Current and preferred services of specialized professionals in childcare settings in Quebec, Canada: A descriptive survey of childcare administrators' perspectives.

BACKGROUND: Many challenges exist in promoting inclusion in childcare settings. Adequate support from specialized professionals is necessary to create inclusive childcare settings. Understanding which services are being delivered by specialized professionals in childcare contexts is an important first step. The aim of this study was to (1) describe the services currently being delivered by specialized professionals in childcare settings in Quebec (Canada) and (2) seek childcare administrators' perspectives on their preferred services. METHODS: An online province-wide descriptive survey was conducted with childcare administrators (n = 344). Questions focused on 11 service delivery dimensions (e.g. professionals involved, children served). Descriptive statistics were calculated. RESULTS: Childcare settings received services from a median of two specialized professionals (IQR [1-4]). Most services were delivered by early childhood special educators (61.3%), speech-language pathologists (57.6%), psycho-educators (43.6%) and occupational therapists (43.3%). Childcare administrators identified these four services as being particularly supportive. Professionals delivered a median of 0.4 h of service per week in each childcare setting (IQR [0.1-3.0]). A high percentage (91.2%) of administrators reported unmet needs for professional support in at least one developmental domain, with a high percentage (57.3%) of administrators identifying needs in the socio-emotional domain. Most (63.3%) expressed a desire to prioritize services for children without an established diagnosis but identified by early childhood educators as having needs for professional support. Most administrators (71.4%) also preferred in-context services. CONCLUSIONS: Childcare administrators perceive an important role for specialized professionals in supporting inclusion in their settings. Recommendations emerging are based on the four main professional service needs identified: (1) increasing the intensity and stability of services; (2) providing services for undiagnosed children identified by early childhood educators as having unmet needs; (3) ensuring that services encompassing all developmental domains with a focus on the socio-emotional domain; and (4) prioritizing of in-context services.

Proposed framework and knowledge synthesis of services delivered by specialized professionals in childcare settings: A scoping review.

BACKGROUND: Services from specialized professionals in childcare settings contribute to support early childhood development. Little is known, however, about how services are delivered in this context. The aims of this scoping review were to propose a framework to describe services delivered by specialized professionals in childcare contexts and synthesize knowledge about those services. METHODS: Documents published between 2000 and 2022 in APA PsychINFO, ERIC, CINAHL and MEDLINE were included. These documents described services delivered by a range of specialized professionals (e.g., speech-language pathologists, occupational therapists, physical therapists and early childhood special education teachers) in childcare contexts and whose aim was to support motor, cognitive, affective, language or social development of children. Deductive and inductive qualitative analyses and descriptive statistics were carried out. RESULTS: The review included 47 documents. The Description of Services delivered by specialized Professionals in Early Childhood (D-SPEC) Framework emerged from qualitative analyses. The D-SPEC Framework included 11 dimensions: three actors and their context, specialized professionals involved, children served, purpose of service, type of service, service duration and intensity, mode of service delivery, mode of access to services and funding. Most services delivered by specialized professionals in childcare were provided by a single professional and targeted language. Two documents described multitiered service delivery models with a continuum of services ranging from general support for all children to individualized interventions for children with specific needs. In-context services were preferred to pull-out services in most documents reviewed. CONCLUSIONS: The D-SPEC Framework may be a useful tool to assist researchers in documenting and comparing services delivered by specialized professionals. More importantly, this framework will facilitate the development of intersectoral and interdisciplinary services essential for supporting early childhood development. Multitiered service delivery models appeared to be a promising way to develop those services addressing the various needs encountered in childcare.

The Development and Pilot Testing of a Fidelity Checklist for a Family-Centered Telehealth Intervention for Parents of Children with Motor Delay.

This multi-methods study describes the development of a pediatric rehabilitation telehealth intervention fidelity checklist, estimates its inter-rater reliability, and documents raters' implementation experience. A literature scan and expert consultation identified eighteen key behaviors and categorized them into three subdomains, measured using a 5-point measurement system. To estimate the checklist's inter-rater reliability, three raters scored 33 video recordings. A Shrout and Fleiss Class 1,1 intraclass correlation (ICC)) and 95% confidence intervals (CI) calculated ICCs = 0.5 (CI: 0, 0.9) for both the Therapist and the Parent-Therapists subdomains, and the Parent subdomain an ICC = 0.3 (CI: 0, 0.8). In the implementation surveys, raters reported high levels of satisfaction (100%), ease of use (84% to 88%), and confidence in their video ratings (87% to 100%). Changes in procedures and scoring were recommended. Capturing raters' implementation experiences is crucial in the early evaluation of the fidelity checklists for telehealth.

