It Takes Two to Talk--The Hanen Program and families of children with motor disorders: a UK perspective

BACKGROUND: Speech and language therapy for young children who have motor disorders targets both the children themselves and their parents. Therapy for parents often involves training about communication and how to foster children's development. It Takes Two to Talk--The Hanen Program for Parents has become popular in the UK, but has not been specifically evaluated for this client group. This study, which was part of a larger investigation of the acceptability and potential effects of the programme on the communication patterns of mothers and their young children with motor disorders, investigated therapists' experiences of providing the training in the National Health Service (NHS) and their views on its effectiveness. METHODS: Four focus groups, which involved 16 speech and language therapists who provide It Takes Two to Talk in NHS Trusts in England, were analysed using qualitative methods. RESULTS: The themes indicated that therapists perceived the training programme to be effective in helping parents to develop a facilitative communication style. Therapists reported secondary outcomes of positive changes in parents' confidence and in relationships between parents and their children and between parents and therapists. Barriers to the provision and success of the programme were thought to relate to resources, parents' apprehensions about the programme's content and delivery and support from key stakeholders. Barriers were seen to be minimized in services where other members of the healthcare teams actively supported the training programme and where the intervention was integrated as part of a care pathway. CONCLUSIONS: The information from this study may assist service providers in the marketing, planning and delivery of new intervention methods, to ensure that they are seen as valuable and acceptable by parents.     

Establishing Reliability and Validity for “Make My Day” – A New Tool for Assessing Young Arab‐Israeli Children's Typical Daily Activities

There is a paucity of literature regarding the daily routines of young children (4–7 years) and their perception of their performance. Research indicates that children's involvement in treatment therapy improves their self‐consciousness, which contributes in return to the therapy's progress. Until recently, occupational therapists set goals for children by involving their parents in the planning. However, recent studies indicate that children are aware of their performance and can provide reliable data, given an evaluation that is adapted to their stage of development. “Make My Day” (MMD) is a new evaluation developed for young children, which provides information regarding the child's performance with respect to their daily activities. The MMD incorporates two versions – one for the children's self‐report and the other for the parent's report. Participants included 62 healthy 4‐ to 7‐year‐old children of Arab‐Israeli decent and their parents. They were assessed using the MMD, Perceived Efficacy and Goal Setting (PEGS), Time Organization and Participation (TOPS) and a socio‐demographic questionnaire. Correlations between the MMD and the TOPS/PEGS were examined regarding the differences between children's and parents' reports of performance in three age groups (concurrent validity). Results demonstrated that children's self‐report of their occupational performance in daily tasks are reliable and valid. Thus, occupational therapists may obtain data from the child himself or herself and not only from the parents. Further research on the MMD is recommended in other clinical populations to increase our knowledge of their daily functioning and of MMD's validity. Copyright © 2013 John Wiley & Sons, Ltd.     

Impact of refugee trauma on children's occupational role as school students*

Current literature identifies a lack of knowledge and understanding of the long-term responses to extreme trauma in children, particularly from an occupational therapy perspective. Five school children participated in the present study to explore and describe a child's occupational performance as a school student following their experience of refugee trauma. The study used semi-structured, indepth interviews with the children, parents and teachers. The interviews were combined with participant observation within various school environments. The results indicate that a child's student role performance can be affected by the experience of refugee trauma. Effects were manifested in various ways, such as poor academic performance, gross motor problems and difficulty interacting with peers. It is critical that occupational therapists recognize their potential contribution in meeting the needs of children from politically troubled countries who have experienced trauma. Opportunities to work with these children are suggested, as are avenues for further research.     

