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

How do we capture child and family goals? Examining the goal setting practices used by community-based allied health professionals

PURPOSE

This study aimed to i) identify child and family goals reported in a community allied health service, ii) map goals to ICF domains, and iii) evaluate goal characteristics against child-centred and family-centred practice principles.

METHODS

A retrospective study design was used to extract and analyse raw goal data documented for children and families accessing a community-based allied health service. ICF linking rules were used to map goals to the ICF domains. A study-specific goal rating criterion was used to examine the extent to which child-centred and family-centred practice principles were evident in documented goals.

RESULTS

355 goals were documented for 181 children (aged 0 < 12 years). The most common goal domain was 'Body Functions' (57%), following by Activity and Participation (33%), then Environment (9%). Few participation-focused goals were reported (4%). Documentation showed consistent collaboration with caregivers, however, minimal information for children. Goals were often phrased in therapist-specific language without reference to the child or family's functional context. As a result, many goal records did not meet the child-centred and family-centred criteria.

INTERPRETATION

Results highlight the critical need for tools and training which can support professionals to collaboratively construct goals, to ensure that documented goals reflect meaningful child and family priorities.

Family-Professional Collaborative Physical Therapy Intervention via Telehealth for Children with Developmental Disabilities: A Mixed-Method Feasibility Study

AIMS

To evaluate attendance rates, daily therapy engagement, parents' perceptions regarding feasibility, acceptability, family-centeredness, and individualized outcomes of a collaborative telehealth-based physical therapy intervention for children with disabilities.

METHOD

Mixed-method design involving 15 families and 17 children with disabilities (range age 4-90 months). Parents recorded time spent on home activities. Family-centeredness was assessed using the Measure of Processes of Care-20-item (MPOC-20). The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were used to measure individualized outcomes. Interviews were conducted on families' perceptions of the telehealth service.

RESULTS

Parents attended an average of 8.29 out of 9 scheduled telehealth sessions and spent an average of 1.32 (±0.58) hours per day on therapy activities. Parents rated the services as family-centered "to a fairly great extent" or "to a great extent". On average, children achieved individualized goals. Parents identified therapists' collaborative behaviors and information sharing as facilitators, beliefs about their abilities and technical issues as barriers, and empowerment and active engagement as benefits of the telehealth sessions.

CONCLUSION

The family-professional collaborative telehealth physical therapy was perceived by parents as acceptable and feasible to address their children needs. Children achieved individualized goals and participating families actively engaged in the intervention process.

e-EARLY TOGETHER Intervention for Infants at High Risk of Cerebral Palsy: Randomized Controlled Trial Protocol

PURPOSE

The purpose of this study is to evaluate the effectiveness of an early intervention program, e-EARLY TOGETHER, that combines goal-oriented training, parental coaching, environmental enrichment in a telehealth approach in a low- and middle-income country.

METHODS

Protocol for a randomized controlled clinical trial to evaluate the effectiveness of e-EARLY TOGETHER intervention compared to standard guidelines on outcomes related to development and performance in infants at high risk of cerebral palsy.

DISCUSSION

This protocol will inform and enrich clinical practice related to early intervention in low- and middle-income countries. It is expected that the data obtained will contribute to the implementation of effective early intervention programs with positive and lasting results for the child, their family, and the community.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials: RBR-7WWJRQ3, registered May 10, 2023; WHO Trial Registration UTN Code U-1111-1286-4639.

Family-professional collaborative intervention via telehealth with an infant with Down syndrome and visual impairment: a case report

BACKGROUND

Collaborative interventions, involving partnerships between professionals and families, make it possible to actively engage families in the rehabilitation process. However, no study was found that used a physiotherapy intervention via telehealth for infants with Down syndrome (DS).

OBJECTIVE

Describe the case report of a family-professional collaborative intervention via telehealth for an infant with Down syndrome and visual impairment during the COVID-19 pandemic.

CASE DESCRIPTION

A male infant five months old participated in a collaborative intervention for a period of eight weeks. Three goals were set with the family, and a goal-oriented home program, involving visual stimulation strategies, was organized.

OUTCOMES

Two goals were achieved. The family scored changes in performance and satisfaction with the infant's performance according to the adapted Canadian Occupational Performance Measure. Improvement of motor skills was verified by Alberta Infant Motor Scale and changes in mobility and daily activities performance were measured by the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test.

CONCLUSION

The use of family-professional collaborative intervention via telehealth during the COVID-19 pandemic shows promising results for achieving the goals established by the family collaboratively with the physical therapists.

