EXAM 1 SLIDES.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...

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  Parents Want…. reserved. Copyright © 2020 by Elsevier, Inc. All rights A dependable A true resource for partnership specific, objective information Flexibility in service delivery Sensitivity and and in responsiveness to communication their concerns style Positive, optimistic Effectiveness attitudes 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  Cultural Competence reserved. Copyright © 2020 by Elsevier, Inc. All rights Critical in this diverse country where practice Cultural diversity in the WILL include provision of United States services to cultures different than one’s own Growing and changing in makeup Shifts can occur rapidly 8  A Culturally Competent Therapist: reserved. Copyright © 2020 by Elsevier, Inc. All rights Demonstrates an Participates in Accepts and interest in traditions or embraces understanding the cultural patterns diversity family’s culture of the family Inquires about Integrates family routines, intervention cultural practices, recommendations traditions, and into the family’s priorities 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  Who are the members of reserved. Copyright © 2020 by Elsevier, Inc. All rights Examples of the family? Is there a hierarchy in the Guiding family based on gender or age? Questions: Who makes decisions for Cultural the family? Who is the primary Values and caregiver? Styles 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  The OT Process in Pediatric reserved. Copyright © 2020 by Elsevier, Inc. All rights 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  Specific Aspects of Intervention reserved. Copyright © 2020 by Elsevier, Inc. All rights Establish Establish a therapeutic relationship Focus on Focus on inclusion and natural environments Use Use preferred occupations, client engagement, and child-centered care Create Create the just right challenge Modify and adapt Modify and adapt tasks and environments Use Use evidence-based interventions Advocate 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 for its validity (truthfulness), impact (level of effect), and clinical meaningfulness. 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 theirown experience and education, the child’s and family’s priorities, and the research evidence. Copyright © 2020 by Elsevier, Inc. All rights reserved. 23  Direct Service indiv or reserved. Copyright © 2020 by Elsevier, Inc. All rights group Indirect services Consultation Coaching Other Support others in creating their own Aspects of solutions Pediatric Requires good communication and Practice 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  CHAPTER 2 THEORY AND PRACTICE MODELS FOR OCCUPATIONAL THERAPY WITH CHILDREN Copyright © 2020 by Elsevier, Inc. All rights reserved.  OBJECTIVES DESCRIBE HOW MODELS OF PRACTICE HELP OCCUPATIONAL THERAPISTS ENGAGE IN THERAPEUTIC REASONING. DEFINE OCCUPATION-CENTERED PRACTICE MODELS AND FRAMES OF REFERENCE AND COMPARE AND CONTRAST HOW THEY ARE SIMILAR AND DIFFERENT. DISCUSS THE BENEFITS OF AN OCCUPATION-CENTERED MODEL OF PRACTICE. EXPLAIN HOW FRAMES OF REFERENCE INFORM OCCUPATIONAL-THERAPY EVALUATION AND INTERVENTION PLANNING FOR CHILDREN AND YOUTH. Copyright © 2020 by Elsevier, Inc. All rights reserved. 28  THEORY A “PLAUSIBLE OR SCIENTIFICALLY ACCEPTABLE GENERAL PRINCIPLE OR BODY OF PRINCIPLES OFFERED TO EXPLAIN PHENOMENA” (MERRIAM WEBSTER, ND). EXPLANATION OF OBSERVED BEHAVIORS THAT IS BASED IN DATA. DESCRIBE FUNDAMENTAL PRINCI­PLES AND CREATE AN ABSTRACT LANGUAGE SYSTEM FOR A PROFESSION. Copyright © 2020 by Elsevier, Inc. All rights reserved. 29  FOUNDATIONAL THEORIES USED IN OCCUPATIONAL THERAPY DEVELOPMENTAL THEORIES LEARNING AND SYSTEM THEORIES Copyright © 2020 by Elsevier, Inc. All rights reserved. 30  FOUNDATIONAL THEORIES DEVELOPMENTAL THEORIES PIAGET AND COGNITIVE DEVELOPMENT ADAPTATION: THE CHILD’S ABILITY TO ADJUST TO CHANGE TO FIT INTO THE ENVIRONMENT SCHEMA: HOW CHILDREN REPRESENT OBJECTS, EVENTS, AND RELATIONSHIPS ASSIMILATION: INCORPORATING NEW KNOWLEDGE INTO EXISTING COGNITIVE STRUCTURES ACCOMMODATION: NEW LEARNING, ADAPTING COGNITIVE STRUCTURE TO NEW INFORMATION Copyright © 2020 by Elsevier, Inc. All rights reserved. 31  FOUNDATIONAL THEORIES VYGOTSKY AND THE ZONE OF PROXIMAL DEVELOPMENT  COGNITIVE PROCESSING IS A SOCIAL PROCESS.  LEARNING IS CRITICALLY DEPENDENT ON SOCIAL INTERACTION ZONE OF PROXIMAL DEVELOPMENT: THE DISTANCE BETWEEN THE CHILD’S ACTUAL DEVELOPMENTAL LEVEL WHEN ACTING INDEPENDENTLY AND THE LEVEL OF POTENTIAL DEVELOPMENT WHEN SUPPORTED BY AN ADULT. SCAFFOLDING: THE PROCESS BY WHICH THERAPISTS SUPPORT OR GUIDE A CHILD’S ACTIONS TO IMPROVE COMPETENCE. Copyright © 2020 by Elsevier, Inc. All rights reserved. 32  FOUNDATIONAL THEORIES MASLOW’S HIERARCHY OF BASIC NEEDS PHYSIOLOGICAL NEEDS NEED FOR SAFETY NEED FOR LOVE AND BELONGING NEED FOR A SENSE OF SELF-ESTEEM NEED FOR SELF-ACTUALIZATION Copyright © 2020 by Elsevier, Inc. All rights reserved. 33  FOUNDATIONAL THEORIES LEARNING AND SYSTEMS THEORIES BEHAVIORAL THEORIES INSTRUMENTAL OR OPERANT LEARNING APPLIED BEHAVIORAL INTERVENTIONS SHAPING INCIDENTAL TEACHING PIVOTAL RESPONSE Copyright © 2020 by Elsevier, Inc. All rights reserved. 34  LEARNING THEORIES SOCIAL COGNITIVE THEORIES CHILDREN CAN LEARN BY OBSERVING THE BEHAVIOR OF OTHERS. CHILDREN DETERMINE THEIR OWN LEARNING BY SEEKING CERTAIN EXPERIENCES. CHILDREN LEARN INDIRECTLY BY OBSERVING HOW THEIR PEERS’ BEHAVIORS ARE REWARDED OR PUNISHED. CHILDREN LEARN SOCIAL SKILLS THROUGH GROUP EXPERIENCES. Copyright © 2020 by Elsevier, Inc. All rights reserved. 35  SELF-EFFICACY THE INFLUENCE OF MOTIVATION AND SELF-EFFICACY ON LEARNING. IF CHILDREN EXPERIENCE SUCCESS, THEY ARE MORE LIKELY TO SEEK ADDITIONAL CHALLENGES. SELF-EFFICACY BELIEFS DETERMINE  THE GOALS THAT PEOPLE SET FOR THEMSELVES.  HOW MUCH EFFORT THEY EXPEND.  HOW LONG THEY PERSEVERE IN THE FACE OF DIFFICULTIES.  HOW THEY RESPOND TO FAILURE. Copyright © 2020 by Elsevier, Inc. All rights reserved. 36  LEARNING THEORIES DYNAMIC SYSTEMS THEORY PERFORMANCE DEPENDS ON INTERACTIONS OF THE CHILD’S INHERENT AND EMERGING SKILLS. CHARACTERISTICS OF THE DESIRED TASKS OR ACTIVITY. THE ENVIRONMENT. SELF-ORGANIZATION IS OPTIMAL IF THE TASK HAS A GOAL AND OUTCOME. Copyright © 2020 by Elsevier, Inc. All rights reserved. 