Ecological Intervention for Childrenwith Developmental Coordination Disorder:

The School-based Occupational Therapy Practice Framework

Andrea HasselbuschPhD candidate, MOccTh, Bc OT, PG Cert Ed, Dip OT

Senior Practice Fellow in Occupational TherapyBournemouth 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)– 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

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.

Enter- Receiving Referral

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 ObservationsAnd 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.

Coaching

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 HasselbuschBournemouth University

School of Health & Social Care

Royal London House, R601

Christchurch Road

Bournemouth, Dorset, BH1 3LT

United Kingdom

E-mail:

ahasselbusch@bournemouth.ac.uk