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.

Gynecological Cancer Survivors' Experiences of Dyspareunia and Factors Influencing Care-Seeking Behavior: A Qualitative Study.

Pain during sexual intercourse, also called dyspareunia, affects most women after treatment for gynecological cancer. Previous work adopted a biomedical approach to depict dyspareunia in this population, which provided a narrow perspective of this condition. Taking into account women's experiences of dyspareunia and the factors influencing their care-seeking behaviors would provide insight to improve care in the context of gynecological cancer. The aim of this study was to describe gynecological cancer survivors' experiences of dyspareunia and factors influencing care-seeking behavior. A qualitative study was performed with 28 gynecological cancer survivors with dyspareunia. Individual telephone interviews were conducted based on the Common-Sense Model of Self-Regulation. Interviews were recorded and transcribed for analysis using the interpretative description framework. Concerning their experience, participants reported the oncological treatments as the primary cause of dyspareunia. Loss of libido, lower vaginal lubrication, and smaller vaginal cavity were described as being linked with dyspareunia. Women explained how dyspareunia and these changes had led them to engage less in, and even interrupt, sexual activity. They expressed that they were distressed, felt less of a woman, and experienced low control and/or self-efficacy. Regarding the factors influencing women's care-seeking behaviors, participants emphasized that they were provided with insufficient information and support. Balancing priorities, denial or reluctance, misbeliefs, resignation and acceptance, and negative emotions were reported as barriers, whereas acknowledgement of sexual dysfunction, desire for improvement, awareness of treatment possibilities, willingness to undertake treatment and treatment acceptability were reported as facilitators to seeking care. Findings suggest that dyspareunia is a complex and impactful condition after gynecological cancer. While this study highlights the importance of alleviating the burden of sexual dysfunction in cancer survivors, it identified factors that should be considered in the provision of services to improve care.

Acceptability of multimodal pelvic floor physical therapy to treat dyspareunia after gynecological malignancies: a qualitative study of women's views and experiences.

INTRODUCTION AND HYPOTHESIS: Multimodal pelvic floor physical therapy (PFPT) is recommended after gynecological malignancies to treat dyspareunia. However, data to strongly support its implementation in the cancer care continuum are lacking. The aim of this study was to explore the views and experiences of gynecological cancer survivors with dyspareunia regarding the acceptability of multimodal PFPT. METHODS: This qualitative study was conducted with the participants (n = 28) of a study investigating a 12-week multimodal PFPT treatment. Individual semi-structured telephone interviews served to collect qualitative data pertaining to women's views and experiences of the treatment they received. Interviews were recorded and transcribed for analysis using the interpretative description framework. RESULTS: Our cohort described the appropriateness of the treatment in terms of modalities, physical therapist, care delivery, and intensity (Theme 1). While the intensity was reported as demanding by a few, all participants stressed that it was relevant to see significant improvements (Theme 2). In addition to the treatment characteristics and women's beliefs and attitudes, noticing the treatment effects motivated their participation (Theme 2). Women expressed being highly satisfied with the treatment based on their positive experiences and the balance between their efforts and the results they obtained (Theme 3). As a result, they all recommended this treatment (Theme 3). CONCLUSIONS: This is the first study to examine the acceptability of multimodal PFPT in the context of gynecological malignancies. This treatment was found acceptable and can be offered to gynecological cancer survivors.

Barriers and facilitators influencing parental adherence to prevention strategies for deformational plagiocephaly: Results from a scoping review.