Foundational concepts of collaborative practice with parents in occupational therapy for children

INTRODUCTION

In occupational therapy for children, collaborative practice with parents is crucial for meaningful family-centred interventions, yet it remains undefined and inconsistently addressed. This study aimed to establish foundational concepts for collaborative practice with parents in occupational therapy for children in progressing the field with a universal description.

METHODS

This paper encompasses the second dataset of a larger scoping review and a preliminary validation of findings by an advisory panel. Data were gathered from indexed sources on collaborative practice with parents in occupational therapy for children (ages 0-10) using MedLine, PsychInfo, ERIC, Embase, OTSeeker, Scopus, and ProQuest Central. Data were extracted, charted, and descriptively analysed by paired independent reviewers. The Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-extension for Scoping Reviews were used. A draft definition of collaborative practices, developed based on preliminary review findings and an operational definition, was validated by an advisory panel of 13 experienced Australian occupational therapists, whose input was integrated into a final, comprehensive description of collaborative practice.

RESULTS

The scoping review encompassed 299 sources, revealing three major components of collaborative practice: 'collaborative practice aims', 'parent-therapist partnership', and 'strategies for collaboration'. The advisory panel endorsed the draft definition, confirmed its professional relevance, and suggested some modifications.

CONCLUSION

The major outcome of this study is an evidence-based and discipline-specific preliminary description of collaborative practice with parents in occupational therapy for children. This description provides a common language and foundational concepts for the future development of a collaborative practice framework to guide practice and research. Future studies can explore specific components, exploring their mechanisms and significance. Further expanded validation is required, incorporating the perspectives of a wider community of occupational therapists and families to enhance the description's applicability.

The experiences of occupational therapists supporting children with self-regulation needs: A qualitative descriptive study

INTRODUCTION

Occupational therapists support children with self-regulation needs to engage in meaningful occupations at home, school, and in the community. However, little is known about how Australian practitioners perceive their role working with children with self-regulation needs in the Australian healthcare context. Therefore, we explored the contemporary practice experiences of Australian occupational therapists working with children 4-12 years referred for self-regulation support, to better understand elements constituting efficacious service delivery to enhance occupational engagement.

METHODS

A qualitative descriptive design, underpinned by constructivism and relativism, was implemented to address the research aim. Occupational therapists were recruited online to participate in audio-recorded focus groups and interviews. The audio recordings were anonymised, transcribed verbatim, and analysed through reflexive thematic analysis.

CONSUMER AND COMMUNITY INVOLVEMENT

No consumers were involved in the study design or analysis.

FINDINGS

Four themes were generated, encapsulating the experience of 13 occupational therapists working with children with self-regulation needs: (1) navigating the complexities of self-regulation, (2) intervening to support the child and surrounding systems, (3) bringing the occupational therapy perspective to the self-regulation puzzle, and (4) working within an evolving practice context. Themes 1-3 describe specific processes that all occurred within the context of Theme 4. Overall, participants detailed successful practice to support children with self-regulation needs to participate in meaningful occupations that required person-centredness, collaboration, coaching, and adaptability of therapists responding to different stakeholder demands.

CONCLUSION

Self-regulation is a complex area of practice, and occupational therapists have a key role in supporting occupational engagement by balancing the child's needs with those of family, other stakeholders, and funding bodies. Findings support occupational therapists and decision-makers advocating for the unique role of occupational therapy in supporting self-regulation in childhood as part of a collaborative, multi-disciplinary approach. Specific consideration must also be given to ways that current funding schemes in Australia enable occupational therapy services for children with self-regulation needs.

PLAIN LANGUAGE SUMMARY

Controlling emotions and behaviours is sometimes called 'self-regulation'. Some children find this hard and need help from an occupational therapist, who knows a lot about the body and the systems within it. A lot of occupational therapists in Australia help children with their self-regulation. There is not much known about how these therapists see their role in working with these children. We wanted to understand what it is like for occupational therapists who help children, between 4 and 12 years old, with their self-regulation. We interviewed 13 occupational therapists from across Australia and analysed what they said. The data showed four main points: (1) understanding the challenges of self-regulation, (2) helping the child and their environment, (3) using an occupational therapy approach to solve self-regulation issues, and (4) working in a changing practice environment. The therapists described how important it is to focus on the child, work together with many people like caregivers and teachers, and being flexible. They talked about how they balance the needs of the child, family, and funding bodies, which could sometimes be tricky. The study shows the things that therapists are doing when working with children who need help with their self-regulation and the things that therapists find hard working in this space. The results of the study can be used by people who advocate for services that help children and by people who make decisions about Australia's healthcare. One way the study can be used is to think about how current funding schemes do or do not allow different people and professions to work together to support children's self-regulation. Even though there were some limitations, such as a low response rate due to the stress of the COVID-19 pandemic, we did interview therapists from different parts of Australia who work in different settings to each other.

Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Foundation Principles

This article is the fifth in a series of eight articles that comprise a special issue on Family-Centered Early Intervention (FCEI) for children who are deaf or hard of hearing (DHH) and their families, or FCEI-DHH. The 10 FCEI-DHH Principles are organized conceptually into three sections (a) Foundation Principles, (b) Support Principles, and (c) Structure Principles. Collectively, they describe the essential Principles that guide FCEI for children who are DHH and their families. This article describes the Foundation Principles (Principles 1 and Principle 2). The Foundation Principles emphasize the essential elements of ensuring that families with children who are DHH can access early intervention (EI) and other appropriate supports, as well as highlight the need for provision of EI that is family-centered. Implementation of these FCEI-DHH Principles is intended to improve the lives and the outcomes of children who are DHH and their families around the globe.

Theoretical-Methodological Foundations for the Global Integration Method (Método de Integração Global-MIG) in the Treatment of Autism Spectrum Disorder

Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, "Método de Integração Global"), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD's impact. MIG's theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment.

Family-centred care interventions for children with chronic conditions: A scoping review

INTRODUCTION

Children with chronic conditions have greater health care needs than the general paediatric population but may not receive care that centres their needs and preferences as identified by their families. Clinicians and researchers are interested in developing interventions to improve family-centred care need information about the characteristics of existing interventions, their development and the domains of family-centred care that they address. We conducted a scoping review that aimed to identify and characterize recent family-centred interventions designed to improve experiences with care for children with chronic conditions.

METHODS

We searched Medline, Embase, PsycInfo and Cochrane databases, and grey literature sources for relevant articles or documents published between 1 January 2019 and 11 August 2020 (databases) or 7-20 October 2020 (grey literature). Primary studies with ≥10 participants, clinical practice guidelines and theoretical articles describing family-centred interventions that aimed to improve experiences with care for children with chronic conditions were eligible. Following citation and full-text screening by two reviewers working independently, we charted data covering study characteristics and interventions from eligible reports and synthesized interventions by domains of family-centred care.

RESULTS

Our search identified 2882 citations, from which 63 articles describing 61 unique interventions met the eligibility criteria and were included in this review. The most common study designs were quasiexperimental studies (n = 18), randomized controlled trials (n = 11) and qualitative and mixed-methods studies (n = 9 each). The most frequently addressed domains of family-centred care were communication and information provision (n = 45), family involvement in care (n = 37) and access to care (n = 30).

CONCLUSION

This review, which identified 61 unique interventions aimed at improving family-centred care for children with chronic conditions across a range of settings, is a concrete resource for researchers, health care providers and administrators interested in improving care for this high-needs population.

PATIENT OR PUBLIC CONTRIBUTION

This study was co-developed with three patient partner co-investigators, all of whom are individuals with lived experiences of rare chronic diseases as parents and/or patients and have prior experience in patient engagement in research (I. J., N. P., M. S.). These patient partner co-investigators contributed to this study at all stages, from conceptualization to dissemination.

Physicians and nurses view on their roles in communication and collaboration with families: A qualitative study

BACKGROUND

Families are introduced as new partners in interprofessional communication and collaboration during hospitalisation of an adult patient. Their introduction into the healthcare team has consequences for the roles and responsibilities of all healthcare professionals. Role clarification is thus needed to create optimal communication and collaboration with families.

AIM

To gain insight into how physicians and nurses view their own roles and each other's roles in communication and collaboration with families in the care of adult patients.

METHODS

A qualitative interpretive interview design was used. Fourteen semi-structured interviews, with seven physicians and seven nurses, were conducted. Data were analysed according to the steps of thematic analysis. For the study design and analysis of the results, the guidelines of the consolidated criteria for reporting qualitative studies (COREQ) were followed. The ethical committee of the University Medical Center Groningen approved the study protocol (research number 202100640).

FINDINGS

Thematic analysis resulted in three themes, each consisting of two or three code groups. Two themes "building a relationship" and "sharing information" were described as roles that both nurses and physicians share regarding communication and collaboration with families. The role expectations differed between physicians and nurses, but these differences were not discussed with each other. The theme "providing support to family" was regarded a nurse-specific role by both professions.

CONCLUSION

Physicians and nurses see a role for themselves and each other in communication and collaboration with families. However, the division of roles and expectations thereof are different, overlapping, and unclear. To optimise the role and position of family during hospital care, clarification and division of the roles between physicians and nurses in this partnership is necessary.

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.

