First Section Flashcards
Family-Centred Care Tenants
1) Families know their children best and want what is best for their children
2) Families are unique and different
3) Optimal Child functioning occurs within supportive families and communities
4) The family is the child’s primary source of strength and support
1) Families know their children best and want what is best for their children
If this is your first assumption what will you assess first?
do some formal assessments around the occupations that are most important to them
-If it is outside our scope we would help them get connected
3) Optimal Child functioning occurs within supportive families and communities WHat will you assess or measure Person-level? Occupation-Level? -Why
- Assessing occupation
- assess the family for the purpose of supporting them
- this is a sticky part because families have fear of being judged (there a lot of aspects some don’t come from nurture)
- Family should not be considered the cause but assess to leverage the strength and find them help in the areas of weakness
Working with families
-setting goals and evaluating outcomes from a family-centered perspectives means
- listening to family concerns
- Establishing current participation
- Setting meaningful goals
- Evaluating family-centered outcomes
- Goals are set collaboratively
- Practitioners are facilitators and view families as full and equal participants
System Perspective of Family Occupations
-Key Concepts of a family system model
- ->A family system is composed of interdependent individuals or sub-systems
- Within the family, subsystems are defined with their own patterns of interaction and shared occupations
- A family must be understood as a whole, and it is more than the sum of the abilities of each member
Family Occupations
- Rhythms and rituals within the home provide connection, structure and meaning to participation
- Routines are often adapted to facilitate performance of a child with a disability
e. g. opportunity and cost
Feeding as Family
Theme and Subtheme
Example
Feeding as a family (theme)
Subtheme G-tube and sleep -Impact on family -Participation of feeding and eating as a family -Outings and travel (mobility)
Family Resources
- Financial Resources
- Personal skills/human resources
- Time resources
Participation and activity limitation Survey
in 2015 the national benefits association reported
average income for a household wit a child with a disability was nearly 10 000 ls than the average income (59,980 vs 68,940)
-20% of households with a disabled child fell below the low-income cutt-off 13.4 percent of non-disabled households
-38% of canadians parents with children who have disabilities were forced to reduce the number of hours worked, while an additional 36% had to adjust their work schedule
-76% of Canadian parents listed their child’s disability (this references severe disabilities) as reason for divorce or separation, leading to more single-family homes which often correlates to lower-income
Family Resources
Emotional energy Resources
- Children with disabilities may require more emotional energy from parents
- Parents may experience anxiety and depression
- Parents may become exhausted and sleep deprived
- Stress levels in families seem to relate to the resources that they have: financial, educational, emotional, or social
Sources of Diversity in Families
- Ethnic background
- Family Structure
- Socioeconomic status
- Parenting style and practices
Therapy assumptions in children’s rehab
- The wisdom of dichotomising “fix” versus “function”
- The ethics of ‘it might help but it won’t hurt’ therapy approaches
- The emphasis on early intervention rather than lifespan approach
- The challenges of providing care for new rehab populations
- Discrepancies between performance outcome and patient satisfaction
Cultural Considerations
Fill in in class
Considerations when developing a Home programs
-Be realistic - lest you get the “smile and nod” or create a burden of guilt for failing to meet your expectations
-Acknowledge the time and effort the therapy programs absorbs from the family
-Find out information about important and meaningful daily routines and activities
-Identify naturally occuring moments where behaviours can be taught and modified
-Explore possibilities rather than make recommendations
–Weight and discuss the opportunity cost with parents
-Express concern for parents’ well being
Positively reinforce and validate parents’ efforts
Blending Therapy into Routines
-Parents have identified that they are best able to carry out home programs when they receive the following types of supports
- ->coaching and follow-up support from the therapist at regular intervals;
- Prognostic information and guidance from the therapist about what to realistically expect;
- ->a coordinated team approach rather than multiple home programs;
- ->Regular feedback from the therapist about the child’s progress from the home program
Blending Therapy into Routines
A program designed around the child’s goal so that the program is motivating and enjoyable to carryout;
- ->emotional and physical support from family members;
- -> Provision of equipment needed to do the activities
- ->a logbook as a reminder to practice
- ->having a program with a small number of exercises that they feel confident and capable to carry out safely and therapeutically
How is AME important to
- Set the stage
- Assess and evaluate
- Agree and plan
- Monitor and modify
- Evaluate outcome
Assessment is
A process of gathering information about an area of interest through
- Specific tools and instruments
- Observation, discussion
Assessments must be
- interpreted to be useful to others
- describe a person or situation that helps
- inform a decision
Measurement is
The assignment of a number to a construct or a thing
-Where smaller quantities represent less and larger represent more according to a clear metric
Evaluation is
the process of judging the quality, importance, value of something
-Usually involves an assessment and a measurement
The FRAP-U FRAMEWORK
Frame of Reference
- Appropriate Application or Purpose
- Psychometric fit
- Utility
Frame of Reference and AME
Where/when does frame of reference come into play in the course of therapy
-Your AME-ing needs to be consistent with your theory or model
Step 1: AME
Narrow focus on assessments based on Frame of Reference
Step 2:
Define clearly an appropriate application or purpose
What have YOU decided about your main Purpose In This Case
How is it appropriate or not?
