Physical & Occupational Therapy In Pediatrics, 31(4):359–361, 2011C© 2011 by Informa Healthcare USA, Inc.Available online at http://informahealthcare.com/potpDOI: 10.3109/01942638.2011.619090

EVIDENCE TO PRACTICE COMMENTARY

Take Time to Listen: A First Step TowardCollaborative Transition Planning

Debra Stewart

School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada

The article in this issue by Tina Mankey about the beliefs and involvement of occu-pational therapists in secondary transition planning raises some important clinicalissues. Through her survey of occupational therapists in the state of Arkansas, Dr.Mankey found that few occupational therapists in school settings are involved intransition planning, despite their beliefs that occupational therapy does have a roleto play in this area (Mankey, 2011). These findings are supported by other evidencecited by the author.

The two primary barriers to occupational therapy involvement in transition plan-ning in this study were time and the therapists’ knowledge about the adult transi-tion. “Lack of time” is a reason given by many people when asked why they do notdo something. It is a primary reason cited by therapists who have not shifted theirpractice to client-centered approaches (Wilkins, Pollock, Rochon, & Law, 2001).Occupational therapists and other rehabilitation professionals working in schoolsettings cite increasing caseloads as the explanation.

Perhaps Mankey’s discussion offers another explanation. When occupationaltherapists focus their school-based practice on “remedial, task-oriented, and spe-cialized treatment” (pg. 354), there is little time left to spend on re-focusing or shift-ing practice toward evidence-based interventions that are more person-centered.Similarly, the other barrier of “lack of knowledge” about adult transition processesand needs can be explained in terms of “lack of time,” to learn about something new.But if therapists believe that clients would benefit from a more person-centered ap-proach that focuses on daily occupations, now and in the future, then we need tofind the time to gain the knowledge needed to put this into practice. And the onlyway to do that is to let something go—to stop using treatment approaches thatdo not have the evidence to support them, and to start taking small steps towardevidence-based practice. Taking small steps, one at a time, is more reasonable andachievable than trying to change everything at once. So where can therapists work-ing in high schools start? Some strategies are offered here to help take that firststep.

Address correspondence to: Debra Stewart, School of Rehabilitation Science, McMaster University, IAHSBuilding, 1400 Main Street West, Hamilton, ON L8S 1C7, Canada (E-mail: stewartd@mcmaster.ca).

359

Phys

Occ

up T

her

Pedi

atr

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Uni

vers

ity o

f So

uthe

rn C

alif

orni

a on

11/

24/1

1Fo

r pe

rson

al u

se o

nly.

360 Stewart

If every therapist who works in a high school takes one “treatment” session tosit down and ask their clients about their future plans and needs, the clients’ storiescan guide them toward transition planning. For example, if a client identifies a goalto go to university, an occupational therapist can use their knowledge and skills ofoccupation and task analysis to figure out the steps and demands of university lifethat the client needs to work toward and the skills they need to develop. This canstill be done within the context of high school. For example, if a client needs to learnto direct another person to assist them with self-care in the bathroom, or gettingdressed in the morning in order to live in residence, then the occupational therapistcan work with the client and the high school educational assistants to facilitate this.This requires education of both client and school staff to understand the importanceof directing one’s own care, for future self-management in the adult world. I believethat if the focus of therapy remains on the self-identified goals of the client towardfuture occupations, the occupational therapist can start transition planning rightaway.

The other important “first step” for occupational therapists to take toward a newpractice approach is to communicate their “new” or “revised” role to others. AsMankey suggested, collaboration and communication are important strategies forincreasing understanding of each others’ roles. Collaboration sounds simple and isan expectation of all licensed health care professionals. But it becomes more diffi-cult when a clinician from one system (health care) has to collaborate with otherprofessionals in a different system (education). Terminology, definitions, concepts,and the underlying cultures can all be different, and it behooves all team membersto spend time learning about each other. Time spent up front in clarifying roles andlanguage will save time later on during transition planning. And perhaps the bestway to improve team communication and collaboration, to bridge the differences inlanguage between systems, is to use the clients’ own words. Person-centered plan-ning means we all listen to the client, find out about their goals, and then, set ourunique treatment objectives to facilitate goal attainment. This is the beginning ofcollaboration.

