Occupation-Based Coaching by means of telehealth for families of young children with autism spectrum disorder

Article Reviews
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Read Full Text: Occupation-Based Coaching by Means of Telehealth for Families of Young Children With Autism Spectrum Disorder (Available via NBCOT/ProQuest and AJOT)
Journal: The American Journal of Occupational Therapy
Year Published: 2018
This week’s article was chosen in response to the coronavirus pandemic.

One of the general trends we’ve been following in the Club is the potential of using coaching strategies in occupational therapy.

And, as therapists around the globe are dialing into teletherapy, this research trend merits some consideration. After all, it may be an effective strategy to consider as many of us are seeking to restructure how we offer our occupational therapy services.

This week’s article on Occupation-Based Coaching via telehealth really paints a picture of how coaching techniques may be an effective tool for OT professionals as our profession navigates this new frontier.

The study we are looking at today is small. But, I hope you are able to draw some inspiration from it, along with some logistical ideas. And, most importantly, I hope you take comfort that even though teletherapy is new to many of us, it is a topic that has been studied for many years—and there IS guidance out there for you.

A brief note on coaching (and our past discussions of it)

The current article gives little background on coaching in a broader sense, other than to say it has been highlighted as a best-practice method (citing this article.)

Honestly, defining coaching is difficult because the practice, certification, and regulation of coaching is already somewhat nebulous.

But, in my reading, the one consistent—albeit oversimplified—distinction between coaching strategies and traditional therapy that stands out to me is this: coaching strategies empower clients to solve their own problems, whereas in traditional therapy, we are more likely to offer guidance and direction.

This theme of helping clients self-identify problems and self-generate solutions is consistent with other research we’ve explored in the Club. Overall, the results seem promising! Here are a few of the previously examined studies that come to mind:

So, what is “occupation-based coaching?”

Ok, back to the article. The article explored a specific type of coaching called Occupation-Based Coaching.

The process of this model includes:

  • Setting goals
  • Exploring options
  • Planning action
  • Carrying out the plan
  • Checking performance
  • Generalizing

The process differs from typical “parent-mediated interventions,” where caregivers are asked to help implement therapist-driven strategies. Instead, parents identify goals that align with their own family’s needs—and they also identify what success would look like to them.

What was the goal of this particular study?

The article states that previous studies have shown Occupation-Based Coaching to be effective at increasing parent efficacy and child participation. And, it also states that telehealth has been shown to be an effective option for families of kids with autism spectrum disorder (ASD).*

So, what happens when the two are combined?

The aim of this study was to explore whether Occupation-Based Coaching via telehealth is effective at increasing parent efficacy and child participation.

The study followed 18 families with children with ASD ages 2-6 years old.

What details were given about the intervention?

Occupational therapy sessions were delivered via Zoom.

I’ve read and reread the study, and I’m not sure how many sessions were delivered on average—nor how long each session lasted. If you have any insight into this, please let me know in the comments.

The study does say that the intervention adhered to the 5 key principles adapted from The Early Childhood Coaching Handbook. These principles are:

  1. Authentic context
  2. Family’s interests and routines
  3. Caregiver interaction and responsiveness
  4. Reflection and feedback
  5. Joint plans

The goals identified by the parents were related to: toilet training, eating, sleeping, bathing, social interaction, self-regulation, transitions between activities, and safety in the home and community.

What assessments were used?

Below are the assessments that were used. Note that they are all tools that rely on parent reporting.

What were the results/conclusions?

Notably, the researchers observed the following:

  • A significant increase in parenting efficacy
  • No change in parenting satisfaction
  • A significant increase in the child’s frequency of activity participation
  • A significant increase in diversity of activities in which the child engaged

These observations led the authors to conclude that the intervention increased parent efficacy and child participation, which aligns with findings from previous studies.

Takeaways for OT practitioners

(These are my personal takeaways, and were not mentioned in the article.)

1. We can still be effective in telehealth.

One concern that many of us have expressed is whether we can still be effective via telehealth—without our tried-and-true, hands-on approaches. This study, along with other research we are gathering, should bring you the comfort of knowing that we can still provide value, even when we are not physically present.

2. We are having to reframe how we think about our therapy—but new research was already pushing us to do so.

Oh man, I know that changing the way we practice can feel overwhelming, especially when that change is piled on top of all of the other life changes we are now experiencing.

