Chapter 1- Overview of OT process(1).pptx

Chapter 1 An Overview of the Occupational Therapy Process for Children Copyright © 2020 by Elsevier, Inc. All rights reserved. Objectives Describe pediatric practice. Explain the benefits of child- and family-centered interventions. Define and describe components of effective pediatric interv...

Chapter 1 An Overview of the Occupational Therapy Process for Children Copyright © 2020 by Elsevier, Inc. All rights reserved. Objectives Describe pediatric practice. Explain the benefits of child- and family-centered interventions. Define and describe components of effective pediatric interventions. Identify and discuss elements of cultural competence. Define and illustrate evidence-based practice with children. Copyright © 2020 by Elsevier, Inc. All rights reserved. 2 Pediatric Practice Includes occupational therapy with infants, toddlers, children, and youth Ends with the period of adulthood legally the age of majority, as defined by the States adulthood can be a “fuzzy” topic Boundaries of “pediatric practice” often created by US laws Copyright © 2020 by Elsevier, Inc. All rights reserved. 3 Primary Philosophies of Pediatric Practice Child- and family-centered care Strengths focus Cultural competence Copyright © 2020 by Elsevier, Inc. All rights reserved. 4 Child- and Family-Centered Practice Three primary core beliefs (King & Chiarello, 2014):  Respect for children and families Appreciation of the family’s impact on the child’s well-being Family-professional collaboration Copyright © 2020 by Elsevier, Inc. All rights reserved. 5 Copyright © 2020 by Elsevier, Inc. All rights reserved. Parents Want…. A true partnership A dependable resource for specific, objective information Flexibility in service delivery and in communication style Sensitivity and responsiveness to their concerns Positive, optimistic attitudes Effectiveness 6 Strengths Focus     Must evaluate not only a child’s difficulties but also the strengths Use those strengths to facilitate performance in difficult areas Help parents to understand their child’s unique strengths Supports and promotes self efficacy and self determination Copyright © 2020 by Elsevier, Inc. All rights reserved. 7 Copyright © 2020 by Elsevier, Inc. All rights reserved. Cultural Competence Critical in this diverse country where practice WILL include provision of services to cultures different than one’s own Cultural diversity in the United States Growing and changing in makeup Shifts can occur rapidly 8 Copyright © 2020 by Elsevier, Inc. All rights reserved. A Culturally Competent Therapist: Demonstrates an interest in understanding the family’s culture Accepts and embraces diversity Inquires about family routines, cultural practices, traditions, and priorities Participates in traditions or cultural patterns of the family Integrates intervention recommendations into the family’s cultural practices 9 Influence of Culture Influence of cultural practices On a child’s development of occupations and skill development Choices of occupation Choices regarding level of independence at specific ages Copyright © 2020 by Elsevier, Inc. All rights reserved. 10 Copyright © 2020 by Elsevier, Inc. All rights reserved. Examples of Guiding Questions: Cultural Values and Styles Who are the members of the family? Is there a hierarchy in the family based on gender or age? Who makes decisions for the family? Who is the primary caregiver? Do family members value independence? Are they reliant on each other? What are the cultural rules or norms about breast feeding, mealtime, self-feeding, and eating certain foods? 11 Copyright © 2020 by Elsevier, Inc. All rights reserved. The OT Process in Pediatric Much the same as with adults and the elderly Referral Evaluation Occupational profile Analysis of occupational performance Use of variety of methods Top down versus bottom up or combined Consideration of context Intervention using evidence-based approaches, with measurement of outcomes Use of theory to guide clinical decision making 12 Intervention Methods  Occupational therapists improve children's performance and participation:    by providing interventions to enhance performance by recommending activity adaptations and environmental modifications through consultation, coaching, and education Copyright © 2020 by Elsevier, Inc. All rights reserved. 13 Copyright © 2020 by Elsevier, Inc. All rights reserved. Specific Aspects of Intervention Establish Establish a therapeutic relationship Focus on Focus on inclusion and natural environments Use Create Modify and adapt Use Advocate Use preferred occupations, client engagement, and child-centered care Create the just right challenge Modify and adapt tasks and environments Use evidence-based interventions Advocate for and educate others 14 Establish the Therapeutic Relationship Select an activity of interest that motivates the child and gives the child choices. Respect the child’s emotions. Convey positive regard toward the child. Attempt to connect with the child. Create a climate of trust and emotional safety. Promote child’s self-actualization. Copyright © 2020 by Elsevier, Inc. All rights reserved. 15 Occupational Therapy Services That Support Inclusion Services in the child’s natural environment Flexible service delivery models Integrated therapy (natural environment) Provision of supports and accommodations Modifying to allow greater participation and access Copyright © 2020 by Elsevier, Inc. All rights reserved. 16 Optimize Child’s Engagement Begin with the child’s interest. Invite the child to select and help design the activity. Pose a problem to be solved. Use meaningful whole tasks rather than repetition of single step tasks. Copyright © 2020 by Elsevier, Inc. All rights reserved. 17 Provide “Just Right” Challenge Matches the child’s developmental skills and interests Provides a reasonable challenge to current performance level Engages and motivates the child Can be mastered with the child’s focused effort Copyright © 2020 by Elsevier, Inc. All rights reserved. 18 Modifying Tasks and the Environment Requires high levels of collaboration Requires ongoing evaluation of the impact on the child and others in the environment Consider child’s sensory processing needs and level of arousal Consider child’s physical abilities and level of access to places, spaces, and activities Environment modification should have positive effect on the child and a neutral effect on others in the environment Copyright © 2020 by Elsevier, Inc. All rights reserved. 19 Copyright © 2020 by Elsevier, Inc. All rights reserved. Evidence-Based Practice “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” Sackett, Rosenberg, Muir Gray, Haynes, and Richardson (1996) 20 5 Steps in Evidence-Based Practice STEP 1 Convert the need for information (about intervention effects, prognosis, and therapy methods) into an answerable question. STEP 2 Search the research databases using the terms in the research question. Track down the best evidence to answer that question. STEP 3 Critically appraise the evidence validity (truthfulness), impact (level of effect), and clinical meaningfulness. for its Copyright © 2020 by Elsevier, Inc. All rights reserved. 21 Steps in Evidence-Based Practice STEP 4 Critically appraise the evidence for its applicability and usefulness to your practice. STEP 5 Implement the practice or apply the information. Evaluate the process. Copyright © 2020 by Elsevier, Inc. All rights reserved. 22 Evidence-Based Practice Is achieved when occupational therapists make careful decisions that reflect their own experience and education, the child’s and family’s priorities, and the research evidence. Copyright © 2020 by Elsevier, Inc. All rights reserved. 23 Copyright © 2020 by Elsevier, Inc. All rights reserved. Other Aspects of Pediatric Practice Direct Service indiv or group Indirect services Consultation Coaching Support others in creating their own solutions Requires good communication and collaboration Education and advocacy On behalf of specific children with disabilities OR Vying for system change on behalf of all children Often interprofessional 24 Use of Varied Service Delivery Direct Push in Pull out Workload versus caseload Block scheduling and coteaching Indirect consult through collab and communication with other professionals Telehealth Copyright © 2020 by Elsevier, Inc. All rights reserved. 25 Summary This chapter introduces Occupational Therapy for Children. Highlights key concepts related to best practices. Defines the scope and broad aims of occupational therapy practice with children and considers the similarities and differences between it and practice with adults. Copyright © 2020 by Elsevier, Inc. All rights reserved. 26