Does your ‘purpose’ for therapy fit your frame of reference
Possible Applications of AMEs
- Setting goals
- Classifying children or their level of functioning
- Describing strengths and difficulties
- Screening for occupational performance to other children
- Assessing/monitoring change
- Predicting a developmental trajectory
Step 3
Now that you have FRAA, start looking for AMEs that are suitable candidates
Step 4
Assess the psychometrics RELATIVE to FRA
Psychometrics are Not An Instrument Property
Venn Diagram
Scale
- Reliability
- Validity
- Scale Content
Situation
- Does one need to describe or evaluate?
- What are the practical realities of the situation?
- Ethical implications of applying the scale
Group
- Does the sample represent the population?
- Fit between scale development group and user’s group
Defining Play by Characteristics: framing
A play frame sets play transactions apart from “real life”
-Players give cues about how they want to be treated and read the cues of others so that they know how they should interact with them.
Defining Play by Characteristics:
Internal Control
- Player feels in charge of some important aspects of the play transaction
- –>What to play?
- –>Who to play with?
- ->How will the play turn out?
- Players must feel safe to feel internal control
Develop socially through play
Defining Play Characteristics:
Freedom from Unnecessary Constraints of Reality
- Players choose how close the play is to reality
- “Suspension of reality”
Measuring Participation
- Observation
- Children’s assessment of Participation and Enjoyment (CAPE)
- Participation and Environment Measure of Children and Youth: PEM-CY
- Pediatric Activity Card Sort (PACS)
- Environments and Experiences: SEAS, MEQAS
Play and Leisure:
Babies
They play alone, play with toes, then gradually reach out to toys
Play and Leisure:
1 - 2
- watch others play might not be ready to join in
- start to repeat activities that they enjoy
Play and Leisure:
2-3
- start playing next to other children
- not keen on sharing
Play and Leisure:
3-4
- start to play and share with other children
- not participating in games with rules
Play and Leisure:
5+
- start collaborating with each other
- Rules are very important
Play and Leisure:
Older children and teens
participation in social activities, teams, hobbies
Leisure Time and Participation
- involvement in activities of rest, recreation, enjoyment, and social and community engagement undertaken with others and on one’s own
- Considerable portion of the day for children and adolescents
- Provides opportunities to:
- ->develop skills and competences
- ->Support mental and physical well-being/health
- –>Form friendships and relationships
- ->Sense of Belonging
- ->Develop self-identity
- -> Express creativity
Participation vs enjoyment
Participation
- Easily observable, quantifiable
- Multi-dimensional
- ->attendance, frequency
- ->Involvement - the “experience” (affect, motivation, social connection)
Enjoyment
- Abstract, subjective
- Determinant of participation; motivation
- Child-preferred activities
Factors Affecting Leisure Participation
Child/Youth Factors
- perceptions of their competence (athletic and scholastic)
- Physical, cognitive and communication abilities
- Emotional, behavioural, and social abilities
- Activity preferences
Environmental Factors
- Supportive physical and institutional environments
- Presence of supportive relationships
- Presence of support relationships for parents
Family Factors
- Absence of financial and time impact on the family
- Supportive family demographics
- Supportive home environments
- Family preference
Leisure Participation-Preference congruence of children with CP a Children’s Assessment of Participation and Enjoyment International Network descriptive study
- Used CAPE and PAC
- Proportion of children doing non-preferred activities in each activity type was generally low
- Not doing preferred activities
- ->50% not doing active physical, skill-based and social activities they would prefer doing
- 25% not doing self-improvement activities they prefer
- Doing non-preferred activities
- ->58% doing self-improvement activities they did not prefer
- Children with the most severe mobility limitations experience the greatest discrepancy between preferences and participation
- Family factors - income, supports
Implications for interventions:
- how to support children to address participation barriers
- supporting children so they can develop relationships
Leisure Activity Enjoyment of children with autism Spectrum Disorders
The study compared leisure activity enjoyment experienced by typically developing children and those with ASD
- Used CAPE
- Findings
- ->Most enjoyed activities and least enjoyed activities for both groups were the same (most enjoyed, playing computer, video games, playing with pets, going to the movies. going to parties) (least enjoyed, sing learning to dance, paid job, taking art music )
- Significant differences were seen among the children with ASD in enjoyment of informal, recreational and self-improvement activities with less enjoyment
- Significant relationship between severity and enjoyment of overall, formal, physical and social activities
- Significantly different scores in formal and physical activity enjoyment
- Swimming was number 5 for ASD 30th for normal developing children
- Playing games was 6 for normal developing for kids 27 for ASD
Implications for intervention
- Knowing what they prefer
- Knowing that there are less enjoyment with older ASD children
Play in Intervention
- Play is a modality: used when specific skills need to be taught or when a specific goal needs to be met
- Play as a intervention goal: improvement of play skills and playfulness enables competent interaction in the world
- Facilitating playfulness: increasing internal motivation, internal control, ability to suspend reality, and how to read cues with play partners
- Adaptations: adapted access and safe play space