37  MODELS A PICTORIAL REPRESENTATION THAT EXPRESSES OBSERVATIONS AND DATA ABOUT CERTAIN PORTIONS OF A THEORY. ARE OFTEN USED TO TEST THEORIES. IF A MODEL IS ACCURATE, IT WILL ALLOW PREDICTIONS WITH ACTUAL DATA. Copyright © 2020 by Elsevier, Inc. All rights reserved. 38  MODELS OF PRACTICE AN EXAMPLE OF A MODEL PEO MODEL PERSON ENVIRONMENT OCCUPATION Copyright © 2020 by Elsevier, Inc. All rights reserved. 39  MODELS OF OCCUPATIONAL THERAPY PRACTICE PROVIDE STRUCTURE TO GUIDE THE PROCESS OF CLINICAL REASONING. THE PRACTICAL EXPRESSION OF THEORY PROVIDES THERAPISTS WITH SPECIFIC METHODS AND GUIDELINES FOR OCCUPATIONAL THERAPY INTERVENTION PROMOTE THE USE OF OCCUPATION CENTERED PRACTICE AND A BROAD SCOPE OF PRACTICE. Copyright © 2020 by Elsevier, Inc. All rights reserved. 40  MODELS ABOUT HUMAN OCCUPATION CONSIDER THE INTERACTION BETWEEN THE PERSON, THE ENVIRONMENT, AND THE TASK/OCCUPATION. THE PROFESSION HAS MULTIPLE MODELS NOW. MODEL OF HUMAN OCCUPATION (MOHO) PERSON-ENVIRONMENT-OCCUPATION-PERFORMANCE (PEOP) CANADIAN MODEL OF OCCUPATIONAL PERFORMANCE AND ENGAGEMENT (CMOP-E) OCCUPATIONAL ADAPTATION Copyright © 2020 by Elsevier, Inc. All rights reserved. 41  MODELS OF PRACTICE SYSTEMS APPROACH: IMPORTANCE OF CONTEXT IN ASSESSMENT AND INTERVENTION DEVELOP A PICTURE OR PROFILE OF THE CHILD’S PERFORMANCE. FOCUS ON THE INTERACTION OF PERSON, ENVIRONMENT, AND OCCUPATION. FOCUS ON CHANGING THE CHILD, TASK, OR ENVIRONMENT. MODIFY THE TASK OR ENVIRONMENT TO IMPROVE THE CHILD’S SKILLS. INCREASE THE CHILD’S ENGAGEMENT BY USING ACTIVITIES THAT ARE MEANINGFUL. Copyright © 2020 by Elsevier, Inc. All rights reserved. 42  FRAMES OF REFERENCE “A SET OF INTERRELATED INTERNALLY CONSISTENT CONCEPTS, DEFINITIONS AND POSTULATES THAT PROVIDE A SYSTEMATIC DESCRIPTION OF AND PRESCRIPTION FOR A PRACTITIONER’S INTERACTION WITHIN A PARTICULAR ASPECT OF A PROFESSION’S DOMAIN OF CONCERN” (MOSEY, 1981, P. 129). PROVIDE OCCUPATIONAL THERAPISTS WITH SPECIFIC STRATEGIES AND TECHNIQUES BASED ON THEORETICAL PRINCIPLES. ARE LENSES OR WAYS OF VIEWING A CHILD’S/FAMILY’S BEHAVIOR OR PERFORMANCE. Copyright © 2020 by Elsevier, Inc. All rights reserved. 43  COMMONLY USED FRAMES OF REFERENCE DEVELOPMENTAL BIOMECHANICAL MOTOR LEARNING REHABILITATION NEURODEVELOPMENTAL SENSORY INTEGRATION BEHAVIORAL COGNITIVE COGNITIVE-BEHAVIORAL Copyright © 2020 by Elsevier, Inc. All rights reserved. 44  DEVELOPMENTAL BASED ON THE IDEAS AND KNOWLEDGE ABOUT THE TYPICAL PROGRESSION OF DEVELOPMENTAL SKILLS BY AGE PREDICTS SKILLS WILL BECOME MORE COMPLEX AND MORE COMPETENT OVER TIME SUGGESTS A TEMPORAL SEQUENCE DURING WHICH SPECIFIC SKILLS SHOULD BE EXPECTED SUGGESTS INTERVENTION TO GENERATE THE “NEXT” SKILL BASED ON OLDER LINEAR VS SYSTEMS IDEAS ABOUT MATURATION Copyright © 2020 by Elsevier, Inc. All rights reserved. 45  NEWER DEVELOPMENTAL THINKING DEVELOPMENTAL TRAJECTORIES CAN BE TYPICAL DELAYED SLOWED DELAYED AND SLOWED NONLINEAR OR INITIALLY TYPICAL FOLLOWED BY A “FALLING OFF” Copyright © 2020 by Elsevier, Inc. All rights reserved. 46  BIOMECHANICAL BASED ON KINESIOLOGY AND PHYSICS. REQUIRE THE UNDERSTANDING OF ANATOMY AND PHYSIOLOGY RELATED TO POSTURE AND MOVEMENT. MOVEMENT OCCURS AGAINST GRAVITY AND PRESSURE. LIMB MOVEMENT REQUIRES POSTURAL ADJUSTMENTS TO ALLOW INDIVIDUALS TO REMAIN UPRIGHT AGAINST GRAVITY. OPTIMIZE ALIGNMENT AS BASIS FOR MOVEMENT AND CONTROL OF EXTREMITIES. METHODS INCLUDE RANGE OF MOTION, STRENGTHENING, POSITIONING, AND MODIFICATION. Copyright © 2020 by Elsevier, Inc. All rights reserved. 47  MOTOR CONTROL/LEARNING MOTOR CONTROL = DIRECTING/REGULATING MOVEMENT. MOTOR LEARNING = WAYS OF LEARNING MOVEMENTS. PROBLEM-SOLVING METHOD, HELPING CHILD FIND THE BEST WAYS TO MOVE TO SOLVE A MOTOR PROBLEM. ANALYZE MOVEMENT SYNERGIES. CONSIDER CHILD’S STAGE OF LEARNING. PROVIDE FEEDBACK TO IMPROVE EFFICIENCY. PROVIDE OPPORTUNITIES FOR PRACTICE. PROMOTE INDEPENDENCE AND GENERALIZATION. Copyright © 2020 by Elsevier, Inc. All rights reserved. 48  REHABILITATIVE ALLOWS A CHILD OR YOUTH TO ENGAGE IN DESIRED OCCUPATIONS WITH COMPENSATIONS AND ADAPTATIONS PROVIDING ADAPTIVE EQUIPMENT OR MODIFICATIONS PROVIDING APPROPRIATE ASSISTIVE TECHNOLOGY REQUIRES A THOROUGH ANALYSIS OF THE ACTIVITY Copyright © 2020 by Elsevier, Inc. All rights reserved. 49  NEURODEVELOPMENTAL (NDT) ANALYZE MISSING OR ATYPICAL MOVEMENT PATTERNS. USE THERAPEUTIC HANDLING TO FACILITATE POSTURAL CONTROL AND MOVEMENT SYNERGIES. INHIBIT OR CONSTRAIN ABNORMAL MOVEMENT PATTERNS. FOCUS ON CHANGING MOVEMENT PATTERNS. CHILD IS ACTIVE PARTICIPANT. THERAPISTS EMPHASIZE QUALITY OF MOVEMENT. Copyright © 2020 by Elsevier, Inc. All rights reserved. 50  SENSORY INTEGRATION BASED ON NEUROSCIENCE. CHILDREN RECEIVE, PERCEIVE, INTERPRET, AND REACT TO SENSATIONS, AND USE SENSORY INFORMATION TO PRODUCE ADAPTIVE BEHAVIORS IN RESPONSE TO ENVIRONMENTAL DEMANDS. WITH SENSORY INTEGRATION AND EXPERIENCES OF SUCCESS, DEVELOPMENT OCCURS, ENHANCING NEUROPLASTICITY. SENSORY INPUT CAN BE INCORPORATED INTO ACTIVITIES SYSTEMATICALLY TO ELICIT AN ADAPTIVE RESPONSE. MUST BE ACTIVE, CHILD-DIRECTED. Copyright © 2020 by Elsevier, Inc. All rights reserved. 51  BEHAVIORAL BASED ON ANIMAL RESEARCH EXAMINING LEARNING LEARNING OCCURS THROUGH REPETITION OF SPECIFIC BEHAVIORS WITH APPROPRIATE REINFORCEMENT USE REINFORCEMENT TO MODIFY OR ALTER BEHAVIOR PUTS LITTLE EMPHASIS ON INTRINSIC MOTIVATION, AS MOTIVATION TO PERFORM A SKILL IS GENERATED BY EXTERNAL MOTIVATION PROVIDED BY REINFORCEMENT REQUIRES CAREFUL ANALYSIS TO DETERMINE WHAT TO REINFORCE AND WHEN Copyright © 2020 by Elsevier, Inc. All rights reserved. 52  COGNITIVE BASED ON THE WORK ON SELF-EFFICACY USE A PROBLEM-SOLVING APPROACH TO WORK TOWARD CHILD-DERIVED GOALS THROUGH CAREFUL QUESTIONING RATHER THAN INSTRUCTING STEPS INCLUDE TASK ANALYSIS ANTICIPATION OF THE CHILD’S DIFFICULTIES EXPLORATION AND SELECTION OF TASK-SPECIFIC STRATEGIES APPLICATION OF A STRATEGY TO THE TASK EVALUATION Copyright © 2020 by Elsevier, Inc. OF STRATEGIES All rights reserved. 53  COGNITIVE EXAMPLE: COGNITIVE ORIENTATION TO DAILY OCCUPATIONAL PERFORMANCE (CO-OP) STEPS: FOCUS ON THE OCCUPATIONS THE CHILD SELECTS. USE A GENERAL PROBLEM SOLVING FRAMEWORK. USE PROCESS QUESTIONS TO INCREASE THE CHILD’S AWARENESS OF THE USE OF STRATEGIES. PLAN FOR TRANSFER AND GENERALIZATION OF THE STRATEGIES. Copyright © 2020 by Elsevier, Inc. All rights reserved. 