Pediatric Occupational Therapists Research Articles

Cultural Adaptation of the Evaluation in Ayres Sensory Integration® (EASI) for Spanish-Speaking Populations.

Spanish-speaking populations represent a significant percentage of occupational therapy clientele globally. Culturally appropriate Spanish translations of assessments are therefore imperative. This study describes the process of a culturally adapted translation of a set of tests for use with Spanish-speaking pediatric populations. To produce a culturally adapted Spanish translation of the Evaluation in Ayres Sensory Integration® (EASI) for international use. We used cultural adaptation methodology that included direct and back translations of the EASI by bilingual translators and interviews with pediatric occupational therapists and children ages 3-6 yr from Spain. Linguistic experts helped revise the translations, and pediatric occupational therapy leaders in five Spanish-speaking North and South American countries reviewed the translations for comprehensibility and cultural appropriateness. Back translations demonstrated equivalence with the original EASI tests except for a few test instructions and scoring criteria. Interviews with occupational therapists and children in Spain revealed some comprehension difficulties for several tests, which were revised in consultation with a linguistic expert. Additional adaptations were made on the basis of recommendations to address cultural differences by occupational therapy leaders from five North and South American countries. Most changes in wording were made in one EASI test (Praxis: Following Directions) that is heavily dependent on language comprehension. We used currently recommended methodologies to develop and adapt a Spanish translation of the EASI for use across diverse cultures. What This Article Adds: A Spanish translation of the EASI has been developed for use in culturally diverse Spanish-speaking countries around the world.

Occupational Therapists’ Perceptions of Intraprofessional Collaboration When Working with Young Children Aged Birth to 3 Years

Background: Birth to 3 years of age is a critical period in a child’s development, and occupational therapy intervention during this period can serve many purposes. While pediatric occupational therapists may be working in different settings with different specialties, the foundational knowledge all occupational therapists possess provides a common lens through which they approach treatment. Intraprofessional collaboration is considered best practice, as it is not uncommon for young children to receive occupational therapy services by more than one therapist, and in more than one practice setting at the same time.

Occupational Therapy Services in School-Based Practice: A Pediatric Occupational Therapy Perspective from Ireland.

Purpose School is a primary setting for pediatric occupational therapy practice, yet little is known about the provision of school-based occupational therapy in many countries internationally. The purpose of this study was to explore current school-based occupational therapy practice for the first time in Ireland to gain insight into current and potential service provision and to identify new directions and potential pathways for development. Methods This descriptive quantitative study utilized a cross-sectional online survey to gain the perspectives of the population of pediatric occupational therapists working regularly in schools across Ireland. Respondents were recruited through convenience and snowball sampling. Data were analysed through qualitative content analysis and descriptive statistics. Results The survey elicited 35 responses, yielding a 21.2% estimated response rate. Findings demonstrated that respondents provided therapy services in schools most commonly on a weekly (28.6%) or monthly (34.3%) basis, with only 5.0% working in the same school on a weekly or fortnightly basis. The majority of respondents (54.3%) used a direct therapy approach with a child, rather than coaching or modelling, to primarily address sensory, hand function, or daily living needs. None used a whole class or whole school (universal or tiered) approach. While respondents (54.3%) generally viewed collaborative practice as a strength of school-based practice, they also identified barriers to collaboration in schools. A core barrier is related to how services are constructed across health and education, with differing philosophies of service provision. The majority of respondents (75.0%) reported that they had not received any training to deliver evidence-based practice in therapy provision specific to school-based practice. Implications for Practice. This study indicates that therapists require continual education on evidence-based school practice as it applies in an Irish context. Furthermore, clarification of school therapy roles and service delivery models are required in order to determine how they contrast with traditional clinic roles. This will enable therapists to strengthen the coordination of service delivery between health and educational services to maximize the outcomes of school-based practice.

