Occupational Therapy News OTNews March 2020 | Page 38

REPORT CHILDREN’S SERVICES
A reflective conversation, grounded
in person-centred care
L
ast September, I was motivated to attend
a one-day workshop on occupational
performance coaching, organised by the
RCOT Specialist Section – Children, Young
People and Families, and delivered by Dr Fi Graham, as
I had heard about the strong evidence base supporting
this intervention.
To quote from Dr Graham: ‘Coaching is the new
black.’ It is definitely something I am hearing about more
frequently.
The day was organised by the specialist section,
so the examples related to working with children and
families, however, occupational performance coaching
is equally applicable to adult populations, especially
within mental health and chronic illness.
At the start of the presentation, Dr Graham cautioned
that occupational performance coaching is a shift
away from the traditional impairment-led thinking that
occupational therapists are used to.
She describes occupational performance coaching
as a ‘reflective conversation, which is grounded in
person centred care.’
Occupational performance coaching recognises
the parent or carer as an adult learner. This takes them
38 OTnews March 2020
Kim Griffin reflects on occupational
performance coaching, having
attended an RCOTSS-CYPF-
organised workshop on the subject
out of the classic patient role, which is where the shift
in thinking begins, as when you remove the patient
role, you also strip away the idea that an occupational
therapist is the expert.
It was incredible to see Dr Graham seamlessly
shift between her researcher and clinician hats. The
occupational performance coaching approach is
steeped in research. However, unlike some researched
approaches, it is not ‘a programme’ that was used in ‘a
study’, which is not available to others.
It is a clearly articulated approach. There is a manual
and online training on the way.
Occupational performance coaching has four core
assumptions. They are, as previously cautioned, a
shift away from traditional thinking. It is centred on
occupational performance and daily life; it shifts away
from the medical focus on impairments and body
systems.
It considers the client’s perception of the problem
as central to the assessment. If the client can articulate
their perception of the problem, they have capacity to
make change.
Enablement of the client is the central outcome.
The model believes that activity and performance
should be the focus on the first and all subsequent
appointments, rather than impairment.
The first piece of advice that Dr Graham
gave attendees related to moving away
from our formal training and thinking. She
acknowledged that, as therapists, we are
trained to assess and give recommendations.
However, when using occupational
performance coaching she said we need to
‘park that approach’ and accept that the
person we are working with is capable of
making their own ‘best’ decision.
Outcomes should therefore focus on the
client’s analysis and what they identify as a
way for them to self-manage. The therapist’s
role is to ask good questions, which enable
the client to make their own analysis.
There are three ‘enabling domains’ or steps
that are integral to occupational performance
coaching.
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