But, I hope you take comfort in knowing that research is increasingly supportive of using our skills in more of a coaching approach—and that’s a care model for which telehealth is particularly well suited. So, as crazy at it seems, COVID-19 is simply speeding changes to our practices that were already in motion. We are not being asked to do something ineffective; we are simply stepping into the future more quickly than we anticipated.

3. We can do this together.

This community is here for you. I know you all have many questions, stresses, and worries right now. We will tackle them one day at time. And, we will do so together.

Here are some additional resources, related to telehealth we’ve been building for you:

Listen to my takeaways in podcast form:

Find platforms for listening to the OT Potential Podcast here.

(Possibly) Earn CEUs/PDUs for reading this article.

Many of you can receive continuing education credits for reading this article. Here’s a form to help you do it, along with information to help you understand who qualifies.

And, here’s the full APA citation you many need:

Little, L. M., Pope, E., Wallisch, A., & Dunn, W. (2018). Occupation-Based Coaching by Means of Telehealth for Families of Young Children With Autism Spectrum Disorder. American Journal of Occupational Therapy, 72(2). doi: 10.5014/ajot.2018.024786

What questions/thoughts does this article raise for you?

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Thank you, Sarah, for this timely topic. I have started moving some of my clients to telehealth since COVID19 so this is interesting research for me to hear. I was already using the CO-OP method with some clients and that continues to work well during telehealth. I am struggling with some of the ASD clients with attention issues though who have more difficulty paying attention to me on a screen and are more distracted. They are also used to a previous routine and adjusting to a new routine. I need to improve my parent coaching skills for these clients so the parents can intervene more where I used to. This article nudged me to think I need to revisit our goals and set some new cooperative goals with these parents and not continue to use some of the goals I had previously.

Thank you,
Tee

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Thank you for this article it is timely. Teletherapy, had it been suggested before COVID19 i would have been sceptical as to how it would work however as we have been thrown into this I realise its such an amazing opportunity to put into action all the things I’ve wanted to do but time and location and scheduling have created barriers. Managing and mentoring a team of therapists has become amazing, we can all meet to discuss clients and case reviews, professional development of the team who are located in different Centres is now doable with ease and efficiency, more quality time spent with the therapy team and team building, supervising one to one therapists in different locations, training for parents and potential staff in different countries, professional therapy ( a team of) is now accessible to people who previously didnt have access, and i believe one of the major benefits to teletherapy is the involvement of the parent/carer and the carry over of the therapy plan into the home on a daily basis. It is so exciting with all of these possibilities for us to provide a more time efficient service and to spend more quality professional time with the team. Negatives can be turned into positive results.

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@meg2, I’ve heard really good things about your webinar on teletherapy and and coaching. I’m assuming it primarily focuses on working with families with Autistic kids?

Are there any other resources you would recommend to people as they get started?

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Thanks for mentioning it @SarahLyon! My clinical trainings are largely on working with autistic kids. However, the coaching webinar gives a framework for teletherapy with any pediatric clients.

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I love this article. I’ve been speaking to a lot of pediatric therapy practices in the past two weeks, and many therapists are struggling to not feel like parent coaching is a “lesser” therapy. They are used to being very hands on and packing so many activities into their sessions. But the truth is parents don’t watch these sessions and feel inspired to try things on their own. Adults learn by doing, not by watching. And a session jam-packed with activities likely feels out of reach to many busy parents.

Teletherapy and parent coaching move more slowly but they also go deeper into the family’s life and into the parent’s own goals and learning.

After therapists shift their thinking and learn that parent coaching is, in many ways, more effective, they have to make huge changes in how they think about therapy. But then they often get excited about the opportunity to learn a new way to do OT.

I don’t think teletherapy is more effective than in-person by any means. But it certainly the best we have right now. And it does force our hand to really work with families, their routines, and the things they have in their homes. Like you said, it’s launching us forwards. Theory, on average, takes 17 years to impact practice…unless, I suppose, something dramatic happens.

