The Role of the Therapist in Therapeutic Change: How Knowledge From Mental Health Can Inform Pediatric Rehabilitation

Strategies Used by Professionals in Pediatric Rehabilitation to Engage the Child in the Intervention Process: A Scoping Review

AIM

To investigate strategies used by professionals in pediatric rehabilitation to engage children in every step of the intervention process, including assessment, goal setting, planning and implementation of the intervention, and results evaluation.

METHODS

A scoping literature review was conducted, and seven databases were searched, including CINAHL and MEDLINE, ProQuest Central, PsycINFO, Social Science Premium Collection, PubMed, and Web of Science. A citation search of included articles was completed. Predetermined criteria, quality standards, and PIO framework guided the selection process. Results were presented in relation to Self-Determination Theory (SDT) and the contextual model of therapeutic change.

RESULTS

In total, 20 studies were included in the review. Pediatric professionals reported that therapeutic use of self and their own engagement in the intervention facilitated the establishment of a supportive relationship. Providing clear explanations about their role and therapy rationale developed positive expectations. By making the child feel successful within-session and outside-session activities, professionals enhanced child mastery. Professionals' strategies were abstractly described.

CONCLUSIONS

Further research is needed to investigate strategies that are effective in the different steps of the intervention. More observational, longitudinal studies are required to capture fluctuations in in-session engagement.

Using PRPP-Assessment for measuring change in everyday activities by home-based videos: An exploratory case series study in children with multiple disabilities

BACKGROUND

Currently, paediatric health care aims to use a child-centred tailor-made approach. In order to design tailored occupational therapy, the implementation of personalised occupation-based measurements that guide and evaluate goal setting and are responsive to change is necessary.

PURPOSE

Primarily, this study explored the potential of the Perceive, Recall, Plan, and Perform (PRPP) assessment to measure the change in the performance of children with multiple disabilities. As a secondary evaluation, the feasibility of the PRPP-Intervention in a home-based program to enable activities was described. The overall aim is to show the potential of the PRPP-Assessment as an outcome measure to use as a base for designing tailor-made person-centred care.

METHODS

An exploratory longitudinal multiple case series mixed-methods design was used. The PRPP-Assessment, scored by multiple raters, was conducted based on parent-provided videos. The assessed activities were chosen by the child and/or parents. Responsiveness was evaluated by hypotheses formulated a priori and by comparing measured change with change on concurrent measures: Goal Attainment Scaling (GAS) and Canadian Occupational Performance Measure (COPM). Over a 6-week period, children and their parents (or caregivers) participated in an online home-based video coaching program where parents were coached in the implementation of the training, based on the PRPP-Intervention, by paediatric occupational therapists on a weekly basis. The feasibility of the intervention was explored using semi-structured interviews with children, parents, and the treating occupational therapists and was analysed by directed content analysis.

RESULTS

Three out of 17 eligible children agreed to participate and completed post-intervention measurement, of which two completed the intervention. Quantitative results showed that eight out of nine activities improved on the PRPP-Assessment and the COPM, and nine improved on the GAS. In total, 13 out of 15 hypotheses for responsiveness were accepted. Participants experienced the intervention as successful and acceptable. Facilitators and concerns over demand, implementation, practicality, integration, and adaptation were shared.

CONCLUSION

The PRPP-Assessment showed the potential to measure change in a heterogeneous group of children. The results indicated a positive tendency for the intervention and also provide directions for further development.

Transforming Occupational Therapy for the 21st Century PAIRE: Recognize Privilege, Acknowledge Injustice, and Reframe Perspective to Reach Equity

Theories, models, and frameworks provide the foundation for occupational therapy education, research, and clinical practice. While most have a systems approach focus, other factors, such as societal influences and structural inequities, also contribute to health. Using a cross-sectional design, this study identified the gaps in occupational therapy models of practice and presents a novel approach, the PAIRE (Recognize Privilege, Acknowledge Injustice, and Reframe Perspective to Reach Equity) Model. PAIRE is focused on achieving occupational equity through the reciprocal and intersectional impact of the provider/team, the person/people seeking occupational therapy, and the occupation-in-context, with continuous influences of access, context, and justice. We describe the components of PAIRE and illustrate its functionality in education, research, and clinical practice contexts as well as case examples.

