Effects of Comorbid Developmental Coordination Disorder and Symptoms of Attention Deficit Hyperactivity Disorder on Physical Activity in Children Aged 4-5 Years.

Developmental coordination disorder (DCD) is often comorbid with attention-deficit/hyperactivity disorder (ADHD). While children with DCD engage in less moderate-to-vigorous physical activity (MVPA) compared to typically developing (TD) children, research pertaining to how ADHD affects this relationship is limited. We investigated the effect of ADHD on MVPA among children at risk for DCD (DCDr). 507 children aged 4-5 years (DCDr = 233, TD = 274) participated. Motor skills were assessed using the Movement Assessment Battery for Children-2nd edition (DCDr; ≤ 16th percentile), ADHD symptoms were assessed using the Child Behaviour Checklist, and Actigraph accelerometers measured MVPA over seven days. DCD did not negatively affect MVPA, however, after adjusting for ADHD symptoms, the effect of DCD became significant and was driven by symptoms of inattention. Symptoms of ADHD may be suppressing the negative effects of DCD on MVPA, highlighting the importance of assessing and controlling for ADHD symptoms in this population.

Physical activity in young children at risk for developmental coordination disorder.

AIM: To examine cross-sectional differences in patterns of daily physical activity accumulation between preschool children at risk for developmental coordination disorder (DCD) compared to typically developing children. METHOD: In total, 514 children (292 males, 222 females; 4-5y) were recruited as part of the Coordination and Activity Tracking in CHildren (CATCH) study. Motor competence was assessed using the Movement Assessment Battery for Children, Second Edition; children scoring ≤5th centile comprised the probable DCD group (pDCD, n=87), between the 6th and 16th centile were considered to be at risk for DCD (rDCD, n=149), and >16th centile were considered typically developing (n=278). Seven-day physical activity was measured using hip-worn accelerometers. Average daily intensity of activity, frequency, and duration of moderate-to-vigorous physical activity (MVPA) bouts, and triaxial activity counts per minute were determined. RESULTS: No differences in daily activity in any intensity or axis of movement were found among the three groups. However, young children with pDCD accumulated their MVPA in slightly shorter bouts compared to typically developing children. INTERPRETATION: Young children at risk for DCD are not yet in an activity deficit. This may be because of the low motor skill demands of play in this age group. Early motor interventions may be able to promote continued physical activity participation in children with DCD. WHAT THIS PAPER ADDS: Preschool children at risk for developmental coordination disorder (DCD) are not less active than their peers. Overall intensity and frequency of daily activity bouts are similar among motor groups. Children with probable DCD accumulate their activity in shorter bouts.

ACTIVIDAD FÍSICA EN NIÑOS PEQUEÑOS CON RIESGO DE TRASTORNO DEL DESARROLLO DE LA COORDINACIÓN: OBJETIVO: Examinar por medio de un corte transversal las diferencias en los patrones de actividad física entre los niños en edad preescolar con riesgo de trastorno del desarrollo de la coordinación (TDC) en comparación con niños con un desarrollo típico MÉTODO: En total, se reclutaron 514 niños (292 varones, 222 mujeres; de 4 y 5 años) como parte del estudio Coordinación y Seguimiento de Actividad en niños (CATCH). Las capacidades motrices se evaluaron utilizando el test MABC 2 (Movement Assessment Battery for Children). Los niños con puntaje ≤5 percentilo formaron el grupo con TDC probable (pTDC, n = 87), entre percentilos 6 y 16 se consideraron en riesgo de TDC (rTDC, n = 149), y > percentilo 16 se consideraron con desarrollo típico (o normal, n = 278). La actividad física a lo largo de siete días se midió utilizando acelerómetros portados en la cadera. Se determinó la intensidad diaria promedio de la actividad, la frecuencia y la duración de los momentos de actividad física moderada a intensa (MVPA), y los recuentos de actividad triaxial por minuto. RESULTADOS: No se encontraron diferencias en la actividad diaria en ninguna intensidad o eje de movimiento entre los tres grupos. Sin embargo, los niños pequeños con pTDC desarrollaron su MVPA (actividad física moderada a intensa) en episodios ligeramente más cortos en comparación con los niños con un desarrollo típico. INTERPRETACIÓN: Los niños pequeños en riesgo de TDC aún no presentan un déficit de actividad. Esto puede ser debido a las bajas exigencias motrices del juego en este grupo etario. Las intervenciones motoras tempranas pueden promover la participación en actividades físicas de los niños con TDC.

