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Collaborative goal setting with and for children as part of therapeutic intervention
Disability and Rehabilitation
Abstract
Purpose:
This study explored collaborative goal setting with children, parents, and teachers, and children's reasons for their goals based on their perceived self-efficacy, using the Austrian-German Perceived Efficacy and Goal Setting System (AG-PEGS).
Method:
Thirty-eight children from age 5 to 10 years (referred to occupational therapists because of difficulties in performing everyday activities), their parents and teachers participated in this mixed methods study. Participants' goals were analyzed using descriptive statistics and content analysis. Data were grouped into thematic categories, and attributed to health factors according to the International Classification of Functioning, Disability, and Health-Children & Youth Version (ICF-CY).
Results:
Children's responses underlined the significance of self-efficacy and participation for a child's health and well-being. They gave priority to their independence, competence, and joy in meaningful everyday activities and indicated social motives such as belonging to and being accepted by others for their mainly participation-oriented goals. Parents' main concerns were related to school task performance, whereas teachers mainly chose body functions and school activities to be the focus of occupational therapy intervention.
Conclusions:
Exploring clients' priorities, the meanings they attributed to activities in daily life, and their underlying motives for goals should be part of therapeutic intervention. Children and their caregivers are valid and important sources for therapeutic goal setting. Basic human needs, e.g., for relatedness, competence (self-efficacy), autonomy, and meaningful personal orientation, should be considered when prioritizing goals for intervention. Implications for Rehabilitation Children are a valid and important source for therapeutic goal setting. Children's goals focused on activities and participation in all life areas, and half of the parents' goals on activities as relevant for productivity (followed by self-care and leisure), while teachers tended to prioritize goals at the body functions and structures level. The experience of their task performance affecting participation, and the basic needs for independence, relatedness (belonging to and being accepted by others), competence (self-efficacy), and joy through engagement in personally meaningful activities are main motives for children with developmental disabilities to choose their goals for intervention. A client-centred approach in working with children with developmental disabilities requires time and attention for exploring meaning-attributed activities for children and their proxies when collaboratively setting goals.
... 2,18 Additionally, child and caregiver perspectives on goals can differ considerably. 12,19 Therefore, it is advisable not to place sole emphasis on caregiver goals; children's voices should also be amplified. 20 Structured approaches can aid engagement in goal setting. ...
... 9,[61][62][63][64][65][66] Study inclusion criteria for children related to other developmental areas varied. The most common criterion was adequate cognition (n = 24 studies), including: children having average or higher cognition as measured on standardized testing; 40-42,46-48,63,65-77 no intellectual delay as per clinical or caregiver report; 78,79 cognition above the level of a 5-year-old; 19,52 cognition above the level of an 8-year-old; 58,59 the ability to make choices between two options; 19,[52][53][54] or the ability to formulate goals. 66,78 The second most common criterion was communication (n = 19 studies), with studies including: children having sufficient expressive and receptive language skills; 63,67-69 able to communicate verbally; 19,60,64,66 able to communicate or understand information at or above the level of a 5-year old; 12,53-56,80 demonstrate age-appropriate language skills on standardized testing; 73,76 have receptive language at a two-word level; 81 or have intentional communication. ...
... The most common criterion was adequate cognition (n = 24 studies), including: children having average or higher cognition as measured on standardized testing; 40-42,46-48,63,65-77 no intellectual delay as per clinical or caregiver report; 78,79 cognition above the level of a 5-year-old; 19,52 cognition above the level of an 8-year-old; 58,59 the ability to make choices between two options; 19,[52][53][54] or the ability to formulate goals. 66,78 The second most common criterion was communication (n = 19 studies), with studies including: children having sufficient expressive and receptive language skills; 63,67-69 able to communicate verbally; 19,60,64,66 able to communicate or understand information at or above the level of a 5-year old; 12,53-56,80 demonstrate age-appropriate language skills on standardized testing; 73,76 have receptive language at a two-word level; 81 or have intentional communication. 82 ...
Aim
To examine child‐led goal setting and evaluation tools and approaches for children with a disability or developmental delay.
Method
Six databases were searched for studies that included population (children aged less than 18 years with disability or developmental delay); construct (child‐led goal setting tool or approach); and context (developmental therapy or rehabilitation). The utility of tools and approaches across the goal setting and evaluation process was investigated using abductive content analysis.
Results
Fifty articles met the inclusion criteria. Three approaches and four tools for child‐led goal setting and evaluation were identified. No studies reported the clinimetric properties of tools specifically for child self‐respondents. Qualitative analysis revealed six distinct goal phases in which tools and approaches were used, which were synthesized into a new framework for child‐led goal setting and evaluation titled DECIDE: Direct children to goal setting; Elicit goal topics and priorities; Construct a goal statement; Indicate baseline goal performance; Develop an action plan to address the goal; and Evaluate goal progress after the intervention.
Interpretation
Children actively participated in goal setting and evaluation across six DECIDE goal phases. Further clinimetric information is required to support use of goal setting and evaluation tools with child self‐respondents. Future research should emphasize the development of multi‐phase goal setting tools and approaches for diverse populations of children.
... The included studies were published between 2000 and 2020 with 13 between 2015 and 2020 and the remaining six studies between 2000 and 2010. There were five studies from Australia (Branjerdporn et al., 2018;Galvin et al., 2010;Jenkin et al., 2020;Milgate, 2015), five from Canada (Greco et al., 2017;King et al., 2018King et al., , 2020Pritchard et al., 2020;Tam-Seto & Versnel, 2015), four from USA (Missiuna et al., 2006;Missiuna & Pollock, 2000;Palisano, 2006;Price & Miner, 2007), and one each from Austria (Costa et al., 2017), Ireland (O'Dea et al., 2021, Japan (Tomori et al., 2020), UK (Young et al., 2006) and Sweden (Vroland-Nordstrand et al., 2016). ...
... The included studies comprised quantitative, qualitative and mixed methods. Two studies used a mixed methods design, applying a survey and semi-structured interviews (Costa et al., 2017;King et al., 2018), one was an RCT (Vroland-Nordstrand et al., 2016), six used an observational design (Branjerdporn et al., 2018;Galvin et al., 2010;King et al., 2018King et al., , 2020Missiuna et al., 2006;Missiuna & Pollock, 2000), two were single case reports (Palisano, 2006;Price & Miner, 2007). The remaining 9 studies were qualitative and reported a wide range of qualitative data collection methods including observation Greco et al., 2017), interviews (Greco et al., 2017;Jenkin et al., 2020;Milgate, 2015;O'Dea et al., 2021;Pritchard et al., 2020;Tam-Seto & Versnel, 2015;Young et al., 2006) and focus group interviews (Tomori et al., 2020;Young et al., 2006). ...
... The observational studies applied various instruments: the Canadian Occupational Performance Measure (COPM) (Branjerdporn et al., 2018;Galvin et al., 2010;King et al., 2018), the Perceived Efficacy and Goal Setting System (PEGS) (Costa et al., 2017;Galvin et al., 2010;Missiuna et al., 2006;Missiuna & Pollock, 2000), the Pediatric Rehabilitation Intervention Measure of Engagement -Service Provider (PRIME-SP) and Goal Attainment Scaling (GAS) (King et al., 2018), all of them reporting descriptive statistics. Details of study characteristics are presented in Table 2. ...
Aims
The aim of this study was to investigate the extent, range and nature of research activity specifically reporting the inclusion of the voices of children or adolescents when therapists are setting therapy goals and implementing therapy.
Methods
We conducted a scoping review and searched the following electronic bibliographic databases: Pedro, SciELO, Google Scholar, MEDLINE, EMBASE, Web of Science and CINAHL. We included primary studies focusing on involvement of children and/or adolescents in goalsetting, decision-making or conduct of physical or occupational therapy. Results are presented descriptively and narratively.
Results
Nineteen studies were included presenting various instruments or strategies for involvement. We found sparse evidence that children and adolescents with disabilities were included in therapy goal setting using goal setting instruments, especially children under 5 years of age or with communicative or cognitive disabilities.
Conclusions
There are few studies reporting the way in which the voices of children or adolescents are heard in therapy. Further research is needed to develop new methods and studies with stronger designs are needed to determine the extent to which listening to children’s voices affects therapeutic outcomes.
... The characteristics of the fifteen included papers are presented in Table 1. Six of the studies were conducted in the United Kingdom [31,45,[49][50][51][52], five in Canada [33,34,44,53,54], one in Austria/ Italy [55], one in Brazil [56], one in Belgium [57], and one in New Zealand [58]. In total, data from one hundred and nine participants were included in the qualitative synthesis. ...
... In total, data from one hundred and nine participants were included in the qualitative synthesis. Nine papers had participants with a mean age ranging from 6.9 years to 11 years [33,34,45,49,[54][55][56][57][58]. Five papers had participants with a mean age range of 13 years to 14.9 years [31,[50][51][52][53] and one study included young adults aged 19-25 years who reflected upon their experiences as an adolescent [44]. ...
... Appraisal of the included papers highlighted a large variation in methodological quality across the studies as seen in Table 2. Ten studies presented the philosophical perspective on which the study was based and a methodological approach which was congruent with the perspective [31,34,44,51,52,[54][55][56][57][58]. However, the philosophical or theoretical perspective was not clearly represented in the remaining five papers [33,45,49,50,53]. ...
Background
To date services for children with Developmental Coordination Disorder (DCD) have not been informed by the perspective of children with DCD. This study aimed to synthesise the findings of discrete qualitative studies reporting the lived experiences views and preferences of children and young with DCD using a meta-ethnographic approach to develop new conceptual understandings.
Methods
A systematic search of ten databases; Academic Search Complete, AMED, CINAHL, ERIC, MEDLINE, PsychArticles, PsychInfo, EMBASE, SPORTDiscus, and Web of Science, was conducted between March and April 2019, and updated in early June 2020. Meta-ethnography, following the method described by Noblit and Hare was used to synthesise included studies. The Joanna Briggs Institute Checklist was used to appraise all included papers. PROSPERO registration number CRD42019129178.
Results
Fifteen studies met the inclusion criteria. Meta-ethnographic synthesis produced three themes; a) ‘It’s harder than it should be’: Navigating daily activities b) Fitting in, and c) ‘So what? I drop things’: Strategies and supports to mitigate challenges. Children with DCD describe a mismatch between their abilities and performance norms for daily activities that led to a cascade of negative consequences including negative self-appraisal, bullying and exclusion. In the face of these difficulties children described creative and successful strategies they enacted and supports they accessed including; assistance from others (parents, friends and teachers), focusing on their strengths and talents, accepting and embracing their difference, adopting a “just do it” attitude, setting personal goals, self-exclusion from some social activities, using humour or sarcasm, viewing performance expectations as a social construct, and enjoying friendships as a forum for fun, acceptance and protection against exclusion.
Conclusion
Service provision for children and young people with DCD should address the social and attitudinal environments, focus on friendship and social inclusion and address stigma-based bullying particularly within the school environment. Furthermore, practitioners should identify and foster children’s own strategies for navigating daily life activities with DCD. The identified themes resonate with contemporary disability theory and the International Classification of Functioning. The social and attitudinal environmental context of children and young people with DCD profoundly influences their experiences. Future intervention development and service provision for children and young people with DCD should consider opportunities to address social and attitudinal environmental factors.
... To achieve value-based care, we need to know how children value their activities. Previous literature that studied the perspective of children on their everyday life activities focused specifically on leisure or play and not on everyday activities, even though children want to participate in all parts of everyday life (Costa et al. 2017). For example, Powrie et al. (2015) conducted a systematic evidence synthesis of the meaning of leisure for children and young people with physical disabilities. ...
... Unfortunately, they included more literature about children with physical disabilitiesthanchildrenwithmultipledisabilities.Theyalsoincludedstudiesfromboththe children's and parents' perspectives. While Costa et al. (2017) mentioned that parents' main concerns are related to school task performance, children assign priority to their independence, competence and joy in meaningful everyday activities. Nonetheless, we are aware of one study that focused on participation concepts in children and adults with multiple disabilities (Eriksson and Granlund 2004) that may be comparable to our study population. ...
... Parents, teachers and children do not mention the same goals for occupational therapy intervention. Costa et al. (2017) compared these goals and showed that whereas parents and teachers are mainly focused on the occupational performance area productivity, children mention goals in all three areas: productivity, personal maintenance and leisure. This finding fits within the large scope of activities performed by children with a mitochondrial disorder, which was already known (Lindenschot et al. 2018) and expanded in the current study. ...
Engagement for children with mitochondrial disorder is not self evident. To develop personalised and value-based care for this population, we require knowledge about their perspectives and values with regards to everyday activities. To gain insight into children’s perspective on activities by (1) asking what activities they perform, (2) how they perform them, (3) how they experience these activities and (4) their wants and needs. Seven semi-structured content analyzed interviews. The interviews identified a variety of activities. The overarching themes on wants/needs were ‘I want to meet up with others whenever I want to’,‘I want to be able to…’, ‘I don’t want to…’ and ‘Dream’. These themes were interconnected to thirteen other themes that captured how children experience and perform activities, for example, ‘Because I can decide by myself’, ‘Because I can do it on my own’ and ‘It is more fun to do things with other people’. The activities children performed represent regular childhood activities. The identified themes fit with the three aspects of the self-determination theory: autonomy, competence and relatedness. This study exposed the broad child perspective and should provide better understanding of children’s choices in their participation in everyday activities.
... Measures of participation involving attendance and involvement can provide a picture of the actual daily life performance of children, and may facilitate the children's expression of their own wishes for participation based on an individual child's strengths and life experiences in their natural contexts. The outcomes of assessing participation may expand knowledge on the different views on life of child and proxy-respondents [20,[23][24][25]. A recent review of participation measures shows that few measures provide information on both attendance and involvement and even fewer are designed as self-rating measures where children with disabilities can self-rate their perceptions of participation [26]. ...
... Emerging evidence also suggests that children with disabilities and their caregivers value different things. For example, a study has suggested the incongruence of children's and their caregivers' goals for school-based therapy services [25]. Children wanted to perform better in various life skills including self-care, school, and leisure, and parents focused on school task performance, while teachers tended to set goals related to motor and cognitive skills [25]. ...
... For example, a study has suggested the incongruence of children's and their caregivers' goals for school-based therapy services [25]. Children wanted to perform better in various life skills including self-care, school, and leisure, and parents focused on school task performance, while teachers tended to set goals related to motor and cognitive skills [25]. Even when the child and parent selected the same activity, they might have different rationale. ...