54  COGNITIVE BEHAVIORAL BASED ON THE IDEA THAT PROBLEM BEHAVIORS ARE CAUSED BY BELIEFS OR THOUGHTS (COGNITION) CHANGE THE THOUGHTS, CHANGE THE BEHAVIOR USES POSITIVE SELF-TALK AND FEEDBACK FOR SUCCESSES Copyright © 2020 by Elsevier, Inc. All rights reserved. 55  SUMMARY OCCUPATIONAL THERAPISTS USE A VARIETY OF THEORIES THAT ORIGINATED FROM OTHER DISCIPLINES. MODELS OF OCCUPATIONAL THERAPY PRACTICE EXAMINE THE COMPLEXITY OF HUMAN OCCUPATION AND CONSIDER THE PERSON, THE ENVIRONMENT, AND THE TASKS TO BE COMPLETED. CURRENT IDEAS ABOUT OCCUPATIONAL PERFORMANCE EMBRACE DYNAMIC SYSTEMS THEORIES. THERAPISTS MAY USE A MODEL OF PRACTICE AS WELL AS MULTIPLE FRAMES OF REFERENCE. THERAPISTS MUST USE EVIDENCE-BASED PRACTICE WHEN SELECTING FRAMES OF REFERENCE FOR ASSESSMENT AND INTERVENTION. Copyright © 2020 by Elsevier, Inc. All rights reserved. 56  Chapter 3 Working with Families and Interprofessional Teams Copyright © 2020 by Elsevier, Inc. All rights reserved.  Guiding Questions 1. How does family systems theory describe the occupations and functions of families? 2. How do we learn about a family’s culture and background, and why is knowledge of diversity important? 3. What is the family life cycle, and how do we identify times of potential stress for families of children with special needs? 4. How does having a child with special needs influence family function and co-occupations of family members? Copyright © 2020 by Elsevier, Inc. All rights reserved. 58  Guiding Questions 5. What are the roles of the occupational therapist when collaborating with families and teams? 6. How does an occupational therapist establish and maintain partnership with a family? 7. How can families be empowered to facilitate their children’s development? 8. What are the best strategies for supporting the strengths of families facing multiple challenges? Copyright © 2020 by Elsevier, Inc. All rights reserved. 59  Purpose and Power of Families Families are complex systems. OTs must be prepared to work with a variety of families. It is important to understand the influence of families’ daily routines and goals on how children spend their time. Involvement of family members is central to the best practice of occupational therapy. Copyright © 2020 by Elsevier, Inc. All rights reserved. 60  The Family: A Group of Occupational Beings Families Transmit a cultural model Give children a sense of support, identity, and emotional well-being Help children develop fundamental routines and lifestyle habits Prepare children to become productive adults Copyright © 2020 by Elsevier, Inc. All rights reserved. 61  Outcomes of Family Occupations Family occupations contribute to the following outcomes for children: Establish a cultural foundation for learning occupations that enables children to participate in a variety of contexts. Help shape children’s basic sense of identity and emotional well-being. Copyright © 2020 by Elsevier, Inc. All rights reserved. 62 Outcomes of Family Occupations Help children learn to master routines and habits that support physical health and well-being. Foster readiness to learn and to participate in educational programs. Foster readiness to assume place in community and society. Copyright © 2020 by Elsevier, Inc. All rights reserved. 63  System Perspective of Family Occupations Key concepts of a family system model A family system is composed of individuals who are interdependent and have reciprocal influences on each other’s occupations. Within the family, subsystems are defined with their own patterns of interaction and shared occupations. A family must be understood as a whole, and it is more than the sum of the abilities of each member. Copyright © 2020 by Elsevier, Inc. All rights reserved. 64  System Perspective of Family Occupations (cont’d)  The family system works to sustain predictable patterns in family occupations and to be part of a larger community.  Change and evolution are inherent in a family.  A family, as an open system, is influenced by its environment. Copyright © 2020 by Elsevier, Inc. All rights reserved. 65  Family Resources and the Child with Special Needs Financial resources Parents may have many hidden and ongoing expenses. Child care may be more expensive or unavailable. One parent may quit work to care for the child. Human resources Copyright © 2020 by Elsevier, Inc. All rights reserved. 66  Family Resources and the Child with Special Needs Time resources Extra caregiving needed Additional supervision May require more structure and organization in daily life Parents may have less time for socialization and recreation Copyright © 2020 by Elsevier, Inc. All rights reserved. 67  Family Resources and the Child with Special Needs Emotional energy resources Children with disabilities may require more emotional energy from the parents. Parents may experience anxiety and depression. Parents may become exhausted and sleep deprived. Stress levels in families seem to relate to the resources that they have financial, educational, emotional, or social. Copyright © 2020 by Elsevier, Inc. All rights reserved. 68  Sources of Diversity in Families Ethnic background Immigrants Family structure Fragile Families & Child Wellbeing Study Socioeconomic status Parenting style and practices Parents and children with special needs Copyright © 2020 by Elsevier, Inc. All rights reserved. 69  An Ecologic Perspective of Dynamic Family Systems Families are dynamic, interdependent systems. Social and physical features influence the family. Be aware of how things distant and not under family’s control can influence the family. Communities vary in how they support the inclusion of families with children with disabilities. Copyright © 2020 by Elsevier, Inc. All rights reserved. 70  Family Subsystems Parents Birth, adoptive, partner, blended, or foster Effect of child with special needs on mothers and fathers Effect of child with special needs on parents’ relationship Copyright © 2020 by Elsevier, Inc. All rights reserved. 71  Family Subsystems Siblings Effect of child with special needs on siblings Siblings as a source of support Siblings in caregiver roles Occupational therapist roles with siblings Copyright © 2020 by Elsevier, Inc. All rights reserved. 