Occupational therapy experiences of interprofessional collaboration in the support of autistic children

INTRODUCTION

Autistic children commonly receive simultaneous services from various health-care and other professionals, including occupational therapy, throughout their journey of diagnosis and consequent therapeutic support. Current best practice guidelines for supporting autistic youth emphasise the importance of interprofessional collaboration. Despite this, collaboration among health-care professionals does not always occur, and little is understood about clinicians' experiences of collaborative care. The aim of this study was to explore Australian paediatric occupational therapists' experiences of interprofessional collaboration and their perception of factors influencing collaboration when supporting autistic children.

METHODS

This study employed an exploratory qualitative descriptive design. Semi-structured interviews were conducted with 13 Australian paediatric occupational therapists involved in service provision to autistic children. Questions explored clinicians' experiences and perceptions of interprofessional collaboration. Reflexive thematic analysis was used to inductively analyse data.

CONSUMER AND COMMUNITY CONSULTATION

This study was conceptualised and conducted by a team of researchers with a range of personal and professional experiences with the autistic community. The research design was strongly informed by the Autism CRC'S research guidelines.

FINDINGS

Three themes were generated highlighting factors that influence collaboration between occupational therapists and other professionals. The first emphasised that 'clinicians' capacity to collaborate' at both organisational and individual levels was understood to be greatly influenced by funding structures. The second emphasised that 'relationships are key to collaboration' with these often established through shared workplaces or clients. The third, 'shared perceptions make collaboration easier' described how shared perceptions of collaboration, the occupational therapy role, and autism-related frames of reference were perceived to influence interprofessional collaboration.

CONCLUSION

Findings indicate that, while occupational therapists perceive interprofessional collaboration as valuable in the support of autistic children, there are barriers to effective collaboration, particularly in the context of a marketised service delivery model.

PLAIN LANGUAGE SUMMARY

This study looked at how Australian occupational therapists work with other professionals to support autistic children. Even though it is recommended that professionals work together to support autistic children and their families, this does not always happen. In this study, researchers interviewed 13 occupational therapists and asked what it is like working with other professionals, what is helpful, and what makes working together difficult. From these interviews, it was found that many things affect how well occupational therapists can work with other health professionals and teachers to support autistic children. Factors like funding and workplace rules affect how professionals work together. Having someone take on the role of leader and having good relationships between professionals made it easier to work together. It was also helpful when occupational therapists and other professionals shared similar ideas on how to support autistic children. The study could be improved if it had gathered more information about the occupational therapists' education and what they have learnt about working with other professionals. Overall, the therapists in this study believed that working together to support autistic children and their families was important, but that there are many challenges to making this happen. More research on this topic would be helpful.

Initial evaluation of an environment-based intervention for participation of autistic children: a randomized controlled trial

PURPOSE

To evaluate the efficacy of environment-based intervention on participation outcomes and parent efficacy in autistic children.

MATERIALS AND METHODS

Twenty-one autistic children 6-10 years old and their parents were randomized to environment-based intervention (n = 11) or usual care (n = 10). The environment-based intervention targets individualized participation goals in leisure and community activities through changing environment and activity demands. The study outcomes were Canadian Occupational Performance Measure (COPM), Goal attainment scaling (GAS), and Parent Empowerment and Efficacy Measure (PEEM). Assessments included baseline, 12 weeks (post-test), and 24 weeks (follow-up). Mixed ANOVAs were used to examine within-group and between-group effects in outcome variables.

RESULTS

The COPM performance and satisfaction scores and GAS T-scores increased after environment-based intervention from baseline to 12 weeks and 24 weeks (p < 0.001) but did not significantly differ from usual care. The medium to large effect sizes of COPM performance and GAS T-scores favored the environment-based intervention. For the PEEM scores, no significant differences were found.

CONCLUSIONS

Environment-based intervention may support school-age autistic children to participate in self-chosen activities over time. The intervention effects on participation goals and parent efficacy, however, were inconclusive and need further research.

Inclusion of autistic students: promising modalities for supporting a school team

PURPOSE

School staff who work with autistic students are at a high risk of exhaustion. More training and guidance are needed to enable them to respond to these students' needs. The purpose of this study was to design and evaluate a professional development program offered by an occupational therapist to help a team of school staff facilitate the participation of autistic students and their peers.

METHODS

A design-based research approach guided the development and evaluation of the modalities of the program. A case study was conducted in a school with nine school staff members using individual interviews, questionnaires, and a logbook.

RESULTS

The program comprised five modalities: regular presence of the occupational therapist, a needs analysis, content focused on the features of an inclusive school, individual coaching, and team coaching. The following elements emerged as particularly helpful for the participants: frequent interactions with the occupational therapist, opportunities to collaborate, personalized support, experimentation of new practices with the occupational therapist, and concrete training content that can benefit all students.

CONCLUSION

The modalities of the program appear promising to help a school team facilitate the participation of all students, including those who are autistic.Implications for rehabilitationOccupational therapists can help school teams to facilitate the participation of autistic students and their peers.A combination of individual and team coaching sessions appears promising in helping school staff adopt practice changes to make their school more inclusive.Using a multi-tiered approach can help therapists collaborate with school staff members to first find solutions that will be applicable with all of their students.

Evidence for Implementing Tiered Approaches in School-Based Occupational Therapy in Elementary Schools: A Scoping Review

IMPORTANCE

Internationally, it is suggested that school-based occupational therapy (SBOT) has an important role in supporting inclusion in educational settings. In SBOT, multitiered service delivery models are identified as a way forward to maximize school inclusion. Therefore, identifying evidence for the implementation of tiered interventions in SBOT is vital.

