Re: Information on O/T

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The Following is FYI...Barb Rutt Occupational Therapy in Community-Based Early Intervention Settings Occupational therapy intervention for infants and toddlers promotes their participation in their natural environments (i.e., home, child care, playground). Therapists address the performance

skills and demands required for both caregiver and child to engage in their daily routines and activities together. Occupational Therapists are committed to looking at the personal and contextual factors affecting a child’s engagement in meaningful occupations. The key to providing effective occupational therapy services to very young children is to collaborate with family members to select meaningful occupations that will support the physical, cognitive, and psychosocial dimensions of a young child’s play, self-care, and interaction as a family member and playmate (AOTA, 2007). The primary areas of occupation for this population are: (a) activities of daily

living (ADL) such as feeding, functional mobility, and toileting; ( play exploration and participation; © education; and (d) social participation (AOTA, 2002 a). Guiding Principles for Occupational Therapy Intervention Five core family centered principles guide occupational therapy practitioners in providing effective

services as part of an early intervention team Principle 1: The family is the core of an early intervention team. Occupational therapy services are family centered and are respectful of each family, along

with their unique hopes, dreams, values, and priorities (Turnbull, Turbiville, & Turnbull 2000). Occupational therapists recognize that parents’ expertise concerning their child and family life is a critical component throughout the evaluation and intervention process and that a partnership must be developed in order to establish successful and meaningful outcomes. Families are entitled to be involved in all aspects of their child’s intervention plan, including phases of development, assessment, implementation, review, and during the phase of transition to other services and/or programs when appropriate (IDEA Final Regulations, 2004). Families also have the right to decline any early intervention service, or to modify services to accommodate their work and family responsibilities (IDEA, 2004). Principle 2: Families function as unique systems within social and cultural systems. Each family is unique and interacts within cultural and social systems at home and in their community, providing natural learning opportunities for a child (Dunst et al., 2001). By encouraging family involvement, occupational therapists help to identify activities that are both meaningful and appropriate for their child within the family’s natural social and cultural

context. Principle 3: All team members should support each other’s roles and should select outcomes and strategies together. In order to best meet the child’s needs, the therapist provides options and

choices; the family is encouraged to express individual preferences. The input and collaboration of all IFSP team members is essential for determining the best strategies to help family members facilitate their child’s growth and learning. Gathering the perspectives of all service personnel is necessary when considering all areas of a child’s development as well as understanding the full impact of challenges on his/her access, participation and progress in meaningful activity.\ Principle 4: Team members must understand each family’s story and expectations for early intervention. Occupational therapists and other early intervention team members must engage in a dialogue with family members regarding their needs in caring for a very young child (Hanft & Feinberg, 1997; Hirshberg, 1996). A picture of a child’s interests, personality, abilities, and challenges emerges, and supportive interventions can be identified. By truly listening to the family’s needs, the occupational therapist considers the family’s current level of functional performance, and, in collaboration with other team

members, meaningful intervention strategies can be identified. Principle 5: Team members must foster positive relationships between children and their primary caregivers. Children need responsive, nurturing, and interactive relationships with their primary caregivers in order to grow and develop.

Current research in early childhood confirms that these relationships organize all of early development (Commission on Children at Risk, 2003; National Research Council, 2000; Weston, Ivins, Heffron, & Sweet, 1997). Occupational therapists, like other members of an early intervention team, are responsible for fostering the “goodness of fit” between a child and his or her key caregivers by providing family supports and sharing information, as desired by family members. Intervention Following a child’s evaluation, an occupational therapist and other team members decide with a family if and when occupational therapy services are needed to reach their desired outcomes. These outcomes are identified on a child’s IFSP, which summarizes all the early intervention services and supports for a child and family. If occupational therapy intervention can help a child reach a specific outcome, the occupational therapist discusses with the parents about how the child’s strengths and challenges (i.e., their performance patterns/skills And client factors) affect his or her participation in specific areas of

occupation. The following are examples of intervention approaches: Establish/restore: Play oral-motor games to establish more mature tongue movement so that a child can transport the food bolus to the side for chewing and enjoy some

of her family’s favorite foods. Adapt/modify: Modify a child’s high chair for proper head, neck, shoulder, trunk, and pelvis alignment to help a boy play with his sister. Alter: Assist a child care provider to incorporate calming and altering sensory activities throughout a child’s day to improve her attention to the task at hand. Create: Work with staff at a community pool to adapt the toddler pool, ensuring access for children with various mobility patterns. There are many different methods in which occupational therapists provide services in community based early intervention settings. These methods include working with children and families and caregivers during individual sessions in homes, co-leading small groups in child care centers, consulting with early intervention teams, and providing in-services for

child care providers. For an IFSP to be individualized for each child and family, all team members must collaborate so the process is an interactive and flexible one. A family’s desires for their child should guide the discussions and decisions. Occupational therapists can participate in initial planning discussions with families, conduct eligibility evaluations, evaluate how a child’s abilities and challenges affect participation in family-selected activities, and assist families in choosing specific child centered outcomes to guide the provision of family supports and services. Schefkind, MS, OTR, is the Pediatric Coordinator, American Occupational

Therapy Association, Bethesda, MD. She can be reached at sschefkind@.... Adapted from Hanft, B. & , D. (2004). Occupational Therapy in Community-Based Early Intervention Settings, OT Practice, 9(1), CE1-CE8. This article is from the IDEA Infant & Toddler Coordinators Association (www.ideainfanttoddler.org) October 2007 Newsletter.