ATIVIDADE FÍSICA EM CRIANÇAS PEQUENAS COM RISCO DE TRANSTORNO DO DESENVOLVIMENTO DA COORDENAÇÃO: OBJETIVO: Observar as diferenças transversais nos padrões de acumulação de atividade física diária entre crianças na idade pré-escolar com risco de transtorno do desenvolvimento da coordenação (TDC) e crianças de desenvolvimento típico. MÉTODOS: Um total de 512 crianças (292 meninos, 222 meninas; de idade entre 4 e 5 anos) foram recrutadas como parte do estudo Acompanhamento da Coordenação e de Atividades de Crianças (Coordination and Activity Tracking in CHildren - CATCH). As competências motoras foram avaliadas por meio da Bateria de Avaliação do Movimento para Crianças (Movement Assessment Battery for Children - MABC) segunda edição. Crianças com pontuação abaixo do quinto percentil compunham o provável grupo com TDC (pDDC, n=87), entre o percentil 6 e 16 foram consideradas com risco de DDC (rTDC, n=149), e aquelas com pontuação acima do percentil 16 foram consideradas de desenvolvimento típico (n=278). A atividade física ao longo de 7 dias foi mensurada utilizando-se acelerômetros posicionados no quadril. Foram avaliadas a média de intensidade da atividade diária, frequência e duração das atividades físicas moderadas a vigorosas e contagem das atividades triaxiais por minuto. RESULTADOS: Não foram encontradas diferenças entre os três grupos avaliados para intensidade ou eixo de movimento. Entretanto, crianças do grupo pTDC acumularam suas atividades físicas moderadas a vigorosas em blocos ligeiramente mais curtos do que crianças de desenvolvimento típico. INTERPRETAÇÃO: Crianças mais novas com risco de TDC ainda não apresentam déficits de atividade física. Isso pode ser devido às baixas demandas motoras de brincar nessa faixa etária. Intervenções motoras precoces podem ser capazes de promover participação em atividades físicas continuada em crianças com TDC.

Recommended practices to organize and deliver school-based services for children with disabilities: A scoping review.

BACKGROUND: Inclusive educational environments can have a positive effect on the general health and well-being of children with disabilities. However, their level of academic success and participation remains limited. Considering scarce resources and high needs, identifying efficient methods for providing interdisciplinary services is critical. This scoping review, therefore, aims to (a) synthesize current evidence about principles for organizing and delivering interdisciplinary school-based support services for students with disabilities and (b) ascertain useful strategies for implementation of principles in the school setting. METHODS: Scholarly and grey literature in rehabilitation and education were reviewed collaboratively with school-based stakeholders. A search of five databases identified 13,141 references and resulted in 56 relevant articles published from 1998 to 2017. Information (e.g., principles to organize services and strategies for implementation) was extracted, and thematic analysis was used to summarize findings. RESULTS: Within the documents retained, 65% were scientific and 35% were grey. Services primarily targeted students with behavioral issues, followed by those with cognitive and learning disabilities with a focus on improving social-emotional functioning and academic performance. Thematic analysis revealed 10 common principles to guide service organization (e.g., collaborative interventions and support for teachers) and seven implementation strategies (e.g., training and coordination) for employing these principles. CONCLUSIONS: Findings can guide rehabilitation professionals, educators, and policy makers in restructuring well-coordinated collaborative services involving training and capacity-building of school-based service providers. Such knowledge can contribute to the improved provision of care and, consequently, promote children's school participation and inclusion.

Early developmental influences on self-esteem trajectories from adolescence through adulthood: Impact of birth weight and motor skills.

While the trajectory of self-esteem from adolescence to adulthood varies from person to person, little research has examined how differences in early developmental processes might affect these pathways. This study examined how early motor skill development interacted with preterm birth status to predict self-esteem from adolescence through the early 30s. We addressed this using the oldest known, prospectively followed cohort of extremely low birth weight (<1000 g) survivors (N = 179) and normal birth weight controls (N = 145) in the world, born between 1977 and 1982. Motor skills were measured using a performance-based assessment at age 8 and a retrospective self-report, and self-esteem was reported during three follow-up periods (age 12-16, age 22-26, and age 29-36). We found that birth weight status moderated the association between early motor skills and self-esteem. Stable over three decades, the self-esteem of normal birth weight participants was sensitive to early motor skills such that those with poorer motor functioning manifested lower self-esteem, while those with better motor skills manifested higher self-esteem. Conversely, differences in motor skill development did not affect the self-esteem from adolescence to adulthood in individuals born at extremely low birth weight. Early motor skill development may exert differential effects on self-esteem, depending on whether one is born at term or prematurely.