Examining the Convergent Validity of the Test of Visual Perceptual Skills – Fourth Edition (TVPS-4) in the Australian Context

ABSTRACT The Test of Visual Perceptual Skills – Fourth Edition (TVPS-4) is a recently revised assessment of motor-free perceptual abilities, that was standardized in the United States. The TVPS-4 is commonly used by pediatric occupational therapists, health professionals and educators, therefore it is important that its psychometric properties and use in cross-cultural contexts are investigated. The study aim was to examine the convergent validity of the TVPS-4 when completed by Australian children. Thirty typically developing children aged 6–12 years (17 females and 13 males; mean age 8.7 years; SD = 1.7) completed the TVPS-4, the Developmental Test of Visual Perception – Third Edition (DTVP-3) and the Motor-Free Perception Test – Fourth Edition (MVPT-4). Spearman Rho correlation analyses with bootstrapping were completed to examine the associations between the TVPS-4, DTVP-3 and MVPT-4. The TVPS-4 total scale raw score exhibited strong significant correlations with the DTVP-3 (rho = .745, p < .000) and MVPT-4 (rho = .791, p < .000) total scale raw scores, and moderate to strong significant correlations with all of the DTVP-3 subscales (rho = .540 to .717, p = .002 to .000) and three of the MVPT-4 subscales (rho = .536 to .695, p = .004 to .000). Several weak to moderate significant correlations were found between the TVPS-4 and DTVP-3 subscale raw scores (rho = .370 to .607, p = .044 to .001). The TVPS-4 and MVPT-4 subscale raw scores exhibited several weak to strong, positive and statistically significant associations (rho = .385 to .600, p = .036 to .001). Australian children appeared to complete the TVPS-4 without any cross-cultural issues. The study findings suggest that the TVPS-4 assesses some similar motor-free perceptual abilities as the DTVP-3 and MVPT-4. This study provides some preliminary insights about the TVPS-4’s convergent validity with the Australian context. The primary clinical implication is that the study findings add to the TVPS-4’s body of validity evidence. Further research studies are recommended.

Spanish Cultural Adaptation and Inter-Rater Reliability of the Test of Playfulness

Aim To adapt the Test of Playfulness (ToP) to the Spanish context (culturally and linguistically) and analyze the inter-rater reliability of the translated version. Methods Following a specific methodology for cultural adaptation, direct and back translations were carried out, together with cognitive interviews with pediatric occupational therapists, to analyze the comprehensibility of the translated version. The resulting version was analyzed by a linguistic expert to determine its grammatical and linguistic adequacy. Finally, inter-rater reliability was analyzed in a sample of typically developing children aged between 4 years old and 6 years and 11 months (n = 12). Results Direct and back translation phases showed a good conceptual equivalence with the original version. The cognitive interviews enabled the identification of difficulties surrounding the understanding and the terminology used in several items. The linguistic expert and the research team revision ensured that final grammatical and conceptual improvements were made. Inter-rater reliability analysis showed an almost perfect degree of agreement (0.82 ≤ κ ≤ 1.00; p < 0.001), as well as stability and a strong positive linear correlation (0.81; p < 0.001). Conclusions The translated version of the ToP fits the Spanish context and can be used in the clinical setting of pediatric occupational therapy in Spain.

Translation and cross-cultural adaptation of the performance-based test – Evaluation in Ayres Sensory Integration®

Background The Evaluation in Ayres Sensory Integration ® (EASI) is a performance-based assessment tool, aiming to assess sensory perception, sensory reactivity, postural/ocular/bilateral integration, and praxis in children aged 3–12 years. These types of tests are currently not available in Swedish. A structured, multistep process of translation is crucial for maintaining equivalence between the source and target version of a test. Objective Develop a culturally adapted Swedish research version of the EASI for use in the forthcoming international normative data collection. Method The translation process followed the first four stages in recommended guidelines for cross-cultural adaptation. Each subtest was translated by two occupational therapists and merged into one Swedish version. That version was reviewed by clinical paediatric occupational therapists in focus groups. The meetings were recorded, transcribed and a content analysis was conducted. One subtest was then subjected to a back-translation process. Result Some discrepancies regarding semantic equivalence were found and adapted through all stages. No discrepancies regarding idiomatic or conceptual equivalence were found. Revisions due to the translation process have been incorporated into the final research version of the EASI. Conclusion A first, culturally adapted research version of the EASI is ready for the Swedish normative data collection.

