Occupation-Centred Practice with Children E-Book
48,99 €
Mehr erfahren.
- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Occupation-Centred Practice with Children remains the only occupational therapy book which supports the development and implementation of occupation-centred practice with children. Drawing on the latest occupational therapy theory and research, this new edition has been fully updated throughout, and includes new chapters on occupational transitions for children and young people, assessing children’s occupations and participation, intervention within schools, the arts and children’s occupational opportunities, as well as using animals to support children’s occupational engagement.
Key features:
- Written by an international expert team of contributors.
- Each chapter begins with preliminary questions to assist with consideration of current knowledge, and then reflection questions at the conclusion to allow revision of key content in order to support independent learning.
- Highly practical, with a range of case studies, key point summaries, reflective questions, best practice guidelines, and a range of tools, interventions and techniques to aid applications to practice.
- A new appendix outlining all the assessments referred to in the book has now been included.
Occupation-Centred Practice with Children is a practical, theoretically grounded and evidence based guide to contemporary occupational therapy practice, and is important reading for all occupational therapy students and therapists wishing to make a real difference to children and their families’ lives.
Sie lesen das E-Book in den Legimi-Apps auf:
Seitenzahl: 796
Veröffentlichungsjahr: 2017
Ähnliche
Table of Contents
Cover
Title Page
Notes on Contributors
Foreword
Preface
Acknowledgements
Chapter 1: Introduction to Occupation‐centred Practice for Children
Introduction
Re‐affirming occupation: The core of occupational therapy
External influences impacting occupational therapy practice
International Classification of Functioning, Disability and Health (ICF)
United Nations’ declarations
The evolution of occupational therapy practice with children
Changing views of child development and maturation
Emerging views about occupational development
Re‐focusing occupational therapy with children
Conclusion
References
Chapter 2: Becoming an Occupation‐centred Practitioner
Introduction
Theoretical underpinnings of occupational therapy with children
Occupation‐centred and performance‐component focused approaches to practice with children
Characteristics of occupation‐centred practice for children
Focus on occupational performance and participation throughout the process
Conclusion
References
Chapter 3: Child and Family‐centred Service Provision
Introduction
Defining the client: Who and how many?
Client‐centred practice
Unequal power in relationships
Recognising expertise and goal setting
Child‐centred practice
Family‐centred practice and service provision
Family‐centred practice, family‐centred services and family‐centred care
Becoming a child‐ and/or family‐centred practitioner
Developing family‐centred services
Outcomes of family‐centred practice and family‐centred services and their measurement
The extended family and community
Conclusion
References
Chapter 4: Cultural Influences and Occupation‐centred Practice with Children and Families
Introduction
Culture and the occupations of the child
Culturally responsive occupational therapy
The child’s and family’s stories are central
Getting connected
Being connected
Staying connected
Building connections
Case studies
Making the invisible visible
Conclusion
References
Chapter 5: Occupational Goal Setting with Children and Families
Introduction
Giving children and families a voice
Goal setting and motivation
Goal setting and outcomes
Tools to facilitate goal setting with children and families
Summary
Goal setting contributes to outcome measurement
Case studies: Goal setting with children and parents
Conclusion
References
Chapter 6: Occupational Transitions for Children and Young People
Introduction
Definition of transition using a life course perspective
Transition from home to early childcare centres
Transition from early childhood care to primary school
School readiness
Transition to secondary school
Tips for transition to secondary school
Transition to post‐school options
Conclusion
References
Chapter 7: Assessing Children’s Occupations and Participation
Introduction
Bottom‐up or top‐down approaches to assessment?
Occupation‐ and Participation‐Centred Assessment with Children (OP‐CAC) framework
Implementation of Occupation‐ and Participation‐Centred Assessment with Children (OP‐CAC) framework: Assessment in action
Occupation‐ and Participation‐Centred Assessment with Children (OP‐CAC) framework: Tools
Conclusion
References
Chapter 8: Cognitive Orientation for Daily Occupational Performance (CO‐OP)
Introduction
CO‐OP: A brief overview
CO‐OP Approach: An occupation‐centred intervention
Review of handwriting intervention
Conclusion
References
Chapter 9: Perceive, Recall, Plan and Perform (PRPP)
Introduction
Information processing, cognitive strategy use and occupational performance
The Perceive, Recall, Plan and Perceive (PRPP) System of Task Analysis and intervention
Using the PRPP system of task analysis and intervention: David
‘Perceive’: Observing and prompting sensory processing strategies during task performance
‘Recall’: Observing strategies used for storage and retrieval of information during task performance
‘Plan’: Processing information for organizing and problem‐solving
Conclusion
References
Chapter 10: Occupational Performance Coaching (OPC)
Introduction
Theoretical and philosophical basis
Three enabling domains
Research about OPC
Conclusion
References
Chapter 11: Occupation‐centred Intervention in the School Setting
Understanding the occupations of the school student
Educationally relevant occupational therapy in schools
Ways of working in schools
Planning educational programmes for diverse learners
Occupation‐centred information gathering in educational settings
Occupation‐centred programme planning and intervention in schools
Collaboration in service delivery
Conclusion
References
Chapter 12: Occupation‐centred Practice
Introduction
Practicalities of implementing occupation‐centred classroom‐based practice
Partnering for Change: A description of the model
Conclusion
Acknowledgements
References
Appendix 12.1 Occupational performance analysis template
Appendix 12.2 Occupational performance skills included in the OTIPM: Motor, process, and social interaction
Chapter 13: Enablement of Children’s Leisure Participation
Introduction
Outcomes of leisure engagement
Engaging and Coaching for Health – Child: Model of leisure coaching
Step One: Creating successful engagements
Step Two: Coaching to promote personal growth
Conclusion
References
Chapter 14: The Arts and Children’s Occupational Opportunities
Introduction
The affordances of the arts
Overview of arts in children’s health care
Role of creativity and the performing arts within childhood play: Identity, imitation and imagination
Skill acquisition and empowerment
Motivation and motivationally enhanced learning
Self‐reflection, feedback and competition
Emerging evidence for creative performing arts in therapies for children
Conclusion
References
