The Evolving Role of the
Occupational Therapist in Early
Intervention
STEPHANIE DE SAM LAZARO, OTD, OTR/L
Historical Context
Part H - 1986
Establishment of
services for infants
and toddlers
Center-based
1990, 1997, 2004
Changes in name
Focus on first 3
years of life
Focus on equity
Shift to homes
Update to Part C - 2011
Focus on
family-centered
practices
Focus on natural
settings
Center for Parent Information and Resources, [CPIR}, 2014
Evolution of Practice
2011
Family Centered, Natural environments Transdisciplinary, Role Release, Coaching, Top Down
2000s
Update to IDEA, Focus on 0-3 Interdisciplinary, Joint V isits, Hands-on
1990s
IDEA, LRE more important Multidisciplinary, Component Based
1980s
Part H, Center-based Multidisciplinary, Hands-on, Bottom up
Differentiating the Lingo
u
Multidisciplinary
u
Administration of evaluations and interventions in separate sessions by separate
disciplines
(King et al., 2004; Linder & Linas, 2009; Myers & Others, 1996) u
Interdisciplinary
u
Administration of evaluation and intervention occurs during joint visits of separate
disciplines, however there is a separate but coordinated mentality
u
Transdisciplinary
u
Aims to defragment services to increase communication among team members
and caregivers in order to avoid conflicting messages from team members
uPractitioners from multiple disciplines assess/provide intervention simultaneously
across developmental domains
(King et al., 2004)Developing a Common Language
u
Family-Centered or Family-Guided Practices
u
Natural Settings
u
Routines-Based Interventions
u
Family-guided assessment/routines-based assessment
u
Coaching
u
Primary Service Provider Model
OT Scope for Early Intervention (0-5)
uFeeding uEating/Swallowing uDressing uBathing uToileting uGrooming/HygieneuPersonal dev ice care
uCommunity mobility
uCare of pets
uMeal preparation
uSleep and rest
uPre-literacy skills u Educational participation u Play uExploration uParticipation u Leisure uIndividual uFamily u Social Participation uCommunity uFamily uPeers
OT and Family-Centered Practices
EI Principles
uChildren learn best in familiar contexts
uFamilies can enhance their child’s learning and dev elopment (with the appropriate support and resources)
uServ ice prov ider needs to work with and support family members
uEI process is dynamic and indiv idualized to reflect child and family preferences, needs, learning styles, and cultural beliefs (NECTAC, 2008)
OT Framework
uEvaluation and Interv ention must consider contexts and env ironments
uCultural, Temporal, Personal, Virtual
uPhysical, Social
uEducation, training, and advocacy are part of our practice … this includes dev eloping role competence
uOccupations are “client-directed daily life activ ities that match and support or address identified participation goals”
(AOTA, 2014b)
Natural Settings
uEarly interv ention serv ices are to be prov ided in natural env ironments (*to the maximum extent appropriate for the child and for the serv ice) within the naturally occurring routines of the child and family(34 C. F. R. § 300.114, 2011; 34 C. F. R. §303.26, 2011; CPIR, 2014)
Person Environment Occupation Lee, 2010 Person-Env ironment-Occupation Model
Routines-Based Interventions
uRoutines-Based Intervention:
u
Model of intervention in which naturally occurring routines are used to guide the
caregiver in helping the child to transfer and generalize skills to non-therapy times
(McWilliam, 2010)u
A routines-based interview is used to help determine interventions that will address
family concerns, priorities, and resource needs “within the context of everyday
routiens, experiences, and activities with familiar people”(National Early Childhood Technical
Assistance Center, [NECTAC], 2011, p. 2)u
Definition of OT from AOTA (2014b):
u
“Occupational therapy is defined as the therapeutic use of everyday life activities
(occupations) with individuals or groups for the purpose of enhancing or enabling
participation in roles, habits, and routines in home, school, workplace, community,
and other settings” (p. S1)
Models of Practice
Coaching
u Can be used in any area of clinical practice within OT
u Positiv e equal relationship
u Non-directiv e, goal-oriented, solution focused (Rush & Shelden, 2011)
u Capacity building, performance based, context driv en
u Improv es caregiv er perception of their child’s gains and facilitated skills of parent (Kingsley & Mailloux, 2013)
Primary Service Provider
u One person is the primary point of contact forthe family
u Emerged from practice
u Role release and role expansion
u Extensive communication
u Challenges the belief in “traditional” intervention
u Goes beyond “dose of therapy” model
u Supported by DEC, APTA, AOTA, and ASHA
u Evidence of support (Kingsley & Mailloux, 2013)
Terminology
IDEA, Early Intervention
uEnvironmental contexts Impact
performance
u
Motivation/meaningfulness impacts
performance
u
Habits, routines, and daily activities
u
Coaching, modeling, observational
learning
u
Self-efficacy and capacity building
Occupational Therapy in EI
uOccupational Science
u
Combine client-centered practice with
naturally occurring meaningful
occupations
(Hocking & Wright-St. Clair, 2012)u
Social Learning Theory
u
Observational learning, Reinforcement,
Self-efficacy, self-regulation, motivators,
learning does not equal change
(Bruce & Borg, 2002; Grusec, 1992; Rosenstock, Strecher, & Becker, 1998)u
MOHO
u
PEO
OT’s Role as a Coach
Kolb’s
Learning
Cycle
Concrete Experience Reflective Observation Abstract Conceptualization Active ExperimentationJoint planning, observ e, reflect, solution-focused, performance based, context driv en
Observ e, reflect, non-directiv e Content sharing related to solutions,
performance, and context Hands-on, directiv e learning, goal oriented, performance and solution based
Knowles et al., 2011
Unique Contribution of OT to EI team
u
Many area of professional expertise to meet needs of child and family
u
Capacity to provide interventions across ALL domains of
development
u
OT education has roots in team consultation
u
OT education has roots in client centered care
u
OT education provides skills to provide client capacity (includes
caregiver capacity)
(34 C. F. R. § 303.321, 2011; 34 C. F. R. § 303.322, 2011; AOTA, 2014a)
The Heart of OT
u
Use of meaningful activities to help children develop skills and
thrive
u
Occupations are used as a means AND an end
u
We embrace natural environments,
natural tools, preferred activities
u
Adaptation of materials
and environment
(AOTA, 2015b; NECTAC, 2011)Response, Reaction, Comments, Questions
u
What are your initial reactions to this related to scope of practice, billing
concerns, role release, models of practice, or other information
presented?
