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

IMPORTANCE: Coaching is an effective intervention strategy in occupational therapy but there lacks consensus in the literature about terms, definitions, and approaches used which can be barriers to the clinical use of this method. OBJECTIVE: The purpose of this review is to understand how coaching adults is used as an intervention to support children with disabilities. METHODS: Guidelines from foundational scoping review articles and PRISMA-ScR were followed. Studies using adult coaching as an intervention to support children with disabilities were reviewed. A total of 20 articles met inclusion criteria and were included in the review. FINDINGS: The use of coaching terms and definitions vary. There are commonalities with coaching structures, "key ingredients," and use of outcome measures among studies which can provide a starting framework for occupational therapists wanting to use coaching as an intervention in their practice. CONCLUSIONS AND RELEVANCE: Coaching adults to support children with disabilities is already known to be an effective occupational therapy intervention strategy. Developing structured protocols with clearer and more unified terminology may improve the fidelity of this intervention approach. WHAT THIS ARTICLE ADDS: This article presents current practices in adult coaching to support children with disabilities in Occupational Therapy. The authors discuss commonalities across coaching practices for therapists who wish to use coaching protocols in their clinical practice.

Participation Patterns and Associated Factors in Japanese Children With Autism.

BACKGROUND: Children's participation is an important outcome for children, families, and rehabilitation. OBJECTIVES: We compared participation patterns (home and community) of 6- to 12-year-old Japanese children with autism and children with typical development (TD) and explored the associations of participation with familial, environmental, and child-related factors. METHOD: Twenty-five mothers of children with autism and 21 mothers of TD children completed a survey covering their child's participation and environment, family empowerment, autism symptoms, sensory processing, behavior, and demographic characteristics. RESULTS: Children with autism showed restricted home and community participation. Home involvement was associated with family empowerment and the children's age, whereas home frequency was linked to environmental supportiveness and household income. CONCLUSION: Japanese children with autism need appropriate support to address decreased participation. Occupational therapists may focus on family empowerment and the child's environment to facilitate the home participation of children with autism.

Participation Patterns and Associated Factors in Japanese Children with AutismParticipation in daily activities is essential for children's health and well-being. We investigated the characteristics of and factors associated with home and community participation among Japanese children with autism without intellectual disability. The degree of environmental support at home, maternal perceptions of family empowerment, annual household income, and the age of the children were all associated with home participation in children with autism. These findings may be useful for professionals who support the daily lives of Japanese children with autism. They also suggest the importance of professionals focusing on children's environment and family when effectively supporting their home lives.

Development of GO Move: A Website for Children With Unilateral Cerebral Palsy.

It is unknown if an online tool is wanted by therapists and parents of individuals with unilateral cerebral palsy (UCP) to support implementation of goal-directed home programs, and if wanted, the recommended features for the tool. The objective was to explore the experiences of therapists and parents who have implemented home programs, seek guidance on translating a paper-based home program toolbox into a mobile website, and develop the website. Qualitative descriptive methodology guided data collection using semi-structured interviews and thematic analysis, validated with field notes and member checking. A team science, iterative approach was used to integrate the themes into the development of the mobile website. Five primary themes including recommendations for the functionality, features, content, and naming of the mobile website were identified. Parents and therapists value home programs. Participants provided recommendations regarding content and features, and the GO Move mobile website was developed based on the recommendations.

Development of Go Move: A Website for Children With Unilateral Cerebral PalsyTherapists and parents of children with unilateral cerebral palsy were interviewed to understand their experience of home programs and gain input for creating a mobile website with information on goal setting and implementing home programs. The interviews provided valuable information about the functionality, features, content, and naming of the website. GO Move, a mobile website aimed to provide information on goal setting, activity selection, and tracking of exercises and activities in the home environment for children with unilateral cerebral palsy, was developed based on the information from the interviews.

Focus Group With Parents of Children With Mental and Behavioral Health Concerns.