Other strategies to improve collaboration among different team members, andwith youth with disabilities and their families (who should be viewed as active teammembers during transition planning) are offered below, from a study to developbest practice guidelines for the transition to adulthood for youth with disabilities(Stewart et al., 2009). An expert panel in this study reviewed evidence from differ-ent sources and recommended a number of different strategies to facilitate collab-oration across systems, communities, and people:

• Schools, rehabilitation centers and health care agencies should sit down togetherfor a meeting to explore how they can work collaboratively with each other, andother community groups and service providers to begin transition planning early;

• Build collaboration into the Individualized Education Plan (IEP) process byidentifying other people and agencies to communicate with during transitionplanning;

• Create co-op experiences and career planning opportunities within the commu-nity;

Phys

Occ

up T

her

Pedi

atr

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Uni

vers

ity o

f So

uthe

rn C

alif

orni

a on

11/

24/1

1Fo

r pe

rson

al u

se o

nly.

Evidence to Practice Commentary Take Time to Listen 361

• Form a task group to work together to develop common transition resourcesand processes, such as one common “transition planning” form or one common“intake” package for adult services;

• Rehabilitation professionals and educators can work with communities, alongwith youth and families, to develop collaborative community capacity buildingopportunities. For example, create opportunities for youth to use and test skillsin community settings, such as businesses, community centers, and extracurricularclubs or groups as part of preparation;

• Emphasize “shared management” (Gall, Kingsnorth, & Healy, 2006) with fami-lies within services and schools, and take the focus off just the “expertise” amongservice providers. Youth and families should attend planning meetings, and overtime a young person can take on some leadership roles;

• Peer support and word of mouth can bring about collaboration and reductionof barriers between agencies in various sectors and communities. Bring peerstogether to discuss collaborative initiatives—start with youth peers and familypeers, then broaden to service/professional peers.

To summarize, evidence is mounting about the importance of the transition toadulthood for youth with disabilities, and occupational therapists have a role to playin this area. Mankey’s article offers evidence about the barriers and strategies forinvolvement in transition planning. Using a person-centered approach with eachclient in high school, occupational therapists can naturally start to focus more onoccupations that the client needs to, wants to, or is expected to participate in whenhigh school finishes. And through collaboration and communication with otherteam members in the education system, using the clients’ own words to set goalsand plan for the future, occupational therapists can begin to play an important rolein secondary transition planning.

Declaration of interest: The authors report no conflict of interest. The authorsalone are responsible for the content and writing of this paper.

REFERENCES

Gall, C., Kingsnorth, S., & Healy, H. (2006). Growing up ready: A shared management approach.Physical and Occupational Therapy in Pediatrics, 26, 47–62.

Mankey, T. (2011). Occupational therapists’ beliefs and involvement with secondary transitionplanning. Physical and Occupational Therapy in Pediatrics, 31, 345–358.

Stewart, D., Freeman, M., Law, M., Healy, H., Burke-Gaffney, J., Forhan, M., et al. (2009).“The best journey to adult life” for youth with disabilities. An evidence-based model andbest practice guidelines for the transition to adulthood for youth with disabilities. Hamilton,ON: McMaster University. Retrieved July 23, 2011, from http://transitions.canchild.ca/en/OurResearch/bestpractices.asp? mid =2594

Wilkins, S., Pollock, N., Rochon, S., & Law, M. (2001). Implementing client-centred practice: Whyis it so difficult to do? Canadian Journal of Occupational Therapy, 68(2), 70–79.

Phys

Occ

up T

her

Pedi

atr

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Uni

vers

ity o

f So

uthe

rn C

alif

orni

a on

11/

24/1

1Fo

r pe

rson

al u

se o

nly.