The Content Validity and Clinical Utility of the Kindergarten Readiness Inventory (K-READI): A Screening Tool of School Readiness for Children on the Autism Spectrum

ABSTRACT There is currently a gap in available assessments for evaluating school readiness in children with Autism Spectrum Disorder (ASD). The Kindergarten Readiness Inventory (K-READI) is a non-standardized screener for basic kindergarten readiness skills of children with autism. The K-READI includes five subscales to assess overall school readiness, which include: (1) school activities of daily living, (2) school-related activities, (3) basic school concepts, (4) social participation, and (5) school behavior. The K-READI is proposed as a screener for collaborative treatment planning and further evaluation. The purpose of this study was to determine the content validity and clinical utility of the K-READI. To determine the content validity of the K-READI, the researchers recruited seven participants who were identified as pediatric occupational therapy practitioners or autism experts to review the K-READI. Item level content validity index (I-CVI) and scale level validity (S-CVI) were calculated, as well as modified kappa indices to reduce probability of chance agreement. The K-READI was then revised based on feedback from the content experts. To determine clinical utility of the K-READI, the researchers recruited 16 pediatric occupational therapists to assess the clinical usage of the revised version of the tool. Responses were thematized and analyzed as collective case studies. The content experts agreed that 17 of the 19 items in the K-READI are essential items to screen for kindergarten readiness. Two of the scale items (Cleans Up and Eye Contact) were removed from the K-READI. The other 17 items and scales were also revised and refined for clarity based on feedback. Modified kappa indices showed excellent level of agreement between raters supporting validity of the I-CVI and S-CVI findings. Clinician reviewers found that the K-READI is a potentially useful tool in practice. Four themes emerged from the analysis of clinical utility responses: The K-READI is (1) a thorough assessment of school readiness skills, (2) generally easy to use, (3) may have potential challenges in administration in different settings, and (4) assesses real life school occupations as a reflection of ecological validity. The K-READI shows initial content validity and potential usefulness in clinical practice. Future research directions include the need to establish construct validity and test reliability of the tool.

The Role of Occupational Therapy with Children with Attention Deficit Hyperactivity Disorder (ADHD): A Canadian National Survey

ABSTRACT Children with Attention Deficit Hyperactivity Disorder (ADHD), a neurobehavioral disorder prevalent in childhood, demonstrate a persistent pattern of inattention and hyperactive and/or impulsive behavior that is more severe than their typically developing peers. Much of this challenging behavior is observed in the classroom. However, current literature on ADHD for school-aged children largely examines issues of clinical diagnosis and pharmacological management. Consequently, the associated challenges in functional limitations and participation restrictions that these children demonstrate have not been well examined. Fortunately, as members of the school-based team, occupational therapists are uniquely suited to address this important perspective. Therefore, the purpose of this study was to 1) identify the scope of occupational therapy (OT) practices in assessment, intervention and service delivery with children/youth with ADHD across Canada, 2) indicate potential research and practice gaps, and 3) discuss future implications with respect to OT intervention for children with ADHD. A bilingual national survey was created based on a comprehensive literature review and consultation with experts in pediatrics and knowledge translation. The survey link was sent to pediatric occupational therapists across Canada through mailing lists obtained from national and provincial organizations. A total of 172 surveys were completed (response rate = 10%). The majority of respondents reported that children with ADHD comprised 26–75% of their caseloads. More than 90% of respondents reported using OT interventions to address skills related to impairments (sensory processing), activity (fine motor function), and participation (school functioning) in their treatment of children with attentional disorders. OTs frequently reported using sensory-based principles to address the behavioral symptoms of children with ADHD. The most common form of service delivery was individualized sessions, followed by consultation. Potential gaps and implications at the research, practice and organizational levels are discussed to further support the role of OT with school-aged children with ADHD.

