Therapist perceptions of barriers to telehealth uptake in children's occupational therapy.

INTRODUCTION: The COVID-19 pandemic resulted in a rapid shift to telehealth implementation across paediatric occupational therapy services. Although telehealth can be an appealing option, access is conditional, and the delivery of a telehealth service differs from face-to-face. If telehealth is to be a viable and equitable option for families, insight is needed into why the service might be declined. The purpose of our study was to explore barriers to paediatric occupational therapy telehealth services from client and therapist perspectives in a Greater Sydney local health district. METHOD: A mixed method approach was used, including (i) retrospective review of clinical records for 250 clients seeking occupational therapy who declined the service and (ii) a focus group with four therapists providing the service. Client demographic information was summarised using descriptive statistics. Open-text responses about reasons for declining telehealth were analysed using qualitative content analysis, whereas thematic analysis was used to explore focus group data. FINDINGS: Key findings from the mixed methods analysis identified barriers and issues to consider when working to ensure equitable access to telehealth for children and families. These issues included child engagement, family complexity, the nature of assessments, interventions, and overarching service characteristics as well as the family's digital inclusion. Digital inclusion comprises affordable access to the internet, data, and devices and the capacity of a child and/or family to engage online. CONCLUSION: Our findings suggest that telehealth is not a panacea when face-to-face services are not available. Multiple barriers confounded uptake of telehealth prompting a call to action to ensure equitable access to occupational therapy services for all children.

The parenting occupations and purposes conceptual framework: A scoping review of 'doing' parenting.

INTRODUCTION: Parenting is a valued, common and challenging adult role. Many parents, including some living with disability or difficult social circumstances, experience barriers to fulfilling their parenting roles. Yet, occupational therapy involvement in parenting is rarely documented. Current understandings about 'doing' parenting lack cohesion and are dispersed in occupational therapy literature. This study aims to map and synthesise occupational therapy literature on 'doing' parenting to describe the state of the existing knowledge base, and develop a conceptual framework of parenting occupations as portrayed in occupational therapy literature. METHODS: A scoping review was conducted. Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science were searched on 28 October 2019 and updated on 18 February 2021. Journal articles and book chapters were screened for eligibility. Included texts' publication characteristics, methodological characteristics, and areas of focus were summarised. Interpretive content analysis was conducted. RESULTS: From 5945 unique records, 105 texts were included. These discussed general parenting, parents with disabilities, and parenting in challenging social situations. Most texts focussed on mothers caring for young children in Western cultural contexts. The analysis culminated in the development of a conceptual framework: the Parenting Occupations and Purposes (POP) Framework. This comprises 10 interrelated areas of parenting occupations, which are performed for the purposes of addressing the child's basic, developmental and social needs. Parenting occupations were also found to be influenced by additional, underlying occupations that build parenting capacity - Continuous Parental Development (CPD) occupations. CONCLUSION: These findings provide an overview of current occupational therapy conceptualisations of parenting. Unlike most of the existing literature on parenting, the POP Framework is parent-centric rather than child-centric. More research on parenting occupations is needed, especially with more diverse representation (fathers, ages of children, parental disability and sociocultural background). Further research is required to examine the POP Framework's usefulness in guiding research and practice, particularly among parents with diverse characteristics.

Construct validity of the Child-Initiated Pretend Play Assessment-For 3-year-old Brazilian children.

INTRODUCTION: Play is an indication of children's development and how they function. In occupational therapy it is regarded as an important occupation of childhood. Assessment of a child's play should be included in the test batteries of occupational therapists, who understand the construct validity of the assessment they have chosen. Our aim was to provide evidence of reliability, internal consistency and hypotheses testing of the construct validity of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment. METHODS: Two hundred typically developing Brazilian children aged 3 years were evaluated individually using the Child-Initiated Pretend Play Assessment. RESULTS: The internal consistency showed a Cronbach's alpha coefficient to Percentage of Pretend Play Actions (PEPA) of 0.86 and NOS of 0.81. There were significant differences between the younger children (aged 36-41 months) and the older children (aged 42-47 months) for elaborate play across both conventional-imaginative play (p = .002), symbolic play (p = .012), and the combined score (p = .005). There were significant differences between younger and older girls for elaborate play with symbolic play materials (p = .009) and elaborate play overall (p = .039). There were significant differences between young and older boys for elaborate play with conventional toys (p = .006) and elaborate play overall (p = .025). There were no significant differences for object substitution or imitated actions. CONCLUSION: The measurement properties of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment for 3-year-old Brazilian children identified evidence for response processes, internal structure, with discussion of consequences of testing for 3-year-old Brazilian children.

