatough & Smith, 2017; Smith et al., 2022). In contrast to post-positivist psychological research that is nomothetic and aims to make broad claims and identify trends in populations, IPA is idiographic in nature, meaning that it has a focus on understanding the \u201cparticular\u201d, that is, individual phenomenon in specific instances (Smith et al., 2022). The purpose of exploring things at an idiographic level is to allow for sufficient depth and richness of understanding of a particular person or people within a specific context. Every person experiences the world through their own unique lens and thus IPA seeks to uncover that subjective experience and understand how it is meaningful to the individual (Eatough & Smith, 2017; Smith et al., 2022). IPA has philosophical roots in both phenomenology and hermeneutics, both stemming from an interpretative theoretical perspective.    35 Phenomenology looks at phenomenon (events, process, or relationships) in the context that the subject experiences it. In other words, understanding what a subjective experience is like for an individual (Smith et al., 2022). On the other hand, hermeneutics aims to give meaning and understanding to an experience, text, or account (Eatough & Smith, 2017). Many hermeneutic theorists use the hermeneutic circle as a way to understand the dynamic relationship between a whole and its parts. Through the concept of the hermeneutic circle, researchers understand that a segment of communication (for example, a quote from an individual) can only be understood within its context, so understanding experiences becomes iterative, where one must repeatedly analyze the whole context, the parts, and the whole again, until the interpretation is adequately rich. Originally IPA was developed for use within psychology, however, today it is a well-established qualitative approach both in the field of psychology and beyond (Eatough & Smith, 2017). IPA is typically suitable when researchers are interested in the meaning of experiences to participants, and it is especially useful to examine novel ideas that have not been well-researched (Smith & Osborn, 2004).  IPA utilizes purposive sampling and requires small sample sizes (Smith et al., 2022). Researchers aim to create homogenous samples so that conclusions about the group can be attributed to their similarities rather than their differences. Data collection typically involves one-on-one semi-structured interviews that allow for flexibility and give power to the participant to discuss what they view as important (Smith et al., 2022). After familiarization with the interview transcripts, each participant is analyzed on a case-by-case basis and themes and subthemes are derived from each interview. Slowly patterns between participants are identified and integrated to highlight both similarities and differences between a small group of people (Smith et al., 2022). Borrowing from hermeneutic theory, researchers are encouraged to,     36 Work with their data in a dynamic, iterative and non-linear manner, examining the whole in light of its parts, the part in light of the whole, and the contexts in which the whole and parts are embedded and doing so from a stance of being open to shifting ways of thinking what the data might mean (Eatough & Smith, 2017, p. 198). Once the superordinate and subordinate themes for the group are identified with examples, they are discussed in a narrative write up that includes direct quotes from the participants in order to highlight individual voices (Smith et al., 2022). In IPA, the interpretation is done by both the participant and the researcher, resulting in a double hermeneutic process. In other words, the researcher is the primary instrument through which research is conducted. Critically, the researcher is aware that interpretation is subjective, and thus actively reflects on how their own positionality (perspectives, beliefs, worldview) may be impacting the research process (Eatough & Smith, 2017). There are several key reasons this methodology was chosen. IPA is suitable to examine novel ideas that have not been well-researched (Smith & Osborn, 2004), which is the case for the current study. IPA\u2019s inductive approach ensures that findings are grounded in the data and highlights the voices of participants, which is important for groups who have been historically marginalized, such as immigrant parents. The research question seeks to understand the experiences of immigrant parents finding out their child\u2019s psychoeducational diagnosis, which is consistent with the purpose of IPA: understanding lived experience in a particular context (Smith & Fieldsend, 2021). Through the double hermeneutic, the participants interpret their experiences, and the researcher interprets participants interpretations of the phenomenon (finding out their child\u2019s diagnosis), fostering deeper insights into lived experience. Lastly, IPA acknowledges that people exist within their social context, which is especially important when engaging with people    37 from different cultures in the context of western practices, such as assessing and providing a psychoeducational diagnosis to children.  Procedures  Ethics and Consent   Ethics approval was obtained from the Behavioural Research Ethics Board (BREB) at the University of British Columbia. The study was comprised of two interviews and a follow up member reflection. For one participant, the first interview was conducted in collaboration with a doctoral student as part of a larger study. When interested parents reached out to the researchers, they were given more detailed information about the larger study and were also asked a series of screening questions to see if they were eligible for participation in the present study (see Appendix A). If inclusion criteria were met, they were provided with a consent form (see Appendix B) and the first interview was scheduled. At the beginning of the interview, the consent form was reviewed in detail and the participants were given the opportunity to ask questions about the study. Participants were informed of their right to withdraw from the study at any time prior to submission of the thesis to the supervisory committee and to skip any questions they did not wish to answer. Once informed consent was obtained, demographic information was collected (see Appendix G) and the interview commenced. A second ethics approval was obtained from BREB at the University of British Columbia to utilize that data in the present study and to recruit additional participants. Participants who completed interview one as part of the larger study were contacted and given information on the current student (see Appendix E for Introductory Script A) and asked for consent (see Appendix C for Consent Form A) to use their interview data in the present study as well as to participate in a second interview. Once participants provided informed consent, the second interview was conducted. After recruiting    38 specifically for the current study (see recruitment poster in Appendix J) participants (N=9) who were interested in participating reached out to me, and the same processes of informing them about the study (see Appendix F for introductory script B) and checking eligibility criteria (Appendix A) were followed. When participants were deemed eligible and agreed to move forward, they were forwarded Consent Form B (See Appendix D). Prior to beginning of the first interview, the consent form was reviewed in detail and the participants had the opportunity to ask questions about the study. Again, participants were informed of their right to skip questions or withdraw from the study any time before data analysis was complete. Once informed consent was obtained, they completed the demographic questionnaire and began the first interview. The second interview was then scheduled and completed. After data from the interviews was analyzed, participants were contacted to provide their reflections on the findings, either through Zoom or email.   Participant Recruitment  Ten participants were recruited for this study, which is on the upper end of what Smith and colleagues (2022) recommend for graduate level research. This sample size allows for each participant to be examined ideographically as well as allow for comparisons within the group (Eatough & Smith, 2017). Recruitment occurred in two steps. First, individuals who participated in the larger study were recruited through circulating recruitment posters (see Appendix I) online through social media and to relevant community centres, non-profit organizations, and local clinics. Each participant in this larger study was compensated with a 20-dollar electronic gift card for a local store or food delivery company. To participate in the second interview, these same participants were contacted through email. Two out of three participants in the larger study responded, and ultimately one participant agreed to take part in the current study and complete a    39 second interview. This participant was compensated with an additional 20-dollar electronic gift card for a local store for participating in interview two. The remaining nine participants were recruited through circulating a recruitment poster specifically for the current study (see Appendix J) on social media, to various agencies and organizations that work with immigrants and newcomers, and to clinics who carry out psychoeducational assessments for children and youth.  Participant Inclusion Criteria In order to participate in the study, participant had to meet the following criteria:  1. Immigrated to Canada from another country.  2. Comfortable enough in communicating in English to participate in the semi-structured interviews without an interpreter.  3. Currently lives in Canada.  4. Have at least one child who has received a psychoeducational assessment in Canada.   5. Participated in a feedback meeting with the assessing practitioner.    6. Their child who received an assessment received a specific diagnosis or designation at the time of assessment.   Participant Characteristics Participant demographics characteristics are summarized in Table 1. A brief description of each participant is provided below to situate them within their context, which allows for greater contextualization and transferability. Pseudonyms are used to protect participants\u2019 anonymity.         40 Table 1 Demographic Characteristics of Participants (N=10)    Demographic Descriptor Number of Participants Parent\/Child Relationships  Mother\/Daughter 2 Mother\/Son 4 Mother\/Son + Mother\/Daughter 1 Father\/Daughter 1 Father\/Son 2 Country of Origin    Syria 2  Taiwan 2  Poland 1  France 1  United Stated  1 India 1 Mexico 1 Malaysia 1 Length of Time in Canada   1-5 Years 1  6-10 Years 2  11-20 Years 2  Over 20 Years 5 Employment  Employed 8 Not Employed outside the Home 2 Education   Grade 10 1 Diploma\/Certificate 1     41 Table 1 (continued)  Demographic Descriptor Number of Participants Bachelor\u2019s Degree 6 Graduate Degree 2 Location of Assessment              Private Clinic 7  Hospital 3 Diagnosis or Designation  Autism Spectrum Disorder 7 Specific Learning Disorder 1 Specific Learning Disorder and Gifted 1 Generalized Anxiety Disorder 1 Attention Deficit\/Hyperactivity Disorder 1  Amara. Amara is a 35-year-old woman who immigrated to Canada from India approximately 9 years ago, in 2015. Her first language is Hindi, and in addition to English, she also speaks Gujarati, Punjabi, and Kutchi. Amara completed a bachelor\u2019s degree in accounting and currently is a stay-at-home mother. Her daughter was assessed due to concerns with anxiety. The assessment occurred at a private clinic and her daughter was diagnosed with generalized anxiety disorder in 2023.  Layla. Born in Syria, Layla is 27 years old, and her first language is Arabic. She also speaks English and a little French. She completed an undergraduate degree in banking before coming to Canada in 2020 (4 years ago). Prior to coming to Canada, she also lived in Saudi Arabia. Currently, she is studying English. Layla had concerns for her son because he was not speaking, did not make eye contact, and preferred to be alone and away from other children.    42 When she first came to Canada, she lived in Quebec, which was challenging for her because she was not comfortable in either French or English and she was also pregnant at the time. While in Quebec, her family doctor referred her to a pediatrician who told her that her son did not have autism. However, Layla continued to have concerns for her son, and when she moved to British Columbia, she was able to get an assessment through the hospital. Her son was then diagnosed with autism spectrum disorder in 2022, at age five.  Fatima. Fatima is a 33-year-old woman from Syria who came to Canada in 2017. She also lived in Lebanon before coming to Canada. Fatima\u2019s first language is Arabic, and she also speaks English and a little French. Back home, she completed school up to grade 10 and, after moving to Canada, she completed English learning classes. Currently, she works part time providing afterschool care. Fatima has five children, two of whom have had assessments and received a diagnosis through a hospital. Fatima\u2019s son (who is now in grade 6) was diagnosed with ADHD and faces behavioural issues, such as trouble controlling his temper at school. When her daughter was three, she noticed that she was having challenges, including difficulty communicating and frequently getting frustrated and angry. After receiving an assessment at a hospital, her daughter was diagnosed with autism spectrum disorder at age four. Fatima was not present for her daughter\u2019s feedback meeting, but she spoke on her experiences finding out the diagnoses for both of her children\u2019s assessments. Fatima referred to the clinician who completed her childrens\u2019 assessments as a doctor but was unsure if they were a psychologist or psychiatrist. She returned to this clinician for further appointments after the assessment and also received medication for her children at these appointments; however, due to language barriers, it was unclear if this clinician prescribed the medication directly or if it was diagnosed by someone else    43 in the hospital team. Therefore, it was not determined if Fatima\u2019s clinician was a psychologist or other medical professional such as a psychiatrist.  Rashmi. Born in the United States of America, Rashmi is a 45-year-old second generation immigrant of Indian descent. She has lived in several countries including Thailand, Ecuador, and India, and moved to Canada in 2009. Her first language is English, and she also speaks Spanish, Hindi, Swahili, and French. Rashmi has obtained her PhD and works as a researcher. Her son was born premature, so his development was carefully monitored by a team of professionals. After noting echolalia and other symptoms, the professionals working with the family recommended an assessment when Rashmi\u2019s son was a toddler. In 2021, her son received an assessment at a private clinic and was diagnosed with autism spectrum disorder by a multidisciplinary team.  Diego. Diego is Rashmi\u2019s husband who was referred as a participant through Rashmi. Diego also spoke on his experience with their son (to whom he is a stepfather) who was diagnosed with autism spectrum disorder in 2021. Diego is 40 years old and moved to Canada in 2012. He is originally from Mexico and his first language is Spanish. He also spent time living in New Zealand. He currently works as a graphic designer and completed a Bachelor of Industrial Design.  Henry. In 1990, Henry moved from Taiwan to Canada. Now 47 years old, Henry works as a software developer\/engineer and has completed a bachelor\u2019s in computer engineering. His first language is Mandarin, and he additionally speaks Taiwanese, Cantonese, basic Japanese, French, and a little Haka. His son was diagnosed with autism spectrum disorder, but in our interviews, we spoke mostly about his daughter who was assessed through a private clinic after the learning resource teacher at her school noticed ongoing problems with spelling and    44 recommended an assessment. Henry\u2019s daughter was twice exceptional, meaning that she received diagnoses of a specific learning disorder (dyslexia and dysgraphia) and giftedness. Melissa. Melissa is a 57-year-old woman from Poland who immigrated to Canada in 1989. Her first language in Polish, and in addition to English, she also speaks Spanish. In Poland, she completed 2 years of college and part of a university degree, but she left before finishing it. While in Poland she worked as a bookkeeper and teacher. After moving to Canada, she later completed a 2-year diploma in autism support and currently works as an educational assistant (and previously as a behavioural interventionist). Her son was diagnosed with autism spectrum disorder at a hospital in 2007 when he was three years old. She had noticed that her son\u2019s development was behind, and he displayed symptoms such as not speaking and banging his head. He participated in speech therapy, but it was not effective. He was then referred to a centre for children with behavioural problems, who eventually made the referral to the hospital where the assessment was completed.  Grace. Born in Malaysia, Grace immigrated to Canada as a child in 1989 and is now 39 years old. She speaks English, French, and Mandarin, with Mandarin being her first language. Grace completed a bachelor\u2019s degree and currently works in investment compliance. She noted that her son had strong markings of autism starting at 18 months, including difficulties with speech, motor, and adaptive skills. Her son was assessed in 2022 through a private clinic and was diagnosed with autism spectrum disorder.  Stephanie. Stephanie is a 51-year-old woman from France whose first language is French. She also lived in the Middle East and immigrated to Canada in 2001. She has a master\u2019s degree and works as a manager of events. Her daughter was assessed in 2017 (grade 5) through a    45 private clinic after ongoing challenges with literacy, spelling, and reading. Through the assessment, her daughter received a diagnosis of specific learning disorder (dyslexia).  David. David is 41 and immigrated to Canada from Taiwan in 1993. His first language is Mandarin. He completed a Bachelor of Arts and works as an RCMP officer. When his son was three years old, he noticed behaviours that were not typical, such as watching the clock and playing with toys in a repetitive manner. When David and his wife had their son in their late 20s, most of their friends did not yet have children. Thus, David and his wife did not have a point of reference for typical child development and they were not sure what to do. However, after his wife read some articles about autism, they decided to do an assessment through a private clinic, and his son was diagnosed with autism spectrum disorder at age four.  Methods Demographic Questionnaire   Prior to beginning the first interview, participants answered a series of background questions in order to situate them within their context. This demographic questionnaire included questions about the participant and their child\u2019s age, sex, gender, educational and\/or occupation, as well as details about their language and country of origin and information regarding the psychoeducational assessment. A copy of the demographic questionnaire is provided in Appendix G. A summary is highlighted in Table 1 and discussed in the participant characteristics highlighted above. These demographics were used for descriptive purposes and were not a formal part of the data analysis.  Semi-Structured Interviews Semi-structured interviews were used to collect data from the participants. The objective of these interviews was to gain insight into the participants\u2019 experience of the feedback session    46 and receiving news of their child\u2019s diagnosis. Semi-structured interviews are the most common method for collecting data within IPA, and when used effectively, can produce rich data by covering broad topics yet remaining flexible (Smith et al., 2022). Interviews were conducted over two sessions. During the interviews, participants were asked to answer open-ended questions about their experience. Some questions prompted participants to be more descriptive and others encouraged the participant to evaluate their experience (Smith et al., 2022). As the conversation progressed, relevant follow up questions, prompts, and probes were asked that allowed for a rich account of the experience. The questions were used as a means to focus the conversation back to the central topic of the feedback meeting and diagnosis. See Appendix H for a copy of the guiding interview questions. All interviews were audio recorded and transcribed for qualitative analysis. Each interview was between 12-58 minutes in length (the average interview length was 34 minutes). The participants had the choice to hold in the interviews in person or online, which resulted in all interviews being held online.  First Interview. The first interview for one participant was conducted as part of a larger, separate study about emotional discourse and communication between immigrant parents and psychologists during feedback sessions. For the participant who participated in the larger study, the first interview was conducted by the researcher and another graduate student completing her dissertation. For all other participants (N=9), interviews were one-on-one. The initial interviews were all conducted online through a UBC-licensed Zoom account, although participants had the option to hold the interviews in person in a private library or community centre room. Before beginning the first interview, the researchers reviewed the consent in detail and participants had the chance to ask questions and gain clarification about the process. After informed consent was obtained, participants answered the demographic questionnaire (see Appendix G) and engaged in    47 the interview. After this interview, participants were informed that they would be contacted for a second interview. Most second interviews occurred 1-2 weeks after the first. However, there were two exceptions: Amara, who had a 6-month gap between interview one and two due to her participation in the larger study, and Layla, who had a 6-week gap between interviews due to scheduling difficulties.   Second Interview. The second interview was conducted to ensure that each participant had adequate time to explore their experience with sufficient depth. Additionally, the gap between the two interviews allowed participants to discuss thoughts or reflections that occurred to them after the first interview. Participants who took part in the first interview as part of the larger study reviewed the consent form for the present study prior to beginning the second interview and were given the chance to ask any questions about the process. For those who did not take part in the larger study, there was no need to go over the consent form again before beginning the second interview; however, participants were reminded that they could stop at any time or skip any questions they did not wish to answer. The second interviews were all conducted online through a UBC-licensed Zoom account, although participants had the option to hold the interview in person in a private room at a community centre, library, or the University of British Columbia.  Interview Technique. Smith and colleagues (2022) describe the interview process as iterative, meaning that it can be continuously adapted as needed. The interviews remain flexible in order to allow dialogue to flow naturally without being bound by a rigid structure. Thus, the interview schedule was used as a guide and did not require strict adherence. Since in-depth discussion requires vulnerability and a level of comfort, interviews began with building rapport and ensuring that the participant was comfortable. Participants were also informed there were no    48 wrong or right answers and that they should take their time to think about their answers if needed (Smith et al., 2022). Furthermore, it was emphasized that it would not be a two-way conversation so much as a chance to learn as much as possible about their experience (Smith et al., 2022). Framing the interview in this way ensured participants knew what to expect and were comfortable. All interviews were conducted in English; however, several interview questions were translated into Arabic using ChatGPT (OpenAI, 2024) for Layla and then copied into the Zoom chat to ensure her understanding of the interview questions. This was done because Layla expressed that she did not understand some of the questions even after rephrasing.  Active listening was used with prompting when necessary to delve deeper into the participants lifeworld. It was especially important to prompt further when the participant inferred something was meaningful or when meaning was unclear (Smith et al., 2022). In an effort not to jump in too quickly and to allow for pauses and reflection, one question was asked at a time. Additionally, the researcher limited contributing their own thoughts and reactions to allow space for participants to share. Key questions that allowed the conversation to go deeper included: Why? How? Can you tell me more about that? Tell me what you were thinking? How did you feel? (Smith et al., 2022, p. 65). Participants were also encouraged to move from the \u2018general\u2019 to the \u2018specific.\u2019 For example, by posing seemingly obvious questions. Smith and colleagues (2022) give the example of asking a participant why receiving news of a HIV diagnosis was \u201ca big thing,\u201d as a way to demonstrate how asking seemingly obvious questions can help the participant delve deeper into their thoughts and beliefs surrounding an experience (Smith et al., 2022, p. 65). When necessary, participants were reminded the focus of interest was their experience, not a group they may represent, their friends, or their families (Smith et al., 2022). Each successive interview was used as a learning and reflection opportunity to enhance the interviewing    49 technique and assess what went well and what might have gone better. In this way the data-collection process became a cycle of action, reflection, and learning.   Member Reflections  Once data-analysis was complete, participants were contacted by email and invited to reflect on the superordinate and subordinate themes that were derived from the analysis. Participants were invited to share their reflection through email or Zoom. If the participants decided to meet on Zoom to discuss their reflections, their responses would have been audio-recorded and transcribed. Only one parent participated in the member reflection, and this was a brief comment through email.  Data Analysis  The seven-step framework outlined by Smith and colleagues (2022) was used to analyze the data. Smith et al., (2022) emphasize that this framework should act as a guideline and be used flexibly. To begin, each recording was transcribed and read multiple times in order to facilitate familiarization with the data. I began writing in depth exploratory notes that were further analyzed and consolidated into experiential statements. Experiential statements were then grouped into clusters of personal experiential themes and subthemes. This process was repeated for each participant independently before identifying overarching group experiential themes and subordinate themes that spanned across participants. Throughout this analysis I engaged in the double hermeneutic by interpreting the participant\u2019s interpretations of their experience.    Transcription  Interviews were initially transcribed by the Microsoft Word transcription software. A research assistant and\/or I then checked the transcriptions carefully and added missing details. This process involved listening to the recording and ensuring everything was transcribed    50 verbatim (Smith et al., 2022). All verbalizations, hesitations, and pauses were included in the transcript. Each participant was treated as an individual case, so their transcripts from the first and second interviews were analyzed together.  Seven-Step Analysis Framework Step 1: Reading and Re-reading. In order to become familiar with the data, each transcript was read several times independently and initial reactions and thoughts were recorded (Smith et al., 2022). Step 2: Exploratory Noting. Step two involved taking exploratory notes, making commentary, and highlighting initial patterns that arose within each transcript. The goal of this step was to think about and analyze each line of transcript and then document everything that arose. Notes were written in the column beside the transcript and involved various levels of interpretation from face value notations to questioning deeper meanings. Key words, emotions, and shifts were noted, and ideas and events that appeared meaningful to the participant were written down. An interrogative stance was assumed and questions that arose from the transcript were recorded. In this stage, I started thinking critically about the data, moving from the descriptive to the interpretive (Smith et al., 2022).  