All in the Family
Parents Play a Crucial Role in the Success of a Child's Therapy Goals
Monday February 16, 2009
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“Parents play an absolutely essential role in their child’s development because they’re the ones who live with the child,” says Lindsey Biel, MA, OTR/L, a private practice pediatric therapist in New York and co-author of "Raising a Sensory Smart Child." “I approach parents as partners in the treatment team, along with any related service providers and teachers. I also try to include others who are involved with that child: grandparents, baby-sitters, and so on.”
A 2003 study published in Physical and Occupational Therapy in Pediatrics looked at the adjustment by parents of children with cerebral palsy and their participation in home therapy programs. Researchers conducted in-depth interviews of eight parents and four therapists. Parents expressed that in the early days of their child’s therapy they were “overwhelmed by their situation and unable to participate in providing activities at home for their child. Furthermore, they concealed their lack of participation from the therapists, with whom they [had] not yet developed a trusting relationship.”
Researchers suggest that being aware of a parent’s state of mind in the early days of therapy and building a service model in which OTs facilitate communication and education might lead to greater parent participation in a child’s home therapy program.
The study’s suggestions are supported by the experiences of practitioners in many OT practices.
Ashley Civello, MA, OTR, and owner of Theraplay Associates in Dallas, says one of her OTs treated a child in the third grade who came to the clinic for handwriting help. Because of the therapist’s emphasis on communication and teamwork, not to mention the high level of motivation of the patient and parents, the family followed the home program exactly and with successful results, Civello says.
“This child’s parents did all the things at home that the OT told them to do,” Civello says. “For patients with a similar diagnosis whose parents participate in the home program, but not as consistently, their treatment might take six to nine months. This child [was] discharged in three months. It just shows that if parents are able to incorporate the home program and show up for appointments, they can really speed up the treatment time.”
More Info
Resources
- • Biel L, Peske N. Raising a Sensory Smart Child. New York, NY: Penguin; 2005.
• Hinojosa J, Sproat CT, Mankhetwit S, Anderson J. Shifts in parent-therapist partnerships: twelve years of change. Am J Occup Ther. 2002;56(5):556-63.
• Piggot J, Hocking C, Paterson J. Parental adjustment to having a child with cerebral palsy and participation in home therapy programs. Phys Occup Ther Pediatr. 2003;23(4):5-29.
• Segal R, Beyer C. Integration and application of a home treatment program: a study of parents and occupational therapists. Am J Occup Ther. 2006;60(5):500-10.
“Compared to speech and physical therapy, I find I have to do a lot more upfront explanation to help parents understand OT because it is not as straightforward as the other therapies,” says Kristen Churches, OTR, CINT, of Building Bridges Therapy Center in Plymouth, Mich. “I have realized that when I spend more time educating parents, the better their children do.”
Once the basic understanding of OT is established, and the assessments are complete, Churches works closely with parents to establish goals that meet both the needs of the child and parents. She says when parents understand “what’s in it for me,” they are more willing to follow through with the home programs.
“The first question I ask parents is ‘what is the one area that would make the biggest difference during your day,’” she says. “Then we set goals based on those priorities.”
She also tries to create home programs that parents are more likely to follow.
“If a parent is out doing errands or at home doing chores, I tell them to have their child carry the shopping bags or push the laundry basket across the floor,” she says. “I don’t want to set them up for failure. That’s why I work very hard with families and their existing schedule to [fit OT] into their day.”
With parents who are supportive and diligently follow through on their children’s home program, Churches sometimes has to remind them not to get caught up in the details. “Sometimes parents can get so caught up in the specifics of the activities, they don’t see the whole picture,” she says. “There are a million ways to get the same outcome, so I have to remind parents to be flexible because a child’s needs can change from day to day, hour to hour, minute by minute.” Biel is sure to remind her parents that they are parents, not therapists.
“It’s really important that a parent enjoy his or her time with the child,” she says. “So if she is feeling burdened or resentful about having OT homework to do with the child, we need to come up with some new strategies together.”
Biel coaches parents to incorporate OT exercises during together time with activities such as playing with Play-Doh, baking bread, or gardening. Churches suggests parents be a little silly with their kids, such as doing a wheelbarrow walk to get them in the bathroom to brush their teeth.
And for many pediatric OTs, that’s the focus of their therapy: to support children in their primary occupation of play.
“I’ll be the first to tell parents that if it looks like what we’re doing is play, that’s the biggest compliment they can give me,” Civello says. “That means the kids are happy and they don’t know they are working that hard on what challenges them.”
Marnie McLeod Santoyo is a medical writer for the Gannett Healthcare Group. To comment, e-mail to oteditor@gannetthg.com.