Negotiating expectations for therapy between mothers and service providers: a narrative analysis

PURPOSE

To use stories about mothers and service providers negotiating expectations for therapy to illuminate processes contributing to power differences within partnerships.

METHODS

This narrative study presented stories from three mothers and three service providers. Stories were co-constructed between participants and researchers and analyzed using narrative analysis. Building on An and Palisano's (2014) Model of Family-Professional Collaboration, stories were organized into the stages of goal setting, planning, and doing therapy.

RESULTS

Each story illuminated a process unique to that story that can redistribute power between mothers, service providers, and therapy environments while negotiating expectations: protecting sacred issues, facilitating knowledge exposure, filling voids/vacuums, recognizing cultural conditioning, re-discovering eclipsed roles, and connecting relay teams. We propose including three additional strategies to An and Palisano's model to increase the readiness of mothers and service providers to negotiate expectations for therapy and collaborate fully as the model intends: 1) exploring power-sharing conversations; 2) looking for social context clues; and 3) adopting a humility stance.

CONCLUSION

Information on the six illuminated processes can help structure a client story grounded in optimal negotiation of expectations and equal partnerships.Implications for RehabilitationKnowledge of diverse stories about mothers and service providers negotiating expectations for therapy can be a resource to guide actions in related situations.Leaving the topic of expectations for therapy implicit or unchallenged increases the risks that negotiations remain unbalanced and unproductive.Service providers may enhance collaboration with mothers in paediatric rehabilitation by exploring power-sharing conversations, looking for social context clues, and adopting a humility stance.

Central yet overlooked: engaged and person-centred listening in rehabilitation and healthcare conversations

PURPOSE

Listening in healthcare practice is often overlooked. This article addresses the misconception that listening in rehabilitation and healthcare is a simple skill, and proposes a conceptual framework of effective listening in healthcare conversations, based on conceptualizations, attributes, and outcomes associated with listening.

METHOD

A critical review was conducted, encompassing literature on listening in everyday and healthcare conversations. Articles were retrieved through database and hand searching.

RESULTS

Although various types of listening have been proposed, they share common attributes, including being attentive, emotionally involved, and non-judgmental. A conceptual framework is proposed in which listening in healthcare is seen as a relational process fostered by the 'engaged and person-centred listener', leading to relational outcomes (e.g., mutual engagement, collaboration) and client-specific outcomes. Listening in healthcare conversations can be difficult due to situational conditions and the level of self-regulation required.

CONCLUSIONS

Effective listening in healthcare differs from everyday listening with respect to its attributes, intentionality, and challenges. In healthcare, listening is essential to mutual engagement and other relational outcomes that mobilize the client towards pursuing goals. There is a need for greater understanding of the centrality and challenges to effective listening in healthcare conversations. Implications for rehabilitation practice are discussed.Implications for RehabilitationListening in rehabilitation conversations is a core skill or advanced competency-not a 'soft' skill with little effect on client outcomes.Effective listening is essential to mutual understanding, engagement, relationship building, and collaboration, which mobilize the client towards pursing goals in rehabilitation.Listening effectively in rehabilitation conversations involves deliberately adopting a person-centred perspective.Effective rehabilitation professionals have several listening intentions in mind in addition to understanding, including engaging the other person in the therapy session, building relationship, and collaborating.Rehabilitation professionals can deliberately adopt the intention to be an "engaged and person-centred listener" who is with and for the client.

Fisioterapia com brinquedos e terapia assistida por cães em lactentes: estudo observacional