Chapter 15: Using Animals to Support Children’s Occupational Engagement
Introduction
AAT as an enabler of occupational engagement
Theory in AAT
Attachment patterns, secure child–therapist relationships, and the effects of human–animal interaction
Physiological stress response
Understanding the individual meaning of engagement in human–animal interaction
Methods of AAT
AAT to support an increase in desired social behaviours/attention in social interaction
Using AAT to facilitate social interaction and positive social attention
Assisting participation in meaningful activities
Decision‐making in AAT
Conclusion
References
Chapter 16: Decision‐making for Occupation‐centred Practice with Children
Introduction
Decision‐making and information sources
Information from clients, families and their contexts
The child’s current abilities and functioning across different environmental contexts
Information about the practice context
Information from empirical research
Information from clinical experience
Integrating information given alternatives and uncertainties
Shared decision‐making
Conclusion
Appendix 1: Assessments Referred to Throughout the Book
Index
End User License Agreement
List of Tables
Chapter 02
Table 2.1 Comparison of performance component‐focused and occupation‐centred approaches and theoretical models and frames of reference
Table 2.2 Comparison of five occupational therapy process models
Table 2.3 Classifications of occupational therapy interventions and description in terms of occupation as means versus ends
Table 2.4 Occupation‐related taxonomy of terms
Chapter 03
Table 3.1 Family‐centred practice assessment scales
Table 3.2 Strategies for implementation of child‐ and family‐centred services
Table 3.3 Summary of MPOC and MPOC‐SP tools
Chapter 05
Table 5.1 Perceived Efficacy and Goal Setting System (PEGS)
Table 5.2 The Family Goal Setting Tools (FGSTs)
Chapter 07
Table 7.1 Assessment tools that measure children’s occupational performance and participation
Table 7.2 Assessment tools that measure children’s play and leisure occupations
Table 7.3 Assessment tools that measure children’s productivity and school occupations
Table 7.4 Assessment tools that measure children’s self‐care occupations
Table 7.5 Assessment tools that measure the environmental impacts on children’s occupational performance and participation
Table 7.6 Issues identified by Jill and her parents using the OP‐CAC framework
Chapter 08
Table 8.1 CO‐OP: A uniquely occupation‐centred intervention
Table 8.2 Summary of key features of CO‐OP (adapted from Polatajko and Mandich, 2004)
Table 8.3 Cognitive strategies used to master handwriting by four boys with DCD
Chapter 09
Table 9.1 Core principles of intervention of the PRPP System of Intervention
Table 9.2
Stop/Attend, Sense, Think, Do
example of verbal prompting for cognitive strategy used by David’s teacher during written classwork
Table 9.3
Stop/Attend, Sense, Think, Do
verbal prompting example using ‘chunks’ of PRPP descriptors used by David’s mother during written homework
Chapter 10
Table 10.1 Collaborative Performance Analysis for Goal: Eating Tidily at the Dinner Table
Chapter 11
Table 11.1 Assessment tools for education settings
Chapter 12
Table 12.1 Challenges and strategies for occupational therapists implementing whole‐class or whole‐school interventions
Chapter 13
Table 13.1 Assessment of interests, participation and contexts relevant to children’s leisure
Table 13.2 Leisure questions derived from Personal Projects Analysis – Children
List of Illustrations
Chapter 01
Figure 1.1 Daily life and occupations of a boy aged 11 years in metropolitan Brisbane.
Figure 1.2 Daily life and occupations of a boy aged 15 years in East Timorese village.
Figure 1.3 External influences and internal evolution within the profession leading to occupation‐centred practice with children and families.
Figure 1.4 Interactions between the components of the ICF.
Chapter 02
Figure 2.1 Occupation‐centred service delivery process for children and families.
Chapter 03
Figure 3.1 Example of family centred philosophy embedded in a service mission, values and principles.
Chapter 04
Figure 4.1 Making Connections framework.
Figure 4.2 The Kawa Model showing rocks and driftwood in the river.
Figure 4.3 Charlie’s ‘river’.
Chapter 05
Figure 5.1 PEGS sample item.
Figure 5.2 FGST materials.
Figure 5.3 FGST sorting baseplates.
Figure 5.4 Couple sorting cards.
Chapter 06
Figure 6.1 Adapted PEO model for adolescents transitioning to secondary school.
Chapter 07
Figure 7.1 Steps in the occupational therapy assessment and intervention process using an occupation‐based and participation‐focused approach.
Figure 7.2 Conceptual interaction between the International Classification of Functioning, Disability and Health and occupational performance.
Figure 7.3 OP‐CAC framework from a top‐down perspective.
Chapter 08
Figure 8.1 Key features of the CO‐OP Approach.
Figure 8.2 Joey’s early session writing.
Figure 8.3 Later session writing.
Figure 8.4 Some letter and number writing strategies.
Chapter 09
Figure 9.1 Information processing model with associated processing strategies.
Figure 9.2 The PRPP System of Task Analysis conceptual model showing the four processing quadrants: Perceive, Recall, Plan and Perform (inner circle); subquadrants (middle ring); and associated cognitive strategy behaviours (outside ring).
Figure 9.3 Examples of cognitive strategies associated with information processing in each of the PRPP quadrants.
Chapter 10
Figure 10.1 Three enabling domains of occupational performance coaching.
Figure 10.2 The coaching process and Person–Environment–Occupation Model.
Figure 10.3 Collaborative Performance Analysis within Occupational Performance Coaching.
Chapter 11
Figure 11.1 Strategies to support Jacob’s occupational success at school: Application of a clinical reasoning framework for children with autism spectrum disorder experiencing sensory challenges.
Chapter 12
Figure 12.1 The Occupational Therapy Intervention Process Model.
Figure 12.2 Classroom corridor prior to intervention.
Figure 12.3 Coats hanging in the corridor following occupational therapy intervention.
Figure 12.4 Partnering for Change Model.
Chapter 13
Figure 13.1 Engaging and Coaching for Health – Child: Model of leisure coaching.
Figure 13.2 The Rocket Motivation Model.
Chapter 14
Figure 14.1 Magic and models.
Figure 14.2 Children in a dance project.
Figure 14.3 Spinning plates necessitates a bi‐manual approach.
Figure 14.4 Learning the balls and cups trick.
Chapter 15
Figure 15.1 Simon enjoying the mischievous dog.
Figure 15.2 Simon monitoring the dog’s water needs.
Figure 15.3 Schematic representation of considerations and decision‐making process regarding AAT.
Chapter 16
Figure 16.1 Development and expansion of a therapist’s body of knowledge in practice.
Guide
Cover
Table of Contents
Begin Reading
Pages
iii
iv
xi
xii
xv
xvi
xvii
xviii
xix
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
373
374
375
377
378
379
380
381
382
383
384
385
386
387
Occupation‐Centred Practice with Children
A Practical Guide for Occupational Therapists
Second Edition
Edited by
Professor Sylvia Rodger
The University of Queensland, Australia
Dr Ann Kennedy‐Behr
University of the Sunshine Coast, Australia
This edition first published 2017. © 2017 John Wiley & Sons Ltd
First edition published 2010 by John Wiley & Sons Ltd.
