10/9/2015. The Evolving Role of the Occupational Therapist in Early Intervention. Historical Context. 1980s. Evolution of Practice. 1990s.

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1 The Evolving Role of the Occpational Therapist in Early Intervention STEPHANIE DE SAM LAZARO, OTD, OTR/L Historical Context Part H , 1997, 2004 Establishment of services for infants and toddlers Center-based Changes in name Focs on first 3 years of life Focs on eqity Shift to homes Update to Part C Focs on familycentered practices Focs on natral settings Center for Parent Information and Resorces, [CPIR}, 2014 Evoltion of Practice Part H, Center-based IDEA, LRE more important 1980s 1990s Mltidisciplinary, Hands-on, Bottom p Mltidisciplinary, Component Based Update to IDEA, Focs on s Interdisciplinary, Joint Visits, Hands-on Family Centered, Natral environments 2011 Transdisciplinary, Role Release, Coaching, Top Down CPIR,

2 Differentiating the Lingo Mltidisciplinary Administration of evalations and interventions in separate sessions by separate disciplines (King et al., 2004; Linder & Linas, 2009; Myers & Others, 1996) Interdisciplinary Administration of evalation and intervention occrs dring joint visits of separate disciplines, however there is a separate bt coordinated mentality Transdisciplinary Aims to defragment services to increase commnication among team members and caregivers in order to avoid conflicting messages from team members Practitioners from mltiple disciplines assess/provide intervention simltaneosly across developmental domains (King et al., 2004) Developing a Common Langage Family-Centered or Family-Gided Practices Natral Settings Rotines-Based Interventions Family-gided assessment/rotines-based assessment Coaching Primary Service Provider Model OT Scope for Early Intervention (0-5) Feeding Eating/Swallowing Dressing Bathing Toileting Grooming/Hygiene Personal dev ice care Commnity mobility Care of pets Meal preparation Sleep and rest Pre-literacy skills Edcational participation Play Exploration Participation Leisre Individal Family Social Participation Commnity Family Peers (American Occpational Therapy Association [AOTA}, 2014b) 2

3 OT and Family-Centered Practices EI Principles Children learn best in familiar contexts Families can enhance their child s learning and dev elopment (with the appropriate spport and resorces) Service provider needs to work with and spport family members EI process is dynamic and individalized to reflect child and family preferences, needs, learning styles, and cltral beliefs (NECTAC, 2008) OT Framework Evalation and Intervention mst consider contexts and environments Cltral, Temporal, Personal, Virtal Physical, Social Edcation, training, and advocacy are part of or practice this incldes developing role competence Occpations are client-directed daily life activities that match and spport or address identified participation goals (AOTA, 2014b) Natral Settings Early intervention services are to be provided in natral environments (*to the maximm extent appropriate for the child and for the service) within the natrally occrring rotines of the child and family (34 C. F. R , 2011; 34 C. F. R , 2011; CPIR, 2014) Person Person-Env ironment- Occpation Model Lee, 2010 Occpation Environment Rotines-Based Interventions Rotines-Based Intervention: Model of intervention in which natrally occrring rotines are sed to gide the caregiver in helping the child to transfer and generalize skills to non-therapy times (McWilliam, 2010) A rotines-based interview is sed to help determine interventions that will address family concerns, priorities, and resorce needs within the context of everyday rotiens, experiences, and activities with familiar people (National Early Childhood Technical Assistance Center, [NECTAC], 2011, p. 2) Definition of OT from AOTA (2014b): Occpational therapy is defined as the therapetic se of everyday life activities (occpations) with individals or grops for the prpose of enhancing or enabling participation in roles, habits, and rotines in home, school, workplace, commnity, and other settings (p. S1) 3

4 Models of Practice Coaching Can be sed in any area of clinical practice within OT Positiv e eqal relationship Non-directiv e, goal-oriented, soltion focsed (Rsh & Shelden, 2011) Capacity bilding, performance based, context driven Improves caregiver perception of their child s gains and facilitated skills of parent (Kingsley & Maillox, 2013) Primary Service Provider One person is the primary point of contact for the family Emerged from practice Role release and role expansion Extensive commnication Challenges the belief in traditional intervention Goes beyond dose of therapy model Spported by DEC, APTA, AOTA, and ASHA Evidence of spport (Kingsley & Maillox, 2013) Terminology IDEA, Early Intervention Environmental contexts Impact performance Motivation/meaningflness impacts performance Habits, rotines, and daily activities Coaching, modeling, observational learning Self-efficacy and capacity bilding Occpational Therapy in EI Occpational Science Combine client-centered practice with natrally occrring meaningfl occpations (Hocking & Wright-St. Clair, 2012) Social Learning Theory Observational learning, Reinforcement, Self-efficacy, self-reglation, motivators, learning does not eqal change (Brce & Borg, 2002; Grsec, 1992; Rosenstock, Strecher, & Becker, 1998) MOHO PEO Co-Occpations 4

