Background: In the last few decades, there has been a major shift in the general public’s awareness of many common physical and mental disorders, especially regarding autism spectrum disorder (ASD). This rise in general awareness has led to greater efforts in providing early intervention, quality services, and parental support, but these advances are all just starting points for the family with a special needs child. Focusing on the southern states, there is still a shroud of mystery that remains over children with special needs, and the stigma with not just seeking but following through with professional help continues to prevent many families from getting quality care.
Importance of issue: A child will benefit most from health care and occupational therapy if the family is on board with reasonable goals and expectations, the trajectory of the disorder, and the therapist’s perspective.
Goal: Parental compliance to therapeutic suggestions can easily be neglected, but it is extremely important to the child’s health care plan. This issue with lack of compliance leads to a need for a specialized continuing education course in parental communication for practicing occupational therapists. Building an open conversation between health care professionals and families should be taught and encouraged through an education class offered by the American Occupational Therapy Association (AOTA.)
Recommendations: Three levels of communication
To be a practicing occupational therapist in the United States, you are highly encouraged to enroll in continuing education courses each year to hone your skills and maintain awareness of new research. To improve the parental compliance of therapeutic practices in a pediatric setting, a specialized communications course should be taught to these practicing therapists through AOTA. This course can be structured in three parts; communication with parents before therapy sessions, approaches with children during therapy, and activities to encourage therapeutic practices at home by parents. This method of focusing on “before, during, and after” will allow OTs to utilize their time and knowledge in the best way possible.
Implementation: Curriculum for this course
Step 1: First, the teachers of the course would collaborate to create an effective syllabus for the class. The class would be set up with different modules highlighting different lessons. The main topics of the class are detailed below.
Step 2: The course would be made available through AOTA’s website. Promotional materials could be distributed at the national AOTA conference which occurs yearly, and the first class of therapists could receive a discount to register, which would encourage them to try this new course.
Step 3: Once the course has enough therapists enrolled (this class size would be determined by the teachers), the course would move onto the evaluation stage. In the first few years of courses, detailed questionnaires would measure the therapists’ skills before, during, and after taking the program.
Sample Curriculum
The course would teach clinicians how to improve their mindset before each session, how to have a successful session, and how to communicate to the parents after the session.
Before sessions: A well rounded view of health care incorporates understanding a situation from multiple interdisciplinary perspectives, and in this case that means that of the pediatric OT, the parent, and the child. The OT knows the diagnosis and general expectations for a child, and it is sometimes easy to pigeonhole a child by their diagnosis. Unfortunately, with experience as a therapist comes experience with clients “just like this one,” and there is a temptation to treat children with similar conditions the same way. Therapists in this proposed course would be trained to incorporate their medical understanding and experience with the ideas and opinions of the family to create a successful working relationship. Setting realistic goals and expectations for the child is necessary for the parents and therapist to work cohesively. Though the parents may not have the academic background that the therapist has, the child will learn more from the parents than anyone else.
As I learned in my research position described in my first key insight, understanding and improvisation are great tools to handle different viewpoints. This leadership project allowed me to see the beauty in flexibility, and that it’s ok for things to go a different way than originally planned. These skills of empathy, flexibility, and understanding can be sharpened through the continuing education course by role playing, group projects, and team building activities. Working on this will help therapists approach patients and their parents in a more understanding and respectful way, which will help build the OT/parent relationship.
During sessions: Everyone has unique interests, likes, and dislikes, and it is usually not too difficult to discover what it is that makes a child with special needs interested and happy. Pediatric therapists are trained to make therapy fun, but this idea often gets lost in the mix for parents who are struggling to handle their child day after day. To make therapy fun, sometimes therapists utilize methods that seem rather silly and useless. For example, in my Perceptual Motor Development Class (Exsc 303), I worked with a child with serious hand writing issues. We would play with playdoh before writing, which he enjoyed, but his mother didn’t see why she was paying for us to make little animals out of playdoh instead of working on spelling words. By explaining that our activities were fun ways for him to work on strengthening the muscles in his hands, she became more accepting of our therapy, which translates to better parental compliance later on.
In the proposed course, therapists would share multiple tactics for handling various childhood issues and ways to communicate these activities to parents. There are so many creative ways to approach a problem, but it is common to use the same technique for each child. This can be very successful, but it has the potential to grow into therapist complacency. It is so important for therapists to actively seek different opinions and new treatment ideas and to share their results with other therapists.
After sessions: It is necessary to keep an open line of communication with the parents explaining what it is that the child needs to work on, what common and fun activities can help him, and what happens during therapy. Parental compliance stems from full understanding and trust of the health care system, and the therapist can actively build this relationship. One way to do this is to teach the therapist to use an online note taking system. This is an efficient way to provide detailed feedback to the parents about the child’s behaviors and performance during therapy if the parent doesn't get to watch the sessions. Therapists in the course would be encouraged to share any sort of physical evidence of progress (pictures of the child doing therapy, handwriting samples, coloring pages, etc) with the family to provide visual feedback about the child’s development.
