Child and parent engagement in occupational therapy

Abstract

AbstractBackgroundChild and parent engagement in the therapeutic process has been linked to positive outcomes in several contexts of health care, particularly mental health. While child and parent engagement is advocated as an important part of occupational therapy practice, there is a paucity of research in this area. Engagement has been defined as a multifaceted state of involvement of the client over the therapy process in mental health and has been considered as both a process and a state in adult health care. In this thesis, the process and state of child and parent engagement as it manifests in occupational therapy will be explored.AimsThe primary aim of this thesis was to understand engagement when working with children and their parents in occupational therapy. The objectives of this thesis were to: (1) review the literature on engagement and develop a perspective of its role in occupational therapy when working with children and families; (2) identify and critique measures of parental engagement in the context of children receiving therapy; (3) review measures of child engagement and motivation in developmental and rehabilitation settings; (4) develop an understanding of parent engagement in therapy from the perspective of occupational therapists; (5) gain an understanding of child engagement from the perspectives of occupational therapists; and (6) explore strategies for engagement enacted by occupational therapists through observations of therapy sessions.Research design Objective One was addressed by undertaking a literature review. Objective Two was addressed by conducting a systematic review on engagement measures for parents of children receiving developmental or rehabilitation services. Objective Three was addressed by conducting a literature search on child measures of therapy engagement. Objectives Four and Five were addressed by undertaking a qualitative investigation using interpretive description to understand occupational therapy perspectives about child and parent engagement through focus groups and/or individual interviews. An interpretive description approach was also used to address Objective Six, which involved observing occupational therapy sessions and gaining occupational therapy perspectives through a key informant interview after the observation.Results The literature review resulted in a publication (Chapter Two) in which child and parent engagement were proposed to represent a process that could be informed by Self-Determination Theory (SDT). SDT proposes that the fulfilment of three psychological needs for autonomy, relatedness and competence will harness an individual’s motivation and therefore informs how engagement could be facilitated. The viewpoint paper also outlined that the state of child and parent engagement in occupational therapy could reflect affective, cognitive and behavioural domains of an individual’s investment in therapy.The systematic review on parent engagement measures of children receiving developmental and rehabilitation services found no current ideal measure of parent engagement that captured all three domains of engagement or was psychometrically sound (Chapter Three).The literature review in Chapter Four on child therapy engagement measures found the Paediatric Rehabilitation Intervention Measure of Engagement-Observation to be the most appropriate measure. The chapter explored engagement measures that could be further informed by features of existing measures of motivation (age-appropriateness and self-report).A paper on parent engagement in occupational therapy is presented in Chapter Seven. Two overarching themes emerged: (1) parent-therapist relationship and; (2) therapist responsiveness. Four subthemes were embedded within these themes: (1) parent feelings; (2) time and timing of therapy; (3) levels of engagement; and (4) factors influencing parent engagement.A paper on child engagement in occupational therapy is presented in Chapter Eight. Four themes emerged from the data: 1) signs of child engagement and disengagement; 2) it’s about the child feeling safe; 3) a sense of meaning and purpose; and 4) service and therapist factors influencing child engagement.A paper on strategies used to engage children and parents in occupational therapy sessions is presented in Chapter 9. Two themes emerged from the data that represented engagement strategies: 1) engaging the child; and 2) engaging the parent.ConclusionsThe findings of this thesis confirm the view that child and parent engagement in occupational therapy can be conceived as both a process of engaging with and a state of being engaged in therapy. The process of engagement and the strategies therapists use to engage children and parents were mapped against the tenets of SDT. The results of this thesis also demonstrate that the affective, cognitive and behavioural domain can somewhat represent child and parent engagement, and offers extension of the definition of these domains. Research into child and parent perspectives can provide more evidence to support the role of the cognitive domain in child engagement. Further work is also required to develop and test measures of child and parent engagement in developmental or rehabilitation settings and more specifically in occupational therapy contexts.