72  Family Subsystems Extended family Aunts, uncles, and grandparents Extended family support Potential issues of extended families Copyright © 2020 by Elsevier, Inc. All rights reserved. 73  Family Life Cycle Transitions Normative events Non-normative events Characteristics and issues at each life stage are variable Copyright © 2020 by Elsevier, Inc. All rights reserved. 74  Family Life Cycle Early childhood Diagnostic process. Parents request information and ask questions. Parents have questions about the future. Parents gather information about the early intervention systems, their rights, and community resources. Caregiving for an infant with special needs may be similar to caring for a typical infant. Copyright © 2020 by Elsevier, Inc. All rights reserved. 75  Family Life Cycle School age Families may experience less support when the child enters school. They may be no longer directly involved with the child’s program. The gap between the child’s performance and that of typical peers may widen. Making friends may be a priority. Copyright © 2020 by Elsevier, Inc. All rights reserved. 76  Family Life Cycle Adolescence May be a stressful time with growing social, financial, and sexual needs. Parents may be increasingly concerned about child’s vulnerability. Increased social stigma from peers. Parents have difficulty caring for child’s growing physical and emotional needs. Copyright © 2020 by Elsevier, Inc. All rights reserved. 77  Family Adaptation, Resilience, and Accommodation Adaption—recognize the situation, an interruption in activities, or a loss of emotional well-being Cope by redefining the event and comparing Resilience—families draw on resources to restructure add/or get rid of routines Accommodation—changes that maintain daily routines Copyright © 2020 by Elsevier, Inc. All rights reserved. 78  Supporting Participation in Family Life Development of independence in self-care and health maintenance routines Adapting daily routines to conserve energy and avoid injury Strategies to increase children’s independence in self-care Embedding adapted strategies and learning opportunities into the family’s daily routine Copyright © 2020 by Elsevier, Inc. All rights reserved. 79  Supporting Participation in Community Activities Fostering readiness for community living Provide families with information. OTs help to advocate for youth. Socialization and participation in social activities With ADA, more recreational opportunities have become available. OTs suggest strategies to enhance family’s participation in recreation. Copyright © 2020 by Elsevier, Inc. All rights reserved. 80 Families and the Interprofessional Team Family partnerships include family-centered care and services. family support. direct services. family collaborative education. Copyright © 2020 by Elsevier, Inc. All rights reserved. 81  Partnering with Families Establishing a partnership Trustbuilding Equality and reciprocity Respect Providing helpful information Child- or diagnosis-related information Characteristics of helpful communication Respect family in decision-making Copyright © 2020 by Elsevier, Inc. All rights reserved. 82  Partnering with Families Providing flexible, accessible, and responsive services Being flexible within systems Listen with empathy Acknowledge family priorities Adapt service based on parent input Explain the constraints of the system Suggest alternative resources when request cannot be met within the system Advocate for parents within the system Copyright © 2020 by Elsevier, Inc. All rights reserved. 83  Communication Strategies Effective communication builds on trust and respect. honesty and sensitivity. Communicate with parents Formal and informal Written Verbal Nonverbal See Table 5-2: Communication Methods between Parents and Professionals (p. ##) for details Copyright © 2020 by Elsevier, Inc. All rights reserved. 84 Home Programs: Blending Therapy Into Routines Find out information about important and meaningful daily routines and activities. Identify naturally occurring moments where behaviors can be taught and modified. Parents appreciate specific, objective information. flexible service delivery. sensitivity and responsiveness to their concerns. positive, optimistic attitudes. technical expertise and skill. Copyright © 2020 by Elsevier, Inc. All rights reserved. 85  Summary Family participation is a critical element of intervention. Therapy goals and activities must reflect family priorities. Families are unique and multidimensional. Children with disabilities have positive and negative effects on families. Occupational therapists who respect family values and maintain a positive attitude can become important supports to families of children with special needs. Copyright © 2020 by Elsevier, Inc. All rights reserved. 86  Chapter 4 Development of Occupations and Skills From Infancy Through Adolescence Natasha Smet and Cheryl B. Lucas Copyright © 2020 by Elsevier, Inc. All rights reserved.  Objectives Using an occupational science perspective how is long-term health and wellness promoted through occupation? How does neuroplasticity inform us on the use of occupations as both a means and an end for occupational skill development? How do a child’s unique characteristics influence occupational development? How do co-occupations promote long-term independence in occupational performance in all contexts? How do individual biologic and cultural, social, geo-political, physical, and virtual contexts transact to impact infant/toddler/child/adolescent Copyright © 2020 by Elsevier, Inc. All rights reserved. 88  Human Development Through an Occupational Science Lens Development of occupational performance occurs within support contexts that lead to improvement in occupational competence, health and wellness, and quality of life. Development of children is embedded in occupational justice and occupational participation frameworks. Top-down approach encompasses all of the contexts that are supporting or facilitating a child’s occupational performance, that is, technology, globalism, capitalism, attitudinal, and political. Copyright © 2020 by Elsevier, Inc. All rights reserved. 