Depression in youth recovering from concussion: Correlates and predictors.

OBJECTIVES: Although depression can be a serious consequence of concussion, little is known about the factors that predict depression and concussion recovery outcomes in children. The purpose of this study was to explore the risk and possible predictors of developing significant depressive symptoms in children recovering from concussion. METHODS: A prospective cohort study was conducted in a paediatric tertiary care clinic. Depression data were collected from 92 children using the Children's Depression Inventory-2 (CDI-2) screening tool. Correlations, t-tests and logistic regression were used to examine the associations between depression scores and demographic as well as injury-related factors. RESULTS: Depressive symptoms were found in 22% of the children (T score on CDI-2 >65). Children with evidence of depressive symptomatology had significantly higher mean post-concussive symptom inventory (PCSI) scores in recovery (p = 0.004) than children who were not depressed. Variables of i) Sex; ii) hospital admission; iii) number of head injuries; iv) post-concussion symptom score and v) experience of prolonged symptoms were predictive of clinically significant CDI T scores, explaining 36% of the variation in the binary logistic model. CONCLUSION: Depression is commonly reported in this subset of children. High post-concussive symptom scores and hospital admission were strong predictors of depression. Screening for depression should be standard practice in concussion management in children and youth.

Measuring Participation of Children and Environmental Factors at Home, School, and in Community: Construct Validation of the Korean PEM-CY.

AIMS: To determine construct validity of the Korean Participation and Environment Measure for Children and Youth (KPEM-CY) in South Korea. METHODS: A total of 184 parents of children with (n = 80) and without disabilities (n = 104) aged 5 to 13 years completed the KPEM-CY. Construct validity was analyzed by assessing differences in the participation and environment scores for children with and without disabilities across age and gender. RESULTS: Validity of the KPEM-CY was supported by significant differences in participation and environmental factors for subgroups (p < .05). Children with disabilities participated less in typical activities and had more environmental barriers than those without disabilities across all settings. Parents of children with disabilities reported a higher level of desire to change their children's participation patterns. Similar participation patterns and environmental factors, which were influenced by interaction effects between disability and age, were confirmed at home and in the community. CONCLUSIONS: KPEM-CY is a valid measure to assess participation and environmental factors in home, school, and community settings for Korean children, aged 5-13 years, with and without disabilities.

Cognitive Orientation to daily Occupational Performance (CO-OP): A New Approach for Children with Cerebral Palsy.

AIMS: The results of a small single-case study series suggested that Cognitive Orientation to daily Occupational Performance (CO-OP) may be a successful approach for children with cerebral palsy (CP). Therefore a pilot randomized controlled trial was conducted with the following research questions-is CO-OP a feasible approach to use with children with CP, what are the effects of CO-OP when compared to usual practice, and is a larger study warranted? METHODS: 18 children between age 7 and 12 (nine in CO-OP group and nine in Current Usual Practice Approach (CUPA) group) received ten 1-hour sessions of intervention on average once per week at home. Primary outcome measures were the Canadian Occupational Performance Measure and the Performance Quality Rating Scale (PQRS). PQRS assessors were blind to group allocation and timing of assessment. RESULTS: All children in the CO-OP group were able to learn the strategies and achieve their chosen goals, thus demonstrating the feasibility of the approach. Both approaches equally promoted skill acquisition and skill maintenance at follow-up. Effect sizes suggest that CO-OP may show some advantage for transfer and maintenance. CONCLUSION: Based on these initial findings, further research is warranted.

Evaluation of the revised Nipissing District Developmental Screening (NDDS) tool for use in general population samples of infants and children.