Visuoperceptual deficits and participation in older adults after stroke.

BACKGROUND/AIM: Visuoperceptual deficits frequently occur after a stroke, but little is known about how they evolve over time. These deficits may have an impact on participation in daily activities and social roles. The aims were to (i) track changes over six months in the visual perception of older adults with persistent visuoperceptual deficits after a stroke; (ii) examine if these changes differed between participants who had and had not received rehabilitation services; and (iii) verify if participation differed between participants with and without visuoperceptual deficits. METHODS: Visual perception as well as participation of 189 older adults who had had a stroke were evaluated in the first month (T1) after being discharged home from an acute care hospital (NO REHAB group) or rehabilitation unit (REHAB group). For visual perception, only participants presenting deficits at T1 were re-evaluated at three months (T2; n = 93), and those with deficits at T2 were re-evaluated at six months (T3; n = 61). RESULTS: A total of 57 people (30.2%) had visuoperceptual deficits six months after discharge home. Despite persistent deficits, approximately 45% of the participants in the two groups improved whereas 50% of the NO REHAB group and 24.3% of the REHAB group deteriorated. Changes in the mean scores on the MVPT-V were similar in the two groups. Participation, and especially participation in social roles, was more restricted in participants with visuoperceptual deficits (P < 0.001), independent of the severity of the stroke. CONCLUSION: Visuoperceptual deficits are common post-stroke. However, they evolve differently in different people and are associated with a reduction in participation.

[Description of a Pilot Project for Pediatric Occupational Therapy in Daycare and Community Settings]. / Description d'un projet pilote d'ergothérapie pédiatrique en milieux de garde et communautaires.

Background. Occupational therapy interventions that promote and prevent children's health and well-being aim to reduce health inequalities and foster protective factors. The purpose of this study is to describe a pilot community-based occupational therapy project for preschoolers in partnership with community organizations and childcare services. Method. A participatory action research approach was implemented with support from an advisory committee. An occupational therapist provided community-based occupational therapy services in a tiered organization model over one year. Findings. Services were offered in three tiers: 7 awareness workshops for parents and caregivers (Tier 1), 57 visits and 27 consultations in 8 community agencies (Tier 2), and 23 individual follow-ups (Tier 3). Implications. There is an opportunity to implement with community agencies and daycare settings an occupational therapy service based on community-based rehabilitation for children under 5 years of age.

Description. Les interventions ergothérapiques en promotion et prévention de la santé et du bien-être des enfants visent à réduire les inégalités de santé et favoriser les facteurs de protection. But. Cette étude vise à décrire un projet pilote de service d'ergothérapie à base communautaire, pour les enfants d'âge préscolaire, en partenariat avec les organismes communautaires et les milieux de garde. Méthodologie. Une approche de recherche-action participative avec soutien d'un comité aviseur a été mis en place. Une ergothérapeute a offert des services d'ergothérapie communautaire selon un modèle d'organisation par paliers durant un an. Résultats. Les services étaient offerts selon trois paliers : 7 ateliers de sensibilisation pour parents et intervenants (palier 1), 57 visites et 27 consultations dans 8 organismes communautaires (palier 2) et 23 suivis individuels (palier 3). Conséquences. Il est possible d'implanter un service d'ergothérapie s"inspirant de la réadaptation à base communautaire avec les organismes communautaires offrant des services aux enfants de 5 et moins et les milieux de garde.

Collaboration between Public Health and Schools: An Example of an Integrated Community Social Care Model.