Wiley‐Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing.
Registered OfficeJohn Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial Offices9600 Garsington Road, Oxford, OX4 2DQ, UKThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK111 River Street, Hoboken, NJ 07030‐5774, USA
For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley‐blackwell.
The right of Sylvia Rodger and Ann Kennedy‐Behr to be identified as the editors of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.
The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added
warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising here from.
Library of Congress Cataloging‐in‐Publication Data
Names: Rodger, Sylvia, editor. | Kennedy‐Behr, Ann, 1971– editor.Title: Occupation‐centred practice with children : a practical guide for occupational therapists/[edited by] Sylvia Rodger, Ann Kennedy‐Behr.Description: 2e. | Chichester, West Sussex ; Hoboken, NJ : John Wiley & Sons Inc., [2017] | Includes bibliographical references and index.Identifiers: LCCN 2016055383 (print) | LCCN 2016056138 (ebook) | ISBN 9781119057628 (pbk.) | ISBN 9781119057758 (Adobe PDF) | ISBN 9781119057765 (ePub)Subjects: | MESH: Occupational Therapy–methods | ChildClassification: LCC RJ53.O25 (print) | LCC RJ53.O25 (ebook) | NLM WS 368 | DDC 615.8/515083–dc23LC record available at https://lccn.loc.gov/2016055383
A catalogue record for this book is available from the British Library.
Cover Design: WileyCover Images: (Background) © Alex Bors/Gettyimages; (Top Right) © FatCamera/Gettyimages; Children Images: Courtesy of the authors
Notes on Contributors
Jill Ashburner, BOccThy, PhDManagerResearch and DevelopmentAutism QueenslandBrisbaneAustralia;Project LeaderCooperative Research Centre for Living with Autism (Autism CRC)BrisbaneAustraliaSally Bennett, BOccThy (Hons), PhDAssociate ProfessorDivision of Occupational TherapySchool of Health and Rehabilitation SciencesThe University of QueenslandSt LuciaBrisbaneQueenslandAustraliaTed Brown, PhD, MSc, MPA, BScOT (Hons), OT(C), OTRAssociate ProfessorDepartment of Occupational TherapySchool of Primary Health CareFaculty of MedicineNursing and Health SciencesMonash University,FrankstonVictoriaAustraliaChristine Chapparo, PhD, MA, DipOT(NSW)Senior LecturerDiscipline of Occupational TherapyFaculty of Health SciencesThe University of SydneyNew South WalesAustraliaChi‐Wen Chien, PhD, MEd (Hons), BScOT, OTRAssistant ProfessorOccupational Therapy ProgramDepartment of Rehabilitation SciencesFaculty of Health and Social SciencesHong Kong Polytechnic UniversityHung HomKowloonHong KongJodie Copley, BOccThy (Hons), PhDSenior LecturerDivision of Occupational TherapySchool of Health and Rehabilitation SciencesThe University of QueenslandSt LuciaBrisbaneQueenslandAustraliaKarina Dancza, PhD, MA, BAppSc(OT)Professional Adviser – Children and Young PeopleThe College of Occupational TherapistsSouthwarkLondonUnited KingdomFiona Graham, B OccTher, PhD, Dip HESenior LecturerRehabilitation Teaching and Research Unit (RTRU)Department of MedicineUniversity of OtagoWellingtonNew ZealandDido Green, DipCOI, MSc, PhDReader in RehabilitationOxford Brookes UniversityMarston Road CampusOxfordUnited KingdomElizabeth Hinder, BOccThy(Hons)Senior Advisor – Occupational TherapyDepartment of Education and TrainingToowoombaQueenslandAustraliaMichael K. Iwama, PhDChairDepartment of Occupational TherapyGeorgia Regents UniversityAugustaGeorgiaUnited StatesFiona Jones, PhD, BOccThy (Hons)DirectorOccupational TherapistOCC Therapy Pty LtdKenmoreQueenslandAustraliaJudy Jones, BOccThySenior Occupational TherapistAutism QueenslandSunnybankBrisbaneAustraliaAnja Junkers, BOT, MScOTPractice for Occupational Therapy and Animal‐assisted TherapyMunichGermanyDeb Keen, PhD, MA, BSpecEd, DipEdPsych, BScProfessorAutism Centre of ExcellenceSchool of Education and Professional Studies (Brisbane, Logan)Faculty of Education ExecutiveMt Gravatt CampusGriffith UniversityMt GravattQueenslandAustraliaAnn Kennedy‐Behr, BAppSc(OT), MOccThy, PhD, OTRLecturerProgram Coordinator – BOccThy(Hons)School of Health and Sport SciencesUniversity of the Sunshine CoastQueenslandAustraliaTara Lewis, BSpPathThe Institute for Urban Indigenous HealthBowen HillsBrisbaneQueenslandAustraliaSok Mui Lim, PhD, BScOT (Hons), GCertHigherEdAssistant ProfessorProgramme Director – BSc (Hons) Occupational Therapy (SIT)Deputy Director – Centre for Learning Environment and Assessment Development (Co‐LEAD)Academic ProgrammeSingapore Institute of TechnologySingaporeChrisdell McLaren, BOccThy, MOccThy (Cont.Prac)The Institute for Urban Indigenous HealthBowen HillsBrisbaneQueenslandAustraliaCheryl Missiuna, PhD, OTReg. (Ont.)ProfessorSchool of Rehabilitation ScienceScientistCanChild Centre for Childhood Disability ResearchJohn and Margaret Lillie Chair in Childhood DisabilityMcMaster UniversityHamiltonOntarioCanadaAlison Nelson, BOccThy, MOccThy (Research), PhDThe Institute for Urban Indigenous HealthBowen HillsBrisbaneQueenslandAustraliaHelene Polatajko, BOT, MEd, PhDProfessorUniversity of TorontoDepartment of Occupational Science and Occupational TherapyRehabilitation Sciences InstituteUniversity of Toronto Neuroscience ProgramProgram AffiliateSt John’s Rehab Hospital;Editor‐in‐ChiefCanadian Journal of Occupational TherapyTorontoCanadaNancy Pollock, MSc, OTReg. (Ont.)Associate Clinical ProfessorSchool of Rehabilitation ScienceScientistCanChild Centre for Childhood Disability ResearchMcMaster UniversityHamiltonOntarioCanadaAnne A. Poulsen, BOccThy (Hons), PhDSenior ResearcherDivision of Occupational TherapySchool of Health and Rehabilitation SciencesThe University of QueenslandSt LuciaBrisbaneQueenslandAustraliaSylvia Rodger, AM, BOccThy, MEdSt, PhDEmeritus ProfessorSchool of Health and Rehabilitation SciencesDirector Research and EducationCooperative Research Centre for Living with AutismThe University of QueenslandSt LuciaBrisbaneQueenslandAustraliaMerrill Turpin, BOccThy (Hons), PhDSenior LecturerDivision of Occupational TherapySchool of Health and Rehabilitation SciencesThe University of QueenslandSt LuciaBrisbaneQueenslandAustraliaJenny Ziviani, BOccThy, MEd, PhDProfessorChildren’s Allied Health ResearchChildren’s Health QueenslandSchool of Health and Rehabilitation SciencesThe University of QueenslandSt LuciaBrisbaneQueenslandAustralia
Foreword
Design and delivery of effective occupational therapy for children is both an art and a science. This book is undoubtedly the da Vinci Einstein of paediatric occupational therapy textbooks! It is a master class in painting and inventive thinking, underpinned by exceptional contemporary science.