5 OT s Role as a Coach Concrete Experience Joint planning, observe, reflect, soltion-focsed, performance based, context driven Hands-on, directive learning, goal oriented, performance and soltion based Active Experimentation Kolb s Learning Cycle Reflective Observation Observ e, reflect, non-directiv e Content sharing related to soltions, performance, and context Abstract Conceptalization Knowles et al., 2011 Uniqe Contribtion of OT to EI team Many area of professional expertise to meet needs of child and family Capacity to provide interventions across ALL domains of development OT edcation has roots in team consltation OT edcation has roots in client centered care OT edcation provides skills to provide client capacity (incldes caregiver capacity) (34 C. F. R , 2011; 34 C. F. R , 2011; AOTA, 2014a) The Heart of OT Use of meaningfl activities to help children develop skills and thrive Occpations are sed as a means AND an end We embrace natral environments, natral tools, preferred activities Adaptation of materials and environment (AOTA, 2015b; NECTAC, 2011) 5

6 Response, Reaction, Comments, Qestions What are yor initial reactions to this related to scope of practice, billing concerns, role release, models of practice, or other information presented? What shold be done at the state level? What shold be done at the federal level? What needs to be done at the MOTA, AOTA level? What needs to be done at the state interagency level and federal interagency level? Others? References American Occpational Therapy Association. (2011). Occpational therapy services in early childhood and school-based settings. American Jornal of Occpational Therapy, 65(Spplement), doi: /ajot S46 American Occpational Therapy Association. (2014a). AOTA practice advisory on the primary provider approach in early intervention. Retrieved from American Occpational Therapy Association. (2014b). Occpational therapy practice framework: Domain and process, 3 rd Edition. American Jornal of Occpational Therapy, 68(Spplement1), S1-S48. doi: /ajot American Occpational Therapy Association. (2009). FAQ: What is the role of the occpational therapist in early intervention? Retrieved from OT_1/Early%20Intervention%20FAQ%20Final.ashx American Occpational Therapy Association. (2015b). The role of occpational therapy with children and yoth. Retrieved from Sheets/Children%20and%20Yoth%20fact%20sheet.pdf Brce, M. A. G., & Borg, B. (2002). Psychosocial frames of reference: Core for occpation-based practice. (3 rd edition). Thorofare, NJ: Slack Inc. Center for Parent Information and Resorces. (2014). Early intervention, then and now.retrieved from Center for Parent Information and Resorces. (2014). Providing early intervention services in natral environments. Retrieved from References Cross, R. J. (2012). Parental involvement: Transdisciplinary service delivery model increases parental involvement with special edcation stdents. Colleages. 8(2), Retrieved from Division for Early Childhood. (2014). DEC recommended practices in early intervention/early childhood special edcation Retrieved from Early Intervention Program for Infants and Toddlers with Disabilities. 34 C. F. R (2011). Early Intervention Program for Infants and Toddlers with Disabilities.34 C. F. R (2011). Early Intervention Program for Infants and Toddlers with Disabilities.34 C. F. R (2011). Early Intervention Program for Infants and Toddlers with Disabilities.34 C. F. R (2011). Grsec, J. E. (1992). Social learning theory and developmental psychology: The legacies of Robert Sears and Albert Bandra. Developmental Psychology, 28(5), doi: / Hocking, C., and Wright-St. Clair, V. (2011). Occpational science: adding vale to occpational therapy. New Zealand Jornal of Occpational Therapy, 58(1), Retrieved from King, G., Strachan, D., Tcker, M., Dwyn, B., Desserd, S., & Shillington, M. (2009). The application of a transdisciplinary model for early intervention services. Infants and Yong Children, 22(3), doi: /IYC.0b013e3181abe1c3 Kingsley, K. & Maillox, Z. (2013). Evidence for effectiveness of different service delivery models in early intervention services.american Jornal of Occpational Therapy, 67, doi: /ajot

7 References Knowles, M. S., Holton, E. F., & Swanson, R. A. (2011). The adlt learner: The definitive classic in adlt edcation and hman resorce development. (7 th edition). Brlington, MA: Btterworth-Heinemann. Lee, J. (2010). Achieving best practice: A review of ev idence linked to occpation-focsed practice models. Occpational Therapy in Health Care, 24(3), p doi: / Linder, T., & Linas, K. (2009). A fnctional, holistic approach to developmental assessment throgh play: The transdisciplinary play-based assessment, second edition. Zero to Three, 30(1), McWilliam, R. A. (2010). Rotines-based early intervention: Spporting yong children and their families. Baltimore, MA: Brookes Pblishing. Myers, C. L., & Others, A. (1996). Transdisciplinary, play-based assessment in early childhood special edcation: An examination of social validity. Topics in Early Childhood Special Edcation, 16(1), doi: 10/1177/ The National Early Childhood Technical Assistance Center. (2008). Seven key principles: Looks like/doesn t look like. Retrieved from The National Early Childhood Technical Assistance Center (2011). The otcomes of early intervention for infants and toddlers with disabilities and their families. Retrieved from Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health Edcation Qarterly, 15(2), doi: / Rsh, D. D., & Shelden, M. L. (2011). The early childhood coaching handbook. Baltimore, MA: Brookes Pblishing. 7