Occupational Therapy News OTnews October 2018 | Page 36

FEATURE CHILDREN’S SERVICES
Achieving the best outcomes for
children, young people and their families
Ben Harris and Vicky d’Abo explain how a working party has been developing
the pathway for children with Autism Spectrum Disorder referred to the Evelina
London Children’s Heathcare community occupational therapy service, to include
occupational performance coaching
W
ith an increasing number of referrals
and tightening of acceptance criteria,
as occupational therapists we need
to ensure that we do not compromise
the quality of therapy for our service users.
Using up-to-date evidence to guide our work has
been proven to support achieving the most beneficial
outcomes for our service users. Although, as therapists,
we commonly use the evidence base to guide our
delivery of interventions, we can also use the evidence
base to support how we structure our services and
produce or develop pathways to achieve best quality
practice (HCPC 2013; Upton et al 2014).
In recent years, children’s occupational therapy
practice has followed both top-down and bottom-up
approaches. This has sometimes resulted in a heavy
focus on the underlying component skills, with the
‘occupation’ being neglected.
With this in mind, occupational therapists working
with children who have a diagnosis of Autism Spectrum
Disorder (ASD) were supporting children in their sensory
processing differences and how these differences may
be impacting on daily occupations.
RCOT recently highlighted in a practice briefing
document the importance of working with an
occupation centred focus, providing a holistic
assessment and highlighting ways occupational
therapy can support those identified with occupational
performance needs (COT 2015).
This briefing, alongside other conversations, helped
identify a clear need to remain occupation-focused and
use the evidence base to support the definition of our
role and our practice within statutory services.
Original referral criteria and pathway
Previously within the Evelina London Children’s
Heathcare community occupational therapy service
– serving the London boroughs of Southwark and
Lambeth – children with ASD meeting the referral
criteria would all be assessed and offered a block of
one-to-one treatment sessions, regardless of their
initially identified needs.
36 OTnews October 2018
This relied on individual therapists to identify the most
appropriate evidence based approach or intervention to
support the child, family and their needs.
On reflection, if chosen interventions worked
on underlying component skills, occupation was
sometimes placed in the background.
Within the community occupational therapy team a
working party was formed to look at feedback that was
given to the team from families with children following
the current ASD pathway.
Feedback highlighted that there was a real need
to listen to our families and service users, have
consistency in our service and empower parents, giving
them the ability to implement advice and strategies and
to generalise this advice.
The working party evaluated what the community
occupational therapy service and other local
services offered these children, and what direction
and interventions were proving to be most clinically
valuable in the latest research.
It found that the current ‘one-way stream’ ASD
pathway in place could be diversified, while keeping
within the boundaries of the current statutory service
provision.
There were evidence-based interventions that had
not previously been used by the service that could
be implemented into practice, one of them being
occupational performance coaching.
Why occupational performance coaching?
Occupational performance coaching is a strengths-
based intervention approach for working with people
affected by occupational performance difficulties. It
is seen as an alternative intervention for therapists
working toward improving the occupational
performance of children and their families (Graham
and Rodger 2017; Graham et al 2018).
Occupational performance coaching enables
occupational therapists to be both family centred
and occupation focused, while backed by a growing
evidence base. Parents play a vital role in supporting
the learning, development and occupational