Participation has significant impact on children’s health and well-being. Knowledge is limited on how children with disabilities perceive their participation and whether their perceptions differ from their parents. This pilot study aimed to explore whether self-reported frequency of participation and prioritized activities differ between children with disabilities and their parents. Thirty children with disabilities eligible for special education in elementary school and their parents were included. Each of them were interviewed with the Chinese version of Picture My Participation (PMP), separately, to identify the child’s participation frequency in 21 activities at home, school, and community, desire-to-change activities, and the level of involvement in these activities. The results indicated that children’s ratings of participation frequency were significantly lower than parents’ ratings in home activities but not in school and community activities, as analyzed by the Wilcoxon Signed Ranked test. Nineteen (63%) child–parent pairs had selected entirely different items as their desire-to-change activities. Children selected the activities that they were somewhat to very involved in; while parents selected the activities they thought their children were less involved in. Our findings suggest that children with disabilities had unique views on life and this should be supported in their health care and individualized education plans.
... Engaging the child and parents in the goal determination process appears to lead to better results in therapy (MISSIUNA et al., 2006;VROLAND-NORDSTRAND et al., 2016). Research has shown that both children and parents are able to set goals for intervention (MISSIUNA et al., 2006;MISSIUNA;POLLOCK, 2000;DUNFORD et al., 2005;COSTA;BRAUCHLE;KENNEDY-BEHR, 2016) and that goals set by children can be trusted and may be prioritized to improve their involvement in therapy (VROLAND-NORDSTRAND et al., 2016). ...
... Engaging the child and parents in the goal determination process appears to lead to better results in therapy (MISSIUNA et al., 2006;VROLAND-NORDSTRAND et al., 2016). Research has shown that both children and parents are able to set goals for intervention (MISSIUNA et al., 2006;MISSIUNA;POLLOCK, 2000;DUNFORD et al., 2005;COSTA;BRAUCHLE;KENNEDY-BEHR, 2016) and that goals set by children can be trusted and may be prioritized to improve their involvement in therapy (VROLAND-NORDSTRAND et al., 2016). ...
... No significant differences were found between the perceptions of caregivers, teachers and children based on the total scores on the PEGS, which supports the notion that children are capable of self-evaluation (STURGESS; RODGER; OZANNE, 2002;VROLAND-NORDSTRAND et al., 2016;COSTA;BRAUCHLE;KENNEDY-BEHR, 2016). The Kappa index (Table 3), however, indicated low agreement between children, parents and teachers for most individual items. ...
Introduction:
The engagement in client-centered practice requires instrumentation that allows the participation of the child and family in the definition of treatment goals.
Objective:
The aim of the present study was to pilot a translated version of the Perceived Efficacy and Goal Setting System (PEGS) and determine its validity and reliability for clinical use with Brazilian children.
Method:
Eighty children six to nine years old (40 public school children and 40 private school children), as well as their caregivers and teachers, completed the PEGS.
Results:
The children understood the pictures and interview procedures. Caregivers and teachers reported no difficulties in understanding the questionnaires. Gender, age, and type of school had no significant influence over the children’s scores. Cultural influence on the response to two items was identified but could be resolved with extra explanation. Stability of the goals was supported and the children, caregivers, and teachers appear to share views regarding the overall abilities of the children.
Conclusion:
The PEGS has potential for clinical use with Brazilian children, but clinicians should be aware that some items require further instructions. The usefulness of the PEGS as a tool to promote client-centered practice among Brazilian occupational therapists should be investigated.
... A lack of suitable opportunities, resources, and support hampers children's and young people's developing capacity to take care of their health, engage in their communities, and exercise their citizenship (Gorter and Gibson, 2015). Although participation-and evidence-based practices underline collaboration (Anaby et al., 2018;Palisano et al., 2012) and identification of a child's perspectives and child-determined goals (Costa et al., 2017), rehabilitation services continue to be criticised for being professional-led (Piškur et al., 2016), adult-centred (Teleman et al., 2021), and not focussing on realising children's agency (Bekken, 2014;Coyne et al., 2016). ...
... Consistent with previous studies (Costa et al., 2017;Jeglinsky et al., 2012;Teleman et al., 2021), this study found that children's active role in family-professional collaboration is not self-evident or systematic in rehabilitation practices. The findings show the need to create a safe space for the child's involvement in planning rehabilitation because they need protection from its problematic issues (Teleman et al., 2021) and special attention to promote participation (Coyne and Harder 2011;Davies et al., 2023). ...
Practices for promoting a child's best interests in rehabilitation are not sufficiently understood. This study describes the practices from the perspectives of professionals and parents of children with disabilities. We conducted 11 interviews: 5 in focus groups with professionals (n = 27 [69%]), 3 with parents (n = 9 [23%]), and 3 individual interviews of paediatric neurologists (n = 3 [8%]). We used a qualitative approach, which included inductive content analysis, to examine the transcribed interview data. The practices for promoting a child's best interests consisted of collective framing of child-specific rehabilitation, fostering a fulfilling daily life for the child, and ensuring appropriate rehabilitation. This was enhanced by using child-specific practices and comprehensively understanding the child's rehabilitation in everyday life but was hindered by the absence of an established process and guidelines. The results highlighted substantial challenges in collaboration aligned with the child's best interests, enabling the child's active participation, and addressing the individual needs of the child and family. Promoting best interests through family-professional partnerships by using a systemic and ecological approach could guide the rehabilitation process and ensure the child's right to participate.
... Collaborative goal setting in Pritchard's et al., study (2020) with the child actively engaging in the process, enabled the identification of functional and motivational goals [36]. Costa et al., (2017) presented that in setting rehabilitation goals, adults focused more on the children's competencies and abilities instead of enjoyable social participation that was prioritized by the children themselves [37]. Sipari et al. [38] found that children value agreement and that agreed things were taken care of. ...
... Collaborative goal setting in Pritchard's et al., study (2020) with the child actively engaging in the process, enabled the identification of functional and motivational goals [36]. Costa et al., (2017) presented that in setting rehabilitation goals, adults focused more on the children's competencies and abilities instead of enjoyable social participation that was prioritized by the children themselves [37]. Sipari et al. [38] found that children value agreement and that agreed things were taken care of. ...
Purpose: Collaboration between parents and professionals is essential to enable participation of children with disabilities. Participation is a widely researched topic in pediatric rehabilitation, and evidence for it providing opportunities for involvement and a sense of belonging in community and in larger society exists. There are, however, less research results on how collaboration builds participation pertaining to involvement in life situations. In collaboration with parents, therapists and teachers, the aim of the study was to describe factors that (a) promote and (b) prevent participation in life situations for school-aged children with disabilities, working towards participation in adulthood. Methods: The study applied a qualitative research design. The data was collected during the 2015–2016 academic year with five focus-group interviews by sampling procedure. The study involved five parents of children with disabilities, three therapists and two teachers. The research data was analyzed by inductive content analysis. Results: The results identified thirteen factors that promote child participation, with an emphasis on taking the child’s individuality into account. There were three barriers, which focused on attitudes or technical issues. Conclusions: The results suggest that collaboration on child-related factors has been well identified and implemented, but collaboration on enabling environmental factors needs to be developed. The results can be utilized to design what adults’ collaboration should focus on in promoting child participation.
... Based on previous literature (Costa et al., 2016;Harding et al., 2009;Huus et al., 2015;Nelson et al., 2017), we hypothesised that (a) there would be a discrepancy in the perceptions of attendance of everyday activities between the child with ID and their caregiver; (b) everyday activities that children with ID considered important would differ from the perceptions of their caregivers in that children would consider activities related to playing and social interaction as most important, while primary caregivers would consider activities related to skills most important. ...
... The children's selection of activities from all items on the PmP may suggest that they have a range of interests that they perceive as important. This correlates with previous research, which indicated that while caregivers may be valid proxies for their children, the perceptions of children with disability may offer different insights than are deduced from adult perceptions (Costa et al., 2016;Harding et al., 2009;Huus et al., 2015;Nelson et al., 2017). Adults fulfil a primary role as caregivers in guiding and protecting the child. ...
n a low-and middle-income country (LMIC) such as South Africa, not much is known about how children with intellectual disabilities (ID) participate in everyday activities, as no studies to date have compared their participation to peers without ID from the same background. Using a newly developed, contextually valid measure of participation, Picture my Participation (PmP), 106 children with (73) and without ID (33), rated their frequency of participation in activities of daily living. Previous international research has established that children with ID tend to participate less frequently than children without ID in everyday activities outside of the school setting. However, much of this research is based on proxy ratings from caregivers rather than children with ID themselves. There is a growing body of evidence that suggests children with disabilities have uniquely different views of their own participation than their caregivers. The existing research evidence is also delimited to studies conducted predominantly in high income contexts (HICSs). Since it is universally acknowledged that participation patterns are affected by the environment, it is important to evaluate the generalizability of the current evidence to LMICs. The current study found that there were many similar patterns of participation between the two groups although significant differences were noted in social, community, leisure and self-care activities. We compare these results to findings from studies conducted in HICs and find that there are similarities but also differences across contexts. This study highlights the importance of gaining a child’s perspective of participation and understanding how intellectual disability can affect participation relative to peers without ID in LMICS.
... Based on previous literature (Costa et al., 2016;Harding et al., 2009;Huus et al., 2015;Nelson et al., 2017), we hypothesised that (a) there would be a discrepancy in the perceptions of attendance of everyday activities between the child with ID and their caregiver; (b) everyday activities that children with ID considered important would differ from the perceptions of their caregivers in that children would consider activities related to playing and social interaction as most important, while primary caregivers would consider activities related to skills most important. ...
... The children's selection of activities from all items on the PmP may suggest that they have a range of interests that they perceive as important. This correlates with previous research, which indicated that while caregivers may be valid proxies for their children, the perceptions of children with disability may offer different insights than are deduced from adult perceptions (Costa et al., 2016;Harding et al., 2009;Huus et al., 2015;Nelson et al., 2017). Adults fulfil a primary role as caregivers in guiding and protecting the child. ...
Background
Participation of children with ID it is argued must be understood in relation to the fit with the environment. Since caregivers are a vital factor within the close environment of a child with intellectual disability, their perceptions are unequivocally important.
Aims
The main aim of this study is to describe the self-reported participation of children with ID and the perceptions of their primary caregivers. Both frequency of attendance and perceived importance of activity was measured with self-reported and proxy-reports.
Methods & Procedures: A custom developed Picture my Participation (PmP) survey was utilised in an interview format with children with intellectual disability whilst their primary caregivers completed the survey independently.
Results
Overall, the perceptions of children with intellectual disabilities and of primary caregivers showed similarities regarding attendance and activities considered important. On group level, both children and primary caregivers perceived the child to have a high level of attendance ofFormal learning in school, Family mealtime, Interacting with family and Celebrations. An overall poor agreement in perceived frequency of attendance was found. However, in child-primary cargiver-dyads poor agreement in perceived frequency of attendance was found.
Conclusions
While primary caregivers and children’s ratings of attendance and selection of the most important activities appeared somewhat similar, there was a noted difference, in that primary caregivers’ were uniform in their selection, whilst there was a diversity in the selection of activities amongst children.
... To set child-determined goals for participation interventions, children need to respond to questions about their own participation [23][24][25]. Still, few studies capture children's opinions directly, and the use of parents or therapists as proxies is common [24,26]. ...
... To set child-determined goals for participation interventions, children need to respond to questions about their own participation [23][24][25]. Still, few studies capture children's opinions directly, and the use of parents or therapists as proxies is common [24,26]. A means to gather information about children's patterns of participation is to use selfratings [27,28]. ...
The aim is to evaluate the feasibility of an intervention model with a client-centered goal-directed approach with the aim to enhance the child’s participation in leisure activities, self-efficacy, and activity performance. A pilot intervention using a client-centered goal-directed approach and a single-subject design was performed. Two Swedish boys with neuropsychiatric diagnosis aged 12 and 14 years old were included, and 3 leisure activity goals were identified. The intervention was carried out over 8 weeks and took place in the adolescent’s everyday environment and at the pediatric rehabilitation center. The goal attainment of participation goals (GAS), the perceived performance ability according to the Canadian Occupational Performance Measure (COPM), the self-efficacy, and the participants’ satisfaction were used to study the effect. The participants succeeded in attaining their leisure goals as specified by the GAS by achieving +2 on one goal and +1 on the other two goals. They estimated higher performance ability and self-efficacy in their goal performance. Participants, parents, and therapists were overall satisfied and found the intervention to be applicable and helpful in optimizing leisure participation. The intervention model with a client-centered goal-directed approach in which participants define their own leisure activity goals appears to be effective in increasing participation in leisure activities.
... 15 Costa, et al, also found that when children were involved in their own goal-setting, 78.6% of goals were set at the activity and participation level rather than at the body function and structure level. 16 The inclusion of participation in IEP goals promotes meaningful, student-centered goals and may increase the likelihood of goal attainment. 16,17 Although participatory goals have been recommended as best practice in school-based therapies, discrepancies often exist between ideal and actual clinical practice. ...
... 16 The inclusion of participation in IEP goals promotes meaningful, student-centered goals and may increase the likelihood of goal attainment. 16,17 Although participatory goals have been recommended as best practice in school-based therapies, discrepancies often exist between ideal and actual clinical practice. 18 Wynarczuk et al, found that 96% of school-based Physical Therapists, surveyed about their goal development practices, reported they "always or most of the time" write goals focused on participation restrictions. ...
Aims: To explore the body of evidence for the inclusion of contextual participation (International Classification of Functioning, Disability, and Health-ICF) in the Physical and Occupational Therapy goals of students with disabilities with Individualized Education Programs(IEP) in the US. Participation supports the ability of individuals with disabilities to reach their full potential and is a primary entrance point and outcome of interventions, but the level of uptake in school-based practice is unknown.
Methods: Comprehensive literature searches conducted in PubMed, CINAHL, Cochrane Library, OpenGrey,and Web of Science for literature in any language. Inclusion criteria: Papers published from 2001 examining Physical and Occupational Therapy IEP goals for inclusion of ICF-contextual participation.
Results: 3,567 articles were found, 60 screened by full-text. Three met inclusion criteria, representing the participation of 226 physical and occupational therapists and 632 IEP goals for students in kindergarten through 12th grade across 29 states.
Conclusions: A gap in the evidence exists with important implications for students with disabilities receiving Physical and Occupational Therapy in school-based settings. Little research examines the uptake of participation-focused goal development in school-based settings. Many goals continue to address impairments or capacity but not participation. Factors influencing the focus of therapeutic IEP goals require further study.