The art of working with children involves listening and respecting children’s goals, aspirations and insights. After that, it entails using these learnings to design individualised occupation‐based interventions at the just‐right challenge that are motivating, fun and contribute to the child’s sense of positive self‐worth. Children are not miniature adults and cannot be given a list of pre‐set prescribed exercises, with a regimen to follow. Designing intervention that responds to children’s goals, preferences and decisions requires vision and the kind of skilled perseverance da Vinci spent carving David from a single slab of marble. Like marble, children have boundless potential, but are vulnerable. We must respect their fragility yet resilience and handle their personhood with care and dignity! As a sculptor, the occupational therapist must also consider the structural contributions arising from the marble’s physical attributes – the knowledge, values, strengths, preferences and skills of the child’s family, school and community.
Imagine that a physician referred an 8‐year‐old boy with cerebral palsy to you for occupational therapy. The doctor’s goal is to optimise fine‐motor function following injection of a muscle relaxant. The mother’s goal is for her son to write more legibly in his schoolbooks. The boy’s goal is to thread sinkers onto a fishing line so he can fish by himself. The art is to resolve – who is the client? Can your intervention plan address all the team members’ priorities and still remain child‐centred? Is shared decision‐making possible or is negotiation required? What does empirical evidence suggest will work?
This book elegantly outlines the principles of contemporary occupational science in a compelling and accessible way. Contemporary paediatric occupational science fundamentally involves evidence‐based practice. That is, after hearing what the child and family want to achieve, the therapist plans, collaborates and implements the most effective interventions known to help the child achieve their goal, in partnership with the family. Scientific occupational therapists will examine trustworthy sources of empirical research, interpreting what to do within the context of the child’s goals and setting plus their own clinical experience. The book explains the science and evidence behind: goal‐setting; working with families using the family centred‐approach; partnering with schools to develop universal design solutions that promote all children’s learning and inclusion; the Cognitive Orientation to Occupational Performance (CO‐OP) intervention approach; Occupational Performance Coaching; task‐analysis with consideration of the child’s cognitive abilities; participation‐based interventions; and how to creatively use magic, art, animals and leisure activities to stimulate children’s curiosity and enjoyment of learning.
The senior editor, Professor Sylvia Rodger, is an inspirational, world‐renowned paediatric occupational therapist, whose research, leadership and writings have transformed the way we think and act when working with children. She is a voice of hope for vulnerable children with disabilities and their families, and an academic with noble purpose – her contributions to paediatric occupational therapy leave an enduring legacy. Her book is a must read for occupational therapists wishing to make a real difference in children’s and families’ lives.
Professor Iona Novak, PhD, MSc Hons, BAppSc OTHead of Research, Cerebral Palsy Alliance, The University of Sydney
Preface
The first edition of Occupation‐Centred Practice with Children was very well received by students and practitioners alike across a range of countries. Given the expansion of literature in occupation‐centred practice over the past six to seven years, revision of the first edition became timely. Of note, there has been development of a number of new goal setting tools, assessments of occupations, roles and participation for children and adolescents, further research on occupation‐centred interventions such as Cognitive Orientation for daily Occupational Performance (CO‐OP ApproachTM), coaching approaches such as Occupational Performance Coaching, use of performing arts such as circus and magic as basis for more occupational interventions, particularly for children with cerebral palsy, adjunct interventions such as animal‐assisted therapy and a range of whole‐of‐class and school‐based interventions. This second edition provides an update of a number of chapters from the first edition, but also adds new chapters relevant to the changes evident in the literature and clinical practice. Consistent with the first edition, we have aimed to continue a strong theoretical basis within each chapter and also to provide practice examples and strategies to enable therapists to envisage use of many tools, interventions and techniques in practice. Each chapter starts with preliminary questions to assist with consideration of current knowledge and then reflection questions at its conclusion to allow revision of key content and a focus on what has been learnt, supporting independent learning and consideration of application of new learning in practice. In addition, an Appendix outlining all the assessments referred to in the book has been compiled.
Chapters 1 and 2 provide a background to occupation‐centred practice and its characteristics. Chapter 3 goes on to update readers on child‐ and family‐centred practice at individual and organisational levels. Cultural influences are considered in Chapter 4 enabling reflection on culture from a range of perspectives. This is followed by a review of the latest goal setting tools for children and families in Chapter 5. Chapter 6 provides a much‐needed new chapter addressing transitions that are part of childhood and youth and how occupational therapists need to consider these times of change. Chapter 7 updates readers on all English language occupation‐centred assessments available for children and young people. The next three chapters provide overviews of the latest research on three occupation‐centred interventions (CO‐OP Approach, Chapter 8; Perceive, Recall, Plan and Perform, Chapter 9; and Occupational Performance Coaching, Chapter 10). These are followed by two chapters focusing on practice within school settings. Chapter 11 addresses school‐based occupation‐centred practice with a focus on the individual child, while Chapter 12 provides a guide to intervention with the whole class and school, based on Partnering for Change (P4C) using universal design and response to intervention. Additionally, an intervention approach based on whole‐of‐classroom observation, teacher discussion and reasoning is presented. Chapters 13–15 address children’s leisure pursuits, the use of magic, dance and circus as motivations for engagement in specific therapy and creative pursuits and animal‐assisted therapies and their role in occupational therapy. The final chapter, Chapter 16, provides an overview of professional reasoning as it is used in occupation‐centred practice combining research evidence, clinical expertise and shared decision‐making.