Family-Professional Collaboration on Modified Ride-on Car Intervention for Young Children: Two Case Reports

AIMS

The study aimed to describe the implementation of a collaborative ride-on car (ROC) intervention by applying a practice model of family-professional collaboration. The model involves specific strategies for collaboration, "visualizing a preferred future" and "scaling questions."

METHODS

The participants were two young children with mobility limitations and their mothers. The 12-week of ROC intervention involved training sessions with a therapist and home sessions. The outcomes included the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS).

RESULTS

The collaborative strategies facilitated parent engagement in goal setting, planning, and evaluation. After the intervention, the mothers' ratings of their children's performance and parent satisfaction on the COPM increased by 6 and 3 points, respectively, and the level of goal attainment exceeded expectations (+1 on GAS) in both families. Prior to the ROC intervention, both families were hesitant to use powered mobility. However, the experience of participating in the ROC intervention process broadened parents' perspectives on self-directed mobility and led them to explore options for their children to move independently.

CONCLUSIONS

The collaborative ROC intervention can be used as an intervention for early mobility and a bridging step for families reluctant to use a powered wheelchair.

The Conceptual Analysis of Collaboration in the Occupational Therapy by Combining the Scoping Review Methodology

BACKGROUND

Collaboration is an important concept in goal-setting in occupational therapy. However, this concept is not stable due to various definitions. The purpose of this study was to clarify the concept of collaboration in occupational therapy.

METHOD

A scoping review was used to search for all articles related to occupational therapy and collaboration. PubMed, Web of Science, CINAHL, and OT Seeker searches were conducted using predetermined keywords. Three examiners independently reviewed and assessed the quality of each study using Walker and Avant's concept analysis method.

RESULTS

Results of the database searches yielded 1873 studies, 585 of which were deemed eligible to include in this review. Results showed five attributes ("active participation for the common objective", "existence of something to share", "matured communication and interaction", "relationship founded on the respect and trust" and "complementing each other") and two antecedents and several consequences.

CONCLUSIONS

Our findings may contribute to collaborative goal-setting and occupational therapy.

Shared decision-making for children with medical complexity in community health services: a scoping review

BACKGROUND

Children with medical complexity is an increasing population whose parents and healthcare providers face multiple decisions. Shared decision-making is a process where patients, their families and healthcare providers collaborate to make decisions based on clinical evidence and informed preferences of the family. Shared decision-making has benefits for the child, family and healthcare providers, including improved parental understanding of the child's difficulties, increased participation, improved coping skills and more efficient healthcare use. It is, however, poorly implemented.

AIMS AND METHODS

A scoping review was conducted to explore shared decision-making for children with medical complexity in community health services, including how shared decision-making is defined in research, how it is implemented, including barriers and facilitators and recommendations for research. Six databases were systematically searched for papers published in English up to May 2022: Medline, CINAHL, EMBASE, PsycINFO, PubMed, Cochrane Database of Systematic Reviews and sources of grey literature. The review is reported according to the Preferred Reporting Items for Scoping Reviews.

RESULTS

Thirty sources met the inclusion criteria. Most factors can either be a facilitator or barrier to shared decision-making depending on the context. Two significant barriers to shared decision-making in this population include uncertainty about the child's diagnosis, prognosis, and treatment options and the presence of hierarchy and power imbalance during clinical encounters with healthcare providers. Further influencing factors include continuity of care, the availability of accurate, accessible, adequate, and balanced information and the interpersonal and communication skills of parents and healthcare providers.

CONCLUSION

Uncertainty about diagnosis, prognosis and treatment outcomes for children with medical complexity are additional challenges to the known barriers and facilitators to shared decision-making in community health services. Effective implementation of shared decision-making requires advancement of the evidence base for children with medical complexity, reducing power imbalance in clinical encounters, improving continuity of care, and improving the availability and accessibility of information resources.

Elizabeth Casson Memorial Lecture 2022: Optimising performance, clinical and economic outcomes in occupational therapy service delivery

The rise in health and social care costs has prompted a critical look at the way health and social care services are managed and delivered. There has been a significant change in assessing the performance and evaluating the outcomes of services. Where once only performance outcome data related to service efficiency were required, now evidence of clinical effectiveness and cost-effectiveness is demanded. When evaluating the outcomes of service delivery, it is important to measure performance outcomes (related to service efficiency), clinical outcomes (related to service effectiveness) and economic outcomes (related to cost-effectiveness). This lecture examines the interdependent relationship between performance, clinical and economic outcomes in service delivery which is underpinned by strong leadership, the application of various service improvement strategies and collaborative research between managers, clinicians, researchers and health economists, with patient and public involvement. Service improvement strategies based on practice-based and research-based evidence will be suggested to optimise performance, clinical and economic outcomes. My lecture concludes that occupational therapists should adopt these service improvement strategies and conduct clinical researches and economic evaluations to develop an efficient, effective and cost-effective service which can meet the client's needs by using allocated resources and is value for money from a commissioning perspective.