Step 3: Constructing Experiential Statements. The next step involved using the exploratory notes to make brief statements that reflected the participants thoughts and words, while also including my own interpretation. Experiential statements were more polished than exploratory notes and communicated an understanding of what was being conveyed (Smith et al., 2022).  Step 4: Searching for Connections Across Experiential Statements. This step involved identifying patterns and groupings between experiential statements. I utilized Draw.io    51 (an online diagramming tool) to create text boxes with the experiential statements. I then visually grouped them together in a meaningful way. This was an iterative and creative process that involved trial and error (Smith et al., 2022).  Step 5: Naming the Personal Experiential Themes and Consolidating. Each cluster of experiential statements was then given a name. These clusters are called Personal Experiential Themes (PETs). Most PETs also had sub-themes which were also titled (see Appendix K for an example of one participant\u2019s PETs). At this stage, I used various main organizing devices, such as similarity between experiences or polarization between ideas to emphasize complex experiences (Smith et al., 2022). A table was created to organize PETs and sub-themes along with their corresponding experiential statements and quotations. Using a reflexive journal during this stage was particularly important to provide insight into decisions and document the analysis.   Step 6: Continuing the Individual Analysis of Other Cases. Steps 1-5 were repeated for each individual participant\u2019s transcript.  Step 7: Working with Personal Experiential Themes to Develop Group Experiential Themes Across Cases. In this step PETs were arranged into Group Experiential Themes (GETs), in order to emphasize both common and unique experiences across participants. Similar to step five, arranging PETs into GETs was a creative and iterative process. I used Drawio, a diagram and graph drawing software, to create visual boxes of all the PETs and dragged them around and grouped them together to form the GETs. Participants PETs were color coded to aid with visualization. Next, I created color-coded boxes of all the individual sub-PETs which were grouped together to create Group-level subordinate themes (see Appendix L). In some cases, it was necessary to rearrange some of the PETs or PET sub-themes. Group-level subordinate    52 themes were also named, and table was created that included the superordinate themes (the GETs) and subordinate themes (Smith et al., 2022).  Ensuring Scientific Rigor  Rigor has been outlined and examined in various ways within the qualitative research literature (Koch, 2006; Guba & Lincoln, 1989; Levitt et al., 2018; Morse et al., 2002) and is a key component of good IPA work (Smith et al., 2022). Rigor, sometimes referred to as trustworthiness, ensures that the study is credible and is grounded in the data (Koch, 2006; Guba & Lincoln, 1981). In Guba & Lincoln\u2019s (1981) framework for ensuring trustworthiness in qualitative research, they outline the need for credibility, transferability, dependability, and confirmability - essentially the naturalistic equivalents to internal validity, external validity, reliability, and objectivity respectively. Yet, they also state that this framework should only be used as a guideline (Guba & Lincoln, 1982). In a task force report from the American Psychological Association on standards for qualitative research in psychology, they state that \u201crigor is centrally based in the iterative process of qualitative analyses, which inherently includes checks within the evolving, self-correcting, iterative analyses\u201d (Levitt et al., 2018, p. 36). Similarly, Morse and colleagues (2002) argue that appropriate verification strategies should be built into the study to ensure rigor, rather than simply being evaluated at the study\u2019s conclusion. The present study ensured rigor by considering reflexivity, thick description, contextualization, member reflections, audit trail and an external audit. Through these processes, not only was rigor evaluated at the study\u2019s culmination, but also continuously refined throughout its duration.  Reflexivity Reflexivity refers to being aware of how one\u2019s own biases, background, and assumptions impact decision making within the research process. This required me to be transparent about my    53 own bias and background that could potentially influence decision making and interpretation. Thus, I kept a reflexive journal to enhance credibility through self-awareness and critical reflection on experiences and decisions (Guba, 1981; Koch, 2006; Shrenton, 2004). This journal included records of my thoughts and reflections throughout the transcription and analysis process to promote flexibility and ensure conclusions were grounded in the data. As things came up in the reflexive journal, it was vital that I remained responsive and adjusted as necessary. Indeed, investigator responsiveness (i.e., being responsive to the data and working in an iterative and creative way) is an important part of ensuring rigor in qualitative research (Morse et al., 2002).  Thick Description  Thick description is another way of saying in-depth description, which is a means to support methodological integrity in qualitative research (Levitt et al., 2018). Thick description is also an important aspect of all four quality indicators of good IPA studies proposed by Nizza and colleagues (2021) and includes: a) constructing a compelling, unfolding narrative, b) developing a vigorous experiential and\/or existential account, c) close analytic readings of participants\u2019 words, d) attending to convergence and divergence. I consistently reflected on these indicators throughout the data collection and analysis stages. In part, this was achieved through the thorough documentation of PETs and GETs in tables with sub-themes and quotations that illustrated each theme. Second, the results section of the manuscript provided a detailed narrative and description of participants experience and arising themes across the group to allow for adequate insight into the complexity of the data. My exploratory notes on the transcripts are also included in the analysis, so the nature of the methodology allowed for in depth experiential and interpretative descriptions.   Contextualization     54  Contextualizing data in terms of when it was collected, by who, the cultural situation etc. is a \u201ccatalyst for insight,\u201d leading to an understanding of similarities or differences within a group (Levitt et al., 2018, p. 33). Likewise, giving sufficient depth and contextual details on the position of participants helped establish transferability, the equivalent of external validity or applicability (Koch, 2006). Contextualization of participant details were provided in short descriptions of each participant that were added to the participant characteristics section after data-collection. These descriptions included information such as where the participants immigrated from, their educational level, and their child\u2019s diagnosis. These details were obtained from the demographic questionnaire and the interviews and allow others to relate themselves to the position of the participants and thus establish some level of transferability from the participants to others who may have had similar life experiences. Aside from the participants context, it is also important to contextualize myself and to acknowledge my perspective by disclosing personal values and assumptions (Elliott et al., 1999). My personal context is outlined in the position statement at the beginning of the manuscript and is reflected upon and discussed within the reflexive journal. Member Reflections  In order to allow for participant involvement and input on the findings, participants had the opportunity to reflect on the data after it was analyzed. According to Guba and Lincoln (1989), member checks are one of the most important ways to establish credibility in naturalistic inquiry. Member checks seek participant feedback to ensure the accuracy of the findings (Creswell, 2007). That being said, due to my social constructivist epistemological stance, and the interpretative nature of IPA, member checks are not appropriate since knowledge is being co-constructed by both the participants and researcher and there is no single truth to be discovered.    55 Moreover, Larkin & Thompson (2011) explain that member-checking in an IPA study may only be suitable for single-case study designs since IPA is inherently interpretative and thus member-checking at a group level may be counter-productive. Morse and colleagues (2002) also assert that member-checks may not be appropriate, and at times can even threaten study validity since individual participants may not see themselves in study results that have been \u201csynthesized, decontextualized, and abstracted from (and across) individual participants\u201d (p. 16). However, member reflections can strengthen credibility by providing additional opportunities for collaboration and reflexive elaboration (Tracy, 2010). Thus, participants were emailed a copy of the superordinate and subordinate themes and were given the opportunity to give feedback and reflect on the analysis through email or Zoom. Only one parent ended up providing a member reflection. This was a brief email that stated it was unsurprising that parents had both negative and positive experiences in the feedback meeting. Since he found the results unsurprising, this suggests that he perceived the data as reflecting immigrant parent experiences well. Audit Trail In order to establish dependability, similar to reliability and consistency (Koch, 2006), an audit trail was kept. This means I kept track of my decisions and thinking to increase the trustworthiness of the findings (Shrenton, 2004). This trail of documentation throughout the research project was filed in an organized manner so that others are able to understand the step-by-step process that I went through, adding transparency and rigor to the study (Smith et al., 2022).  External Audit  An external audit was conducted by a graduate student who is not directly involved with the research project but who was informed of the study and is familiar with qualitative research.    56 Given inter-coder reliability would not be a suitable way to check dependability for an IPA study (i.e., the nature of the double hermeneutic process means there is no one right way to code and interpret results and since IPA analysis is extremely time intensive, it would not be practical to have a research assistant re-analyze all the data) an external audit of the paper trail ensured that conclusions based on the data were credible (Smith et al., 2022). The external auditor reviewed the transcripts, exploratory notes, the reflexive journal, subordinate themes, PETs, GETs and member reflections, and gave their feedback on the credibility and dependability of the conclusions of this analysis. Where necessary, the external auditor gave suggestions to adjust themes, and after discussion, adjustments were made on a case-by-case basis.  Chapter Three Summary In chapter three the methodology and methods used to conduct this study is outlined. In order to learn about immigrant parents\u2019 experiences of finding out their child\u2019s psychoeducational diagnosis, this project utilized interviews from 10 participants that were transcribed and analyzed according to the interpretative phenomenological analysis framework (IPA) outlined by Smith and colleagues (2022). IPA is an interpretative approach rooted in phenomenology and hermeneutics that seeks to understand individuals\u2019 subjective lived experiences. Upon receiving informed consent and completing demographic information, 10 immigrant parents participated in two individual interviews. Individual themes and subthemes were identified from each participant\u2019s transcripts, and through an iterative process, group-level superordinate and subordinate themes were also identified. In order to ensure rigour, I kept a reflexive journal, used thick descriptions, contextualized the participants, utilized member reflections, kept an audit trail, and conducted an external audit.        57 Chapter Four: Findings  Chapter Four Overview The purpose of this study was to examine the experiences of immigrant parents when receiving news of their child\u2019s diagnosis in the psychoeducational feedback meeting. Interpretative phenomenological analysis was used to analyze 20 one-on-one interviews conducted with 10 immigrant parents about their experiences. Five superordinate themes and 19 subordinate themes emerged from the data, which are displayed in Table 1. The superordinate themes included: 1) Positive Experiences, 2) Challenges and Doubts, 3) Impact of Culture and Language, 4) Emotional Reactions, and 5) Journey Beyond the Feedback Meeting. Each of these superordinate group-level themes had three to four subordinate themes. In this chapter, each of these superordinate and subordinate themes will be explored in detail. To aid with clarity and readability, false starts, stuttering, filler words (e.g., \u201clike\u201d, \u201cum\u201d) and repeated words or phrases have been left out of quotations. Square brackets with ellipses are used to denote an omission within a quote, indicating that a part of the original quote was removed for clarity or conciseness.         58 Table 2  Superordinate and Subordinate themes  Theme 1: Positive Experiences All parents spoke about positive experiences they had within the feedback meeting where they learned their child\u2019s diagnosis. Positive experiences included the clinician providing clear and detailed examples, the clinician showing their care and compassion through their actions, the clinician guiding the parents through the next steps, and when the clinician built trust and demonstrated care through their personal characteristics, including their expertise, experience, tone of voice, professionalism, and calm demeanour. Four subordinate themes comprise this theme and are discussed in detail below.  Clear and Detailed Explanations.  Superordinate Themes Subordinate Themes 1. Positive Experiences Clear and Detailed Explanations  Care Demonstrated Through Action  Guided Next Steps  Personal Characteristics Established Trust and Comfort  2. Challenges and Doubts Overwhelming and\/or Inadequate Explanation  Doubts, Differences, Discontent   Uncertainty Around Prognosis   3. Impact of Culture and Language Intersectional Barriers to Support Navigating Cultural Differences  Lack of Cultural Consideration  Language Barriers  4. Emotional Reactions Anxiety and Uncertainty   Relief and Understanding  Overwhelm and Upset  Shocked only by the Unexpected  5. Journey Beyond the Feedback Meeting Benefits of Diagnosis Insufficient Support Navigating Next Steps  Strength and Hope in the Face of Ongoing Challenges  Evolving Perceptions     59  Many parents expressed satisfaction with the feedback meeting. Rashmi, a researcher at a university, explained that the assessment \u201cwas fantastic because it was super evidence based and I\u2019m evidence based. So, for me personally it worked really well.\u201d Her husband, Diego, thought \u201ceverything was or is being done properly\u201d and that the assessment was \u201cvery helpful.\u201d He elaborated that the \u201cteam is amazing\u201d and that the assessment helped them gain insight into their son\u2019s behaviours such as echolalia. Grace valued the recommendations made at the end of the feedback meeting, saying that this was \u201cvery positive.\u201d Amara also had positive evaluations of the feedback meeting and assessment. She explained that \u201cit was a really good experience\u201d and the psychologist \u201cwas really good.\u201d Interestingly, Amara believed she was \u201cvery lucky to get a good one\u201d and felt this was like finding \u201ca needle in a haystack.\u201d She was confident that if she continued to follow the recommendations laid out by the psychologist, her daughter\u2019s anxiety would reduce over time. This comment demonstrated Amara\u2019s confidence in the psychologist\u2019s recommendations. Layla shared that she would not choose to change anything about the assessment and noted that the clinician explained why her son met criteria for autism spectrum disorder. Over half of the parents commented on the feedback being very detailed, clear and accurate. Grace shared that the results of her son\u2019s assessment were \u201cvery detailed,\u201d \u201cvery, very in depth\u201d and \u201csuper clear.\u201d Likewise, David commented on the feedback and report being \u201cpretty thorough,\u201d having covered \u201call aspects.\u201d The clinicians ensured that Diego and his wife understood the results. Diego explained that they made sure everything was understandable: \u201cthey were explaining to us and even if they need to repeat us like two or three times, just so make sure that we kind of understand everything.\u201d Amara commented that the assessment \u201cwas done accurately\u201d and \u201cthoroughly.\u201d She explained that \u201csome of the words are, you know, tricky    60 to understand and you're hearing it for the first time. So, she [the psychologist] was very thorough in explaining them.\u201d Although Melissa described many challenging and upsetting aspects of the feedback meeting in her interviews, she explained that \u201cthey were actually correct with the results [\u2026] so that is a huge, you know, positive around that meeting.\u201d Various strategies were helpful in delivering clear results. Amara and Rashmi recalled the use of statistics to explain scores. Rashmi shared that \u201cit was helpful to see, [\u2026] like here is our expectation for his age - what he should be able to do, here is what he is doing.\u201d Grace shared that she really liked the \u201csummary that [the psychologist] would do\u201d and that the use of visuals, such as sharing her screen to review parts of the report, was \u201chelpful to guide us along.\u201d Amara also commented on the use of visuals and examples to walk her through the results. Indeed, many of the parents shared how examples were key to their understanding. Rashmi explained: It was really helpful that she gave examples. Like when he did this and when I did this and he said this, a neurotypical child would have responded this way. Instead, he did this, which is a sign of this, you know. I think that was actually really helpful. Henry also recalled that when receiving news of his daughter\u2019s learning disorder and giftedness, that the psychologist seemed excited about his daughter\u2019s case and shared many personal \u201cstories and anecdotes\u201d about her own experiences (such as working with gifted children when she used to be a teacher), which \u201cleft an impression\u201d and demonstrated care. Several parents stressed the importance of not rushing, using plain and accessible language, and keeping explanations simple in order to digest large amounts of new information. For example, Amara shared that \u201cI have experienced other mothers who have had a bad experience where, you know, they don\u2019t explain things properly and they\u2019re just trying to rush things.\u201d Diego shared there was \u201ca lot of information to try to understand.\u201d His wife, Rashmi,    61 thought that \u201cplain language is the most important\u201d and that keeping explanations as simple as possible was best.   The opportunity for parents to ask questions and address concerns was another factor that led to greater clarity, as mentioned by Rashmi, Stephanie, David, Grace, and Henry. David expressed that when he had questioned the psychologist \u201cshe was able to give us some answer.\u201d He commented that he appreciated the psychologist\u2019s foresight when answering questions, such as not making assumptions about the distant future. When David had a question about the report, there was \u201cno concern bringing that up to the psychologist.\u201d Likewise, Grace said that \u201cif we didn\u2019t understand, we could ask questions.\u201d Henry shared a positive experience in the feedback meeting when he asked for a modification to one section of the report. He explained that he was able to share his perspective on his daughter\u2019s executive functioning, and the psychologist changed the report as per his request. Rashmi mentioned that there was an \u201copportunity for us to ask questions\u201d and Stephanie shared that the psychologist \u201casked if we had questions all the time.\u201d  Care Demonstrated Through Action   Six of the 10 participants spoke about how the clinician\u2019s actions demonstrated their care. This often involved going above and beyond, advocating for their child, and tailoring feedback to the family\u2019s needs. Offering follow-up services was an example of an action that demonstrated care and was reported by Amara and Henry. After Amara\u2019s feedback meeting, the psychologist made a follow-up call to check-in. Amara explained that \u201cSometimes people don\u2019t do it. So, I think that left an imprint on my mind that, you know, she is genuinely concerned.\u201d Henry also expressed how offering follow-up services demonstrated care as the psychologist offered to do a feedback meeting for his daughter. He observed that the psychologist was respectful and    62 considerate of his daughter\u2019s feelings. Later, she told him that if his daughter \u201cever had any need in the future, she could always call the office. That\u2019s what she said. Yeah, and I believe it too.\u201d   Advocating for the child within the school system also demonstrated care to parents. Henry expressed that the psychologist was \u201cvery passionate about my daughter\u2019s ability to get a fair education\u201d and \u201coffered to talk to the teachers. On how to best support my daughter.\u201d Through these conversations, he felt that \u201cshe actually does seem very concerned.\u201d He elaborated that \u201cI keep going back to her because I actually respect her opinion.\u201d Fatima also shared that her clinician advocated for the family to the school: She meet me maybe two times with so many different school, and she talk. She told the school his parents work hard. [\u2026] They need the kids very okay and good kids, but sometimes have hard for parents to keep everything okay or to keep everything great. Parents also felt that tailoring the feedback meeting to the family\u2019s needs demonstrated care. Diego spoke on the importance of understanding parents and tailoring the feedback meeting accordingly. In his experience, everyone was \u201cvery good at just [laughter] understanding us basically.\u201d For instance, he explained that during the assessment, the clinicians understood if they were late because their son had a tantrum in the car and would tailor their approach depending on his son\u2019s \u201cmood or what he was feeling, which [\u2026] I appreciate as well.\u201d Fatima expressed how she felt overwhelmed as a new immigrant taking care of her five children, two of whom had special needs diagnoses. She shared that the clinician was understanding and acknowledged that coming from a different culture and country, and speaking a different language is very hard. Fatima expressed that the clinician was \u201cvery good [\u2026] with my children\u201d and was \u201ctrying to do her best. I see her.\u201d In the feedback meeting, the clinician spoke \u201cvery slow and she\u2019s trying to give me, you know, easy word.\u201d Finally, Henry was appreciative of    63 flexibility in service delivery, including the option of conducting the feedback meeting online as he \u201cdidn\u2019t have to commute. So that was nice. I like that.\u201d  Guided Next Steps Most parents shared that the clinicians guided the next steps after receiving the diagnosis. Many psychologists provided helpful recommendations and direction on next steps and some facilitated access to funding and referrals. Learning about resources and supports available was a pleasant surprise for David and left a \u201cvery good impression.\u201d The psychologist was able to provide \u201cresources\u201d including \u201cnext steps,\u201d \u201cprograms we can look into\u201d and \u201call the things we should do,\u201d including information regarding accessing the disability tax credit. He shared that it was very reassuring to be given government resources in his native language: There was even a website made-up by BC Government on what to do with when your children have autism. It's in Chinese. So that was really helpful in part of understanding the whole process and what we need to go through. I felt like ok; it must be something that happens more often than I thought. I feel more assured that the BC government can probably be able to guide us and have a plan on what to do moving forward. Additionally, the psychologist was able to provide David direction with paperwork and submit forms on his behalf. He also mentioned that she \u201cguided us to look for a behavioural consultant\u201d and put them in touch with a helpful parent network.  The clinician working with Fatima also provided helpful resources and solutions, including managing medications and providing paperwork. In Melissa\u2019s experience, she noted that recommendations were not perfect (\u201cthey missed a few things\u201d), but they were helpful, and she was grateful to be able to access intervention supports. Helpful recommendations were provided to Amara, and she noted that the psychologist \u201cguided me in the right direction.\u201d In    64 Layla\u2019s experience, the psychologist did not provide many recommendations but reassured her and referred her to a social worker who \u201chelped me about speech therapy and about what need my son.\u201d The psychologist also encouraged her to quickly complete forms to access funding and services.  Personal Characteristics Established Trust and Comfort  Participants all spoke about the personal characteristics of the psychologist, which were comforting and helped establish trust. The psychologist\u2019s creditability in terms of their expertise and experience was one way that trust was established. Their personal demeanour also played a large role in establishing trust and demonstrating care. Being calm, gentle, welcoming, respectful, kind, strengths-based, empathetic, professional, reassuring, attentive, honest, and considerate were all qualities and attitudes that were identified by participants that made them feel cared for, comforted, and assured.  Rashmi\u2019s clinician was an experienced and renowned expert who was \u201cvery reputable,\u201d allowing her to build trust and have \u201cmore confidence in her.\u201d Rashmi felt that the diagnosis was \u201cvery black and white,\u201d and that there was nothing to disagree with because she saw the clinician as the informed expert. She elaborated that: This is the doctor. This is what their speciality is. This is what they do. So, they tell me that this, this, and this are characteristics of an autism diagnosis, I\u2019m going to say, okay yes, I believe you. Rashmi also noted that the competency of the office support staff built trust. She described the process as \u201ca well-oiled machine.\u201d Rashmi\u2019s husband, Diego, also built trust due to the clinicians\u2019 expertise and experience. He recalled that the psychologist \u201ctalked about the experience that she had with all these other kids. So, yeah, you need to trust that [\u2026] that\u2019s how I    65 started to roll with it.\u201d Amara said that her psychologist \u201cseemed very knowledgeable\u201d and had been practicing for 25 years, stating that \u201cyou can tell when a person knows what they are doing.\u201d   Passion, professionalism, and experience were highlighted by Grace, who found the psychologist to be \u201cvery passionate about her work.\u201d She appreciated that \u201cshe could talk about this subject, you know, the whole day\u201d and could tell that the work \u201cmeans a lot to her\u201d. The assessment had a \u201cflow,\u201d and she delivered the news of the assessment \u201cvery professionally, very nicely.\u201d David also shared that the psychologist he was working with was \u201cprofessional,\u201d saying that she \u201cdresses up like a doctor too.\u201d He explained that she was not high energy like \u201cone of those teacher type\u201d but was \u201cquiet and nice and kind.\u201d The tone of voice used was \u201cslow, soft\u201d giving the impression that she was \u201ckind,\u201d while also not showing \u201cthat much emotion.\u201d He mentioned several times that she was \u201cvery calm\u201d and delivered results \u201cin a calm manner.\u201d Melissa recalled that the clinicians were \u201cvery pleasant\u201d and \u201cvery professional.