We have aimed to bring together occupational therapy researchers and authors from a range of countries who have expertise in particular areas of occupation‐centred practice and education of students and practitioners. It is our hope that this edition provides inspiration to try new ways of doing occupational therapy, while ensuring practice is theoretically grounded and evidence based.
Sylvia RodgerAnn Kennedy‐Behr
Acknowledgements
We wish to thank our chapter authors who have worked with us over the past 12 months to bring this edition together. In addition, we are grateful to Linda Cartmill, research assistant extraordinaire for her attention to detail, willingness to go the extra mile and persistence with helping us to follow up all the fine details required of an edited book with many authors. In addition, we wish to thank the book reviewers for their suggestions and the staff at Wiley‐Blackwell for their assistance, encouragement and responsiveness to our hundred and one questions.
From Sylvia – I am grateful to Ann Kennedy‐Behr for agreeing to take on the challenge of editing this second edition with me. The task is so much easier with two people and was assisted by having good processes, regular lunches and the odd glass of wine! I dedicate this edition to the children who will benefit from occupational‐centred practice into the future.
From Ann – I am indebted to Sylvia for the opportunity to be part of this project. You are a wonderful mentor and friend. I dedicate this to my children, Jacqueline and Markus, and to all the children I have had the privilege of working with.
Chapter 1Introduction to Occupation‐centred Practice for Children
Sylvia Rodger and Ann Kennedy‐Behr
If we don’t stand up for children, then we don’t stand for much.
Marian Wright Edelman
Preliminary questions
Why a book on occupation‐centred practice for children?
Think about your childhood: what did you most like doing?
Think about your childhood: what did you least like doing?
What were the environments that you engaged in (e.g. home, park, school, neighbourhood)? How did they afford opportunities for occupation?
Did you play sports, learn an instrument or go to clubs or organised activities?
How might your childhood be different to those of children today?
How might living in the city vs country, suburb vs. high rise impact on children’s occupations?
Introduction
The primary aim of this chapter is to set the scene for this book and in doing so to fulfil the following objectives:
Briefly describe the resurgence of occupation within the occupational therapy profession.
Outline some global trends that have occurred in parallel with the refocusing of the profession.
Describe some of the challenges to traditional developmental theory that has historically informed occupational therapy practice with children, as well as emerging views and theories of occupational development that have the potential to better inform our practice with children and their families.
Identify the impact of these professional and global trends on occupational therapy practice with children.
Children engage in many social and occupational roles every day. They are variously grandchildren, children, nieces/nephews, siblings, friends, peers and playmates. In addition, they are school or kindergarten students, players or self‐carers/maintainers, albeit they are developing independence and autonomy in these latter roles (Rodger, 2010; Rodger and Ziviani, 2006). Healthy active children engage in occupations relevant to these roles all the time: they play, dress, eat, manage their personal care needs, engage in household chores and schoolwork tasks and extra‐curricular activities, such as soccer, ballet, scouts, tae kwon do and playing musical instruments. Children engage in these occupations in a range of environments, such as with their families at home, friends at school and in their communities (e.g. church, neighbourhoods, local parks, sports clubs) (Rodger and Ziviani, 2006).
The children’s artwork in Figure 1.1 and Figure 1.2 illustrates the daily occupations of two boys, one growing up in metropolitan Brisbane, Australia and the other in a village in East Timor. Figure 1.1 illustrates the boy’s daily life with family, friends and his occupations of schoolwork, playing sports, ball games, listening to music and the importance of school. By contrast, Figure 1.2 illustrates the outdoor environment in which this Timorese boy lives, his home, the hills, his village and his role in tending crops. These drawings demonstrate some of the many cultural differences in children’s occupations and daily lives.
Figure 1.1 Daily life and occupations of a boy aged 11 years in metropolitan Brisbane.
Source: Courtesy of Thomas Beirne (2008).
Figure 1.2 Daily life and occupations of a boy aged 15 years in East Timorese village.
Source: Courtesy of Jorge do Rosario (2008).
Typically, occupational therapists come into contact with children when there are concerns about their occupational performance (e.g. ability to engage fully in their roles, issues with performance of tasks or activities associated with various occupations, or environmental hindrances to their performance and participation). However, it has been proposed (Rodger and Ziviani, 2006) that as a profession we also have a role in advocating for children’s place and rights in society, their need for health‐promoting occupations and for safe, supportive, healthy environments that can optimise their occupational performance and participation. This may be through supporting campaigns promoting healthy lifestyle choices such as: having smoking banned in children’s playgrounds, lobbying for traffic calming and pedestrian footpaths/pavements to enable safe walking to school, advocating for more green spaces, such as parks, and raising awareness about excessive involvement in virtual environments (e.g. computers and handheld games) which may lead to decreased engagement in physical activity and social isolation. In recent times, issues of children’s health and well‐being in detention centres have been raised in Australia, and elsewhere in conflict zones and refugee camps. From an occupational perspective, these environments lead to significant occupational deprivation for detainees, and impact negatively on children’s development and mental health (Australian Human Rights Commission, 2014). In essence, occupational deprivation is caused by the lack of access to the typical activities, routines and objects (toys, books, games, outdoor recreation spaces) that support children’s development and skill acquisition due to the restrictive institutional environment of detention centres.
There are many advocacy and professional groups whose websites provide information for parents about children’s health and well‐being issues such as the American Academy of Pediatrics (http://www2.aap.org/obesity/community_advocacy.html?technology=2) and Play Australia, which promotes the value of children’s play (https://www.playaustralia.org.au/).
In addition, we have a role as individuals, health professionals and occupational therapists to advocate for children whose lives are deprived of health‐giving occupations and safe environments as a result of war, natural disasters, dislocation, social disadvantage, poverty or neglect/abuse, for example the World Federation of Occupational Therapists Position Statement on Human Rights (WFOT, 2006) and the Occupational Opportunities for Refugees and Asylum Seekers (OOFRAS, 2016). The WFOT (2006, p. 1) Position Statement declares occupation a human right. Specifically it espouses a series of principles:
People have the right to participate in a range of occupations that enable them to flourish, fulfil their potential and experience satisfaction in a way consistent with their culture and beliefs.
People have the right to be supported to participate in occupation, through engaging in occupation, to become valued members of their family, community and society.
People have the right to choose for themselves, to be free from pressure, force or coercion, in participating in occupations that may threaten safety, survival and health, and those occupations that are de‐humanising, degrading or illegal.
The right to occupation encompasses civic, educative, productive, social, creative, spiritual and restorative occupations.