89  Human Development cont. Obstacles related to fast-paced technological environments, family economic hardship, dynamics, and time use, as well as attitudinal, political, and philosophical issues regarding children’s needs and rights for healthy development have contributed to concerns for children’s health and wellness worldwide (World Health Organization, 2001, 2007). Copyright © 2020 by Elsevier, Inc. All rights reserved. 90  Developmental Theories Occupational therapists use knowledge of neurological, physiological, biological, and emotional growth as guidelines for occupational performance. Developmental milestones and progressions vary and are influenced by many factors and expectations, yet they can serve as an indicator as to where the infant, child is currently functioning Copyright © 2020 by Elsevier, Inc. All rights reserved. 91  Developmental Theories and Concepts Neurophysiological development Functioning of CNS is the foundation for participation in occupations Prenatal development Importance of prenatal care and the uterine environment for development and quality of life A typical pregnancy lasts 37-40 weeks Those infants who are born prior to 36 weeks or after 42 weeks are at risk for developmental concerns due to a disruption of gestational growth in the final weeks of pregnancy Copyright © 2020 by Elsevier, Inc. All rights reserved. 92  Developmental Theories Cont  The structures of the brain including cell birth, migration, cell differentiation, and cell maturation occur in the prenatal period.  Synaptogenesis occurs at 28 weeks of gestation  Neurogenesis begins in first 2 weeks of life Copyright © 2020 by Elsevier, Inc. All rights reserved. 93  Developmental Theories and Concepts The development of the brain during the gestation period is imperative for functioning. Gestation occurs in sequential stages: cell birth (neurogenesis), cell migration, cell differentiation, cell maturation (dendrite and axon growth), synaptogenesis (formation of synapses), all of which happen during the first trimester of pregnancy in an overlapping manner. Neurogenesis, the formation of neurons, Copyright © 2020 by Elsevier, Inc. All rights reserved. 94 occurs within the first 2 weeks of gestation.  Developmental Theories and Concepts Neurophysiological development Postnatal development Myelogenesis with myelin sheathe production Cell death and pruning At 12 months: Synaptic overproduction and then pruning again by age 2. Critical periods Language exposure, sensory motor experiences, and stimulation during the first 3 years of life may determine synaptogenesis, myelination, and neuronal activity making this a critical time for development. Copyright © 2020 by Elsevier, Inc. All rights reserved. 95  Developmental Theories and Concepts Synaptic overproduction: In the early months of life, humans produce an excess of synapses. Synaptic pruning: The process through which the brain abandons connections that are not emphasized by experience. While plasticity is greatest during the first few years of life, it continues at a reduced rate throughout the lifespan. Copyright © 2020 by Elsevier, Inc. All rights reserved. 96  Developmental Theories and Concepts Culture, neurophysiological growth, and occupational development Children’s developmental abilities are based on cultural priorities. Standardized assessments do accurately represent children’s different cultural growth trajectories. Cultural practices differ in facilitating development but children are still able to achieve milestones. Copyright © 2020 by Elsevier, Inc. All rights reserved. 97  Developmental Theories and Concepts Dynamic systems theory Dynamic systems theory refers to performance or action patterns that emerge from the interaction and cooperation of many systems, both internal and external to the child (Thelen, Corbetta, & Kamm, 1993). Copyright © 2020 by Elsevier, Inc. All rights reserved. 98  Developmental Theories and Concepts Dynamical systems theory A child’s actions are the result of subsystem interaction. Children show unique trajectories of development. Goal of OT treatment is independence and transformation through occupations that are motivating to the child. Copyright © 2020 by Elsevier, Inc. All rights reserved. 99  Developmental Theories cont. Horizontal development refers to development in multiple areas at the same time (Llorens, 1982). For example, infants develop head control, social trust with feeding, oral motor skills to suck and feed, and begin to hold objects. Longitudinal development refers to the maturation of skills within an area (Llorens, 1982). For example, an infant’s gross motor skills progress from supine to rolling, prone on hands, side-lying, prop-sitting, sitting, to creep, crawl. Copyright © 2020 by Elsevier, Inc. All rights reserved. 100 Copyright © 2020 by Elsevier, Inc. All rights reserved. 101  Developmental Theories and Concepts Neuroplasticity and occupational development Neuroplasticity can be defined as “the ability of the nervous system to respond to intrinsic and extrinsic stimuli by reorganizing its structure, function, and connections” (Cramer et al., 2011) Gottlieb: Fusion of the child and environment Llorens: An individual’s dynamic genetic endowment interacts with environmental context Children grow and change through adaptive neurophysiological processing of internal and external stimuli in response to occupational demands. Copyright © 2020 by Elsevier, Inc. All rights reserved. 102  Neuroplasticity and occupational development cont.  LaCorte: “The sensory motor process of occupational physiology serves as an adaptive change mechanism in central pattern generators to explain inherent value of occupations as purposeful activities and relationships.” Through both experience and development new structures (cells) and function (performance) emerge. Copyright © 2020 by Elsevier, Inc. All rights reserved. 103  Neuroplasticity and occupational development Neuroplastic events are developmental, adaptive, and restorative. There are three types of plasticity that can be distinguished in the developing brain: experience-independent, experience-expectant, and experience-dependent Infancy and early childhood demonstrate the greatest amount of rapid brain growth, and by the age of 5 years, the brain reaches nearly adult size. The initial connections are laid down, and several experience-dependent changes give support to the emerging individual differences in brain functioning Copyright © 2020 by Elsevier, Inc. All rights reserved. 