\u201d Rashmi also shared that the clinician was \u201cgentle spoken\u201d and had a \u201ccalming presence\u201d that put them \u201cat ease.\u201d The same clinician was described by Diego as \u201cvery calm.\u201d In the feedback meeting with Amara, the psychologist was not abrupt and the \u201ctone of voice made it really calming.\u201d Amara recalled how the psychologist helped her regulate her emotions: I still remember to date that you know. If it wasn\u2019t for her, then you know, I would have a had a meltdown, so I think the tone of voice, the people deliver the message; makes a huge difference. Identifying strengths stood out to David, who recalled that the psychologist commented on his son\u2019s physical health and noted that he was not a picky eater, which was often an issue with other children on the spectrum. When Fatima received feedback from the clinician, she    66 remembered comments on her child\u2019s strengths, including the clinician calling her son a \u201cgood child\u201d and \u201csmart.\u201d Grace also mentioned that she always appreciated the complimentary things the psychologist said about her son.  Providing reassurance was another common positive experience. Fatima explained that when she was upset about hearing her child\u2019s diagnosis, the clinician reassured her about the future and told her that \u201cyour child will be fine when they\u2019re growing and don\u2019t worry, we\u2019re working here to make sure everything is okay.\u201d The clinician also normalized challenges, such as noting that \u201ceverybody have something not okay\u201d and that as a doctor, she also went to other doctors and that \u201ceverybody seeing each other and ask for help.\u201d The psychologist that worked with Layla provided reassurance by telling her not to worry. When his son was diagnosed with autism, David identified that the psychologist reassured him by telling him not to worry and that many children were on the spectrum. Stephanie recalled being told that her daughter\u2019s learning disability \u201cis not gonna stop her to succeed in life later.\u201d She also noted that it was \u201ca little bit reassuring knowing there\u2019s something [\u2026] that could be done for her.\u201d  For Amara, the psychologist created a safe space by demonstrating care and empathy. She felt that she \u201cgenuinely cared\u201d and that she let her \u201chave my moment.\u201d Henry felt that his clinician really \u201ccares about getting it right.\u201d He \u201cwas comforted\u201d as he felt the psychologist \u201ccared\u201d and \u201cwas very considerate.\u201d Specifically, he noted that \u201cbeing considerate of parents feelings\u201d was the most important thing for the psychologist to do. Stephanie shared how the psychologist made her feel welcome, comfortable, and respected. He gave her his full attention, and \u201creally looked at us.\u201d She also commented on the seating arrangement, saying that \u201cwe were not just like far from us, it was really next to us. So, I felt kind of we were welcome.\u201d The conversational nature of the meeting put her at ease. Furthermore, she appreciated that the    67 psychologist made her child comfortable by being respectful, open, and considerate. She felt that the behaviour towards her daughter, Vanessa, was \u201cvery open.\u201d The psychologist was \u201cvery friendly\u201d and treated Vanessa \u201ckind of not like a kid, but at the same level. That was kind of nice to see.\u201d Two parents mentioned how it was important for clinicians to balance compassion with being honest. Grace shared that the psychologist \u201cdelivered the message as best she could\u201d and used a \u201cgentle approach\u201d to be as \u201cpersonal and warm as possible\u201d when delivering difficult information. Grace reflected that the psychologist\u2019s job was difficult because \u201cyou don\u2019t want to come off as promising like a new image of the future.\u201d Diego explained that, alongside kindness, trust was built through the clinician\u2019s straightforward honesty: It was very straightforward, and they always told us exactly, even if its was bad news or [\u2026] not something that I would like. [\u2026] She was very straightforward, and I like that [\u2026] I do appreciate the honesty of being like, oh, you know what he\u2019s doing this and I don\u2019t think its good. So we can work on this. This honesty communicated to Diego that the clinicians were being helpful rather than just trying to be nice.  Theme Two: Challenges and Doubts  In addition to speaking about their positive experiences, nine out of 10 parents spoke about the challenges and doubts they experienced in the feedback meeting. Common experiences included being overwhelmed, feeling like the explanation given to them was inadequate, being uncertain about the prognosis, and experiencing doubts, discontent, or differences in opinion from the psychologist. Each of the three subordinate themes are discussed in detail below.  Overwhelming and\/or Inadequate Explanation     68  Eight parents spoke about how the feedback meeting was overwhelming or about how the explanations given by the clinician were inadequate. Several parents shared that they found the feedback meeting overwhelming in regard to the amount and detail, content shared, and use of technical language. David noted that \u201ceven for educated people, unless they're in that field, then it's challenging for ordinary parents\u201d He further explained that,  when she gave the report at the same time when she's doing the feedback meeting, then all I can do is definitely feel overwhelmed. (Anisa: mhm mhm) Really overwhelmed, and then all I can do is listen to what she's saying, right. Stephanie also expressed that the large amount of new information shared in her daughter\u2019s feedback meeting was overwhelming and confusing. She recalled: She is above average, I know she's above average in something. I know she's under in some things, but I couldn't remember which one she was, what she had to work on. So, it was too much information for me to grasp at that time Excessive details and technical language made the feedback overwhelming for Grace. She explained that there were a \u201clot of terms that I didn\u2019t quite understand\u201d and although the examples were helpful, \u201cit was just so much quantity. You know, that it became overwhelming.\u201d She shared that she understood \u201cthe gist of it\u201d but that it was \u201cso so technical\u201d and that \u201ca lot of it went over my head.\u201d Scores were particularly challenging for her to grasp. Grace also shared that the psychologist\u2019s heavy foreign accent was difficult for her husband to understand. The psychologist\u2019s jargon, accent, and pacing also made the information shared in the feedback meeting difficult for Stephanie to comprehend. \u201cHe was speaking quite fast\u201d using \u201cword I couldn\u2019t understand,\u201d and \u201chad a very strong English accent.\u201d Stephanie also mentioned that test names did not mean much to her. \u201cI was still trying to understand what he was saying and not    69 listening to the next sentence. (Anisa: yeah) So yeah, it was really overwhelming.\u201d The stress of the situation meant that it was even harder to understand and assimilate what the psychologist was saying, meaning that Stephanie counted on the report to better understand the assessment results. For Diego, the assessment was somewhat overwhelming, and he predicted that the severity of the child\u2019s diagnosis and prognosis may determine parents\u2019 feelings of overwhelm. Grace also discussed the need to tailor the feedback to the parent\u2019s needs. \u201cSome parents are maybe more involved in child development [\u2026] or work in healthcare, but neither my husband or I do so it just became really overwhelming.\u201d Grace suggested that the psychologist should be \u201cflexible\u201d and tailor to the family and \u201cweight your time differently\u201d based on needs. For example, some parents may want to delve straight into next steps and exploring resources, while others may need more \u201cemotional guidance\u201d and referrals for family counselling.  Three parents explained that feeling overwhelmed made it more difficult to ask questions. Melissa shared \u201cI was dysregulated myself [laughter] at that time, and that was the only opportunity I would have to ask those questions.\u201d She elaborated that \u201ceven though they wanted me to ask more questions, I just, you know, it was just too much.\u201d Melissa explained how the meeting was rushed due to the constraints of the hospital system, and she wished she had more time to prepare for the meeting and prepare questions in advance. David also had trouble coming up with in-depth questions in the feedback meeting and wished he was given the report before the meeting so that he could prepare. After the feedback meeting, David was hesitant to email the psychologist questions for fear of overstepping. He believed psychologists should be treated like doctors, and because they are specialists, he did not want to \u201cbother their time\u201d \u201cunless they get compensated.\u201d Similar to Melissa and David, Stephanie felt that she was \u201cnot prepared to ask question on the spot.\u201d She also wished her daughter\u2019s dyslexia diagnosis was shared at the    70 beginning of the meeting rather than at the end. In her case, the psychologist took a long time to go through the assessment results and \u201cwe have to ask, okay, so what is it? What\u2019s going on?\u201d Stephanie believed that sharing the diagnosis at the beginning of the meeting would have allowed her to understand the assessment results within the context of the diagnosis. Additionally, Stephanie wished that the psychologist engaged her daughter more in the feedback, as she felt the meeting was directed towards parents.  A few parents noted that assessment results were unclear. In Layla\u2019s case, the psychologist did not clearly explain what autism is and how the diagnosis was determined. She expressed her confusion over the process: \u201cI don\u2019t know how the doctor say my son \u201che has autism\u201d, but how is it his doctor does it? Just two hours, you know?\u201d She felt this was not explained well, as \u201cHe doesn\u2019t tell me anything. Just he say, your son have autism and the social worker work with you.\u201d Henry shared that there was lack of clarity about some aspects of the feedback, particularly regarding his daughter\u2019s giftedness designation. \u201cShe never once used the word gifted\u201d but \u201cdid mention that her cognitive ability [\u2026] is in the superior range.\u201d Henry had to follow up on this through email to gain clarification. He also felt that the 20\u201330-page report was long, especially \u201cfor those whose first language is not English, they\u2019re gonna have a lot of problem reading the report.\u201d  Stephanie identified a need to better prepare parents for the assessment and feedback process. She thought that frontloading parents ahead of time about what was going to happen, and sharing the report ahead of time would be helpful. Grace identified that having an agenda for the meeting would help demystify the feedback meeting, saying that \u201cif we had a rough framework of the topics she wanted to cover\u2026 I think it would have really helped bring everyone onto the same page.\u201d Grace also felt that more guidance on understanding the diagnosis    71 and completing the paperwork would help lower barriers. For example, psychologists could \u201cinclude some links you know in the e-mail back when you're attaching the report.\u201d Furthermore, Grace suggested that the psychologist could share a PowerPoint about understanding the diagnosis and regional services available. Doubts, Differences, Discontent  Half of the parents spoke about doubts, discontent, and differences in perception or opinion with the psychologist. In Melissa\u2019s case, whose assessment took place 17 years ago, she felt scrutinized and misunderstood by the clinicians, which impacted her trust in the results. The assessment team harshly judged and falsely interpreted her characteristics as a mother, which was shocking and upsetting. Specifically, she had denied her son a hug during the assessment as she did not want to interrupt the testing, which the clinicians labelled as being a cold mother. Although they \u201cdescribe my behaviour as it was, but they interpreted it as something that was completely opposite [\u2026] Like what!? That was really something, I was shocked.\u201d Furthermore, background questions about Melissa\u2019s education, job, and history made her feel like she was being assessed and blamed for her son\u2019s condition. She felt scrutinized for \u201cmaybe reinforcing these behaviours\u201d and elaborated: I felt that they were suspicious, like they were looking at me and also I felt that this assessment wasn't only for my child, it was also for me as a mother (Anisa: Hmm) to see if there's something not right with me. The assessment team\u2019s misinterpretation of her behaviour sowed seeds of doubt about the results of the assessment: \u201cif they got that wrong so badly, is everything else, correct?\u201d The rigid approach and rushed services due to resource constraints further curtailed trust in the accuracy of the feedback. She shared that having more time would have given the opportunity to build trust    72 with her and that the limited time spent with families meant a potential to miss important details. Although she reported that the clinicians were correct about the autism diagnosis (which was helpful for accessing services), they missed her son\u2019s developmental coordination disorder. Her experience with the clinicians was negative overall, and Melissa was eager to share her story and hopeful that things have changed since her son was assessed in 2007.   David discussed his uncertainty and lack of knowledge about the assessment process, which led to some uncertainty about the assessment process as whole: \u201cWe\u2019re not sure about this field at all, so we\u2019re not sure about the accuracy.\u201d Grace explained that her initial skepticism about validity of the diagnosis resolved over time, especially as she compared her child\u2019s development to her other children. However, even when she had doubts, Grace emphasized that she accepted the assessment results and did not see it as a matter of opinion or alignment. She noted, \u201cit doesn\u2019t matter how aligned we are I think, it was very much like seeing a doctor and your doctor\u2019s diagnosing.\u201d Stephanie also noted some doubts about the accuracy of some aspects of the assessment because they did not align with her daughter\u2019s grades. In terms of differences in opinion, she disagreed with the psychologist about the level of support available at school. For her, what he was suggesting was not realistic as the school had given \u201cno help whatsoever.\u201d Henry experienced some discontent in the feedback and recalled that the psychologist made some comments reflecting negative interpretations of his daughter\u2019s teacher. When the school received the report, the teacher was upset, and he had to ask the psychologist to make changes in the report. \u201cI wish I had caught that\u201d he said, \u201cand then maybe the psychologist could have asked me about this?\u201d Henry\u2019s statement reflects his desire for the psychologist to discuss potentially damaging judgements, which may have prevented him from dealing with the negative repercussions.    73 Three parents spoke about the clinical approach, which felt impersonal. Melissa shared that the feedback meeting was \u201cbusinesslike,\u201d \u201cprofessional,\u201d and followed the medical model. However, this did not feel appropriate for a meeting about \u201ca three-year old child.\u201d She \u201cfelt that those people are like really dis-attached from common ground life [laughter] or family so ... it was something really very new to me as a Polish person.\u201d She found the meeting \u201cgenerally, very clinical and quite harsh.\u201d Melissa also felt disrespected and unacknowledged for her efforts and expertise. Although she had experience and training in child development from Poland, she \u201cfelt underappreciated\u201d and \u201cnot treated as an equal.\u201d Before receiving her son\u2019s autism diagnosis, she \u201cknew right away something is wrong and I was doing everything in my power to address it.\u201d Despite this involvement, she felt her insights were not considered as valuable when making the diagnosis, \u201cmaybe because they were afraid that it\u2019s biased.\u201d Melissa underscored the importance of respecting the parents in the assessment and feedback meeting: I believe that the parents must be treated in a more trustworthy word like primary experts on their children (Anisa: Yup) Even though that the bias may be there, but that they are really experts\u2026they are with their children 24 hours. [laughter] (Anisa: Yeah) So, they have a valuable insight that\u2026should be more listened to and respected. Grace had mixed feelings on the clinical nature of services. She repeatedly noted that the feedback meeting was \u201cextremely clinical,\u201d and she identified that systemic pressure on psychologists may lead them to adopt a formulaic approach to assessment and feedback. While this clinical approach allowed for effective delivery of results, it also meant that understanding and warmth were somewhat lacking. Grace considered: We're all there with a goal. Like there's a purpose to figure out, you know, if this is the road we're going down, but at the same time, it's also very emotional because he's like our    74 child and also, you know, he will get older, and the hope is that he becomes independent, happy adult and what does this mean for the future? Grace identified the difficulty in balancing the clinical job with sufficient empathy and understanding. She noted, \u201cIt\u2019s like day in, day out. This is kind of like their job, right? (Anisa: right) But as the patient, it\u2019s also like your future. [\u2026] It\u2019s hard to get that balance.\u201d Grace spoke about the need to better support parents through the difficult emotions and perceptions of the diagnosis. She cautioned that psychologists should be careful how they \u201cword\u2026a limitation. Yeah, so that it doesn\u2019t come off as a life sentence.\u201d At the same time, Grace shared that the psychologist was more optimistic about her son\u2019s autism diagnosis and viewed it as a journey, whereas she was initially concerned and thought \u201ceverything\u2019s going to be different now. Everything is changing. He may never be independent you know. He has this deficit, like it\u2019s a deficit.\u201d These somewhat contrasting perspectives reveal the complexities of emotions and needs of parents when first hearing their child\u2019s diagnosis.  Stephanie shared some similar sentiments to Grace and described how the psychologist and parents perceived the learning disability diagnosis differently. For the psychologist, \u201cit\u2019s just a routine, another test, another family. Right? But for us, it\u2019s unknown. It\u2019s scary. We feel helpless.\u201d For her, the whole feedback meeting was highly focused on testing and was very brief (less than 20 minutes). She believed that the number one priority for the psychologist should be to have compassion and demonstrate understanding for the family. Uncertainty Around Prognosis  Five parents spoke about how the uncertainty around their child\u2019s prognosis was upsetting or difficult to accept. Grace shared:    75 I think the first time she mentioned that the intellectual disability is inconclusive for his age, you know, very challenging to hear [\u2026] that's a statement that has a really big impact on someone's future.  Rashmi explained how it was challenging to understand what the assessment results meant for her child\u2019s life. \u201cNobody\u2019s going to tell you: and this means they won\u2019t have a normal life, or this means they will have a normal life,\u201d \u201cyou have no idea, what it all means (Anisa: Yeah) Like you have how much of potential? There\u2019s no percentages.\u201d She wished she was told if her child would be able to live on their own when they grow up or if they were anticipated to be nonverbal forever. She wished they would share \u201chowever much they can tell you with a certain degree of certainty and truth.\u201d  Layla also expressed disappointment around the uncertainty of her son\u2019s autism prognosis. Similar to Rashmi, she wished the psychologist confirmed the long-term prognosis for her son: \u201ctalk about autism and if the kids, when you grow up, it\u2019s okay or no? Because I want to just have something my son okay when grow up or no?\u201d She shared that the psychologist did not answer her directly and just told her that taking him to speech-language services would help and not going would make it worse. Difficulty accepting uncertainty about the future was also noted by David. He had similar thought about the future as other parents, wondering: Ok, so what does that mean? [laughter] Like does that mean he can ... like what? What is life gonna be like? Can he lead close to normal life or not at all compared to other kids? How much dependence does he need from us? The psychologists cannot answer, right? She doesn't know. She just know, this is Autism.\u201d David explained that they had no idea how severe their son\u2019s autism was. He \u201clearned about high functioning autism later on by myself, not through the psychologist.\u201d He wished that the    76 psychologist could tell them more details or give them a category of how severe the autism was. In Stephanie\u2019s opinion, the psychologist should begin the feedback by:  Reassuring the parent, you know, saying, there is a lot of child like this and this doesn't mean it's gonna restrict them from succeeding or learning [\u2026] starting with, okay this is not an obstacle to succeed, right? That's not something that is gonna block your child from going to university or anything like this. And, you know, starting by really reassuring the parents. Theme Three: Impact of Culture and Language   All parents spoke about the impact of culture and language on the feedback meeting. Parents spoke about intersectional barriers to support, navigating cultural differences, a lack of cultural consideration from the psychologist, and language barriers in the feedback meeting. The four subordinate themes are discussed in detail below.  Intersectional Barriers to Support  Five parents discussed various barriers to support, including intersectional challenges, difficulty getting support and understanding from cultural communities, and navigating cultural stigma with family members.  Fatima shared that when coming to Canada as a refugee, \u201cwe left a lot something behind and we came to start a new life, and this is very hard with kids.\u201d She explained that it has not been easy to cope with the numerous compounding challenges she faced since moving to Canada. Some professionals do not understand her family\u2019s context, and going through the assessment process was difficult as she had a \u201chard time to understand what\u2019s going on.\u201d It was also very challenging to hear her children\u2019s diagnoses due to everything she had already done and sacrificed to make her kids safe. She shared:    77 I feel upset all the time to make my kids be growing okay. I feel upset. Why? We have the time, to move to free country or stay different place or always not relax not, you know, staying same what we had. Furthermore, intersectional challenges made dealing with the diagnoses even more challenging. For instance, Fatima explained how her family is living in a \u201cdangerous place. It's no space. They are very not safe. Also outside always gets fight. Parents fight too [\u2026]\u201d and that it is not safe for her children to go outside by themselves to play.    Layla experienced exclusion from her cultural community due to lack of understanding about autism, which has caused her deep sorrow. She shared that people from her culture assume that her son is autistic because she is a bad mother: I'm so sad about that people talk about that: Your son okay, this is your problem, not your son a problem. This is idea my country. This is idea my culture. The people not understand what is it autism. Doesn't have any idea about that.  In her experience, people from her culture are not informed about western diagnoses such as autism, and therefore do not understand or accept it, which is \u201cvery hard, very hard for me.\u201d She elaborated that \u201cI can't sit with same my culture. Or my kids play with him (Anisa: Mhm) because different idea. (Anisa: Right) Different idea and he\u2019s doesn't understand my kids.\u201d She often finds herself asking \u201cWhy? Why the people this don't understand my son. Why!? I don\u2019t know...\u201d This also means that her son does not have any friends, which is upsetting to her.  Melissa also spoke about a lack of support she experienced as an immigrant parent. She shared that \u201cin Poland, disabilities are not a burden\u201d and families receive community support from neighbours and community,    78 whereas over here for people who are immigrants. They don't have that environment and they are very much isolated. And this is really affecting their children the most because there\u2019s no grandmother, there's no aunt, there is no friends, there is no neighbors [laughter] that will come and stimulate that child for their social development. The family is alone and nobody wants to talk to them. They have the children who behave in a very unacceptable way and they are nuisance, right? So the family is very much alienated and that's has huge negative impact on that child\u2019s development. So, you know it's the value of yes, those children have both, they have you know, roof over their head, but definitely that community support and you know that the things that the children need the most when they little. Melissa felt that Canadian politeness was a barrier to genuine support and connection: Canadians are quite, ... they don't - like in other culture, people would ask me directly [laughter] what\u2019s wrong with your son (Anisa: Mmm) because that's, you know, is he ok? What's the problem? They would ask direct questions. (Anisa: Yup) Whereas in Canada, the culture is more they just move away from you, right? [laughter] So, they are more polite, but also, they do not provide help whereas in other culture would be more honest, but also, people would more reach out to you to help. Fatima also reflected that in her culture, communities are closely knit and provide support to one another. In Canada, there is a different culture and language, which was a huge adjustment. While she does not have the same community support as she had back home, she felt that the Canadian system tries to help children and families who are struggling. She shared, \u201cthis country I think they help to see the kids and they help to fix what\u2019s going on. If the kids having a difficult time growing or not okay or something happen with the help.\u201d    79 Furthermore, Melissa explained that immigrant families can struggle with the implications of their child\u2019s diagnosis on their immigration status in Canada. \u201cThey may even hide the fact that their child has autism and imagine what kind of consequences has this has for that human being who is losing that window of opportunity.\u201d Melissa also discussed that immigrant families may face barriers in receiving the initial autism diagnosis since language delays typical in autism could be easily hidden for English language learners. Rashmi and Diego both discussed navigating cultural stigma with family members, which was initially perceived as a barrier to support. However, through discussion and time spent together, family members understood the diagnosis and offered their support. Rashmi explained that \u201cthere is definitely some stigma\u201d in her culture around autism, particularly when it impacts academic performance or \u201ccomes with things like intellectual deficits.\u201d She explained that she has been very open and matter of fact about sharing the diagnosis with others. While her parents had initial pushback against the diagnosis, they accepted it fairly quicky. Rashmi\u2019s parents were \u201cborn and raised in India, and they were super, it's like, \u201cOkay, you know what? It's fine\u201d.\u201d However, her husband Diego initially hid the diagnosis from his Mexican parents due to cultural stigma and preconceived notions of autism. Diego expressed that he was worried about his parent\u2019s reaction to the diagnosis. He explained that: from my group of like, I don't know \u2026 that region that I was raised with, my parents, my friends all around, when they hear the autistic they think of someone very, very autistic, very, very like autistic person that cannot even talk or has like a struggling doing everything mostly.  