At a societal level the right to occupation is underpinned by the valuing of each person’s unique contribution to the valued and meaningful occupations of society and is ensured by equitable access to participation regardless of difference.
Abuses to the right to occupation may take the form of economic, social or physical exclusion through attitudinal or physical barriers, or through control of access to necessary knowledge, skills, and resources, or venues where occupation takes place.
Global conditions that threaten the right to occupation include poverty, disease, social discrimination, displacement, natural and man‐made disasters, and armed conflict.
While this book focuses primarily on the occupational therapy practitioner engaging with children and their families at an individual, group or family level, it also addresses occupation‐centred practice in school environments (Chapter 11) and in the context of community‐based leisure pursuits (Chapter 13). The broader benefits of occupational engagement for children who are deprived of occupations is not specifically addressed; however, readers are encouraged to consider the opportunities they may have for advocacy and engagement at a societal and political level in instances where children experience poor health (Spencer, 2008) or occupational deprivation, alienation and injustice (Kronenberg et al., 2005; Whiteford and Wright St‐Clair, 2005).
Re‐affirming occupation: The core of occupational therapy
Over the past several decades, there has been a major focus within occupational therapy on the provision of client‐centred services, with its counterparts in child‐ and family‐centred practice. Emanating from Canada, the emphasis on guidelines for enabling occupation‐ and client‐centred practice has spread throughout the occupational therapy profession internationally (CAOT, 1991; Sumsion, 1996). This is discussed at length in Chapters 2 and 3.
There has also been a resurgence of interest in occupation at the core of occupational therapy. This occurred in response to critical reflection by a number of occupational therapy theorists and researchers (e.g. Clark, 1993; Fisher, 1998; Kielhofner, 2007; Molineux, 2004; Pierce, 2001; Yerxa, 1998). This has led to the reclamation of occupation as the defining feature of our profession and practice focused on occupation, its meaning for individuals, its importance for health and well‐being (Kielhofner, 2007; Molineux, 2001; Wilcock, 1998) and the importance of an individual’s occupational identity as a way of defining self within relevant social and cultural contexts (Christiansen, 1999). The centrality of occupation to occupational therapy practice was referred to by some as the ‘renaissance’ of occupation (Whiteford et al., 2000).
This in turn resulted in a call for the use of occupation‐based assessment (Coster, 1998; Hocking, 2001) as a key way of focusing our resulting interventions on the healing power of occupations (e.g. particular schoolwork or play activities), rather than focusing specifically on performance components (e.g. fine‐motor or visual‐perceptual skills) that may not lead to significant changes in an individual’s occupational functioning. Assessments that facilitate goal setting are addressed in Chapter 5 and those that are occupation‐centred in Chapter 7. Paediatric frames of reference have also been developed that specifically enhance children’s occupations such as Synthesis of Child, Occupational Performance and Environment in Time (SCOPE‐IT) (Haertl, 2009; Poulsen and Ziviani, 2004).
Despite the international movement in occupational therapy calling for a focus on occupation, there has been discussion within the profession as to how that looks in practice (Fisher, 2014; Rodger et al., 2010, 2012) and recognition that contemporary practice is not always consistent with contemporary theory (Gillen and Greber, 2014; Gustafsson et al., 2014).
There has also been an increased interest in scholarship about occupation and the growth of a body of research in the field of occupational science. Since the start of the new millennium, there has been an emphasis on meeting the needs of underserved groups, with seminal books by Kronenberg et al. (2005) and the writing of advocates of occupational justice (Townsend and Whiteford, 2005; Townsend and Wilcock, 2004; Whiteford, 2002). Townsend and colleagues described occupational alienation (where occupational choice is limited by external forces), occupational apartheid (where individuals are denied access to meaningful occupation due to organised political or social agendas) and occupational deprivation (prolonged blocking of access to meaningful occupation due to environmental restrictions) (Polatajko et al., 2007; Townsend and Whiteford, 2005; Townsend and Wilcock, 2004). Children may be caught up in warzones and refugee camps or detention centres, where they experience occupational alienation and deprivation or are victims of neglect and impoverished environments. Coinciding with these trends within occupational therapy, a number of global influences and other changes within health/social care systems have occurred which have also impacted on our practice.
Within our discipline, there has also been a growing emphasis on children’s participation as being a desired outcome of improving children’s occupational performance and activity engagement. Participation is defined as an individual’s involvement in life situations (WHO, 2001) and it is conceptually influenced by the individual’s health condition and a range of intrinsic and extrinsic factors. Children with disabilities are at risk of restricted participation. Promoting children’s participation is increasingly recognised as a clinically important goal and outcome for healthcare and rehabilitation (King et al., 2003; Law et al., 2004). The role of environments in children’s participation is also recognised in the International Classification of Functioning, Disability and Health (ICF) and in theoretical models (Kang et al., 2014; King et al., 2003). There is accumulating qualitative knowledge (Bedell et al., 2011; Harding et al., 2009) that supports the role of environment in enhancing participation. Recent concepts such as ‘helicopter parenting’ and ‘bubble wrapped children’ are likely to have negative impacts on children’s occupations and participation through restrictions on their occupational engagement (in playgrounds, walking to school, playing ball in a cul‐de‐sac out of sight and not being able to take risks/solve problems because of hovering parents). The move towards playgrounds that are so safe they no longer provide sufficient ‘just right challenge’ for children has been criticised by developmental and education experts alike (Bundy et al., 2011; Hyndman and Telford, 2015).
External influences impacting occupational therapy practice
Changes in health and social care impacting on occupational therapy practice over the past two decades include: (1) the emergence of evidence‐based practice (Sackett et al., 1996; Taylor 2007; Whiteford, 2005); (2) managed health care (Pierce, 2003) and health care reform (Mackey, 2014; Russi, 2014); (3) increased incidence of lifestyle‐related diseases (e.g. Rippe et al., 1998; Sokol, 2000); (4) diseases of meaning such as mental illness (Christiansen, 1999); (5) increasingly informed consumers; and (6) increased global awareness of human rights’ abuses amongst marginalised groups, refugees, and asylum seekers (many of whom are children) (Kronenberg et al., 2005). Figure 1.3 illustrates the influences both external to and within the profession that have led to the evolution of occupation‐centred practice with children and families.
Figure 1.3 External influences and internal evolution within the profession leading to occupation‐centred practice with children and families.
Media reports of schools banning physical activities such as handstands due to the risk of injury are frequent in the media (e.g. Courier Mail, 2014). Such societal concerns reinforce the importance of vigilance and for our profession to contribute to the enhancement of children’s health and well‐being.