Keywords: Physical, Occupational, Therapy, Goals, Individual Education Plan, ICF
... An exploratory study by Smart et al. [15] on life skill interventions for youth with physical disabilities proposed that SDT could provide one framework for understanding in-session engagement strategies used during goal setting and goal review. Research on collaborative goal setting with children receiving occupational therapy to work on daily activities, suggested that attending to the SDT basic psychological needs for relatedness (feeling accepted by others), competence (self-efficacy), and autonomy (a sense of internal control participation in personally meaningful activities) should be prioritised when goal setting [16]. This promising line of research is innovative in the field of paediatric occupational therapy. ...
... Observing exactly what occupational therapists do in therapy, and reflecting with the therapist about what they did and why, may offer more insights into what engagement is and how it is facilitated. There is some research about engaging children in therapeutic interactive video home programs and [8] collaborative goal setting in occupational therapy [16]. What remains is to better understand the nature of, and strategies that facilitate engagement for children with a range of disabilities, involved in a range of interventions in a variety of occupational therapy contexts. ...
Purpose: This study aimed to understand parent engagement and disengagement in the delivery of occupational therapy to their children.
Methods: This study used a qualitative interpretive description methodology. Focus groups and individual interviews were employed. Thirty-two occupational therapists participated in focusgroups or one-on-one interviews. Thematic analysis was used to analyse the data.
Results: Thematic analysis of the data revealed two overarching themes which influenced parent engagement and disengagement in therapy: (1) Parent-therapist relationship and; (2) Therapist responsiveness. Within these two themes: parent feelings; time and timing of therapy; levels of engagement and factors influencing parent engagement were evident.
Conclusions: Findings contribute to understanding parent engagement and disengagement in therapy. The findings extend current models of therapeutic engagement in occupational therapy informed by self-determination theory (SDT). Autonomy-, relatedness- and competence-supportive SDT strategies to enhance parent engagement in therapy are described.
• Implications for Rehabilitation
• Occupational therapists reported that parents experience a range of feelings when engaged and disengaged in therapy. These feelings related to hopelessness, having confidence in the therapist and feeling supported, validated and empowered.
• Parent engagement and disengagement in therapy was described by occupational therapists as occurring at different levels: when it works well (engaged); engaged in the idea of therapy but not engaged in the doing of therapy (middle ground engagement); and when it doesn’t work well (disengagement).
• Occupational therapists reported the importance of being aware of how the factor of time and family, service and therapist characteristics can variously impact parent engagement in therapy.
• Occupational therapists focus on the parent-therapist relationship and being responsive to parent needs and feelings when engaging parents in therapy.
• Occupational therapists can draw on principles from self-determination theory to guide them regarding the selection of strategies to engage parents in therapy.
... Resilient parents aspire to enhance their parental competences through active involvement in their child's therapy. Research reveals parents' needs to participate in the therapeutic process to learn more about effective developmental stimulation and to support basic human needs such as autonomy or self-determination [48,49]. The carer's personal competence to cope and tolerance of negative emotions (a subscale from Resilience Scale 25) were found to correlate with the cognitive (knowledge) and affective (relationships and feelings) aspects. ...
... The overarching aim of this research was to produce a group program to be provided over telehealth. Adaptations to the SELFI curriculum included expanding curriculum to be more advanced (including the addition of a session related to online romance) and adding evidence-based strategies, such as visual supports to support content retention (Shane et al., 2012) and collaborative goal setting to support individualized needs (Costa et al., 2017). Use of peer mentors, another evidence-based strategy (Watkins et al., 2015), was added to the intervention to provide participants with more personalized support within the revised group format. ...
Many autistic adults report preference for computer-mediated communication and social media use. Despite many benefits to online socialization, there are many challenges including anxiety and cyber-victimization. To date, support is limited related to helping autistic adults with safe and effective internet use. The purpose of this study was to evaluate the feasibility, acceptability, and preliminary efficacy of the novel SELFI program. This pilot study utilized a randomized controlled trial design. A total of 25 autistic adults enrolled in the study and were randomized to the nine-week SELFI program or a waitlist control condition. Feasibility assessed enrollment, attrition, and fidelity of delivery. Acceptability examined attendance and feedback from participants and peer mentors. Efficacy evaluated change in Facebook activity, social media utility/anxiety, and individualized goals. Regarding feasibility, the recruitment goal was met within one month, there was limited attrition, and therapists delivered the program with high fidelity. Participants attended a majority of scheduled sessions and feedback from participants reflected high levels of agreement with several facets of the program. Compared to the control group, more participants assigned to the SELFI condition were perceived by autistic and non-autistic raters as having improved Facebook activity. SELFI participants also reported reduced difficulty meeting their individualized goal. Findings support the piloted SELFI program as feasible and acceptable with signals of preliminary efficacy. This study establishes an exciting foundation regarding an innovative social media skills program, however more research is necessary.
... On the contrary, primary caregivers who fulfill a primary role in guiding and protecting the child may prioritize selecting activities deemed to be beneficial or important for adult life. This result is in line with a previous study, which suggested that while caregivers may be valid proxies for their children, children with long-term health conditions may exhibit different views regarding their perceived participation (33,34). Future studies can explore children's perceptions of the facilitators and barriers of the three most important activities to gain a more comprehensive understanding of participation. ...
Background:
There is limited knowledge regarding the perceived participation of children with long-term health conditions in everyday activities. Children may have perceptions that differ from those of their primary caregivers. It is unclear whether children and caregivers rate their participation in everyday situations in the same way.
Objectives:
We aimed to explore the level of agreement pertaining to perceived participation (attendance and involvement) and examine whether differences exist in the rank order of activities selected as the three most important between reports from children with long-term health conditions and their primary caregivers.
Methods:
The simplified Chinese version of the Picture My Participation (PMP-C; Simplified) was used in an interview with children with long-term health conditions; meanwhile, their primary caregivers finished the questionnaire independently. Data were analyzed using Wilcoxon tests, weighted kappa values, and Spearman's rank order correlation.
Results:
Children with long-term health conditions reported significantly lower attendance scores for six activity items (p < 0.05) and higher involvement scores for two activity items (p < 0.05) than their primary caregivers did. An overall slight to fair agreement in perceived participation was found at the child-caregiver dyad level, though differences in dyads were observed. A strong correlation was identified between the rank order of the most important activities for both groups (r = 0.81).
Conclusions:
Differences may exist between the perceived participation of children with long-term health conditions, as reported by primary caregivers and the children themselves. The findings highlight that children with long-term health conditions exhibit unique views with respect to their perceived participation and have to be asked regarding their perceptions themselves.
... Collaboration plays a critical role in the goal-setting process, as supported by a substantial body of literature [1][2][3][4]. Collaborative goal setting is a process through which healthcare professionals and patients mutually agree upon health-related goals, which allows for personalized care that aligns with patient's goals, values, and available resources [5]. Numerous studies have shown that engaging patients in goal-setting improves their confidence, motivation, and satisfaction with rehabilitation [6][7][8][9]. ...
Background:
Collaboration is an important concept in goal-setting in occupational therapy. However, this concept is not stable due to various definitions. The purpose of this study was to clarify the concept of collaboration in occupational therapy.
Method:
A scoping review was used to search for all articles related to occupational therapy and collaboration. PubMed, Web of Science, CINAHL, and OT Seeker searches were conducted using predetermined keywords. Three examiners independently reviewed and assessed the quality of each study using Walker and Avant's concept analysis method.
Results:
Results of the database searches yielded 1873 studies, 585 of which were deemed eligible to include in this review. Results showed five attributes ("active participation for the common objective", "existence of something to share", "matured communication and interaction", "relationship founded on the respect and trust" and "complementing each other") and two antecedents and several consequences.
Conclusions:
Our findings may contribute to collaborative goal-setting and occupational therapy.
... Since participation as a complex concept cannot easily be measured by a single instrument, the use of a combination of instruments which are sensitive to detecting minimal clinically significant change is recommended [97,98]. Additionally, only three studies included child-report outcomes even though studies suggest that children from about five years of age can make reliable self-ratings if appropriate methods are used and identify relevant goals for intervention [99,100]. ...
Background
There is a lack of evidence-based knowledge in paediatric occupational therapy about the effectiveness of interventions using daily activities as a treatment modality in improving children’s participation.
Objective
This study aimed to evaluate the effectiveness of occupation-based and occupation-focused interventions in improving participation in everyday occupations for young children with a disability.
Material and methods
A systematic review based on Joanna Briggs Institute methodology and critical appraisal tools was conducted. Six databases were searched for quantitative intervention studies aimed at improving participation in everyday occupations of young children with a disability through the use of everyday occupation.
Results
The search yielded 3732 records, of which 13 studies met inclusion criteria. Ten studies met methodological quality criteria and were included in the synthesis, five randomised controlled trials and five quasi-experimental studies, involving a total of 424 children with a mean age of 6.5 years. The studies were classified into cognitive (n = 5), context-focussed (n = 2) and playgroup interventions (n = 3). Study quality ranged from low to moderate, only one study was rated high quality.
Conclusions and significance
Occupation-based and occupation-focused interventions may have a positive effect on participation in everyday occupations for young children with a disability, but study design, risk of bias and insufficient reporting limit confidence in the body of evidence.
... Franklin and Sloper [42] advocate that the child's participation in planning is a developing process that needs careful attention to child-centered practices and attitudes. Creative methods such as drawing and photographing [43] and adapting the Collaborative Process for Action Plans so that it is meaningful for the child have been useful for understanding children's views and engaging children as partners in the process [44]. In the LOOK-project, the CMAP (Child's Meaningful Activities and Participation) was developed to enable the child, with the help from an adult, to describe activities and participation that are important in everyday life with an application using photographs, videos, texts, recordings, and drawings [45]. ...
Content validity and clinical utility of the Collaborative Process for Action Plans to Achieve Children’s Participation Goals were evaluated. The collaborative process is designed to assess child, family, and environment strengths and areas for improvement specific to a child’s participation goal and identify intervention strategies and the person(s) responsible for each strategy. Twelve pediatric therapists participated in one of two Nominal Group Consensus Process. Following discussion, therapists rated the importance of child, family, and environment attributes, clarity of wording, and the usefulness of the collaborative process. Ratings for 91% (first group consensus) and 100% (second group consensus) of the statements met the criterion for consensus, supporting content validity. Ten parent/child/therapist teams evaluated clinical utility. Written responses to open-ended questions were coded using inductive content analysis. Parents and therapists indicated that the collaborative process promotes engagement, the goal is considered from many viewpoints, and there is a joint commitment to the action plan. Limitations included time to complete, the need for preparation and more guidance, and unfamiliar expressions. Familiarity with collaborative, solution focused processes and participation interventions are considerations for use in practice. Research is recommended in which the action plan is implemented, progressed, and achievement of participation goals are evaluated.
... In this respect, children's opinions in their own life experiences have been under investigated [5]. Emerging research suggests that children with disabilities and their caregivers value different things [6][7][8][9], supporting the need to hear children's voices. An appropriate instrument with a structured procedure may help engage children with disabilities in expressing their life experiences. ...
Background
Picture My Participation (PmP) is a picture-supported child-report instrument of participation of children with disabilities.
Aims
This study described the development of a mobile application of the PmP Traditional Chinese version (PmP-C) and evaluated its usability.
Methods
The PmP-C App includes features that allow the input of a child’s demographics, identification of frequency and involvement of 22 culturally appropriate activities, selection of the three most important activities and the specification of the environmental facilitators and barriers. The usability test was conducted with 10 healthcare workers, who interviewed 10 children with disabilities aged 6–12 years. The healthcare workers completed a usability questionnaire and were asked to provide feedback on the ease of use, learning, satisfaction and perceived usefulness.
Results
The mean score for the usability questionnaire ranged from 2.7 to 4.6 out of 5.0. The feedback indicated that the interface was simple to operate by the healthcare workers and was attractive and motivating to children. Improvements of layout design, operation instructions and technical problems were recommended, which contributed to the app program optimization.
Conclusions
The PmP-C App provides a practical tool with initial support for usability to enable active engagement and communication of children with disabilities with healthcare providers.
... However, in most studies the COPM is administered with the parents of the children with various diagnoses, rather than with the children themselves Ferre et al., 2017;Ghorbani et al., 2017;Hahn-Markowitz et al., 2017;Morgan et al., 2016;Preston et al., 2016). Several studies show that parents identify different issues for their children than the children do for themselves (Costa et al., 2017;Vroland-Nordstrand & Krumlinde-Sundholm, 2012) and that children differ in their view from their parents on enabling participation (Peeters et al., 2014). In order to enable the participation of children with disabilities and other special needs, it is important to collect their own wishes for improvement with the COPM and use these for their own goal setting. ...
Aims:
The Canadian Occupational Performance Measure (COPM) can be used to support children to clarify their needs themselves. However, for pediatric occupational therapists it is not sufficiently clear how to effectively use the COPM with children from 8 years of age.This study aimed to formulate specific instructions for using the COPM with children themselves, based on the experience of children, parents, and occupational therapists. In addition, professional consensus on the instructions was reached.
Methods:
A multi-stage approach was used to develop the instructions. Triangulation of methods was used to gather knowledge of how the COPM with children themselves is performed in daily practice: interviews with 23 children, questionnaires completed by 30 parents, interviews with 13 therapists, and 10 video recordings of COPM administration. Specific instructions were derived from this knowledge and consensus for these instructions was reached by Delphi method.
Results:
The data were analyzed and resulted in 40 specific instructions. Consensus of at least 80% amongst 10 occupational therapists, who regularly use the COPM with children, was achieved on each instruction.
Conclusion:
There is consensus on 40 specific instructions for administering the COPM with children. Following these instructions might help children to formulate their own goals for intervention.
... In parent-involved interventions, goals may involve parent behaviors such as parents demonstrating fidelity with delivering specific intervention strategies and may require families to engage in home practice activities (Magaña et al., 2017;Carter et al., 2011;Chlebowski et al., 2018;Peredo et al., 2018). Goal setting should be a collaborative process between persons involved in the intervention (see Brewer et al, 2014;Costa et al 2017). Cultural factors may arise in regard to setting goals and communicating expectations about them; for example, Latinx parents participating in AIMHI noted the need for therapists to support parents by creating brief home practice assignments, which are set up in ways that enable families to be successful in reaching the goal targets (Chlebowski et al., 2018). ...
Background
Parent involvement in interventions for children with Autism Spectrum Disorder (ASD) provides parents with education about ASD diagnosis and treatment, improves parent-child interactions, and offers access to cost-effective resources. The Latinx population represents the fastest growing minority population in the United States and a growing percentage of children seeking ASD intervention services.
