Prevention and Intervention

Caregiver Coaching in Early Intervention

Meredith Santana, OTD, OTR/L
Chatham University, Pittsburgh, PA, USA
DOI: 10.5014/ajot.2020.74S1-PO4133

Date presented: March 27, 2020

Primary Author and Speaker: Meredith Santana, menackley@gmail.com

Occupational performance coaching is a family-centered model of intervention where therapists guide caregivers through the
problem-solving process to attain self-identified goals for their child. Research has shown that coaching can be an effective practice
model in improving parents’ self-competence (Dunn, Cox, Foster, Mische-Lawson, & Tanquary, 2012; Graham, Rodger, & Ziviani,
2013). Coaching has also been successful in improving parents’ satisfaction with their children’s participation in self-care tasks
(Graham et al., 2013). The three domains of occupational performance coaching are: structured process, emotional support, and
information exchange (Graham, Rodger, Ziviani, & Jones, 2016). A one group pre-test post-test quasi-experimental design was
conducted based upon this research to determine the effectiveness of caregiver coaching as an intervention to improve caregiver
satisfaction with the child’s self-care performance as well as their confidence in their ability to carry out the therapist’s
recommendations. Participants were recruited via convenience sampling and had various roles related to the child. Recruitment
yielded seven participants including two adoptive parents, two biological fathers, one biological mother, one grandparent, and one
daycare provider. Coaching was implemented in an early intervention (EI) setting over the course of seven weeks. Caregivers each
selected one or two self-care goals for their child to address in coaching sessions. Self-care areas that were addressed included self-
feeding (n=5), grooming (n=3), dressing (n=1), and sleep (n=2). Coaching sessions were conducted in individualized, face-to-face
treatment sessions in the child’s natural environment and via phone. Each session consisted of feedback for the previous week,
exploration of new interventions, and a review of newly learned strategies. Direct instruction was limited, and a focus was placed on
caregivers being active problem-solvers for their child’s needs. A caregiver confidence survey was used in conjunction with the
Canadian Occupational Performance Measure (COPM) to gather outcomes about caregivers’ satisfaction and confidence at pre-
intervention and post-intervention. Clinically significant positive change was noted in eight out of 11 of the addressed, caregiver-
selected self-care goals, or 73% of all goals. Six out of seven participants experienced some clinically significant positive changes in
their satisfaction following this intervention. Overall, caregivers reported a 72.3% increase in satisfaction. All seven participants
experienced increased confidence as a result of this intervention. Pre-intervention averages on the caregiver confidence survey were
compared with post-intervention averages for all the Likert-style questions. Positive percent change in average confidence scores
ranged from 8.5% to 55.9%. Caregivers who had a low confidence at pre-intervention experienced a greater percent change
increase in confidence following the intervention. Results support coaching as an effective intervention for caregivers of young
children in various roles, not just the role of parent. Findings suggest that caregiver coaching improves satisfaction and confidence in
carrying out the therapist’s recommendations. Occupational therapists can collaborate with caregivers and let caregivers take an
active role in the shared decision-making process for their child with positive therapy outcomes. This study is relevant to practice as it
establishes coaching as an effective alternative to traditional models of intervention in EI and aligns with the collaborative pillar of
Vision 2025.

References
Dunn, W., Cox, J., Foster, L., Mische-Lawson, L., & Tanquary, J. (2012). Impact of a contextual intervention on child participation and parent competence
among children with autism spectrum disorders: A pretest-posttest repeated-measures design. American Journal of Occupational Therapy, 66, 520-
528. http://dx.doi.org/10.5014/ajot.2012.004119
Graham, F., Rodger, S., & Ziviani, J. (2013). Effectiveness of occupational performance coaching in improving children’s and mothers’ performance and
mothers’ self-competence. American Journal of Occupational Therapy, 67, 10-18. http://dx.doi.org/10.5014ajot.2013.004648
Graham, F., Rodger, S., Ziviani, J., & Jones, V. (2016). Strategies identified as effective by mothers during occupational performance coaching. Physical &
Occupational Therapy in Pediatrics, 36(3), 247-259. http://dx.doi.org/10.3109/01942638.2015.1101043

The American Journal of Occupational Therapy, August 2020, Vol. 74, Supplement 1
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