Exploring 10 years of dissemination of the F-words for Child Development: A multifaceted case study

BACKGROUND

There is growing interest in exploring how to move research findings into practice. Since 2014, a team of families and researchers has been working to promote and study the dissemination of the "F-words for Child Development" (Function, Family, Fitness, Fun, Friends, and Future). This case study describes our dissemination strategies and uses the Diffusion of Innovation theory to understand the factors contributing to the uptake of the F-words-a function-promoting, strengths-based, and family-centred innovation in child health and development.

METHODS

Between November 2011 and November 2021, we collected data from multiple sources: our dissemination strategies, including affiliated documents/artefacts (e.g., videos and presentations) and evaluation data (e.g., surveys and Google/video analytics). We used a two-step analysis: (1) a chronological time series to describe the processes involved along with indicators of dissemination over time (e.g., increase knowledge and awareness); and (2) Diffusion of Innovation theory to explore the factors that contributed to the uptake of the F-words.

RESULTS

Multifaceted dissemination strategies were essential to raise awareness and increase families' and service providers' knowledge of the F-words. These included three primary strategies: (i) development and distribution of educational materials; (ii) presentations at educational meetings; and (iii) educational outreach visits. Additional strategies, such as the use of mass media, collaboration with early adopters/champions, and the involvement of family members further supported dissemination efforts. Diffusion of Innovation factors (innovation characteristics, time, social systems, and communication channels) all contributed to the uptake of this innovation.

CONCLUSIONS

Purposeful planned dissemination practice, to increase knowledge and awareness of an innovation, is an important step in the knowledge translation process. Over a period of 10 years, through the use of multiple dissemination strategies conducted in partnership with families and service providers, the F-words have spread globally. Diffusion of Innovation theory has served to help understand how and why the F-words are being shared and adopted around the world.

Parent-therapist partnership to ELEVATE gross motor function in children with perinatal stroke: protocol for a mixed methods randomized controlled trial

Background

There is increasing evidence for early, active rehabilitation to enhance motor function following early brain injury. This is clear for interventions targeting the upper extremity, whereas passive treatment approaches for the lower extremity persist. The purpose of this trial is to evaluate the effectiveness of early, intensive rehabilitation targeting the lower extremity and delivered in a parent-therapist partnership model for children with perinatal stroke.

Methods

We describe a protocol for a waitlist-control, single-blind, mixed methods effectiveness randomized controlled trial, with an embedded qualitative study using interpretative description. Participants are children with perinatal stroke aged eight months to three years with signs of hemiparesis. Participants will be randomly allocated to an immediate ELEVATE (Engaging the Lower Extremity Via Active Therapy Early) intervention group, or a waitlist-control group, who will receive usual care for six months. The ELEVATE intervention involves one hour of training four days per week for 12 weeks, with a pediatric therapist and a parent or guardian each delivering two sessions per week. The intervention targets the affected lower extremity by progressively challenging the child while standing and walking. The primary outcome measure is the Gross Motor Function Measure-66. Secondary outcomes include the Pediatric Quality of Life Inventory™, Young Children's Participation and Environment Measure, and an instrumented measure of spasticity. A cost-effectiveness analysis and qualitative component will explore benefit to costs ratios and parents’ perspectives of early, intensive rehabilitation, and their role as a partner in the rehabilitation, respectively.

Discussion

This study has the potential to change current rehabilitation for young children with perinatal stroke if the ELEVATE intervention is effective. The parent interviews will provide further insight into benefits and challenges of a partnership model of rehabilitation. The mixed methods design will enable optimization for transfer of this collaborative approach into physical therapy practice.

Trial registration

ClinicalTrials.gov NCT03672864. Registered 17 September 2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03525-6.

Collaborative practices between parents and primary caregivers in pediatric occupational therapy: a scoping review protocol

OBJECTIVE

This scoping review aims to identify and describe the available literature on current collaborative practices between parents and primary caregivers in pediatric occupational therapy. The review will also explore the definition of collaborative practices and the therapeutic approaches employed in the literature.

INTRODUCTION

The family-centered approach in occupational therapy has proven effective in supporting families' education about their child's condition, as well as intervention strategies. One of the pillars of this approach is parent-therapist collaboration. Collaborative practices enable shared decision-making and mutual engagement between families and professionals. The literature has shown inconsistencies in the definitions, language, and implementation of collaborative practices and family-centered literature. Such inconsistencies have been hindering the transition from traditional service delivery to a family-centered approach.