He felt that \u201cbeing autistic it\u2019s not that common, at least in Mexico.\u201d He wanted his parents to spend time with their grandchild before sharing the diagnosis. When he did eventually share the    80 diagnosis, his parents were surprisingly \u201cvery chill about it\u201d and said, \u201cwe\u2019re gonna love it no matter what. So, it was very nice as well to hear that.\u201d Rashmi shared that having their parents spend time together with their son and having them observe intervention services increased cross-cultural understanding of the diagnosis. Rashmi said that culturally, some people may believe that children grow out of autistic traits, which is something she has had to address. Diego also talked about this, sharing how he and his mother initially thought that after his son received treatment, \u201cthe autism is going to be done.\u201d Rashmi also discussed how culture plays a role in how you raise a child and interpret certain actions. For instance, Diego\u2019s parents were upset that their grandchild kept removing his shoes and going barefoot, because this was perceived as \u201cvillage people stuff.\u201d Rashmi noted it was difficult to \u201ctry to explain to him that it\u2019s like a sensory neural processing thing.\u201d While navigating these difficult conversations, Rashmi expressed how grateful she was to have a supportive partner. Likewise, Diego shared that his wife was incredibly helpful in helping him understand the diagnosis and its implications.  Navigating Cultural Differences   Navigating cultural differences in the feedback meeting with the psychologist was an experience that seven participants spoke about. While some parents were very conscious of cultural differences between themselves and the psychologist, several parents also spoke about culture not playing a role within the feedback meeting, culture being adequately acknowledged by the clinician, or experiencing cultural alignment with the psychologist. These diverse perspectives are explored below. In Melissa\u2019s experience, she was aware of cultural differences between herself and the clinicians within the feedback meeting. Specifically, she wondered if her expressive emotions may not have been culturally normative. She also felt that some of the recommendations were    81 not acceptable in her culture. Namely, she said that behavioural intervention \u201cwas something that would not be acceptable.\u201d The entire assessment experience was a \u201cculture shock\u201d for Melissa, who found the clinical approach in the feedback meeting to be impersonal. She reflected: I think maybe, since the Canada is extremely competitive environment, ... I believe that even the psychologists are very tense (Anisa: Hmm) and that makes there's a lot on stake with their professionalism and they want to perform so well and be so correct in everything they do that they kind of lose a bit of humanity or they are very suspicious of everything, too suspicious. When the psychologist shared her daughter\u2019s anxiety diagnosis in the feedback meeting, Amara noted differences in culture between herself and the psychologist and felt that the western focus on independence contrasted with her hands-on and nurturing culture. She shared, \u201cmy perspective is a child has to be dependent.\u201d Fear of being rude prevented her from voicing these differences of cultural perception. She did not want to invalidate the psychologist\u2019s perspective and worried that if she voiced her difference of opinion, it would be \u201crude,\u201d so she \u201cjust listened to what she had to say.\u201d Stephanie also experienced cultural differences at various points of the assessment. She shared that she was unsure of her role as a parent in her daughter\u2019s education because \u201cin France is the parent don\u2019t really play a role in education.\u201d Because of these cultural differences, her daughter\u2019s challenges went unaddressed because she did not feel it was appropriate to bring up concerns to the teacher. Additionally, she \u201cwas a little bit skeptical at the start\u201d of the assessment due to culture and the assessment being something completely new to her. In France, it was \u201ctaboo\u201d to speak about learning disabilities. In her experience, children who could not keep up in school were not given accommodations and instead would typically switch into a technical    82 school. She found Canada to be \u201cmore open\u201d and to have more \u201copportunity to support the kids compared to back home.\u201d Amara spoke about selecting the best aspects of western and Indian culture to align with her personal values and provide the best care for her child. She discussed having personal agency to utilize the psychologists\u2019 recommendations that aligned with her personal and cultural beliefs and to adapt traditional cultural values where needed. For example, she grew up in a strict environment where she was yelled at if she threw a tantrum. However, she changed her approach with her daughter: I don\u2019t supress her emotions, I understand where and why she\u2019s doing it and then try to do the same thing that I feel right as a mother. So my culture taught me a little bit differently, but I do my own tweaking. She also reflected on the diversity of cultural beliefs and values within one culture, sharing that \u201ceven in our culture there is so much deviation; there are so many branches you know, how and which way you are treated, you know, how you\u2019re supposed to deal with things.\u201d Her comment speaks to the importance of not stereotyping expectations based on a family\u2019s cultural background but instead taking the time to understand the family\u2019s unique beliefs and culture.  Rashmi, Henry, and Grace shared that they did not perceive culture as playing a role in the feedback meeting. All three of these parents had spent a portion of their childhood in North America, which may have played a role in their perceptions. When asked about the role of culture in the feedback meeting, Rashmi shared that \u201cI don\u2019t think it played a role for us.\u201d She did not perceive culture as impacting the way results were delivered or the next steps given to them. This may have been because \u201cwe didn\u2019t have a language barrier\u201d or because of her diverse cultural experiences. Specifically,     83 I think the fact that I was raised here, but have that Indian culture and the culture of other parts of the world that I've lived in, it was easy for me to identify and agree with and know kind of what they're talking about, and how they're delivering it, and my expectations Furthermore, Rashmi felt that there was little time to consider culture when there was so much to process within the feedback meeting. Grace also felt that culture did not play a role within the feedback meeting. She said she did not \u201cperceive anything different\u201d and although the clinician had gathered background information on the family, it was \u201cnot really focused at all on cultural\u201d and Grace did not see how the psychologist could have adapted it.  Henry also felt that culture did not impact the feedback meeting. He explained that because he came to Canada when he was \u201creally young,\u201d he did not feel that his culture had \u201cany kind of influence\u201d on the feedback meeting and \u201cwasn\u2019t on his mind.\u201d However, he reflected on the fact that culture may have unconsciously impacted his perspectives. For instance, he resonated with the psychologist\u2019s push for equal education for his daughter and \u201cwhether that\u2019s culturally or not, that\u2019s hard to say because I guess as an Asian parent, you always want your kids to have the best education [\u2026] especially in Taiwan they want their kids to do well.\u201d In contrast, Layla felt that the clinician understood her culture because he asked her questions about it. She recalled discussing her lifestyle and the cultural differences between Canada and Saudi Arabia with the clinician, who was able to take this into consideration during the assessment.   Lack of Cultural Consideration  Half of the parents discussed feeling like their culture was not considered by the psychologist. Some parents saw this as an issue, while others did not. As mentioned previously, Rashmi felt that the clinician did not consider their family\u2019s cultural background beyond basic    84 demographics and did not feel there was a need to \u201cgive us information that was more culturally sensitive or anything like that.\u201d Rashmi\u2019s husband Diego thought that the clinicians likely considered the family\u2019s cultural background but did not go \u201cinto detail asking questions about that.\u201d He did not \u201cknow if it actually has some impact at all in what happened in the end.\u201d He was unsure if the feedback \u201cwould affect the depending on the nationality of the immigrant\u201d and said, \u201cI don\u2019t think it will be different, hopefully.\u201d Diego\u2019s perspective reflects his perception that the diagnosis is black and white and not something that should be impacted by culture.   On the other hand, Henry and Amara did not think the psychologist considered their cultural backgrounds. Henry explained how he identified with both the Taiwanese and the Canadian\/western culture; however, he did not believe the psychologist took his dual cultural identity into consideration. Amara believed that even if she talked to the psychologist about her cultural identity, \u201cit would not have changed her answer in any way, she would still have given me the result that she has and what she wants me to do.\u201d Amara believed that her culture should have been considered more. She noted:  It would be nice for psychologists to understand the cultural background, because North America is such a vast and multicultural society. There are so many people coming from different parts of the world. Amara suggested that the psychologist should research a client\u2019s culture beforehand and ask specific questions based on their culture. She stated that \u201cnot having 100%, even having like the 10% of the knowledge and background [\u2026] will be very helpful.\u201d She also believed that psychology training programs should incorporate cultural reflexivity and individualized treatment while adhering to ethical codes. She explained,     85 there should be some kind of deviation when your patient is different, right? (Anisa: Definitely) Like, you know, even if we go to a doctor, the doctors are going to prescribe you the same medicine for cold and cough that he prescribed the previous patient. You know, he looks into and digs into why it is because your cold and cough symptoms are going to be different than the patient before you, if you know what I mean? Melissa felt that her expertise and education was undervalued and unrecognized by the clinicians because of linguistic and cultural barriers. Melissa explained that she was \u201ceducated in early intervention, and I was education in pedagogy. So even though I didn\u2019t have English words, I knew how to approach my son.\u201d However, she felt her opinions and education were not recognized by the psychologists. In general, she has observed that North American knowledge and research is privileged above other countries\u2019 research, experts, and knowledge. Melissa emphasized it \u201cdoesn't matter if they [the parents] speak broken language. They have the very valuable knowledge, and they may have higher education than the tester.\u201d Her words reflect the importance of considering and respecting the parents\u2019 culture and education received from other countries.  Language Barriers  Several parents spoke about language barriers within the feedback meeting. For Melissa, some of the language and terminology used was unclear. Diego also discussed language barriers, explaining that certain aspects of the feedback meeting were difficult to understand, especially the technical or \u201cmedical\u201d terms that were unfamiliar. The two participants who spoke about language barriers most were Layla and Fatima, who are both Syrian refugees who arrived in Canada more recently than the other participants. Fatima explained that she often missed    86 important information due to language barriers, which led to overwhelment and confusion. She expressed:  It's very difficult and hard because we need to know, not my language, to go to, okay, I understand what's going on. Sometimes you need translator to make understand what this word means. So many words coming. We don't understand what's going on and sometimes very, very important to know what's going on about this happen or what we need to do.  She explained that she speaks better English than her husband but is nonetheless often \u201cvery very confused\u201d. She shared that it was difficult to \u201cfind out anything\u201d regarding her child\u2019s diagnosis. Layla also discussed the challenges associated with navigating the assessment process as a newcomer. She shared that it was \u201cvery hard for the body, coming in Canada\u201d when her son \u201cdoesn\u2019t have language.\u201d Not speaking the language was frustrating and upsetting because she could not communicate with the psychologist well.  Both Fatima and Layla spoke about the importance of having an interpreter, and the challenges associated with having appropriate and confidential interpreter services. While Layla was provided with an interpreter for the feedback meeting, she did not have one available for the duration of the assessment. Layla was shocked that interpretation services were not provided throughout, and that she had to pay for services herself. Fatima had the opposite experience, where she had an interpreter for most of the assessment, but not for her son\u2019s feedback meeting. For Fatima, getting an interpreter in the hospital often meant she had to wait until one was available (often waiting 30 to 60 minutes), which substantially increased appointment times. The prolonged appointments were difficult to manage when she had her children with her. She shared that getting an interpreter for the appointment was unpredictable and stressful. Fatima discussed    87 the importance of having an interpreter to understand the diagnosis, to understand \u201cnext steps in the future,\u201d and to help with paperwork. Due to a lack of an interpreter in the feedback meeting, she felt that she \u201cmiss[ed] a lot what\u2019s going on\u201d and did not fully understand \u201cwhat\u2019s going on with my daughter,\u201d which meant her children may not be getting access to all the supports available to them. The report and subsequent paperwork were particularly challenging to understand, as they were only in English. She mentioned that the report has \u201cso many\u201d pages and that it was sometimes \u201cvery hard trying to understand what they\u2019re [the paperwork] words saying exactly.\u201d Layla also touched on the importance of interpreter confidentiality, as the diagnosis \u201cis very important story\u201d that is \u201cvery sensitive for family.\u201d  Theme Four: Emotional Reactions  All the parents spoke about the emotions they experienced when they heard their child\u2019s diagnosis. These emotions were often mixed and multifaceted. Four subordinate themes emerged from the data, reflecting the key emotional experiences that parents tended to have. These include feeling anxiety and uncertainty, relief and understanding, overwhelm and upset, and being shocked by unexpected news.  Anxiety and Uncertainty Many parents reflected on feeling anxious or uncertain leading up to the assessment. Melissa shared that it was an \u201cextremely distressing moment in my life. I was a mess basically as a parent, I was extremely worried.\u201d She wondered if she was doing something wrong. Stephanie felt overwhelmed and apprehensive leading up to the assessment because it was the \u201cunknown\u201d and she \u201cdidn\u2019t know what to expect\u201d or what \u201cthey were going to tell us.\u201d Layla was worried, \u201cvery stress[ed],\u201d and lonely leading up to the assessment. Amara also recalled feeling \u201canxious\u201d because her daughter was \u201cnot acting the way she\u2019s supposed to.\u201d Fatima also described feeling    88 stressed leading up to the assessment after having \u201cmove[d] so many places to make my kids safe.\u201d Grace felt fearful and uncertain about her son\u2019s future leading up to the assessment. She felt \u201creally scared\u201d because \u201che was not able to grasp very basic life skills.\u201d At the same time, Grace \u201cdidn\u2019t know what to expect\u201d from the assessment. She shared \u201cit's hard to get information from the internet when you don't really know what to look for and how to filter.\u201d Additionally, despite the assessment itself being very professional, the unprofessional nature of the business model and payment system was alarming and increased uncertainty and apprehension about the assessment for Grace. She explained, you had \u201cto pay either by Interact or cash, which blows my mind because it's thousands of dollars.\u201d There was also \u201cno receptionist,\u201d and emails went to a \u201crandom inbox.\u201d She described the payment for the assessment feeling like a \u201cFacebook marketplace kind of transaction\u201d and felt that \u201ca lot of confusion could have been avoided.\u201d While Diego discussed feeling uncertain about the assessment and \u201cwasn\u2019t sure what to expect,\u201d he also reflected on feelings of unconditional love for his son. He said, \u201cI loved him so much [laughter]. So, I thought no matter what happened, we'll support him (Anisa: Yup) no matter what.\u201d Some parents also felt anxiety and uncertainty upon being told their child\u2019s diagnosis. Stephanie was initially anxious when she heard her daughter\u2019s learning disability diagnosis, as she worried about her daughter\u2019s future. Her first reaction was \u201cOh my God, she\u2019s going to have a hard life.\u201d When told her daughter\u2019s anxiety diagnosis, Amara felt anxious, emotional, and surprised. She shared these emotions came up because she's the only child I have, and I just wanted to make sure that everything is okay. Any mother- if there is any situation or any occurrences with the child, a mother is    89 always very stressed and very nervous and anxious and just making sure that she's taking care of her child.  Melissa, David, and Layla all recalled the feelings of anxiety and uncertainty when told their child\u2019s autism diagnosis. David shared he felt \u201ca bit concerned,\u201d whereas Melissa felt \u201clike this panic attack.\u201d For Melissa, hearing the diagnosis was emotional and scary because she wondered if she was doing the right thing for her child: It's a very tough moment for a parent because you want to have that intervention and that you are scared. What if it's a mistake for my child? Well, what if I'm providing a label to him, and maybe that's not true. Maybe they made mistakes, maybe I make mistakes? Is there another way? What can I do as a parent, for this child? Melissa\u2019s and her husband also had serious doubts about the diagnosis. She shared that \u201cI wasn't sure if this is autism. I thought actually that he may have schizophrenia. So, I went back and I was start reading a lot about autism.\u201d  Four parents discussed feeling anxious because they wondered if they were to blame for their child\u2019s diagnosis or for not identifying it earlier. Despite assurance from the psychologist, Layla worried that she might be to blame for her son\u2019s autism diagnosis. She recalled thinking that \u201cmaybe my son has autism because he's sit at home with me alone. I don't have any family. I don't have any friend. Just with him.\u201d Melissa felt similarly and shared \u201cit was tough even to receive this diagnosis because it meant there's something wrong with my son, there's something wrong with me, there's something wrong with my genes.\u201d In Stephanie\u2019s case, she blamed herself for not having the diagnosis confirmed until her daughter was 12. She asked herself, \u201cwhat did I do wrong at the start?\u201d Grace also felt \u201can aspect of guilt for not seeing signs sooner and for letting the childcare situation deteriorate.\u201d     90 Relief and Understanding Relief and understanding were another set of emotions commonly experienced in the feedback meeting. Relief was felt by Melissa when she was told her son\u2019s diagnosis because it meant her son \u201cwould have more professional support\u201d and that she \u201cwould no longer be alone.\u201d Stephanie felt relieved that her hypothesis about the diagnosis was correct because it meant that she knew her daughter well and taken the right steps. Likewise, Grace said \u201cit was very affirming\u201d because it meant her \u201cgut feeling\u201d was correct. Henry was expecting and prepared for his daughter\u2019s dyslexia diagnosis, so when the feedback meeting confirmed this, he found it \u201creaffirming.\u201d Seeing his daughter\u2019s qualities reflected in the feedback and report was also validating. He recalled, \u201cI've always known she has this perfectionism [\u2026] but it kinda validates it.\u201d  The diagnosis also brough parents\u2019 feelings of understanding and clarity. For Stephanie, naming the diagnosis clarified her daughter\u2019s challenges. She said: Having a name feels like, okay. Now we know what it is, maybe now we can, you know, I'm sure there is people who are doing a lot of research on that and maybe there is a way to help.  For Henry, the assessment revealed new perspectives on his daughter\u2019s challenges and helped him \u201cunderstood her a little bit more.\u201d When told the diagnosis, Diego focused on understanding the information and taking a positive and problem-solving approach. He shared that he was \u201cgoing with the flow\u201d and tried to \u201calways stay positive.\u201d He reflected that while he was not experiencing \u201csuper happy feelings,\u201d he also was not experiencing \u201csuper sad feelings.\u201d Instead, he focused on \u201ctrying to understand\u201d and tried to work out \u201cthe next steps after he was    91 diagnosed.\u201d  Diego saw the feedback meeting as a learning experience, from which families have to adapt and grow.   Overwhelm and Upset  Feeling overwhelmed and upset when told their child\u2019s diagnosis was another common emotional experience for parents. Fatima felt upset and overwhelmed when told her children\u2019s diagnoses because she anticipated it would be a long and difficult journey to help them. She expressed distress over the challenges her children would face in social situations, sharing that she felt \u201cupset inside because I don\u2019t like my kids they having a hard time with other kids, with other people.\u201d For Layla, hearing the autism diagnosis suddenly was shocking, upsetting, and overwhelming: I don't like it this part because when the doctor tell me fast \u201cYour son have autism\u201d. Um what is it!? \u201cNo, no, no! My son no, no, not have, not have\u201d and two days I am cry. Two days my feeling not good She described hearing the diagnosis \u201csuddenly\u201d as \u201cvery hard for family.\u201d Despite knowing that her son was not developing typically, she was very emotional and was grieving when told the diagnosis: I'm crying. (Anisa: Aw. Yeah) Because in my inside, in my heart, I know, in my idea, I know my son have something, (Anisa: Mhm) but I don't want said that. You know?   Layla discussed how the psychologist should have made the family feel more comfortable and reassured them more before announcing the diagnosis. Fatima also reflected on how it was difficult to accept the truth of the diagnosis. Layla wished that her son was not autistic and the diagnosis has been difficult for her to accept:     92 Yeah, every time I speak with myself, (Anisa: Mhm) I wish my son he doesn't have autism because, you know suddenly and...this is feeling [laughter] I don't want to cry right now, but (Anisa: Yeah, no its okay!) this is story\u2026 Uncertainty and the unknown made the disclosure more overwhelming and upsetting. For Grace, hearing the diagnosis was metaphorically dizzying due to the uncertainty about the future. She shared that the feedback meeting \u201cwas a really tough day\u201d and \u201ckind of like a slap across the face because\u2026 now the future is uncertain.\u201d She believed that most families are \u201cgoing to spin\u201d after hearing new of their child\u2019s diagnosis. Grace also explained how she felt a sense of grief: I think a little bit also... like grieving, almost, because your image of the future ... the ideal future that you saw in your mind has just now been turned upside down. Right? And it's really unfair because that's really just your personal projection of what the future will look like\u2026  Fatima also reflected that dealing with unknowns about the future was overwhelming and \u201cvery hard to manage.\u201d She questioned how she would be able to balance everything: \u201cI get tired. How I can do this? Because she's not one child. I have another child and I need to be okay with other things.\u201d Melissa also felt overwhelmed when she considered the implications of the diagnosis and next steps. She thought, \u201cWhat do I do now?\u201d and \u201cI have to now compose myself and thinks what\u2019s the next step. And I need to make sure that everything is done properly.\u201d Shocked only by the Unexpected  Some parents expressed feeling shocked when told their child\u2019s diagnosis, but this only occurred in situations where the diagnosis was unexpected. For Rashmi and Diego, they experienced a gentle lead up the assessment through the Infant Development Program, where their son\u2019s developmental milestones were consistently monitored over time. Because of these    93 check-ins throughout his development, Rashmi expected the autism diagnosis and did not find it surprising when it was delivered in the feedback meeting. For her, the possibility of autism was not overly alarming due to the comparison with other children with significant disabilities: As I was seeing him I kind of knew that if he was on the spectrum, it wouldn't the end of the world, you know? Especially because there were so many kids that I'm still in touch with that we were in the NICU with who are in wheelchairs, who are, you know, in specialized schools who are like, nonverbal autistic kids [\u2026]  Diego also expected the diagnosis, and he recalled that \u201cI was just still kind of processing all these things that were happening, so I wasn't sure how to actually feel at the moment.\u201d Additionally, the identification of symptoms through the assessment process meant that hearing the diagnosis was not shocking or surprising. Henry was familiar with the assessment process as he had gone through it for his older child before. For him, knowing what to expect led to calmness. While he expected his daughter\u2019s dyslexia diagnosis, he was shocked upon hearing that his daughter also met criteria for giftedness, as this is not something he had expected. Grace also felt shocked when told the diagnosis. She recalled that she \u201cdidn\u2019t realize that there were enough markers for him to qualify for that diagnosis\u201d so when the autism diagnosis was confirmed, she felt \u201cstunned and shocked.\u201d   David discussed the role of education and research in preparation for receiving his son\u2019s autism diagnosis. He shared that he and his wife are \u201cwell educated.\u201d Having graduated from a well-known university, David explained that he had done research ahead of time and was not \u201cunprepared or shocked.\u201d The month between the testing and the feedback meeting also allowed for mental preparation, research, and acceptance of the diagnosis. While he and his wife had the resources to become \u201cmore and more prepared for the essential outcome,\u201d he shared that:     94 a lot of parents who don't have enough research may be shocked, may be clueless, may be frustrated, may be surprised when they're hearing the result, they may feel anger even right, like at the time if ... they're not prepared [\u2026] Rather than feeling shocked, David shared that he \u201cacknowledged the truth\u201d, came to terms with the fact that his son would have a \u201cslightly different\u2026future life than [laughter] the others\u201d, and focused on \u201chow to move forward.