BACKGROUND: Deformational plagiocephaly can be prevented in many healthy infants if strategies are implemented early after birth. However, despite efforts to disseminate accurate information, parental adherence to evidence-based prevention strategies is a challenge. To date, factors - barriers and facilitators - influencing parental adherence to strategies have yet to be identified in a comprehensive manner. OBJECTIVES: This scoping review aims to identify and synthesize current evidence on barriers and facilitators impacting adherence of parents of newborns to deformational plagiocephaly prevention strategies. METHODS: This review followed the Joanna Briggs Institute (JBI) process guidelines. Seven electronic (Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, SPORTDiscus, Academic Search Complete, AMED, PsychINFO and Scopus) and two grey literature (Health Systems Evidence and Grey Literature Report) databases were searched. Studies published between 2001 and 2022 were included. The deductive thematic data analysis used was guided by the Capability, Opportunity, Motivation Behavioral Model (COM-B) of health behaviour change. RESULTS: From a total of 1172 articles, 15 met the eligibility criteria. All components of the COM-B framework were identified. Capability-psychological and opportunity-environmental factors dominated the literature, whereas capability-physical, motivation and, in particular, opportunity-social factors were understudied. The most often reported barriers were a lack of knowledge of deformational plagiocephaly and the associated prevention strategies, ambiguous or inconsistent messaging, intolerance of babies to prone positioning and a lack of time. The most frequently reported facilitators were an awareness of deformational plagiocephaly, postural asymmetry and prevention strategies, skill acquisition with practice, accurate convincing information, scheduled time and environmental organization to position the baby at home. DISCUSSION: Recommendations focused on diffusing accurate and detailed information for parents. Our review also suggests a gap regarding the comprehensive identification of factors influencing parental adherence to deformational plagiocephaly prevention strategies. Further studies exploring comprehensive opportunity-social and motivation factors influencing parental adherence to deformational plagiocephaly prevention strategies are warranted to inform prevention programmes and foster better infant outcomes.

The effect domains, measures, and methods reported in pediatric-specialized multidisciplinary outpatient rehabilitation programs: An integrated review.

OBJECTIVES: Specialized pain rehabilitation is recognized as the treatment of choice for youth with pain-related disability. Appropriate outcomes for program evaluation are critical. This study aimed to summarize the effect domains and methods used to evaluate pediatric-specialized outpatient pain rehabilition programs, map them to the PedIMMPACT statement, and highlight future directions. METHODS: An integrated review framework, incorporating stakeholders, was used. Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycINFO, and Google Scholar were searched for studies published in 1999-2021 featuring the treatment effects of specialized outpatient pain rehabilitation on youth with pain-related disability and their parents. Selected studies were critically appraised using the Quality Assessment Tool for Studies of Diverse Design, organized by study characteristics, and analyzed using constant comparison. RESULTS: From the 1951 potentially relevant titles, 37 studies were selected. Twenty-five effects targeted youth and 24 focused on parents, with a maximum of 15 youth and 11 parent effect domains (median = 5 domains per study). Although most studies measured a combination of effect domains and were inclusive of some recommended in the PedIMMPACT statement, no effect was measured consistently across studies. Youth physical functioning and parent emotional functioning were measured most often. Eighty-five instruments were used to assess youth outcomes and 59 for parents, with self-report questionnaires dominating. DISCUSSION: A lack of standardization exists associated with the domains and methods used to evaluate the effects of pediatric-specialized outpatient pain rehabilitation programs, hindering comparisons. Future program evaluations should be founded on their theory, aim, and anticipated outcomes.

Perspectives of International Experts on Collaborative Tiered School-Based Physiotherapy Service Delivery.

AIMS: The purpose of this Phase II study is to identify the perceived strengths and weaknesses of a collaborative tiered school-based physiotherapy (PT) service delivery model, considering its core attributes and tiered interventions identified in the first phase of the study (Phase I), and explore the potential facilitators and barriers to implementing the model internationally. METHODS: Three focus group discussions were conducted with international experts (n = 16) Discussions focused on the core attributes and tiered interventions of the model in Phase I. Data were analyzed using a framework approach and SWOT (strengths, weaknesses, opportunities, and threats) analysis. RESULTS: Themes surrounding the perceived characteristics of the model included comprehensiveness, guiding document, collaborative approach, and inclusiveness. Additional themes were related to the implementation that included governance, professional roles, workload, implementation in different countries, advocacy, and available opportunities. A framework table was tabulated to present the strengths and weaknesses of the service delivery model and available opportunities, and potential barriers to implementation. CONCLUSIONS: This study revealed international perspectives regarding a proposed collaborative tiered school-based PT service delivery model and presented a framework to guide clinicians, researchers, and policymakers for the implementation of tiered approaches.Relationships between health and education have been more pronounced in recent years, and interactions between healthcare and the education system have evolved (Zajacova & Lawrence, 2018). Recent recommendations of the World Health Organization (WHO) and UNESCO suggest that "every school should be a health-promoting school", and provided intervention guidelines for the global standards for health-promoting schools (WHO., 2021a). In the meantime, education sectors in different countries have shifted inclusive education policy, with a focus not only on students with disabilities, but all students (Whitley & Hollweck, 2020). In conjunction with the changes in both education and school health services (WHO., 2021b), researchers in the field of speech-language therapy (SLT), occupational therapy (OT) (Camden et al., 2021), and physiotherapy (PT) (Cinar et al., 2021), have been exploring tiered approaches to delivering services in schools, and searching for collaborative strategies to encourage interaction between stakeholders in health and education sectors.