Struggling to understand: the experience of nonsmoking parents with adolescents who smoke

Smoking among adolescents is a major public health concern. Most parents would not want their children engaged in this risk-taking behavior. Although a majority of parents of smokers are themselves smokers, many are nonsmokers. The purpose of this grounded theory study was to understand what nonsmoking parents experience due to their adolescent children 's smoking behavior. The purposive sample consisted of 25 parents. The interview data generated the theory that nonsmoking parents struggle to understand their adolescents' smoking. They experienced four stages: discovering the smoking, facing the problem, reflecting, and waiting it out. Their experience can be examined from a stress paradigm. Programs are needed that provide parents with the knowledge and skills required for effective prevention and intervention strategies.     

Early intervention services in daily family life: mothers' perceptions of ‘ideal’ versus ‘actual’ service provision

Although the occupational therapy and early intervention literature espouses a family-centred approach to intervention, families have rarely been asked about their experiences of these services. This paper describes a qualitative study that aimed to identify and explore parents' perceptions of occupational therapy services and the impact of these services in their daily family life. Ten mothers of children (aged 0–6 years) with disabilities and high support needs completed questionnaires and semi-structured, in-depth interviews. Analysis revealed that mothers thought in terms of early intervention services in general, rather than in terms of occupational therapy specifically. Mothers used early intervention services primarily to enhance their child's abilities, while considering what was best for their family and, as a lesser priority, themselves. Ideally, relaxed and friendly service providers were perceived as having a greater insight into daily family life, and therefore a greater capacity to provide services to meet family needs (e.g., flexible, home-based services). However, the mothers in this study did not experience many ‘ideal’ characteristics of services and service providers, suggesting that changes are needed in occupational therapy practice and in the education of therapists. Implications for occupational therapy education and practice are discussed in the context of the family-centred literature, and recommendations are made for future research with families. Copyright © 1998 Whurr Publishers Ltd.     

社会支持对学龄期白血病患儿及其家长的影响

目的 探讨社会支持体系对学龄期白血病患儿的情绪状态及其家长的心理健康和生活质量的影响。方法 采用前瞻性、病例-对照研究方法,通过心理调查问卷分析,分别调查白血病、非恶性血液系统疾病及健康学龄期儿童及其家长,比较社会支持干预前后白血病患儿的情绪及其家长心理状况和生活质量的变化。社会支持干预包括信息支持、经济支持、心理支持等方面。结果 1)白血病患儿较对照组儿童存在较多的负性情绪(P<0.05),经过社会支持干预后,其躯体化/惊恐、广泛性焦虑、学校恐惧和焦虑总分方面与正常对照组相比,差异无统计学意义(P>0.05),且主观心境好转。2)白血病组患儿家长的心理问题突出,表现在各因子得分均高于对照组(P<0.05);经过社会支持干预,人际关系敏感、敌对、恐怖、偏执方面有明显改善(P<0.05)。3)家长的心理问题与患儿的负性情绪存在正相关(P<0.05)。4)社会支持干预下,白血病患儿家长的生活质量总评提高,躯体、社会和心理维度均较无社会支持组家长有所改善(P<0.05)。结论 学龄期白血病患儿存在较多的负性情绪,其家长存在较多的心理问题,积极的社会支持系统有助于减少患儿的负性情绪及改善家长的心理健康,提高家庭的生活质量。     

Parents' perspectives on feeding medically compromised children: Implications for occupational therapy

Managing feeding difficulties in infants and young children with chronic medical conditions can be very stressful for parents. Occupational therapists providing feeding interventions need to be sensitive to the psychological stresses experienced by families as well as the biomedical issues that can contribute to paediatric feeding disorders. Qualitative research, using the phenomenological theory, was conducted with eight families to explore parents' perceptions of the impact of feeding difficulties on family life. This article reports on preliminary findings, describing factors that contributed to parental stress and factors that influenced their psychological adjustment. A unifying theme emerged drawing together parents' perceptions of how they had 'survived' and coped with chronic stress. Parents attributed satisfaction with medical care, management of nutrition, and support from professionals, partners and family as contributing to their ability to cope and adjust over time. Based on these preliminary findings, recommendations that acknowledge the psychosocial aspects of feeding intervention in occupational therapy practice are discussed, along with recommendations for future research.     