RESUMO O objetivo deste trabalho foi comparar a fisioterapia com brinquedos com a terapia assistida por cães no desenvolvimento neuromotor de lactentes de quatro meses de idade com e sem alterações neuromotoras. Trata-se de pesquisa descritiva e observacional de caráter qualitativo, realizada com 10 lactentes, que foram avaliados pela escala motora infantil de Alberta (EMIA), divididos em grupo 1 (G1) e grupo 2 (G1) e subdivididos em grupo brinquedo (G1B e G2B) e grupo cão (G1C e G2C) para a realização das intervenções quinzenais. O questionário Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) foi escolhido para avaliar as oportunidades presentes no ambiente domiciliar. A análise de dados qualitativos foi feita por meio de fotos e filmagens. A presença do cão nos grupos G1C e G2C resultou em um ambiente descontraído e divertido, interesse dos lactentes em tocar o pelo do animal, movimentos alternados de membros, contato visual, emissão de sons, evolução na interação social e sentimento de segurança. Nos grupos G1B e G2B, constatou-se diminuição da motivação, ausência de emissão de sons pelos lactentes e contato visual e interesse pelo toque restrito a brinquedos que tivessem diversas cores e sons, havendo pouca agitação e motivação para as habilidades motoras nesses grupos. Conclui-se que a presença do cão promoveu melhores resultados motores, sociais, afetivos e cognitivos. A terapia assistida por animais pode ser um método eficaz para auxiliar na fisioterapia convencional de lactentes com atraso no desenvolvimento neuropsicomotor.

Physical therapy with toys and dog-assisted therapy in infants: observational study

ABSTRACT This study aimed to compare physical therapy with toys with dog-assisted therapy in the neuromotor development of 4-month-old infants with and without neuromotor alterations. This is a qualitative descriptive and observational study carried out with 10 infants, who were evaluated by the Alberta Infant Motor Scale, divided into Group 1 (G1) and Group 2 (G1), and subdivided into Toy Group (TG1 and TG2) and Dog Group (DG1 and DG2) for the performance of fortnightly interventions. By the Affordances in the Home Environment for Motor Development - Infant Scale, we assessed the opportunities present in the home environment. Qualitative data were analyzed using photos and videos. The presence of a dog in DG1 and DG2 resulted in a relaxed and fun environment, infants interested in touching the animal’s fur, alternating limb movements, eye contact, sound production, increased social interaction, and feeling of security. In TG1 and TG2, decrease in motivation was observed as well as the absence of sound production and eye contact by infants, and interest in touch restricted to toys that had different colors and sounds, with little agitation and motivation for motor skills in those groups. We concluded that the dog’s presence promoted better motor, social, affective, and cognitive results. Animal-assisted therapy can be an effective method to support conventional physical therapy for infants with delayed neuropsychomotor development.

Cognitive Strategy Training in Childhood-Onset Movement Disorders: Replication Across Therapists

Objective: To explore preliminary effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach in improving outcomes in childhood-onset hyperkinetic movement disorders (HMDs) including dyskinetic cerebral palsy following deep brain stimulation (DBS) across UK clinical occupational therapists. Methods: Randomized, multiple-baseline, Single Case Experimental Design N-of-1 trial with replications across participants. Five self-selected goals were identified: three goals were worked on during CO-OP and two goals were left untreated and used to assess skills transfer. Participants were between 6 and 21 years and had received DBS surgery with baseline Manual Ability Classification System (MACS) levels I-IV. Participants were randomized to typical or extended baseline (2 vs. 6 weeks), followed by 10 weekly individual CO-OP sessions. The primary outcome was functional performance measured by the Performance Quality Rating Scale-Individualized (PQRS-I), assessed before, during, and following treatment. Outcome assessors were blinded to baseline allocation, session number, and assessment time. A non-overlapping index, Tau-U, was used to measure effect size. Results: Of the 12 participants recruited, 10 commenced and completed treatment. In total, 63% of trained goals improved with effect sizes 0.66-1.00 ("moderate" to "large" effect), seen for all children in at least one goal. Skills transfer was found in 37% of the untrained goals in six participants. Conclusions: Cognitive strategy use improved participant-selected functional goals in childhood-onset HMD, more than just practice during baseline. Preliminary effectiveness is shown when the intervention is delivered in clinical practice by different therapists in routine clinical settings.

A measure of parent engagement: plan appropriateness, partnering, and positive outcome expectancy in pediatric rehabilitation sessions

PURPOSE

To examine the psychometric properties of a parent-report measure of engagement in pediatric rehabilitation.

METHOD

113 parents (of children 4 months to 18 years, varying in diagnoses) were recruited from standard outpatient/inpatient, early intervention, and life skills programs, sampled from different sites in Canada, the US, and Australia. Parents completed the Pediatric Rehabilitation Intervention Measure of Engagement-Parent version (PRIME-P) twice, after two therapy sessions approximately two weeks apart. Analyses examined factor structure, internal consistency, and test-retest reliability, and assessed construct validity hypotheses concerning participant characteristics and contextual factors.

