Focusing on the Environment to Improve Youth Participation: Experiences and Perspectives of Occupational Therapists
2. Experimental Section
2.2. Data Analysis
3.1. Sample Characteristics
3.2. Main Findings
3.3. Informative Themes
3.3.1. Multi-Layered Composition of the Environment
“The main barrier (of this goal) was finding the right place that could take (the participant) on as a volunteer without adding more responsibility to the staff”.(Gail)
“That (organization) was for adults only, or for people who don’t go to school at all. He [the participant] already goes to school full time and he’s a youth, so it didn’t, at first, make him eligible. I ended up speaking to the director of the non-profit as well as the registrar and they sort of understood the situation and they were able to accommodate him, which was really good”.(Lucia)
“I think (the mom) felt isolated she told me she had felt kind of isolated because they are not really part of a big community. I just don’t think they knew where to start, really. So I think they were appreciative just knowing that I was here”.
“I think that it opened their eyes to what is possible and what they could do with their child and what they could do with their family. I think it was very beneficial for the family in that way”.
3.3.2. Leveraging Resources and Problem-Solving
“It was really to find the resources and to connect them with the child as well as the family that was pretty much the most significant type of intervention that I had to do”.
“So I spent a lot of my time trying to find someone who would be suitable, and I found a Master’s student who is studying Adaptive Physical Activity at (name of a University) who is willing to do it (work with the youth) on a volunteer basis. And she came and met the client and I went over some things she could do to practice it”.
3.4. Reflective Themes
3.4.1. A New Take on the OT Role
“I thought it was really nice experience. Very different than what I do on a daily basis, which is great, because it shows a different side of OT and I really like the idea of finding these kids and helping them participate more in the community. It’s great and they should have that opportunity to do so and to find more resources”.(Gail)
“We are more facilitators, we are helping them finding resources, establishing links, getting confidence in that networking. But we are not doing therapy. The intervention is really a mentorship facilitating process.”
“I enjoy that type of rehab much more. I’m not a very therapy-room, you know basket of toys on the floor-type. That’s not my style. I’m much more into adapting the environment and adapting equipment” .(Alexandra)
3.4.2. Re-Positioning the Concept of Participation
“I think that it’s a good reminder of the importance of participation and what the barriers are, because it’s something that I think is important. I think one thing this study has shown me has taught me a lot so far in the last two sessions with the clients is how much the family situations – the family income, where they live, their ability to be involved, the transportation really has big impact—and I think those barriers or facilitators, depending on what they are, have a huge impact on child’s ability to participate. But I think that we can’t deny the effect the family has on participation”.
“I think being integrated into the community, being part of their home and being onsite really made it all work. Being able to do the walk and ride the bike riding route in the neighbourhood and to know their family.”
“I think it is more, kind of, personal or appropriate in your own environment right. Because for it to actually work out in the long term you want it to be, you know, convenient and easily accessible. So for this particular family, they live in (suburb city). So finding resources in that city was very important.”
“We (therapists) really need to just put away our ideas of what success actually is and go with the perception of the client, and if they had fun and feel it was successful, then I think we’ve done a good job”.