Furthermore in service contexts, reduced funding, mergers and new models of care (e.g. clinical pathways, diagnostic related groups, managed care) have changed the way allied health services are delivered in the health/human service sectors (Layman and Bamberg, 2003). From a health sector perspective, significant changes have occurred with respect to financing and the organisation of health care (such as programme management, regionalisation) and service delivery (such as technological advances impacting on life span, quality of life and the shift of care from institutions to the community) (Layman and Bamberg, 2003).
According to Wood (1998), occupational therapists have not easily implemented occupation‐centred and evidence‐based practices. Wood et al. (2000) challenged us to think outside the box to fully meet the occupational wants and needs of persons receiving our services. Chapter 16 in this book highlights how professional reasoning can be utilised along with evidence‐based and occupation‐centred practice to better meet the needs of children and families. The next section turns to international classifications/frameworks and declarations that have impacted on our practice.
International Classification of Functioning, Disability and Health (ICF)
On the international stage, the World Health Organization (WHO; 2001) released the ICF, which evolved from an earlier iteration, International Classification of Impairments, Disabilities and Handicaps (Wood, 1980). It was proposed as a scientific framework for understanding and studying health and health‐related states, outcomes and determinants. Its authors also argued that it would enhance communication between healthcare workers, researchers and the public by providing a classification system for a person with a given health condition (WHO, 2001). See Figure 1.4. This re‐conceptualisation outlined the impact of a health condition on an individual’s functioning at the levels of body structures and functions, activities and participation. The domains of activity and participation are of special interest to occupational therapists and include: learning and applying knowledge; general tasks and demands; communication; mobility; self‐care; domestic life; interpersonal interactions and relationships; major life areas; and community, social, and civic life (WHO, 2001). Equally it illustrates the importance of understanding the personal characteristics and environmental factors that impact on how a health condition may be experienced and how these may help or hinder the person’s engagement in activities and participation in life situations. Under environmental factors, one needs to consider the physical, social and attitudinal environment in which people live and conduct their lives. Personal factors, though not classified in the ICF, comprise features such as a person’s gender, race and age, which are features of an individual but not part of a health condition or health states.
Figure 1.4 Interactions between the components of the ICF.
Source: Reproduced with permission of World Health Organization.
In adopting a ‘biopsychosocial approach’ (WHO, 2001), the ICF acknowledges the bidirectional impact of body functions on the ability to perform activities and hence enable participation, but also that environmental factors can impact on the performance and even modify body function and structures. International Classification of Functioning, Disability and Health for Children and Youth (ICF‐CY) (WHO, 2007) was designed for the purpose of recording characteristics of the developing child and the influence of his/her environment. For children, the mediating roles of environment and development are highly significant as their environments change across the stages of infancy, early childhood, middle childhood and adolescence. In addition, adults, usually parents/carers or teachers, exercise significant control over children’s environments and opportunities for engagement. There are a number of assessments available for children that are compatible with the components of the ICF (see Simeonsson et al., 2003). Since 2010, there has been a dramatic increase in the number of assessment tools to address children’s occupations and participation. These are discussed further in Chapter 7.
The ICF classification system and framework have proven useful for occupational therapists and other health team members in conceptualising where they provide the most input/expertise in assisting the individual manage and promote his/her health and well‐being. In contrast to its predecessor, it provides a more global view of health and well‐being that is highly consistent with occupational therapy philosophy and practice (Baum and Baptiste, 2002), particularly with its emphasis on participation (Christiansen et al., 2015). Health professionals endorse best practice interventions that effectively support a person’s meaningful and satisfactory participation in real life activities and situations (Law and Baum, 1998; WHO, 2001). With the availability of the ICF‐CY, occupational therapists working with children and their families can use this version to consider a child’s development in health, education and social sectors (WHO, 2007).
United Nations’ declarations
World Fit for Children
Other global declarations have also developed in parallel with the work of the WHO, such as the United Nations’ (2002) declaration of a World Fit for Children (WFFC), an action plan with 21 goals and targets for improving children’s welfare (e.g. eradicating poverty, caring for every child, education, protection from harm, war, combating HIV/AIDS, listening to children and ensuring their participation, and environmental protection). Most pertinently, the declaration acknowledges the rights of children and young people for self‐expression and participation in all matters relating to themselves according to their age and maturity. Consistent with this declaration, the Canadian Association of Occupational Therapists (CAOT) produced a position statement on healthy occupations for children and youth (CAOT, 2009). This position paper recognises that children and youth have the right for opportunities to develop healthy patterns of occupations and outlines CAOT’s approach to advocacy for children and youth to protect and fulfil this right. In addition, the statement recognises the inequities and occupational injustices that limit children’s and young people’s opportunities for engagement in healthy occupations (e.g. indigenous youth, immigrants, refugees, children with disabilities and those living in poverty or care/protection). The role of occupational therapists, in advocacy and taking collective action at multiple levels (systems, provincial/state and national) raised in this document is exemplary. Occupational Therapy Australia contributed to the Australian Human Rights Commission’s (2014) consultation and report The Forgotten Children that addressed children in detention providing advocacy for children’s needs for education, right to play and to engage in developmentally appropriate, purposeful and meaningful occupations.
Millennium Development Goals
Another important United Nations’ Declaration is the Millennium Development Goals (United Nations, 2000). The Millennium Development Goals (MDGs) agreed to in 2000 range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education, by the target date of 2015. These were agreed to by all the world’s countries and leading development institutions. They have spurred international efforts to meet the needs of the world’s poorest citizens many of them being vulnerable children. The eight goals were to:
Eradicate extreme poverty and hunger.
Achieve universal primary education.
Promote gender equality and empower women.
Improve child mortality (by two‐thirds for children under 5 years).
Improve maternal health.
Combat HIV/AIDS, malaria and other diseases.
Ensure environmental sustainability.
Develop a global partnership for development.