Searching for Evidence in Pediatric Occupational Therapy Using Free versus Subscription Databases: A Comparison of Outcomes

This study compared the results of searching free versus subscription databases and using brief versus comprehensive search strategies to locate evidence for three pediatric occupational therapy clinical questions. Three clinical questions were nominated by practicing pediatric occupational therapists. Brief and comprehensive search strategies were then developed. Searches were conducted in three free-to-access databases and four subscription databases. Based on descriptive data, more relevant citations were retrieved using the subscription databases compared with the free databases and when using a comprehensive search strategy. Citations that were present in some databases were not always retrieved by the searches. This was mainly due to the inclusion of an insufficient number of search terms in the brief search strategies used in this study and a mismatch between terms used in the search strategies and the databases. Clinicians may need to use both subscription and free databases and use comprehensive search strategies to maximize retrieval of relevant articles to answer pediatric clinical questions.

A Systematic Review on Clinimetric Properties of Play Instruments for Occupational Therapy Practice

Play is considered the main occupation for children. Pediatric occupational therapists utilize play either for evaluation or intervention purpose. However, play is not properly measured by occupational therapists, and the use of play instrument is limited. This systematic review was aimed at identifying play instruments relevant to occupational therapy practice and its clinimetric properties. A systematic search was conducted on six databases (Academic Search Complete, CINAHL, MEDLINE, Psychology and Behavioral Science Collection, Scopus, and ASEAN Citation Index) in January 2020. The quality of the included studies was evaluated using Law and MacDermid's Appraisal for Clinical Measurement Research Reports, and psychometric properties of play instruments were evaluated using Terwee's checklist while the clinical utility is extracted from each instrument. Initial search identifies 1,098 articles, and only 30 articles were included in the final analysis, extracting 8 play instruments. These instruments were predominantly practiced in the Western culture, which consists of several psychometric evidences. The Revised Knox Preschool Play Scale is considered the most extensive and comprehensive play instrument for extrinsic aspect, whereas the Test of Playfulness + Test of Environmental Supportiveness Unifying Measure is a promising play instrument for intrinsic aspect on play, where both instruments utilize observation. My Child's Play is a potential questionnaire-based play instrument. However, the current development of play instruments in the occupational therapy field is immature and constantly evolving, and occupational therapists should exercise good clinical reasoning when selecting a play instrument to use in practice.

Item development, internal consistency, and known-groups validity of the Self-Directed Mobility Scale

Purpose The aims of the current study include to: (1) describe the item development; and (2) begin the process of establishing the internal consistency and known-groups validity of the Self-Directed Mobility Scale. The purpose of the scale is to assess paediatric physical and occupational therapists’ views towards self-directed mobility and their perceived ability and intentions to advocate for children’s access to self-directed mobility. Methods Three individuals with expertise in kinesiology, psychology, paediatric rehabilitation, and disability studies served as the expert panel for item development. Four samples were included to determine internal consistency and known-groups validity: 350 physical therapists, 89 occupational therapists, 279 kinesiology undergraduate students, and 528 health and wellness undergraduate students. Results The internal consistency was above the acceptable level of 0.70 (range = 0.72–0.77) for all samples when two items regarding promoting other motor skills prior to powered mobility use and the temporary use of a mobility device were removed. Known-groups validity was established between all samples. Conclusions The Self-Directed Mobility Scale appears to be a valid tool for assessing views of self-directed mobility and mobility advocacy intentions in paediatric physical and occupational therapists, as well as undergraduate students. Future work should examine the internal consistency based on study sample to ensure the (> 0.70) acceptable Cronbach’s alpha level is met. Implications for rehabilitation The Self-Directed Mobility Scale is a viable measurement tool to assess views of self-directed mobility and mobility advocacy intentions of pediatric physical and occupational therapists. In combination with other measures, the Self-Directed Mobility Scale may be used in future rehabilitation research to evaluate factors associated with provision of mobility technology to children with disabilities.