104  Development Through Occupational Science Theories Occupational science research can be used to understand the occupational development of children by exploring the occupational perspective of health, including doing, being, becoming, and belonging; transactional relationship between the child and the contexts in which they participate; and bioecological view of development, including the relationships with child, caregivers, family, community, and within geopolitical contexts. Copyright © 2020 by Elsevier, Inc. All rights reserved. 105  Development Through Occupational Science Theories Occupational Perspective of Health (OPH) Doing: Children may engage actively or passively in the performance of occupations they need to do, want to do, or are expected to do. This can promote the child’s identity as a dynamic participant in the world. Being: How one feels about participation in an occupation from a psychological or spiritual sense, and the understanding and advocacy of the self as an occupational being. The adoption of roles is important in understanding being. The inner essence of the child. Copyright © 2020 by Elsevier, Inc. All rights reserved. 106  Development Through Occupational Science Theories Occupational Perspective of Health (OPH) Becoming: “… aims for a person's highest potential, the best possible outcome.” (Hitch, Pepin, & Stagnitti, 2014b). Through participating in new experiences, opportunities, and challenges, children may be able to achieve goals that they set for themselves. In becoming, the child develops into an active participant by doing self-selected occupations. Belonging: “being part of, a member of, a constituent of, associated with, connected with, included in something, feeling right and fitting in” (Wilcock & Hocking, 2015, p. 137). Active engagement in occupations within the contexts that children participate provide opportunities for social, educational, and cultural inclusion. Physical and social inclusions are the first step in the process of active engagement and participation. Copyright © 2020 by Elsevier, Inc. All rights reserved. 107  Development Through Occupational Science Theories Transactional Relationship Between Child and Contexts A transactional view of occupation is based on a relationship between the person and environment instead of viewing occupational performance as separate units of the individual, environment, and occupation. By defining the mutual, reciprocal, multifaceted, interfaces that occur between an individual and the contexts in which they live, the developmental growth and trajectory of a child can be examined. Copyright © 2020 by Elsevier, Inc. All rights reserved. 108  Development Through Occupational Science Theories Bioecological Model of Development Transaction between any and among contexts promotes occupational development through building strong relationships and changing environment. The bioecological model emphasizes the importance of the physical, social, cultural, virtual, and temporal context on child development and explains the reciprocal interactions among and between the child, family, community, and geopolitical contexts on a child’s occupational participation and performance. Copyright © 2020 by Elsevier, Inc. All rights reserved. 109  Development Through Occupational Science Theories  Individual child (layer 1) Genetics Adverse childhood experiences Resiliency  Caregivers (layer 2) Socio emotional status Education Health Availability Copyright © 2020 by Elsevier, Inc. All rights reserved. 110  Development Through Occupational Science Theories Bioecological Model of Development Extended family (layer 3) Support or hindrance Community (layer 4) Funded child activities: sports, recreation centers Access to playgrounds Safe schools Public transportations Green spaces Copyright © 2020 by Elsevier, Inc. All rights reserved. 111  Developmental Theories and Concepts Bioecological Model of Development Geopolitical contexts (Layer 5) Healthcare policies Racism Sexism Ableism Globalism Technology Copyright © 2020 by Elsevier, Inc. All rights reserved. 112  Developmental Theories and Concepts The geopolitical context invokes the concepts of occupational justice, occupational alienation, and deprivation, which limit an individual’s participation in living the life he or she chooses based on broader contexts out of his or her immediate control. See Box 4.2 for definitions. Historical attitudes of racism, sexism, and ableism may covertly limit occupational participation in various contexts such as home, school, and community and have a negative effect on occupational performance. This is evidenced through the statistics that fewer children of color achieve school completion, literacy, and math achievement, while more students of colors are placed in special education settings (Children’s Defense Fund, 2017) Copyright © 2020 by Elsevier, Inc. All rights reserved. 113  Occupations for Transformational Development Gain knowledge of occupations children want to do, need to do, and are expected to do within their contexts. OT practitioners provide Instruction. adaptation. empowerment. Goal: Development of essential skills of daily living and transformation into an occupational being for improved health, wellness, and quality of life. Copyright © 2020 by Elsevier, Inc. All rights reserved. 114  Occupations and Co-Occupations for Transformational Development Co-occupations are integral to child development and initially consists of caretakers participating in the same occupation as the child to help the child develop, such as feeding an infant, reading aloud at bedtime, or cooking a meal ( Humphrey & Thigpen, 1998; Zemke & Clark, 2006). Co-occupation is the performance of occupation “in a mutually responsive, interconnected manner that requires aspects of shared physicality, shared emotionality, and shared intentionality” Copyright © 2020 by Elsevier, Inc. All rights reserved. 115  Developmental Milestones Developmental milestones are skills children achieve that may inform intervention planning. The ages in which children achieve developmental milestones can vary and many factors and environmental contexts influence a child’s performance.  