Shifts in Parent–Therapist Partnerships: Twelve Years of Change

Level of Family centered care and associated factors among parents of children with cancer at tertiary level hospital, Ethiopia

OBJECTIVE

To determining level and factors affecting Family Centered Care (FCC) in pediatric oncology unit of Tikur Anbessa Specialized hospital (TASH), Ethiopia.

METHOD

A cross sectional study was conducted from June to December 2022. Three hundred ninety-three parents of children with cancer were consecutively interviewed using Measure of Processes of Care (MPOC-20). Multivariable linear regression was used to identify independent predictors of FCC.

RESULT

The total MPOC 20 means was 3.71(SD = 1.04). The mean score for respectful and supportive care, coordinated and comprehensive care, enabling and partnership, providing specific information and providing general information were found to be 4.8, 4.6, 3.7, 2.3 and 2.6, respectively. Family employment (-0.33(95% CI = -0.63, -0.03; P = .029)), low family education (-0.40 (95% CI = -0.70, -0.11; P = .008)), referral cases (-0.37(95% CI = -0.59, -0.14; P = .001)), shorter time spent in hospital (-0.49(95% CI = -0.85, -0.12; P = .010)) and psychological distress (-0.01(95% CI = -0.026, -0.001; P = .028)) were associated with lower mean score of FCC.

CONCLUSION

The total FCC mean score was found to be low. From the five FCC components providing general and specific information scored the lowest mean level.

PRACTICE IMPLICATIONS

Mechanism to improve information delivery that address parents from different background and referred from other health facility should be in place in order to improve FCC level. In addition, the FCC should be designed to address parents of children with different lengths of stay.

Exploration of the Influential Factors on Adherence to Occupational Therapy in Parents of Children with Cerebral Palsy: A Qualitative Study

BACKGROUND

Cerebral palsy (CP) is the leading cause of permanent disability in children. Occupational therapists serve a primary role in the rehabilitation of children with CP. Poor adherence to treatment is common. The aim of this study is to explore the viewpoint of occupational therapists on factors which impact adherence to occupational therapy (OT) interventions among parents of children with CP.

MATERIAL AND METHODS

A qualitative approach using semi-structured interviews were employed. Our participants were recruited by purposive sampling among occupational therapists who were working in Kermanshah province, western Iran. The interviews were taped and transcribed. Content analysis using constant comparison was performed.

RESULTS

The mean age of our participants was 34.23±7.50. Four main categories with specific subcategories emerged as important in affecting adherence. The first category of child and family-related factors described factors such as the clinical status of the child and family composition. These factors had the potential for both improving and reducing adherence to treatment. The second category of therapist-related factors described the effect of appropriate professional skills of the therapist on improving adherence and included clinical competency, communication skills, and job satisfaction. The third category of environmental factors addressed factors such as cultural views of child disability and access to OT interventions. The category mostly emphasized environmental barriers to adherence to treatment. The fourth category of therapy-related factors described barriers such as the type of therapy, and the length of treatment.

CONCLUSION

Adherence to OT interventions in parents of children with CP can be influenced by several factors. These factors range from child and family-related factors to therapy-related factors and have the potential for both positively and negatively affecting adherence. Programs to improve adherence should address these factors together.

The Home Program Evaluation Questionnaire - HoPE-Q - for Infants with Hemiplegic Cerebral Palsy: Development and Psychometric Properties

To develop and examine the psychometric properties of the Home Program Evaluation Questionnaire (HoPE-Q), a novel tool designed to assess the effectiveness of home treatment programs for infants with hemiplegia. The HoPE-Q includes a pre- and a postintervention version and items that relate to Child's Function, Parents' Competence, and their Expectations and Satisfaction from the program. The research was performed in three stages. The first stage consisted of item construction and content validity, followed by the analyses of the tool's reliability and construct validity. The final stage involved the examination of the tool's sensitivity to determine its suitability as an outcome measure of the effectiveness of home programs for infants with hemiplegia. Results showed moderate-to-high internal consistency (α = 0.65-0.85) and high test-retest reliability in Child's Function and Parents' Competence (r = 0.75, r = 0.76) respectively (p = 0.01). Evidence for Construct Validity, was demonstrated by significant group difference in the Child's Function (t_(74)=-12.3, p ≤ 0.001) and Parents' Competence (t_(68) = -3.7, p = 0.01), and high sensitivity to change after treatment was presented in Child's Function (F_(32,1) = 49.38) and Parents Competence (F_{(32,1) =} 26.72) (p ≤ 0.001). Preliminary data support the validity and reliability of the HoPE-Q as well as its suitability as an outcome measure, thereby providing a means of examining the effectiveness of home intervention programs for infants with hemiplegia.