The Relationship between School-age Children’s Perceptions of Their Self-concept & Self-esteem and Parents’-reported Executive Functioning

ABSTRACT Self-concept (SC), self-esteem (SE) and executive functioning (EF) are factors that can influence school-aged children’s daily occupational performance particularly at school. The aim of this study was to investigate the association between children’s self-reported SC and SE with their EF (based on parental report). Using a cross-sectional, quantitative, non-experimental design, 20 typically developing children (40% boys; M age 9.7 years, SD 1.5) were recruited and completed the Piers-Harris Self-Concept Scale-Third Edition and Culture Free Self-Esteem Inventories-Third Edition. Parents of the children completed the Behavior Rating Inventory of Executive Function-Second Edition. The data were analyzed using Spearman rho correlations and linear regressions with bootstrapping. Several positive associations were found between a child’s self-reported SC and SE. Linear regression analysis determined that several statistically significant (p < .05) predictive relationships between SC & EF and SE & EF existed. This study highlights the importance for pediatric occupational therapists and other professionals to be aware of children’s presenting SC and SE, as these variables may be important predictors of a children’s EF.

Brain magnetic resonance imaging is a predictor of bimanual performance and executive function in children with unilateral cerebral palsy.

To examine the association between brain magnetic resonance imaging (MRI) characteristics and executive function and bimanual performance in children with unilateral cerebral palsy (CP). Clinical MRI brain scans were classified as: (1) predominant pathological pattern (normal, white matter injury [WMI]; grey matter injury; focal vascular insults [FVI]; malformations; or miscellaneous); and (2) focal lesions (frontal, basal ganglia, and/or thalamus). Assessments included: (1) bimanual performance; (2) unimanual dexterity; and (3) executive function tasks (information processing, attention control, cognitive flexibility, and goal setting) and behavioural ratings (parent). From 131 recruited children, 60 were ineligible for analysis, leaving 71 children (47 males, 24 females) in the final sample (mean age 9y [SD 2y], 6y-12y 8mo). Brain MRIs were WMI (69%) and FVI (31%); and frontal (59%), thalamic (45%), basal ganglia (37%), and basal ganglia plus thalamic (21%). Bimanual performance was lower in FVI versus WMI (p<0.003), and with frontal (p=0.36), basal ganglia (p=0.032), and thalamic/basal ganglia lesions (p=0.013). Other than information processing, executive function tasks were not associated with predominant pattern. Frontal lesions predicted attention control (p=0.049) and cognitive flexibility (p=0.009) but not goal setting, information processing, or behavioural ratings. Clinical brain MRI predicts cognitive and motor outcomes when focal lesions and predominate lesion patterns are considered. What this paper adds Early brain magnetic resonance imaging (MRI) predicts bimanual performance and cognitive outcomes. Brain MRI may identify children requiring targeted interventions. Basal ganglia with/without thalamic lesions predicted bimanual performance. Frontal lesions were associated with attention control and cognitive flexibility. Brain MRI predominant patterns predicted motor, not cognitive outcomes, other than information processing.

American and Canadian therapists’ perspectives of age and cognitive skills for paediatric power mobility: a qualitative study

Purpose: To explore the views of paediatric occupational therapists and physical therapists in Canada and the USA related to (1) the rationale for the age at which power mobility is considered for children and (2) the cognitive skills considered when trialling power mobility.Materials and methods: This study was part of a larger web-based survey study and analyzed responses to two open-ended survey questions: one related to age and one related to cognitive skills. Data were analyzed using the constant comparative method.Results: Analysis revealed four unique themes in the question related to age: (1) ‘Power Mobility Should be Introduced at a Specific Age or Stage’; (2) ‘Child Requirements’; (3) ‘Developmental Impact of All Forms of Independent Mobility’; and (4) ‘Benefits of Power Mobility’. In the question concerning cognitive skills, two unique themes were identified: ‘Cognitive Skill Requirements?’ and ‘Non-Cognitive Requirements’. Two additional themes were identified in both questions: (‘Non-child Requirements’ and ‘Power Mobility Trials, Use, and Options Are Dependent on Age and Goal’).Conclusions: Data indicate wide variability in respondents’ views related to the provision of power mobility. Additional research is needed to explore both therapists’ reasoning regarding power mobility use for children and how to best facilitate knowledge translation in this area.Implications for RehabilitationWide variability exists related to the provision of power mobility for children.Children’s age or stage in life influences therapists’ consideration of power mobility.Many respondents considered cognitive skills when trialling power mobility but some did not.

