Week 1

Question 1

What factors have shaped the development of occupation centred practice in occupational therapy?

Answer 1

• Clinical experience
• Research evidence
• Clients values & circumstances
• Information from the practice context

Question 2

What is the difference between the ICF and the ICF-CY?

Answer 2

● ICF = International Classification of Functioning, Disability and Health

● ICF-CY = International Classification of Functioning, Disability and Health for CHILDREN AND YOUTH

Question 3

ICF-CY details

Answer 3

○ New classification of child & youth disease/disability
○ New framework for service provision
○ Enables recording characteristics of the developing child & influence of his/her
environment
○ RecogniSes stages of development: infancy, early childhood, middle childhood,
adolescence
○ Recognize that parents/carers/teaching exercise significant control over
children’s opportunities for engagement

Question 4

What are the key aspects you would need to consider if you were to implement an occupation centred approach to practice?

Answer 4

• The goals of the child and the family (family-centred practice, client centred)
• The frame of reference eg biomedical or aquistional (4QM, coop, psychosocial, coaching)
• Evidence based practice
• Resources available to the child and family

Question 5

What are the 11 characteristics of occupation centred practice? For each characteristic identify at least one way in which practice is implemented to ensure the characteristic is met (ie., what you do to make sure practice is occupation centred).

Answer 5

1. Client centred orientation
2. Client chosen goals
3. Contextual relevance
4. Individualisation of intervention

Question 6

What would you observe if you were working with a child using top down approach to intervention?

Answer 6

• Assessment focus on a broad range of issues of the individual
• Not easily addressed in acute care situations (resources, time limitations, priorities of care)
• Emphasis on valued tasks and roles, foundational skills
• Adopts a general problem solving the structure.

Question 7

What would you observe if you were working with a child using bottom up approach to intervention?

Answer 7

• Evidence suggests limitations of linear child development & neuro-maturation views
• Limited empirical evidence to support that this approach leads to functional gains
• May neglect functional outcomes e.g., ROM gains may not mean improved ability to dress

Question 8

What is the difference between an assessment that is directed by a top-down approach and one that is directed by a bottom-up approach for a 4 year old that has been referred with concerns that they are having difficulties keeping up with the other children in playground and tabletop activities at childcare?

Answer 8

● Top down- working with parent and child to identify a specific activity or goal and start working on that activity to see where the problems are and where to intervene - it looks at the context of the child
● Bottom up- looking at motor skills etc. and how he is functioning.

Question 9

ICF details

Answer 9

• highlights personal characteristics impacting the experience of a health condition & how these may help or hinder engagement in activities or occupation
• highlights different environmental considerations including social, physical and attitudinal

Question 10

How does the ICF-CY facilitate OT process and clinical reasoning?

Answer 10

It provides a useful guide to directing information gathering and types of information required and purpose for which it can be used

Question 11

Family-centred services

Answer 11

• Recognises and considers the strengths of all family members
• Family and services providers work together to make informed decisions about the services and supports the child and family receives

Question 12

How do therapists know what to do: decision making

Answer 12

• Use of evidence in clinical decision making

- Make clinical/professional judgement based on multiple sources of information

Question 13

What makes family centred practice?

Answer 13

Collaborative and open partnership between family, service provider and organisation

Question 14

What is unique about children’s occupations?

Answer 14

• Micro occupational development: children engage in many social & occupational roles every day
• Occupational transitions: children engage in a range of different environments that become increasingly complex and diverse with age
• Meso occupational development: children’s occupations change throughout childhood and adolescence

Question 15

Assumptions of FCP

Answer 15

1. Parents know their children best and want the best for their children
2. Families are different and unique
3. Optimal child functioning occurs within a supportive family and community context. The child is affected by stress and coping by other family members

Question 16

Principles of FCP

Answer 16

1. • Each family should have the opportunity to decide the level of involvement they wish in decision making for their child
   • Parents have ultimate responsibility for the care of their child
2. • Each family and family member should be treated with respect (as individuals)
3. • The needs of all family members should be considered
   • The involvement of all family members should be supported and encouraged

Question 17

Why is Top-Down approach more consistent with occupation-centred practice

Answer 17

Top down: more occupation-centred

• Emphasis on child’s valued tasks and roles, foundational skills
• Adopts a general problem solving structure
• Questioning a child to increase meta-cognitions
• Plans for transfer and generalisation to relevant contexts

Question 18

4 types of frames of references

Answer 18

1. Acquisitional
2. Biomechanical
3. Sensory Processing
4. Social Participation

Question 19

Acquisitional Frame of Reference e.g.

Answer 19

Motor Learning (4 Quadrant Model of Facilitated Learning 4QM)
Cognitive/Behavioural – Cognitive Orientation for daily Occupational Performance (CO-OP)
Coaching – Occupational Performance Coaching (OPC

Question 20

Biomechanical Frame of Reference e.g.

Answer 20

Environmental accommodations

Optimal positioning

Question 21

Sensory Processing Frame of Reference e.g.

Answer 21

Visual processing

Sensory modulation

Question 22

Social Participation Frame of Reference e.g.

Answer 22

Coaching – Occupational Performance Coaching (OPC)

Motivational

Question 23

Why might there be a disparity between goals identified by parents, the child and teacher when they all complete the same goal setting tool? What are the implications of this for the goal setting process?

Answer 23

• Child will be more concerned about thing that they find important, which will differ from the parent (e.g. running vs neat writing)
• The professional will have evidence based knowledge which will inform what they think is important (e.g. dressing)
• The teacher may be more concerned with academic and social goals as that is what they will be more closely linked to
• The parent will have a more holistic view (i.e. home, school and leisure goals), however, a child may behave differently when parent isn’t around

Question 24

How are goal setting tools used in an occupation centred manner for evaluation of intervention outcomes?

Answer 24

● Setting explicit, client-centred, occupation-based goals prior to initiating intervention facilitates measurement of specific intervention outcomes
● If everyone in decision making process agree on desired outcomes, if these are met, should be easy to judge
● Have a measurement scale which permits degrees of change over time (must be validated as an outcome measure)

Question 25

How to select the correct tool for the purpose

Answer 25

1. Establishing occupational goals for intervention
2. Informing intervention planning
3. Documenting change and intervention effectiveness
4. Determining eligibility for services
5. Documenting program effectiveness - Research

Question 26

Things to consider when selecting an approach to information gathering: what do you want the information to do?

Answer 26

• Predict performance (e.g., Beery VMI and handwriting)
• Identify children at risk
• Informing intervention planning
• Determining service effectiveness
• Research
• Determining eligibility for services

Question 27

Strategies for Goal Setting

Answer 27

1. Individualised approach
   - Different families will require a different approach and different level of support and structure
2. Use a common language
   - Avoid rephrasing the goal in professional jargon
3. Honour and work toward family’s goals
   - Break down into smaller steps if necessary to make manageable
4. Involve the child in goal setting
   - Children can contribute from 5 years

Question 28

Compare micro-occupational, meso-occupation and macro-occupational development. What are occupational transitions?

Answer 28

● Micro-occupational development
○ Developing occupational competence along a continuum of novice to mastery for a specific occupation
○ Repeated for each new occupation
● Meso-occupational development
○ Developing an occupational repertoire
○ Developing competence and mastery changes across lifespan (expanding and
shrinking)
● Macro-occupational development
○ Development of occupations resulting from exposure and opportunities
● Occupational transitions
○ shift from one set of occupations to alternative set as a result of life-events or
developmental processes
○ occur at individual, group or societal levels