\u201d   Theme Five: Journey Beyond the Feedback Meeting  Participants all reflected their journey beyond the feedback meeting. Several discussed the benefits of the diagnosis, such as access to intervention, as well as how they received insufficient support for navigating the next steps. Parents also shared their stories of strength and hope in the face of ongoing challenges. Finally, parents spoke about their evolving perceptions of the diagnosis over time. These four themes are discussed below.  Benefits of Diagnosis Over half of the parents spoke about the benefits of getting a psychoeducational diagnosis. Diego shared that receiving the diagnosis was \u201cvery helpful\u201d and has provided insight into his son\u2019s behaviours and symptoms. The diagnosis also helped Rashmi understand her son, which has made it \u201cso much easier to help him communicate.\u201d Layla shared that before the assessment, it was \u201cvery hard\u201d because her son \u201cdoesn\u2019t talk any word\u201d; however, he is doing \u201cbetter than before\u201d and is using \u201csome word\u201d now. Stephanie saw the assessment and diagnosis as turning point for her daughter\u2019s education and self-esteem, as she was able to better understand her strengths and challenges. David shared that the feedback meeting was a \u201cvery important meeting and [\u2026] part of the process I guess in learning about my son's disability and what to do next.\u201d The diagnosis also gave David the opportunity to support other families. He    95 explained, \u201cWhen we have friends who we suspect their kids might be in that spectrum as well, we kind of tell them to get your kid diagnosed [\u2026] we are able to ... I guess share exchange information.\u201d  Several parents spoke about the diagnosis being beneficial in accessing intervention services and supports. For some, the diagnosis also provided funding. Rashmi expressed her gratitude, stating that she felt \u201cvery lucky and very fortunate that we were able to ... access the funding through the private sector diagnosis within the time frame where he had the high neuroplasticity.\u201d Diego discussed how receiving the diagnosis was helpful for getting targeted support and intervention, which has led to his son becoming \u201cmore social.\u201d For David, the diagnosis was a tool to access support and accommodations at school: The school will know that he has autism spectrum disorder, so [\u2026] they're going to pay more attention, offer him more school support ... right, so, things like that you become more assured, (Anisa: mhm) and then knowing that he doesn't have to complete the same assignment compared to other kids because his ability is not there ... compared to other kids. So, that made me feel reassuring because he doesn't have to go through that much pressure.  Melissa spoke about the duality of early diagnosis, which leads to access to early intervention, but family and professionals may also lower expectations for the child, which could stunt their growth and prevent them from being pushed to reach their true potential.  Insufficient Support Navigating Next Steps  Four mothers discussed that there was insufficient support for navigating the next steps after the feedback meeting. For Melissa, it was challenging and overwhelming to figure out next steps and to coordinate intervention services:    96 It's very overwhelming, extremely overwhelming [\u2026] so, now you have the diagnosis. Now I have to still make sure that I provide that intervention myself and being distracted and now dysregulated myself, ... yet knowing I have to do all sorts of bureaucratic visits and ... you know, it's very tough. Despite being told the next steps and how to get support, it was not easy. Grace described feeling \u201clost right at the beginning\u201d and wished there was \u201cmore done to connect these dots.\u201d For her, understanding the system and implications of the diagnosis was a huge learning curve. For Stephanie, the psychologist sent recommendations and resources with the report, but did not go over next steps or recommendations within the feedback meeting, which meant that \u201cout of the assessment I didn\u2019t know what my role was.\u201d She elaborated: I think was unclear as the next step. The next steps for us we knew what the diagnosis, but it was not clear what do we do with it (Anisa: Right). What do we do with the report? What do we do with the information you give us? In Rashmi\u2019s experience, she expressed that the feedback meeting fulfilled the role of communicating the diagnosis but did not adequately prepare parents to navigate next steps. She noted: \u201cAs my dad says, there's a slip between the cup and the lip. [laughter] You know, old men saying. So, yeah, I think there's a gap here.\u201d \u201cThe hardest part was that I didn\u2019t really know what was next,\u201d she explained. Rashmi felt that autism funding should be better explained to parents, because in British Columbia, managing the funding is a daunting and complex task. In general, Rashmi spoke about how complex it was to navigate the diagnosis and support services, even as a native English speaker with graduate level education:  I recognized this gap, especially for newcomers, I mean, you know, I have a PhD and I'm a native English speaker and it was a complicated thing to navigate. What about these    97 people who are English is their third language, and they're relatively lower educated, and you know? (Anisa: Yeah) They come from a country where you don't question medical authority, you know, you just say yes, yes, and move on, you know. I mean, even my friends that I have here that are newcomers, they are completely lost when it comes to autism diagnosis. Rashmi did not necessarily feel that it was the psychologists\u2019 role to support them through the whole process; however, she identified a definite gap between receiving the diagnosis and accessing adequate supports. She stated:  the navigating afterwards, like figuring out what you have to do afterwards. There's no peer support networks. There's no guides [\u2026] I feel like there should be more of a your child has just been diagnosed with autism pamphlet. You know what I mean? [laughter] (Anisa: Uh-huh) Like, you may be feeling this: here's how you connect to a counselor, here's how you connect to other peers in your area who are going through the same thing, here's how you connect to a nurse who you can sit down and have a Q&A with. Grace also discussed how overwhelming it is for parents, who are ultimately responsible for keeping up to date and coordinating constantly changing funding and support services: Oh, and then there's this and that CRA like so many parts, right. And then prioritizing the timeline, too, like preschool. Ok, and then the under 6 funding, and then ok, now he's school age. What does that mean? The funding decreases. Well, I got to make sure, you know, I get that IEP meeting. [\u2026] What I'm doing today is not going to be what I'm doing in six month, and like understanding that you always have to move forward almost.     98 In terms of insufficient support being provided, Stephanie wished that the psychologist could have facilitated sharing the report with the school and that he had followed up after they received the report.  Strength and Hope in the Face of Ongoing Challenges In the journey beyond the feedback meeting, another sub-theme that emerged was the strength and hope that parents maintained in the face of ongoing challenges. Six parents discussed the challenges they continued to face after the diagnosis and\/or their resilience, positive attitude, and sources of support navigating this journey.  Fatima discussed ongoing difficulties balancing her children\u2019s needs. For her, it has been extremely taxing to navigate caring for her two children who both have special needs and also attend different schools. She recalled one day where she was in a language class and got a call from her son\u2019s counsellor telling her to come to school to address his behaviours. At the same time, she got a call from her daughter\u2019s school telling her to come for a meeting. In times such as these, she felt completely overwhelmed. She explained that after the diagnosis, parents still need support: \u201cfor me, I\u2019m still need extra help. I call her social worker yesterday and I asked for meeting. I asked for help because still I'm need.\u201d She explained that navigating the support systems is also difficult, and she often has to talk to many people before she gets the information she needs. It is also difficult for other people to understand her children and for her to explain her children\u2019s challenges to others.  In order to deal with these ongoing challenges, Fatima models strength and resilience to her family. Although things are \u201cvery hard\u201d \u201cwe just keep going,\u201d she said. She explained that \u201cyou need to work with what you have if you have difficulty.\u201d She elaborated that the diagnosis    99 \u201cis not end, this is life.\u201d And \u201clife not easy for everybody.\u201d Fatima teaches her children to be strong and resilient:  But we need to be strong [\u2026] Kids they need to be knows, how can they be strong? When I told my daughter, \u201cYou smart girl, you strong. We can do it\u201d. Today we run to the school. She was mad. She need the car because her dad always drop her with the car. [\u2026] She don't like to walk. She get tired sometimes, she says, \u201cOh, I will not able to walk\u201d or sometimes hard for me. [\u2026] But today I told her, \u201cYou\u2019re strong, you need to be run\u201d. She start to run with me, until that she gets her tired. I just wait for her. [\u2026] I gave her time; I told her you strong. You can run; you can walk. Don't wait for me to hold you. No, this time we go just by walk and run if you have just you need to run with me. And she do it. Likewise, she works with her son on emotion regulation strategies:  This year I work hard with him always if we have a difficult time when we play soccer or when we play anything. I always told him when you get very, very angry, you need to break, break down, leave what you have just go, talking with yourself, I am okay. Fatima chooses to focus on her children\u2019s strengths instead of labels in order to avoid internalizing negative stigma. She discussed that she does not like her children hearing their diagnoses or speaking about their challenges. She tells her children, \u201cDon\u2019t believe what other people they saying,\u201d she tells her son: You don\u2019t have nothing. You very good and you\u2019re smart. Focus in your learning and don\u2019t look to other teacher or other people they\u2019re saying, \u201cOh you have angry issue or you have something different than the other kids.\u201d I tell them always, don\u2019t keep it in    100 your brain. Just forgot what you hear and keep going. And you\u2019re very good. You\u2019re excellent. You\u2019re doing good job. Amara also avoids diagnostic labels because she does not want the word \u2018anxiety\u2019 to be at the forefront of her daughter\u2019s thoughts or identity. She explained that anxiety is \u201ca negative word, and I don\u2019t want her to listen to that word [\u2026] she\u2019s too little and too young to hear this word.\u201d Instead, she prefers to talk about emotions in general, explaining that her daughter \u201cknow[s] what emotion is [\u2026] and that will help her\u201d since it is a \u201cbetter fit to her actions, rather than saying anxious.\u201d  For Grace, an ongoing challenge has been the obstacles to inclusion within educational settings. She shared that many caregivers and educators are not well informed about neurodiversity. In her experience, daycares are businesses that often take a one-size fits all approach. \u201cThe kids that don't fit there, they need to move. It's not the center that's going to change,\u201d she said. She also shared that inclusive education, interventions, and accommodations are effective, but are often not possible due to limited resources: \u201cIt's almost like your environment needs to be a little bit flexible ... and like, how do you do that in in a classroom with 30 kids and one teacher?\u201d Grace reflected that many mental health challenges neurodivergent children face may be due to exclusion rather than neurodivergence:  a lot of the issues that come up later, it it's not really due to your neurodivergence. It's due to you feeling different? And then how people around you are treating you, for something that you don't even realize and don't know how to change and really, you shouldn't be changing it, right?    101 Grace\u2019s own research and reading has helped her understand the assessment and diagnosis and move through these challenges. In Diego\u2019s case, he emphasized that having a supportive partner is important to work through the inevitably challenging aspects of the diagnosis.  Melissa and Fatima discussed their belief that things change over time, which provides hope for the future. Fatima tells herself and her children that nothing is final or definite and that things always change and evolve. In her words: \u201cEverything continue; everything keep going.\u201d She shared that assessors cannot know everything, and while she appreciates their opinion, she sees the diagnosis as a partial truth that can change through hard work:  \u2026don't believe one hundred what the doctor say because [\u2026] I think they knows 30% not 50\/50 or not 100. They got what they seen and what they have the assessment, but sometimes when we work them hard to change something, it would be fine. We will change, we will fix, we will be okay, nothing. (Anisa: mhm) I think. I agree, I'm not agree. You know, half and a half. For myself, half and half. It's still the three years. They knows what they culture or what they talk or what they\u2026 (Anisa: Observe?) Yeah, but still I'm not agree, because something changed. Something coming it will be fine. With these beliefs in mind, Fatima encourages her children not to take the results to heart and instead to focus on self-growth. Melissa also discussed the same idea. She shared that the assessment is \u201cjust initial diagnosis and initial psychoeducational assessment,\u201d but that psychologists should \u201cnever sound definite\u201d because \u201cnobody knows\u201d for certain.  When discussing challenges that parents face after the feedback meeting, Rashmi identified \u201ca need not only for psychosocial support to these parents, but there's also a need for opportunities for parents to connect with each other without their children.\u201d She suggested:    102 there needs to be something where parents have respite [\u2026] or a place that they could drop off their kids on site while they go have counseling or meet with other parents.  Joining or starting support groups is one way that several parents found support for the challenges they faced. To address the concerns she identified, Rashmi demonstrated strength by starting a support group for parents with neurodiverse children. She described how parents were eager for any information:  when I was like, \u201cOkay like tell me what do you guys want?\u201d Everyone's like, \u201cAnything, we have had zero contact with any other family who has any idea what we're going through\u201d, and I'm like, \u201cOkay, well, I want to bring in an expert for like, a topic every week or every month, and what are the topics?\u201d they're like, \u201cAnything. Like, we're starved for information. We have no idea,\u201d you know? Amara, David, and Grace also spoke about parent networks being a source of support. In Amara\u2019s case, she joined Facebook groups and noted:  there are like a bunch of mom groups on Facebook and stuff and people post and just reading through that, and kind of saying, \u201coh, I'm not alone in the journey.\u201d [\u2026] there are more fish in the pot than just one, right? There are so many fishes and then they kind of swim together and they kind of feed off each other David shared that parent networks and support groups have shaped his perspective of the diagnosis and are a place where parents \u201cshare resources among ourselves.\u201d Specifically, joining a geographically based group of Taiwanese dads of children with autism was extremely helpful and provided a sense of community. He noted that he felt \u201cpretty lucky\u201d to meet other parents and make \u201cfriends\u201d who are in \u201ca similar situation\u201d and had a \u201csimilar background\u201d and have    103 \u201csimilar interests.\u201d Grace also discussed geographically based Facebook groups being helpful in navigating the system of support services.   Rashmi suggested that systems could be put in place to exchange or donate equipment between families who have neurodiverse children:  \u2026the ministry is paying for all this, equipment and stuff that we get and you know, [\u2026] so we've got all these chewies that the government paid for essentially with the autism funding. But now we have all of them and he's not really using them anymore. We could take our things that the government provided and somehow give them to another family with autism. Somehow package them to give to a program in a developing country as tools that they could use [\u2026] there should also be some kind of exchange facilitated thing [\u2026] someplace like a store where you could just go and a free store for things with people who have learning disabilities, ADHD, whatever, all those things, you know. Similar to Rashmi, Melissa discussed that because she \u201cunderstand[s] very much what other families are going through\u201d and \u201cunderstand[s] that barriers as well,\u201d she \u201cbecame an advocate for these families.\u201d Parents demonstrated strength and resilience when, despite their own ongoing challenges, they helped and advocated for other families going through similar experiences.  Evolving Perceptions Nine parents spoke about how their perceptions of the diagnosis have changed (or remained constant) over time. After the feedback meeting, Stephanie recalled doing \u201ca lot of research and reading\u201d to find out more about her daughter\u2019s dyslexia diagnosis. She found the research and success stories reassuring. In particular, stories about famous dyslexic people provided hope. As Stephanie learned more, she began to focus on how to help rather than    104 worrying about the future. She also thought about how to harness her daughter\u2019s strengths and remembered thinking, \u201cokay she is smart. And she's very determined [\u2026] so I'm like, okay, you know, we gotta make it work.\u201d Moving schools helped Stephanie\u2019s daughter because it was a \u201cplace that accept[ed] her for who she is\u201d and supported her learning appropriately. Soon, Stephanie observed that \u201cactually, she\u2019s improving and she\u2019s making changes.\u201d Slowly, Stephanie moved from fear to acceptance, seeing the diagnosis as an important piece of her daughter\u2019s identity and resilience.   Melissa also discussed how her perception of the diagnosis changed \u201cdramatically\u201d through research, experience, and education. She expressed that she\u2019s \u201cbecome an expert,\u201d has \u201cread every single article [\u2026] I encounter about autism\u201d and she even became \u201can autism service provider\u201d in order to help her son and other families going through the same thing. As she learned more, she learned not to reinforce harmful behaviours. Additionally, she considered that she may also have autistic traits, \u201cI knew that my family was a bit quirky. I felt really looking at myself, maybe I have autism.\u201d  Rashmi also identified that her perception of the diagnosis \u201chas definitely changed.\u201d She discussed constantly learning more, working on getting the language around autism right, and is still \u201cfiguring all that out.\u201d She reflected on small changes she has had to make in her own life such as \u201cbecom[ing] a planner\u201d instead of being her spontaneous self. Overall, she is still learning to balance teaching her neurodiverse child to function in society and find a sense of belonging while encouraging him to be his authentic self: that balance between seeing how much of my child's individuality do I retain, and how much do I mainstream them into believing- essentially the way that I look at it is that you have Maslow's hierarchy of need, and the first thing is belonging. So, if my child    105 can feel they belong in a mainstream society, fantastic! That's the first step to being themselves. And so, if that means that we teach him how other people behave so that he could behave a little bit similar to other people, by kind of rewiring some of those- you know, using the high neuroplasticity at this day and age? Okay, well, we'll do that so that he could potentially blossom Grace spoke extensively about navigating ingrained stigma around neurodivergence. She explained that \u201cgrowing up, it wasn\u2019t really referred to as oh your brain is wired differently. It\u2019s more like your brain is wrong.\u201d Because of generational and cultural stigma towards autism, she previously believed that neurodivergence was a deficiency. In addition, attending Canadian schools growing up, she recalled:  I perceived it as almost like a life sentence of exclusion, right? Because I'm referencing what I know, and it was the special needs group, of the class of the school, you know, always specialized programs like very rarely with the rest of the group.  For Grace, she assumed that \u201cthe learning curve was so steep\u201d because she was never around neurodiverse children as an adult and because of this ingrained \u201cstigma.\u201d Nonetheless, transformation of her perspectives on the diagnosis occurred over time through ongoing learning and through observing intervention services. For example, she learned about the power of observation, which was a huge shift in perspective:  \u2026you need to observe, like, really observe, not ask, because the verbal is not there. The self-awareness is there is not there. He's not going to tell me, right? Not at that age. Probably not even at this age. Someone needs to observe without intervening, like what trigger that meltdown. What triggered this conflict? Because it did not just appear out of nowhere, it looks like it appeared out of nowhere because no one was watching and he is    106 not able to tell you, you know. So, that really opened my eyes and I try to spend as much time as I can watching and also, asking the right questions. In addition, she learned that the environment plays an \u201cimportant role\u201d in supporting neurodivergent children. Grace explained that her perspective on autism has completely changed through witnessing the cultural shift towards inclusivity:  I think a lot of stigmatism surround neurodivergence of any kind [\u2026] It has a negative connotation, right? That it\u2019s inferior\u2026 and cannot be\u2026 remedied. Not be accommodated [\u2026] and really, my eyes have been open because, it's not the case at all, you know, and I do see the shift ... that happened in schools and just even workplaces. Like in the community, focus on inclusion is a lot more prominent.  Diego explained that learning about the diagnosis has made him \u201cmore knowledgeable\u201d and he shared that his perspective \u201chas definitely changed.\u201d David said that \u201cover the past eight years, definitely learn a lot more about autism.\u201d He shared that, \u201cthe more I learn about it, the more positive I think I feel.\u201d Social media is one reason David identified for his change in perspective. David and Diego both spoke about how interacting with neurodivergent children has helped them understand their own child. David explained,  you understand more about how other kids in the spectrum behave and then you can compare, and then see, oh, yeah my son is progressing well on this level (Anisa: mhm mhm) and versus ... there's still things he needs to ... have more progress on Overall, David shared:  After all these years, the more you learn, the more accepting you- I have become, right? In knowing that, yeah, that\u2019s just the way he is, and he may take longer to get to the    107 similar level compared to his peers [\u2026] But he may still get there, he may not get there, but we'll have plans for him.   In contrast to the other parents, Henry, Layla, and Amara shared that their perspectives of their child\u2019s diagnosis have remained consistent over time. However, Layla shared that she is still \u201clearn[ing] more about\u201d it, and while Amara\u2019s \u201cperception has stayed the same. It\u2019s more dealing with it that has changed.\u201d She shared that in \u201cbeing a first-time mom\u201d and \u201cbeing new to all this,\u201d she is learning and growing alongside her daughter.  Chapter Four Summary   In this chapter, participants\u2019 experiences in the feedback meeting were explored through the five superordinate themes and 19 subordinate themes that arose from the data. Participants spoke about both their positive experiences in the feedback meeting, as well as the challenges they faced. Participants appreciated clear and detailed explanations, when clinicians demonstrating their care through their actions, and when clinicians guided them through the next steps. In addition, the clinicians\u2019 personal characteristics, including their expertise, experience, and personal demeanour (e.g., being calm, kind, respectful, and honest) established trust and provided comfort to parents. In contrast, many parents spoke about the information in the feedback meeting being overwhelming and explanations being inadequate. For some, the clinical approach in the feedback meeting felt impersonal, and uncertainty around their child\u2019s prognosis was difficult to accept. Furthermore, several parents had doubts about the assessment and\/or had differences in opinion to the assessing clinician. The impact of culture and language was also discussed by all participants. The identification of intersectional barriers for immigrant parents was discussed, including navigating cultural stigma and challenges accessing communities of support. Participants also discussed navigating cultural differences with the psychologist. While    108 some parents were very aware of these differences, others experienced cultural alignment or did not feel that culture played a significant role within the feedback meeting. Several parents also had to navigate language barriers within the feedback meeting. In addition, some participants felt that their culture was not considered in the feedback meeting, which was identified as an issue for some and was not an issue for others. All participants discussed the complex emotions they experienced when hearing news of their child\u2019s diagnosis. Common emotions included anxiety, uncertainty, relief, understanding, overwhelm, upset, and being shocked only by unexpected news. Participants also shared their journey beyond the feedback meeting. Several participants discussed the benefits of the diagnosis as well as the insufficient support for navigating next steps after the assessment was complete. While many participants faced ongoing challenges, they also discussed their strengths and hope when navigating these difficulties. Finally, participants discussed their evolving perceptions of the diagnosis over time.       109 Chapter Five: Discussion Chapter Two Overview  The purpose of this chapter is to summarize and discuss the results of this study in the context of the literature. Next, I examine the significance and implications for school psychologists, along with the strengths and limitations of this study. Based on the study results, future research directions are explored. The chapter ends with a conclusion of the present study.   Discussion of the Results in the Context of the Literature Overview The current study provides an in-depth look at the experiences of 10 immigrant parents upon hearing news of their child\u2019s diagnosis. Interpretative phenomenological analysis was used to investigate the research question: what are immigrant parent experiences of receiving their child\u2019s diagnosis within the psychoeducational feedback meeting? Transcripts were analyzed, and individual and group-level themes were inductively derived from the data, resulting in five superordinate themes and 19 subordinate themes. Each of the five superordinate themes, positive experiences, challenges and doubts, impact of culture and language, emotional reactions, and journey beyond the feedback meeting, are discussed in the context of the literature below. The experiences of immigrant parents when hearing news of their child\u2019s psychoeducational diagnosis have not been explored in previous studies; thus, this study offers novel insights into the experience of this population.  