BACKGROUND: Scholars from multiple fields have shown that parents raising a child with mental and behavioral health concerns (MBHC) need additional support. We need parents to self-identify necessary supports as a basis for intervention planning. OBJECTIVES: In this study, we examined what parents say they need from professionals to support their families. METHODOLOGY: Occupational therapy faculty and students employed a strengths-based coaching approach to conduct a focus group with five parents. We conducted qualitative thematic analysis and used inductive coding to identify themes related to unmet self-identified needs of families. We refined themes through an iterative process and achieved 93% agreement after three rounds of coding. RESULTS: Four themes emerged from the transcript analysis: External Control, Internal Competence, Relating to Others, and Role of Self-Care. CONCLUSION: Professionals must consider the unique needs identified by parents who have children with MBHC when planning interventions within our education and health care systems.

Family-professional collaborative intervention via telehealth with an infant with Down syndrome and visual impairment: a case report.

BACKGROUND: Collaborative interventions, involving partnerships between professionals and families, make it possible to actively engage families in the rehabilitation process. However, no study was found that used a physiotherapy intervention via telehealth for infants with Down syndrome (DS). OBJECTIVE: Describe the case report of a family-professional collaborative intervention via telehealth for an infant with Down syndrome and visual impairment during the COVID-19 pandemic. CASE DESCRIPTION: A male infant five months old participated in a collaborative intervention for a period of eight weeks. Three goals were set with the family, and a goal-oriented home program, involving visual stimulation strategies, was organized. OUTCOMES: Two goals were achieved. The family scored changes in performance and satisfaction with the infant's performance according to the adapted Canadian Occupational Performance Measure. Improvement of motor skills was verified by Alberta Infant Motor Scale and changes in mobility and daily activities performance were measured by the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test. CONCLUSION: The use of family-professional collaborative intervention via telehealth during the COVID-19 pandemic shows promising results for achieving the goals established by the family collaboratively with the physical therapists.

Partnering with families known to child protection in an interprofessional context.

BACKGROUND: To meet the diverse needs of children and their families known to child protection, interprofessional collaboration across a range of services is critical. Children and their parents/caregivers are key stakeholders in these collaborations and current research highlights the need to strengthen their participation in these service responses. Practitioners have a critical role in strengthening family member participation in child welfare and protection responses. OBJECTIVE: To explore professional's experiences and perceptions of working in partnership with children and families known to child protection in an interprofessional context. PARTICIPANTS AND SETTING: 14 professionals with extensive experience in the fields of family support and child protection. METHODS: Semi-structured interviews were completed, recorded, transcribed, and then coded using NVivo 12 Pro. Reflexive thematic analysis was used to guide data analysis. RESULTS: Trusting practitioner-family relationships were affirmed to be critical to engaging and partnering with families. Results pertaining to the interprofessional context encourage a more community-oriented perspective of practitioner-family relationships, where practitioners have a collective responsibility to welcome families into an integrated network of community services. Further, the conflict for child protection practitioners between their legislated role and their need to build trusting relationships with families to support partnered work is discussed. CONCLUSIONS: The centrality of practitioner-family relationships needs to be better recognized and supported in policy and practice across all sectors supporting children and families known to child protection. An interprofessional approach to building practitioner-family relationships across this range of services may enhance family engagement and partnerships in their service responses.

Benefits and Challenges of a Telehealth Eating and Mealtime Intervention for Autistic Children: Occupational Therapy Practitioners' Perspectives.

Eating and mealtime challenges are common in autistic children, yet intervention access is limited. Telehealth may provide opportunities to address this gap and increase access for underserved families. This study examined the occupational therapy practitioner's perceptions of transitioning from a caregiver-mediated, in-home eating, and mealtime intervention for autistic children to telehealth owing to COVID-19 while considering the impact on accessibility, challenges, and benefits. Family characteristics were compared between groups. Thematic analysis of semi-structured interviews explored practitioners' experiences of telehealth. Statistical findings and themes were directly compared and contrasted. The following three themes emerged: Intervention Adaptations, Challenges for Interventionists, and Benefits of Telehealth. The differences in the families' geographic location were identified. Themes and family characteristic differences supported increased intervention accessibility for the telehealth group. This study provides preliminary evidence that telehealth can increase access to specialized services. There are benefits and challenges to implementing telehealth with families and autistic children.

Parent Satisfaction With a Telehealth Parent Coaching Intervention to Support Family Participation.