While many of these have not been achieved, a recognition of these goals taps into occupational therapy’s interest in social justice and preventing occupational deprivation and alienation (Townsend and Whiteford, 2005; Townsend and Wilcock, 2004) experienced by individuals, especially children, in countries affected by war, natural disasters, occupation forces, where issues of extreme poverty, lack of education, poor health outcomes due to sanitation issues, lack of clean water, low rates of immunization, and infectious diseases are pervasive. While in Western developed countries we do not face these issues on a daily basis, there continue to be examples of children who are disadvantaged through poverty, domestic violence, abuse and neglect, and lack of appropriate housing in many large cities and in rural locations where there are large indigenous communities. Despite many successes with the MDGs, the world’s poorest and most disadvantaged continue to be left behind (United Nations, 2015). (See Chapter 4 for discussion of the cultural implications of occupation‐centred practice.) Until early 2016, Australia’s policy on asylum seekers also resulted in a large number of children being kept in closed immigration detention while awaiting assessment of their refugee status. Children living in closed detention have very limited opportunities to engage in meaningful occupations appropriate for their age and level of development. They are not able to engage in usual family routines or eat the food they are accustomed to and are being raised by parents who, due to the circumstances, have high levels of stress and mental illness, which impacts on their ability to provide a safe and predictable environment. Furthermore, children held in detention are potentially exposed to adults engaging in self‐harm and witnessing adults in deep distress. As a profession and as individuals, we still have an obligation to reflect and take action to improve the situations in which future generations of children grow and develop.
The evolution of occupational therapy practice with children
Paediatric occupational therapy researchers have supported the renaissance of occupation and have made very strong calls for a better understanding of the essence of children’s occupations and their optimal participation. Some examples are illustrative. Lawlor (2003) called for a better understanding of the significance of ‘being occupied’ and the social construction of childhood occupations given that children do so many things ‘with’ significant others (e.g. parents, siblings, peers and teachers). She argued that occupations are socially co‐constructed and negotiated with others. Hence, how children interpret and engage in their everyday social worlds is pivotal to our understanding of human development and childhood occupations. Understanding the social engagement of children during their ‘doing’ of occupations is critical so that we can optimise their participation. Specific frames of reference have been described that focus on enhancing social participation (Olson, 2009) in recognition of the social nature of many occupations.
Equally, Segal and Hinojosa (2006) argued that we need to better appreciate the contexts or settings in which childhood occupations occur. They researched the ‘doing of homework’ as an example of a productive occupation that occurred at home. In order to better assist children and parents with this (at times stressful) occupation, we need to understand the activities, tasks, values and goals of children and their parents and the social interactions that occur around the task performance. Further, Larson (2004) called for an understanding of children’s work/productivity occupations and children’s decisions about whether activities are work or play. Her qualitative study explored chores and schoolwork tasks and how parents graded children’s participation in household tasks with age. She also documented the scaffolds, supports and supervision provided to enable task completion. The application of such occupational science research focusing on understanding occupations helps occupational therapy clinicians to better support parents and children with issues related to a broad range of occupations.
Changing views of child development and maturation
Coster (1998) proposed that one of the largest obstacles to practitioners becoming more occupation‐centred (especially in assessment) was the dominance of the developmental model. This model promulgates development as linear and emphasises performance components and abilities and was seen as a critical determinant of children’s behaviour. Major criticisms of this model are that it: (1) lacks extensive consideration of the context (environment), the characteristics of the child (person), such as a focus on personal goals, motivation, and temperament and (2) ignores multiple developmental pathways (Horowitz, 2000). The pervasive use of standardised developmental tests and interventional approaches aiming to normalise underlying developmental processes continues to feature strongly in paediatric practice many years later. Coster (1998) argued for a focus on the primacy of tasks/activities and occupations and the environmental context in organising a person’s behaviour.
Alternate theories of development arising in the mid‐1990s such as dynamical systems theory (Thelen, 1995) and motor behaviour/motor relearning theories (Mathiowetz and Bass Haugen, 1994) challenged occupational therapists to reconsider their views about children’s developmental progress as being reflex orientated, neuro‐maturational and hierarchical in nature. They also challenged the previously accepted linear nature of development expressed as genetically pre‐determined ages and stages. The traditional models also failed to address the role of the environment in motor control.
Systems models such as dynamical systems theory (Mathiowetz and Bass Haugen, 1994) have been proposed based on a heterarchical model that focuses on the interaction of a person with his/her environment and emphasise task performance as well as the unique task and environmental constraints. Both functional tasks and the environmental context are used to organise behaviour. Use or modification of personal and environmental constraints leads to optimal strategy development for functional task performance. This approach arose from an ecological view of perception and action by Gibson (1966) and Bernstein (1967) both cited in Mathiowetz and Bass Haugen (1994). This ecological approach focuses on studying the person‐environment interaction during daily functional tasks. Some occupational therapy models related to these concepts include the Ecological Model of Human Performance (Dunn et al., 1994), Person‐Environment‐Occupation Model (Law et al., 1996), and the Person, Environment Occupational Performance Model (Christiansen et al., 2005).
Dynamical systems (Thelen, 1995) acknowledge that order and patterns emerge from the interaction and cooperation of many systems that lead to self‐organisation. This model explains the relative stability of movement patterns in the face of efficient movement requiring the least amount of energy (attractor states). The reciprocity between person and environment is also emphasised. Mathiowetz and Bass Haugen (1994) proposed a systems model of motor control for occupational therapy, illustrating the interaction between the personal characteristics or systems of the person (sensorimotor, cognitive, psychosocial) and the environment (physical, socioeconomic, cultural) that lead to occupational performance (ADL, work, play/leisure) enabling role performance.
The traditional view of development incorporating invariable stages guided therapists’ intervention using developmental milestones to mark progress and led to the extensive use of reflex testing and developmental assessment, with normal developmental sequences being the organising framework for therapy. While the emphasis was on working at the child’s developmental level, it lacked a focus on functional tasks. These were considered to result in ‘splinter skills’ that would not generalise and might interfere with developmental sequences. However, contemporary theories of motor learning view nervous system maturation as only one influence with other systems having important roles to play. Motor learning relies on practice or experience leading to changes in the capabilities of the learner using random rather than blocked practice and practice of the whole rather than parts of the task. It also focuses on the use of physical and verbal guidance during practice and the use of feedback (e.g. intermittent, random and after multiple trials) (Mathiowetz and Bass Haugen, 1994).
Ongoing research with individuals with disabilities and in naturalistic versus lab/clinic‐based settings is needed. Cognitive Orientation to daily Occupational Performance (CO‐OP) (Polatajko and Mandich, 2004) is an example of an occupation‐centred intervention based on contemporary views of development and motor control that has been evaluated with children with a range of occupational performance problems (see Chapter 8). The contemporary approaches to motor skill acquisition focus on the goal of helping clients to become competent problem solvers when they engage in functional tasks within relevant performance contexts. Similarly Perceive, Recall, Plan and Perform (PRPP) (Chapparo and Ranka, 1997a, 1997b) and Occupational Performance Coaching (Graham et al., 2009) provide other examples of occupation‐centred interventions discussed in this book (Chapters 9 and 10 respectively).