Acceptability of Pediatric Telerehabilitation Interventions Provided by Physical Therapists and Occupational Therapists-A Scoping Review.

AIMS: The purpose of this scoping review was to explore the available literature and identify gaps regarding the acceptability of telerehabilitation interventions provided by pediatric physical therapists and occupational therapists. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) framework to guide this scoping review. We systematically searched eight scholarly databases (CINAHL, Medline, SPORTDiscus, AMED, APA PsychInfo, SCOPUS, PEDro, OTseeker), five gray literature databases (MedlinePlus, Gray Literature Report, OpenGrey, National Institute for Health, ProQuest Dissertation & Theses Global [PQDT]), conducted a manual search of selected references and contacted international experts. We included articles published between 2000 and 2021. Acceptability was defined in accordance with the Theoretical Framework of Acceptability of Sekhon et al. RESULTS: From a total of 1567 unique references, 123 were deemed eligible for full-text review. Eighteen studies published between 2011 and 2021 were included in this review. Even though every aspect of the Theoretical Framework of Acceptability was assessed from a variety of angles, a complete appreciation of the concept is still lacking for pediatric telerehabilitation. CONCLUSIONS: This review highlights important gaps in our knowledge regarding the acceptability of pediatric telerehabilitation interventions and supports the need for further research focusing on the subject.

Pediatric Assessments for Preschool Children in Digital Physical Therapy Practice: Results From a Scoping Review.

PURPOSE: To examine and map the extent and scope of pediatric physical therapy assessments previously used in the digital context. METHODS: A 6-step evidence-based scoping methodological framework was used. Articles containing assessments conducted by a physical therapist using technology to assess a child aged 0 to 5 years were included and synthesized using descriptive statistics and thematic analysis. RESULTS: Eighteen studies identifying 25 assessments were eligible. Asynchronous observational developmental instruments administered in the child's natural environment to those at risk or presenting with neurodevelopmental conditions were the most common. There is a need for detailed procedures and training for caregivers and clinicians. CONCLUSION: Limited research exists on the use of pediatric physical therapy assessments for young children with musculoskeletal and cardiorespiratory conditions in a digital context. The development of new instruments or modifications of existing ones should be considered and be accompanied by detailed administration protocols and user guides.

Pediatric Teleheath: Opportunities Created by the COVID-19 and Suggestions to Sustain Its Use to Support Families of Children with Disabilities.

AIMS: Telehealth is being rapidly adopted by physical and occupational therapists in pediatrics as a strategy to maintain services during the COVID-19 crisis. This perspective presents a mix of theoretical and practice perspectives to support the implementation of telehealth. Although research evidence is just emerging, there is sufficient indication to believe telehealth is effective. However, which telehealth strategies are best for which children and families, and which intervention goals, are not yet clear. METHODS: We discuss how different telehealth strategies (e.g. videoconferencing, emails, phone calls, online programs) are being used to address specific intervention goals. Comments from therapists using telehealth and examples of practices in different context and with different populations are provided. We discuss how newly adopted telehealth practices could be included in future hybrid service delivery models and programs, as well as factors influencing the decision to offer face-to-face or online interventions. CONCLUSION: Although telehealth has been implemented quickly as a response to a health care crisis, and is not a one-size-fits-all intervention, we believe it offers great opportunities to increase the accessibility, cost-effectiveness and family-centredness of our services, to best support families of children with disabilities.

Look Around Me: Environmental and Socio-Economic Factors Related to Community Participation for Children with Cerebral Palsy in Québec.