Effects of a Collaborative Intervention Process on Parent-Therapist Interaction: A Randomized Controlled Trial

Aim: To determine whether a collaborative intervention process facilitates parent-therapist interactions. Methods: Participants were 18 children with physical disabilities, their mothers, and 16 physical therapists. Therapists randomized to the experimental group were instructed in strategies for collaboration (working together) with parents in goal setting, planning, and implementing interventions. Family-therapist dyads participated in 6 weekly sessions. Four sessions were videotaped and combined (1st and 2nd for goal-setting/planning, 3rd and 5th for implementation) to code behaviors using Response Class Matrix. Multivariate analysis of variance was used to compare therapist and parent behaviors between groups. Results: Therapists in the experimental group demonstrated a higher frequency of "seeking information" (p < 0.01), "giving information" (p < 0.05), "positive behavior" (p < 0.01) and lower frequency of "child-related behavior" (p < 0.001) than therapists in the comparison group during goal-setting/planning and implementation. Parents in the experimental group demonstrated a higher frequency of "giving information" than parents in the comparison group (p < 0.01) during goal-setting/planning and implementation. Conclusion: Parents and therapists in the experimental group interacted more with each other, whereas those in the comparison group focused more on the child. The collaborative strategies appear to have increased parent participation in the intervention process, which has been a challenge for physical and occupational therapists.

Determinants of parent-delivered therapy interventions in children with cerebral palsy: A qualitative synthesis and checklist

INTRODUCTION

Parent-delivered therapy interventions for children with cerebral palsy can help achieve a sufficient therapy dose, improve parental mental well-being, and facilitate parent-child relationships creating a more relaxed familial environment. However, parent-delivered interventions may also lead to increased parental stress, guilt if the therapy is not delivered, and time constraints. The primary aim of this review was to gain a deeper understanding of the determinants of effective parent-delivered therapy interventions.

METHOD

Searches were conducted in the following databases: Medline, PubMed, Scopus, Embase, CINAHL, and Cochrane. Studies had to meet the following inclusion criteria: descriptions of parent/health care professional/child experiences of parent-delivered therapy interventions for children and young people age 0-18 years with cerebral palsy, published in the English language between January 1989 and May 2017, with qualitative or mixed methods research design. The articles were critically appraised, then synthesized using a meta-ethnographic approach.

RESULTS

A literature search identified 17 articles, which met the inclusion criteria. Three main themes were identified: (a) building trusting relationships, (b) enabling the parents to cope, and (c) for parents and health care professionals to see the intervention as a priority. Further synthesis presented three concepts identifying the important aspects of the interventions: empowerment, motivation, and relationships.

CONCLUSIONS

The themes and concepts emerging from this qualitative synthesis can be addressed by specific points of action to support parent-delivered therapy interventions. We have summarized these in a checklist for use by intervention developers, health care professionals, and parents.

Psychometric Properties of the Parents as Partners in Intervention (PAPI) Questionnaires

This article describes two studies that focused on parents' expectations and satisfaction with occupational therapy intervention for their children (N = 208). The first study determined the psychometric properties of the Parents as Partners in Intervention (PAPI) Questionnaire set (n = 146). The 2nd study examined parental expectations, satisfaction, and perception of their child's functional gains from individual- (n = 30 parents) and group- (n = 32 parents) based interventions. Overall, the results of these studies further support the PAPI Questionnaire set's validity and reliability and suggest that parents' expectations are high and not necessarily in line with their actual satisfaction with the outcomes of their child's intervention and functional gains.

Occupational Therapy for Children with Attention Deficit Hyperactivity Disorder (ADHD), Part 1: A Delineation Model of Practice

An occupational therapy delineation model of practice is presented, which guides a multidimensional understanding of the psychopathology of attention deficit hyperactivity disorder (ADHD) and its management. Previous research has established that occupational therapists lack detailed training or theory in this field. The delineation model of practice is based on a literature review, clinical experience and a consensus study carried out with occupational therapists to determine their priorities for the evaluation of, and intervention with, children with ADHD.