Introduction: There is a need to improve public health interventions to promote youth social and emotional development in close collaboration with schools, families and local communities. A close intersectoral collaboration between the regional public health, schools and school boards was established to co-construct and implement "Positive Intervention (PI)" in the Eastern Townships region (Quebec, Canada). This paper describes its implementation according to the "Integrated Community Care (ICC)" framework. Description: PI is a collaborative and personalized intervention leaning toward an integrated community social care model. In fact, PI relies on the close proximity between Public Health and their educational counterpart as well as their individual temporality. However, PI offered mainly social services and its relationships with Primary Care services was not yet a priority. Discussion: The results show that it is possible to develop and implement an intervention promoting positive mental health in children, with and for local organisations. The level of integration between schools and Public Health services achieved after only 6 months of implementation is encouraging. Conclusion: More research is needed to thoroughly document the implementation, social validity, and effects of such an intervention by taking in the point of view of all stakeholders.

Introduction: Il est nécessaire d'améliorer les interventions de santé publique pour promouvoir le développement social et émotionnel des jeunes en étroite collaboration avec les écoles, les familles et les communautés locales. Une telle collaboration intersectorielle entre la santé publique régionale, les écoles et les commissions scolaires a été mise en place pour coconstruire et mettre en œuvre l'Intervention positive (IP) en Estrie (Québec, Canada). Cet article décrit sa mise en œuvre initiale selon le cadre conceptuel des soins de santé et services sociaux intégrés en proximité des communautés. Description: L'IP est une intervention collaborative et personnalisée qui s'inscrit dans un modèle de services sociaux intégrés en proximité des communautés. En fait, l'IP s'appuie sur une forte proximité entre les services de santé publique et les milieux scolaires, ainsi qu'un ajustement à la temporalité des partenaires. Cependant, l'IP offre principalement des services sociaux et ses relations avec les services de soins primaires n'étaient pas encore une priorité. Discussion: Les résultats montrent qu'il est possible de développer et de mettre en œuvre une intervention de promotion de la santé mentale positive chez les enfants, avec et pour les organisations locales. Le niveau d'intégration entre les écoles et les services de santé publique atteint après seulement six mois de mise en œuvre est encourageant. Conclusion: Des recherches supplémentaires sont nécessaires pour documenter de manière approfondie la mise en œuvre, la validité sociale et les effets d'une telle intervention en prenant en compte le point de vue de toutes les parties prenantes.

Training Intervention and Program of Support for Fostering the Adoption of Family-Centered Telehealth in Pediatric Rehabilitation: Protocol for a Multimethod, Prospective, Hybrid Type 3 Implementation-Effectiveness Study.

BACKGROUND: Children with disability face long wait times for rehabilitation services. Before the COVID-19 pandemic, telehealth adoption was low across pediatric rehabilitation. Owing to the COVID-19 pandemic restrictions, pediatric therapists were asked to rapidly shift to telehealth, often with minimal training. To facilitate the behavior changes necessary for telehealth adoption, provision of appropriate evidence-based training and support is required. However, evidence to support the effective implementation of such training is lacking. The successful real-world implementation of a training intervention and program of support (TIPS) targeting pediatric therapists to enhance the adoption of family-centered telerehabilitation (FCT) requires the evaluation of both implementation and effectiveness. OBJECTIVE: This study aimed to evaluate TIPS implementation in different pediatric rehabilitation settings and assess TIPS effectiveness, as it relates to therapists' adoption, service wait times, families' perception of service quality, and costs. METHODS: This 4-year, pan-Canadian study involves managers, pediatric occupational therapists, physiotherapists, speech-language pathologists, and families from 20 sites in 8 provincial jurisdictions. It will use a multimethod, prospective, hybrid type 3 implementation-effectiveness design. An interrupted time series will assess TIPS implementation. TIPS will comprise a 1-month training intervention with self-paced learning modules and a webinar, followed by an 11-month support program, including monthly site meetings and access to a virtual community of practice. Longitudinal mixed modeling will be used to analyze indicators of therapists' adoption of and fidelity to FCT collected at 10 time points. To identify barriers and facilitators to adoption and fidelity, qualitative data will be collected during implementation and analyzed using a deductive-inductive thematic approach. To evaluate effectiveness, a quasi-experimental pretest-posttest design will use questionnaires to evaluate TIPS effectiveness at service, therapist, and family levels. Generalized linear mixed effects models will be used in data analysis. Manager, therapist, and family interviews will be conducted after implementation and analyzed using reflective thematic analysis. Finally, cost data will be gathered to calculate public system and societal costs. RESULTS: Ethics approval has been obtained from 2 jurisdictions (February 2022 and July 2022); approval is pending in the others. In total, 20 sites have been recruited, and data collection is anticipated to start in September 2022 and is projected to be completed by September 2024. Data analysis will occur concurrently with data collection, with results disseminated throughout the study period. CONCLUSIONS: This study will generate knowledge about the effectiveness of TIPS targeting pediatric therapists to enhance FCT adoption in pediatric rehabilitation settings, identify facilitators for and barriers to adoption, and document the impact of telehealth adoption on therapists, services, and families. The study knowledge gained will refine the training intervention, enhance intervention uptake, and support the integration of telehealth as a consistent pediatric rehabilitation service option for families of children with disabilities. TRIAL REGISTRATION: ClinicalTrials.gov NCT05312827; https://clinicaltrials.gov/ct2/show/NCT05312827. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40218.