OBJECTIVE

To identify and map evidence in the occupational therapy literature relating to SBOT interventions delivered in elementary schools for all children, for those at risk, and for those with identified diagnoses.

DATA SOURCES

Peer-reviewed literature published in 14 occupational therapy journals between 1990 and 2020, indexed in the EBSCOhost database.

STUDY SELECTION AND DATA COLLECTION

Included studies were those within the scope of SBOT that reported on school occupations and focused on elementary school-age children (excluding kindergarteners or preschoolers).

FINDINGS

Forty studies met the criteria. Individual-tier intervention studies (n = 22) primarily reported direct interventions with children at risk or with identified diagnoses (Tier 2 or Tier 3), focusing mostly on remedial approaches. None adopted a whole-school approach. Despite handwriting and self-regulation being dominant areas of concern, these studies were not explicitly related to inclusion outcomes. Evidence for implementing multitiered models primarily used indirect, collaborative consultation, embedded in the school context (n = 18). These studies identified positive school staff and child outcomes when collaboration was timely, consistent, and authentic.

CONCLUSIONS AND RELEVANCE

More rigorous individual-tier intervention studies are required to inform the design and implementation of multitiered interventions in SBOT and to support participation and inclusion in schools. What This Article Adds: This scoping review provides evidence to support occupational therapists' professional reasoning in developing evidence-based, contextual, educationally relevant multitiered models of intervention in SBOT.

Sensory Integration Training and Social Sports Games Integrated Intervention for the Occupational Therapy of Children with Autism

This paper presents a research design for an integrated intervention using sensory integration training fused with social sports games for the treatment of children with autism. This study used a multiple baseline cross-subject design in a single-subject experiment, with structured play as the independent variable and expressive language skills of children with autism spectrum disorders as the dependent variable, with three phases of intervention: baseline, intervention period, and maintenance period. The expressive language ability was examined in terms of both oral expression and gestural expression, where the intervention effect of the oral expression was analyzed in terms of four components: the total number of words, the total number of sentences, average sentence length, and vocabulary complexity of oral expression, and the intervention effect of the gestural expression was analyzed in terms of changes in the frequency of children's gestural expression behaviors. For the categories classified by sensory integration ability, there are corresponding specific training programs that combine various physical exercises and play equipment to train the various abnormal functions of children with autism. Stereotyped behavior is a repetitive, self-imposed, and purposeless physical action, usually in the form of continuous and repetitive movements, sounds, and so on. 4 times a week, 25 minutes each time, the activity of recognizing pictures and familiar objects is carried out first, and then the children choose the structured game model and the initiative to build and take turns with the researchers to build. Stereotypic behaviors cause a great deal of distress in the lives of children with autism, and it is necessary to explore how to implement positive and effective interventions. Subjects' play abilities developed after receiving effective critical response training. The subjects' practice and symbolic play showed good immediate and maintenance intervention effectiveness; their associative and functional play showed no significant intervention effectiveness. The enhancement of the sensory integration skills of children with autism through sensory integration training resulted in a relative reduction of stereotypic behavior about the stimulus-seeking function, which had a positive effect on the intervention of stereotypic behavior.

Health professional-educator collaboration in the delivery of school-based tiered support services: A qualitative case study

BACKGROUND

Educators and health professionals support the learning and participation of diverse children in school environments. Tiered approaches to service delivery may assist these efforts through consideration of universal supports that are useful to all children, targeted supports for some children and individualized supports for the smallest number of children. This study explored how an interprofessional team worked with educators to develop and implement tiered services in two school communities where many families experience economic and social disadvantages.

METHODS

Using a participatory action research approach and qualitative case study methods, the research and stakeholder teams jointly designed and conducted this study in two schools during the 2017-2018 school year. Data collected included weekly logs written by the interprofessional team members and 16 interviews conducted with team members, parents, educators and administrators.

RESULTS

The team provided a variety of services to individual students, groups, whole classes and the school community. Collaboration and communication were needed to define roles and expectations and to plan and share student information. Reported benefits included timely service, capacity building and student goal achievement. The main barriers were related to service fragmentation, time and workload.

CONCLUSIONS

Recommendations included clearer direction about expectations and improved coordination within the systems that offer services. Further research should include exploration of comparative cases with varying contexts, the inclusion of child perspectives and direct observation.

Implementing Partnering for Change in Québec: Occupational Therapy Activities and Stakeholders' Perceptions

Background.

The occupational therapy school-based Partnering for Change (P4C) model has mostly been documented in Ontario.

Purpose.

This implementation study describes the implementation of P4C in two Québec elementary schools (P4C-Q), as well as therapy practices, their impacts, factors perceived to influence implementation, and recommendations.

Method.

A sequential mixed-methods design was applied. Therapists (n=2) completed daily journals, describing activities by P4C-Q level. Therapists and other school-stakeholders (n=11) participated in semi-structured interviews, analyzed through a content analysis framework.

Findings.

Daily journals illustrated that the majority of therapy time was spent on activities targeting the entire classroom, and on collaboration with educators. Interviews illustrated how coaching was used across different practices and the impact of these practices for schools (e.g., capacity-building) and children (e.g., increased functioning), and highlighted how relationship-building is key to facilitating the implementation of this model.

Implications.

Lessons learned may be helpful for others implementing P4C in their own contexts.