Aims
Identify factors that impact Latinx parent involvement in interventions for children with ASD as an example of cultural considerations for diverse families and communities.
Methods and procedures
In this conceptual overview, we synthesize literature on cultural considerations for intervention design/adaptation for Latinx families and parent involvement in interventions for children with ASD through the lens of the Ecological Validity Model.
Outcomes and results
Frameworks such as the Ecological Validity Model can be used when creating or adapting interventions for specific cultural groups. Parent-involved interventions for children with ASD in the Latinx community should consider language of intervention delivery, family make-up, community support, disability knowledge of the family, the therapeutic alliance, and methods of implementation.
Conclusions and implications
Incorporating cultural components into parent-involved interventions will best support intervention implementation and dissemination in diverse communities. Research is needed into the process and outcomes of intervention programs in order to increase understanding of how specific cultural dimensions impact participation in and efficacy of parent-involved interventions for Latinx families of children with ASD.
... According to this study's findings, the child-specific tools, such as the new CMAP Book, can help the child, family and professionals to build partnership that is based on shared understanding of the child's meaningful participation, individual needs, wishes and aspirations in her/his daily life. Costa et al. [32] emphasise that the child's possibilities for feelings of relatedness, competence, autonomy, and meaningful personal orientation need to be identified together with the child and family in order to establish meaningful goals for rehabilitation. The use of CMAP Book support family and professionals to create a joint understanding in multidisciplinary rehabilitation planning and goal setting resulting in a coherent and common rehabilitation plan with meaningful goals. ...
Purpose
The purpose of the co-development project was to create a tool that enhances children’s active participation and agency in rehabilitation and in everyday life.
Materials and methods
Action research was the methodological approach. Participants in the different phases of the process (2015–2017) were children with disabilities, parents and rehabilitation professionals. The co-development process included: (1) designing the tool’s first version, (2) piloting the tool, (3) evaluating the tool by collecting feedback and reflection, (4) generating the tool’s final version.
Results
Through the co-development process, an accommodating and digital tool called the CMAP Book–a description of the child’s meaningful activities and participation–was developed. The CMAP Book is used with an electronic app enabling the identification and description of what is meaningful in daily life from the child’s perspective with videos, photos, pictures, recording and writing. The tool enables the child, family and professionals to prepare and build collaboration in rehabilitation with flexibility according to child and family needs.
Conclusions
Use of the CMAP Book promotes the active involvement of the child and parents in designing the rehabilitation process in daily life in partnership with professionals. The stakeholder involvement in the co-development facilitated meaningful results and a concrete tool for rehabilitation.
•
IMPLICATIONS FOR REHABILITATION
• The CMAP book is a new tool that enhances the child’s active participation and agency in the rehabilitation process based on meaningful activities in everyday life expressed by the child.
• Identifying and utilising meaningful issues in the child’s daily life through collaboration increases the child’s commitment and motivation, and thus may enhance the benefits and effects of rehabilitation.
• Through co-development, the child and his/her family can be active and equal partners not only in development projects but also in the rehabilitation process.
• In the future, child-specific practices and policies should be developed to promote participatory co-research between families and clinicians linked to the daily lives of families with children.
... Striving to develop a supportive peer environment can also serve to increase cooperative skills and better engage peers who might not typically interact. Social acceptance is a basic need (Costa et al., 2017;Wesselman et al., 2017) and it is necessary for a child's healthy development. One's tolerance of another's individuality with the encouragement of uniqueness without negative repercussions, can promote positive acceptance and a network of support (Flook et al., 2015;Turner & Cameron, 2016). ...
Children with peer acceptance problems struggle to fit in among classmates and often feel rejection and social isolation. Common reasons can stem from a child’s unique personality, individuality or special needs issues. These children often experience emotional problems and symptoms resulting from poor social relationships and difficulty fitting in to their environment. Within the classroom, teachers may provide encouragement and support for these children as well as their better adjusted peers, helping them equally engage through improved understanding and acceptance. In this article, a cooperative classroom approach is discussed to help students develop healthier communication with mutual respect and the freedom to be their natural, core self. A Democratic Student Council is presented as a cooperative classroom activity that encourages peer compassion and openness while supporting individuality and feelings of belonging.
... Research in other fields of allied health care has provided evidence for the necessity for including the child's environment in service provision. For example, in a study on occupational therapy, children and parents valued functional outcomes, while professionals tended to focus more on the improvement of physiological functions of the body (Costa et al., 2017). The collaboration between the health care professional and the parent or patient forms part of shared decision making (SDM), which has been described as two-way communication and information exchange (Charles et al., 1997). ...
Purpose
Our aim was to develop consensus on the definition and operationalization of communicative participation (CP) in 2- to 8-year-old children with language disorders (LDs). A clear definition and operationalization can facilitate the discussion about children's communication problems in daily life between parents and professionals.
Method
In an online Delphi study, anonymized thoughts and opinions were collected on the definition and operationalization of CP in young children with LD. The 47 Delphi panel members were Dutch parents, young adults with LDs, teachers and assistants, speech-language pathologists, clinical linguists, and clinical researchers. Thematic content analysis was used to develop a concept definition and items operationalizing CP. The Delphi panel rated the suitability of concept definitions using a 7-point Likert scale. Concept definitions were revised with feedback from the Delphi panel until consensus was achieved. The Delphi panel rated items on how well they operationalize CP, using the same Likert scale.
Results
The majority (79%) of the Delphi panel indicated that the essence of CP was captured by the definition: “CP is understanding and being understood in a social context, by applying verbal and non-verbal communication skills.” In addition, 33 behavioral items were developed.
Conclusion
This study resulted in strong consensus on the definition of CP between Dutch parents and professionals. Items were developed that can inform speech-language pathologists on the type of questions to ask a child's parents or teacher when discussing CP. Further research is needed on how the items can best be used in clinical practice.
... Considering the broader context, this review found that the COPM was utilized in conjunction with the ICF-CY (World Health Organization (WHO), 2007). The use of the ICF-CY is becoming more prevalent in pediatric research internationally (Costa, Brauchle, & Kennedy-Behr, 2017;Cunningham et al., 2017;Darcy et al., 2015;Hsieh et al., 2017;Löwing, Hamer, Bexelius, & Carlberg, 2011). The research included in this review used the ICF-CY to design interventions (Maeir et al., 2014), to choose appropriate outcome measures (Wallen et al., 2011) and to code the goals once they had been established . ...
This scoping review was prompted by the introduction of the National Disability Insurance Scheme (NDIS) in Australia, with a focus on young children with disabilities. The review began by investigating individualized outcomes measures used within Early Intervention (EI). The Canadian Occupational Performance Measure (COPM) was chosen as it is a widely used goal identification and outcome measurement tool. This paper explores how the COPM is used with young children with disabilities alongside other developmental assessments, what it contributes to the goal identification and outcome measurement process and the formulation of possible recommendations for early intervention (EI) services and the NDIS. This review highlighted that the COPM is currently used across several countries, with children aged birth-seven years with a range of disabilities. The COPM is being utilized to support the identification of functional goals and accurately track parent’s satisfaction and their perception of their child’s performance. This review indicated that the COPM builds in key elements of family-centered practice and would be a valuable tool to trial in the NDIS and to implement more broadly in early intervention internationally.
... The priority list could be influenced by the children's ability to express their priorities. There is growing evidence that children above 5 years of developmental cognitive age have this ability, 19 and this might partially explain the age group difference in this study. Another explanation of the age-and functioning-dependent priority differences could be the fact that the ability to sit and stand freely facilitates daily routines, which are more often carried out by parents and caregivers in young and more severely affected patients. ...
Aim
To develop a detailed priority list of family‐centred rehabilitation goals on the activity level within the International Classification of Functioning, Disability and Health (ICF) chapters d4 ‘Mobility’ and d5 ‘Self‐care’ in a paediatric population with a broad range of health conditions.
Method
Twenty‐two months after implementing a systematic, family‐centred, goal‐setting process, the rehabilitation goals of 212 inpatients were retrospectively allocated to the most detailed level of ICF categories by two independent researchers. The overall frequencies of these goals were calculated and stratified by health condition, functional independence, and age.
Results
Ninety‐three females and 119 males were included in the study (mean age 10y 9mo, SD 4y 5mo, range 2y 1mo–21y 5mo). The five most frequent rehabilitation goals were ICF codes d4500 ‘Walking short distances’ (11%), d4200 ‘Transferring oneself while sitting’ (9%), d5400 ‘Putting on clothes’ (7%), d451 ‘Going up and down stairs’ (6%), and d4153 ‘Maintaining a sitting position’ (5%). These top goals varied in the subgroups with regard to the underlying health condition, functional independence, and age.
Interpretation
The findings of this study are not generalizable due to the large heterogeneity in priorities. However, they can be used to incorporate families' needs into future research designs and the development of new technologies.
What this paper adds
Walking short distances is the most frequent mobility/self‐care goal of paediatric rehabilitation.
The top goals depend on health condition, functional independence, and age.
Priorities vary considerably between children undergoing rehabilitation.
Rehabilitation goals need to be assessed individually for each child.
... Taking the concept of child-centered practice one step further, researchers now stress the need to move from earlier guidelines of child-focused health care toward the child's focus within their own health care [16]. The importance of including the child´s perspective has been interpreted as the importance of inviting children to share their needs [17][18][19][20] and allowing the child to take a more active role in goal formulation and decision making [21,22]. The use of SDM is thus supported as well as promoting the fulfillment of the UNCRC. ...
Background:
Building a health care system in accordance with the rule of law requires child-centered care, where children and young people, regardless of ability, are allowed to participate in visits with their health care professionals. As part of an overall project focusing on developing and implementing a digital decision support tool to increase the participation of children with disabilities in pediatric rehabilitation, this study brings new knowledge as to how this specific patient group views participation.
Objective:
The aim of this formative study was to explore the experiences of children and young people with disabilities concerning increasing their participation in the pediatric rehabilitation services.
Methods:
The formative study had an explorative design, based on a latent qualitative content analysis with an inductive approach. Interviews were conducted with 20 children (6-17 years) and 8 young people (19-30 years) with disabilities about their experiences of participation in pediatric rehabilitation services.
Results:
A total of 3 categories emerged reflecting the participants' possibilities of participation in the pediatric rehabilitation services: to feel involved, to feel independent, and to work in partnership. To feel involved meant being listened to and being connected, to feel independent meant being admitted and being enabled, and to work in partnership meant being supported and being able to entrust others with the decision making. With the overall theme moving toward empowerment of children in pediatric rehabilitation, a true feeling of participation can be experienced.
Conclusions:
The views of children and young people with disabilities are that children should be given the prerequisites for empowerment by being allowed to feel involved and independent as well as to work in partnership to experience true participation in the pediatric rehabilitation services. This finding is essential in the design of a digital decision support tool based on the children's needs and perspectives.
... goals were focused on the body functions and structure and activities domains. However, families identified other goals that they find meaningful (e.g., self-care, leisure activities), and what was most important for families was that the goals identified would allow their child to lead happy and fulfilling lives [64,65]. Healthcare providers in pediatric rehabilitation often work in multidisciplinary teams that may include physiotherapists, occupational therapists, physicians, child life specialists, speech language pathologists, and nurses [49]. ...
Introduction: The International Classification of Functioning, Disability and Health (referred to as the ICF) is the World Health Organization’s framework for health. It can be used to identify goals that capture all aspects of a person’s life and to inform clinical goal-setting processes. This review aims to report how healthcare providers are using the ICF framework to support goal-setting practices in pediatric rehabilitation services.
Methods: A rapid review was conducted using scoping review principles in the following databases: CINAHL, Medline and PsycINFO. Key terms included: “ICF”, “goal-setting” and “pediatrics”.
Results: Sixteen studies met the inclusion criteria. Three main themes emerged about the use of the ICF in pediatric rehabilitation: 1) match the content of goals to the ICF domains; 2) implement with existing tools for goal-setting; and 3) inform the development of new tools for goal-setting. Healthcare providers often use a combination of goal-setting tools. The SMART approach is used to frame goals, while the Canadian Occupational Performance Measure and Goal Attainment Scale have been used to document and evaluate goals.
Conclusion: The ICF framework can be used with current goal-setting practices and offers a common lens and language with which to facilitate collaborative goal-setting with families and healthcare providers.
• Implications for Rehabilitation
• The International Classification of Functioning, Disability and Health (ICF) provides a common framework and language to support collaborative goal-setting between families and healthcare providers
• Despite the opportunity for the ICF to be used as a framework with goal-setting approaches, to date the ICF has mainly been used to match the content of goals to ICF domains for documentation purposes
• The ICF should be incorporated into the established clinical routines in order to promote its use among healthcare providers
• The ICF can be used with existing goal-setting tools in clinical practice and to inform the ongoing development of new tools to support the goal-setting process in family-centred services
... This potentially explains the high levels of intrinsic motivation that many children experience in video-gaming. Children's goals for rehabilitation therapies are also highly reflective of self-determination theory and tend to give "priority to their independence, competence, and joy in meaningful everyday activities" [23]. As proposed by D'Arrigo et al., self-determination theory may offer the "key" to optimizing and sustaining engagement in rehabilitation processes when interventions are designed to nurture the individual's intrinsic needs for autonomy, relatedness, and competence [13]. ...
Purpose: To provide a theoretically grounded understanding of engagement in interactive computer play-based motor therapies by children with cerebral palsy in home settings.
Methods: A motivational framework for engagement and its relationship with three contemporary theories (self-determination theory, expectancy-value theory, social cognitive theory of self-regulation) was overviewed. A scoping review was conducted to understand how engagement is influenced by features of the technology and intervention design that impact intrinsic and extrinsic motivation, child and parent values and expectancies, and the processes of self-regulation. Multiple reviewers screened and extracted data from 26 articles describing home-based clinical trials of interactive computer play-based motor interventions for children with cerebral palsy. A narrative synthesis framework was used for analysis.
Results: Features of the technology and the intervention influence feelings of autonomy (e.g., personalization), competence (e.g., calibration), and relatedness (e.g., social play, virtual therapist/coach). There may be multiple and differently valued goals in interactive computer play-based interventions (e.g., game- and therapy-focused) that, if disconnected or unmet, negatively impact engagement. Multiplayer interactions, real-time feedback and progress tracking provide information that influences self-regulation and engagement over time.
Conclusions: Optimizing engagement in interactive computer play-based motor interventions requires closer alignment with client-led values/goals; design of technologies and interventions that sustain intrinsic motivation; and feedback that informs/builds self-efficacy.