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I am an OT clinical reviewer for insurance. I wanted to let the clinicians know that,from an insurance point of view, we are not concerned with how OT services are delivered, but whether the services are medically necessary (just like when you see your clients in the clinic or through home health), so I would encourage all you OT practitioners to keep that in mind as you serve your clients. Telehealth is just a different modality for service delivery, and it does not have to be “less quality” as someone mentioned earlier, just a different method. Although telehealth requires more flexibility and forethought, it should let you see what is really important in the life of the family members and enable more inclusive home programs that fit into daily routines. I was reading an article the other day about telehealth being used for feeding aversion and the provider was really able to see how hard it was for the mother to implement some of the SOS strategies when the basics for behavior at the dining table were a problem. I think that some one should do a study contrasting the effectiveness of home programs through telehealth as opposed to in the clinic, as I bet there would be greater compliance in telehealth due to better parent education opportunities, and realistic design of the home program due to what the OT practitioner “sees” of the client’s home life. I see real value in parent coaching through telehealth and I want to encourage all of you on the front lines!!

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Oofta. Thank you all and especially for the input from an OT clinical reviewer for insurance @lori.

This quote hit me and made me smile.

Hearing what is helping others and inspiring others is already helpful. Way to go @meg2 on that webinar tooooo!

Here are my takeaways and one question.
Stay close to our value that we can add as OTs AND to what our payor sources are regulating to help find the happy medium FORWARD. Our own routines are changing, including how we prepare and deliver our own sessions. I can see it as valuable to already plan time to gain new skillsets, to be compassionate as I navigate deeper into this new modality. And to always consider, especially in my current home health OT role, is it medically necessary?

What I am super curious about is the format of the sessions and of our communication. In reading the article I was inspired to google search “routine-based questionnaire” as they mentioned they used this for the first session. I found a pdf here that has some fascinating questions (for peds) that are already inspiring me to make one geared to my own home health practice. Others might like this, too (esp if you scroll all the way to the bottom). https://blogs.illinois.edu/files/6150/364271/88801.pdf

For those gearing up, what is the ONE thing you could do to help you prepare for sanity and success with telehealth esp given this article’s info?

Thanks for all the great info.

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Thank you Meg! I referenced (and forwarded - to many therapist) :slight_smile: your webinar on telehealth session - which was great example of “Coaching”!!! thank you for that!!
I think sometimes it’s hard to really find ways to engage the family - I am very open that we are trying session by session and that they definitely look different that ANYTHING we’ve done before and admit it’s hard for me because I love to be hands on while teaching / coaching. So being open and honest seems to encourage the families.
However, I think some goals can not be addressed in teletherapy sessions, so I am watching for that now in my 2nd week of teletherapy. AND some sessions are more difficult due to limited ‘online’ space capacity - glitches, iphone vs. access to computer, etc… I think this is where I would love more guidance !
I do however, love connecting to families more than I have before now… some new things/concerns arise when we talk/coach in this manner! so I definitely feel this situation is expanding our thinking in how we engage with the families.
thanks Meg
AND thanks Sarah for continuing to put more info out about teletherapy!!

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Hello Sarah,
Thank you, for keeping us up to date on the use of telehealth in occupational therapy. I was not aware that occupational therapists could use coaching as a means of administering therapy to a patient/client. I was concerned on how occupational therapy could properly deliver therapy but with this article, I see that it is possible to administer therapy in an effective and ethical way. I was wondering if you had any more insight on other conditions were occupation-based health could be used effetely?

Respectfully,
Josephine Rammel, OTAS

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@SarahLyon Thank you so much for sharing this article. Not only does this article describe the benefits of telehealth OT services for children with ASD, but it also highlights the positive results of the occupation-based coaching practice model over more traditional parent-mediated interventions. An article by Kraversky describes this model and focuses on the family-centered approach it brings (Kraversky, 2019). Involving caregivers in specific goal planning will not only create positive results for the children, but the caregivers themselves are likely to be more satisfied if they feel they are valued just as much as the children.

Respectfully,
Kristen Borntreger, OTAS

Kraversky, D. G. (2019, November). Occupational Performance Coaching as an Ultimate Facilitator. American Occupational Therapy Association. https://www.aota.org/~/media/Corporate/Files/Publications/CE-Articles/CE_Article_November_2019.pdf

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Kristen,
thanks for sharing that article too!!