Case study assessing the feasibility of using a wearable haptic device or humanoid robot to facilitate transitions in occupational therapy sessions for children with autism spectrum disorder.

INTRODUCTION: Some children with autism spectrum disorder (ASD) have difficulties with transitions that may lead to problem behaviours. Although the use of technologies with children with ASD is receiving increasing attention, no study has looked at their effect on transitions in activities of daily living. This study aimed to document the feasibility of (1) using two intervention technologies (NAO humanoid robot or wearable haptic device) separately to facilitate transitions in occupational therapy sessions for children with ASD and (2) the method used to document changes. METHODS: Using a single case reversal (ABA) design, two children with ASD were randomly assigned to one of the intervention technologies (humanoid robot or haptic bracelet). Each technology was used as an antecedent to stimulate the start of transitions in eight intervention sessions at a private occupational therapy clinic. Data concerning the time required for transitions, child's behaviours during transitions at the clinic and mother's perception of the child's performance in transitions at home were analysed graphically. RESULTS: When using technology, both children's behaviours were appropriate, quick and relatively stable. Also, both mothers reported improved perceptions of their child's performance in transitions. CONCLUSIONS: This exploratory study suggests no detrimental effect of using these technologies.

Parent training interventions for toddlers with autism spectrum disorder.

Background. Now that early identification of toddlers with autism spectrum disorder (ASD) is possible, efforts are being made to develop interventions for children under three years of age. Most studies on early intervention have focused on intensive and individual interventions. However, parent training interventions that help parents interact and communicate with their toddlers with ASD might be a good alternative to promote the development of their child's sociocommunicative skills. Objective. This review aims to systematically examine (1) the use of parent training interventions for children with ASD under three years of age and (2) their effects on children's development, parents' well-being and parent-child interactions. Methods. Systematic searches were conducted to retrieve studies in which at least one parent was trained to implement ASD-specific techniques with their toddlers (0-36 months old) with a diagnosis of or suspected ASD. Results. Fifteen studies, involving 484 children (mean age: 23.26 months), were included in this review. Only two of them met criteria for conclusive evidence. Results show that parents were able to implement newly learned strategies and were generally very satisfied with parent training programs. However, findings pertaining to the children's communication and socioemotional skills, parent-child interactions, and parental well-being were inconclusive.

The effect of supervised Tai Chi intervention compared to a physiotherapy program on fall-related clinical outcomes: a randomized clinical trial.

PURPOSE: To assess some fall-related clinical variables (balance, gait, fear of falling, functional autonomy, self-actualization and self-efficacy) that might explain the fact that supervised Tai Chi has a better impact on preventing falls compared to a conventional physiotherapy program. METHODS: The participants (152 older adults over 65 who were admitted to a geriatric day hospital program) were randomly assigned to either a supervised Tai Chi group or the usual physiotherapy. The presence of the clinical variables related to falls was evaluated before the intervention (T1), immediately after (T2), and 12 months after the end of the intervention (T3). RESULTS: Both exercise programs significantly improved fall-related outcomes but only the Tai Chi intervention group decreased the incidence of falls. For both groups, most variables followed the same pattern, i.e. showed significant improvement with the intervention between T1 and T2, and followed by a statistically significant decrease at the T3 evaluation. However, self-efficacy was the only variable that improved solely with the Tai Chi intervention (p = 0.001). CONCLUSIONS: The impact of supervised Tai Chi on fall prevention can not be explained by a differential effect on balance, gait and fear of falling. It appeared to be related to an increase of general self-efficacy, a phenomenon which is not seen in the conventional physiotherapy program.