• Implications for rehabilitation
• The decision to prescribe an interactive computer play-based motor intervention should be guided by client-led goals and an informed understanding of the capacity of the interactive computer play-based intervention to meet individual client values/expectancies.
• Sustaining intrinsic motivation in interactive computer play-based motor therapies is greatly influenced by features of the technology (e.g., calibration, feedback, personalization) and the intervention (e.g., interactions with therapists, social play).
• Increased effort should be directed towards ensuring that interactive computer play-based interventions and technologies reward and reinforce efforts towards therapy goals.
Purpose
To compare the participation ratings between children with special educational needs and their primary caregivers and investigate the activities children desire to change and their participation-based goals.
Methods
Twenty children with special educational needs aged 8 to 12 years were interviewed using the Functioning Scale of the Disability Evaluation System—Child to measure participation frequency and independence and select desire-to-change activities. The International Classification of Functioning, Disabilities, and Health-based Collaborative Problem Solving was used to form participation-based goals.
Results
Children reported participation differently from their primary caregivers. Nineteen children identified desire-to-change activities mostly related to the home and community settings and indicated a desire to change participation frequency. Children’s participation-based goals reflected their desires to do their preferred activities more often.
Conclusions
Children with special educational needs had unique perspectives different from those of their caregivers, and they could identify desired activities and set participation goals with semi-structured methods.
Purpose:
This study aimed to i) identify child and family goals reported in a community allied health service, ii) map goals to ICF domains, and iii) evaluate goal characteristics against child-centred and family-centred practice principles.
Methods:
A retrospective study design was used to extract and analyse raw goal data documented for children and families accessing a community-based allied health service. ICF linking rules were used to map goals to the ICF domains. A study-specific goal rating criterion was used to examine the extent to which child-centred and family-centred practice principles were evident in documented goals.
Results:
355 goals were documented for 181 children (aged 0 < 12 years). The most common goal domain was 'Body Functions' (57%), following by Activity and Participation (33%), then Environment (9%). Few participation-focused goals were reported (4%). Documentation showed consistent collaboration with caregivers, however, minimal information for children. Goals were often phrased in therapist-specific language without reference to the child or family's functional context. As a result, many goal records did not meet the child-centred and family-centred criteria.
Interpretation:
Results highlight the critical need for tools and training which can support professionals to collaboratively construct goals, to ensure that documented goals reflect meaningful child and family priorities.
Planetary health is fundamental to the health of all beings on this earth. Climate change has direct implications on biopsychosocial aspects of humans’ health. This contribution introduces concepts of resilience relevant to promoting health of individuals, communities, and populations within a planetary health context. Additionally, it encourages reflection and action to strengthen resilience in the face of climate change-related implications and consequences, with recommendations for health professionals and beyond. Based on a consecutive literature review, inspired by Ziglio et al.’s work on resilience capacities, we are focusing on the development of the term resilience within the last decade, and are suggesting a nexus between resilience, engagement in meaningful, responsive, and anticipatory activities, and (planetary) health. An integrative interdisciplinary, occupation-based approach was taken to elaborate reciprocal transactions between resilience-related aspects, especially sense of belonging, self-efficacy, and human agency, as relevant on micro, meso, and macro-level. Conscious decisions in relatedness to planetary health, affecting occupational patterns and routines, may improve resilience on an individual, community, and system level. Attempts to promote resilience in the sense of wellbeing and health for all—as part of individual, community, population, global, and planetary health—are as well dependent on macro-level developments and players. Sense of place and belonging, ethical and strategical reasoning are pivot for decision makers in any context; this matter of fact emphasises the need for responsiveness, empathy, and wisdom for everybody and encouragement for meaningful doing in all levels and contexts.
Aim:
To achieve expert consensus on optimal child-led goal setting and evaluation practices for school-aged children (5 ≤ 17 years) who have a disability or delay.
Method:
A three-round, eDelphi consensus design was used. In Round 1, expert allied health professionals identified factors important during child-led goal setting for: (i) planning, (ii) process steps and tools, and (iii) support strategies. Factors were collated into items for Rounds 2 and 3. Participants rated item agreement on a 7-point Likert scale. Consensus was determined as ≥75% of participants in agreement or disagreement.
Results:
Sixty professionals from nine countries and six disciplines participated. Of 323 unique items generated, 159 (50%) reached consensus. Strong agreement was reached for goal setting and evaluation "process steps" and "support strategies" to engage children. It was strongly recommended that allied health professionals should tailor their processes to each child's individual needs, provide ability-specific strategies and resources, and empower children to share their perspectives. Fewer items reached consensus for "planning" and "tools" to guide child-led goal setting.
Interpretation:
Professional experts agree that children can be actively involved in goal setting and evaluation. Future research should focus on tools and technologies to support child-led goal setting for children with diverse abilities.
Aim:
Prior studies on Japanese parents raising children with developmental disorders have predominantly emphasized negative psychological aspects like parenting conflicts and challenges. Purpose of this study was to construct a conceptual model to aid mothers in parenting children with developmental disorders by identifying effective parenting strategies.
Methods:
In this qualitative study, participants were mothers who engaged in a home program through individual outpatient occupational therapy. Therapy sessions occurred biweekly, totaling 12 sessions, each lasting 40 min. Data collection involved semi-structured interviews, and the data were analyzed through the Modified Grounded Theory Approach.
Results:
Analysis of mothers' narratives revealed heightened physical burden, psychological distress, severe stress, and social isolation. Our findings highlight those mothers who engaged in the home program navigated the intricate parenting landscape through problem-solving, including managing negative emotions, their demanding schedules, and societal norms.
Conclusion:
This study offers insights into the perceptions, experiences, and behaviors of families in supporting the development of parenting strategies within the family. Occupational therapy should prioritize evaluating a mother's parenting context and her interactions with her environment. Furthermore, it is crucial to provide support for her to independently formulate suitable parenting strategies that resonate with the specific circumstances of her family.
Aim:
To investigate strategies used by professionals in pediatric rehabilitation to engage children in every step of the intervention process, including assessment, goal setting, planning and implementation of the intervention, and results evaluation.
Methods:
A scoping literature review was conducted, and seven databases were searched, including CINAHL and MEDLINE, ProQuest Central, PsycINFO, Social Science Premium Collection, PubMed, and Web of Science. A citation search of included articles was completed. Predetermined criteria, quality standards, and PIO framework guided the selection process. Results were presented in relation to Self-Determination Theory (SDT) and the contextual model of therapeutic change.
Results:
In total, 20 studies were included in the review. Pediatric professionals reported that therapeutic use of self and their own engagement in the intervention facilitated the establishment of a supportive relationship. Providing clear explanations about their role and therapy rationale developed positive expectations. By making the child feel successful within-session and outside-session activities, professionals enhanced child mastery. Professionals' strategies were abstractly described.
Conclusions:
Further research is needed to investigate strategies that are effective in the different steps of the intervention. More observational, longitudinal studies are required to capture fluctuations in in-session engagement.
This article describes the development process of the Safe Mobilisation Program to improve functional mobility and reduce fall risk in cognitively impaired older adults with gait disorders. We drew on a systematic review, informed by a theoretical paper and data collected during a feasibility study. Data collected were field notes of observation and participant feedback. Reflexive thematic analysis was undertaken. Home-based, one-on-one, low-intensity interventions are suitable designs. Key features of the tailored intervention to enhance participation include collaborative goal setting, individualized activities, rapport building, and carer training. Strategies targeting gait and cognitive deficits are integral to achieving optimal outcomes.
[Purpose] In after-school daycare services, understanding and sharing the goals and challenges of children with their parents and staff leads to effective support. This study aimed to clarify these goals and issues from the perspectives of parents and staff to propose rehabilitation issues. [Participants and Methods] The target group consisted of 10 parents and five staff members, and the goals and tasks of 10 children were surveyed using an open-ended questionnaire. The responses were analyzed using the open coding method, in which the contents of the open-ended statements were coded, categories were extracted, and the results were organized into short-term and long-term goals and tasks. [Results] Parents and staff members had different perceptions of short-term goals and issues, whereas many of the long-term goals and issues were related to employment for both. [Conclusion] The future rehabilitation issues included bridging the gap between parents and staff in terms of short-term goals and issues, and promoting appropriate support for children to work or go on to higher education in terms of long-term goals and issues.
Handwriting is an important daily occupation for children. When assessing children’s handwriting, it is recommended that clinicians use objective handwriting performance tests as well as solicit children’s and parents’ perspectives to promote client-centered practice. However, it remains unknown to what extent objective handwriting performance test results reflect children’s and parents’ perspectives about children’s handwriting itself. This study investigates the relationship between subjective perceptions of children’s handwriting legibility with the objectively assessed quality of children’s handwriting.
Twenty-seven pairs of school-aged children and parents were recruited. Both groups completed the Handwriting Proficiency Screening Questionnaire (HPSQ) and “Here’s How I Write” (HHIW) instrument. Children also completed the Evaluation Tool of Children’s Handwriting (ETCH). Data were analyzed using Spearman’s rho correlations and linear regressions with bootstrapping.
Children- and parent-reported perceptions were significantly correlated (rho = .50, p = .008). Children’s perceptions of their own handwriting legibility predicted ETCH letter legibility (p < .001); parents’ perceptions of their children’s handwriting legibility predicted ETCH word legibility (p < .003).
The reported perceptions of children’s handwriting quality provide significant information to the overall children’s handwriting assessment process. Therapists should solicit children’s and parents’ perspectives to optimize a holistic approach to children’s handwriting assessment.
Introduction
Occupation-centred practice is key to aligning with the contemporary paradigm. Benefits of this approach for clients and the profession are well documented, yet how to identify occupation-centred practice is not yet understood. Therefore, this study aimed to uncover the characteristics of occupation-centred practice and how they can be identified in practice.
Methods
A three round Delphi survey was conducted to gain consensus on the defining characteristics of occupation-centred practice. Purposive, convenience, and snowball sampling were used to distribute three survey rounds to occupational therapists internationally. Content analysis was used to create characteristics, descriptions, and examples of occupation-centred practice. Percentage agreement between occupational therapists were calculated to determine consensus.
Results
Responses were received from 100 participants in round one, 89 in round two, and 70 in round three. Round one generated 12 characteristics that were refined and finalised into four defining characteristics, one of which had three subcharacteristics. The four characteristics are as follows: guided by theory and philosophy grounded in occupation, language and documentation promotes occupation among stakeholders, understanding and incorporating the person's context, and occupation as core to practice, which includes occupation in goal setting, assessment, and intervention. Descriptions and examples were generated for each characteristic.
Conclusion
This study presents valuable information for occupational therapists wanting to practise in an occupation-centred manner. The characteristics, descriptions, and examples provide a foundation upon which occupational therapists can understand and identify occupation-centred practice. Examples provided were highly influenced by factors including practice settings and preferred terminology. Future research will explore the creation of a tool for occupational therapists to evaluate their own practice against the characteristics to demonstrate areas of strength and for development.
Occupational therapists (OTs) and physical therapists (PTs) are rehabilitation therapists with distinct but complementary roles who contribute to pain assessment and management in young people either as solo providers, or as a critical component of the interdisciplinary treatment team. Pain in infants, children, and adolescents interferes with their ability to engage in essential interactions with caregivers, acquisition of developmental milestones, and with participation in activities related to self-care, leisure, play, school, and work. OTs and PTs use specific treatment strategies, such as positioning, splinting, adaptive equipment, exercise, manual therapy, electrophysical agents, education on energy conservation, joint protection strategies, and pain self-management training to facilitate participation in valued life activities and occupations. This chapter provides an overview of important theoretical frameworks for rehabilitation therapists, reviews evidence for OT and PT interventions, and describes a framework for planning procedural pain management for rehabilitation therapists when working with pediatric clients.
Occupational therapy (OT) is a profession that supports engagement in meaningful occupations, a term consistent with participation in activity in the ICF model. Children with cerebral palsy (CP) have complex movement and posture disorders accompanied by both associated and secondary conditions (seizures, vision loss, intellectual disabilities, feeding problems, etc.). This intricate mix of body function and structure components affects participation in activity that is further complicated by personal factors and both social and physical environmental issues. The role of OT is to work in conjunction with the child and family to negotiate these factors in order to promote the child’s ability to care for themselves and participate in activities they choose at home and in their communities. OT strategies to achieve these goals cover a variety of approaches, including behavioral and movement interventions, problem-solving, and judicious use of assistive technologies. Environments where OTs work include hospitals, outpatient clinics, early intervention programs, and school systems, all settings that include children with CP. This chapter describes those interventions OTs use that are supported by evidence.
Purpose:
Although the Canadian Occupational Performance Measure (COPM) is used with children, it is unclear how they and their parents experience this. This study aims to investigate the opinions of children and their parents about the COPM when it is used with children.
Methods:
Semi-structured interviews were performed with 23 children varying in age between 8 and 18 years. The transcripts of the interviews were analysed using MAXQDA software to discover overarching themes. Parents' responses to an eight-item multiple-choice questionnaire were analysed using SPSS software.
Results:
Five themes extracted from the interviews with the children show: My way of doing the COPM; The COPM shows my own problems and wishes for change; The COPM is important for identifying the support I need; The influence of my parents and my therapist; and The COPM is suitable for me. The children experienced the COPM as a valuable tool for determining and measuring the impact of an intervention. The parents experienced the COPM as suitable for their child and judged that the child's scores were useful for showing the outcome of an intervention.
Conclusion:
Both the children and their parents valued the COPM as an outcome measure for intervention.
Purpose
To explore child, parent, and clinician experiences with a child-driven approach to rehabilitation goal setting.
Methods
Nine children receiving inpatient and outpatient rehabilitation aged 5.0–12.3 years ( x ¯ = 8.3, SD = 2.3; 5 females) and their parents (n = 9) participated in a goal setting process intended to maximize child engagement with their physical or occupational therapist. Qualitative interviews were conducted with children (n = 7), their parents (n = 9), occupational therapists (n = 2), a nurse practitioner and a physician to explore their experience with the child-driven approach to goal setting.
Results
Three themes that reflect child, parent, and clinician experience with a child-driven approach to goal setting were identified: (1) children have voice and insight, (2) child identified goals are rewarding and motivating for children, and (3) we are a team: goal setting as a co-constructed process.
Conclusions
Engagement in goal setting resulted in the identification of functional goals that were perceived as motivating for children. Children described feeling valued and heard. Parents and clinicians recognized they had previously underestimated the capacity of children to identify their own goals. Parents wanted input from therapists, particularly related to shaping their goals to focus on shorter-term outcomes. Relational autonomy, which emphasizes the social and relational aspects of decision-making, may be more useful than traditional, individualistic views of autonomy for conceptualizing clinician roles in collaborative goal setting.
