Ecological Intervention for Children The School-based Occupational Therapy Practice Framework Andrea Hasselbusch

Ecological Intervention for Children
with Developmental Coordination Disorder:
The School-based Occupational
Therapy Practice Framework
Andrea Hasselbusch
PhD candidate, MOccTh, Bc OT, PG Cert Ed, Dip OT
Senior Practice Fellow in Occupational Therapy
Bournemouth University, School of Health and Social Care (UK)
Overview
• Introduction
– Literature review: SBOT & DCD
– Background to research projects
• School-Based Occupational Therapy
Practice Framework (SB-OT-PF)
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–
–
–
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School Environment & Educational Context
Practice Process Principles
Practice Process in School Environment
Collaborative Problem Solving Processes
Clinical Reasoning & Decision Making
• Conclusion
– Implications for Practice
– Further resources (compatible with SB-OT-PF)
Literature Review:
School-aged Children with DCD
• Prevalence: 5 to 6% of
population (APA 2000)
• OP issues at school:
– school work (incl. handwriting)
– self-care (e.g. dressing)
– leisure (e.g. lower level of
participation in structured &
unstructured sport)
• Secondary issues, when
unsupported: mental
health challenges (Cairney
2011, Cairney, Veldhuizen &
Szatmari 2010, Engel-Yeger &
Hanna Kasis 2010)
Literature Review:
School-based OT for Children with DCD
• School-based OT
– theoretically derived models (e.g.
Bundy 2002, Hanft & Place 1996)
– model developed by local service
providers (e.g. Bayona et al 2006)
– effectiveness research (e.g. Dunn
1990, Kemnis & Dunn 1996)
• Working in schools...
– feeling unprepared (e.g. Swinth &
Hanft 2002)
– attitudes vs. implementation (e.g.
Case-Smith & Cable 1996, Weintraub
& Kovshi 2004
Initial Development of the
School-based OT Practice Framework
• Practice Context:
New Zealand
• Aim Of The Study:
Explore SBOT practice
• Participants
• Grounded Theory –
allows theory to
emerge from the data.
Current Research: Implementation,
Consolidation & Evaluation of SB-OT-PF
• Practice Context:
England
• Aim of the Study:
Explore usefulness &
effects of SBOTPF
• Participants
• Mixed-methods:
QUALquan
Components of the
School-Based Occupational Therapy
Practice Framework (SB-OT-PF)
School and Classroom Environment – Educational Context
Practice Process Principles
Practice Process in Educational Context
Collaborative Problem Solving Process
Clinical Reasoning & Decision Making Processes
• International/
national policies &
legislations
• Funding restraints
& resources
available
• Behavioural & social
expectations
• Relationships &
friendships
• Educational culture
• Attitudes, values &
beliefs
• School & class
routines
Institutional
Context
School &
Classroom
Culture
Social
Environment
Physical
Environment
• Natural & built
elements
• School grounds
• School buildings
Interactive –
Interpersonal
Focused
Principles:
Occupation-inContext
Focused
Principles:
• Client- centeredness
• Collaboration
• Consultation
• Occupation-centred
• Ecological Approach
Collaboration & Consultation:
Working Together in Partnership
… you are not dealing with the
student in a vacuum …
We become partners in
supporting the work with the
child rather than …the people
who come in and provide the
alternative because this child is
too hard.
Client-centredness:
Listening, Power & Choice
I prioritise from the needs that I’m hearing
from the staff, the team and the parents,
…what the parents really wanted for him
as well... And from my observations...
I think my involvement tends to be more
responsive to those issues rather than
perhaps creating those issues… the
perceived need or request from the
parent and from the teacher aide …was
the place that I had to come in at because
that’s what they wanted for the child.