RESULTS

The resulting 11-item PRIME-P has three factors capturing engagement in terms of Plan Appropriateness, Partnering, and Positive Outcome Expectancy. The factors displayed strong internal consistency and test-retest reliability (Partnering demonstrated slightly weaker test-retest reliability). Construct validity was shown by significant associations between the PRIME-P scales and parents' presence versus absence during the sessions, as well as service providers' years of experience.

CONCLUSIONS

The PRIME-P captures parent engagement as a multifaceted construct involving appropriateness of the therapy plan, a sense of active partnership in the intervention process, and an expectation for a positive outcome. The PRIME-P has promise for research, clinical practice, and educational purposes.IMPLICATIONS FOR REHABILITATIONThe PRIME-P is a psychometrically sound tool that fills a gap in how researchers and practitioners can measure the engagement of parents in the therapy process.To enhance parent engagement, service providers can encourage collaboration in planning, foster a sense of working in partnership, and convey a sense of hope.The findings point to the need to pay attention to parents' beliefs about the therapy plan and outcomes, in addition to their behavioral involvement.The PRIME-P is a promising tool for pediatric rehabilitation that can be used to investigate the role of a crucial, yet poorly understood variable in the therapy process.

Program factors influencing parents' engagement in a friendship-making intervention for youth with disabilities

PURPOSE

The aim was to examine parents' experiences of engagement in a friendship-making intervention for youth with physical and developmental disabilities.

METHOD

This mixed methods study used a convergent parallel design where quantitative and qualitative data were collected concurrently, analyzed independently, and then merged into an overall interpretation. Four parents completed the Pediatric Rehabilitation Intervention Measure of Engagement-Parent version at four points during the 8-week program. They also took part in post-intervention interviews about their engagement-related experiences, including their involvement, interest, and confidence in the parent sessions.

RESULTS

Parents' engagement experiences were captured in four themes involving the person-intervention fit: the relevance of program content, the usefulness of the content, their behavioral involvement in planning and group discussions, and seeing youth experience success. The themes corroborated the quantitative measurement of engagement and illustrated and elaborated on how program factors influenced engagement.

CONCLUSIONS

This study indicates the value of including a parent component in a youth friendship-making intervention, and points to the importance of considering relevance, usefulness, behavioral involvement, and success in designing these sessions. The four themes reflect important program factors that may be broadly relevant to the design of group-based interventions for parents of youth with disabilities.IMPLICATIONS FOR REHABILITATIONThe findings indicate the value of including a parent component in youth interventions.Parents are engaged when they feel programs are relevant and useful, are behaviorally involved, and see youth experience success-these factors should be considered in optimal program design.It is important to optimize parent engagement by personalizing content, such as by providing choices and options to increase relevance and decrease burden.Transparent communication about program content and the benefits experienced by other parents will help new parents be more fully informed about what to expect.

A pragmatic case series of clients living with medically diagnosed migraines self-referred to reflexology

BACKGROUND AND PURPOSE

Migraine affects approximately 2% of the population of the UK with around 190,000 people experiencing a migraine daily. This study investigated the effectiveness of reflexology on migraine symptoms provided under pragmatic, personally funded conditions.

MATERIALS AND METHODS

Data was gathered on a case series of 20 reflexology clients with medically diagnosed migraine. All participants self-referred to a member of the Association of Reflexologists (AoR). The Measure Yourself Medical Outcome Profile (MYMOP) was completed at each appointment. All participants received six reflexology sessions.

RESULTS

In terms of an improvement in the overall MYMOP profile, 75% (n = 15) of clients had an improvement of two or more points. The minimal clinically important difference for the MYMOP change score is 1.0; this was achieved by 90% (n = 18) of participants. The mean difference in scores for each of the MYMOP aspects was calculated and the greatest improvement was found with symptom 1, their chosen primary symptom, which changed an average of 3.40 points (95% CI: 2.35, 4.45.) CONCLUSION: The results indicate the potential for reflexology to relieve the symptoms of migraine.

The Engaged Child in Occupational Therapy

BACKGROUND.