BACKGROUND: There is widespread interest in identification of developmental delay in the first six years of life. This requires, however, a reliable and valid measure for screening. In Ontario, the 18-month enhanced well-baby visit includes province-wide administration of a parent-reported survey, the Nipissing District Developmental Screening (NDDS) tool, to facilitate early identification of delay. Yet, at present the psychometric properties of the NDDS are largely unknown. METHOD: 812 children and their families were recruited from the community. Parents (most often mothers) completed the NDDS. A sub-sample (n = 111) of parents completed the NDDS again within a two-week period to assess test-retest reliability. For children 3 or younger, the criterion measure was the Bayley Scales of Infant Development, 3rd edition; for older children, a battery of other measures was used. All criterion measures were administered by trained assessors. Mild and severe delays were identified based on both published cut-points and on the distribution of raw scores. Sensitivity, specificity, positive and negative predictive values were calculated to assess agreement between tests. RESULTS: Test-retest reliability was modest (Spearman's rho = .62, p < 001). Regardless of the age of the child, the definition of delay (mild versus severe), or the cut-point used on the NDDS, sensitivities (from 29 to 68 %) and specificities (from 58 to 88 %) were poor to moderate. CONCLUSION: The modest test-retest results, coupled with the generally poor observed agreement with criterion measures, suggests the NDDS should not be used on its own for identification of developmental delay in community or population-based settings.

Children Who Use Communication Aids Instructing Peer and Adult Partners During Play-Based Activity.

Little is known about how children with severe motor impairments who use communication aids provide instructions when given control over interaction. In this study, 35 children - 18 who used communication aids and 17 who used natural speech - were videotaped in play-based activities. Both groups successfully instructed partners to build replications of models the partners could not see. The results demonstrate that children using communication aids can also have an active role in play-based activities using language, but that their experience with activities may be limited and their instructions may take longer to give. The children who used natural speech provided more detailed instructions and were more successful in guiding their partners. Creating opportunities for active participation in play may be important for the development of communicative autonomy.

The Coordination and Activity Tracking in CHildren (CATCH) study: rationale and design.

BACKGROUND: Past studies have found that children with Developmental Coordination Disorder (DCD) engage in less physical activity than typically developing children. This "activity deficit" may result in children with DCD being less physically fit and more likely to be overweight or obese, potentially increasing later risk for poor cardiovascular health. Unfortunately, the majority of DCD research has been limited to cross-sectional designs, leading to questions about the complex relationship among motor ability, inactivity and health-related fitness. Of the few longitudinal studies on the topic, determining precedence amongst these factors is difficult because study cohorts typically focus on mid to late childhood. By this age, both decreased physical fitness and obesity are often established. The Coordination and Activity Tracking in CHildren (CATCH) study will examine the pathways connecting DCD, physical activity, physical fitness, and body composition from early to middle childhood. METHODS: The CATCH study is a prospective cohort study. We aim to recruit a cohort of 600 children aged 4 to 5 years (300 probable DCD [pDCD] and 300 controls) and test them once a year for 4 years. At Phase 1 of baseline testing, we assess motor skills, cognitive ability (IQ), basic anthropometry, flexibility and lower body muscle strength, while parents complete an interview and questionnaires regarding family demographics, their child's physical activity, and behavioural characteristics. Children who move on to Phase 2 (longitudinal cohort) have their body fat percentage, foot structure, aerobic and anaerobic fitness assessed. An accelerometer to measure physical activity is then given to the child and interested family members. The family also receives an accelerometer logbook and 3-day food dairy. At years 2 to 4, children in the longitudinal cohort will have all baseline assessments repeated (excluding the IQ test), and complete an additional measure of perceived self-efficacy. Parents will complete an ADHD index twice within the follow-up period. To assess the association between DCD, fitness and adiposity, our primary analysis will involve longitudinal growth models with fixed effects. DISCUSSION: The CATCH study will provide a clearer understanding of pathways between DCD and health-related fitness necessary to determine the types of interventions children with DCD require.

Knowledge to practice in developmental coordination disorder: utility of an evidence-based online module for physical therapists.

AIMS: Developmental coordination disorder (DCD) is a chronic condition with potential negative health consequences. Therapists working with children with DCD need access to tailored, synthesized, evidence-based information; however a knowledge-to-practice gap exists. The aim of this study was to develop and evaluate the utility of an evidence-based online DCD module tailored to physical therapists' (PTs) needs. METHODS: Guided by the Knowledge to Action framework, we interviewed PTs working with children with DCD (n = 9) to identify their information needs. Their recommendations, along with synthesized DCD research evidence, informed module development. These PTs as well as others (n = 50) evaluated the module's usefulness. RESULTS: The module incorporated important content areas including: (1) identification; (2) planning interventions and goals; (3) evidence-based practice; (4) management; and (5) resources. Case scenarios, clinical applications, interactive media, links to resources, and interactive learning opportunities were also embedded. PTs perceived the module to be comprehensive and useful and provided feedback to improve module navigation. CONCLUSIONS: Involving end-users throughout the development and evaluation of an online PT DCD module contributed to its relevance, applicability, and utility. It will be important to evaluate whether use of this module improves the quality of services provided by PTs.

