Module 1: Best Practice and Treatment Planning in Occupational Therapy with Children and Youth

What is “best practice” in occupational therapy with children?

• Child and Family-centered

• Comprehensive evaluation

  • Occupation centered (i.e., how does the child engage in occupation? e.g., play, school, education, dressing, feeding, etc.)

• Effective Intervention (evidence based)

  • Enhance child’s performance

  • Provide the “just right challenge”

  • Adapt activities and/or modify the environment

  • Consult, educate and advocate

• Support Inclusion

  • Within the child’s natural environment

• Follow Professional Practice Standards (NBCOT)

Domain 1: Client-Centered Care

Maximize occupational performance for individuals and populations while embracing diversity in roles, habits, routines, values, beliefs, expressed needs, and preferences through engaging in a process of ongoing client collaboration

Domain 2: Interprofessional Teams

Cooperate, collaborate, communicate, and integrate care in teams to ensure that services are reliable and effective

Domain 3: Evidence-based practice

Integrate the best available research with clinical expertise and client values for optimum care

Domain 4: Quality Improvement

Design and implement processes and interventions to continually measure and refine quality of care for improved client and program outcomes

Domain 5: Informatics

Use data and information technology to manage and communicate client information to improve the delivery of occupational therapy services

• need to know how to score manually —> and then, move onto electronic

• also need to know how to electronically document things

Domain 6: Professional Responsibility

Elevate occupational therapy practice through communicating the value of occupational therapy services, advancing clinical competence, and adhering to professional and ethical codes of conduct

Interventions enhancing cognitive development

• Therapist-led interventions with premature infants

  • Clinic and home-based interventions

• Therapist-led interventions with Preschoolers

  • Parent education and interactions

  • Touch interventions

    • i.e., something in the sensory realm (e.g., desensitization of the skin, proprioceptive input)

  • Other interventions

• Interventions implemented by a Preschool Team

  • Early literacy programs

  • Reading books

  • Other interventions

Interventions supporting mental health and positive behavior

• Touch-based interventions

  • Kangaroo Care and Skin-to-skin (i.e., putting baby on the bare-chest of mom or dad)

  • Massage

• Parent-child interaction therapy

  • to create bonding and communication

• Instruction-based interventions

  • Parent training: parenting behavior, child behavior, parental mental health, child mental health, and infant sleep

• Group-based parent training

• Preschool teacher training

Interventions supporting motor development

• EI for children 0-3

  • Premature infants

  • Parent-implemented home-based interventions

    • e.g., education/training of the parents

  • Combined clinic and home-based interventions

    • used if home treatments are not enough (e.g., need clinic equipment/technology)

  • Massage

  • Caretoy

  • Other interventions

  • See Table 1

Interventions for Preschool Children Ages 3–5 Years

• Video games

  • can be used if motivating for the child

  • but still not the best intervention traditionally; still probably better for the child to use basic toys in which the child must engage w/ their imagination, cause and effect perception, etc.

• Programs emphasizing motor skills

• Movement

• Sensory-based interventions

Interventions for Children With or At Risk for CP
Ages 0–5 Years

• EI programs

• Constraint-Induced Movement Therapy and Bimanual Intensive Therapy

  • constrain the unaffected side

• Child- and Context-Focused Interventions

• Hippotherapy

• Other Interventions

Interventions Supporting Activities of Daily Living, Rest, and Sleep

Feeding and Eating

• Repeated exposure

• Nonnutritive suck

  • give pacifer, chewy toy, etc. to work on their oral motor skills

• Parent training

• Tube feeding weaning

Toileting

• Caregiver education

• Multidisciplinary approach in CP

Rest and Sleep

• Parent training for infants and young children

• Touch-based interventions

• Positioning devices

Activity- and Occupation-Based Interventions to Improve Activities of Daily Living, Instrumental Activities of Daily Living, Play and Leisure, and Rest and Sleep

• Activities of Daily Living (ADL’s)

