SERVICE DEVELOPMENT FEATURE
coaching links the principles of coaching and occupation-centred
reasoning (Graham, Roger and Ziviani 2013), which we have found
to be effective in making positive changes in a child’s occupational
performance and the parental satisfaction of this performance.
Telephone screening
We have structured our service in ‘pathways’ for various client
groups. The process prior to COVID-19 was to have an initial
telephone screening with families of children with ASD. This is a
time for the parent to be able to give their narrative of their child, as
well as discuss their child’s current occupational performance, their
priorities for their child, and to come up with an occupation-focused
goal to work on.
We would then use the Canadian Occupational Performance
Measure (COPM) to obtain pre-intervention importance,
performance and satisfaction scores for the family’s goal.
Having a parent-generated goal at the centre of our coaching
intervention helps us to remain family-centred as well as increase
the family’s ownership of the goal and commitment to making
changes (Hilly 2010). This process is also in place for children with
other diagnoses attending mainstream schools.
Transition online
Our aim of translating the parent coaching groups online was to
create an experience that mimicked the face-to-face groups as
closely as possible. We had previously structured the face-toface
sessions and their activities in a specific sequence to act as
‘building blocks’ for parents through sessions one and two.
This allowed parents to gradually build their confidence,
observation/analytical skills and ultimately independence while
being able to make changes in relation to the person, environment
and occupation, with specific attention to what the parent/
supporting adult can alter for the benefit of their own child’s
occupational performance.
As a working party we reviewed our existing resources from the
face-to-face groups, focusing on the outcomes we had achieved
with parents through these specifically sequenced activities.
We also considered the needs and feedback of our families
during lockdown as a result of the COVID-19 pandemic, specifically
their availability for online input while juggling the responsibilities of
being a caregiver, home-teacher and/or working from home.
We determined that most families would only have availability for
45 to 60 minutes during their day and we therefore needed to make
changes not only to the duration and number of sessions offered,
but also to how we delivered the activities, so that parents could
continue to get the full benefit from the intervention.
We also recognised that the internet and technology may not be
accessible for all families and made alternative provisions available
to these families.
Due to the limitations of technology versus face to face, we
realised we would not be able to deliver the activities in the same
way. Additionally, we would require extra time in each session
to navigate the online platform (for example technical difficulties)
and the dynamics that working virtually posed within the group
(structured time for reflection and contribution for each participant).
We realised that changes were required so that we did not
compromise the time needed for us to be able to initiate or guide
discussions and coach the parents – both of which are critical in
helping parents to view their child, the environmental context and
the occupation through a different lens (Foster et al 2012).
We adapted existing activities into a workbook format, where
parents are expected to complete a series of short activities each
week and then come to the next group session to discuss these
activities.
This allows us to focus our time in the groups on the discussions
and coaching with parents. We ran a pilot group to test the
workbook and virtual processes to ensure the outcomes and
experience for families was as similar to a face-to-face group as
they could be.
Based on the feedback we received from the pilot group and
the feedback we continue to receive following the live groups, the
workbook activities have been successful in generating similar
parental observation, analysis and reflection on their own child as
the activities in the face-to-face groups.
When we considered transitioning to a virtual service, it was
important for us to keep the social element of the group. We
learned from our face-to-face groups that parents benefitted from
the social support of other parents, sharing ideas and learning, and
we valued this feedback.
However, there is a logistical challenge to promoting online
discussions. In online platforms, participants can often interrupt
each other and it can be difficult to maintain a flow in the group
discussion. This can become a frustrating and tiring experience for
both participants and clinicians running the group.
One solution was to adjust the number of participants in the
group. In our face-to-face groups, there were a maximum of eight
sets of parents with two occupational therapists. In the online
group, only a maximum of four sets of parents are invited, while
two occupational therapists were kept to help manage and support
group dynamics and technical difficulties.
Another solution has been to ensure there is structure in the
communication within the group.
The ground rules for the group include written guidance on
virtual etiquette, to ensure that each participant has equal time for
sharing their thoughts and ideas. This also includes guidelines for
the occupational therapists to facilitate the group and adopt a turntaking
policy for each participant to speak one at a time.
We initially had reservations this would be too formal; however,
the structure creates a necessary order in which participants are
now given an equal amount of spotlight. This encourages parents
to discuss ideas and offer support and advice for each other.
Outcome measures
The Online Parent Group has been consistently measured for
its effectiveness through the use of participant surveys and via
COPM. With the COPM, scores and goals are recorded at the initial
OTnews August 2020 17