While attending an interesting training day at Guy’s Hospital from Sylvia Rogers (ASD expert and best practice advocator), she drew our attention to the fact that occupational performance ‘coaching’ and other related concepts seem to be appearing again in recent OT literature generated by our colleagues.

Afterwards, I decided to persuade my team into having a whole journal club and discussion around it so that we could explore how this really works in OT clinical practice. After digging up a few recent articles (see some Refs at the end), it still looked like a reasonable idea. It brings together key longstanding OT concepts such as client/family centeredness and occupation-based practice, as well as the idea of enabling participation in the person’s natural environment.

This really got me thinking: after doing our occupation-based assessments and client-centred goal setting; are we still making our clients the passive recipients of our interventions, based on the assumption that we are professionally trained and should model the right way of doing things, or that they expect us to come up with the solutions to their problems anyway? Are there other people out there alone in a therapy clinic treating a child that does not want to be there and a mother that feels that it is your job to change her child’s difficulties into achievements?

There has to be a better way of getting families (or teachers or a wider constellation of people around our clients) invested in our interventions. We should not take whole responsibility for the success of our interventions, and, more importantly, we could even save some valuable therapy time in the long run!

Although there seems to be several approaches to coaching (i.e. solution-focused, occupational performance coaching, problem-solving interventions, etc.), they all seem to share a number of (not steps, as they do not follow a sequence) common features:

–          Joint planning and collaborative relationships are essential to make this approach work.

–          Observations of the new strategy being implemented by the parent / client/ carer.

–          Real Life practice of the ‘strategy’.

–          Reflection to gain insights into the strategies attempted.

–          Feedback from the professional related to further development of new strategies and resources.

My team also felt that there are many similarities to the CO-OP approach for children with DCD (http://www.ot.utoronto.ca/coop/about.htm ), and there is also good evidence behind this method.

Personally, I see a few gaps in the application of this model of service delivery:

–          It is heavily dependent on Language, which rules out families with poor verbal/literacy/understanding skills and possibly from other cultures.

–          Requires a good insight from the user, so it may not be appropriate for parents/clients who have difficulties to recognise their own problems and have an overly positive vision of the goals they would like to achieve.

–          The OT does not provide intervention ideas based on his/her own expertise. This can be quite limiting and potentially de-skilling for the professional: can we not give parents a little background on their child’s condition or existing good practice, to help them make better informed decisions later on when deciding on their own strategies? Can we not at least make some suggestions or model successful tried and tested methods (i.e. backward chaining, visual supports, sensory calming techniques or equipment, etc.)?

In the end, we decided that it may not be applicable to everyone, but the whole idea of ‘coaching’ to create an optimal environment that improves our client’s chances for motivation and change continues to appeal to OT practitioners and supports our core beliefs.

At this stage, we are keen to find out more. Studies on OT interventions are still in their infancy (small studies and case reports), but evidence is apparently robust in other disciplines such as education, business and psychology. Let’s not forget that ‘Life coaching’ has been around for a very long time and its popularity is not fading.

Are OTs to become the ‘new’ experts in occupational performance coaching?

What are your thoughts on this topic? Let us know if you are already using this approach in your practice.

Refs.

Aust Occup Ther J. 2009 Feb;56(1):16-23. Coaching parents to enable children’s participation: an approach for working with parents and their children. Graham F, Rodger S, Ziviani J.

Phys Occup Ther Pediatr. 2013 Apr 24. Solution-Focused Coaching in Pediatric Rehabilitation: An Integrated Model for Practice. Baldwin P, King G, Evans J, McDougall S, Tucker MA, Servais M.

Phys Occup Ther Pediatr. 2013 May;33(2):253-63. Coaching mothers of children with autism: a qualitative study for occupational therapy practice. Foster L, Dunn W, Lawson LM.

Useful OT website with more information on Occupational Performance Coaching: http://www.occupationaltherapycoaching.com/