INCLUSION CRITERIA

This review will include studies investigating collaborative practices in pediatric occupational therapy. Accepted studies must include a description of the therapeutic practices undertaken and an explanation of how the collaboration between parents and/or primary caregivers and professionals occurred. All pediatric occupational therapy areas will be considered for inclusion, including practices with other disciplines. However, studies including only adolescents or using child-centered interventions exclusively will be excluded.

METHODS

The search will employ indexed terms and keywords in seven databases (MEDLINE, PsyclNFO, ERIC, Embase, OTseeker, Scopus, and ProQuest Central). Eligible sources must be written in English, and will not be limited to date range or location. Data will be extracted, charted, and descriptively analyzed by four reviewers based on JBI recommendations. Study findings will be presented and mapped in tables and diagrams to address the study aims.

Collaborative Goal-Setting Beliefs and Practices of Out-Patient Pediatric Physical Therapists Working in Saudi Arabia and the United States

AIMS

(1) identify and compare family-centered care (FCC) and collaborative goal-setting (CGS) beliefs and practices of out-patient pediatric physical therapists (PTs) in Saudi Arabia (SA) and the United States (US); (2) describe CGS approaches; and (3) determine the association between CGS practices and educational level, clinical experience, and FCC beliefs and practices.

METHODS

87 PTs completed an online survey.

RESULTS

Ninety percent of PTs believed in FCC to a great extent. PTs in the US rated their organization's family-centeredness and their own FCC application significantly higher than PTs in SA. PTs believed in CGS with parents (86%) and children (66%) to a great extent while 69% of PTs reported applying CGS with parents to a great extent compared to 39% with children. PTs in SA rated the importance of determining therapy goals by PTs significantly higher than PTs in the US. The most selected CGS strategy was asking about concerns and needs. Low to moderate significant positive associations were found between CGS practices and PTs belief of their organization's family-centeredness and their own FCC application.

CONCLUSION

Similarities and differences were found between the two countries in FCC and CGS beliefs and practices. Organizational and individual FCC practices influence CGS practices.

Efficacy of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach with and without parental coaching on activity and participation for children with developmental coordination disorder: A randomized clinical trial

BACKGROUND

Cognitive Orientation to daily Occupational Performance (CO-OP) is recommended for its effectiveness in improving activity performance in children with Developmental Coordination Disorder (DCD). Since parental support is a key element in CO-OP, parental coaching seems relevant to be investigated.

AIMS

Compare the efficacy of the CO-OP Approach with and without additional parental coaching to improve activity and participation in children with DCD.

METHODS AND PROCEDURES

Randomized clinical trial with 7-12-years-old children with DCD, randomly assigned to experimental (E-group) or active control (AC-group) groups, with 11 children each. Both groups received traditional CO-OP, E-group received four additional parental group-coaching sessions. Occupational performance and satisfaction on intervention goals were measured at baseline, post-intervention, and follow-up. Participation, motor performance and executive function were assessed at baseline and post-intervention.

OUTCOMES AND RESULTS

CO-OP with and without additional parental coaching resulted in improved occupational performance according to children, parents, and external evaluators. Children showed statistically significant gains in motor performance and cognitive flexibility. Participation measures did not change.

CONCLUSIONS AND IMPLICATIONS

As coaching did not add additional gains, parent's required participation in CO-OP might be enough to support children's occupational performance.

Feasibility and effectiveness of home-based therapy programmes for children with cerebral palsy: a systematic review

OBJECTIVE

To assess the feasibility and effectiveness of home-based occupational therapy and physiotherapy programmes in children with cerebral palsy (CP), focusing on the upper extremity and reporting on child-related and/or parent-related outcomes.

DESIGN

Systematic review.

DATA SOURCES

Electronic searches were performed in MEDLINE, EMBASE, CINAHL, PsycINFO, OTseeker and PEDro, and in ICTRP and CENTRAL trial registers, from inception to 6 June 2019.

ELIGIBLE CRITERIA

The review included all types of original studies concerning feasibility or effectiveness of home-based therapy in children aged <18 years with any type of CP. No language, publication status or publication date restrictions were applied.

DATA EXTRACTION AND SYNTHESIS

Study and intervention characteristics and the demographics of participating children and their parents were extracted. Feasibility was assessed by outcomes related to acceptability, demand, implementation, practicality, adaptation, expansion or integration. Regarding effectiveness, child-related outcome measures related to any level of the International Classification of Functioning, Disability and Health, or parent-related outcomes were investigated. Two authors independently extracted the data. Risk of bias was assessed using the Downs and Black checklist and the Joanna Briggs Institute Critical Appraisal Checklist.