In my third key insight, I discuss my experience of working with an OT and nannying at the same time. I have gained a unique perspective about what it’s like to have a child while seeing children in therapy, and one of the main lessons I’ve learned is just how busy life can be. The child I nanny is normally developing, but it is still hectic and time consuming to make sure he is playing with appropriate toys, eating at the perfect times, and growing at a normal rate. For parents of special needs children, I can see how it can be very difficult to keep track of all the things that you are being told to do for your child on a daily basis. When I shadow the OT, it is not uncommon for the parent to be distracted with other kids, confused about what he did in therapy, or not even be there if we are doing therapy in a school. This type of perspective can be used in the course. The instructors would give therapists time to brainstorm better ways to convey information to parents and encourage parental involvement. This open communication training would teach therapists to frequently ask parents what they are having issues at home with and what they want to see their child accomplish in the near future.
Oftentimes, it is possible to create goals which match the family’s expectations depending on the functional difficulties that the child has. Progression and setbacks are inevitable with any child, but these can be especially difficult with a child with special needs. There are many resources which a therapist can utilize to help a parent get through a tough time, like promoting social support groups, helpful blogs, or books from a parent or academic perspective. This course would focus on these parent-therapist interactions and also promote therapist-therapist interactions with social and academic support systems. Since this career is often highly emotional and very personable, the course would allow therapists a chance to refocus on what they need to be better in the workplace. Therapists enrolled in this course would talk with one another about difficult situations they have experienced and how they handled it, share helpful literature or handouts, and encourage one another to have strength and patience when the job is stressful.
Evaluation
The course would be continually evaluated as a successful program and would be updated to include other ideas from different OTs. Research to show the effectiveness of the course would involve surveying. Therapists could log their own interactions with parents and rate any changes demonstrated before and after taking the course, and they could also give surveys to parents before and after taking the course, which would detail how the parents felt their relationship with the OT changed after the course.
To continue to improve therapist-parent relationships, continual and honest feedback should be given by the therapist to the parent about the child’s performance. Therapists need to be understanding and sensitive to the parents, and many therapists could benefit by a continuing education course in parental communications. By keeping the conversation constructive and not critical, the therapist can best help the family embrace their special needs child.
Final Thoughts
The most important tool for the parent is the therapist, and this relationship can be very meaningful if promoted correctly. OTs have the responsibility to be a listening ear for families who may not know of anyone else to turn to, and these conversation will sometimes be more important than even the most cited literature. By training therapists to become better communicators, they are better prepared to work with the most difficult cases.
Importance of issue: A child will benefit most from health care and occupational therapy if the family is on board with reasonable goals and expectations, the trajectory of the disorder, and the therapist’s perspective.
Goal: Parental compliance to therapeutic suggestions can easily be neglected, but it is extremely important to the child’s health care plan. This issue with lack of compliance leads to a need for a specialized continuing education course in parental communication for practicing occupational therapists. Building an open conversation between health care professionals and families should be taught and encouraged through an education class offered by the American Occupational Therapy Association (AOTA.)
Recommendations: Three levels of communication
To be a practicing occupational therapist in the United States, you are highly encouraged to enroll in continuing education courses each year to hone your skills and maintain awareness of new research. To improve the parental compliance of therapeutic practices in a pediatric setting, a specialized communications course should be taught to these practicing therapists through AOTA. This course can be structured in three parts; communication with parents before therapy sessions, approaches with children during therapy, and activities to encourage therapeutic practices at home by parents. This method of focusing on “before, during, and after” will allow OTs to utilize their time and knowledge in the best way possible.
Implementation: Curriculum for this course
Step 1: First, the teachers of the course would collaborate to create an effective syllabus for the class. The class would be set up with different modules highlighting different lessons. The main topics of the class are detailed below.
Step 2: The course would be made available through AOTA’s website. Promotional materials could be distributed at the national AOTA conference which occurs yearly, and the first class of therapists could receive a discount to register, which would encourage them to try this new course.
Step 3: Once the course has enough therapists enrolled (this class size would be determined by the teachers), the course would move onto the evaluation stage. In the first few years of courses, detailed questionnaires would measure the therapists’ skills before, during, and after taking the program.
Sample Curriculum
The course would teach clinicians how to improve their mindset before each session, how to have a successful session, and how to communicate to the parents after the session.
Before sessions: A well rounded view of health care incorporates understanding a situation from multiple interdisciplinary perspectives, and in this case that means that of the pediatric OT, the parent, and the child. The OT knows the diagnosis and general expectations for a child, and it is sometimes easy to pigeonhole a child by their diagnosis. Unfortunately, with experience as a therapist comes experience with clients “just like this one,” and there is a temptation to treat children with similar conditions the same way. Therapists in this proposed course would be trained to incorporate their medical understanding and experience with the ideas and opinions of the family to create a successful working relationship. Setting realistic goals and expectations for the child is necessary for the parents and therapist to work cohesively. Though the parents may not have the academic background that the therapist has, the child will learn more from the parents than anyone else.