Achieving optimal outcomes for children in occupational therapy settings is influenced, in part, by their engagement. The nature of child engagement from the occupational therapy perspective remains relatively unexplored.

METHOD.

A qualitative research methodology was adopted, using an interpretive description approach. Thirty-two occupational therapists participated in five focus groups and six individual interviews that were thematically analyzed.

FINDINGS.

Four themes emerged from the data: (i) signs of child engagement and disengagement; (ii) it's about the child feeling safe; (iii) a sense of meaning and purpose; and (iv) service and therapist factors influencing child engagement.

IMPLICATIONS.

Helping the child feel safe; providing meaningful experiences; and being flexible and responsive were key means of connecting with, and supporting, child engagement. Strategies occupational therapists reportedly used to engage the child aligned with the tenets of self-determination theory (autonomy, relatedness, and competence).

Speech-language-hearing therapy and clinical listening in a mental health team: perception of parents of children with autism spectrum disorder

ABSTRACT Purpose: to analyze the effects of clinical listening in the discourse of parents of children with autism about the speech-language-hearing work in the team of a Children and Youth Psychosocial Attention Center (Centro de Atenção Psicossocial Infanto-Juvenil). Methods: a descriptive case study research with nine parents of children with autism. Results: the parents recognize, in the therapeutic experience with the speech-language-hearing therapist, changes in the quality of communication and relationship with their children, becoming more linguistically open and interesting figures to their children, because they understand the communication dynamics and feel ready to develop it. The parents incorporated the idea that it is through a shared playing that their children develop both subjectively and cognitively. They realize that the change and interaction with and between their children, as proposed by the speech-language-hearing therapy, generate care and enlarge the social repertoire of communication. Conclusion: speech-language-hearing therapy was considered as belonging and fundamental to the field of mental health in the work with children with autism, which reinforces the listening offered to the parents by the team.

The Nature, Value, and Experience of Engagement in Pediatric Rehabilitation: Perspectives of Youth, Caregivers, and Service Providers

Purpose: To conduct a qualitative investigation of engagement in pediatric rehabilitation therapy.Methods: Interviews were conducted with 10 youth, 10 caregivers, and 10 service providers. Transcripts were analyzed thematically using an inductive approach.Results: Themes illustrated three perspectives: engagement as a connection with components of the therapy process, engagement as working together, and engagement as an affective and motivational process. Engagement created valued connections with therapy components and forward momentum for therapy.Conclusions: The themes supported a view of engagement as complex, transactional, and multidimensional. Participants focused on different, yet not discrepant, aspects of engagement. Youth focused on having fun and personal connection with service providers. Caregivers provided a more complex perspective encompassing both their own and their child's engagement, with an emphasis on relationship, understanding what is taking place, and feeling valued in the process. Service providers highlighted goal attainment and the value of engagement in bringing about outcomes.

Investigating a Participation-Based Friendship Intervention for Youth with Disabilities: Effects on Goal Attainment, Social Self-Efficacy, and Engagement

Aims: This preliminary study examined the effects of a participation-based friendship intervention for youth with physical and developmental disabilities on their goal attainment, social self-efficacy, and engagement in program sessions.Methods: Before and after the eight-session intervention, five youth with physical and developmental disabilities ages 15-20 (3 females) completed a measure of goal attainment scaling (GAS) and the Canadian Occupational Performance Measure (COPM) for goals related to friendship, along with a measure of social self-efficacy. Engagement was assessed after every second session (i.e. four times). After the program, youth completed interviews to capture their perceptions of each of these variables. Quantitative data were analyzed descriptively, enriched with the qualitative data.Results: Overall, youth achieved their GAS goals and demonstrated clinically significant change in mean COPM performance and satisfaction. Three youth displayed clinically significant change in social self-efficacy. Engagement in the program was high, with the majority of participants reporting slightly increasing levels of engagement over the sessions. The interviews substantiated these quantitative changes.Conclusions: There are few evidence-informed friendship interventions for youth with disabilities. This study provides initial evidence for the effectiveness of a participation-based friendship intervention incorporating coaching and focusing on real-world goals and contexts.