COVID-19 catalyzed telehealth practice creating opportunities for clients and providers to discern best applications. Parent satisfaction with services supports partnership within therapy processes, potentially augmenting outcomes. We examined parent satisfaction levels and experiences with the telehealth approach of a parent coaching intervention for families of children with special health care needs (CSHCNs). We used a mixed-methods descriptive design. Fifteen parents completed the Telehealth Usability Questionnaire (TUQ) and a semistructured interview. We analyzed TUQ ratings using descriptive statistics, and we thematically analyzed participants' telehealth experiences. Parents found telehealth useful, easy to use, effective, reliable, and satisfactory. Parents described that telehealth addressed needs conveniently, enhanced parent-provider communication, and fostered shared parent involvement. Telehealth appears to be a satisfactory occupational therapy service delivery approach for parents of CSHCN. Findings build preliminary evidence for understanding for whom telehealth is well suited, supporting determination of relevant, fundable telehealth services.

Assessment Fidelity of Parents Implementing a Standardized Telehealth Infant Autism Screener.

Telehealth is effective for service delivery in pediatric occupational therapy across ages and diagnoses. Remote parent coaching provides unique benefits for both parents and infants. As a result of COVID-19, practitioners and researchers pivoted to remote assessment and intervention without much preparation or training. It is critical that we evaluate the quality of these telehealth services. One important component of remote evaluations is assessment fidelity. To examine assessment fidelity of a telehealth-delivered observational autism screening tool for infants. An assessment fidelity checklist was applied as the primary outcome measure. Parents conducted assessments with 82% adherence to the fidelity checklist. Implications: A parent coaching telehealth approach may be valid for assessment in pediatric telehealth. Continually monitoring the assessment fidelity of a tool is critical for the valid administration of remote services.

Health Care Professionals' Perceptions About a Telehealth Model of Therapy After NICU Discharge.

The Baby Bridge program is an implementation strategy to improve access to in-person early therapy services following neonatal intensive care unit (NICU) discharge. The objective of this study was to evaluate acceptability of Baby Bridge telehealth services among health care providers. Interviews with health care providers were conducted, transcribed, and coded in NVivo. Deductive analysis was used to organize data into negative and positive comments, suggestions for optimization, and perceptions about the first visit. Next, a conventional approach was used to organize the data into themes. Telehealth was viewed as an acceptable, but not necessarily preferable, form of Baby Bridge delivery. Providers identified how telehealth may improve access to care, but with potential challenges in delivery. Suggestions for optimization of the Baby Bridge telehealth model were proposed. Identified themes included delivery model, family demographics, therapist and organizational characteristics, parent engagement, and therapy facilitation. These findings provide important insights to consider when transitioning from in-person therapy to telehealth.

A Telehealth Delivered Toilet Training Intervention for Children with Autism.

BACKGROUND: Independence in toileting is a vital skill, yet toilet-training interventions for children with autism are limited. OBJECTIVES: We investigated the acceptability and preliminary efficacy of a hybrid telehealth intervention that used synchronous individualized coaching sessions and asynchronous online educational materials to support parents in toilet training their children with autism. METHOD: Participants included 34 families of children with autism ages 2 to 8 years. Measures were administered at pre- and postintervention (10-12 weeks) and included the Toileting Behavior Questionnaire, Goal Attainment Scaling, and Canadian Occupational Performance Measure. RESULTS: Twenty-five families completed all intervention procedures. Parents found the intervention highly acceptable and reported significant improvements in child toileting behaviors; however, families accessed the asynchronous intervention materials at a low rate. CONCLUSION: A parent coaching model delivered through telehealth may be a promising method to increase toileting independence among families of young children with autism.

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

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

Family life and autistic children with sensory processing differences: A qualitative evidence synthesis of occupational participation.