Communicating an evolutionary diagnosis of disability to parents

Communicating a diagnosis of disability to parents, when the diagnosis and prognosis are unclear, is problematic. This is discussed in the light of information received from mothers of such children who attended a counselling and support group. It is concluded that dissatisfaction with diagnosis is not inevitable, if similar guidelines to those suggested for children with Down's syndrome are used. It is essential that parents are involved in management and feel they have something practical to do to help their children. Clinics must organize themselves to avoid swamping parents with information and to provide regular ongoing support.     

Towards family-centred practice in paediatric occupational therapy: A review of the literature on parent–therapist collaboration

The importance of parent involvement in intervention with children has always been recognised by occupational therapists. Current trends in paediatric service delivery have been towards family-centred care, with a central component of this approach being parent–therapist collaboration in planning and evaluating intervention. This paper reviews issues and provides suggestions for clinical practice from the literature on parent–therapist collaboration, including consideration of parents' diversity and unique perspectives, development of effective parent–therapist relationships, establishment of shared goals and priorities when planning intervention, and development of services that support parent–therapist collaboration. Further research is needed in Australian settings to explore the nature of parent–therapist partnerships, the impact of parent participation throughout the intervention process and the extent to which collaboration with parents results in better therapy outcomes for the child and their family.     

Early Intervention for Preschoolers with Mild Disabilities

This paper describes a pilot project on an early intervention program for 40 preschoolers with mild disabilities. Its main objective was to ascertain the feasibility of integrating children with mild disabilities into mainstream preschool centers in Singapore. Professional staff including psychologists, occupational therapists, speech and physio-therapists intervened through the provision of services and consultations to the teachers and parents and teachers of these children. Results of the evaluation conducted after nine months of implementation found positive effects for the children, both disabled and non-disabled, their parents and teachers.     

Parent-time: psychoeducational groups for parents of adolescents

Many parents find their children's entry into adolescence a particularly stressful time. This article reports on a series of groups providing support, information, and help in problem solving that was devised for parents who are troubled by the changes taking place in their children but who are not necessarily in need of psychiatric intervention.     

The Domain of Concern of Swedish Occupational Therapists Working in Psychiatric Care

As a consequence of the development of psychiatric care in Sweden, occupational therapists have adapted their roles to changing practice settings. The aim of this study was to investigate the domain of concern of occupational therapists in psychiatric care, operationalized as perceived responsibilities. Furthermore, the relationships of the domain of concern to underlying theories and models, clinical supervision, intervention strategies, and organization of the care were investigated. Data were collected by a mail questionnaire to occupational therapists working in psychiatric care with a response rate of 67%, in all 334 occupational therapists. A factor analysis revealed six domain-of-concern areas. The three most prominent factors were ADL, housing and leisure, Psychosocial dysfunction, and Work and studies, which confirmed that occupational therapists' focus is on the patient's occupational performance skills as well as the environment that supports or hinders the patient's performance. The occupational therapists were using a broad range of underlying theories and models as well as intervention strategies and several relationships to domain-of-concern factors were found. This study gave an overall view of the occupational therapists' domain of concern, but there is also need for a more detailed and thorough understanding of how occupational therapists define their domain of concern, which calls for more qualitatively oriented in-depth studies.     

The Four-Quadrant Model of Facilitated Learning (Part 1): Using teaching–learning approaches in occupational therapy

Occupational therapists routinely use teaching–learning approaches to support clients in their acquisition of skills supporting occupational performance goals. This paper is the first of a two-part presentation that positions teaching–learning in occupational therapy through a discussion of the Four-Quadrant Model of Facilitated Learning (4QM). The 4QM provides a means of informing clinical reasoning when using teaching–learning approaches in occupational therapy. Although developed to actualise teaching–learning approaches with children, it has the potential to be applied more broadly. This first paper explores the relationship between occupational therapy principles and the use of teaching–learning approaches. It draws on current literature to understand the use of learning strategies as therapeutic tools. In this context, the 4QM is presented as a way of organising occupational therapy intervention when a teaching–learning approach is used.     