Patterns of cognitive strategy use common in children with reduced social competence derived from parent perceptions.

INTRODUCTION: Occupational therapists are increasingly being referred children who experience reduced social competence. Ineffective use of cognitive strategies during social interactions is known to contribute to reduced social competence in children who have difficulty learning. Little is known about the nature of social cognitive strategy use or how it may be observed in children during performance of school occupations. This study aimed to explore the type of difficulties in cognitive strategy use that children experience during performance of social tasks as perceived by their parents. METHODS: A retrospective chart review was used to analyse 306 PRPP@HOME (Primary) Parent/Caregiver Questionnaire responses targeting parent perceptions of their child's cognitive strategy use during social interactions. The children were in the first four years of formal schooling and identified by their teachers as having difficulties with social skills. Factor analysis was used to discover conceptual groupings amongst cognitive strategy use items. RESULTS: Four factors emerged from the analysis. Factor One grouped PRPP cognitive strategy items related to organised thinking, attention and processing external sensory details during social performance. Factor Two grouped items related to higher level thinking for internal self-evaluation of behaviour. Factor Three grouped items related to focused and dual attention during social interactions. Factor Four grouped items related to performance and adjustment of behaviour to match the context of social interaction. CONCLUSION: Parent perceptions indicate that children with reduced social competence experience inefficient use of cognitive strategies which organise attention, sensory perception and planning. This information can be used to specifically target programs which better support the thinking strategies which facilitate children's participation during social activities at school.

Measuring movement skill perceptions in preschool children: A face validity and reliability study.

BACKGROUND/AIM: The aim of this study was to determine the face validity and the reliability of a pictorial scale to assess preschool children's perceived movement skills. METHODS: The pictorial scale examines the perceptions of the 12 fundamental movement skills presented in the Test of Gross Motor Development-2 (six locomotor and six object control skills) and six active play skills (e.g. cycling). A total of 91 Australian children aged four to five years from 14 preschools completed the scale on two occasions to determine test-retest reliability. Internal consistency was determined for all 18 items and for each subscale. After the second test, participants were asked open-ended questions to gain insight into their understanding of what was happening in the pictures to determine the face validity. RESULTS: Overall, children demonstrated a better understanding of object control and play skills compared to locomotor skills. Test-retest reliability values were good for object control (intra-class correlation, ICC = 0.75), locomotor (ICC = 0.78), active play skills (ICC = 0.80) and all 18 skills combined (ICC = 0.77). Internal consistency was acceptable for locomotor (Test 1 0.64, Test 2 0.75), object control (0.71, 0.76), active play skills (0.76, 0.74) and for all 18 skills combined (0.88, 0.90). CONCLUSIONS: Overall, this instrument demonstrated an acceptable reliability in preschool children and has provided preliminary information for examining the perceptions of movement skills. This age group presents a key target area for occupational therapists, who can assist preschool children to further develop fundamental movement skills, integrate these skills in their roles and occupations and increase engagement in meaningful physical activity in the long term.

Interactive hazards education program for youth in a low SES community: a quasi-experimental pilot study.

A pilot study of an interactive hazards education program was carried out in Canberra (Australia), with direct input from youth participants. Effects were evaluated in relation to youths' interest in disasters, motivation to prepare, risk awareness, knowledge indicators, perceived preparedness levels, planning and practice for emergencies, and fear and anxiety indicators. Parents also provided ratings, including of actual home-based preparedness activities. Using a single group pretest-posttest with benchmarking design, a sample of 20 youths and their parents from a low SES community participated. Findings indicated beneficial changes on a number of indicators. Preparedness indicators increased significantly from pre- to posttest on both youth (p < 0.01) and parent ratings (p < 0.01). Parent ratings reflected an increase of just under six home-based preparedness activities. Youth knowledge about disaster mitigation also was seen to increase significantly (p < 0.001), increasing 39% from pretest levels. While personalized risk perceptions significantly increased (p < 0.01), anxiety and worry levels were seen either not to change (generalized anxiety, p > 0.05) or to reduce between pre- and posttest (hazards-specific fears, worry, and distress, ps ranged from p < 0.05 to < 0.001). In terms of predictors of preparedness, a number of variables were found to predict posttest preparedness levels, including information searching done by participants between education sessions. These pilot findings are the first to reflect quasi-experimental outcomes for a youth hazards education program carried out in a setting other than a school that focused on a sample of youth from a low SES community.