Autistic children with sensory processing differences successfully navigate and engage in meaningful family daily occupations within home and community environments through the support of their family. To date however, much of the research on autistic children with sensory processing differences, has primarily been deficit focused, while much of the caregiver research has focused on issues of distress, burden, effort, and emotional trauma in coping with their child's diagnosis. This study aimed to conduct a qualitative evidence synthesis, using a meta-ethnographic approach to explore the gap identified in understanding successful occupational experiences of family participation and daily family routines when supporting an autistic child with sensory processing differences and to offer an alternative strengths-based perspective. Inclusion criteria were studies which were peer-reviewed qualitative design, published from 2000 to 2021, and that concerned parents/caregivers' perspectives of family occupations of children diagnosed with autism spectrum disorder. Studies were electronically searched in eight databases from October to December 2021 and 23 studies were identified which met the inclusion criteria. Noblit and Hare's seven step approach for conducting analysis in meta-ethnography was used, and three themes identified: (1) sensory processing differences in daily life, (2) what is hard about hard, and (3) orchestrating family life. Results identified the centrality of sensory experiences in understanding family life. Living with unpredictability while orchestrating certainty through routines was core to successful participation. This review provides insights into how parents negotiate the complexities of constructing family life when living with an autistic child. The results can inform the design of future interventions that specifically address the relationship between meaningful participation in family occupations and daily routines and sensory processing in autistic children. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022298938, identifier: CRD42022298938.

Persistence, strength, isolation, and trauma: An ethnographic exploration of raising children with cleft palate.

BACKGROUND: The lives of families of young children with cleft palate (±lip) are complex. Multiple interventions are required as part of the long-term multidisciplinary treatment for children with CP±L, with an impairment-focused approach prevailing. Research with young children with CP±L has focused on treatment and intervention, and previous qualitative research has been collected predominantly via interviews, so little is understood about the day-to-day lives of families of young children with CP±L. AIMS: (1) To increase understanding of the lives of children with CP±L and their families by applying an ethnographic lens to improve clinical practice (2) to identify key interactions and encounters that shape the experiences of children with CP±L and their families (3) to examine how family-centered practice can enhance practitioner-family relationships in providing effective and evidence-based care for children with CP±L. METHOD: Ethnographic observations of seven families of children with CP±L and their families and educators including parents, siblings, aunts, grandparents, and teachers involved multiple site visits. Rich data were collected to gather information about different aspects of their lives (such as their strengths, routines, preferences, challenges and experiences). There were 84 artefacts collected: 18 interviews, 29 videos, one extended audio recording of a mealtime, seven photos contributed by families, seven case history questionnaires, and 22 field notes. These data were analyzed inductively using thematic analysis. RESULTS: Three overarching themes and 11 subthemes were identified: (1) the whole child (persistence, communication, activities, mealtimes), (2) family strength and support (strong families, external support, attitudes, advocacy, positive medical experiences) and (3) family isolation and trauma (negative medical experiences, traumatic and challenging experiences). CONCLUSION: This is the first study to use ethnographic methodology to facilitate the collection of unique insights into the lives of young children with CP±L and their families to improve clinical practice for SLPs. The unique application of family-centered practice with these families promoted trust and highlighted their challenges and strengths which could be considered by SLPs to provide holistic intervention.

Commercial Exergaming in Home-Based Pediatric Constraint-Induced Therapy: A Randomized Trial.

Constraint-induced therapy (CIT) is highly effective yet not accessible to many families. Integrating commercial exergaming in home-based CIT may support the availability and attainability of the intervention. The study compared the effects of supplementary use of Nintendo Wii in home-based CIT with dose-equivalent conventional CIT. Eighteen children with cerebral palsy were randomly assigned to 8 weeks of CIT (CIT) or 4 weeks of CIT, followed by 4 weeks of Wii-augmented CIT (CIT-Wii). Outcome measures included the Bruininks-Oseretsky Test of Motor Proficiency (Manual Dexterity), the ABILHAND-Kids, the WeeFIM (Self-Care), the Test of Playfulness, the Engagement Questionnaire, and the Parenting Stress Index-Short Form. Both groups significantly improved motor outcomes and playfulness. The CIT group demonstrated greater improvement in self-care skills, whereas parental stress decreased only in the CIT-Wii group. CIT-Wii yields no significant difference in treatment effects from conventional CIT and may provide psychosocial benefits.

Parental Feeding Concerns for Children With Autism Spectrum Disorder: A Family-Centered Analysis.