A Service Delivery Model for Children with DCD Based on Principles of Best Practice.

AIMS: In this perspective article, we propose the Apollo model as an example of an innovative interdisciplinary, community-based service delivery model for children with Developmental Coordination Disorder (DCD) characterized by the use of graduated levels of intensity and evidence-based interventions that focus on function and participation. METHODS: We describe the context that led to the creation of the Apollo model, describe the approach to service delivery and the services offered. RESULTS: The Apollo model has 5 components: first contact, service delivery coordination, community-, group-, and individual-interventions. This model guided the development of a streamlined set of services offered to children with DCD, including early-intake to share educational information with families, community interventions, inter-disciplinary and occupational therapy groups, and individual interventions. Following implementation of the Apollo model, wait-times decreased and the number of children receiving services increased, without compromising service quality. CONCLUSIONS: Lessons learned are shared to facilitate development of other practice models to support children with DCD.

Knowledge to practice in developmental coordination disorder: impact of an evidence-based online module on physical therapists' self-reported knowledge, skills, and practice.

AIMS: To evaluate the impact of an evidence-based online module on Developmental Coordination Disorder (DCD) on self-reported physical therapist (PT) knowledge, skills, and practice. METHODS: Fifty PTs completed a questionnaire before and after the completion of the online module, with 41 PTs completing the same questionnaire 2 months later. The questionnaires included items rated using a 7-point Likert Scale and short open-ended questions. RESULTS: There was a significant effect of Time for 17 out of 18 items on self-reported knowledge, and all 19 items for self-reported skills. Post-hoc analyses indicated that mean scores at Time 2 and Time 3 were higher than the mean scores at Time 1. Forty-six (92%) participants reported an increase in their confidence to provide evidence-based services. Forty-three (86%) participants indicated their intentions to modify their evaluative practices (e.g., involving children in goal setting) and their management of DCD (e.g., using the best practice principles, providing resources to families). At the 2-month follow-up, 19 (46%) participants had returned to the module to review information (e.g., video, resources) or to download handouts. CONCLUSIONS: The online DCD module appears to be an effective knowledge translation strategy to increase PTs' self-reported knowledge and skills, and to support evidence-informed practice.

Social participation of school-aged children who use communication aids: the views of children and parents.

Social participation is crucial for children's development and well-being; however, little is known about the social participation of children who use communication aids. This article presents findings from interviews with eight 5- to 14-year-old children who used communication aids and their parents about social participation, communicative interactions, and peer relationships. Video- and audio-recordings were transcribed and analyzed using thematic content analysis, and five themes were identified. Two themes reflect parents' views: Communication partners and strategies and Access to aided communication. Three themes reflect perceptions expressed both by children and parents: Participation in society, Interaction opportunities, and Social relationships. The findings provide insights into both the achievements and the challenges experienced by young people who use aided communication.

The motor learning strategy instrument: interrater reliability within usual and virtual reality physical therapy interventions.

PURPOSE: To evaluate and compare the interrater reliability of the Motor Learning Strategy Rating Instrument (MLSRI) within usual and virtual reality (VR) interventions for children with acquired brain injury. METHODS: Two intervention sessions for each of 11 children (total, 22) were videotaped; sessions were provided by 4 physical therapists. Videotapes were divided into usual and VR components and rated by 2 observers using the MLSRI. A generalizability theory approach was used to determine interrater reliability for each intervention. RESULTS: Interrater reliability for usual interventions was high for the MLSRI total score (g-coefficient, 0.81), whereas it was low for the VR total score (g-coefficient, 0.28); MLSRI category g-coefficients varied from 0.35 to 0.65 for usual and from 0.17 to 0.72 for VR interventions. CONCLUSION: Adequate reliability was achieved within ratings of usual interventions; however, challenges related to MLSRI use to rate VR-based interventions require further evaluation.