•
IMPLICATIONS FOR REHABILITATION
• Children are often not optimally involved in setting their own rehabilitation goals.
• In this qualitative study, we report that children, parents, and clinicians recognized the value of optimizing child engagement in goal setting including children feeling heard, valued and more motivated to participate in therapy.
• Parents expressed a need for a collaborative approach to goal setting that respects child, parent, and clinician input.
• Relational autonomy may be a useful framework for reframing the role of clinicians in collaborative goal setting processes.
This commentary is on the original article by Rast et al. on pages 483–488 of this issue.
Interprofessional collaborative practice between the fields of occupational therapy and applied behavior analysis has the potential to enhance the quality of school services available for children on the autism spectrum. This article will explore how these two disciplines can use a synergistic approach to develop a more comprehensive picture of the student and to provide a wider range of intervention possibilities through a discussion of: discipline-specific practice guidelines, informed coordinated decisions for programming, and collaborative practice. Activity analysis and proactive strategies are highlighted as two overlapping scopes of practice scenarios. Despite their differences in theory and methods, occupational therapists and behavior analysts can respectfully work together for the shared goals of increased competence, performance, and participation outcomes in school for their students on the autism spectrum.
Hintergrund
Schreiben gilt als eine der wichtigsten und zeitaufwändigsten Betätigungen im Leben von Kindern, welche gleichzeitig durch ihre Komplexität mit Schwierigkeiten verbunden sein kann. Das „Here’s How I Write“ Handschrift-Assessment wird bereits in der hebräischen und englischen Version zur Selbst- und Fremdeinschätzung der kindlichen Handschrift verwendet. Die deutsche Übersetzung fand nach den Stufen der „Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures“ statt.
Ziel
Ziel dieser Arbeit ist die sprachliche und kulturelle Validierung der 24 Bildkarten, des „HHIW: Selbsteinschätzungsbogen SchülerIn“ und des „HHIW: Einschätzungsbogen LehrerIn“ der deutschen Version des HHIW Handschrift-Assessments für Kinder und LehrerInnen an österreichischen Volksschulen.
Methodik
32 Kinder wurden mit den Bildkarten und dem Selbsteinschätzungsbogen des HHIW persönlich getestet und zur Verständlichkeit befragt. 24 LehrerInnen wurden mittels Schneeballverfahren rekrutiert und mit Hilfe eines Online-Fragebogens zur Verständlichkeit des Fremdeinschätzungsbogens befragt. Die erhobenen Daten wurden in Excel übertragen und ausgewertet.
Ergebnisse
Bei vier Items äußerten mehr als 10% der Befragten eine Unverständlichkeit. Bei acht weiteren Items stießen die Forscherinnen auf Übersetzungs- oder Darstellungsfehler. Zur besseren Verständlichkeit wird eine sprachliche und grafische Adaptierung einiger Items benötigt. Vor einer Veröffentlichung des Assessments in Österreich wird eine Anpassung bestimmter Bildkarten und der Bögen empfohlen. Zusätzlich halten es die Forscherinnen für sinnvoll, das restliche Manual auf Deutsch zu übersetzen und ein Informationsblatt für LehrerInnen zu erstellen.
Background
In order to make informed decisions about how best to support children and young people with disabilities, effective strategies that facilitate active and meaningful participation in school are required. Clinical factors, diagnosis or impairments somewhat helpful in determining what should be provided in interventions. However, clinical factors alone will not offer a clear view of how to support participation. It is helpful then to look at wider psychosocial and environmental factors. The aim of this review was to synthesise evidence of psychosocial and environmental factors associated with school participation of 4–12 year old children with disabilities to inform the development of participation-fostering interventions.
Methods
A systematic search and synthesis using realist methods was conducted of published research. Papers had to include consideration of psychosocial and/or environment factors for school participation of children with disabilities. The review was completed in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Papers were identified via Boolean search of the electronic databases MEDLINE, CINAHL, PhycINFO and ERIC (January 2006-October 2018). Appraisal focussed on contributions in terms of whether the articles are appropriate for the review (relevance) and research quality (rigour). Data were analyzed using content and thematic analysis methods using a realist framework. A narrative synthesis of results was reported.
Results and implications
We identified 1828 papers in the initial search. Seventy two papers were included in the final synthesis. Synthesis of findings led to three overarching mechanisms representing psychosocial factors for children (1) identity (2) competence and (3) experience of mind and body. Environmental aspects (context) compromised five interrelated areas: (1) structures and organization, (2) peers, (3) adults, (4) space and (5) objects. Our synthesis provides insights on how professionals may organize efforts to improve children’s participation. Consideration of these findings will help to proactively deal with suboptimal participation outcomes. Development of theoretically determined assessments and interventions for management of school participation are now required.
Purpose
Collaborative, child‐ and family‐centred goal setting is essential in paediatric, acquired brain injury (ABI) rehabilitation. This study aims to understand which goals children and families prioritize and how accurately therapists predict expected levels of achievement for these goals.
Methods
Routinely collected Goal Attainment Scale‐Light data from 122 children with severe ABI receiving residential rehabilitation were retrospectively analysed. Goals were mapped onto the International Classification of Functioning, Disability and Health. Descriptive analysis of accuracy of therapists' prediction of goal achievement was conducted.
Results
Eight‐hundred sixty goals were set: 82% in activities and participation domains, most commonly mobility, self‐care, and communication chapters. Forty‐six per cent of therapist‐set expected levels of achievement for these goals were met at the expected level, and 24% were exceeded. Chapters with the highest prediction accuracy included two environmental chapters and one body structure and function. Accurate prediction of activity and participation goals varied (35% in general tasks and demands to 58.8% in major life areas).
Conclusions
Children and families prioritize mobility, self‐care, and communication during ABI residential rehabilitation. Setting expected outcomes for these goals is challenging, as demonstrated by the variety in accurate prediction rates between and within chapters. Families need to be aware of this uncertainty during goal‐setting discussions.
Introduction: A systems-oriented approach in contemporary health-care requires health professionals to include clients’ and their proxies’ perceptions to design specific, efficient, and cost-effective interventions. This influences the choice of appropriate methods and means for assessment and intervention. To learn more about the benefits of a systems-approach in assessment and intervention planning, there is a need to study how children and their proxies describe children’s abilities. Aims: This study aimed to explore, describe, and compare perceived competences in everyday activities as reported by children with difficulties in their occupational performance, their parents and teachers, using the first Austrian-German version of the Perceived Efficacy and Goal Setting System (AG-PEGS). Method: Forty-two children, their parents and teachers completed the AG-PEGS. Data analysis included descriptive statistics, calculation of inter-rater agreement, differences between groups, and correlations between categories. Results: Overall, adults scored children’s competences lower than the children themselves. Statistically significant differences of the perception of children, parents and teachers were found in single items, total scores and life areas (productivity, self-care, leisure), respectively. Differences in perceived competence were also found related to gender and schooling. Agreement in children’s and adults’ scorings varied depending on shared life areas (children and parents showing most agreement in self-care). Conclusion. Agreement and differences in perceived competences support the importance of children’s and proxies’ participation in assessment in order to gain a comprehensive picture and a better understanding of a child’s situation and conditions, address a child’s and his/her proxies’ concerns, and provide individualized and context-relevant intervention. Children - assessment - self-efficacy - perceived competence - parents - teachers - participation
This article presents a view of occupation as the principal means through which people develop and express their personal identities. Based on a review of theory and research, it proposes that identity is instrumental to social life because it provides a context for deriving meaning from daily experiences and interpreting lives over time. The article proposes that identity also provides a framework for goal-setting and motivation. It is asserted that competence in the performance of tasks and occupations contributes to identity-shaping and that the realization of an acceptable identity contributes to coherence and well-being.
Within this framework, it is postulated that performance limitations and disfigurement that sometimes result from illness or injury have identity implications that should be recognized by occupational therapy practitioners. By virtue of their expertise in daily living skills, occupational therapy practitioners are well positioned to help address the identity challenges of those whom they serve. In so doing, they make an important contribution to meaning and well-being.
The authors summarize 35 years of empirical research on goal-setting theory. They describe the core findings of the theory, the mechanisms by which goals operate, moderators of goal effects, the relation of goals and satisfaction, and the role of goals as mediators of incentives. The external validity and practical significance of goal-setting theory are explained, and new directions in goal-setting research are discussed. The relationships of goal setting to other theories are described as are the theory’s limitations.
Aim:
The aim of this grounded theory study was to explore mothers' perspectives of the processes of collaborative goal setting in multidisciplinary child development services involving follow-up home therapy.
Methods:
Semi-structured interviews were conducted in South East Queensland, Australia with 14 mothers of children aged 3-6 years who were accessing multidisciplinary child development services. Interviews were focussed around the process of goal setting.
Results:
A grounded theory of Maternal Roles in Goal Setting (The M-RIGS Model) was developed from analysis of data. Mothers assumed Dependent, Active Participator and Collaborator roles when engaging with the therapist in goal-setting processes. These roles were characterized by the mother's level of dependence on the therapist and insight into their child's needs and therapy processes. Goal Factors, Parent Factors and Therapist Factors influenced and added complexity to the goal-setting process.
Conclusion:
The M-RIGS Model highlights that mothers take on a range of roles in the goal-setting process. Although family-centred practice encourages negotiation and collaborative goal setting, parents may not always be ready to take on highly collaborative roles. Better understanding of parent roles, goal-setting processes and influencing factors will inform better engagement with families accessing multidisciplinary child development services.
Background:
Paediatric rehabilitation involves the therapist delivering intervention-specific and non-specific behaviours. Non-specific (or general therapy) characteristics are a key part of family-centred service (FCS); however, little research identifies observable behaviours to examine intervention fidelity to FCS principles and their impact on outcomes.
Purpose:
To generate a list of observable general therapy attributes essential to FCS interventions for children with physical disabilities.
Methods:
Attributes of general therapy behaviours were derived based on a Delphi Process with multidisciplinary researchers. A separate method identified attributes through the content analysis of semi-structured interviews with occupational therapists and physiotherapists. A triangulation procedure identified general therapy behaviours for FCS.
Results:
Eight researchers participated in the Delphi Process. Seventeen therapists participated in semi-structured interviews. The Delphi Process generated 35 behavioural attributes divided into three categories: therapist behaviours (21), client behaviours (9) and client-therapist behaviours (5). Of the 19 attributes generated from the therapist interviews, 17 mapped onto those identified in the Delphi Process. General therapy attributes addressed a range of behaviours including characteristics of the intervention procedure and the therapeutic process.
Conclusions:
This work provides an improved understanding of how practitioners conceive essential and observable behaviours of FCS that will enable future researchers to identify their presence within an intervention session.
Implications for rehabilitation:
This article broadens the focus of fidelity measurement of paediatric rehabilitation to include observable behaviours relevant to family-centred service. Attributes of the therapist's practice behaviour in family-centred service were identified. Attributes of paediatric rehabilitation involving the child's response to intervention, parent participation and child and therapist interaction were generated.
Tested the hypothesis that self-motivation through proximal goal setting serves as an effective mechanism for cultivating competencies, self-percepts of efficacy, and intrinsic interest. 40 children (7.3–10.1 yrs of age) who exhibited gross deficits and disinterest in mathematical tasks pursued a program of self-directed learning under conditions involving either proximal subgoals, distal goals, or no goals. Results of the multifaceted assessment provide support for the superiority of proximal self-influence. Under proximal subgoals, Ss progressed rapidly in self-directed learning, achieved substantial mastery of mathematical operations, and developed a sense of personal efficacy and intrinsic interest in arithmetic activities that initially held little attraction for them. Distal goals had no demonstrable effects. In addition to its other benefits, goal proximity fostered veridical self-knowledge of capabilities as reflected in high congruence between judgments of mathematical self-efficacy and subsequent mathematical performance. Perceived self-efficacy was positively related to accuracy of mathematical performance and to intrinsic interest in arithmetic activities. (25 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objective: to evaluate the test–retest reliability of children's perceptions of their own competence in performing daily tasks and of their choice of goals for intervention using the Swedish version of the Perceived Efficacy and Goal Setting System (PEGS). A second aim was to evaluate agreement between children's and parents' perceptions of the child's competence and choices of intervention goals. Methods: Forty-four children with disabilities and their parents completed the Swedish version of the PEGS. Thirty-six of the children completed a retest session allocated into one of two groups: (A) for evaluation of perceived competence and (B) for evaluation of choice of goals. Cohen's kappa, weighted kappa and absolute agreement were calculated. Results: Test–retest reliability for children's perceived competence showed good agreement for the dichotomized scale of competent/non-competent performance; however, using the four-point scale the agreement varied. The children's own goals were relatively stable over time; 78% had an absolute agreement ranging from 50% to 100%. There was poor agreement between the children's and their parents' ratings. Goals identified by the children differed from those identified by their parents, with 48% of the children having no goals identical to those chosen by their parents. These results indicate that the Swedish version of the PEGS produces reliable outcomes comparable to the original version.
Objective: To translate, adapt, and evaluate the applicability of the Perceived Efficacy and Goal Setting System (PEGS) for use in Sweden. Method: Based on guidelines for cross-cultural adaptation of self-reports, the study was performed in several phases involving (i) translation and back-translation, (ii) pre-testing of the translated version, (iii) development of adjusted items and, finally, (iv) field testing of the proposed Swedish version. Participants were 63 parent–child dyads recruited through convenience sampling by 19 therapists. Results: Overall, five items in the original PEGS required adaptation, and one new item was added. Using the Swedish version of the PEGS, both children and parents were able to identify individual strengths and weaknesses in the child's performance of daily tasks as well as to select goals for intervention. Conclusions: The Swedish version of the PEGS thus showed evidence of validity based on test content and was applicable for use with children enrolled in paediatric rehabilitation who had a variety of disabilities and who were between five and 12 years of age.
Optimizing home and community participation of children with physical disabilities is an important outcome of rehabilitation.
A review of literature identified research and theory on participation of children with physical disabilities. The authors' incorporated current knowledge to conceptualize the experience of optimal participation, formulate principles of participation-based physical and occupational therapy, and develop a five-step process for intervention. A case report was completed to illustrate application to practice.
Optimal participation involves the dynamic interaction of determinants (attributes of the child, family, and environment) and dimensions (physical, social, and self engagement) of participation. Real-life experiences enable children to learn new activities and develop skills that optimize their participation and self-determination. Interventions are: goal-oriented, family-centered, collaborative, strengths-based, ecological, and self-determined. A distinguishing feature of intervention is that the therapist's primary role is to support the child and family to identify challenges to participation and solutions to challenges. The therapist is a consultant, collaborating with the child, family, and community providers to share information, educate, and instruct in ways that build child, family, and community capacity.