Developmental milestones therefore, are considered guides and not fixed age norms. Understand the Usual occupations children perform in various stages and the performance skills required Copyright © 2020 by Elsevier, Inc. All rights reserved. 116  Development of Occupations from OTPF ADLs: Development of daily routine that fits within the family and child’s contexts. IADLs: Differences exist among cultures regarding chores. Rest/Sleep: Sleep deprivation affecting children’s behavior, academic achievement, and social participation. Copyright © 2020 by Elsevier, Inc. All rights reserved. 117  Development of Occupations from OTPF Education: Inclusive models of education are effective for both disabled and nondisabled children. Focus on social-emotional learning and relationships Self-regulation Functional literacy Work: dependent on contexts, values, and beliefs Copyright © 2020 by Elsevier, Inc. All rights reserved. 118  Occupations from OTPF Leisure: Child initiated and child directed free time improved executive function skills of emotional regulation, organization, and memory. Adolescent burnout: withdrawal from activities leads to boredom leads to maladaptive behavior. Play: Ability to play is an important outcome of OT and reflects the “being” of childhood. Copyright © 2020 by Elsevier, Inc. All rights reserved. 119  Development Through the Lens of Doing, Belonging, and Becoming Infants are born with the ability to see, hear, communicate (through crying and nonverbal expressions) and respond motorically through reflexes. The first demonstration of an infant’s emotional regulation is observed in the ease with which he or she feeds and sleeps. Problems in feeding, sleeping, toileting (urination, defecation), mobility, and play are a concern for overall health and interaction within the infant’s environment. Copyright © 2020 by Elsevier, Inc. All rights reserved. 120  Summary Points Engaging in desired occupations promotes occupational identity, self-efficacy, and self-determination which leads to health and wellness. As children develop a positive sense of control over their environment by engaging in occupations, they become more satisfied and involved in meaningful activities which in turn support mental and physical health and wellness. Neuroplasticity refers to the creation of new neural synapses, dendritic sprouting or improved neural connections in the brain. Multisensory activities (occupations) which require children to problem-solve and adapt in flexible natural environments promote neuroplasticity. Occupational therapists use occupations, such as play (a natural, meaningful, and whole activity) to engage children which, in turn, facilitate brain plasticity. Copyright © 2020 by Elsevier, Inc. All rights reserved. 121  Summary Points The child participates and performs in occupations based on their current skills and physical and mental health. The influence of environmental factors on a child's development is profound and influences self-identity and self-actualization. Children grow and develop into competent occupational beings and full participants in the community through an interaction between the child's biologic and emotional being and his/her cultural, social, physical, virtual, and temporal contexts. Both internal (e.g., child's intelligence, positive affect, emotional regulation) and contextual (e.g., supportive family relationships) protective factors are needed for positive outcomes (e.g., school success and positive relationships). Copyright © 2020 by Elsevier, Inc. All rights reserved. 122  Summary Points Children learn to be active participants in their daily occupational routines with supportive adults. Participation in co-occupations (engagement that has distinct or overlapping meaning or purpose for two people) forms a foundation for emotional growth, increased autonomy, and intrinsic motivation leading to increased participation (Edsaile, & Olson, 2004). Co-occupations are integral to child development and initially consist of caretakers participating in the same occupation as the child to help the child develop such as feeding an infant, reading aloud at bedtime, or cooking a meal (Humphrey & Thigpen, 1998; Zemke & Clark, 2006). The nurturing of co-occupational relationships is important for occupational development. Copyright © 2020 by Elsevier, Inc. All rights reserved. 123  Summary Points The Bioecological Model emphasizes the importance of the physical, social, cultural, virtual, and temporal context on child development and explains the reciprocal interactions among and between the child, family, community, and geopolitical contexts on a child’s occupational participation and performance. This model views the transactions between many systems as influencing a child’s development rather than a single factor. Therefore, infants, children, and adolescents all develop somewhat differently and individually based on the set of contexts that influence them. Copyright © 2020 by Elsevier, Inc. All rights reserved. 124  Chapter 11 Assessment and Treatment of Play Copyright © 2020 by Elsevier, Inc. All rights reserved.  Objectives Describe and define play. Describe how play theory influences the use of play in occupational therapy. Explain the ways occupational therapists use play in their therapy. Describe barriers and facilitators for children’s play. List play assessments and determine their usefulness for assessment and treatment planning. Describe how play is used in intervention. Describe how occupational therapists can become advocates for play in our society. Copyright © 2020 by Elsevier, Inc. All rights reserved. 126  What Is Play? Hard to define but has specific characteristics Spontaneous, fun, or joyful Intrinsically motivated and internally controlled Emphasis on process Pretend or “as-if” component Include active engagement and thinking Often social Copyright © 2020 by Elsevier, Inc. All rights reserved. 127  Definitions of Play Through the Years  See Case Smith Table 11.1  Why is defining play important?  In order to study something effectively, researchers must be able to define it clearly. If professionals from varied disciplines wish to determine the importance of play for learning, quality of life, or mental health, a clear definition is critical. Copyright © 2020 by Elsevier, Inc. All rights reserved. 