Part 1 of this article presents the model and examines its implications for evaluation and intervention at the levels of child, task and environment. A family-centred assessment and treatment package, based on the delineation model, is described. Part 2 of this article will report the results of a multicentre study, which was designed to evaluate the effectiveness of this package.

The International Classification of Functioning, Disability and Health provides a Model for Adaptive Seating Interventions for Children with Cerebral Palsy

Children with severe types of cerebral palsy use adaptive seating systems to encourage function and assist in delaying the development of deformity. These systems are often assessed for and provided by occupational therapists. However, there has been no unifying policy or theoretical basis on which these systems are provided and research evidence is lacking, with studies tending to be small and non-controlled.

The International Classification of Functioning, Disability and Health (World Health Organisation 2001a,b) aims to establish a common language for clinical practice as well as research, while bringing together the opposing social and medical models of health care delivery. This paper suggests that the ICF model is an ideal theoretical basis for adaptive seating system assessment and provision, given that these systems often conflict between the medical model of reducing or delaying impairment of body functions and structures and the social model of children and families accessing life and environmental situations through mobility and seating equipment.

The paper considers all the domains of the ICF with regard to the current literature. It concludes that using the model in the context of providing adaptive seating gives occupational therapists both a powerful tool for communicating with children and families as well as managers and a basis for evaluating practice.

Scenes of fathering: The automobile as a place of occupation

OBJECTIVE

While occupations are increasingly analyzed within contexts, other than the home, the ordinary places that facilitate occupations have been overlooked. The aim of this article is to explore the automobile as a place of occupation using data from an ethnographic study of fathers of children with disabilities.

METHODS

Qualitative data obtained through observations and interviews with the fathers and their families were analyzed using a narrative approach. Properties that influence interactions include opportunities to communicate, the vehicle itself, and electronics.

RESULTS

Driving children in the automobile fulfills fathering responsibilities and is a time for connecting. For the fathers in this study, the automobile represents a place for negotiating complex demands of fathering.

CONCLUSIONS

This study demonstrates not only the importance of the automobile, but also the influence of the immediate space on the construction of occupations.

Assessment of knowledge of Iranian occupational therapists of handling of children with cerebral palsy

The purpose of this study was to assess the knowledge of Iranian occupational therapists regarding the handling of children with cerebral palsy and the application of their knowledge into practice. A questionnaire with two scales of a self-report and a knowledge-based test was designed. Data were analysed by using descriptive statistics and Spearman correlation. Of 77 participants, 64.9% participants reported their knowledge of handling at moderate, 14.3% at low and 6.5% at very low level. The result of the test showed that 57.1% participants had knowledge at moderate and 16.9% at low level. Toileting and bathing are the least focused areas by occupational therapists in teaching handling techniques to caregivers. These results suggest that the participants need further training to increase their knowledge in the various areas of handling and positioning techniques especially toileting and bathing. Because participants were from one area of Iran, future research could include a larger population of occupational therapists.

Working alliance development in occupational therapy: a cross-case analysis

BACKGROUND

Despite reverence afforded the therapeutic relationship construct in occupational therapy, many occupational therapists feel ill equipped to use themselves therapeutically to enhance the relationship with their clients. Furthermore, although occupational therapists often link the strength of the therapeutic relationship to therapy outcomes, related occupational therapy specific research has been limited. According to the psychotherapy literature, the working alliance is one element of the therapeutic relationship which has in fact been linked to therapy outcomes.

METHODS

A mixed-methods, prospective, multiple case study approach was used to compare the experiences of the working alliance by both occupational therapists and clients across four therapeutic dyads.

RESULTS

Several key elements were identified in this study's qualitative data as shaping the process of alliance development in occupational therapy including: the fostering of an interpersonal connection; the use of humour as therapeutic modality; an impetus to act that leads to functional enhancements; a shared sense of success and a positive feedback mechanism created through successfully attaining clearly delineated, client-centred therapy goals.

CONCLUSIONS

By considering these identified elements, occupational therapists may focus upon tangible considerations towards enhanced therapeutic use-of-self in the development of sound working alliance with their clients potentially improving therapy outcomes.