What occupational and physical therapists know about farmers’ health

Farmers are at high risk for losing their occupation because of their susceptibility for developing chronic conditions and incurring injuries. Although, occupational and physical therapists have basic education in return-to-work methods, specialty training is needed to help farmers with disabilities. The North Carolina AgrAbility Partnership, part of the U.S. Department of Agriculture’s supported AgrAbility Program, implemented an exploratory survey of North Carolina occupational and physical therapists before developing training curricula for working with farmers. State occupational and physical therapy association members were surveyed on what types of conditions they could treat, how comfortable they were in treating these conditions and making recommendations for environmental modifications, and what resources are available for farmers related to work site accommodations. Findings showed that less than one third of therapists had farm exposure or had ever treated farmers. Significant differences in identifying farmers’ typical conditions were found between therapists who had treated and those who had not treated farmers. Physical therapists were more comfortable than occupational therapists in treating farmers for repetitive stress syndromes, work-related trauma, and musculoskeletal disorders while occupational therapists were more comfortable in treating farmers for social isolation and low vision. More physical therapists also rated themselves as competent in farm environmental assessment and adaptation. On the other hand, occupational therapists were aware of more agencies that aid farmers. Finally, few therapists had education on working with farmers or had heard of AgrAbility. To create farmer-centered intervention, therapists should take continuing education courses and investigate resources for helping farmers with chronic conditions and disabilities return to their chosen occupation.     

An evaluation of dyadic peer support for caregiving parents of children with chronic lung disease requiring technology assistance

This study evaluated a dyadic peer support pilot intervention for parents of technology-assisted children with chronic lung disease. These medically-fragile children, living at home in the primary care of their parents, require continuous or intermittent assistance from technological support such as home oxygen, respiratory or cardiac monitors and/or mechanical ventilators. The intervention consisted of matching parents with similar caregiving responsibilities, in order to reciprocally engage in parent-to-parent support. Results identified mixed outcomes based on quantitative and qualitative methods. Participants conveyed benefits and limitations of this modality of peer-based support. They generally favoured peer support as a clinical resource for caregiving parents as the intervention offered a valued opportunity for mutual sharing with another parent who could understand the unique realities particular to caring for a medically-fragile child. Sharing daily experiences was reported to reduce isolation, increase knowledge, and provide an important sense of feeling understood. Challenges associated with peer support included scheduling difficulties and personality incompatibility. Recommendations for program development in clinical settings are described.     

Who cares?—Supporting parents in the care of children in Hong Kong

The paper addresses the following questions: Why are children placed in residential care? What problems do the parents have in caring for their children at home? What services have been used by the parents in seeking solutions to these problems? Are parents' personal resources so inadequate that the risk of removing a child into care must be taken?

The study involved a sampling of the parents of children who were placed in residential care facilities. The findings indicated that most children were placed in residential care because the parents lacked the tangible resources necessary for them to bring up the children themselves. The findings challenge the simplistic assumption that only children who are orphaned or of irresponsible parents are placed in residential care, and prompt social workers to reflect on the practical means to support parents in the care of children in Hong Kong.     

Family education in the workplace: A prevention program for working parents and school-age children

Many school-age children from diverse backgrounds take care of themselves before or after school while their parents are away from home. Research on the nature of the self-care situation as well as the characteristics of the children who are most affected has grown considerably. Recent studies conclude that understanding and addressing the unique aspects of each self-care situation is more important than debating whether or not self-care, as a distinct entity, has a positive or negative affect on children. This paper describes a new workplace-based prevention program for families with children home alone. Through a series of six workshops, the program helps parents determine if their children are ready to be on their own and, if so, how they can best prepare. Using activities which are based on methods of prevention technology, the program teaches parents and children about family communication, safety in the home and neighborhood, decision-making and substance abuse.