128  Play Theories Theories of Play:  Classical  Modern  Animal Copyright © 2020 by Elsevier, Inc. All rights reserved. 129  Play Theories Older theories Surplus energy theory - play to release excess energy The recreation or relaxation theory - replenishes energy and used to relax The practice or pre‐exercise theory - allows children to practice skills they need for later survival, or practice roles they will need in adulthood The recapitulation theory - Play development recreates the development of the species. A child passes through play stages that mimic the stages of evolution of the species. Copyright © 2020 by Elsevier, Inc. All rights reserved. 130  Play Theories  Modern theories  Psychoanalytic theory - Children play to help them cope with and manage their emotions, and develop solutions to developmental tasks.  Arousal modulation theory - A child plays because his or her nervous system either has too much or needs more stimulation.  Metacommunicative theory - Children use communication about play to identify that it IS play; through play children learn to perform on two levels at once, in reality and the make believe.  Cognitive theories – Play’s purpose is to foster cognitive development Copyright © 2020 by Elsevier, Inc. All rights reserved. 131  Play in Occupation Therapy Meyer—Work, play, rest, and sleep (1922) Hull house – included play in course work Reilly – instrumental in bringing play to the forefront in OT Drive of curiosity exploration, competency, and achievement Takata, Florey, and Knox and early assessment development Emergence of play as an occupation Copyright © 2020 by Elsevier, Inc. All rights reserved. 132  Play as an occupation  Examining play in natural environments  Considering  Form - may be described through the categories of activities in which children engage, the specific types of play that are accepted and named. These include such activities as games, building and construction, social play, pretend, sensorimotor play, symbolic or dramatic play, team sports, and digital play.  Function - way in which play serves the person and influences health and well-being. Few studies examine the impact of play on health and quality of life. Copyright © 2020 by Elsevier, Inc. All rights reserved. 133  Play as an Occupation  Context The Occupational Therapy Practice Framework (OTPF; 3rd ed.; AOTA, 2014) describes context as consisting of physical and social environments, as well as cultural, personal, temporal, and virtual contexts. Play, like any other occupation, takes place within context and obtains meaning through context. Copyright © 2020 by Elsevier, Inc. All rights reserved. 134  Importance of Context  Physical  Playgrounds  Play spaces  Toys and materials  Social  Interactions with parents and peers  Parenting style and playfulness  Sibling play  Changes in play with adult presence  Gender Copyright © 2020 by Elsevier, Inc. All rights reserved. 135  Importance of Contexts  Cultural  Perceptions of importance of play  Cultural differences in children’s use of time  Different cultural forms of play  Temporal  Changes throughout history  Changes throughout seasons or time of day  Virtual contexts—the digital realm  Intersection of contexts and impact on play Copyright © 2020 by Elsevier, Inc. All rights reserved. 136  Play Deprivation  Extreme deprivation can lead to  delayed development.  self stimulation.  difficulties with social interaction.  difficulties with mental health. Copyright © 2020 by Elsevier, Inc. All rights reserved. 137  Playfulness  Examining playfulness - focused attention on the attitudes of children while they play. Bundy theorized that the combination of three elements together make play playful. These three different elements of playfulness, intrinsic motivation, internal control, and the ability to suspend reality, each occur on a continuum. These elements are framed so that all players understand the context (i.e., this is fun). Copyright © 2020 by Elsevier, Inc. All rights reserved. 138  Leisure  Defined as “nonobligatory activity that is intrinsically motivated and engaged in during discretionary time, that is, time not committed to obligatory occupations such as work, self-care, or sleep” in the OTPF.  Important for development and quality of life.  Preference, desire, and motivation are critical.  May be limited in youth with disabilities. Copyright © 2020 by Elsevier, Inc. All rights reserved. 139  Play and Leisure Assessment Consider What, why, how play, and leisure occur for a child or youth Use multiple methods, observation, interview, and assessment tools Attitudes, preferences, and playfulness Developmental competencies expressed through play Copyright © 2020 by Elsevier, Inc. All rights reserved. 140  Play Intervention  Play is used three ways  As a tool Complete an activity analysis to determine that a specific skill may be developed by engaging in a play activity or with a certain toy.  As a reward An incentive for the completion of some other form of “therapy” work.  As an occupation Focus is on the play itself and the development of play performance or play skill, playfulness or the attitude during play, or intrinsic motivation and exploration of play preferences. Copyright © 2020 by Elsevier, Inc. All rights reserved. 141  Facilitating Playfulness Therapist is playful Attitude Body language Speech Model playfulness Novelty Imaginary play Having fun Shared negotiations of control and decision making Copyright © 2020 by Elsevier, Inc. All rights reserved. 142  Importance of Modifying, Adapting, and Assistive Technology  Leads to the “just right” challenge.  Allows activities to be fun rather than boring or frustrating.  Promotes access and allows full range of choice.  Safety is critical. Copyright © 2020 by Elsevier, Inc. All rights reserved. 143  Additional Roles for OT  Education of others  Coaching  Advocacy and focus on physical wellness, quality of life, and mental health Copyright © 2020 by Elsevier, Inc. All rights reserved. 144  Summary Through play, children learn about themselves, and the environment. Play has been identified as a primary occupation. There are two sides of play: the study of play and the art of play. Copyright © 2020 by Elsevier, Inc. All rights reserved. 145