Establishing Fidelity of Occupational Performance Coaching

Coaching to Support Children With Disabilities in Occupational Therapy: A Literature Review

IMPORTANCE

Coaching is an effective intervention strategy in occupational therapy but there lacks consensus in the literature about terms, definitions, and approaches used which can be barriers to the clinical use of this method.

OBJECTIVE

The purpose of this review is to understand how coaching adults is used as an intervention to support children with disabilities.

METHODS

Guidelines from foundational scoping review articles and PRISMA-ScR were followed. Studies using adult coaching as an intervention to support children with disabilities were reviewed. A total of 20 articles met inclusion criteria and were included in the review.

FINDINGS

The use of coaching terms and definitions vary. There are commonalities with coaching structures, "key ingredients," and use of outcome measures among studies which can provide a starting framework for occupational therapists wanting to use coaching as an intervention in their practice.

CONCLUSIONS AND RELEVANCE

Coaching adults to support children with disabilities is already known to be an effective occupational therapy intervention strategy. Developing structured protocols with clearer and more unified terminology may improve the fidelity of this intervention approach.

WHAT THIS ARTICLE ADDS

This article presents current practices in adult coaching to support children with disabilities in Occupational Therapy. The authors discuss commonalities across coaching practices for therapists who wish to use coaching protocols in their clinical practice.

Effects of Telehealth Parent Coaching in Supporting Family Participation, Cohesion, and Adaptability

Families provide foundational contexts in which most children develop and grow. For families of children with special health care needs (CSHCN), interdisciplinary supports can build family participation capacities, beyond individualistic child supports. This single-group pretest-posttest quasi-experimental study sought to determine the preliminary effects of the Healthy Families Flourish Program (HFFP), a telehealth occupation-based parent coaching intervention to promote participation, cohesion, adaptability, and communication for families of CSHCN. Eleven families, including 17 parents and 27 children, completed the 10-session intervention consisting of parent education and individualized coaching. Participants completed the Canadian Occupational Performance Measure, Goal Attainment Scaling, and the Family Adaptability and Cohesion Evaluation Scales pre-/post-intervention. Within-group comparisons showed improvements in family participation, cohesion, adaptability, and communication with Cohen's d effect sizes ranging from 0.55-3.32. Researchers found positive relationships between family participation and cohesion as well as participation and adaptability. Findings provide considerations for supporting families within socioecological contexts.

“I Could Really Use This”: Occupational Therapy Students’ Perceptions of Learning to Coach

Coaching, an evidence-based approach in other fields, is relatively novel within occupational therapy (OT) and is not yet widely taught in OT programs. In recent studies, experienced occupational therapists have reported that coaching added value to their practice, but OT students’ perspectives are missing from the literature. This phenomenological study explored OT students’ ( $n=14$ ) perceptions of the value of learning to coach while in fieldwork. Three themes emerged from the inductive qualitative analysis: Coaching Requires a Mindset Shift, Change is a Journey, and Impact on Clients. Occupational therapy students perceived that coaching required a different way of thinking and reimagining their role, saw the value of learning to coach in the clients’ outcomes, and recognized the potential for their future practice regardless of settings. The study findings suggest that incorporating coaching skills into OT education could be beneficial to students when they enter the profession.

Fidelity Protocol Development for a Telehealth Type 1 Diabetes Occupation-Based Coaching Intervention

Background. Preserving fidelity ascertains that the intervention is delivered as intended in occupational therapy (OT) contexts. The process of conceptualizing and developing fidelity standards, however, is seldom documented in the existing literature. Purpose. The purpose of this methodological description paper was to (a) describe the process of generating a comprehensive fidelity plan based on the National Institutes of Health Behavioral Change Consortium's five-domain fidelity framework and (b) evaluate the development process and utility of the end product, the Occupation-Based Coaching (OBC) Fidelity Protocol. Key Issues. There is no known research that documents the process of developing fidelity standards and tools to support the OBC intervention. Implications. The OBC Fidelity Protocol proposes an example of how a comprehensive fidelity plan and tools can be developed from a well-established scientific framework. This can also inform OT practitioners and researchers to deliver OBC sessions with consistency across clients, providers, and interventions/studies.

Early Intervention Service Delivery via Telehealth During COVID-19: A Research-Practice Partnership

Coaching has been identified as a best practice for early intervention (EI) services provided through the Individuals with Disabilities Education Act (IDEA) Part C. The current study describes the establishment and progress of a research-relationship partnership to deliver coaching via telehealth during the COVID-19 pandemic. Community-based EI providers implemented 9-weeks of telehealth coaching and evaluated the extent to which child and caregiver outcomes differed between families that had previously received in-person services versus telehealth only. Four EI providers completed the intervention with n=17 families of children aged 6-34 months during the pandemic (April-August 2020). We used the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) to collect outcomes on caregiver identified goals; we used Wilcoxon Signed Rank Tests to examine pre- to post-intervention data. Results showed significant improvements in parent satisfaction, child performance, and goal attainment (all p<.01). Findings suggest that telehealth coaching procedures implemented by community-based EI providers resulted in improvements in caregiver identified goals for young children.

