Friday, June 3, 2011

Special Needs Kids: Therapy/Early Intervention Strategies

 A recent study published in The American Journal of Occupational Therapy (AJOT), Identifying Strategies Early Intervention Occupational Therapists Use to Teach Caregivers, compared different occupational therapy strategies and outcomes.  The study focused on the vital role of the family as the teacher of the child and the role of the therapist as the family educator. 

The study compared Early Intervention service approaches of therapists with children requiring therapeutic intervention and the families most often the moms.  This study although conducted with Early Intervention service providers can be generalized to outpatient therapists, school therapists (teacher having caregiver role) and many other venues in which OT is practiced.

The service approaches studied were:
Routines or activities based interventions, the more traditional approach in which the providers do not facilitate caregiver-child teaching interactions nor incorporate interventions with family activities and routines.  The service provider spend more than half of their time directly teaching the child with the primary role of the caregiver more often being and observer during interactions between the provider and the child.

Participation-based intervention is provided by teaching caregivers how to use two primary types of child interventions to promote their participation and learning: (1) adapting the environment, materials or the activity/routine including assistive technology and (2) embedding individualized learning strategies into family routines.

Main difference between traditional and participation based strategies.

Traditional service models are child focused and oriented to the child’s developmental or physical needs.  The provider creates learning opportunities for the child by working directly with the child to promote functional improvements.  The caregiver may participate as an observer but does not receive specific teaching from the provider.

Participation based service models are focused on teaching the caregivers to interact therapeutically with child.   The provider works with the caregiver (teacher/parent) and the child to assist the caregiver in creating therapeutic learning opportunities in the natural environment.  The caregiver can then carry out therapeutic interventions in the absence of the professional.

Provider’s Perspectives:
Most providers describe ideal treatments as including caregivers and using family teaching techniques such as coaching, modeling, providing explanations and problem solving.  Although descriptions of the ideal reflecting participation-based treatment a low frequency of ideal treatment sessions were reported.

The importance of participation-based intervention strategies is based on the Bronfenbrenner’s (1992) theory that families have the most proximal influence on their children’s development.  In the school setting this theory could be generalized to the classroom teacher having the most influence on the child’s development during the school day.

Because recommended practices focus on traditional approaches this researched showed a low frequency of ideal visits being reported. 

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