- Parent education and training regarding importance and value of play
- Societal concern: play for all has diminished, less risk-taking in play, over-structuring and over-scheduling of child’s day
Play and the Playground Environment
- Participation in play is a critical occupation of childhood
- Play participation may be limited or facilitated by an or all of the
- ->Physical
- ->Social
- ->Cultural
- ->Institutional environments
Institutional Environment
Proximity of teacher Recess curriculum School policies may restrict play -Type of equipment -->risk aversive insurance issues -Amount of time for play -Access to playgrounds may be contingent umong classroom behaviour
Physical environment (school playground)
- Modern playgrounds with fixed equipment
- “Loose parts” play
- Access and Safety
Social Environment
- Girls are consistently less physically active in their play on playgrounds than boys
- For the largest disability groups (ASD, ADHD, LD, Anxiety), social play interaction skills need to be explicitly taught
- Lack of supervision during unstructured time can leave marginalization students vulnerable to bullying
Cultural Environment
- Social culture
- Geographic and socioeconomic composition of school catchment area
- ->those in minority or low-income groups have increased risk for inactivity in their play
- Attitudes towards aggressive play and bullying
Play summary
Building capacity in their children or youth
- Building capacity in the family
- Building capacity in the environment
Influences on development
- Internal - temperament, social-emotional, cognitive, sensory
- Cultural
- Social
- Physical
- Interplay between abilities and experiences
- Participation of occupation in natural environment supports integration of learning
- Children with disabilities require greater direct support and scaffolding to support new learning
- Positive reinforcement
- Natural course of development
Principles for selecting assessments, measures, evaluations in Clinical Practice - FRAP-U
Frame of Reference
Appropriate Application or Purpose
Psychometric fit
Utility
Frame of Reference
Narrow your focus on assessments based on your conceptual approach or frame of reference. Is your primary assessment consistent with the primary goal of therapy?
Appropriate Application or Purpose
Appropriate: Is your assessment or evaluation within your scope of practice? Is the assessment chosen achievable within the time and resources you have?
Appropriate is necessary but not sufficient. You also need to make sure the assessment or evaluation fits the purpose of therapy. Are you there to generate impact with respect to an occupation? If so, do you need an assessment that helps you determine the goals from the child or parent perspective or both? There are many reasons to choose an AME, what is yours? Be explicit
Psychometric fit
-Basic screens of reliability, validity. and generalizability will fare into your selection of AMEs also. Has the measure been validated on a sample of children that apply to your case or situation? Does it contain questions and components that map well to your ‘F’ approach? Will you look for a measure that is reliable enough to be used across therapists or team members if that is needed? Is the measure reliable enough on test-retest reliability that you can use it to evaluate whether your intervention had an impact?
Utility
Are the cost, time constraints and expertise of administering the assessment balanced with the value of implementing the assessment?
Neurodevelopmental
Relative to motor based occupations:
Fill in from textbook (stroke and cerebral palsy)
Sensory integration
Relative to motor based occupations:
Fill in from textbook
The era of occupation
when the emphasis of therapy shifted to meaningful occupation (activity and participation) it became most important to have a big affect at this level
Motor Learning Tasks - Coach’s Principles (Willis)
-Transfer
-Knowledge of Result’s/knowledge of performance
Feedback
Verbal Instruction
-Whole versus part practice
-Mental practice
-Transfer
- skill experiences are presented in logical progression
- simple, foundational skills are practiced before more complex skills
- Skill practice includes “real” life and simulated settings
- Skill with similar components are more likely to show transfer effect
- Practice in natural context with actual objects is most effective
-Knowledge of Result’s/knowledge of performance
- Utilize a variety of both KR and KP to facilitate learning
- It is important to balance between feedback that is error-based and that which is based on “appropriate” or “correct” characteristics of the performance
- KP and KR can be prescriptive
- KP and KR should be given close in time to but after completion of the task, but not necessarily given 100% of the time
- Learning is enhanced if KP/KR are given at least 50% of the time
Feedback -Modeling or Demonstration
- Demonstrate is best if it is given to the individual before practicing the skill and in the early stages of skill acquisition
- Demonstration should be given throughout practice and as frequently as deemed helpful
- Allow child time to “figure it out”
Feedback -Verbal Instruction
- Verbal cues should be brief, to the point and involve 1-3 words
- Verbal cues should be carefully timed to not interfere with performance
- Verbal cues should not emphasize key aspects of movement
-Whole versus part practice
-Whole practice may be preferable when the skill/task is simple; Part practice may be preferable when the skill is more complex
-If part practice is used, be sure that the parts practiced are “natural units: that they go together
-To simplify a task, reduce the nature and /or complexity of the objects to be manipulated. For example, use a balloon for catching instead of a ball, etc.
To simplify a taak, provide auditory or rhythmic accompaniment; this may facilitate learning through assisting the earning in getting the appropriate ‘rhythm’ of the movement