'I Didn't Know What to Expect': Describing Parents' Expectations in Children's Rehabilitation Services

Aims: The aim of this paper is to provide a holistic description of the nature, formation and impact of parents' therapy related expectations.Methods: This qualitative descriptive study drew from initial and follow up interviews with 20 parents of children ≤ 6 years who had a developmental disability or delay and used therapy services at a children's treatment center in Ontario, Canada. Conventional content analysis was used to inductively generate themes and investigator triangulation was completed.Results: Parent's child related expectations focused on whether the child would receive a diagnosis and what they might achieve. Parents held expectations about the availability of service and how it would be offered. Parents' expectations of service providers included their knowledge, skills, relationships and communication with the children and parents. Parents held expectations of themselves related to attendance and roles in therapy sessions and home practice. These expectations are described according to how they are shaped and changed them over time. The impact of matched/mismatched expectations is explored.Conclusion: Service providers can improve family-centred care and collaboration with parents by explicitly discussing parents' expectations when beginning, and throughout, therapy. Parent satisfaction and therapy engagement may improve if parents and service providers negotiate and agree upon expectations.

The complexities and synergies of engagement: an ethnographic study of engagement in outpatient pediatric rehabilitation sessions

PURPOSE

To investigate client (youth/caregiver) and service provider engagement in outpatient pediatric rehabilitation therapy sessions.

METHODS

In an ethnographic study, five research assistants attended 28 outpatient sessions, mostly delivered by occupational, physical, and speech-language therapists, and rated signs of client, provider, and relational engagement using the Pediatric Rehabilitation Intervention Measure of Engagement - Observation version. Post-session interviews were conducted individually with 13 youth, 15 caregivers, and 26 providers.

RESULTS

Overall, there was a moderate to great extent of engagement. Provider engagement was rated as higher than client engagement, particularly in sessions with activities focusing on body structure/function. The interviews indicated associations among engagement-related constructs: (a) expectations influenced engagement/disengagement and therapy progress, (b) engagement was associated with positive affect and relationships, and (c) engagement was strongly associated with relationships and collaboration.

CONCLUSIONS

Engagement is a central process within a complex system of psychosocial constructs operating in therapy. Engagement is emergent, synergistic, and change-inducing - it emanates from, involves, and influences multiple aspects of therapy. Notably, engagement ties two pivotal elements - positive expectations and positive affect - to positive relationships, collaboration, and therapy progress. Implications for practice include an understanding of how providers manage the therapeutic context and work to foster engagement.Implications for rehabilitationEngagement, and its various elements, plays a central role in shaping how clients, parents, and clinicians value therapeutic encounters.Optimal therapy is often thought to include engagement, relationships, and collaboration; the importance of therapy expectations, positive affect, and perceptions of progress are frequently overlooked.Engagement and motivation may be maximized when youth and caregivers are asked explicitly about how they view their engagement in therapy.In addition to clarifying and aligning expectations with youth and caregivers, service providers can enhance engagement and motivation by intentionally creating enjoyable and meaningful interactions, developing relationships, negotiating consensus on goals and plans, and demonstrating therapy progress.Service providers can harness engagement and the system of related constructs by listening and communicating effectively, by entering the world of the client and family, and by being aware of, anticipating, and responding to engagement and disengagement.

Reliability and validity of the Pediatric Clinical Assessment of Modes in outpatient pediatric rehabilitation

Introduction

Therapists’ interpersonal skills are important contributors to client participation. Providing therapists with opportunities to self-reflect on their approach to therapeutic communication can support occupational therapy best practice. The aim of this study was to evaluate the reliability and validity of the observer version of the Pediatric Clinical Assessment of Modes.

Method

The Pediatric Clinical Assessment of Modes was used to rate therapists’ overall and individual communication mode use according to the Intentional Relationship Model. Successful and unsuccessful attempts were rated separately.

Results

The observers rated 125 therapist–child interactions. The successful and unsuccessful domains of the Pediatric Clinical Assessment of Modes demonstrated appropriate internal consistency, inter-rater reliability, and structural validity for evaluating the therapist’s overall communication and individual use of the collaborating, empathizing, encouraging, instructing, and problem-solving modes. The empathizing, encouraging, and problem-solving subscales demonstrated greater than expected floor effects and could not effectively separate therapists into high and low performance groups for the unsuccessful domain. The observers reported low frequency of successful and unsuccessful communication attempts for the advocating subscale, raising concerns related to the reliability of this subscale for evaluating therapist–child interactions.