Life Participation for Parents: A Tool for Family-Centered Occupational Therapy

OBJECTIVE. This study describes the continued development of the Life Participation for Parents (LPP), a measurement tool to facilitate family-centered pediatric practice.

METHOD. LPP questionnaires were completed by 162 parents of children with special needs receiving intervention at 15 pediatric private practice clinics. Results were analyzed to establish instrument reliability and validity.

RESULTS. Good internal consistency (α = .90) and test–retest reliability (r = .89) were established. Construct validity was examined through assessment of internal structure and comparison of the instrument to related variables. A principal components analysis resulted in a two-factor model accounting for 43.81% of the variance. As hypothesized, the LPP correlated only moderately with the Parenting Stress Index–Short Form (r = .54). The variables of child’s diagnoses, age, and time in therapy did not predict parental responses.

CONCLUSION. The LPP is a reliable and valid instrument for measuring satisfaction with parental participation in life occupations.

Occupational therapy home program for children with intellectual disabilities: a randomized, controlled trial

This study aimed to investigate the effectiveness of a proposed occupational therapy home program (OTHP) for children with intellectual disabilities (ID). Children with ID were randomly and equally assigned to OTHP or to no OTHP groups. The primary outcome measures were Canadian Occupational Performance, Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, and The Children's Assessment of Participation and Enjoyment scores at 10 and 20 weeks. The 20-week OTHP produced significant difference in fine motor function, activity participation, and parent satisfaction with performance, compared to those of no OTHP. Pediatricians can advise families to implement 20 weeks of OTHP with an average 15 min per session to facilitate functional changes of children with ID.

Practitioners' Use of Interpersonal Modes within the Therapeutic Relationship: Results from a Nationwide Study

Although occupational therapy literature emphasizes the importance of therapeutic use of self, there have been few studies of the interpersonal strategies used in response to different client needs. This study sought to explore therapists' use of self according to the Intentional Relationship Model by examining the use of different modes of interacting with clients. A questionnaire was mailed to a random sample of 1,000 practicing occupational therapists. Sixty-four percent responded and 563 met inclusion criteria. Modes used most to least often were: encouraging, collaborating, problem-solving, instructing, and empathizing. Mode use did not differ according to client population. Therapists who experienced more difficult behaviors and emotions reported higher levels of using all modes. Therapists facing difficult behavior in general were more likely to report use of the instructing and problem-solving modes. Therapists with anxious clients reported greater use of the problem-solving mode, whereas therapists with depressed clients reported increased use of problem-solving, collaborating, and empathizing modes. Implications for occupational therapy practice and education are discussed.

Efficiency of the home parental programme in visual-motor home activity among first-grade children

BACKGROUND

The objectives of this study were to assess the efficacy of the home parental programme (HPP) in improving children's visual-motor skills, and to assess parent satisfaction with the programme.

METHODS

Forty-five children and their parents participated in the study: 23 children and their parents in the study group (children receiving consultation in the classroom and whose parents participated in the HPP) and 22 children and their parents in the control group (children receiving consultation in the classroom only). All children were recruited based on their scores on the Visual Motor Integration test or upon teacher referral. The Developmental Test of Visual Perception-2 administered before and after intervention served as an outcome measure. HPP lasted approximately 12 weeks and included relevant visual-motor activities carried out at home by the parents with their children.

RESULTS

The study failed to prove that HPP improved children's visual-motor skills beyond the other service delivery methods used in the present study.

CONCLUSIONS

Parent satisfaction was significantly higher among those who participated in the HPP. Parents showed high compliance with the friendly programme despite their low socio-economic status.

Occupational therapy home programs for cerebral palsy: double-blind, randomized, controlled trial

OBJECTIVE

The goal was to assess the effectiveness of an occupational therapy home program (OTHP), compared with no OTHP, with respect to function and parent satisfaction with child function, participation, goal attainment, and quality of upper limb skill in school-aged children with cerebral palsy.