u
What should be done at the state level?
u
What should be done at the federal level?
u
What needs to be done at the MOTA, AOTA level?
u
What needs to be done at the state interagency level and federal
interagency level?
u
Others?
References
American Occupational Therapy Association. (2009). FAQ: What is the role of the occupational therapist in early intervention? Retrieved from
https://www.aota.org/~/media/Corporate/Files/Practice/Children/Browse/EI/Role-of-OT_1/Early%20Intervention%20FAQ%20Final.ashx
American Occupational Therapy Association. (2011). Occupational therapy services in early childhood and school-based settings.
American Journal of Occupational Therapy, 65(Supplement), 1-12. doi: 10.5014/ajot.2011.65S46
American Occupational Therapy Association. (2014a). AOTA practice advisory on the primary provider approach in early intervention. Retrieved from http://www.aota.org/-/media/Corporate/Files/Practice/Children/AOTA-Advisory-on-Primary-Provider-in-EI.pdf American Occupational Therapy Association. (2014b). Occupational therapy practice framework: Domain and process, 3rdEdition.
American Journal of Occupational Therapy, 68(Supplement1), S1-S48. doi: 10.5014/ajot.2014.682006
American Occupational Therapy Association. (2015b). The role of occupational therapy with children and youth. Retrieved from
http://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/CY/Fact-Sheets/Children%20and%20Youth%20fact%20sheet.pdf
Bruce, M. A. G., & Borg, B. (2002). Psychosocial frames of reference: Core for occupation-based practice. (3rdedition). Thorofare, NJ: Slack Inc.
Center for Parent Information and Resources. (2014). Early intervention, then and now. Retrieved from http://www.parentcenterhub.org/repository/ei-history/
Center for Parent Information and Resources. (2014). Providing early intervention services in natural environments. Retrieved from http://www.parentcenterhub.org/repository/naturalenvironments/
References
Cross, R. J. (2012). Parental involvement: Transdisciplinary service delivery model increases parental involvement with special education students. Colleagues. 8(2), 27-30. Retrieved from http://scholarworks.gvsu.edu/cgi/viewcontent.cgi?article=1174&context=colleagues Division for Early Childhood. (2014). DEC recommended practices in early intervention/early childhood special education 2014. Retrieved from http://www.dec-sped.org/recommendedpractices
Early Intervention Program for Infants and Toddlers with Disabilities. 34 C. F. R. § 303.114. (2011). Early Intervention Program for Infants and Toddlers with Disabilities.34 C. F. R. § 303.26. (2011). Early Intervention Program for Infants and Toddlers with Disabilities.34 C. F. R. § 303.321. (2011). Early Intervention Program for Infants and Toddlers with Disabilities.34 C. F. R. § 303.322. (2011).
Grusec, J. E. (1992). Social learning theory and developmental psychology: The legacies of Robert Sears and Albert Bandura.
Developmental Psychology, 28(5), 776-786. doi: 10.1037/0012-1649.28.5.776
Hocking, C., and Wright-St. Clair, V. (2011). Occupational science: adding value to occupational therapy. New Zealand Journal of
Occupational Therapy, 58(1), 29-35. Retrieved from
http://www.otnz.co.nz/public/publications/new-zealand-journal-of-occupational-therapy/
King, G., Strachan, D., Tucker, M., Duwyn, B., Desserud, S., & Shillington, M. (2009). The application of a transdisciplinary model for early intervention services. Infants and Young Children, 22(3), 211-223. doi: 10.1097/IYC.0b013e3181abe1c3
Kingsley, K. & Mailloux, Z. (2013). Evidence for effectiveness of different service delivery models in early intervention services. American
References
Knowles, M. S., Holton, E. F., & Swanson, R. A. (2011). The adult learner: The definitive classic in adult education and human resource
development. (7thedition). Burlington, MA: Butterworth-Heinemann.
Lee, J. (2010). Achieving best practice: A review of ev idence linked to occupation-focused practice models. Occupational Therapy in
Health Care, 24(3), p. 206-222. doi: 10.3109/07380577.2010.483270
Linder, T., & Linas, K. (2009). A functional, holistic approach to developmental assessment through play: The transdisciplinary play-based assessment, second edition. Zero to Three, 30(1), 28-33.
McWilliam, R. A. (2010). Routines-based early intervention: Supporting young children and their families. Baltimore, MA: Brookes Publishing.
Myers, C. L., & Others, A. (1996). Transdisciplinary, play-based assessment in early childhood special education: An examination of social validity. Topics in Early Childhood Special Education, 16(1), 102-126. doi: 10/1177/027112149601600109
The National Early Childhood Technical Assistance Center. (2008). Seven key principles: Looks like/doesn’t look like. Retrieved from http://www.nectac.org/topics/natenv/natenv.asp
The National Early Childhood Technical Assistance Center (2011). The outcomes of early intervention for infants and toddlers with
disabilities and their families. Retrieved from http://ectacenter.org/~pdfs/pubs/outcomesofearlyintervention.pdf
Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health Education Quarterly,
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