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Sarah,
Occupation-based coaching is something that I was not aware of before reading this article, and after reading about it I hope to implement it into my practice in the future after I graduate. It is great because it allows the family and staff to feel completely involved in the patient’s life, and helps them to not become so dependent on the therapist. In an article provided by Physical & Occupational Therapy in Geriatrics (2020), a study was performed to see how effective this form of therapy is on the geriatric population. In the conclusion section it states that it “is feasible and potentially effective in assisted living with greater consideration of family needs and staff involvement” (Lamarre et al., 2020, p. 17). This shows that occupation-based therapy can be used for a wide variety of ages, and is not limited to a specific group. Therapy is successful when it allows the family or client to be able to feel empowered to solve their own problems, rather than relying on the therapist to solve all of their problems for them. Thank you for sharing this article and for allowing us to increase in our knowledge and understanding of OT!

Respectfully,
Rebecca Allen, OTAS

Lamarre, J., Egan, M., Kessler, D., & Sauvé-Schenk, K. (2020). Occupational Performance Coaching in Assisted Living. Physical & Occupational Therapy in Geriatrics , 38 (1), 1–17. https://doi-org.elibrary.huntington.edu/10.1080/02703181.2019.1659466

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Sarah,

Thank you so much for sharing this article. As many have already stated, the use of telehealth is drastically increasing as our current circumstances almost require it. As practitioners, it is important that we are able to understand the efficacy of telehealth and show that OT can be just as successful through this format. As I continued to research, I found that there are an immense amount of articles written on the efficacy of occupation-based coaching as effective for those with ASD. However, one article performed a review of looking to see the efficacy of occupation-based coaching on children with SP-SI disorders, but found very few articles actually addressed this independently of ASD (Miller-Kuhaneck, Watling, 2017). This study was performed in 2017, so I would be interested to see if this method has been further investigated since then, and if this too could be just as successful through telehealth.

Respectfully,

Rachel A. Bush, OTAS

Reference:

Miller-Kuhaneck, H., Watling, R., (2017). Parental or teacher education and coaching to support function and participation of children and youth with sensory processing and sensory integration challenges: A systematic review. The American Journal of Occupational Therapy, 72, 1-11. doi:10.5014/ajot.2018.029017

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Great article for the times! It seems like there are so many directions we can go with virtual contact. On a more broad level, I still am not totally clear between telehealth and telerehabilitation. I love the idea of coaching because it helps with functional problem solving and carryover which is especially important now with putting the entire load on parents. It seems so important right now to help parents through this rather then to add to their load and expect them to be eHelpers as we give them additional strategies to add to their already overloaded plates. With the shift right now as a school based therapist, I am still working on managing everyone (parents, teachers, admin) having different expectations about my unique role in supporting students and families at this time.

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Sarah,

I was particularly interested about parent efficacy after reading the article. According to Pearson clinical, “parent efficacy pertains to how effective the parents feel in implementing strategies and problem solving through difficult situations” (Pearson, 2017). A few months ago, in our pediatrics class, a mom and her son came in so that we could perform a questionnaire and come up with an intervention for her son. She said that in the past, some of the facilities for speech and occupational therapy did not ask her what her goals were for her son. She expressed frustration that they did not listened to her. Including caregivers in the intervention process is so important and beneficial for both the caregiver and the child. I love that occupation-based coaching is an option through telehealth, and it opened my eyes to the ways occupational therapists can expand.

Anna G. Barg, OTAS

References:

Pearson (2017). Images.pearsonclinical.com . Retrieved from https://images.pearsonclinical.com/images/Assets/_landing/ot-telehealth/CLINA15773-9421_OT-Telehealth-Coaching-Whitepaper_Final.pdf?utm_medium=email&utm_source=OTwhitepaper_CLINA15773_12939&utm_campaign=7010N0000003TS7&cmpid=7010N0000003TS7

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Does anyone have advice and/or examples of following up with caregivers & kids via email following the video conference/teletherapy session?

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@reina, @meg2, or @stephanie12 Do you know of any follow-up templates that people can access? I’ve seen a couple of people asking for these!

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Though I am not a pediatric OT, I will offer a few fun ideas for a possible follow up template (as templates make me a little giddy).

What if it included things like, What worked? What’s been most helpful? Where are you struggling? Where would you like more feedback? On a scale of 1-10, how satisfied are you with _____? The top goal we are working on is ____, how close do you perceive we are to achieving it? What is helping the most? What is the biggest barrier?
Take what you like, leave the rest:) I’d be curious to know if ya’ll found any templates that has been helpful. Wishing you all the best as we navigate and reinvent.

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