Discussion of Positive Experiences  All parents discussed their positive experiences during the feedback meeting. Parents identified clear and detailed explanations as an important component of the feedback meeting, including using plain language, not rushing, explaining new terms, using real-life examples, and    110 providing visuals and summaries. Various authors have also highlighted clear communication as central to the success of the feedback meeting, including using clear and concise language (Glazer, 2014; Pollack, 1988), eliminating technical language and jargon (Dombrowski, 2020; Glazer, 2014; Lichtenstein & Ecker, 2019; Scipioni, 2014), avoiding discussion of numbers, and using real-life examples (Drombowski, 2020; Lichtenstein & Ecker, 2019; Scipioni, 2014). Notably, two parents in the current study reported that using scores and (what they called) statistics helped them understand the results. On the other hand, some parents found numbers confusing and unnecessary. The two parents who appreciated discussion of numerical scores had completed undergraduate or graduate-level education, suggesting that educational levels and personal preferences may influence the utility of using numerical scores in the feedback meeting. Parents also appreciated detailed explanations, consistent with previous research (Hasnat & Graves 2000), that found that parents were more satisfied with diagnostic disclosures when more, rather than less, information was conveyed, even if they initially found the amount of information overwhelming. Having adequate time to ask questions was also highlighted by parents and is reflected as another important aspect of feedback in previous research (Davey et al., 2022; Drombowski, 2020; Glazer, 2014; Makino et al., 2021; Pollock, 1988; Scipioni, 2014).    In the current study, parents felt particularly cared for when the psychologist demonstrated care through their actions, such as offering follow-up meetings, advocating for the child, meeting with school staff, and demonstrating an understanding of the family\u2019s unique circumstances. While not identified as an overarching theme in previous research, aspects of this concept have been identified in the literature. For instance, previous authors theorized that taking a flexible approach and understanding parents\u2019 values and background are important components of successful feedback meetings (Lichtenstein & Ecker, 2019; Pollock, 1988; Tharinger et al.,    111 2008). In addition, in a study that explored the experiences of mothers whose child(ren) received a psychoeducational assessment, parents appreciated when psychologists prioritized the child\u2019s needs ahead of the needs of the school (Scipioni, 2014).   Participants in the present study appreciated it when the psychologist they worked with supported them through the next steps, including giving helpful recommendations, referrals, and resources and guiding them through paperwork to access funding. Previous research has also identified guiding next steps as important when delivering diagnostic news to families, such as tailoring recommendations and suggestions about appropriate interventions (Baile et al., 2000; Makino et al., 2021; Scipioni, 2014).  Finally, the psychologists\u2019 personal characteristics such as education; expertise; experiences; personal demeanour including being calm, empathetic, respectful, honest, caring, considerate, and gentle; and being professional, strengths-based, and reassuring helped establish trust and comfort for participants. Similar personal characteristics have been identified in previous research. In general, being empathetic and warm (Glazer, 2014; Merkel, 2010; Makino et al., 2021; Scipioni, 2014), showing respect (Glazer, 2014; Park et al., 2001), and highlighting strengths (Glazer, 2014; Merkel, 2010; Makino et al., 2021; Scipioni, 2014) came up as common qualities of importance across related research. In the current study, being calm, respectful, and professional were identified as particularly important qualities. In addition, maintaining a careful balance between being gentle and honest was a factor mentioned in previous research (Drombowski, 2020; Lichtenstein & Ecker, 2019; Pollock, 1988), which was also identified as a determinant of satisfaction for two of the parents in the present study. Overall, many of the positive experiences parents identified in this study are consistent with prior research. Discussion of Challenges and Doubts    112  In addition to highlighting positive experiences in the feedback meeting, parents discussed many areas of challenge, including being overwhelmed or receiving inadequate explanations, feeling doubt or disagreeing with the psychologist, and being uncertain about the diagnostic prognosis. The feedback meeting was often overwhelming due to the large amount of new information, and explanations were sometimes confusing and unclear. In particular, jargon and technical language were challenging to digest. Furthermore, parents had a difficult time understanding when the clinician spoke quickly or when they had a heavy accent. Understanding accents and rapid speech may be particularly challenging for immigrant parents who speak English as a second language. When overwhelmed, parents found it more challenging to think of questions, and some mentioned they did not feel comfortable reaching out with questions after the feedback was complete. Unclear and overwhelming explanations were common themes in previous research on feedback meetings (Davey et al., 2022; Makino et al., 2021; Scipioni, 2014; Sheets et al., 2012). While overwhelming explanations seem to be a shared experience regardless of immigrant status, it may be particularly true for immigrant parents who have to navigate cultural and linguistic differences.   Several parents also expressed doubts, discontent, and differences in perception from the psychologist regarding the assessment results. When parents had doubts about one aspect of the feedback, this often made them question the diagnostic conclusions as a whole. On a few occasions, doubts arose when there was a misalignment between the psychologist's and parent's perceptions or expectations. Additionally, some parents noted that a lack of knowledge about the assessment process led to doubts about the validity of the results. Prior research found that Hispanic families (versus non-Hispanic White families) had a harder time accepting and processing their child's autism diagnosis (Ferguson & Vigil, 2019). In a study of Asian mothers    113 of children with developmental disabilities, many mothers had doubts about the assessment but followed the clinician's advice regardless of their doubts (Jegatheesan, 2009). This phenomenon was also reported in the current study; regardless of their doubts, parents reported following the psychologists' recommendations. Jegatheesan (2009) found that parent compliance was due to trusting the professional and their expertise, not wanting to offend the professional, and feeling ashamed about their lack of understanding. While parents in the current study did not speak about feeling ashamed for not understanding, some discussed not voicing their doubts because they did not want to offend the psychologist and they trusted the professional's opinion. In terms of discontent, taking an overly clinical and formulaic approach was mentioned by a few parents, who wished that clinicians would take a more empathetic and individualized approach. This is consistent with previous research which identified that parents were unhappy when professionals constantly looked at their child from a medical perspective and focused on the negative deficits of their child (Jegatheesan, 2009).  Another challenge noted by parents was the uncertainty around the prognosis of the diagnosis. Consistent with previous research, parents often worried about what the diagnosis would mean for their child's future, and when this was unclear or the diagnosis was inconclusive, it was more difficult to accept. This is similar to findings in Scipioni's (2014) study, which found that parents were concerned about the future and often felt like they had unanswered questions in the feedback meeting (Scipioni, 2014). Makino and colleagues (2021) also reported that parents had a difficult time accepting autism diagnoses that were uncertain or suspected.  Discussion of the Impact of Culture and Language  Parents discussed the various ways that their culture and linguistic background impacted the feedback meeting. This included intersectional barriers, cultural differences between    114 themselves and the psychologist, a lack of cultural consideration within the feedback meeting, and language barriers. Around half of the parents discussed the intersectional barriers and challenges that they encountered, including financial challenges, compounding stressors, cultural stigma, and accessing communities of support. This is supported by previous research which identified that immigrant parents in Canada may face systemic barriers and stressors when accessing services related to early childhood development and raising children with developmental disabilities including financial stressors, cultural and linguistic barriers, social isolation, stigma and discrimination, legal status, and more (Brown et al., 2020; Khanlou et al., 2015b). In the present study, greater intersectional challenges seemed to be associated with greater challenges in accepting and processing the diagnosis.  Another common intersectional challenge explored by parents was accessing communities of support. Some parents described lacking a support system in Canada because their friends and family were in their home country. Others experienced rejection from their local cultural community due to stigma and misunderstanding about their child's challenges. These challenges are consistent with prior research which posited that immigrant families may face social isolation due to leaving behind strong social networks and because of stigma about their child's diagnosis from within their own support system (Daudji et al., 2011; Jennings et al., 2014; Kramer-Roy, 2012 as cited in Khanlou et al., 2015b). Parents in the current study also worried about sharing the diagnosis within their own families in some instances due to cultural stigma. In these situations, grandparents were more accepting of the diagnosis than initially expected and ended up being strong sources of support. These fears about familial stigma were consistent with a previous study on autism and stigma in South Asian families, which found that parents feared    115 stigma, even from those closest to them (Shafi et al., 2024). These examples illustrate immigrant parents' challenges in the feedback meeting and beyond due to intersectional barriers.   Some parents in this study were conscious of cultural differences between themselves and the psychologist, while others were not. Those who were conscious of these cultural differences appeared to experience cognitive dissonance due to differences in cultural expectations and norms. According to Tharinger and colleagues' (2008) model for providing feedback, information that does not align with the family's beliefs or ways of thinking about their child is more likely to be anxiety-provoking and enact defence mechanisms. Despite their likely discomfort, none of these parents voiced their concerns to the psychologist and preferred to reconcile cultural differences for themselves. In some cases, they believed it would be rude and confrontational to bring their perspective up to the psychologist, who was viewed as the expert in this context. As discussed in the proceeding section, an unwillingness to voice disagreements or doubts may reflect cultural perceptions and values about interacting with professionals (Jegatheesan, 2009).  Several parents indicated that they perceived that the psychologist did not consider their culture. Some parents wished their culture was better understood and discussed with the psychologist, while others said they were glad their culture did not influence the assessment. Parents who did not perceive their culture as playing a role in the feedback meeting appeared to have higher levels of acculturation to Western culture, including a longer time spent in Canada and more fluency in English. Perhaps these parents felt sufficiently acculturated to the mainstream culture and did not want to be treated differently by being asked extensive questions about their culture. Alternatively, parents may have viewed the diagnostic process as a medical process detached from culture. Previous literature has underscored the benefit of understanding    116 parents' cultural background (Lichtenstein & Ecker, 2019). Parkin and Tyre (2021) discuss the need for clinicians to build trust and demonstrate an understanding of parents' values and beliefs to communicate effectively. Furthermore, Tharinger and colleagues (2008) discussed how some information presented in the feedback meeting may challenge or modify the family's beliefs about their child, which are the most challenging aspects to navigate. Additionally, Lichtenstein and Ecker (2019) emphasize the need for clinicians to understand parent's perceptions and beliefs about the diagnosis and to tailor the feedback based on the existing understanding. Tailoring the feedback appropriately requires the clinician to understand the parents' culture and belief systems in order to provide individualized information and support. Results in the present study demonstrate that immigrant parents have different perceptions about the role of culture in the feedback meeting, highlighting the need for a tailored and responsive approach.  Language barriers were also discussed by several parents for whom English proficiency posed a significant challenge. Unfamiliar and technical terms were particularly challenging to understand. Parents who were newer to Canada expressed that they were often confused during meetings with the psychologist and perceived that they missed key information. While having an interpreter was noted as vital for two of the parents, using interpreter services also came with challenges, such as inconsistent services, cost, and longer meetings that were challenging to balance with family needs. Language barriers are a common theme identified in previous research with culturally and linguistically diverse parents in the contexts of assessments and accessing services (Kim et al., 2023; Khanlou et al., 2017; Jegatheesan, 2009; Shaft et al., 2024).  To conclude, culture and language impacted parents in different ways. While some of the results of the present study were consistent with previous research, some findings were novel as    117 there is limited research on the experiences of immigrant families within the psychoeducational feedback meeting.  Discussion of Emotional Reactions  In the current study, parents had a range of emotional reactions when told their child's diagnosis, including anxiety, uncertainty, relief, overwhelm, understanding, upset, and shock (when the diagnosis was unexpected). Previous research about diagnostic disclosures has also discussed a range of positive and negative emotions that parents experience (Davey et al., 2022; Makino et al., 2021; Merkel, 2010; Scipioni, 2014). Scipioni and colleagues (2014) identified that when parents heard news of their child's psychoeducational diagnosis, some felt hopeful while others felt lost and hopeless. While hopelessness was not an emotional experience identified by participants in the current study, some parents had a stronger emotional reaction than others. Generally, those who were newer to Canada, who were not expecting the diagnosis, and\/or were mothers tended to report stronger emotional reactions than those who had been in Canada longer, expected the diagnosis, and\/or were fathers. Although participants in the current study did not explicitly explore gender roles, fathers in the study generally took a problem-solving approach and focused on the next steps when told the diagnosis. More research is needed to understand the factors that influence the intensity of parents' emotional reactions.  In a scoping review of parent's experiences with their child's autism diagnoses, parents reported the disclosures to be emotionally intense, including feeling relief, shock, sadness, isolation, and guilt (Makino et al., 2021). These emotions were also reported in the current study. While the word guilt was not mentioned, several parents wondered if they were to blame for their child's diagnosis, implying emotions of guilt or shame. Parents also identified feeling relief and understanding of their child's behaviours and challenges. Similar emotional reactions were    118 reported in a study on parent's experiences of hearing their child's anxiety diagnosis (Davey et al., 2022). Likewise, Merkel (2010) identified emotional experiences as one of three key themes for mothers when finding out their child's psychoeducational diagnosis. In Merkel's (2010) study, emotions experienced included shock\/overwhelm, upset\/sadness, guilt, uncertainty\/worry, and validation\/pride. Many of these themes mirror the emotions experienced by immigrant parents in this study, although feelings of validation or pride were not commonly expressed. Additionally, parents in the current study only reported feeling shocked when the diagnosis was unexpected. In most cases, parents explained that they were expecting the diagnosis, so they were not shocked or surprised. Similar to prior research, results indicate that immigrant parents felt complex emotions when told their child's psychoeducational diagnosis.  Discussion of the Journey Beyond the Feedback Meeting   Parents in the current study discussed their journey beyond the feedback meeting, including the benefits of the diagnosis, challenges navigating the next steps and support services, strength and hope despite ongoing challenges, and their changing perceptions of the diagnosis over time. Similar to previous research (Davey et al., 2022; Makino et al., 2021), parents reflected on the benefits of the diagnosis, including increased access to support services and accommodations for their child. At the same time, several parents indicated that there was insufficient support for navigating the next steps. Accessing appropriate support services was an ongoing challenge for parents, who perceived that navigating support systems and accessing funding was an overwhelming task. Prior research has identified that immigrant parents face additional intersectional stressors and barriers in accessing support (Brown et al., 2020; Khanlou et al., 2015; Khanlou et al., 2017; Kim et al., 2023), which likely contributed to parent's challenges navigating these systems. Language barriers are noted in the literature as a particular    119 hurdle (Ferguson & Vigil, 2019; Khanlou et al., 2015a). Parents in the current study who faced language barriers reported challenges accessing supports; however, even parents fluent in English reported challenges navigating complex systems. In addition to language and communication barriers, Khanlou and colleagues (2015a) propose that navigating new and complex systems, excessive paperwork, dispersed services, cultural differences, and limitations of services are all factors that impact immigrant parents' access to support services for their children with disabilities.  While many parents identified ongoing challenges, they also discussed their hope and resilience. For example, some parents spoke about taking a strength-based approach and maintaining hope that change will occur over time. Other parents discussed how they prefer to avoid using diagnostic labels with their children. A similar finding was found by Kim and colleagues (2023) in their study of Korean immigrant mothers and their child's autism diagnosis. Participating in support groups was another way immigrant parents found strength and support. The benefits of support groups were briefly noted in a study of mothers' experiences with their child's psychoeducational diagnosis (Merkel, 2010); however, they were not often mentioned in prior studies looking at the experiences of culturally and linguistically diverse parents of children with developmental disabilities. Several parents in the present study discussed how they have become advocates for other parents, such as offering to translate for other parents, initiating support groups, or pursuing education and a career to support children with disabilities. Immigrant parents finding hope and strength by becoming advocates for other parents is a unique finding of this study.  Parents' perceptions of the diagnosis tended to change over time, although some reported that their perceptions stayed consistent. Changing perceptions occurred through learning,    120 research, and experience. In general, parents in the present study reported that they became more knowledgeable, better understood their child, and developed a more positive perception of the diagnosis over time. Some parents also discussed how they have slowly broken down their ingrained stigma, developed a strengths-based perspective, and adjusted their own lives to better suit their child's needs. Results reflect Lichtenstein & Ecker's (2019) supposition that clinicians should view the feedback as a continuous process that does not end with the meeting. Parents' perceptions continue to change over time, and the feedback meeting is simply one part of that journey.  Summary of Thematic Discussion  This study provides a unique contribution to the literature by specifically examining the experiences of immigrant parents in Canada when hearing news of their child's psychoeducational diagnosis in the feedback meeting. The results highlight the complexity of the feedback meeting and the nuanced and diverse experiences of immigrant parents. Throughout the analysis there were many instances of convergence and divergence within each superordinate and subordinate theme. While the commonalities in these parent experiences can be used to inspire change and reflection in psychologists' practices broadly, the differences in each parent's experiences highlight the importance of tailoring feedback to unique family circumstances and needs.  Implications for School Psychologists  Due to the qualitative and idiographic nature of the study, it is important to note that the results cannot be generalized to all immigrant parents. However, school psychologists can examine the characteristics of the sample and determine transferability; that is, they can decide if the findings may be relevant to their work with specific clients. The findings of this study have    121 important implications for school psychologists and other clinicians who conduct psychoeducational feedback meetings with immigrant parents. Clinicians may glean numerous ideas from this study about what is helpful and unhelpful when conducting feedback meetings with immigrant parents. One of the most striking insights from the current study is the need to individualize the feedback meeting based on unique family needs. Nonetheless, overarching patterns certainly arose and are helpful to examine.  Based on the positive and the challenging experiences shared by parents in the current study, clinicians should take care to deliver feedback in a clear manner that it is not overwhelming. This includes eliminating jargon, using real-life examples and anecdotes, providing time for check-ins and questions, using summaries and visuals, explaining new terms, being responsive to parent requests, and balancing detailed explanations with key messages. Trust may be established through the clinicians\u2019 personal characteristics. Demonstrating expertise and credibility may help immigrant parents feel comfortable. In addition, clinicians should strive to be calm, gentle, welcoming, respectful, kind, passionate, strengths-based, empathetic, professional, reassuring, attentive, honest, and considerate. Parents in the study especially emphasized the importance of demonstrating expertise and being calm, professional, and respectful. Additionally, parents in the present study found it challenging to understand when the clinician spoke quickly or had a heavy accent, so clinicians should take care to enunciate, speak at a steady pace, and not rush. Participants also reported that the overwhelming information made it difficult to think of questions during the meeting, especially when the feedback meeting felt rushed. Therefore, in addition to providing time within the feedback meeting for questions, clinicians should encourage parents to reach out with additional questions after the feedback meeting and\/or offer a follow-up meeting. To help frontload and prepare    122 parents for the meeting, being clear about its purpose and providing an agenda may be helpful. Additionally, some parents may appreciate hearing the diagnosis at the beginning of the meeting, while others may benefit from hearing it at the end. In the present study, clinicians made a particularly positive impression on parents when they demonstrated their care through their actions. For example, offering to speak with school staff or the child, advocating for the child within the school system, and demonstrating an understanding of the family\u2019s unique circumstances and challenges.  To avoid parental doubts and discontent, clinicians are encouraged to give parents space to voice any concerns and ask clarifying questions to address doubts and any inconsistencies with previous experiences. Further, if trust is broken due to misunderstandings, efforts should be made to mend the relationship and rebuild trust. Finally, clinicians should offer realistic and reassuring information about future prognoses when possible. Finally, guiding the next steps is an important component of the feedback meeting. Providing resources and recommendations, assisting with paperwork, and making referrals to allied health professionals are examples of helpful ways school psychologists can guide the next steps.   When working with immigrant parents, the current study demonstrates that it is important to consider the family\u2019s culture and language in the feedback meeting. Immigrant parents may face additional barriers in the feedback meeting due to intersectional stressors; therefore, explaining the process of the feedback meeting, frontloading, and building trust is vital to increase parents\u2019 feeling of comfort. Based on the results of the current study, intersectional stressors, including cultural stigma about the diagnosis, may contribute to challenges in processing and accepting the diagnosis. It is also important to consider parents\u2019 access to support systems, as immigrant parents of children with disabilities may face unique barriers in accessing    123 communities of support. Furthermore, the results of the present study illustrate the need for reliable interpreter services to ensure parents understand the results and next steps, thereby ensuring their children have access to adequate supports. The findings in the present study suggests that acculturation level plays a role in parent perception of culture and its role in the feedback meeting. School psychologists may find it helpful to spend more time discussing culture and cultural differences with immigrant parents who are newer to Canada and\/or are less acculturated to the mainstream culture. Notably, not all parents in the present study wanted their culture to play a role in the assessment or feedback meeting. Different experiences and desires demonstrate the diversity of perspectives that immigrant parents have about the role of culture in diagnostic decisions and the assessment process. Some parents may be confused if clinicians spend a lot of time discussing their culture, as they may see it as irrelevant to the process or even an indication that they are being singled out and treated differently than their Western counterparts. Thus, it is important for the psychologist to take a curious and open perspective, explain the rationale for asking about culture, and then let the parents decide if it is something they wish to discuss in more depth. Ultimately, this is a complex issue that requires care and discernment.  School psychologists should also be aware of the complex emotions that parents often experience when hearing news of their child\u2019s diagnosis. Emotional reactions may vary greatly based on many factors such as culture, severity of the diagnosis, whether or not the diagnosis was expected, stigma and understanding of the diagnosis, compounding stressors, gender roles and more. It is key for school psychologists to be responsive to emotional reactions, to help parents co-regulate by remaining calm, and offer reassurance and empathy as they navigate these complex emotions.    