Aims: This study aimed at gaining a deeper understanding of the environmental and socio-economic factors affecting participation outcomes in community and leisure activities for children with disabilities, as well as the trajectories of participation for these children to promote their health and guarantee their rights are respected.Methods: A participatory action research (PAR) approach and linear regression analysis were employed to identify contextual factors associated with the community participation of children with cerebral palsy (CP) living in Quebec, Canada. Stakeholders engaged through the entire research process supported the development of questionnaires, data collection, analysis and interpretation of results.Results: Neighborhood outings were ranked among the most practiced activities by children with CP. Only in a few cases (9%) did children participate in more than two types of activities outside of school. Factors limiting children's participation were predominantly extrinsic in origin, including financial burden and lack of information about existing opportunities.Conclusions: There is a serious need for communities and local governments to inform parents about available resources, programs and policies that can support their child's participation. Rehabilitation professionals could partner with stakeholders to inform the development of public policies that target the identified barriers and promote children's integration and fulfillment.

Scope and Practices of Physical Therapists Working With Children: Results From an International Online Survey.

PURPOSE: To describe the scope of practice of physical therapists (PTs) working with children worldwide. METHODS: PTs working with children in any context and country were invited via social media and email campaigns to complete an online survey containing 42 questions about work context and service delivery. Descriptive statistics were computed. RESULTS: Of the 1133 participants from 77 countries, most worked with children full-time (51.8%), and in government-funded work settings (57.5%). Modalities of access to services varied across countries, work settings, and children's conditions, yet 46.7% of PTs reported that most children had direct access to services. PTs provided services to children with a variety of conditions, with cerebral palsy being most reported (83.3%). Interventions focused primarily on improving body function (42.0%) and on providing face-to-face individual treatment (96.6%). CONCLUSIONS: This study provides an international portrait of pediatric PT practice and illustrates the diversity of services in pediatric PT.

Barriers and Facilitators to Implementing Community Outreach Work, and Inter-professional Collaboration with Regional Partners.

Community outreach workers support individuals in accessing the health and community services they require through various forms of proximity approaches. Even though community outreach has been available in the province of Quebec (Canada) for the past 40 years, it is still difficult to implement and sustain, especially with families of young children. The aim of this study was to document barriers and facilitators to implementing community outreach practices, and to describe how such workers collaborate with sectoral (e.g. health care) and inter-sectoral (e.g. municipalities, community organizations, schools) partners. We performed a content analysis on 55 scientific and grey literature documents, and transcriptions of 24 individual interviews and 3 focus groups with stakeholders including parents, community outreach workers, health care employees, and inter-sectoral partners. This study reveals four categories of barriers and facilitators to the implementation of community outreach work (i.e. organizational factors, nature of the work and worker-related factors, family-related factors, external factors). With regards to collaboration, community outreach workers deal with various partners. Good inter-professional collaboration is achieved through positive interactions and communication, shared or co-developed activities for the families, co-intervention with families, and strategies to enhance role awareness and inter-sectoral meetings. Results highlighted that many factors interact and can either influence, positively or negatively, the opportunity to implement community outreach work. The collaborative practices identified may help to maximize facilitators and overcome barriers. Advocacy and a better understanding of how to integrate community outreach work within health services while maintaining the workers' flexibility are needed to sustain this practice.

Understanding parental concerns related to their child's development and factors influencing their decisions to seek help from health care professionals: Results of a qualitative study.

BACKGROUND: Early identification of children at risk of developmental delay is crucial to promote healthy development. Assessing parental concerns about development is often part of identification processes. However, we currently do not understand well how and why parents become concerned and how and why they access early identification and intervention services. The purpose of this study was to explore parental perceptions about their child's development and the factors influencing their reported professional help-seeking behaviours. METHODS: This exploratory study was part of a larger study describing child development in children aged 2-5 in a small Canadian city. We conducted semistructured interviews with 16 parents whose children were at risk of developmental delay to examine their perceptions of their child's development, their use of community services promoting development, and their recommendations to optimize those services. RESULTS: Four themes were identified: (a) Vision of child development influencing help-seeking behaviours: Natural or Supported?, (b) Internal and external sources contributing to parents' level of developmental concern, (c) Using internal resources and struggling to access external resources, and (d) Satisfaction with services accessed and recommendations to access more support. Parents' vision of child development along with sources of parental concern appeared to influence the level of concern, enhancing our understanding of how parents become concerned. The level of concern and parents' knowledge and perceived access to resources seemed to influence their decision whether or not to consult health care professionals. Parents provided many suggestions to improve services to promote child development and support families. DISCUSSION: Results highlight the importance of supporting parents in recognizing if their child is at risk of delay and increasing awareness of available resources. It appears particularly important to ensure that health care professionals and community-based support services are accessible to provide parents with the support they need, especially when they have concerns.