A commentary on the healthcare transition policy landscape for youth with disabilities or chronic health conditions, the need for an inclusive and equitable approach, and recommendations for change in Canada.

There is a growing number of youth with healthcare needs such as disabilities or chronic health conditions who require lifelong care. In Canada, transfer to the adult healthcare system typically occurs at age 18 and is set by policy regardless of whether youth and their families are ready. When the transition to adult services is suboptimal, youth may experience detrimental gaps in healthcare resulting in increased visits to the emergency department and poor healthcare outcomes. Despite the critical need to support youth with disabilities and their families to transition to the adult healthcare system, there is limited legislation to ensure a successful transfer or to mandate transition preparation in Canada. This advocacy and policy planning work was conducted in partnership with the Patient and Family Advisory Council (PFAC) within the CHILD-BRIGHT READYorNot™ Brain-Based Disabilities (BBD) Project and the CHILD-BRIGHT Policy Hub. Together, we identified the need to synthesize and better understand existing policies about transition from pediatric to adult healthcare, and to recommend solutions to improve healthcare access and equity as Canadian youth with disabilities become adults. In this perspective paper, we will report on a dialogue with key informants and make recommendations for change in healthcare transition policies at the healthcare/community, provincial and/or territorial, and/or national levels.

A multidimensional model of resilience: Family, community, national, global and intergenerational resilience.

This paper aims to unpack the empirical and theoretical complexity that surrounds 'resilience', with particular attention to its application to war-affected children and youth. We expand current conceptual frameworks to adopt a more inclusive and intergenerational approach that accounts for the added layers of national, global and intergenerational resilience, arguing for greater recognition of the shared or relational nature of resilience. We introduce a multidimensional model of resilience that integrates the macro- and micro-level to include resilience-enabling systems at the family, community, national, global and intergenerational levels. The purpose of this conceptual framework is to provide a more holistic and integrative model that combines both bottom-up and top-down approaches to cultivating resilience, highlighting the power of interconnections across interrelated systems and social structures. Using the case example of post-genocide Rwanda and the experiences of children born of genocidal rape, we apply our multidimensional model to illustrate concrete examples of resilience-enabling systems at the family, community, national, global and intergenerational levels. Our proposed multidimensional model as applied to youth born of genocidal rape in Rwanda reveals key gaps in their surrounding social ecological systems, highlighting the importance of coordinated and mutually-reinforcing efforts to engender resilience across all dimensions concurrently. We conclude with a set of policy and practice implications, directions for future research, and lessons-learned on how best to champion the resilience of this unique and important population of children.

Advancing patient engagement: youth and family participation in health research communities of practice.

PLAIN ENGLISH SUMMARY: The involvement of patients in health research has resulted in the development of more effective interventions and policies in healthcare that respond to the needs of healthcare users. This article examines how working with youth and their families as co-researchers in health research communities of practice (CoPs), rather than just as participants, can benefit all involved. Health research (CoPs) promote an environment in which co-researchers have the opportunity to do more than just participate in the data collection phase of the research process. As co-researchers, youth and their families are able to participate, learn, and contribute to knowledge and building relationships that are designed to innovate and improve healthcare systems. However, in order to ensure engagement of youth and their families in health research that they find meaningful and rewarding, three factors have been identified as important parts of the process: promoting identity, building capacity, and encouraging leadership skills. ABSTRACT: Background Patient engagement in health research is becoming more popular as it can lead to evidence for developing the most effective interventions, policy and practice recommendations. Models of patient engagement have been evolving over the past four decades including health research communities of practice (CoPs). Health research CoPs help to break down professional barriers and enhance knowledge sharing for the purpose of improving health outcomes. In this article we consider health research CoPs when youth and their families are involved. Main body As part of an ongoing research program, we identify how insights about youth and their families' views are taken into account as well as their specific roles in health research CoPs. We have worked with youth and their families not only as participants in health research, but instead as co-researchers in health research CoPs. As co-researchers, youth and their families are able to participate, learn, and contribute to knowledge and building relationships that are designed to innovate and improve healthcare systems. Promoting and creating the space for identity, capacity building, and leadership is integral to the engagement of youth and their families in health research in a way that they consider meaningful and rewarding. Conclusions Youth and families can play stronger and more meaningful roles in health research by adopting a CoPs approach. Further examination of the internal structures and connections between youth and families as well other actors (i.e., with service providers and special knowledge holders) within emerging health research CoPs would be advantageous for developing greater understanding and best practices around engaging youth and families in health research.