METHODS

Thirty-six children with cerebral palsy (mean age: 7.7 years; male: 69%; Gross Motor Function Classification System: level I, 47%; level II, 14%; level III, 16%; level IV, 7%; level V, 16%; spasticity, 85%; dyskinesia, 14%; ataxia, 3%) were randomly and equally assigned to OTHPs for 8 or 4 weeks or to no OTHP. The primary end point was Canadian Occupational Performance Measure scores 8 weeks after baseline. Secondary measures were recorded at 4 and 8 weeks.

RESULTS

Eight weeks of OTHP produced statistically significant differences in function and parent satisfaction with function, compared with no OTHP. Parents in the 4-week OTHP group did not discontinue use at 4 weeks, as instructed, and continued for 8 weeks; results demonstrated statistically significant differences, compared with no OTHP. There was no difference in primary or secondary end point measures between intervention groups.

CONCLUSION

Pediatricians can advise families that OTHPs developed with a collaborative, evidence-based approach and implemented by parents at home were clinically effective if implemented 17.5 times per month for an average of 16.5 minutes per session.

Measuring outcomes of family-centered intervention: development of the Life Participation for Parents (LPP)

Raising a child with disabilities impacts the ability of parents to participate in life situations. This paper describes the development of a new instrument, Life Participation for Parents, to measure outcomes of pediatric therapy on parental participation. Items were reviewed by six occupational therapists with experience in pediatrics and instrument development. The number of items was reduced to 23. The resultant instrument was completed by 29 parents of children with disabilities. Their scores were reviewed by the nine occupational therapists working with the children. Parent and therapist respondents were interviewed regarding item content. Instrument responses were evaluated for internal consistency. The respondents confirmed the face and content validity of the construct, variability in responses, and readability of the items. Good internal consistency for items was demonstrated (Cronbach's alpha .85). The preliminary results indicate that the Life Participation for Parents is a promising tool for evaluating parental issues and measuring parent outcomes in family-centered practice.

Relationship between parental PODCI questionnaire and School Function Assessment in measuring performance in children with CP

Little data exists assessing the relationship between functional limitations in children with cerebral palsy (CP) and their participation in everyday activities. This prospective study evaluates the relationship between the Pediatric Outcomes Data Collection Instrument (PODCI), a functional health-related quality of life instrument for children and their parents, and the School Function Assessment (SFA), a school-based functional assessment. One hundred and two children with CP (80.4% dipliegia; 10.8% hemiplegia; 3.9% triplegia; 2.0% quadriplegia; 2.9% unspecified; 60 males, 42 females, mean age 11 years 8 months (SD 3 y 3 mo, range 6-8 y), Gross Motor Function Classification System levels I to IV (13.7% Level I 50% Level II 35.3% Level III 1% Level IV), had complete PODCI and SFA assessments. Significant relationships were noted among multiple PODCI subscales and subscales of the SFA, as well as among individual questions. PODCI predicted performance in all 31 subscales of the SFA when comorbidity subscales were included (r =0.35-0.64). The PODCI in-clinic questionnaire provides an accurate reflection of the child's actual participation in the community setting, as assessed by the SFA. PODCI can reliably be used to help ensure that outcomes assessed in the clinic setting reflect function within the community, and can be used to help with treatment planning, goal setting, and improved patient care.

Keeping It Together: an information KIT for parents of children and youth with special needs

BACKGROUND

Provision and use of information about their children is a major concern to families who have a child with a disability. Strategies or systems to influence parents' abilities to receive, give and use information in a way that is satisfying to them have not been well validated.

METHODS

This paper reports on the development and evaluation of a Parent Information KIT ('Keeping It Together') information management system and child advocacy tool. The KIT was designed to assist parents in giving, getting and organizing information in an effective way. The KIT was evaluated by a sample of 440 parents, with outcomes of use, utility, impact and perceptions of family-centred care measured at baseline, and after 6 months, and 15 months.

RESULTS

Parents' perceptions of their ability, confidence and satisfaction when using information improved significantly after using the KIT. Parents' perceptions of care, as measured with the Measure of Processes of Care, also improved significantly in the areas of 'Enabling/Partnership' and 'Providing General Information'. Parents' ratings of the use and utility of the KIT were associated with increased impact and, in turn, predicted improved perceptions of care.

CONCLUSION

Parents who received and actively used the Parent Information KIT experienced significant increases in their perception of their ability and self-confidence in getting, giving and using information to assist their child with a disability. Strategies for improving the use of the KIT among parents are discussed.