Research and knowledge transfer priorities in developmental coordination disorder: Results from consultations with multiple stakeholders.

BACKGROUND: Priority-setting is a way to focus research and knowledge translation (KT) efforts for community-based research partnerships (CBRP). OBJECTIVE: To identify the developmental coordination disorder (DCD) research and KT priorities of stakeholders in Quebec, Canada, and their perceptions regarding the implementation of a CBRP. DESIGN: An advisory committee oversaw the research process including an online survey and four community forums. SETTING AND PARTICIPANTS: The survey was posted online and four community forums were organized. Participants included parents of children with DCD, adults with DCD, health professionals and school staff. MAIN VARIABLES: Stakeholder generated research and KT priorities, and optimal CBPR conditions. OUTCOME MEASURES: Participants selected their top five priorities based on a predefined list of 16 research and 12 KT priorities determined in collaboration with the advisory committee. They also rated the importance of various CBRP conditions. Preliminary survey results were discussed during the forums. RESULTS: Survey participants (n = 395) identified interwoven research and KT priorities where access to services was considered to be essential: supporting children at school; improving DCD identification and diagnosis; preventing secondary consequences; improving the organization of services and implementing effective services. Forum participants (n = 52) confirmed the relevance of these priorities and supported the establishment of a CBRP inclusive of all stakeholders to improve DCD services, research and KT. DISCUSSION AND CONCLUSIONS: A general consensus emerged among all groups, but adults with DCD were more concerned with employment than were the other stakeholder groups. These findings are presently being used to shape an ongoing, online CBRP.

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.

Developing a classification system of social communication functioning of preschool children with autism spectrum disorder.

AIM: Impairments in social communication are the hallmark of autism spectrum disorder (ASD). Operationalizing 'severity' in ASD has been challenging; thus, stratifying by functioning has not been possible. The purpose of this study is to describe the development of the Autism Classification System of Functioning: Social Communication (ACSF:SC) and to evaluate its consistency within and between parent and professional ratings. METHOD: (1) ACSF:SC development based on focus groups and surveys involving parents, educators, and clinicians familiar with preschoolers with ASD; and (2) evaluation of the intra- and interrater agreement of the ACSF:SC using weighted kappa (кw ). RESULTS: Seventy-six participants were involved in the development process. Core characteristics of social communication were ascertained: communicative intent; communicative skills and reciprocity; and impact of environment. Five ACSF:SC levels were created and content-validated across participants. Best capacity and typical performance agreement ratings varied as follows: intrarater agreement on 41 children was кw =0.61 to 0.69 for parents, and кw =0.71 to 0.95 for professionals; interrater agreement between professionals was кw =0.47 to 0.61, and between parents and professionals was кw =0.33 to 0.53. INTERPRETATION: Perspectives from parents and professionals informed ACSF:SC development, providing common descriptions of the levels of everyday communicative abilities of children with ASD to complement the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Rater agreement demonstrates that the ACSF:SC can be used with acceptable consistency compared with other functional classification systems.

The "5Rs of Reorganization": A Case Report on Service Delivery Reorganization within a Pediatric Rehabilitation Organization.

AIMS: Pediatric rehabilitation centers constantly reorganize services to accommodate changes in funding, client needs, evidence-based practices, accountability requirements, theoretical models, and values. However, there are few service delivery models or descriptions of how organizations plan for change to guide organizations through this complex task. METHODS: This case report presents the "5Rs of Reorganization," a novel process for planning service delivery reorganization projects in pediatric rehabilitation centers. The 5Rs include: 1. Recognize the need for change, 2. Reallocate resources for project management, 3. Review the reality of clients, service delivery, and the community, 4. Reconstruct reality, and 5. Report results. RESULTS: The implementation and outcomes of the "5Rs of Reorganization" process are described for one pediatric rehabilitation center to illustrate how use of this process led to effective service delivery reorganization planning. The resulting multi-component customized service delivery plan reflects high levels of stakeholder involvement. CONCLUSIONS: Principles of project management can be applied to support service delivery reorganization planning within pediatric rehabilitation centers using the "5Rs of Reorganization." Strong communication throughout the planning phase is key to developing and sharing a plan for service delivery reorganization. Communication can be supported through use of the 5R process.

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.