The model may have utility for collaboration with families and community providers, determining goals for participation, and providing evidence-informed interventions.
To compare the effects of goal directed functional therapy (GDT) to activity focused therapy (AT) for preschool children with cerebral palsy (CP) on everyday activities and gross motor function. Another aim was to evaluate goal attainment in the GDT group.
A prospective intervention study comparing two types of intervention carried out in ecological settings. Forty-four children with CP, (25 boys, 19 girls; mean age 4 year 1 month [SD 1 year 5 month]), Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels I-IV participated. Twenty-two children were recruited to the GDT group and 22 to the AT group. Outcome measures were the Pediatric Evaluation of Disability Inventory (PEDI), and the Gross Motor Function Measure-66. Furthermore, goal attainment scaling (GAS) was used in the GDT group. The assessments were performed before and after an intervention period of 12 weeks.
The children in the GDT group improved more in most aspects of everyday activities measured by the PEDI than the children in the AT group (p < 0.001). Only functional skills in social function did not differ between the groups. Furthermore, gross motor function improved more in the GDT group than in the AT group (p < 0.001). Goal attainment to the expected level or higher was achieved in 93/110 goals in the GDT group. The variance of improvements in the different PEDI scales in the GDT group could not be explained by either age, sex, distribution of CP, GMFCS or MACS levels.
GDT demonstrated clear gains for children with cerebral palsy in everyday activities and gross motor function in comparison to AT.
This article presents a view of occupation as the principal means through which people develop and express their personal identities. Based on a review of theory and research, it proposes that identity is instrumental to social life because it provides a context for deriving meaning from daily experiences and interpreting lives over time. The article proposes that identity also provides a framework for goal-setting and motivation. It is asserted that competence in the performance of tasks and occupations contributes to identity-shaping and that the realization of an acceptable identity contributes to coherence and well-being. Within this framework, it is postulated that performance limitations and disfigurement that sometimes result from illness or injury have identity implications that should be recognized by occupational therapy practitioners. By virtue of their expertise in daily living skills, occupational therapy practitioners are well positioned to help address the identity challenges of those whom they serve. In so doing, they make an important contribution to meaning and well-being.
Understanding parents' hopes for therapy outcomes is essential to family-centered care. This qualitative study explored parents' points of view regarding their hopes for the outcomes of occupational therapy using a sensory integration treatment approach.
Data were collected as part of a larger research project on the effectiveness of rehabilitating children who have sensory modulation disorders. Five interviews were randomly selected from 17 parent interviews conducted in the larger study. Data were analyzed using grounded theory methods.
Three themes pertinent to the occupations of children and two themes related to the occupations of parenting and sustaining family life emerged. Child-focused outcomes include social participation, self-regulation, and perceived competence. Parent-focused outcomes include learning strategies to support children and obtaining personal validation.
Interventions are proposed that relate to children's participation in contexts in which they live, learn, and play, as well as the support of parents in the occupations of parenting.
The aim was to evaluate whether the use of a client-centred instrument, the Canadian Occupational Performance Measure (COPM), affects the patients' perception of active participation in the rehabilitation process. The study included 155 patients in the experiment group and 55 in the control group, within geriatric, stroke, and home rehabilitation. The COPM was used in the experiment group. A structured interview was performed within 2-4 weeks after discharge with 88 patients in the experiment group and 30 patients in the control group. The results show significant differences between the groups. More patients in the experiment group perceived that treatment goals were identified, were able to recall the goals, felt that they were active participants in the goal formulation process, and perceived themselves better able to manage after completed rehabilitation compared with patients in the control group. The study indicates that the COPM improves client participation in the rehabilitation process.
The authors summarize 35 years of empirical research on goal-setting theory. They describe the core findings of the theory, the mechanisms by which goals operate, moderators of goal effects, the relation of goals and satisfaction, and the role of goals as mediators of incentives. The external validity and practical significance of goal-setting theory are explained, and new directions in goal-setting research are discussed. The relationships of goal setting to other theories are described as are the theory's limitations.
Ergotherapeuten sind oft mit der Frage konfrontiert, was ihre Behandlung charakterisiert und welche Wirkfaktoren nachgewiesen sind. Daher ist es unverzichtbar, die gesundheitsfordernden und wirksamen Aspekte zu benennen, zu verschriftlichen und wissenschaftlich zu untersuchen. Denn: Was Ergotherapeuten oft als so selbstverstandlich erachten und tun, mussen sie immer haufiger belegen konnen.
Occupation-based participatory assessment and treatment planning requires appropriate tools to explore clients' perceptions and priorities for their day-to-day lives. Currently, no such instrument is available in German for use with children and their proxies. This study aimed to translate and adapt the Perceived Efficacy and Goal Setting System (PEGS) for use in German-speaking regions. Translation, adaptation, and field testing of the Austrian-German PEGS version followed guidelines for cross-cultural adaptation of self-report assessments. Forty-two children, ages 5 to 10, with various health conditions, their parents, and teachers participated in this study. The Austrian-German PEGS was successfully translated and culturally adapted. Children, their parents, and teachers reported the child's competences related to the addressed items and identified goals for intervention. Participants added specific culturally relevant activities. Data can now be used to further develop the PEGS for German-speaking regions and to continue research on culturally meaningful activities for children and families.
Traditional developmental models assume that the underlying capacities of children contribute to their participation. In this framework, preschoolers who are referred for occupational therapy services usually undergo an assessment intended to identify capacities in certain domains. Contrary to this, newer ecological models assume that child participation is a consequence of a multidimensional interaction between personal and environmental factors. As a result clinicians are increasingly focusing their assessment on performance and participation. This study aimed to assess the correlation between children's performance skills, their capacities and participation; and to explore whether parents' observations, alongside therapist observations and standardised assessments, contribute to an enhanced understanding of child participation.
Participants included 188 parents and their children, aged 4-6 years, with and without mild developmental difficulties. Data were collected using standardised assessments for child capacities, and questionnaires completed by parents and occupational therapists regarding child participation and performance skills.
Significant correlations were found between parent assessments of child performance skills and child participation, but not with child capacities. The opposite was found to be true for occupational therapist assessments of child performance skills which were found to correlate with child capacities, but not with participation. Additionally, an interaction effect was found for both groups. Occupational therapists reported higher performance skills as compared to parents, but the difference was only significant for children without mild difficulties.
As suggested by ecological models of child participation, the findings highlight the importance of parent-therapist collaboration in the assessment process of children.
Introduction
This review investigates qualitative evidence regarding the effectiveness of motor interventions for children with developmental coordination disorder (DCD).
Method
Six databases were searched for qualitative studies conducted with school-age children with DCD and their parents to understand better which occupational therapy interventions are most effective for decreasing core symptoms and improving occupational outcomes. The Model of Human Occupation was used as a guide to structure the discussion and to illustrate how a model can be used to guide the therapeutic reasoning process regarding future intervention decisions.
Findings
The findings suggest that, for many families, intervention that addressed everyday occupations and the social consequences for children with DCD was of the utmost importance. Most parents' greatest hope for intervention was to maximise their child's social participation and motivation. Parents described successful interventions that enabled their child to participate regularly in his or her chosen motor activities within the community and that created social participation opportunities. Although children reported similar concerns to parents, they also valued their ability to engage in self-care and play activities.
Conclusion
The qualitative evidence supports the need for practitioners to incorporate the priorities of parents and children in order to optimise the outcomes of intervention. Parental and teacher education was highly valued by parents to help manage their uncertainty and worry associated with raising a child with DCD.
Purpose:
This study explored ways in which program evaluation activities in pediatric rehabilitation settings can become congruent with family-centered service (FCS) philosophy.
Methods:
Two Canadian pediatric rehabilitation centers participated in this study, which included focus groups with staff members and interviews with parents.
Results:
Participants identified seven ways in which program evaluation practices could be made congruent with FCS. Suggestions included: (a) the inclusion of a diverse group of program recipients, (b) the use of processes that facilitate family involvement, (c) the recruitment of family champions, (d) the involvement of families in program development, (e) the establishment of evaluations that are relevant to families (f) the development of center-wide statements about family involvement in evaluation and (g) the compensation of families for their active participation in evaluation.
Conclusion:
For program evaluation practices to be useful and relevant, they should be improved and made consistent with FCS philosophy. Those evaluating pediatric rehabilitation programs need to use approaches and activities that respect the needs, characteristics, cultures and diversity of the program recipients. Such actions will help to improve the quality of care provided, the nature of program evaluation activities, as well as the overall level of FCS in pediatric rehabilitation settings.
Occupational therapy for children and their parents/caregivers has similar foci internationally. However, there are differences in service provision for pediatric clients depending on the health care system, education system, and professional developments in response to the political, social, and demographic context. “Think global, act local,” an essential statement also promoted by the World Federation of Occupational Therapists, may be a guiding principle when introducing Austrian pediatric occupational therapy as related to education, practice, and research.
Occupational therapists believe that there is a relationship between occupation, health and well-being but there is little evidence in the occupational therapy literature to support this belief. This paper describes the results of a critical review of research examining the relationship between occupation and health and well-being. Twenty-two studies from the health and social sciences literature were reviewed using specific methodological review criteria. The findings of these studies provide moderate to strong evidence that occupation has an important influence on health and well-being. Because most of this research has been completed with persons without disabilities, further research is required to explain the nature of the relationship between occupation and health and well-being for persons who experience a disability which affects their daily occupations.
ABSTRACT Goal-setting theory is summarized regarding the effectiveness of specific, difficult goals; the relationship of goals to affect; the mediators of goal effects; the relation of goals to self-efficacy; the moderators of goal effects; and the generality of goal effects across people, tasks, countries, time spans, experimental designs, goal sources (i.e., self-set, set jointly with others, or assigned), and dependent variables. Recent studies concerned with goal choice and the factors that influence it, the function of learning goals, the effect of goal framing, goals and affect (well-being), group goal setting, goals and traits, macro-level goal setting, and conscious versus subconscious goals are described. Suggestions are given for future research.
Purpose:
The primary aim of the study was to investigate the interrelation between needs and functional difficulties and the therapeutic goals in children with cerebral palsy (CP) as documented in individual written rehabilitation plans.
Method:
The study was a retrospective cross-sectional register study. The data consisted of randomly chosen register documents for 77 children and adolescents with CP in different predetermined age ranges. The International Classification of Functioning, Disability and Health-Child and Youth version (ICF-CY) was used as a reference for analyzing the content of the written statements.
Results:
The rehabilitation plans for 70 children, 1-16 years of age, representing all GMFCS levels were analyzed. Goals were not well reflected in the children's needs and functional difficulties. The needs, functional difficulties and goals mainly encompassed the components of body functions and activity/participation. In half of the plans the presence of the parents was mentioned, and the plans were made in multidisciplinary collaboration.
Conclusions:
The results of this study indicate deficiencies in the content and goals of the written rehabilitation plans. The ICF-CY could serve as a framework to help professionals and parents identify the child's needs and those areas where the goals should be targeted. Implications for Rehabilitation Documenting the child's and family's needs in relation to activity and participation preferences is critical to rehabilitation and intervention planning. Goals, based on the child's needs, should be identified in collaboration with all parties involved, and focus on the child's functioning in meaningful everyday activities. The ICF-CY could serve as a framework for the family and professionals to identify needs and to communicate rehabilitation goals.
ABSTRACT The purpose of this study was to examine the relationship between goal achievement measured by the Canadian Occupational Performance Measure (COPM) and child, goal, and intervention factors. Participants were 41 preschool children with cerebral palsy (CP) who were in the context-focused therapy arm of a randomized controlled trial. Factors including child age, Gross Motor Function Classification System (GMFCS) level, type and complexity of goals, and intervention strategies were analyzed. Children made large, positive mean changes on the COPM over 6 months (Performance = 3.8, SD = 1.9; Satisfaction = 4.3, SD 4.3) with younger children showing greater change. The COPM scores had low to moderate correlations with change on the Pediatric Evaluation of Disability Inventory and the Gross Motor Function Measure (GMFM-66). Regression analysis indicated that age, but not GMFCS level influenced COPM change scores. Goal complexity and intervention strategies were not significantly related to COPM change scores. The results provide support for using the COPM as an individualized measure of change in young children with CP receiving intervention.
This book draws on contemporary occupational therapy theory and research to provide occupational therapy students and clinicians with a practical resource on implementing occupation centred practice with children. Each chapter has specific objectives and uses case studies to demonstrate the clinical realities and applications of each of the topics addressed. Best practice guidelines are provided along with a summary of recommendations drawn from the relevant theories, occupational therapy philosophy and existing research. The book aims specifically to be practice based.
ABSTRACT Collaborative goal setting between clinicians and clients/families is considered a fundamental component of the pediatric rehabilitation process. However, truly client-centered goal setting is not without its challenges. The purpose of this paper is to highlight theoretical concepts relevant to rehabilitation goal setting, review clinical studies directly evaluating relationships between goal setting and pediatric rehabilitation outcomes, and provide recommendations to facilitate collaborative goal processes. Four theoretical frameworks were identified that may lie behind and help explain the effectiveness of collaborative goal setting. The four relevant outcome studies found in the review revealed that individualized goal setting is an important component of the intervention, engages families more actively in therapy, and is associated to some extent with positive outcomes. The evidence suggests that the impact of fully collaborative goal setting is sufficiently positive to support investment of organizational and individual time, energy, and resources to make it an integral part of the rehabilitation process.
Children with developmental coordination disorder (DCD) have a motor impairment that affects their ability to perform everyday tasks. Although severity of motor impairment can be measured, methods for assessing the perceived impact of DCD on daily activities have not been established. The purpose of this study was to use a child-focused approach to understand children's views of the impact of DCD on the activities that they perform daily.
Children aged 5–10 years, referred with coordination difficulties to occupational therapists, were assessed using the Movement Assessment Battery for Children: children who received scores below the 15th percentile were included. The Perceived Efficacy and Goal Setting System (PEGS), a pictorial scale validated as a method for engaging children with disabilities, was administered to examine the children's perceptions of their competence in performing everyday activities and to identify goals for therapy. Parent and teacher concerns were collected by a questionnaire.
The children, parents and teachers shared many concerns about the impact of DCD on physical tasks and on academic activities such as handwriting. The children expressed additional concerns, however, about their ability to perform daily self-care tasks and leisure activities, which were rarely recognised by the adults. Children require specialised methods to enable them to express their views and the PEGS appears to be suitable for this purpose.
