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.
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.
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.