Occupational Performance Coaching: A contemporary approach for working with parents of children with occupational challenges

Parents play a critical role in supporting the learning, occupational performance and social participation of their children, particularly when children are challenged by tasks that are typically achievable by their peers. Parents also have needs and aspirations related to their own learning and performance within their parenting roles that are relevant to occupational therapists providing family-centred services. Yet few evidence-based interventions are available to guide occupational therapists’ work with parents as they attempt to enable their children’s occupational performance. Occupational Performance Coaching (OPC) is proposed as an intervention which is family- and occupation-centred, enablement-focused and research informed. OPC involves working alongside parents to achieve parents’ goals for themselves, their children and/or their families. In OPC therapists utilise performance analysis, problem-solving, occupational and disability knowledge to guide parents’ exploration of changes that facilitate goal achievement. Adult learning principles, enablement perspectives of disability and models of occupation underpin therapists’ use of reflection, questioning, modelling and demonstration within the approach. This thesis examined the effects and mechanisms of OPC in two studies. Parents engaged in between 6 and 10 weekly one hour sessions of OPC with the author of this thesis. Sessions occurred in a university research clinic and involved an iterative application of OPC. Study One (a pilot study) examined the effects of OPC with three parent-child dyads (all mothers) on parents’ and children’s occupational performance, and parents’ problem-solving and self-competence. Each parent’s engagement in the intervention was discussed in view of the outcomes achieved. Parents’ experiences of OPC were also explored through post-intervention interviews. Procedures and instruments were also reviewed and adjusted where needed to inform the main study (Study Two). Findings from Study One indicated that occupational performance improved following OPC for all parents and children in the occupations for which goals were set. Improvements in parents’ self-competence in supporting their children with goal-related tasks and more widely in their parenting roles were also observed. Changes in parents’ problem-solving skills were inconclusive. In the post-intervention interviews with parents themes of new learning, changes at home, and a rewarding challenge emerged. Parents were positive about the intervention and recommended its continued investigation. Study Two (n=29) examined the effectiveness of OPC in improving parents’ (all mothers) and children’s occupational performance and self-competence, and parents’ problem-solving with a larger sample using a pre-post study design. Parents’ experiences of engaging in OPC were again sought. Statistically significant improvements in parents’ and children’s occupational performance and goal achievement were observed with some evidence of generalisation of skills to other tasks. Improvements in parents’ and children’s self-competence, and parents’ problem-solving following OPC were all positive but were not all statistically significant. Parents’ reports of their experience of engaging in OPC were similar to those described by parents in Study One with themes emphasising the learning that occurred, and parents’ perceptions that OPC helped to shape a calmer, happier family life. Findings from these two studies indicate that OPC is associated with improvement in both parents’ and children’s occupational performance. These improvements were maintained six weeks after the completion of OPC sessions. There is some indication that improvements in aspects of performance generalised to other tasks and routines however further investigation of this is required. Parents reported significantly higher levels of self-competence in both their parenting roles and in managing the specific situations addressed during OPC following sessions. However, changes in parents’ approach to problem-solving following OPC were not clearly apparent. Improvement in children’s self-competence occurred following OPC however further investigation of this finding is required due to the gradual improvement that was observed over the Wait phase of the study. Parents’ experiences of engaging in OPC were positive, in particular they reported feeling supported, and gaining insights into the impact of their own behaviour and knowledge about ways of supporting their children’s performance. Additionally, parents were satisfied with the performance improvement they observed which they attributed to OPC sessions. The strength of the findings from Study Two are however, limited by the absence of a control group within the research design. Particular features of the sample such as level and nature of impairment among children, the nature of occupational performance issues, the education level of parents and the extent of attrition over the study period also limit the generalisability of findings. Future research directions include investigating the effectiveness of OPC with intervention therapists other than the primary author, and with parents of children from a range of educational backgrounds with children with specific health conditions. Future investigations of effectiveness should include studies using a randomised controlled trial design. The framing of OPC as a distinct intervention has been an important extension of occupational therapy’s renaissance as an occupation-centred profession. Findings from this thesis, while preliminary, add empirical support to occupation-centred practice with parents of children with occupational performance issues and warrant further investigation