124 Lastly, it is helpful for clinicians to think ahead and consider parents\u2019 journey beyond the feedback meeting. Many parents felt overwhelmed when navigating support services and reported that figuring out how to best support their child is an ongoing struggle. To the extent possible, school psychologists should guide the next steps, assist with paperwork, and provide referrals to appropriate services. Referrals to support groups may be beneficial, particularly with parents who have a shared cultural and linguistic backgrounds. Furthermore, connecting parents with ways to give back, advocate, or connect with communities of support may provide a healthy coping strategy. School psychologists should encourage parents to take a strengths-based yet realistic perspective about the future. This may be accomplished by sharing information within the feedback meeting as well as providing additional information about the diagnosis (e.g., a slide deck or info sheet that is separate from the report). Finally, school psychologists should realize that the parents\u2019 perceptions and understanding of the diagnosis will continue to change over time. The feedback meeting should be viewed as an important stepping stone in the family\u2019s journey on a new path. Limitations and Strengths   The current study had specific strengths and limitations. Both a strength and a limitation of this study is the diverse sample, which included immigrant parents from many backgrounds, representing eight countries across three continents. This diversity enhanced the richness of the data and allowed for a broad look into the experiences of immigrant parents. However, heterogeneity in the sample meant that exploring all the commonalities and differences among participants was more challenging. As a result, the analysis required multiple subordinate themes to adequately capture the experiences of the group. Consequently, the reader may need to engage in a closer reading of the analysis to extract meaning that can be applied to practice. Nonetheless,    125 the methodology aligned well with the research question, allowing for an in-depth and detailed look at the participants\u2019 experiences. Given that two interviews were conducted with each participant, there was additional time to build rapport and trust and time for parents to reflect on their experiences between interviews. The abundance of data, along with the time to reflect and build trust, resulted in in-depth and thick descriptions of parent experiences, leading to a rich analysis and detailed themes.  Background information was gathered about participants including their age, occupation, highest-level of education, and their child\u2019s sex and gender. This information was used for descriptive purposes to understand the participants within their context, rather than as part of the analysis. However, a limitation may be that these background characteristics may potentially be misinterpreted by readers. For instance, occupation could be misleading since immigrants may face barriers with credential recognition after moving to Canada.  A limitation was that this study did not have the budget or capacity to hire interpreters; therefore, only participants who could communicate in English were recruited for the study. As a result, the experiences of immigrant parents who do not speak English were not considered, which is an area for future exploration given their experiences were not captured in the current study. Additionally, participants self-selected to participate, meaning they may have had a story they wanted to tell or a desire to change current practices, which may have influenced the results.   It is important to consider the characteristics of the parents who participated in this study and the implications on the resulting themes. The majority (7\/10) of parents had a child diagnosed with autism spectrum disorder. Two children were diagnosed with a specific learning disorder, one with ADHD, one with generalized anxiety, and one with giftedness. While themes reflected the experiences of all parents and common experiences were noted between parents    126 regardless of their child\u2019s specific diagnosis, it is possible that the themes more closely reflect the experiences of receiving an autism diagnosis since this diagnosis was particularly represented in the sample. In addition, seven out of the 10 parents were mothers, eight out of the 10 parents had been in Canada for over six years, and seven out of 10 assessments took place in private practice. Thus, the themes may more closely mirror the experiences of immigrant mothers who have been in Canada for at least six years and who had their child privately assessed.  Participants\u2019 assessments took place outside of the school setting, either in hospitals or private practice. Recruitment did not take place through schools, which may have influenced the sample. Experiences may be different when feedback meetings take place in schools for a variety of reasons. It is possible that the clinician\u2019s training and place of work impacted how the feedback was conducted, and the researcher did not have background of the clinicians who conducted the feedback meeting.  While it was a strength that member reflections were sought from participants, only one parent provided feedback, which was very brief, and simply stated that it was unsurprising that parents had both negative and positive experiences in the feedback meeting. A lack of member reflections is a limitation, as more reflections would have added depth to the analysis and conclusions.  Future Directions  Based on this study, several avenues for future research were identified. Given that schools are the primary place in which school psychologists provide assessments and conduct feedback meetings, future research should explicitly explore immigrant parents\u2019 experiences of receiving news of the child\u2019s diagnosis within the context of a school-based assessment.    127 Furthermore, future studies should examine the experiences of immigrant parents who do not speak English and require interpreter services within the context of Canadian schools.   While this study explored the experiences of immigrant parents broadly, future research may wish to examine the experiences of parents from specific cultural or linguistic groups to gain an even more in-depth understanding of parents coming from specific backgrounds. Additionally, future research may compare the experiences of immigrant parents who have been in Canada for longer with newcomer immigrant parents to understand similarities and differences between these two groups. Another avenue for research is on the experiences of refugee parents, as refugee\u2019s deal with unique stressors and barriers that could be identified and tailored to. Of note was the diversity of opinions and experiences regarding the role of culture in the feedback meeting. Some felt their culture was acknowledged and understood, while others did not. Likewise, some appreciated that their culture was thoughtfully considered, while others were glad their culture did not influence the meeting. Thus, more research is needed to understand the factors that impact immigrant parent preferences regarding the role of culture in the feedback meeting and their subsequent satisfaction. Potential moderators include acculturation level, perceived minority stress, beliefs surrounding the role of culture in diagnostic decisions, and time spent in Canada. Furthermore, future research may explore how psychologists\u2019 training in cultural responsiveness and conducting feedback meetings impact parent satisfaction. Studies involving psychologist-immigrant parent dyads may be particularly beneficial in examining how psychologist and parent characteristics may impact parent satisfaction and adherence to the psychologists\u2019 recommendations. For instance, factors such as communication style, education, the psychologist\u2019s training, and ethnic match\/difference may play a role. Conducting surveys and    128 interviews with parents immediately after (or soon after) the feedback meeting may provide a more in-depth and accurate understanding of parent experiences since the meeting will be salient in their minds.   The central takeaway of the current study is the need for psychologists to tailor the feedback meeting to meet specific family needs. However, there is a lack of empirical research about how psychologists identify parent needs and adapt their feedback accordingly. In addition, more research is needed to determine how successful psychologists are in adapting their approaches. Future studies may use qualitative and quantitative methods to answer questions about whether or not these adaptations are appropriate, effective, and helpful.  Conclusion The aim of this study was to explore the experiences of immigrant parents when hearing news of their child\u2019s diagnosis in the psychoeducational feedback meeting. Parents shared their multifaceted experiences within the feedback meeting, including the positive and challenging aspects, the unique impact of their culture and language within that meeting, the often mixed and complex emotions experienced, and their journey beyond the meeting. Exploring these themes allows school psychologists to learn more about these immigrant parents\u2019 experiences and apply the learnings to their practice. While some common patterns emerged in what parents found helpful and unhelpful within this meeting, there were also many instances of divergence based on the family\u2019s unique circumstances. Thus, this study demonstrates the need for individualized and tailored feedback based on family needs.        129 References Abbott, M., Bernard, P., & Forge, J. (2013). Communicating a diagnosis of autism spectrum disorder - a qualitative study of parents\u2019 experiences. Clinical Child Psychology and Psychiatry, 18(3), 370-382. https:\/\/doi.org\/10.1177\/1359104512455813  American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed. Text Revision). https:\/\/doi.org\/10.1176\/appi.books.9780890425787 Baile, W. F., Buckman, R., Lenzi, R., Glober, G., Beale, E. A., & Kudelka, A. P. (2000). SPIKES\u2014A Six\u2010Step protocol for delivering bad news: Application to the patient with cancer. The Oncologist, 5(4), 302-311. https:\/\/doi.org\/10.1634\/theoncologist.5-4-302 Brown, A., McIsaac, J.-L. D., Reddington, S., Hill, T., Brigham, S., Spencer, R., & Mandrona, A. (2020). Newcomer families\u2019 experiences with programs and services to support early childhood development in Canada: A scoping review. Journal of Childhood, Education & Society, 1(2), 182-215.  https:\/\/doi.org\/10.37291\/2717638X.20201249  Canadian Council for Refugees. (2010, September 1). Refugees and immigrants: A glossary. Canadian Council for Refugees. https:\/\/ccrweb.ca\/en\/glossary Canadian Psychological Association (2007). Professional practice guidelines for school psychologists in Canada. https:\/\/cpa.ca\/cpasite\/UserFiles\/Documents\/publications\/CPA%20Practice%20Guide.pdf  Canadian Psychological Association (2017). Canadian code of ethics for psychologists (4th ed.). https:\/\/cpa.ca\/docs\/File\/Ethics\/CPA_Code_2017_4thEd.pdf  College of Psychologists of British Columbia. (2014). Code of conduct (Revised May 17, 2021). https:\/\/www.collegeofpsychologists.bc.ca\/docs\/10.CPBCCodeofConduct.pdf     130 Creswell, J. W. (2007). Qualitative inquiry & research design: Choosing among five approaches (2nd ed.). Sage Publications. Crotty, M. (1998). The foundations of social research: Meaning and perspective in the research process. Sage Publications. Davey, E., Creswell, C., Percy, R., & Reardon, T. (2022). \u2018It opened my eyes\u2019: Parents\u2019 experiences of their child receiving an anxiety disorder diagnosis. Clinical Child Psychology and Psychiatry, 27(3), 658-669. https:\/\/doi.org\/10.1177\/13591045221088708  DeMatteo, F. J. (2021). Delivering psycho-educational evaluation results to parents: A practitioner\u2019s model. Routledge. https:\/\/doi.org\/10.4324\/9780429020971  Dombrowski, S. C. (2020). Psychoeducational assessment and report writing (2nd Ed.). Springer International Publishing.  Eatough, V., & Smith, J. A. (2017). Interpretative phenomenological analysis. In C. Willig, & W. Stainton-Rogers (2nd ed.), The Sage handbook of qualitative research in psychology (pp. 193-211). Sage Publications. https:\/\/doi.org\/10.4135\/9781526405555 Elliott, R., Fischer, C. T., & Rennie, D. L. (1999). Evolving guidelines for publication of qualitative research studies in psychology and related fields. British Journal of Clinical Psychology, 38(3), 215-229. https:\/\/doi.org\/10.1348\/014466599162782 Ferguson, A., & Vigil, D. C. (2019). A comparison of the ASD experience of low\u2010SES Hispanic and non\u2010Hispanic white parents. Autism Research, 12(12), 1880-1890. https:\/\/doi.org\/10.1002\/aur.2223 Finn, S. E. (1996). Using the MMPI-2 as a therapeutic intervention. University of Minnesota Press.     131 Flanagan, R. (2011). Parent feedback conferences: An opportunity to intervene? Psychology in the Schools, 48(3), 307\u2013315. http:\/\/dx.doi.org\/10.1002\/pits.20555 Glazer, A. (2014). Communication matters: Effective oral communication of evaluation results. Communique, 42(6). Retrieved from www.nasponline.org   Grammarly. (2025). Grammarly (Version v.1.107.0.0) [Large language model]. https:\/\/www.grammarly.com\/  Guba, E. G. (1981). Criteria for assessing the trustworthiness of naturalistic inquiries. Educational Communication and Technology, 29(2) https:\/\/doi.org\/10.1007\/BF02766777 Guba, E. & Lincoln, Y. (1989). Fourth Generation Evaluation. Sage Publications. Hasnat, M., & Graves, P. (2000). Disclosure of developmental disability: A study of parent satisfaction and the determinants of satisfaction. Journal of Paediatrics and Child Health, 36, 32\u201335. https:\/\/doi.org\/10.1046\/j.1440-1754.2000.00463.x  Human, M. T., & Teglasi, H. (1993). Parents' satisfaction and compliance with recommendations following psychoeducational assessment of children. Journal of School Psychology, 31(4), 449-464. https:\/\/doi.org\/10.1016\/0022-4405(93)90031-D  Jegatheesan, B. (2009). Cross-cultural issues in parent professional interactions: A qualitative study of perceptions of Asian American mothers of children with developmental disabilities. Research and Practice for Persons with Severe Disabilities, 34(3-4), 123-136. https:\/\/doi.org\/10.2511\/rpsd.34.3-4.123 Jennings, S., Khanlou, N., & Su, C. (2014). Public health policy and social support for immigrant mothers raising disabled children in Canada. Disability & Society, 29(10), 1645-1657. https:\/\/doi.org\/10.1080\/09687599.2014.966804    132 Kalich, A., Heinemann, L., & Ghahari, S. (2016). A scoping review of immigrant experience of health care access barriers in Canada. Journal of Immigrant and Minority Health, 18(3), 697-709. https:\/\/doi.org\/10.1007\/s10903-015-0237-6 Khanlou, N., Haque, N., Mustafa, N., Vazquez, L. M., Mantini, A., & Weiss, J. (2017). Access barriers to services by immigrant mothers of children with autism in Canada. International Journal of Mental Health and Addiction, 15(2), 239-259. https:\/\/doi.org\/10.1007\/s11469-017-9732-4 Khanlou, N., Haque, N., Sheehan, S., & Jones, G. (2015a). \u201cIt is an issue of not knowing where to go\u201d: Service providers\u2019 perspectives on challenges in accessing social support and services by immigrant mothers of children with disabilities. Journal of Immigrant and Minority Health, 17(6), 1840-1847. https:\/\/doi.org\/10.1007\/s10903-014-0122-8 Khanlou, N., Mustafa, N., Vazquez, L. M., Haque, N., & Yoshida, K. (2015b). Stressors and barriers to services for immigrant fathers raising children with developmental disabilities. International Journal of Mental Health and Addiction, 13(6), 659-674. https:\/\/doi.org\/10.1007\/s11469-015-9584-8 Kim, H., Kim, S. A., Lee, H., & Dodds, R. (2024). Korean immigrant mothers and the journey to autism diagnosis and services for their child in the United States. Journal of Autism and Developmental Disorders, 54(12), 4624-4636. https:\/\/doi.org\/10.1007\/s10803-023-06145-w Koch, T. (2006). Establishing rigour in qualitative research: The decision trail. Journal of Advanced Nursing, 53(1), 91-100. https:\/\/doi.org\/10.1111\/j.1365-2648.2006.03681.x Larkin, M., & Thompson, A. R. (2011). Interpretative phenomenological analysis in mental health and psychotherapy research. In D. Harper, & A. R. Thompson (Eds.), Qualitative    133 research methods in mental health and psychotherapy (pp. 99-116). John Wiley & Sons, Ltd. https:\/\/doi.org\/10.1002\/9781119973249.ch8 Levin, E., & Olfert, D. (2011). Psychoeducational assessment. In S. Goldstein & J. A. Naglieri (Eds.), Encyclopedia of child behavior and development. Springer. https:\/\/doi.org\/10.1007\/978-0-387-79061-9_2295 Levitt, H. M., Bamberg, M., Creswell, J. W., Frost, D. M., Josselson, R., & Su\u00e1rez-Orozco, C. (2018). Journal article reporting standards for qualitative primary, qualitative meta-analytic, and mixed methods research in psychology: The APA publications and communications board task force report. The American Psychologist, 73(1), 26-46. https:\/\/doi.org\/10.1037\/amp0000151 Lichtenstein, R. & Ecker, B. (2019). High-impact assessment reports for children and adolescents. Guilford Press.  Lo, L. (2012). Demystifying the IEP process for diverse parents of children with disabilities. Teaching Exceptional Children, 44(3), 14-20. https:\/\/doi.org\/10.1177\/004005991204400302 Longley, W. A., Tate, R. L., & Brown, R. F. (2023). The psychological benefits of neuropsychological assessment feedback as a psycho-educational therapeutic intervention: A randomized-controlled trial with cross-over in multiple sclerosis. Neuropsychological Rehabilitation, 33(5), 764-793. https:\/\/doi.org\/10.1080\/09602011.2022.2047734 Lopez, K., Maga\u00f1a, S., Xu, Y., & Guzman, J. (2018). Mother's reaction to autism diagnosis: A qualitative analysis comparing Latino and White parents. The Journal of Rehabilitation, 84(1), 41-50.    134 MacNaughton, K. L., & Rodrigue, J. R. (2001). Predicting adherence to recommendations by parents of clinic-referred children. Journal of Consulting and Clinical Psychology, 69(2), 262-270. https:\/\/doi.org\/10.1037\/0022-006X.69.2.262 Makino, A., Hartman, L., King, G., Wong, P. Y., & Penner, M. (2021). Parent experiences of autism spectrum disorder diagnosis: A scoping review. Review Journal of Autism and Developmental Disorders, 8(3), 267\u2013284. https:\/\/doi.org\/10.1007\/s40489-021-00237-y  Merkel, C. (2010). Mothers\u2019 experiences: Participating in the feedback conference of their child\u2019s psychoeducational assessment [Doctoral Dissertation, University of British Columbia]. https:\/\/open.library.ubc.ca\/collections\/24\/items\/1.0054413 Meyer, G. J., Finn, S. E., Eyde, L. D., Kay, G. G., Moreland, K. L., Dies, R. R., Eisman, E. J., Kubiszyn, T. W., & Reed, G. M. (2001). Psychological testing and psychological assessment: A review of evidence and issues. The American Psychologist, 56(2), 128-165. https:\/\/doi.org\/10.1037\/0003-066X.56.2.128  Moon, K., & Blackman, D. (2014). Guide to understanding social science research for natural scientists. Conservation Biology, 28(5), 1167-1177. https:\/\/doi.org\/10.1111\/cobi.12326 Morse, J. M., Barrett, M., Mayan, M., Olson, K., & Spiers, J. (2002). Verification strategies for establishing reliability and validity in qualitative research. International Journal of Qualitative Methods, 1(2), 13-22. https:\/\/doi.org\/10.1177\/160940690200100202 National Association of School Psychologists. (2009). School Psychologists\u2019 Involvement in Assessment. [Position Statement]. http:\/\/surl.li\/gamal National Association of School Psychologists (2020). The professional standards of the National Association of School Psychologists. https:\/\/www.nasponline.org\/x55315.xml     135 Nizza, I. E., Farr, J., & Smith, J. A. (2021). Achieving excellence in interpretative phenomenological analysis (IPA): Four markers of high quality. Qualitative Research in Psychology, 18(3), 369-386. https:\/\/doi.org\/10.1080\/14780887.2020.1854404 OpenAI. (2024). ChatGPT (June 7 version) [Large language model]. https:\/\/chat.openai.com  OpenAI. (2025). ChatGPT (March 1 version) [Large language model]. https:\/\/chat.openai.com  Park, J., & Turnbull, A. P. (2001). Cross-cultural competency and special education: Perceptions and experiences of Korean parents of children with special needs. Education and Training in Mental Retardation and Developmental Disabilities, 36(2), 133-147. Parkin, J. R., & Tyre, A. D. (2021). Facilitating effective communication in school-based meetings: Perspectives from school psychologists. Taylor and Francis. https:\/\/doi.org\/10.4324\/9780367854522 Patton, M. Q. (2002). Qualitative research & evaluation methods (3rd ed.). Sage Publications. Pewewardy, C., & Fitzpatrick, M. (2009). Working with American Indian students and families: Disabilities, issues, and interventions. Intervention in School and Clinic, 45(2), 91-98. https:\/\/doi.org\/10.1177\/1053451209340223 Pollak, J. M. (1988). The feedback process with parents in child and adolescent psycho- logical assessment. Psychology in the Schools, 25(2), 143\u2013153. https:\/\/doi.org\/10.1002\/1520-6807(198804)25:2<143::AID-PITS2310250208>3.0.CO;2-T Province of British Columbia. (2024). Inclusive Education Services: A Manual of Policies, Procedures and Guidelines. Victoria, B.C. Special Education Branch, Ministry of Education. https:\/\/www2.gov.bc.ca\/assets\/gov\/education\/administration\/kindergarten-to-grade-12\/inclusive\/inclusive_ed_policy_manual.pdf     136 Rogers-Adkinson, D. L., Ochoa, T. A., & Delgado, B. (2003). Developing cross-cultural competence: Serving families of children with significant developmental needs. Focus on Autism and Other Developmental Disabilities, 18(1), 4-8. https:\/\/doi.org\/10.1177\/108835760301800102 Scipioni, K. (2014). The View from across the Table: A Qualitative Study of Parent Experiences with the School Psychologist During Initial Evaluation Feedback Conferences (Paper 307) [Doctoral Dissertation, Philadelphia College of Osteopathic Medicine]. PCOM Psychology Dissertations. Selig, A. L. (1983). Common myths of family feedback conferences. Journal of Developmental & Behavioral Pediatrics, 4 (1), 67-69. DOI: 10.1097\/00004703-198303000-00013  Seligman, M., & Darling, R. B. (2007). Ordinary families, special children: A systems approach to childhood disability (3rd ed.). Guilford Press.  Shafi, F., Karunakaran, A., & Ahmad, F. (2024). Autism, stigma, and south Asian immigrant families in Canada. International Journal of Environmental Research and Public Health, 21(3), 369. https:\/\/doi.org\/10.3390\/ijerph21030369 Sheets, K. M., Baty, B. J., V\u00e1zquez, J. C., Carey, J. C., & Hobson, W. L. (2012). Breaking difficult news in a cross-cultural setting: A qualitative study about Latina mothers of children with Down syndrome. Journal of Genetic Counseling, 21(4), 582-590. https:\/\/doi.org\/10.1007\/s10897-011-9425-2 Shenton, A. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22(2), 63-75. https:\/\/doi.org\/10.3233\/EFI-2004-22201    137 Smith, J. A., Flowers, P., & Larkin, M. (2022). Interpretative phenomenological analysis: Theory, method and research (2nd ed.). SAGE. Smith, J. A., & Osborn, M. (2004). Interpretative phenomenological analysis. In G. M. Breakwell (Ed.), Doing social psychology research (pp. 229-254). The British Psychological Society and Blackwell Publishing Ltd. https:\/\/doi.org\/10.1002\/9780470776278.ch10 Smith, S. R., Wiggins, C. M., & Gorske, T. T. (2007). A survey of psychological assessment feedback practices. Assessment (Odessa, Fla.), 14(3), 310-319. https:\/\/doi.org\/10.1177\/1073191107302842 Statistics Canada. (2017). Children with an immigrant background: Bridging cultures. https:\/\/www12.statcan.gc.ca\/census-recensement\/2016\/as-sa\/98-200-x\/2016015\/98-200-x2016015-eng.cfm#  Statistics Canada. (2022). Immigrants make up the largest share of the population in over 150 years and continue to shape who we are as Canadians. https:\/\/www150.statcan.gc.ca\/n1\/daily-quotidien\/221026\/dq221026a-eng.htm Tharinger, D. J., Finn, S. E., Hersh, B., Wilkinson, A., Christopher, G. B., & Tran, A. (2008). Assessment feedback with parents and preadolescent children: A collaborative approach. Professional Psychology, Research and Practice, 39(6), 600-609. https:\/\/doi.org\/10.1037\/0735-7028.39.6.600 Tracy, S. J. (2010). Qualitative quality: Eight \u201cbig-tent\u201d criteria for excellent qualitative research. Qualitative Inquiry, 16(10), 837-851. https:\/\/doi.org\/10.1177\/1077800410383121    138 Ysseldyke, J., Morrison, D., Burns, M. K., Ortiz, S., Dawson, P., Rosenfield, S., et al. (2006). School psychology: A blueprint for training and practice III. Bethesda, MD: National Association of School Psychologists.         139 Appendix A: Screening Questions  1. Are you an immigrant? 2. Where did you immigrate from?  3. Do you feel comfortable enough in communicating in English to participate in the interview without an interpreter?  4. Do you currently reside in Canada?  5. Has your child received a psychoeducational assessment in Canada?   6. Did you participate in a feedback conference with the psychologist to learn about your child\u2019s assessment results?   7. Did your child receive a specific diagnosis or designation at the time of assessment?       140 Appendix B: Initial Interview Consent Form  Emotion Discourse in Feedback Sessions: A Discursive Analysis of Immigrant Families and Psychologists' Intercultural Communication PARENTS CONSENT Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-- \u2010XXX--\u2010XXXX Email: XXX@XX.ca Student Co--\u2010Investigators:           Dorna Rahimi Department of Educational & Counselling Psychology & Special Education Phone: XXX- -\u2010XXX--\u2010XXXX Email: XX@XX.ca  Dear Parents,  Please read the following information carefully. This is a request for you to take part in the study that we are doing. If after reading this letter, you would like to take part in this research study, please sign one copy. Electronic signature or initials are fine. Please email the forms to XX@XX.ca  Please save a copy for your own records.   The Purpose: The purpose of this study is to better understand your experiences and effective communication methods for discussing assessment results with immigrant families. We are talking with both immigrant parents and psychologists in clinics in BC to better understand 1) how psychologists and immigrants are communicating; 2) what emotions they display; 3) how future psychologist could be trained to effectively communicate with immigrant families.   Research Study Participation: 1. Taking part in this study means that you agree to participate in up to 3 focus groups with other immigrant parents to discuss your experiences in psychological feedback sessions. Before the focus groups, you will meet with the researchers on ZOOM or in person where you will take part in an individual interview about your experiences in the feedback session. You may also be contacted to participate in a follow up one-on-one interview on ZOOM or in person, to further discuss your experiences and to confirm that our interpretation of the data aligns with your actual experience and perspectives. These sessions will be recorded via ZOOM or an audio\/video recorder if the session is in person. If you are not comfortable with the video recording, we can only record the audio. You have the option of pausing the recording and restarting whenever you like.   2. All participants will be given a pseudonym to use as their name during ZOOM sessions. If you are using ZOOM for the focus groups or individual interviews, the researcher will provide you with a pseudo name which you will be asked to use as your name during the interviews in order to protect your anonymity. You can turn off your camera and mute your audio if you are not speaking.  3. After the focus groups and the interviews, the interviewer and the research assistants will remove all identifying information and transcribe the session.     141  4. If you agree to take part in the study, we will email you a demographic questionnaire to fill out and ask you to email back it us upon completion. All the demographic information that you provide us are confidential and no individual information will be reported, and no participants will be identified by name in any reports about the study. The information collected will be stored in a secure and encrypted storage at the University\u2019s cloud and in a locked storage at UBC  5. As a thank you for your time, each person who takes part in the study will receive a $20 electronic gift card to a local business or a local food delivery service.   6. The information you give us is confidential. No individual information, including your child\u2019s name, will be reported, and no participant will be identified by name in any reports about the study. The only people who will have access to the information you give us are the researchers including the research assistants working on this study. The information collected will be stored in a secure and encrypted storage at the University\u2019s cloud. A spreadsheet that links the code to the identifying information along with the background questionnaires and the consent forms will be password protected and encrypted and saved on UBC\u2019s OneDrive cloud, separate from the data.  7. Taking part in the study means that you agree to the information being used for the purpose of reporting the results of the research in Ms. Rahimi\u2019s final dissertation and defense and future studies, this includes presentations of brief audio recordings and direct quotes with all identifying information removed. The findings (including the transcripts) may also be submitted in a journal publication to academic journals, including Open Access journals. Open access journals may require Ms. Rahimi to submit the findings and\/or results (transcripts) to a research depository for future research. Please note that once the data is made available to the journals, we cannot remove the data. We acknowledge that this may pose an additional risk in taking part in this study.   