  • Functional physical activity

  • Task-oriented training

    • e.g., need to work on dressing? practice donning the shirt over and over

  • Cognitive-based interventions

  • Technology-based interventions

• Instrumental Activities of Daily Living (IADL’s)

  • Health Maintenance and Management

  • Physical Activity and Fitness

  • Diet and Nutrition

  • Health Routines and Wellness

  • Safety, Driving, and Communication Management

• Play and Leisure

  • Cognitive-behavioral Interventions

  • Computer and Technology Interventions

  • Structured and Guided Play Participation

• Rest and Sleep

Activity- and Occupation-Based Interventions to Improve Mental Health, Positive Behavior, and Social Participation

• Occupations and Life Skills Training

• Outdoor Groups and Camps

• Play

• Sports Activities

• Video and Computer Games

• Yoga

• Meditation

• Animal Assisted Interventions (i.e., emotional support animals)

• Creative Arts

Activity- and Occupation-Based Interventions to Improve Learning, Academic Achievement, and Successful Participation in School

• Educational Participation

  • Stability balls

    • sit the child on a therapy ball, so that they can get some movement while still attending to class

  • Weighted vests

  • Yoga

• Social Participation

  • Peer mediation

  • Manualized programs

• Animal-assisted activities

• Physical Activity

  • Activity- and Interaction-Based Programs

  • Context modifications

  • Video games

• Literacy participation

  • Embedded and Supplemental Creative Literacy Activities

  • Parent coaching

  • Peer tutoring

• Handwritin

  • Visual Perception, Kinesthesis, and Motor Skills

  • Sensorimotor Versus Therapeutic Practice Approaches

  • Combined Sensorimotor and Therapeutic Practice Approaches

Current Views of Best Practice in Early Intervention and School Based Settings (Handley-More et al., 2013)

5 Best Practices

• Providing contextual services (may need to teach the skill in isolation —> but then, must gradually change the environment so the child is learning to do it in their contextual situations)

  • Occupational therapy within the child’s:

    • Natural environment

    • Daily activities

    • Daily routines

  • Best practice for promoting early learning

• Participation-based evaluation, goals, and services

• Collaborative occupational therapy services

• Mental health

• Secondary school transitions

Participation-Based Evaluations, Goals, and Services

begin

• Begin the evaluation process with a participation-based reason for referral

—> utilize

• Utilize participation-based evaluations

—> —> write

• Write goals that address participation in natural environments

—> —> —> provide

• Provide services that promote participation through activity selection or environmental modification

is the child actively particapting in this activity the way this goal is written?

• no, it’s passive (all the child has to do is maintain an upright sitting posture)

rewritten goal

• child must sit for 5 mins

• during an activity

• shows effort that must be maintained while having an upright posture

Collaborative Occupational Therapy Services

• Shared responsibilities, decision making and goals with multiple disciplines

• Hanft & Shepherd (2008) concluded:

  • Added benefits to collaborative interventions

  • Effective collaboration is established via blended services, team communication, respect, sharing of information and resources, and using evidenced-based practices

Mental Health

• Support the emotional well-being, mental health, and social competence of children

• EI therapists assist parents in developing routines, utilizing positive behavioral supports, and facilitating independence and self-efficacy.

• Zero to Three Policy Center (2004): center that does a lot of research on kids aged 0-3 (early intervention)

  • Healthy social-emotional development in early childhood is as important to school readiness as literacy, language, and number skills.

• School-based therapists collaborate with teachers to develop classroom strategies, individualized schedules and routines, and facilitate participation in recess to support social participation of all students

Secondary School Transitions

• IDEA stipulates that special education and related services are intended to prepare students with disabilities for ‘further education, employment, and independent living’ (601(d))

  • law to follow when working with kids

  • prepare kids not just for education, but for them to integrate into the community even after school (skills should be able to carry these skills throughout life)

• Best practices in transition include interventions that promote work experiences in the community, family involvement, social skill development, independent living skills, self-determination, employment preparation, and community collaboration (Landmark et al., 2010)