Conclusion

Study findings support the reliability and validity of the Pediatric Clinical Assessment of Modes for use in pediatric outpatient rehabilitation.

Effects of a Collaborative Intervention Process on Parent-Therapist Interaction: A Randomized Controlled Trial

Aim: To determine whether a collaborative intervention process facilitates parent-therapist interactions. Methods: Participants were 18 children with physical disabilities, their mothers, and 16 physical therapists. Therapists randomized to the experimental group were instructed in strategies for collaboration (working together) with parents in goal setting, planning, and implementing interventions. Family-therapist dyads participated in 6 weekly sessions. Four sessions were videotaped and combined (1st and 2nd for goal-setting/planning, 3rd and 5th for implementation) to code behaviors using Response Class Matrix. Multivariate analysis of variance was used to compare therapist and parent behaviors between groups. Results: Therapists in the experimental group demonstrated a higher frequency of "seeking information" (p < 0.01), "giving information" (p < 0.05), "positive behavior" (p < 0.01) and lower frequency of "child-related behavior" (p < 0.001) than therapists in the comparison group during goal-setting/planning and implementation. Parents in the experimental group demonstrated a higher frequency of "giving information" than parents in the comparison group (p < 0.01) during goal-setting/planning and implementation. Conclusion: Parents and therapists in the experimental group interacted more with each other, whereas those in the comparison group focused more on the child. The collaborative strategies appear to have increased parent participation in the intervention process, which has been a challenge for physical and occupational therapists.

Program opportunities of residential immersive life skills programs for youth with disabilities

PURPOSE

Residential immersive life skills programs provide youth with the skills and outlooks needed to adopt new roles in life. Observed program opportunities and service providers' perceptions of opportunities were examined to determine program fidelity. Service providers' views of how the programs work were also examined.

METHOD

107 activity settings were observed across two summers at three programs, with opportunities assessed using the Measure of Environmental Qualities of Activity Settings (MEQAS-48). Activity settings were classified by session format (instructional versus experiential) and activity type (active physical, skill-based, self-improvement). Qualitative interviews were held with seven service providers.

RESULTS

Service providers indicated the importance of life-preparatory learning opportunities for social interaction, choice, and skill development, which aligned with high observed MEQAS-48 opportunities for social interaction, choice in experiential session formats, and personal growth. Providers individualized program delivery to provide youth with personally meaningful and challenging experiences. Providers also discussed emergent, transformational outcomes, including enhanced awareness of strengths, enhanced confidence in skills, identity development, and greater awareness of future life possibilities.

CONCLUSIONS

The study provided evidence of program fidelity, along with robust evidence for program opportunities as an active ingredient that may be transferable to the design and delivery of other transition-support programs.

Youth Engagement in Pediatric Rehabilitation: Service Providers' Perceptions in a Real-Time Study of Solution-Focused Coaching for Participation Goals

AIM

Client engagement is assumed to affect therapy outcomes. This study examined service providers' perceptions of youth engagement in solution-focused coaching sessions focusing on participation-oriented goals for youth with cerebral palsy.

METHOD

Service providers completed the Pediatric Rehabilitation Intervention Measure of Engagement-Service Provider version (PRIME-SP) at the end of each session of the brief solution-focused coaching intervention (3-5 sessions) for 10 youth.

RESULTS

Youth engagement was high yet fluctuated over the sessions. Service providers noted a range of components of engagement/disengagement (affective, cognitive, and behavioral) and related factors, including client states, components of behavior change (success or nonsuccess between therapy sessions, and pleasure with success), and service provider strategies. Four preliminary patterns involving engagement, client-reported success, and goal difficulty (personally achievable or dependent on others) appeared to be meaningfully related to quantitative measures of youth outcomes.

CONCLUSIONS

The study provides insights into the highly engaging nature of solution-focused coaching and the relational, co-constructed nature of the therapeutic interaction. The study indicates the utility of the PRIME-SP as a tool for recording observations of components of engagement and related factors that may be useful for clinical decisions about the use of engagement strategies and for general reflections on practice.