8. The transcripts and parts of the audio recording may also be presented in academic and conference presentations. All identifying information will be removed. This means a very brief part of the audio recording may be replayed in presentations. If you are not comfortable, you can indicate at the bottom of this consent form and only parts of the transcription will be shared in presentation.   9. We are not aware of any risks if you take part in our study. However, if you feel uncomfortable, you may choose to stop at anytime. If any of the questions in the interview make you feel uncomfortable, you may chose to not respond to the those questions. You are welcome to contact us with any questions.   10. If you have any concerns or complaints about your rights as a research participants\/or your experiences while participating in this study, you ay contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance email at RSIL@ors.ubc.ca or call toll free at 1-877-822-8598.       142 Appendix C: Consent Form A for Present Study   Immigrant Parent Experiences of Receiving their Child\u2019s Psychoeducational Diagnosis: Informing School Psychologists\u2019 Practice Consent Form A Principal Investigator:   Laurie Ford, Ph.D. Department of Education, Counselling Psychology & Special Education Phone: XXX--\u2010XXX-- \u2010XXXX Email: XX@XX.ca Student Co-Investigator:   Anisa Nasseri, B.A.  Department of Education, Counselling Psychology & Special Education Phone: XXX--\u2010XXX-- \u2010XXXX Email: XX@XX.ca  Dear Parents,  Please read the following information carefully. This is a request for you to take part in the study that we are doing. If after reading this letter, you would like to take part in this research study, please sign one copy. Electronic signature or initials are fine. Please email the forms to XX@XX.ca Please save a copy for your own records.   The Purpose: The purpose of this study is to better understand your experiences when you received the results of your child\u2019s psychoeducational assessment in the feedback meeting with the psychologist. Through understanding immigrant parents\u2019 experiences, we aim to offer suggestions for psychologists to better communicate assessment results and diagnoses with immigrant families.  Research Study Participation: 1. By participating in this study, you are giving us permission to use the information gathered during the previous study conducted by Ms. Dorna Rahimi. This includes both the interview audio recordings and the demographic data. This information will continue to be stored in a secure and encrypted storage at the University\u2019s cloud and in a locked storage at UBC. All this information is confidential.   2. Taking part in this study means that you agree to participate in an additional interview about your experience in the feedback meeting and hearing news of your child\u2019s diagnosis. This interview can take place in person or online through Zoom. The interview will be recorded via Zoom or an audio recorder (if the session is in person). You have the option of pausing the recording and restarting whenever you like. If you decide to do the interview online (through Zoom) you have options to protect your privacy. You are welcome to use a nickname or substitute name, or a research code provided by the researcher, instead of your real name. You may also turn off your video camera during the session and mute your microphone when you are not speaking.    143  3. After the interview, the interviewer will remove all identifying information and transcribe the session.   4. As a thank you for your time, you will receive a $20 Amazon e-gift card.   5. The information you give us is confidential. No individual information, including your child\u2019s name, will be reported, and no participant will be identified by name in any reports about the study. The only people who will have access to the information you give us are the researchers, including the research assistants, working on this study. The information collected will be stored in a secure and encrypted storage in the University\u2019s cloud. A spreadsheet that links the code to the identifying information along with the background questionnaires and the consent forms will be password protected and encrypted and saved on UBC\u2019s OneDrive cloud, separate from the data.  6. Taking part in the study means that you agree to the information being used for the purpose of reporting the results of the research in Ms. Nasseri\u2019s master\u2019s thesis and defense and future studies. This includes presentations with direct quotes with all identifying information removed. The findings (including the transcripts) may also be submitted in a journal publication to academic journals, including Open Access journals. Submitting to Open Access journals means that the data collected from this study (with no identifying information, such as names) may be made openly accessible to others. This is so that other researchers can use the data for future research studies. This de-identified data may be made available on an academic journal site. Taking part in this study is voluntary and you may refuse to take part or withdraw at any time before data-analysis is complete. Once data-analysis is complete we cannot remove your data from the study as it will be integrated into the overall analysis. We acknowledge that this may pose an additional risk in taking part in this study.   7. If you agree to take part in the study, you also have the opportunity to give your feedback on the findings. These findings will be emailed to you after the data has been analyzed. You can provide your feedback by email, phone, or Zoom.  8. We are not aware of any risks if you take part in our study. However, if you feel uncomfortable, you may choose to stop at any time. If any of the questions in the interview make you feel uncomfortable, you may choose to not respond to those questions. You are welcome to contact us with any questions.   9. If you have any concerns or complaints about your rights as a research participant or your experiences while participating in this study, you may contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance email at RSIL@ors.ubc.ca or call toll free at 1-877-822-8598.   I __________________ have read the above information and I:    144 \u2751 Agree that my data collected in Ms. Dorna Rahimi\u2019s study can be used in the present study. \u2751 Do not agree that my data collected in Ms. Dorna Rahimi\u2019s study can be used in the present study. AND  \u2751 I agree to take part in a second interview. \u2751 I do not agree to take part in a second interview.    Signature:  _______________  Date: ___________________       145 Appendix D: Consent Form B for Present Study  Immigrant Parent Experiences of Receiving their Child\u2019s Psychoeducational Diagnosis:  Informing School Psychologists\u2019 Practice Consent Form B   Principal Investigator: Laurie Ford, Ph.D. Department of Education, Counselling Psychology & Special Education Phone: XXX--\u2010XXX--\u2010XXXX Email: XX@XX.ca   Student Co-Investigator: Anisa Nasseri, B.A.  Department of Education, Counselling Psychology & Special Education Phone: XXX--\u2010XXX--\u2010XXXX.   Email: XX@XX.ca   Dear Parents,  Please read the following information carefully. This is a request for you to take part in the study that we are doing. If after reading this letter, you would like to take part in this research study, please sign one copy. Electronic signature or initials are fine. Please email the forms to XX@XX.ca Please save a copy for your own records.   The Purpose: The purpose of this study is to better understand your experiences when you received the results of your child\u2019s psychoeducational assessment in the feedback meeting with the psychologist. Through understanding immigrant parents\u2019 experiences, we aim to offer suggestions for psychologists to better communicate assessment results and diagnoses with immigrant families.  Research Study Participation: 1. Taking part in this study means that you agree to participate in two interviews about your experience in the feedback meeting and hearing news of your child\u2019s diagnosis. These interviews can take place in person or online through Zoom. The interview will be recorded via Zoom or an audio recorder (if the meeting is in person). You have the option of pausing the recording and restarting whenever you like. If you decide to do the interview online (through Zoom) you have options to protect your privacy. You are welcome to use a nickname or substitute name, or a research code provided by the researcher, instead of your real name. You may also turn off your video camera during the session and mute your microphone when you are not speaking.  2. After the interview, the interviewer will remove all identifying information and transcribe the session.   3. If you agree to take part in the study, you will answer demographic questions including background information about yourself and your child. The researcher will go through this questionnaire with you prior to starting the interview. The demographic questionnaire is hosted on the UBC Qualtrics, the university\u2019s secure online survey platform. All the    146 demographic information that you provide us is confidential and no participants will be identified by name in any reports about the study. The information collected will be stored in a secure and encrypted storage at the University\u2019s cloud and in a locked storage at UBC.   4. As a thank you for your time, you will receive a $20 Amazon e-gift card per interview (40$ total).   5. The information you give us is confidential. No individual information, including your child\u2019s name, will be reported, and no participant will be identified by name in any reports about the study. The only people who will have access to the information you give us are the researchers including the research assistants working on this study. The information collected will be stored in a secure and encrypted storage in the University\u2019s cloud. A spreadsheet that links the code to the identifying information along with the background questionnaires and the consent forms will be password protected and encrypted and saved on UBC\u2019s OneDrive cloud, separate from the data.  6. Taking part in the study means that you agree to the information being used for the purpose of reporting the results of the research in Ms. Nasseri\u2019s master\u2019s thesis and defense and future studies. This includes presentations with direct quotes with all identifying information removed. The findings (including the transcripts) may also be submitted in a journal publication to academic journals, including Open Access journals. Submitting to Open Access journals means that the data collected from this study (with no identifying information, such as names) may be made openly accessible to others. This is so that other researchers can use the data for future research studies. This de-identified data may be made available on an academic journal site. Taking part in this study is voluntary and you may refuse to take part or withdraw at any time before data-analysis is complete. Once data-analysis is complete we cannot remove your data from the study as it will be integrated into the overall analysis. We acknowledge that this may pose an additional risk in taking part in this study.   7. If you agree to take part in the study, you also have the opportunity to give your feedback on the findings. These findings will be emailed to you after the data has been analyzed. You can provide your feedback by email, phone, or Zoom.  8. We are not aware of any risks if you take part in our study. However, if you feel uncomfortable, you may choose to stop at any time. If any of the questions in the interview make you feel uncomfortable, you may choose to skip those questions. You are welcome to contact us with any questions.   9. If you have any concerns or complaints about your rights as a research participant or your experiences while participating in this study, you may contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance email at RSIL@ors.ubc.ca or call toll free at 1-877-822-8598.   I __________________ have read the above information and agree to take part in this study.     147   Signature _______________  Date ___________________        148 Appendix E: Introductory Script A  Immigrant Parent Experiences of Receiving their Child\u2019s Psychoeducational Diagnosis: Informing School Psychologists\u2019 Practice   Introductory Email\/Script A Dear Parent,   We hope you are doing well. As you know, a few months ago you participated in an interview about your experiences in the psychoeducational feedback meeting with Anisa Nasseri and Dorna Rahimi. At that time, you agreed to be contacted if that data were to be used in another study.   We are emailing\/phoning you today to see if you are interested in participating in our study on immigrant parent experiences of finding out their child\u2019s psychoeducational diagnosis. The study is titled Immigrant Parent Experiences of Receiving their Child\u2019s Psychoeducational Diagnosis: Informing School Psychologists\u2019 Practice. It is our hope that this study will inform psychologists practice and improve communication between psychologists and immigrant families. This research is being done as part of Anisa Nasseri\u2019s master\u2019s thesis at the University of British Columbia, supervised by Dr. Laurie Ford.   What is involved if you take part in the study? This study requires your consent for us to use the data gathered (demographic information and interview transcript) in the study conducted by Dorna Rahimi in the present study, and to participate in a second interview that will be audio recorded. All identifying information will be removed, and the interview will be transcribed by the student co-investigator or research assistants. Your identity will remain confidential, but parts of your interview and direct quotes from the interviews may be used in Anisa Nasseri\u2019s thesis\/presentations without sharing any identifying information. Once the data collection is complete, you will be sent the findings and will have the opportunity to give your feedback and thoughts by email or Zoom.   To participate in this study, you would agree to: A) Allow us to use the data gathered in Dorna Rahimi\u2019s study (demographic information and interview transcript) in the present study. B) Participate in a follow up interview. We can do this interview online or in person depending on what you prefer. If the interview is done in person, please ensure that you are healthy. If you feel sick, please stay home, and reschedule the interview.  You can choose to consent to part A alone, part A and B, or neither. Taking part in this study is voluntary and you may refuse to take part or withdraw at any time during data-collection. More details will be provided when you provide your informed consent prior to the interview.   Compensation As a token of our appreciation, you will be sent a 20-dollar e-gift card for participating in the follow-up interview. The gift card will be for Amazon or for a local caf\u00e9 of your choice.      149 If you would like to learn more about the study or would like to take part, please contact Anisa by email (XX@XX.ca) or by phone at XXX- -\u2010XXX--\u2010XXXX.  We look forward to hearing back from you.  Laurie Ford, Ph.D.       Associate Professor Principal Investigator, University of British Columbia   Anisa Nasseri, B.A. Master's student in School and Applied Child Psychology  Co-Investigator, University of British Columbia        150 Appendix F: Introductory Script B  Immigrant Parent Experiences of Receiving their Child\u2019s Psychoeducational Diagnosis: Informing School Psychologists\u2019 Practice  Introductory Email\/Script B Dear Parent,   We hope you are doing well. We are contacting you because you expressed interest in being contacted for research. We are phoning\/emailing you to see if you are interested in participating in our study on immigrant parent experiences of finding out your child\u2019s psychoeducational diagnosis. The study is titled Immigrant Parent Experiences of Receiving their Child\u2019s Psychoeducational Diagnosis: Informing School Psychologists\u2019 Practice. It is our hope that this study will inform psychologists practice and improve communication between psychologists and immigrant families. This research is being done as part of Anisa Nasseri\u2019s master\u2019s thesis at the University of British Columbia, supervised by Dr. Laurie Ford.   What is involved if you take part in the study? This study involves participating in two interviews where you would share your experiences about finding out your child\u2019s diagnosis and participating in a feedback meeting with the psychologist. These interviews can take place in person (in Vancouver) or online through Zoom. If the interview is done in person, please ensure that you are healthy. If you feel sick, please stay home, and reschedule the interview. They will be audio recorded and transcribed by the researcher or research assistants. All identifying information will be removed and your identity will remain confidential. Parts of your interview and direct quotes from the interviews may be used in Anisa Nasseri\u2019s thesis\/presentations, but no identifying information will be shared. Once the data collection is complete, you will be sent the findings and will have the opportunity to give your feedback and thoughts by email or Zoom. Taking part in this study is voluntary and you may refuse to take part or withdraw at any time during data-collection. More details will be provided when you provide your informed consent prior to the interview.  Compensation As a token of our appreciation, you will be sent a 20-dollar e-gift card for each interview you participate in (total of $40 dollars for participating in both interviews). The gift cards will be for Amazon or for a local caf\u00e9 of your choice.   Who can participate in this research?  You can take part in this study if all the points below are true for you. If you are not sure if some of these are true for you, please contact the researcher.   1. You are an immigrant (you were born outside of Canada)   2. You feel comfortable enough communicating in English to participate in the interview without an interpreter 3. You live in Canada 4. Your child received a psychoeducational assessment in Canada  5. You participated in a meeting with the assessing practitioner to learn about your child\u2019s assessment results     151 6. Your child received a specific diagnosis or designation at the time of assessment (e.g., learning disability, ADHD, ASD, depression, anxiety, intellectual disability etc.).  If you would like to take part in or learn more about the study, please contact Anisa by email (XX@XX.ca) or by phone at XXX--\u2010XXX- -\u2010XXXX.  We look forward to hearing back from you.  Laurie Ford, Ph.D.       Associate Professor Principal Investigator, University of British Columbia   Anisa Nasseri, B.A. Master's student in School and Applied Child Psychology  Co-Investigator, University of British Columbia          152 Appendix G: Demographic Questionnaire for Parents [This questionnaire was created in collaboration with Dorna Rahimi and used for both of our studies]   Demographic Questionnaire for Parents   Please fill out the following background questions to the best of your ability. If you prefer not to answer, please put \u201cprefer not to answer.\u201d    1. Your Age:    2. What is your biological sex?     3. What gender do you identify with?     4. What\u2019s your relationship to the child for whom the assessment was completed?     5. When did you immigrate to Canada?    6. What is your country of origin? Please list any other countries you lived in prior to     immigrating to Canada.    7. What is your first language?    8. What are your additional languages?   9. What is your highest educational level?    10. What is your occupation and are you currently employed?   11. What were the reasons for your child\u2019s psychoeducational assessment?   12. When was your child assessed (month and year)?    13. How old was your child when they were assessed?    14. Did your child receive a diagnosis? If so, what was it?    15. Did your child\u2019s psychoeducational assessment occur at school or in a private clinic?    16. What is your child\u2019s biological sex?   17. What gender does your child identify with?         153 Appendix H: Semi Structured Interview Guiding Questions  First Interview [Interview questions for the first interview were created in collaboration with Dorna Rahimi and used for both our studies]  1. Tell us about your child and why you sought out a psychoeducational assessment for them.   a. Possible prompts:  1) How would you describe your child?  2) How did you feel leading up to the psychoeducational assessment?  3) What emotions were you feeling leading up to the assessment?  2. What did you think of the assessment and feedback session experience?  a. Possible Prompt: 1) What are some words that come to your mind when you think of your experience in the feedback sessions?    3. What was your experience in the feedback session?  a. Possible Prompt:  1) Were there any moments that left a strong impression on you?  4. How did the sessions make you feel?  a. Possible Prompt:  1) What were some of the emotions that you were experiencing?    5. What did you think of the interaction?  a. Possible prompts:  1) What did this meeting mean to you?   6. What were somethings in the interactions that were positive?  a. Possible prompts:  1) What were somethings you liked or appreciated in this meeting?   2) What did the psychologist do well?  7. What were somethings that were challenging? a. Possible prompts:  1) What were some things you didn\u2019t like or wished were different in this meeting?  2) What were some things the psychologist could have done better?  8. If your child was given a diagnosis, how would you explain that diagnosis to someone else?  a. Possible prompt:  1) How does talking about your child\u2019s diagnosis make you feel?   9. Was something unclear?  a. Possible Prompts:    154 1) How else could that information be communicated better?  2) If you had a magic wand, what would you change about the feedback and the assessment process?     Second Interview  1. From your perspective, could you tell me what we discussed in our last meeting? a. Possible prompt:  1) Any highlights?  2) Anything that stood out?  3) Any reflections you\u2019ve had on our last meeting?  2. How did culture or background play a role in the feedback meeting with the psychologist?  a. Possible prompts:  1) Do you feel as though the psychologist considered your cultural background within the feedback meeting?  2) How did your culture influence how you felt about the assessment as a whole?   3. Tell me about any moments during the feedback meeting where you felt that your culture or background either aligned or clashed with the psychologists. a. Possible prompts:  1) Did you always see eye to eye with the psychologist?  2) Did you feel comfortable to voice your differences of opinion?   4. What was your experience when the psychologist first told you your child\u2019s diagnosis? a. Possible prompts: 1) How did you feel?  2) What emotions did this bring up?  3) What do you think about the way this was communicated to you?   5. Tell me about your perception of your child\u2019s diagnosis.  a. Possible Prompts:  1) How has your perception changed from when you first heard about it?  2) What factors influence your perception of the diagnosis?   6. Tell me how you think your perception of the diagnosis may be similar or different to the psychologist\u2019s perception: do you view it in the same way?  a. Possible Probe: Why might that be?   7. Imagine you were a psychologist. What would you make sure to do when talking to parents about the results of their child\u2019s assessment? a. Possible Prompts:  1) What would you not do?  2) Why is that?     155 3) Out of everything you said, what do you consider the most important?   8. Tell me anything else that you wish to share about your experience in the feedback meeting that we may not have covered yet.        156 Appendix I: Recruitment Poster for Larger Study  Dorna Rahimi Dissertation Ad Version 4, August 25th, 2023              H20-01850-A002   Research Opportunity Are you an immigrant family who has completed a psychological assessment? Are you interested to share your experience to improve communication of assessment results? What does it involve?  Participating in this study involves 1-2 individual interviews, and\/or up to 3 focus groups. You will get the opportunity connect with other families and discuss your experience. You will receive a $20 gift card as a token of our appreciation. The meetings will be online or in person, depending on the group\u2019s comfort level. This is a dissertation study as partial requirements for Dorna Rahimi\u2019s PhD and future studies in the School and Applied Child Psychology program at UBC under the supervision of Dr. Laurie Ford.                 What to do next?  If you are interested, and want to hear more about the study, please contact Dr. Laurie Ford (principal investigator) at laurie.ford@ubc.ca or Dorna Rahimi (student co-investigator) at dorna18@student.ubc.ca   Scan to Email    157 Appendix J: Recruitment Poster for Current Study  RESEARCHOPPORTUNITY FORIMMIGRANT PARENTS!Are you an immigrant parent whose child has received apsychoeducational diagnosis? We want to hear from you!This is a thesis study as partial requirements for Anisa Nasseri\u2019sMA in the School and Applied Child Psychology program at UBCunder supervision of Dr. Laurie FordID: H23-00813 | Anisa Nasseri\u2019s Thesis | Recruitment Poster | Version 1: Nov 9,Please contact Anisa Nasseri (student co-investigator) atanisa19@student.ubc.ca or Dr. Laurie Ford (principalinvestigator) at laurie.ford@ubc.ca If  you ar e int er est ed or  want  t ol ear n mor e \u2013 send us an email !What  t o Expect  If eligible, you will be invited to participate in 2 individualinterviews. In these interviews you will talk about yourexperience of getting the news of your child\u2019s diagnosis andparticipating in the feedback meeting with the psychologist.Interviews can be in person (in Vancouver) or online. Conf ident ialParticipation is voluntary and all information you provide isconfidential. No individual information, including names, will bereported or included in any reports about the study.In appreciation of your time,you will receive$20 Amazon e- gif t  car d perint er view (t ot al  $40)$SCAN TO EMAILWe are interested in your experiences of being told your child\u2019s psychoeducational diagnosis(e.g., learning disability, ADHD, ASD, anxiety etc.) in the meeting with a psychologist. We areconducting this research study because we want to improve communication betweenimmigrant families and psychologists.    158 Appendix K: Example Personal Experiential Themes and Subthemes     David\u2019s Personal Experiential Themes (PETs) and sub-PETs:        159 Appendix L: Group Level Superordinate and Subordinate Themes      ","@language":"en"}],"Genre":[{"@value":"Thesis\/Dissertation","@language":"en"}],"GraduationDate":[{"@value":"2025-05","@language":"en"}],"IsShownAt":[{"@value":"10.14288\/1.0448596","@language":"en"}],"Language":[{"@value":"eng","@language":"en"}],"Program":[{"@value":"School and Applied Child Psychology","@language":"en"}],"Provider":[{"@value":"Vancouver : University of British Columbia Library","@language":"en"}],"Publisher":[{"@value":"University of British Columbia","@language":"en"}],"Rights":[{"@value":"Attribution-NonCommercial-NoDerivatives 4.0 International","@language":"*"}],"RightsURI":[{"@value":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/","@language":"*"}],"ScholarlyLevel":[{"@value":"Graduate","@language":"en"}],"Supervisor":[{"@value":"Ford, Laurie","@language":"en"}],"Title":[{"@value":"Immigrant parent experiences of receiving their child's psychoeducational diagnosis : informing school psychologists' practice","@language":"en"}],"Type":[{"@value":"Text","@language":"en"}],"URI":[{"@value":"http:\/\/hdl.handle.net\/2429\/90808","@language":"en"}],"SortDate":[{"@value":"2025-12-31 AD","@language":"en"}],"@id":"doi:10.14288\/1.0448596"}