Agarra el momento/seize the moment: Developing communication activities for a drug prevention intervention with and for Latino families in the US Southwest.

This article presents the development of parent-child communication activities by applying Community-Based Participatory Research and focus group methodology. Three parent-child communication activities were developed to enhance an already efficacious parenting intervention: (1) agarra el momento or seize the moment uses everyday situations to initiate conversations about substance use, (2) hay que adelantarnos or better sooner than later stresses being proactive about addressing critical issues with youth, and (3) setting rules and expectations engages parents in establishing rules and expectations for healthy and effective conversations with youth. Focus group data are presented to illustrate how thematic content from the focus groups was used to inform the development of the activities and, furthermore, how such methods supported the development of a culturally grounded intervention.

Academic Growth Trajectories and Family Relationships among African American Youth.

This study explored trajectories of African American youths' academic functioning and assessed whether changes in parent-adolescent relationships were associated with changes in youths' academic functioning. The data were drawn from a three-year longitudinal study of gender socialization and development in two-parent African American families and included 197 families. Findings revealed gender differences in achievement trajectories and indicated that boys not only had lower levels of academic achievement compared to girls, but also experienced steeper declines in school self-esteem during adolescence. Changes in parent-adolescent relationship quality were linked to changes in academic functioning: Increases in conflict were related to decreases in GPA, school bonding, and school self-esteem and increases in warmth were related to increases in school bonding and school self-esteem.

Promoção do autocuidado em crianças, jovens e familias com necessidades de cuidados de reabilitação / Promotion of self-care in children, youth and families in need of rehabilitation care

O presente relatório descreve o processo de desenvolvimento de competências em enfermagem de reabilitação para o qual contribuíram os três estágios e de um modo particular o estágio final, no qual foi implementado um plano de intervenção direcionado para a promoção do autocuidado em crianças/jovens e famílias com necessidades de cuidados de enfermagem de reabilitação. Seguindo a estratégia dos estudos de caso, as necessidades de autocuidados nas crianças jovens e familiares foram avaliadas a partir da Therapeutic Self-Care Scale traduzida e adaptada para a população portuguesa, aplicada no momento da admissão e aplicada na alta após ensino e treino de acordo com as necessidades identificadas. Objetivou-se a capacitação da criança/jovem e família com necessidades de cuidados de reabilitação através do ensino e treino relativamente às atividades de autocuidado. O referencial teórico utilizado foi a teoria do autocuidado de Orem, uma vez que através da promoção do autocuidado, a maximização das capacidades das pessoas foi possível através dos cuidados de enfermagem de reabilitação e contribuiu para aumentar a sua funcionalidade e a autonomia. A análise reflexiva sobre o processo de desenvolvimento de competências permitiu ajui-zar sobre os resultados obtidos e concluir que o processo de aquisição de competências de en-fermeiro especialista e de mestre também se concretizou.

This report describes the process of developing competencies in rehabilitation nursing in which the three stages contributed and in a particular way the final stage, in which an inter-vention plan directed to the promotion of self-care in children/young people was implemented and families with rehabilitation nursing care needs. Following the strategy of the case studies, self-care needs in young and family children were assessed from the Therapeutic Self-Care Scale translated and adapted for the Portuguese population, applied at the time of admission and applied at discharge after teaching and training according to identified needs. The objective was the training of the child/youth and family with rehabilitation care needs through teaching and training regarding self-care activities. The theoretical framework used was Orem's self-care theory, since through the promo-tion of self-care, the maximization of people's abilities was possible through rehabilitative nurs-ing care and contributed to increase their functioning and autonomy. The reflexive analysis on the process of development of competences allowed to judge on the results obtained and to conclude that the process of acquisition of skills of specialist nurse and master also materialized.