As I learned in my research position described in my first key insight, understanding and improvisation are great tools to handle different viewpoints. This leadership project allowed me to see the beauty in flexibility, and that it’s ok for things to go a different way than originally planned. These skills of empathy, flexibility, and understanding can be sharpened through the continuing education course by role playing, group projects, and team building activities. Working on this will help therapists approach patients and their parents in a more understanding and respectful way, which will help build the OT/parent relationship.
During sessions: Everyone has unique interests, likes, and dislikes, and it is usually not too difficult to discover what it is that makes a child with special needs interested and happy. Pediatric therapists are trained to make therapy fun, but this idea often gets lost in the mix for parents who are struggling to handle their child day after day. To make therapy fun, sometimes therapists utilize methods that seem rather silly and useless. For example, in my Perceptual Motor Development Class (Exsc 303), I worked with a child with serious hand writing issues. We would play with playdoh before writing, which he enjoyed, but his mother didn’t see why she was paying for us to make little animals out of playdoh instead of working on spelling words. By explaining that our activities were fun ways for him to work on strengthening the muscles in his hands, she became more accepting of our therapy, which translates to better parental compliance later on.
In the proposed course, therapists would share multiple tactics for handling various childhood issues and ways to communicate these activities to parents. There are so many creative ways to approach a problem, but it is common to use the same technique for each child. This can be very successful, but it has the potential to grow into therapist complacency. It is so important for therapists to actively seek different opinions and new treatment ideas and to share their results with other therapists.
After sessions: It is necessary to keep an open line of communication with the parents explaining what it is that the child needs to work on, what common and fun activities can help him, and what happens during therapy. Parental compliance stems from full understanding and trust of the health care system, and the therapist can actively build this relationship. One way to do this is to teach the therapist to use an online note taking system. This is an efficient way to provide detailed feedback to the parents about the child’s behaviors and performance during therapy if the parent doesn't get to watch the sessions. Therapists in the course would be encouraged to share any sort of physical evidence of progress (pictures of the child doing therapy, handwriting samples, coloring pages, etc) with the family to provide visual feedback about the child’s development.
In my third key insight, I discuss my experience of working with an OT and nannying at the same time. I have gained a unique perspective about what it’s like to have a child while seeing children in therapy, and one of the main lessons I’ve learned is just how busy life can be. The child I nanny is normally developing, but it is still hectic and time consuming to make sure he is playing with appropriate toys, eating at the perfect times, and growing at a normal rate. For parents of special needs children, I can see how it can be very difficult to keep track of all the things that you are being told to do for your child on a daily basis. When I shadow the OT, it is not uncommon for the parent to be distracted with other kids, confused about what he did in therapy, or not even be there if we are doing therapy in a school. This type of perspective can be used in the course. The instructors would give therapists time to brainstorm better ways to convey information to parents and encourage parental involvement. This open communication training would teach therapists to frequently ask parents what they are having issues at home with and what they want to see their child accomplish in the near future.
Oftentimes, it is possible to create goals which match the family’s expectations depending on the functional difficulties that the child has. Progression and setbacks are inevitable with any child, but these can be especially difficult with a child with special needs. There are many resources which a therapist can utilize to help a parent get through a tough time, like promoting social support groups, helpful blogs, or books from a parent or academic perspective. This course would focus on these parent-therapist interactions and also promote therapist-therapist interactions with social and academic support systems. Since this career is often highly emotional and very personable, the course would allow therapists a chance to refocus on what they need to be better in the workplace. Therapists enrolled in this course would talk with one another about difficult situations they have experienced and how they handled it, share helpful literature or handouts, and encourage one another to have strength and patience when the job is stressful.
Evaluation
The course would be continually evaluated as a successful program and would be updated to include other ideas from different OTs. Research to show the effectiveness of the course would involve surveying. Therapists could log their own interactions with parents and rate any changes demonstrated before and after taking the course, and they could also give surveys to parents before and after taking the course, which would detail how the parents felt their relationship with the OT changed after the course.
To continue to improve therapist-parent relationships, continual and honest feedback should be given by the therapist to the parent about the child’s performance. Therapists need to be understanding and sensitive to the parents, and many therapists could benefit by a continuing education course in parental communications. By keeping the conversation constructive and not critical, the therapist can best help the family embrace their special needs child.
Final Thoughts
The most important tool for the parent is the therapist, and this relationship can be very meaningful if promoted correctly. OTs have the responsibility to be a listening ear for families who may not know of anyone else to turn to, and these conversation will sometimes be more important than even the most cited literature. By training therapists to become better communicators, they are better prepared to work with the most difficult cases.