A literature review was conducted to identify and compare the clinical utility of client-centred, individualised outcome measures for paediatric rehabilitation. Five measures were identified: the Canadian Occupational Performance Measure (COPM) (28 studies); Goal Attainment Scaling (GAS) (34 studies); Perceived Efficacy and Goal Setting System (PEGS) (2 studies); Target Complaints (TC) (1 study); and the Paediatric Activity Card Sort (PACS) (instruction manual only). The COPM and GAS have been used with children across a wide age range and variety of clinical settings. The PEGS and PACS provided young children direct involvement in the goal-setting process. Little evidence supports the use of TC in paediatrics.
Clinicians need to use individualised measures in a way that facilitates the maximal participation of children and families in goal setting and outcome evaluation. Clinicians should document their own role in goal setting. The use of individualised and client-centred measures can motivate children and families and focus their attention on therapy goals.
Background and Aim: Because occupational therapy focuses on occupations and activities of daily living in the context of the environment, conceptual occupational therapy models might be closely related to the International Classification of Functioning, Disability and Health (ICF). The purpose of this paper is to explore the link of conceptual occupational therapy models to the ICF.
Methods and Results: A structured literature search was performed. The concepts on which the models are built were linked to the ICF categories and components according to 10 established linking rules. Three conceptual occupational therapy models were identified in the literature: the Model of Human Occupation, the Canadian Model of Occupational Performance and the Occupational Performance Model (Australia). The majority of the concepts from the three models could be linked to the ICF.
Conclusion: By applying the conceptual models, occupational therapists might add an additional perspective to multidisciplinary teams that use the ICF.
Some authors are beginning to challenge current categorisations of occupation as self-care, productivity, and leisure in favour of categories that address meaning. However, the meaning of occupation receives relatively little attention in the literature.
To provide a synthesis of the contemporary literature that considers the meaning of occupation and to argue that phenomenological insights into the meaning of occupation might usefully inform occupational therapy research, theory, and practice.
Meaning is a key aspect of occupation. Three phenomenological meanings of occupation uncovered by a study conducted in New Zealand-the call, Being-with and possibilities-provide a starting point for practice, research, and theory informed by understandings of the lived experience of occupation.
Occupational therapy's theories would benefit from an evidence base that includes meaning, which in turn would lead to authentic occupational therapy practice.
Self-determination theory (SDT) maintains that an understanding of human motivation requires a consideration of innate psychological needs for competence, autonomy, and relatedness. We discuss the SDT concept of needs as it relates to previous need theories, emphasizing that needs specify the necessary conditions for psychological growth, integrity, and well-being. This concept of needs leads to the hypotheses that different regulatory processes underlying goal pursuits are differentially associated with effective functioning and well-being and also that different goal contents have different relations to the quality of behavior and mental health, specifically because different regulatory processes and different goal contents are associated with differing degrees of need satisfaction. Social contexts and individual differences that support satisfaction of the basic needs facilitate natural growth processes including intrinsically motivated behavior and integration of extrinsic motivations, whereas those that forestall autonomy, competence, or relatedness are associated with poorer motivation, performance, and well-being. We also discuss the relation of the psychological needs to cultural values, evolutionary processes, and other contemporary motivation theories.
This study measures the effectiveness of a goal-orientated group intervention using concentrated practice schedules for children with developmental coordination disorder (DCD). The study design is repeated measures. The sample comprises eight children with DCD, aged 7-11 years. Outcome measures are the Movement Assessment Battery for Children (MABC), the Canadian Occupational Performance Measure (COPM), Harter's Scale of Perceived Competence/Harter and Pike's Pictorial Scale of Perceived Competence, and clinical observations. The children set goals with the perceived efficacy and goal setting system with parents/caregivers input. The intervention used a goal-oriented approach combining motor learning and cognitive strategies consisting of eight 50-min sessions over 2 weeks. The results show significant improvements in the COPM and MABC scores following intervention but no changes in Harter's scores. Fifty-six goals were identified with 34 met totally, 12 met partially, and 10 remained unmet. A goal-oriented group intervention shows potential as an effective intervention method.
The importance of parent involvement in intervention with children has always been recognised by occupational therapists. Current trends in paediatric service delivery have been towards family-centred care, with a central component of this approach being parent-therapist collaboration in planning and evaluating intervention. This paper reviews issues and provides suggestions for clinical practice from the literature on parent-therapist collaboration, including consideration of parents' diversity and unique perspectives, development of effective parent-therapist relationships, establishment of shared goals and priorities when planning intervention, and development of services that support parent-therapist collaboration. Further research is needed in Australian settings to explore the nature of parent-therapist partnerships, the impact of parent participation throughout the intervention process and the extent to which collaboration with parents results in better therapy outcomes for the child and their family.
Developmental Co-ordination Disorder (DCD) may negatively impact children's self-efficacy and limit their performance and participation in school as well as in leisure activities performed after school hours. However, a lack of information exists regarding the relationships between DCD, child's self-efficacy and participation. Moreover, the literature about the way children with DCD experience these limitations and report about them is scarce. This study aimed to compare the perceived self-efficacy and the preference to participate in leisure activities of children with DCD and typical peers and to illuminate the relationship between self-efficacy, activity preference and DCD severity.
Participants were 37 children with DCD and 37 typical peers, aged 5.08-9.83 years. All children performed the Movement Assessment Battery for Children, the Perceived Efficacy and Goal Setting System and the Preference for Activities of Children.
The scores of the Movement Assessment Battery for Children confirmed the motor gaps between the two groups. Children with DCD scored significantly lower in self-efficacy on all the Perceived Efficacy and Goal Setting System subscales and demonstrated a lower preference to participate in leisure activities according to all scales of the Preference for Activities of Children. The lower their self-efficacy, the lower their motor performance and their preference to participate in activities.
Children's preference to participate in activities may be limited by motor difficulties, but further hindered by low self-efficacy. Early identification of DCD and associated negative outcomes, also based on child's self-reports, should receive special attention in intervention programmes in order to enhance children's self-confidence, feelings of belonging, optimal development and participation in daily activities.
One of the central tenets of client-centred occupational therapy is to enable clients to select goals to work on in therapy (Law, 1998). The process of identifying and prioritizing goals is fairly abstract, therefore occupational therapy goals for children are often prescribed by the therapist or by parents and teachers. The purpose of this study was to pilot test a measure and a process that would provide young children with the opportunity to assess their performance on daily tasks and to establish goals for occupational therapy intervention. Parents and children completed the Perceived Efficacy and Goal Setting System (PEGS), a measure of children's perception of their competence performing fine and gross motor tasks. Children 5-9 years of age were able to discriminate among tasks and to rate whether or not they were able to perform each task competently. They were also able to use this information to select and prioritize goals for intervention. While parents often rated the child's competence lower than the child did, there was a high level of agreement regarding which tasks were difficult for the child. Parents and children often did not agree about the specific selection or priority of these tasks for intervention, however, which highlights the need for further research.
With the increase in the number of multinational and multicultural research projects, the need to adapt health status measures for use in other than the source language has also grown rapidly. 1,4,27 Most questionnaires were developed in English-speaking countries, 11 but even within these countries, researchers must consider immigrant populations in studies of health, especially when their exclusion could lead to a systematic bias in studies of health care utilization or quality of life. 9,11 The cross-cultural adaptation of a health status selfadministered questionnaire for use in a new country, culture, and/or language necessitates use of a unique method, to reach equivalence between the original source and target versions of the questionnaire. It is now recognized that if measures are to be used across cultures, the items must not only be translated well linguistically, but also must be adapted culturally to maintain the content validity of the instrument at a conceptual level across different cultures. 6,11‐13,15,24 Attention to this level of detail allows increased confidence that the impact of a disease or its treatment is described in a similar manner in multinational trials or outcome evaluations. The term “cross-cultural adaptation” is used to encompass a process that looks at both language (translation) and cultural adaptation issues in the process of preparing a questionnaire for use in another setting. Cross-cultural adaptations should be considered for several different scenarios. In some cases, this is more obvious than in others. Guillemin et al 11 suggest five different examples of when attention should be paid to this adaptation by comparing the target (where it is going to be used) and source (where it was developed) language and culture. The first scenario is that it is to be used in the same language and culture in which it was developed. No adaptation is necessary. The last scenario is the opposite extreme, the application of a questionnaire in a different culture, language and country—moving the Short Form 36-item questionnaire from the United States (source) to Japan (target) 7 which would necessitate translation and cultural adaptation. The other scenarios are summarized in Table 1 and reflect situations when some translation and/or adaptation is needed. The guidelines described in this document are based on a review of cross-cultural adaptation in the medical, sociological, and psychological literature. This review led to the description of a thorough adaptation process designed to maximize the attainment of semantic, idiomatic, experiential, and conceptual equivalence between the source and target questionnaires. 13 . Further experience in cross-cultural adaptation of generic and diseasespecific instruments and alternative strategies driven by different research groups 18 have led to some refinements
This pilot study examined collaborative, goal-focused therapy to determine its effects on performance of self-care activities, including eating, grooming, bathing, upper body dressing, lower-body dressing, and toileting.
Thirty-one patients at a rehabilitation hospital, divided between control and experimental groups, comprised the sample. Participants' performances on self-care activities were measured using the Functional Independence Measure (FIM) at admission to therapy and again at a 2-week follow-up. Attainment of goals was not emphasized in the control group. In the experimental group, new goals and achievement of previously set goals were regularly discussed and documented. Comparisons were made between 2-week FIM scores of the control and experimental groups, and data were analyzed by the Mann-Whitney U test.
The experimental group demonstrated greater gains on FIM scores when compared to the control group on all self-care activities, but only upper-body dressing met levels of statistical significance.
Findings support the efficacy of collaborative, goal-focused occupational therapy in the treatment of deficits in upper-body dressing, but did not support this approach with toileting, eating, grooming, bathing, and lower-body dressing. Further study, with a larger sample, is recommended.
According to the existential philosophers, meaning, purpose and choice are necessary for quality of life. Qualitative researchers exploring the perspectives of people who have experienced health crises have also identified the need for meaning, purpose and choice following life disruptions. Although espousing the importance of meaning in occupation, occupational therapy theory has been primarily preoccupied with purposeful occupations and thus appears inadequate to address issues of meaning within people's lives.
This paper proposes that the fundamental orientation of occupational therapy should be the contributions that occupation makes to meaning in people's lives, furthering the suggestion that occupation might be viewed as comprising dimensions of meaning: doing, being, belonging and becoming. Drawing upon perspectives and research from philosophers, social scientists and occupational therapists, this paper will argue for a renewed understanding of occupation in terms of dimensions of meaning rather than as divisible activities of self-care, productivity and leisure.
Focusing on meaningful, rather than purposeful occupations more closely aligns the profession with its espoused aspiration to enable the enhancement of quality of life.
To test a theoretical model linking developmental coordination disorder (DCD) to reduced physical activity (PA) through the mediating influence of generalized self-efficacy regarding PA.
This was a cross-sectional investigation of students in grades 4 through 8 from 5 elementary schools in the Niagara region of Ontario, Canada (n=590). Motor proficiency was evaluated using the short-form Bruininks-Oseretsky Test of Motor Proficiency. Generalized self-efficacy was assessed using the Children's Self-Perceptions of Adequacy in and Predilection for Physical Activity scale, and PA levels were evaluated using a 61-item Participation Questionnaire. Structural equation modeling was used to test the influence of generalized self-efficacy on the relationship between DCD and PA.
In this sample, 7.5% (n=44) of the children met the requirements for probable DCD. The effect of DCD on PA was mediated by generalized self-efficacy. In this model, 28% of the variance in children's PA was predicted by generalized self-efficacy and DCD.
Our results suggest that children with DCD are less likely to be physically active and that generalized self-efficacy can account for a considerable proportion of this relationship. The implications for appropriate interventions to increase PA among children with DCD are discussed.
There is ample evidence that hypnosis enhances the effectiveness of psychotherapy and produces some astounding effects of its own. In this paper, the effective components and principles of hypnosis and hypnotherapy are analyzed. The "special" hypnotic and hypnotherapeutic effects are linked to the fact that the ecological requirements of therapeutic change are taken into account implicitly and/or explicitly when working with hypnotic trances in a therapeutic setting. The hypnotic situation is described--theoretically and in case examples--as a therapeutic modality that gratifies and aligns the basic emotional needs to feel autonomous, related, competent, and oriented. It is shown how the hypnotic relationship can help promote a sound ecological balance between these needs--a balance that is deemed to be a necessary prerequisite for salutogenesis. Practical implications for planning hypnotherapeutic interventions are discussed.
The Perceived Efficacy and Goal Setting System (PEGS) is an instrument and a process that enables children with disabilities to reflect on their ability to perform everyday occupations and to identify goals for occupational therapy intervention. In this study, 117 children with disabilities in grades 1-3 completed the PEGS with occupational therapists who work in school settings. Children from 6-9 years of age with a variety of disabilities were able to self-report perceptions of their effectiveness performing 24 activities that would be expected of them each day. Parents and teachers, who completed a parallel questionnaire, rated their abilities lower than the children did. The School Function Assessment, a measure of the amount and type of support required for school participation, had low correlations with the Parent and Teacher PEGS questionnaires and did not correlate with the Child PEGS. No differences in perceived efficacy were found for children across grades or gender; however, differences were found across types of disabilities. Children were able to use the perceived efficacy information to identify and prioritize goals for intervention and these goals remained stable 2 weeks later. Occupational therapists can use the PEGS within a client-centered practice to help the child set goals for therapy and to incorporate explicitly the perspectives of parents and teachers.
Goal setting has been described as the core skill of rehabilitation professionals, but there is little information about patients understanding of goal setting. This study explored how in-patients with neurological impairments experienced two different types of goal setting and identified the issues that underpin individuals' experience of goal setting.
The study took place in a neurological rehabilitation unit in which two approaches to goal setting were being used that differed in the amount of patient involvement. A qualitative research design was adopted. Six focus groups were convened, three for participants experiencing usual participation and three for those with increased involvement in goal setting. A total of 28 participants (12 women, mean age 49 years) with a variety of deficits were recruited to the study over nine months. Thematic analysis was used to analyse the focus group transcripts.
Four themes were identified which impact on the ways in which in-patients make sense of goal setting: The rehabilitation process; personal response to goal setting; previous experience and disease limitations.
Healthcare professionals working in rehabilitation need to explore patients' understandings of their disease and their experiences and expectations of goal setting to ensure goal setting is a meaningful activity.
This paper is a description of inductive and deductive content analysis.
Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method.
When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge.
Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.
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