Limitations and Further Directions
Conflicts of Interest
- WHO. International Classification of Functioning, Disability and Health; WHO: Geneva, 2001. [Google Scholar]
- Engel-Yeger, B.; Jarus, T.; Anaby, D.; Law, M. Differences in patterns of participation between youths with cerebral palsy and typically developing peers. Am. J. Occup. Ther. 2009, 63, 96–104. [Google Scholar] [CrossRef] [PubMed]
- Bedell, G.; Coster, W.; Law, M.; Liljenquist, K.; Kao, Y.C.; Teplicky, R.; Anaby, D.; Khetani, M.A. Community participation, supports, and barriers of school-age children with and without disabilities. Arch. Phys. Med. Rehabil. 2013, 94, 315–323. [Google Scholar] [CrossRef] [PubMed]
- Law, M.; Anaby, D.; Dematteo, C.; Hanna, S. Participation patterns of children with acquired brain injury. Brain Inj. 2011, 25, 587–595. [Google Scholar] [CrossRef] [PubMed]
- Anaby, D.; Hand, C.; Bradley, L.; Direzze, B.; Forhan, M.; Digiacomo, A.; Law, M. The effect of the environment on participation of children and youth with disabilities: A scoping review. Disabil. Rehabil. 2013, 35, 1589–1598. [Google Scholar] [CrossRef] [PubMed]
- Anaby, D.; Law, M.; Coster, W.; Bedell, G.; Khetani, M.; Avery, L.; Teplicky, R. The mediating role of the environment in explaining participation of children and youth with and without disabilities across home, school, and community. Arch. Phys. Med. Rehabil. 2014, 95, 908–917. [Google Scholar] [CrossRef] [PubMed]
- Darrah, J.; Law, M.C.; Pollock, N.; Wilson, B.; Russell, D.J.; Walter, S.D.; Rosenbaum, P.; Galuppi, B. Context therapy: A new intervention approach for children with cerebral palsy. Dev. Med. Child Neurol. 2011, 53, 615–620. [Google Scholar] [CrossRef] [PubMed]
- Law, M.; Anaby, D.; Imms, C.; Teplicky, R.; Turner, L. Improving the participation of youth with physical disabilities in community activities: An interrupted time series design. Aust Occup Ther J 2015, 62, 105–115. [Google Scholar] [CrossRef] [PubMed]
- Law, M.; Coster, W.; Bedell, G.; Anaby, D.; Khetani, M.; Lin, C.Y.; R, T.; Turner, L. Participation knowledge hub. https://www.canchild.ca/en/research-in-practice/participation-knowledge-hub (accessed on 20 August 2015).
- Anaby, D.R.; Law, M.C.; Majnemer, A.; Feldman, D. Opening doors to participation of youth with physical disabilities: An intervention study: Favoriser la participation des adolescents ayant des handicaps physiques: Étude d’intervention. Can. J. Occup. Ther. 2015. [Google Scholar] [CrossRef]
- Graham, F.; Rodger, S.; Ziviani, J. Coaching parents to enable children's participation: An approach for working with parents and their children. Aust. Occup. Ther. J. 2009, 56, 16–23. [Google Scholar] [CrossRef] [PubMed]
- Novak, I. Evidence to practice commentary new evidence in coaching interventions. Phys. Occup. Ther. Pediatr. 2014, 34, 132–137. [Google Scholar] [CrossRef] [PubMed]
- Law, M.; Baptiste, S.; Carswell, A.; McColl, M.A.; Polatajko, H.; Pollock, N. Canadian Occupational Performance Measure; CAOT Publications ACE: Ottowa, ON, Canada, 2014. [Google Scholar]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef]
- AOTA. Occupational therapy practice framework: Domain and process (3rd edition). Am. J. Occup. Ther. 2014, 68, 1–48. [Google Scholar]
- Law, M.; Cooper, B.A.; Strong, S.; Stewart, D.; Rigby, P.; Letts, L. The person-environment-occupational model: A transactive approach to occupational performance. Can. J. Occup. Ther. 1996, 63, 9–23. [Google Scholar] [CrossRef]
- Law, M.; Darrah, J. Emerging therapy approaches: An emphasis on function. J. Child Neurol. 2014, 29, 1101–1107. [Google Scholar] [CrossRef] [PubMed]
- Law, M.; Darrah, J.; Pollock, N.; Wilson, B.; Russell, D.J.; Walter, S.D.; Rosenbaum, P.; Galuppi, B. Focus on function: A cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy. Dev. Med. Child Neurol. 2011, 53, 621–629. [Google Scholar] [CrossRef] [PubMed]
- Townsend, E. Enabling Occupation II : ADVANCING an Occupational Therapy Vision for Health, well-Being, & Justice through Occupation; CAOT Publications ACE: Ottawa, ON, Canada, 2007; p. 418. [Google Scholar]
- American Occupational Therapy Association. The Road to the Centennial Vision. Available online: http://www.aota.org/aboutaota/centennial-vision.aspx (accessed on 9 October 2015).
© 2015 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).