RESULTS

The search resulted in a total of 92 records: 61 studies and 31 conference abstracts. Feasibility studies reported mainly on acceptability and implementation. Overall compliance to home-based training programmes (implementation) was moderate to high, ranging from 56% to 99%. In the effectiveness studies, >40 different child-related outcome measures were found. Overall, an improvement in arm-hand performance within group across time was shown. Only two studies reported on a parent-related outcome measure. No increase in parental stress was found during the intervention.

CONCLUSIONS

Based on the results of the included studies, home-based training programmes seem to be feasible. However, conclusions about the effectiveness of home programmes cannot be made due to the large variability in the study, patient and intervention characteristics, comparators, and outcome measures used in the included studies.

PROSPERO REGISTRATION NUMBER

CRD42016043743.

The three-stage assessment to support hospital-home care coordination in Tshwane, South Africa

Background

In complex health settings, care coordination is required to link patients to appropriate and effective care. Although articulated as system and professional values, coordination and cooperation are often absent within and across levels of service, between facilities and across sectors, with negative consequences for clinical outcomes as well as service load.

Aim

This article presents the results of an applied research initiative to facilitate the coordination of patient care.

Setting

The study took place at three hospitals in the sub-district 3 public health complex (Tshwane district).

Method

Using a novel capability approach to learning, interdisciplinary, clinician-led teams made weekly coordination-of-care ward rounds to develop patient-centred plans and facilitate care pathways for patients identified as being stuck in the system. Notes taken during three-stage assessments were analysed thematically to gain insight into down referral and discharge.

Results

The coordination-of-care team assessed 94 patients over a period of six months. Clinical assessments yielded essential details about patients’ varied and multimorbid conditions, while personal and contextual assessments highlighted issues that put patients’ care needs and possibilities into perspective. The team used the combined assessments to make patient-tailored action plans and apply them by facilitating cooperation through interprofessional and intersectoral networks.

Conclusion

Effective patient care-coordination involves a set of referral practices and processes that are intentionally organised by clinically led, interprofessional teams. Empowered by richly informed plans, the teams foster cooperation among people, organisations and institutions in networks that extend from and to patients. In so doing, they embed care coordination into the discharge process and make referral to a link-to-care service.

A Structured Goal-Setting Process to Promote Functional and Measurable Outcomes in School-Based Physical Therapy: A Knowledge Translation Study

INTRODUCTION

Goal setting is an important component of school-based physical therapy; however, evidence suggests that therapists may not consistently write goals that are relevant, context specific, and measurable. The aims of this knowledge translation study were to evaluate implementation of a goal-setting method for school-based therapists.

METHOD

This study was created to align with the Knowledge to Action framework and included 1-day training and follow-up mentorship. Goals were assessed pre- and posttraining, and questionnaires assessed barriers and facilitators.

RESULTS

Twenty-two physical therapists participated. Nineteen participants (90%) strongly agreed/agreed that the training helped change their perspectives about goal setting in the school environment. There was a statistically significant difference in goal quality pre- and posttraining. Therapists identified barriers and facilitators to implementation of effective goal setting in practice.

DISCUSSION

Results indicate that this method may be effective at improving goal writing that is relevant, context specific, and measurable in school settings.

Collaboration between parents and SLTs produces optimal outcomes for children attending speech and language therapy: Gathering the evidence

BACKGROUND

Collaboration between parents and speech and language therapists (SLTs) is seen as a key element in family-centred models. Collaboration can have positive impacts on parental and children's outcomes. However, collaborative practice has not been well described and researched in speech and language therapy for children and may not be easy to achieve. It is important that we gain a deeper understanding of collaborative practice with parents, how it can be achieved and how it can impact on outcomes. This understanding could support practitioners in daily practice with regard to achieving collaborative practice with parents in different contexts.

AIMS

To set a research agenda on collaborative practice between parents and SLTs in order to generate evidence regarding what works, how, for whom, in what circumstances and to what extent.

METHODS & PROCEDURES

A realist evaluation approach was used to make explicit what collaborative practice with parents entails. The steps suggested by the RAMESES II project were used to draft a preliminary programme theory about collaborative practice between parents and SLTs. This process generates explicit hypotheses which form a potential research agenda.