This study identifies and describes feeding concerns of parents of children with autism spectrum disorder (ASD) and examines the extent to which parents relate those concerns as having been addressed by therapists. Survey data were collected from 113 parents of children with ASD. Of the parents surveyed, 68% described a past or present concern with feeding; 60% of those parents with concerns said a therapist had not addressed those concerns. Feeding concerns were more likely addressed when therapists shared parent's concerns. Specific types of concerns, such as those around food selectivity and food refusal, were more likely addressed than difficulties around mealtime. A gap is identified between parental report of feeding difficulties and parental report of professional services addressing feeding needs. This analysis presents an opportunity for occupational therapists in the area of feeding, particularly around identifying and addressing parental concerns.

From Syringe to Spoon Feeding: A Case Report of How Occupational Therapy Treatment Successfully Guided the Parents of a Child with Autism Spectrum Disorder and Prematurity in an Outpatient Clinic.

This case report details how occupational therapy treatment in an outpatient setting successfully guided the parents of a child with autism spectrum disorder and a history of prematurity from restrained syringe feedings to the acceptance of spoon feedings. Occupational therapy practitioners are qualified, needed and available to assess and treat feeding disorders in children with autism spectrum disorder and a history of prematurity. Family-centered practice must be utilized for successful outcomes in an outpatient service delivery model.

The Family Meal Model: Influences on Family Mealtime Participation.

The family meal affords benefits such as positive nutritional habits, trust building, connecting, parent modeling, and teaching. During the school-aged years, families can support children's development of health behaviors and family routines. This interdisciplinary study examined families' experiences of mealtimes and the factors that support or hinder mealtime participation. Grounded theory methods guided data collection and analysis. Semi-structured interviews were conducted with 21 families with at least one school-aged child (n = 68). Interviews were audio recorded and transcribed. Researchers coded and categorized data, identified themes, and generated a model. Families defined family mealtime as all family members being together at the kitchen or dining room table eating a meal. Families enjoyed being together, conversing, and connecting through family mealtime participation. The Family Meal Model proposes relationships between factors that support or hinder a family's mealtime participation. Discussion includes support for a broadened role of occupational therapy in promoting family occupation through family meals.

Immersing students in family-centered interprofessional collaborative practice.

The goal of interprofessional education (IPE) is to improve outcomes and experience of healthcare services for patients and families through collaborative practice. While patients and families may participate in IPE experiences as recipients of healthcare services, their perspective on students' emerging collaborative skills is rarely sought. We describe a pediatric IPE activity in which participating families rated students' performance of the targeted interprofessional collaborative competencies. We asked whether family ratings would be consistent with student self-ratings and independent observer ratings. Participants were 40 interprofessional pre-licensure student teams representing physical therapy, occupational therapy, nursing, and speech-language pathology. Each team developed a joint assessment plan, conducted a 1-h play-based observation of a child, 30 months of age or under, and interviewed an accompanying parent/caregiver. Quantitative rating scale data indicated consistency between family, student and independent observer ratings of interprofessional collaborative skills displayed by the students. Qualitative data suggested that students gained a better understanding of ways in which an interprofessional team can provide effective family-centered care. Our results suggest that patient/family feedback can provide a useful measure of the effectiveness of IPE activities and should be included in such activities targeting interprofessional collaborative competences across settings and patient populations.

The Infant Toddler Activity Card Sort: A Caregiver Report Measure of Children's Occupational Engagement in Family Activities and Routines.

Early intervention (EI) therapy services aim to address family-centered goals to facilitate young children's development and participation in meaningful life activities. Current methods to evaluate children in EI assess discrete developmental skills but provide little information on the child's ability to successfully incorporate that skill in everyday life. Furthermore, traditional measures have limited opportunity for parent report, despite parent engagement being a critical component for successful implementation of EI services. A measure that involves parents in the therapeutic process to track family-driven EI goals related to a child's occupational engagement in meaningful family activities and routines is desperately needed. Using a qualitative design and conventional content analysis, we identified 41 distinct activities of infant-toddlers from a cohort of 23 caregivers. Activity items were matched with photographs and validated with experts in pediatric rehabilitation using the Delphi method. The resulting 40 activity/photograph pairs were used to develop a new measure of pediatric occupational engagement, the Infant Toddler Activity Card Sort (ITACS).