"Together on the Way": Occupational Therapy in Mainstream Education-A Narrative Study of Emerging Practice in Switzerland.

In Switzerland, recent changes in legislation have reformed special needs education; more children with special needs are now integrated into mainstream schools. Health professionals such as occupational therapists are not embedded in the Swiss education system, but pediatric occupational therapists are starting to work at schools, with the aim of enabling children's full participation as school students. This is bringing a change to the practice of pediatric occupational therapists. Cultural, political, and social factors differ in many ways from those of other countries where most of the current research on pediatric occupational therapists in mainstream education has been conducted. The need for school-based research that is situated within the political, structural, and cultural context of a country has been stressed in different studies. This qualitative study employed narrative analysis to explore the practice experiences and clinical reasoning of Swiss pediatric occupational therapists when working with children with special needs in the school context. Three main themes were identified in the narratives: “bringing in an occupational therapy perspective,” “focusing on school-related occupations,” and “collaborating with different inclusion players.” These represent three different aspects of the therapists' emerging practice. The participants highlight different approaches for children with special needs to enable their participation in everyday life at school through learning, playing, and being with their peers. The findings are discussed in relation to current international research and with respect to European countries with a similar political and structural context, thus complementing approaches to school-based occupational therapy.

The Perceptions of Pediatric Occupational Therapists Regarding Constraint-Induced Movement Therapy

The Perceptions of Pediatric Occupational Therapists Regarding Constraint-Induced Movement Therapy

An occupational therapy community of practice within pediatric acute care: fostering professional, social and cultural capital in resource challenged settings

Introduction: The need to address the way professional knowledge is produced and delivered, has led some occupational therapy scholars to advocate for the creation of communities of practice (CoP) where practitioners may find a generative environment to engage in reflection with others, to collectively share their knowledge, and to develop professional practice knowledge. CoPs may result in the development of social capital by strengthening practitioners’ social connections and advance cultural capital by improving collaborative forms of reflection and knowledge exchange. Objective: This article presents findings from a participatory action research project regarding the creation of a (CoP) with the aim to implement and examine its affordances among pediatric occupational therapists working in acute care in a Brazilian context. Method: This participatory action research involved nine occupational therapists in 10 face-to-face meetings and in virtual interaction through an e-learning software platform. The community of practice group sessions were recorded, transcribed and coded. The hermeneutic and dialectic method was used as the basis for interpreting the results. Results: Five major themes concerning the affordances of the Occupational Therapy CoP in this context were identified: (i) dialogic engagement; (ii) reflective opportunities; (iii) a sense of belonging; (iv) affirming professional identity; (v) cultivating professional practice knowledge. Conclusion: Developing a CoP in occupational therapy may be a fruitful way to cultivate professional, social and cultural capital amongst occupational therapists who work in resource challenged settings.