DISCUSSION & CONCLUSIONS

A preliminary programme theory of collaborative practice with parents was drafted using a realist approach. Potential contextual factors (C), mechanisms (M) and outcomes (O) were presented which could be configured into causal mechanisms to help explain what works for whom in what circumstances. CMO configurations were drafted, based on the relevant literature, which serve as exemplars to illustrate how this methodology could be used. In order to debate, test and expand our hypothesized programme theory for collaborative practice with parents, further testing against a broader literature is required alongside research to explore the functionality of the configurations across contexts. This paper highlights the importance of further research on collaborative practice with parents and the potential value of realist evaluation methodology. What this paper adds Current policy in education, health and social care advocates for family-centred care and collaborative practice with parents. Thereby, collaborative practice is the preferred practice for SLTs and parents. In this paper, we explore collaborative practice and use a realist evaluation approach to achieve the aim of setting a research agenda in this area. Researchers use realist evaluation, a methodology originally developed by Pawson and Tilley in the 1990s, to explore the causal link between interventions and outcomes, summarized as what works, how, for whom, in what circumstances and to what extent. Realist evaluation provides a framework to explore configurations between contexts (C), mechanisms (M) and outcomes (O). We used this methodology to take a first step at making explicit what collaborative practice is and how it might be achieved in different contexts. We did this by drafting a preliminary programme theory about collaborative practice, where we made explicit what context factors and mechanisms might influence outcomes in collaborative practice between parents and SLTs. Based on this programme theory, we argue for the need to develop a research agenda on collaborative practice with parents of children with speech, language and communication needs. The steps between a programme theory and a research agenda could entail exploring each CMO, or step in the programme theory, and evaluating it against the existing literature-both within and beyond speech and language therapy-to see how far it stands up. In this way, gaps could be identified that could be converted into research questions that would stimulate debate about a research agenda on collaborative practice. Understanding how collaborative practice can be achieved in different contexts could support SLTs to use mechanisms to optimise collaborative practice intentionally and tailor interventions to the specific needs of families, thereby enhancing collaborative practice between parents and SLTs.

Challenges Faced by Therapists Providing Services for Infants With or at Risk for Cerebral Palsy

OBJECTIVE

The purpose of this study was to identify the challenges physical therapists (PTs) and occupational therapists (OTs) have in providing early intervention (EI) for infants with or at risk for cerebral palsy.

METHODS

Therapists' responses to an open-ended question were collected via survey that was distributed to EI providers and analyzed using content analysis.

RESULTS

The primary self-reported barriers to PT/OT EI services had 5 themes: (1) inadequate communication and collaboration, (2) challenges in coordination with family, (3) policy limitations, (4) meeting the child's individual medical needs, and (5) unequal access to resources.

CONCLUSION

Respondents reported that barriers are complex and exist at the individual, family, team, and societal levels. Further research is needed to explore barriers and solutions at each of these levels, from meeting a child's individual medical needs to improving interprofessional communication to increasing equitable access to resources.

Steering towards collaborative assessment: a qualitative study of parents' experiences of evidence-based assessment practices for their child with cerebral palsy

PURPOSE

To understand parents' experiences of evidence-based assessment by health professionals for their child with cerebral palsy.

METHODS

A qualitative interpretive description study was undertaken. Primary carers of children with cerebral palsy (aged 3-18 years) from south-eastern Australia were invited to participate. Face-to-face interviews were held using a semi-structured topic guide and data analyzed inductively. Credibility was ensured through: journal reflections; co-author review; audit trail; and, participant member-checking.

RESULTS

Fourteen parents of children with cerebral palsy, representing Gross Motor Functional Classification System levels I-V, participated. Six themes emerged: (1) Protection; (2) Positively Framed; (3) Bridging the Gap; (4) Involvement; (5) Finding Worth; and (6) Trust. Central to parents' experience was protection of their child's identity and personal self. Assessment can be emotionally confronting, at any stage. Representing the child positively and highlighting possibilities was deemed essential. Parents' involvement ranged from being overlooked spectators to being instigators of assessment. Evidence-based assessment was worthwhile when relevant to parents' direction and family context. The researchers' interpretive description generated a schema and metaphor-the Steering Wheel for Collaborative Assessment.

CONCLUSIONS

A strengths-based approach to diagnosis and assessment is essential. The resulting interpretive description may assist health professionals align evidence-based assessment practices with family-centred care.Implications for rehabilitationParents of children who have cerebral palsy describe having to protect their child's identity and representation, and their own personal well-being, through evidence-based assessment and diagnostic processes.Involving parents in the process of evidence-based assessment and adopting a strengths-based approach is essential.The interpretive description developed-the Steering Wheel for Collaborative Assessment-may assist health professionals to implement evidence-based assessment tools in ways consistent with family-centred care principles.