Coaching Parents of Children with Sensory Integration Difficulties: A Scoping Review

Aim

To review current evidence regarding the effectiveness of occupational therapy coaching interventions for parents of children with sensory integration difficulties, delivered to individuals or groups of parents.

Method

A historical scoping review was completed of empirical research records to summarize what is known and how this information can guide future research. The process was guided by PRISMA guidelines. Inclusion criteria were English language and peer-reviewed empirical studies of parent coaching intervention for children with sensory processing or sensory integration difficulties. Five databases were searched. Papers were critically reviewed using McMaster's guidelines.

Results

Four studies met the search criteria. Three studies took a direct coaching approach with individual parents or families. The fourth study took a mixed educational/coaching approach with groups of parents and teachers.

Conclusion

There is some evidence to conclude that occupational therapists can deliver individual parent-focused coaching interventions which impact positively on individual child goals, parental stress, and sense of competence. Group intervention can lead to caregivers' improved perceived and actual knowledge of sensory integration, as well as a sense of self-efficacy in dealing with sensory-related child behaviors. Current evidence is limited. Suggestions for future research are offered.

Preliminary examination of Coaching in Context with clients with spinal cord injury

STUDY DESIGN

Repeated measures pilot study.

OBJECTIVES

This study examined Coaching in Context when introduced to community-dwelling adults with spinal cord injury (SCI).

SETTING

Urban community.

METHODS

Three volunteers participated in up to ten, 45-60-min Coaching in Context sessions. Number of coaching sessions was recorded. Usefulness of Coaching in Context was examined by the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling (GAS), and the Moorong Self-efficacy Scale (MSES). Data were examined descriptively.

RESULTS

Preliminary examination of Coaching in Context revealed successful implementation with adults with SCI living in the community. Mean COPM performance and satisfaction scores increased by 2.55 (SD = 2.25) and 4.27 (SD = 2.41), respectively. With the exception of one, each goal achieved or exceeded GAS expected level. Changed MSES scores ranged from +7 to +16.

CONCLUSIONS

The ability to implement and evaluate Coaching in Context with three adults with SCI was demonstrated. Improvement in goals established for coaching was also documented.

Coaching While Waiting for Autism Spectrum Disorder Assessment: Protocol of a Pilot Feasibility Study for a Randomized Controlled Trial on Occupational Performance Coaching and Service Navigation Support

BACKGROUND

In Australia, the average time between a first concern of autism spectrum disorder (ASD) and diagnosis is over 2 years. After referral for assessment, families often wait 6-12 months before their appointment. This can be a time of uncertainty and stress for families. For some families, other forms of assistance are not accessible and thus timely intervention opportunities are missed. There is little evidence about how to provide the best support for children or caregivers while on assessment waiting lists.

OBJECTIVE

The aim of this study is to determine whether use of a coaching intervention called Occupational Performance Coaching (OPC) combined with service navigation support is feasible for families waiting for ASD assessment, as a crucial first step in planning a randomized controlled trial.

METHODS

A pilot and feasibility study will be conducted using recommended constructs and associated measures, which will be reported using CONSORT (Consolidated Standards or Reporting Trials) guidance. Participants will be child and caregiver dyads or triads, recruited within 4 months of their child (aged 1-7 years) being referred to one of two services for an ASD assessment in Victoria, Australia. A blinded randomization procedure will be used to allocate participants to one of three trial arms: (1) coaching and support intervention delivered face to face, (2) coaching and support intervention via videoconference, and (3) usual care. Descriptive statistics will be used to describe the sample characteristics of parents and children, inclusive of service access at baseline and follow up. Recruitment rates will be reported, and retention rates will be evaluated against a predicted rate of 70%-80% in each intervention arm. Goal attainment, using the Canadian Occupational Performance Measure, will indicate preliminary evidence for efficacy within the intervention arms, with an increase of 2 or more points on a 10-point performance and satisfaction scale considered clinically significant.

RESULTS

The study was approved by The Royal Children's Hospital Research Ethics and Governance Department in September 2018. As of October 2020, 16 families have been recruited to the study. Data analysis is ongoing and results are expected to be published in 2021.

CONCLUSIONS

Study findings will support planning for a future randomized controlled trial to assess the efficacy of OPC and service navigation support for caregivers of children awaiting ASD assessment.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12620000164998; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378793&isReview=true.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20011.

Establishing and measuring treatment fidelity of a complex cognitive rehabilitation intervention: The multicontext approach

Introduction

This article describes the process of establishing and measuring treatment fidelity of a complex cognitive rehabilitation intervention that uses a metacognitive strategy framework (the multicontext approach). We adapted treatment guidelines for use within an inpatient rehabilitation setting for people with acquired brain injury; explored training methods and therapist perspectives; developed and examined inter-rater reliability of a fidelity measure; and examined adherence to and proficiency of treatment methods.