국내 아동 작업치료사의 평가도구 사용 동향

목적 : 본 연구는 국내 아동 작업치료사들이 사용하고 있는 평가도구를 영역별로 구체화하여, 평가도구의 사용 동향을 파악하고자 하였다. 연구방법 : 본 연구는 아동 작업치료사를 대상으로 평가도구 사용에 대한 설문을 실시하였다. 평가도구의 하위영역은 작업수행, 일상생활활동, 교육, 놀이, 감각-지각, 운동 및 실행, 인지, 사회적 상호작용 기술, 발달, 이학적 검사로 구성하였다. 설문에 응답한 105명의 자료를 대상으로 기술통계 및 빈도분석을 사용하여 분석하였다. 결과 : 본 연구 결과는 초기 평가 시 소요되는 시간은 30∼60분(41.9%)이 가장 많았으며, 재평가 주기는 3~6개월(41.0%) 로 가장 많이 실시하는 것으로 나타났다. 영역 별 평가도구를 살펴보면, 작업 수행은 Canadian Occupation Performance Measure(55.2%)을, 일상생활활동은 Wee Functional Independence Measure(57.1%)을, 교육은 School Function Assessment(2.5%)를, 놀이 평가도구는 Revised Knox Preschool Play Scale(28.6%)을, 감각-지 각은 Developmental Test of Visual Perception(94.3%)을, 운동 및 실행 평가도구는 Bruininks-Oseretsky Test of Motor Proficiency-2(42.9%)를, 인지 평가도구는 Lowenstein Occupational Therapy Cognitive Assessment(11.4%)를, 사회적 상호작용 기술은 Evaluation of Social Interaction(6.1%)을, 발달은 Denver Developmental Screening Test-II(92.4%)를, 이학적 검사는 임상관찰(89.5%)을 주로 사용하는 것으로 나타났다. 결론 : 본 연구를 통하여 국내 아동작업치료사들이 사용하고 있는 평가도구를 영역별로 구체적으로 파악할 수 있었으며, 이를 통해 추후 평가 교육 및 개발을 위한 기초적인 근거자료가 될 것으로 기대된다.

Exploring Use of the International Classification of Functioning, Disability and Health in Pediatric Occupational Therapy

Abstract Date Presented 4/19/2018 A study of 78 pediatric occupational therapists’ use of the International Classification of Functioning, Disability and Health (ICF) is presented. Most reported frames of reference and intervention foci were linked to ICF body functions. This study informs ICF use in pediatric practice. Primary Author and Speaker: Janel Anne Belarmino Contributing Authors: Sarah L. Smith, Vanessa D. Jewell

Perceptions and practices of paediatric occupational therapists

Purpose The purpose of this paper is to feedback the results of a survey of paediatric occupational therapists completed by the Paediatric Advisory Group (PAG) regarding perceptions and practices of the assessment of need (AON) process. This survey was completed to gather feedback from occupational therapists about the impact of the AON process on paediatric occupational therapy practice in Ireland. Design/methodology/approach A questionnaire was developed by the authors, who were on the PAG committee, to specifically gather quantitative and qualitative information about the AON. A snowball sampling method was utilised. The results were grouped into themes related to the practices and recommendations from occupational therapists nationally. Findings Surveys were returned from 98 paediatric occupational therapists with a wide national geographical spread with the majority working in the HSE. The amount of time spent on AON assessments, as well as the length of reports, varied nationally. The process of how assessments were completed (unidisciplinary or multidisciplinary) and whether a diagnosis was provided was inconsistent. Concerns were raised about the negative ethical impact of the AON on service provision and intervention and the need for further training of staff along with more frequent assessment reviews. The respondents also highlighted concerns about the increasing age of the AON criteria, with no increase in resources, and they provided suggestions for improvements for the future. Research limitations/implications The survey was sent to all AOTI and PAG members via gatekeepers and then forwarded to others, resulting in a snowball sampling technique; however, this does not represent all paediatric occupational therapists nationally as membership in these groups is voluntary. Practical implications The concerns and inequities raised in the survey regarding occupational therapy practices of completing the AON process need to be shared with relevant stakeholders both at the occupational therapy management level and in the HSE and Department of Health/Disability. The PAG will continue to highlight these concerns from their members to relevant parties and by disseminating findings in articles such as this. Social implications Ethical concerns were raised by some members about the equity of access to interventions as a result of the AON process. The social implication of this for families and children is pertinent, particularly in the context of the increased age in the AON criteria without any increase in resources. Originality/value The PAG aims to support paediatric occupational therapists nationally and the committee often gathers feedback from members regarding concerns which affect day-to-day practice in paediatric OT. Sharing of this information with IJOT readers helps to highlight the challenges faced by paediatric occupational therapists nationally.