Making a Difference

Making a Difference for Children and Families

Occupational therapists (OTs) delivering the Partnering for Change (P4C) model are able to provide service and accommodation to children right away, without the child needing to wait. The occupational therapy services provided are based on need, resulting in children with more intense needs receiving more frequent and appropriate services. In the P4C model, OTs aim to build capacity of educators and parents to enable translation of knowledge and strategies for future use. In the P4C Implementation and Evaluation study, parents valued the information provided but some families requested more frequent communication with the OTs.

							P4C OTs are able to see children more often and can provide suggestions for the child’s educator or school staff many times in a year.
The majority of parents were satisfied with the P4C service.
Further research is needed to explore innovative ways to reach families.
P4C OTs were able to contribute to the development of Individual Education Plans (IEP) for many of the children. 

						

Sheena’s Story*

OTs delivering the P4C model provide services that result in increased child participation and success at home and in the community. One of the most powerful ways to convey what the P4C service looks like is to present a true story of one child in this study. * Names have been changed.

Grade Three

In mid-June, 2014, just before the end of the first school year of the P4C project, a P4C OT was asked by Ms. Tasker, the school’s Special Education Resource Teacher (SERT), to attend a school meeting for a student named Sheena. Sheena’s parents, her classroom teacher, the principal and the resource teacher were all in attendance. Sheena’s parents reported that they had taken Sheena to a pediatrician due to their ongoing concerns about her motor development and her level of frustration and anxiety. The pediatrician had diagnosed Sheena with Developmental Coordination Disorder. The school staff noted that Sheena had difficulty with participation in gym class, in keeping up with her peers in completing written work, as well as some emotional and behavioural issues. The team agreed that involving the P4C OT in September would be ideal.

Grade Four

The OT began the second week of school by observing Sheena in gym, at recess, and in the classroom. She met with the SERT to gather more background and to understand the strategies that had already been tried with Sheena and that were found to be successful. Sheena made a positive start in Grade 4, but her teachers noted, and the OT observed, that Sheena had ongoing difficulties with initiating independent work, making transitions between activities and classes and that she tended to isolate herself at recess. The OT also noticed that Sheena fatigued easily. She was able to help the educators understand why children with DCD tire easily, both mentally and physically, because of the extra effort they are expending just to compete routine tasks. The OT suggested that some breaks be built into Sheena’s schedule to try to reduce her fatigue. The OT also assisted with incorporating an iPad into the classroom for written work and including some apps about self-regulation that could support Sheena in learning to manage her emotions in a more positive manner.

The OT met Sheena’s father in the playground at school drop-off time one day and he was pleased with how things were going in Grade 4. He felt the school staff were all working very hard to ensure that Sheena had a positive school year, especially as she had experienced some bullying in the past.

Sheena had some access to an Educational Assistant (EA), so the OT met with her to discuss some seating options for Sheena, especially for carpet time, some strategies to encourage independent work and to ease transitions using a visual timer. Sheena had decided that she was very keen to learn to cursive write, so the OT provided an instructional program to the EA and suggested that it could be a break time activity.

As the school year progressed, however, Sheena’s social and behavioural difficulties escalated (gave up easily, wouldn’t try new tasks, anger outbursts, school refusal) so the school involved a Child and Youth Worker. The OT shared some resources around self-regulation, organization, and sensory strategies with the SERT that could be shared with the rest of the team as appropriate. The OT also consulted with the team to suggest potential referrals for support external to the school for Sheena and her family as it became clear that they needed more support than the school could provide.

Comparing the P4C Service with Typical Service

In the traditional “non-P4C” model, Sheena may not have been referred for OT at all as the school may not have been aware of the connection between DCD and emotional and behavioral issues. If referred, she would have been on a wait list and she would not have been seen until she was in Grade 5 or 6 and her problems would have been more complex and likely more severe.

In P4C, the OT was able to initiate service right away, interact regularly with multiple school staff and resource personnel, and work with Sheena in context. Having the ability to meet with the team and work closely together is especially valuable for children whose issues are complex. Over the school year, the OT: saw Sheena three times for observation, four times for some direct work and attended the family meeting. There were two additional contacts with her family and 18 staff contacts including her teacher, SERT, EA and psychologist.

Parent Satisfaction with the Service

We have seen a huge improvement over the past six months. Both physically and academically. It has been a huge help!

The Parent Knowledge and Experience Questionnaire was administered in Year 1 and Year 2 to capture parents’ change in knowledge of the impact of coordination difficulties on everyday activities and of their ability to problem-solve and use adaptive strategies.

83.7% of parents answered yes when asked if they felt the Partnering for Change Occupational Therapy Service was beneficial to their child and/or family.
83.1% of parents replied they were satisfied to a moderate or great extent when asked how satisfied they were with the Partnering for Change Occupational Therapy Service.

Although many parents were very satisfied, some parents expressed a desire for more information.

I would have liked more communication about the interventions and recommendations at school by the OT.
— Parent

I am satisfied and grateful but I still am unsure of everything. Would have liked an in-school meeting.
— Parent

Future studies should continue to find innovative ways to help OTs and parents to connect with one another, particularly since the evidence shows how valuable the resources and connections with the OT were to parents. OTs also reported that they did not have as much contact with families as they would have liked. This is reviewed in greater detail in Lessons Learned.

When connections happened between parents and OTs, there was tremendous value for parents. Families who received information accessed the resources provided and repeatedly expressed that the information that was provided was clearly written and easy to read (94.8%), relevant (90.6%), useful (90%) and increased understanding of their child’s needs (87.4%). While only 15% of parents attended an evening workshop about motor development and coordination challenges, most (87%) reported that it was very useful. This finding suggests that evening workshops should be offered in all schools.

Many parents had strategies that were being used in the classroom explained by the OT (85.7%) or their child’s teacher (64.6%). A substantial number (62.4%) had also received suggestions about things they might try at home. Most (75.7%) parents thought that their child would benefit from OT services in the future. This suggests that questions might be asked by families in the future, or additional suggestions made by the OT, without the need to re-refer a child.

Parents’ responses at the end of the study also reveal that nearly 65.3% of children had an Individual Education Plan (IEP) at the end of the second year. Although this is important because it shows that the accommodations that children required were documented and put in place to support the children’s unique learning needs and abilities, it is also important for children and families long term, because it provides parents with a continued way to advocate for their child each year. The Ontario Ministry of Education’s Individual Education Plan Resource Guide states “Principals are legally required to ensure that parents are consulted in the development of the IEP” (Ontario Ministry of Education, 2014). Parents will continue to be invited to contribute to the development of the IEP in the future, establishing a continued method for parent advocacy, support and management.

It would be beneficial to continue to engage with parents to understand the impact of the recommendations offered by the P4C OTs over the long term. On the year end service summary reports provided to parents, it was noted that the OTs offered suggestions for 17 different types of activities. Although the most frequently cited recommendations were specific to printing/cursive writing — 95% of the Year 1 reports and 95% of the year two reports addressed this concern — additional recommendations were made for environmental adaptations such as seating (63% of the year one reports; 52% of year two reports); tool use, organizational skills; gym; clothing, snack/lunch, and knapsack management, areas not typically addressed within the traditional non-P4C model. In Year 2, more reports focused on keyboarding and technology than in Year 1; 71% of year two reports versus 45% of year one reports addressed this. The percentage of reports with recommendations for attention/focus and environmental/sensory recommendations also increased in year two. It would be interesting to monitor this change and the subsequent impact for children and families, over the next several years.