Executive functioning: a scoping review of the occupational therapy literature.

BACKGROUND: Increasingly recognized as an important factor in the performance of complex, goal-directed tasks, executive functioning is understood in different ways across disciplines. PURPOSE: The aim was to explore the ways in which executive functioning is conceptualized, discussed, described, and implied in the occupational therapy literature. METHOD: A scoping review of the occupational therapy literature was conducted following Levac, Colquhoun, and O'Brien's (2010) recommended methodology. RESULTS: Executive functioning is described both as a set of performance component skills or processes and as the executive occupational performance inherent in complex occupations. Executive functioning is implicit in occupational performance and engagement, and some health conditions seem to be commonly associated with impaired executive functioning. Assessing executive functioning requires dynamic occupation- and performance-based assessment. Interventions targeting executive functioning are grounded in metacognitive approaches. CONCLUSION: Executive functioning is a complex construct that is conceptualized with considerable variance within the occupational therapy literature, creating barriers to effective service delivery.

Partnering for Change: collaborating to transform occupational therapy services that support inclusive education.

The United Nations champions inclusive education as a moral obligation, requiring equitable learning environments that meet all individuals' diverse learning needs and abilities, including children and youth. Yet the practice of inclusive education is variable and implementation challenges persist. A participatory action research framework was used to develop a solution, Partnering for Change (P4C), which is a tiered service delivery model that bridges health and education by re-envisioning occupational therapy services and transforming the role of the occupational therapist from a service provider for individual children to a collaborative partner supporting the whole school community. This perspective article will describe the P4C model and its evolution, and will outline how it has been implemented in Canadian and international contexts to facilitate children's inclusion and participation in educational settings.

Usual and virtual reality video game-based physiotherapy for children and youth with acquired brain injuries.

Little is known about how therapists promote learning of functional motor skills for children with acquired brain injuries. This study explores physiotherapists' description of these interventions in comparison to virtual reality (VR) video game-based therapy. Six physiotherapists employed at a children's rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using thematic analysis. Physiotherapists describe using interventions that motivate children to challenge performance quality and optimize real-life functioning. Intervention strategies are influenced by characteristics of the child, parent availability to practice skills outside therapy, and therapist experience. VR use motivates children to participate, but can influence therapist use of verbal strategies and complicate interventions. Physiotherapists consider unique characteristics of this population when providing interventions that promote learning of motor skills. The VR technology has advantageous features but its use with this population can be challenging; further research is recommended.

Technology supporting written productivity in children with learning disabilities: a critical review.

BACKGROUND: Occupational therapists working with school-aged children are often in the position of recommending technology to enhance written productivity. The outcome of using technology on the writing of children with learning disabilities has not been reviewed critically, and this knowledge is necessary for evidence-based practice. PURPOSE: To review evidence regarding the use of technology to support written productivity in children with learning disabilities. METHODS: A systematic search of seven databases, plus a manual search, retrieved 864 papers published between 1985 and March 2012. Twenty-seven papers (28 studies) met inclusion criteria. FINDINGS: The evidence is of a moderately low level and results are inconclusive; however, trends suggest a positive influence of some technology on children's performance and behaviour. Methodological limitations exist in most studies and the description of specific technology intervention is often combined with teaching instructions. IMPLICATIONS: The available research is encouraging, but high-quality investigations with newer technologies are needed.

"Support for everyone": Experiences of occupational therapists delivering a new model of school-based service.

BACKGROUND: Occupational therapists working in school health have recognized the need to move away from a one-to-one direct service delivery model towards a more collaborative, classroom-based approach. Partnering for Change (P4C) is an innovative service delivery model that may enhance school-based collaborative care. PURPOSE: To capture the experiences of occupational therapists implementing P4C and to elicit their perspectives about how this model differs from the direct service approach. METHODS: Semi-structured, face-to-face interviews were conducted with seven therapists who had delivered P4C in 10 Ontario schools. Thematic analysis was utilized with themes verified through member checking. FINDINGS: Five themes (a year of growth, becoming a community, the key ingredients of P4C, a balancing act, and providing services that make an impact) reflected therapists'personal and professional growth, aspects of the model they believed were key, challenges they encountered, and the impact they felt they had made. IMPLICATIONS: Partnering for Change has the potential to transform school-based occupational therapy and overcome existing barriers to collaboration. This model also may better address the needs of children with motor coordination difficulties.