Method

Therapist perspectives of the intervention and training were obtained from written questionnaires and reflections. Inter-rater reliability of 21 treatment components across 22 video-recorded treatment sessions was assessed by examining absolute agreement between two raters using Cohen’s kappa. The proportion of treatment components implemented in individual sessions as well as average proficiency ratings was calculated.

Results

The fidelity measure demonstrated good inter-rater agreement, ranging from 91–100% for treatment adherence and kappa of .77 to .94 for therapist proficiency. Adherence and proficiency varied between therapists but increased to nearly proficient levels with adjustments to training and procedures. Therapists highlighted the critical importance of video review as a training tool.

Conclusion

The fidelity measure provides a clinical tool for therapist self-reflection, supervision and training, as well as a tool for future research.

Intervention strategies in residential immersive life skills programs for youth with disabilities: a study of active ingredients and program fidelity

Objective: To examine intervention strategy use in residential immersive life skills (RILS) programs. Methods: The Service Provider Strategies-Checklist was used to record the strategies used in 100 activity settings across two summers at three RILS program sites. Activity settings were categorized by activity type and session format. Relative occurrence of the strategies was examined using percentages. Results: Socially mediated strategies (listening, engaging youth) and teaching/learning techniques (verbal cues, verbal instruction) were used in over 75% of the settings. Strategy use was highly contextualized, with different strategy patterns observed for different types of activity settings. Conclusion: The findings suggest that RILS programs be characterized by their use of socially mediated strategies and teaching/learning techniques, with socially mediated and non-intrusive strategies appearing to be program hallmarks. Strategy use was aligned with the types of sessions offered, providing evidence of program fidelity and indicating that RILS programs are complex in their formats, activities, and strategy use.

Parent Perspectives of an Occupational Therapy Telehealth Intervention

Occupational therapy services delivered via telehealth can support families of young children with autism spectrum disorders (ASD) in everyday routines such as mealtime, bedtime, and play. The aim of the current study was to understand the lived experiences of parents who participated in a 12-week, telehealth-delivered occupational therapy intervention (Occupation-Based Coaching). We used semi-structured interviews and subsequent thematic content analysis to understand how parents perceived the mechanism of service delivery (i.e., videoconferencing) and the content of the intervention. Themes that emerged from the data included Compatibility with Everyday Life, Collaborative Relationship, and Parent Empowerment. Parents expressed how telehealth fit within their daily lives, how telehealth supported a collaborative relationship with the occupational therapist, and how the content of the intervention built a sense of empowerment.

Sensory sensitivity and its relationship with adult attachment and parenting styles

Parenting styles vary in levels of both warmth and control, with evidence that type of parenting behavior is linked with social-emotional and other developmental outcomes for children. There are well-established associations between adult attachment and parenting styles. Given emerging evidence that people with different attachment patterns vary in how they receive and modulate sensory information, there are potential implications for parenting which have rarely received research attention. This cross-sectional study investigates the links between parenting style and parental sensory sensitivity, and the possible mediating role of parental sensory sensitivity in the relationship between adult attachment and parenting styles. A convenience sample of 155 parents of children aged 4-12 years old completed an online survey measuring: adult attachment (Experiences in Close Relationships-Modified 16-item Scale), sensory sensitivity (Highly Sensitive Persons Scale-Shortened Version), and parenting styles (Parenting Styles and Dimensions Questionnaire). Correlation, regression and mediation analyses were conducted. Analyses revealed that parents who reported more attachment insecurity also reported higher levels of parental sensory sensitivity, and more authoritarian and/or permissive (non-optimal) parenting styles. Parental sensory sensitivity was found to fully mediate the relationship between attachment avoidance and permissive parenting, and to partially mediate the relationship between attachment anxiety and both authoritarian and permissive parenting. This study represents the first quantitative evidence for associations between parental sensory sensitivity and parenting styles, and the mediating effect of parental sensory sensitivity on the known relationship between attachment insecurity and parenting. Awareness of a parent's level of sensory sensitivity, in addition to his/her attachment style, may assist in developing effective strategies to meet both the parent's and child's needs and support the parent-child relationship.

Fidelity of Occupational Performance Coaching: Importance of Accuracy in Intervention Identification

Establishing fidelity processes and measures is an important step in the development of interventions. Accurate referencing, naming of interventions and robust discussion of deviations from the theories, methods or terminology underpinning interventions support the fidelity of future applications of interventions in research and clinical settings. This commentary clarifies the establishment of fidelity for Occupational Performance Coaching (OPC) in relation to a recent article on this topic by Dunn and colleagues. Fundamental flaws in the referencing, labelling, theoretical underpinnings and methods inaccurately described as OPC are outlined. Guidance in establishing fidelity for future applications of OPC is provided.