Ecological Approach
I won’t have an honest
picture of the child
within a school setting
unless I go into where
they are engaged and
learning …
I am trying to get a
reasonable
understanding of the
situation, the people
around the child, the
classroom…
Occupational Focus:
Beyond Handwriting
I try to go in at a time when I can just observe
the student doing the activities that he would
be doing anyway. So maybe at work time, so
they’re on the mat. I find the mornings better
because then you see mat time, you see
some work, often especially in the early years
they have some choosing time, so you’ve got
some time to see some games. And then if
you want to have a look at morning tea and
running around, you can see them having
their morning tea and play time as well so
you can see quite a broad spectrum.
EnterReceiving
Referral
Schoolbased Goal
Setting
Schoolbased
Assessment
Schoolbased
Evaluation
Schoolbased
Intervention
Conclusion
& Exit
Practice Process:
School-based Assessment
• Skilled Classroom
Observations
• Formal & Informal
Interviews
– School Staff
– Parents/ Caregivers
– Student
• Functional, Standardized
Assessment Tools
School-based Assessment:
Skilled Classroom Observations
And then I would often go into the
classroom and … just observe what was
happening within the class.
I just try and be a fly on the wall really, I try
and blend in. I usually go in quietly and
whatever the class is doing at that time I
sort of sit down and join in…
I was just assessing where he was at with
his writing and it was just observations.
I never would have worked that out, if I
hadn’t observed it.
Reframing
Environmental
Modifications
Task
Adaptations
Provision of
Generic
Strategies
Coaching
Provision of
Child Specific
Strategies
School-based Intervention:
Reframing
…one of the key things
that I think we do a lot
of re-interpreting ...
.... “How does that
sound to you? Does
that fit? Does that
make sense?” And
when they say “oh,
yeah, that makes
sense”, you know you
have reframed
something for them....
School-based Intervention:
Reframing & Coaching –
Environmental Modifications
The adaptation is not on the student’s part
…it is for the student... In the sense that
you are helping people adapt their
thinking and their understanding and in
the sense that in that understanding they
then create an adapted environment that
is more matched with the child’s needs.
The adaptation is at the adult level in terms
of perceptions, understanding and at the
physical level, in terms of environment...
Collaborative
Problem Solving Processes
• Trial & Error
• Tweaking – minor
adjustments
• Ill-defined
problems
• Number of
variables
• Pacing
Problem Solving
& Clinical Reasoning
…with a lot of those strategies,...
sometimes it is just a matter of
trial and error to see what is
going to work for the particular
student and what works for one
might not work for another one.
So sometimes it is just a matter
of trying something, seeing if it is
working and if it is not then going
back onto the next plan...
.
Clinical Reasoning
& Decision Making
• Conditional –
Contextual Reasoning
• Interactive Interpersonal
Reasoning
• Narrative Reasoning
CONCLUSIONS:
IMPLICATIONS FOR PRACTICE
Implications For Practice
• Complexity of School-based
Practice - Shift in thinking & practice;
adapting “old” tools & developing “new” tools
• Need for Reflection –
Working/ Being in the School Environment
• Induction & Training –
Preparation of therapists working in education
• Time & Workload Management –
deliberate decisions about way of working
Ecological Intervention for Children
with DCD: Some additional useful resources
• Ecological Intervention: “Movement Coaching”
Sugden DA & Henderson SE (2007) Ecological
intervention for children with movement difficulties.
London: Pearson.
• Partnering for Change (P4C)
Missiuna, Pollock, et al (2012) Partnering for change: An innovative
school-based occupational therapy service delivery model for children
with developmental coordination disorder, Canadian Journal of
Occupational Therapy, 79(1), 41-50.
• CanChild on-line workshop for parents and
school staff, including introduction of MATCH
strategy; website: http://www.canchild.ca/
DCD Resources continued:
MATCH - Strategy
•
•
•
•
•
Modify the task
Alter your expectations
Teach strategies
Change the environment
Help by understanding
http://www.canchild.ca/
(Missiuna, Rivard & Pollock, 2004)
Contact Details
Andrea Hasselbusch
Bournemouth University
School of Health & Social Care
Royal London House, R601
Christchurch Road
Bournemouth, Dorset, BH1 3LT
United Kingdom
E-mail:
ahasselbusch@bournemouth.ac.uk