Achieving optimal outcomes for children in occupational therapy settings is influenced, in part, by their engagement. The nature of child engagement from the occupational therapy perspective remains relatively unexplored.
Method.
A qualitative research methodology was adopted, using an interpretive description approach. Thirty-two occupational therapists participated in five focus groups and six individual interviews that were thematically analyzed.
Findings.
Four themes emerged from the data: (i) signs of child engagement and disengagement; (ii) it’s about the child feeling safe; (iii) a sense of meaning and purpose; and (iv) service and therapist factors influencing child engagement.
Implications.
Helping the child feel safe; providing meaningful experiences; and being flexible and responsive were key means of connecting with, and supporting, child engagement. Strategies occupational therapists reportedly used to engage the child aligned with the tenets of self-determination theory (autonomy, relatedness, and competence).
BrightF. A. S.KayesN. M.WorrallL.McPhersonK. M. (2015). A conceptual review of engagement in healthcare and rehabilitation. Disability and Rehabilitation, 37(8), 643–654. doi:10.3109/09638288.2014.933899
4.
ChuB. C.KendallP. C. (2009). Therapist responsiveness to child engagement: Flexibility within manual-based CBT for anxious youth. Journal of Clinical Psychology, 65(7), 736–754. doi:10.1002/jclp.20582
5.
CsikszentmihalyiM. (2002). Flow: The classic work on how to achieve happiness. Random House.
6.
D’ArrigoR.CopleyJ.PoulsenA. A.ZivianiJ. (2019). Parent engagement and disengagement in therapy: An occupational therapy perspective. Disability and Rehabilitation. doi:10.1080/09638288.2019.1574913
7.
D’ArrigoR.ZivianiJ.PoulsenA. A.CopleyJ.KingG. (2016). Child and parent engagement in therapy: What is the key?Australian Occupational Therapy Journal, 64(4), 340–343. doi:10.1111/1440-1630.12279
8.
EstesJ.PierceD. E. (2012). Pediatric therapists’ perspectives on occupation-based practice. Scandinavian Journal of Occupational Therapy, 19(1), 17–25. doi:10.3109/11038128.2010.547598
9.
GilmoreR.ZivianiJ.SakzewskiL.ShieldsN.BoydR. (2010). A balancing act: Children’s experience of modified constraint-induced movement therapy. Developmental Neurorehabilitation, 13(2), 88–94. doi:10.3109/17518420903386161
10.
JamesS.ZivianiJ.KingG.BoydR. N. (2015). Understanding engagement in home-based interactive computer play: Perspectives of children with unilateral cerebral palsy and their caregivers. Physical and Occupational Therapy in Pediatrics, 36(4), 343–358. doi:10.3109/01942638.2015.1076560
11.
KayesN. M.MudgeS.BrightF. A. S.McphersonK. (2015). Whose behaviour matters? Rethinking practitioner behaviour and its influence on rehabilitation outcomes. In McPhersonK.GibsonB. E.LeplègeA. (Eds.), Rethinking rehabilitation: Theory and practice (pp. 249–271). CRC Press.
12.
KingG. (2016). The role of the therapist in therapeutic change: How knowledge from mental health can inform pediatric rehabilitation. Physical and Occupational Therapy in Pediatrics, 37(2), 121–138. doi:10.1080/01942638.2016.1185508
13.
KingG.ChiarelloL. A.ThompsonL.McLarnonM. J. W.SmartE.ZivianiJ.PintoM. (2017). Development of an observational measure of therapy engagement for pediatric rehabilitation. Disability and Rehabilitation, 41(1), 86–97. doi:10.1080/09638288.2017.1375031
14.
KingG.CurrieM.PetersenP. (2014). Child and parent engagement in the mental health intervention process: A motivational framework. Child and Adolescent Mental Health, 19(1), 2–8. doi:10.1111/camh.12015
15.
KingG.SchwellnusH.KeenanS.ChiarelloL. A. (2018). Youth engagement in pediatric rehabilitation: Service providers’ perceptions in a real-time study of solution-focused coaching for participation goals. Physical and Occupational Therapy in Pediatrics, 38(5), 527–547. doi:10.1080/01942638.2017.1405864
16.
KinnL. G.AasR. W. (2009). Occupational therapists’ perception of their practice: A phenomenological study. Australian Occupational Therapy Journal, 56(2), 112–121. doi:10.1111/j.1440-1630.2007.00714.x
17.
LawlorM. C. (2003). The significance of being occupied: The social construction of childhood occupations. American Journal of Occupational Therapy, 57(4), 424–434.
18.
LawlorM. C. (2012). The particularities of engagement: Intersubjectivity in occupational therapy practice. OTJR: Occupation, Participation and Health, 32(4), 151–159. doi:10.3928/15394492-20120302-01
19.
LevacD. (2016). How can therapists enhance children’s engagement in home-based rehabilitation interventions?Physical and Occupational Therapy in Pediatrics, 36(4), 359–362. doi:10.1080/01942638.2016.1207998
20.
MeynsP.Roman de MettelingeT.van der SpankJ.CoussensM.van WaelveldeH. (2018). Motivation in pediatric motor rehabilitation: A systematic search of the literature using the self-determination theory as a conceptual framework. Developmental Neurorehabilitation, 21(6), 371–390. doi:10.1080/17518423.2017.1295286
21.
MillerL.ZivianiJ.WareR. S.BoydR. N. (2016). Does context matter? Mastery motivation and therapy engagement of children with cerebral palsy. Physical and Occupational Therapy in Pediatrics, 36(2), 155–170. doi:10.3109/01942638.2015.1076556
22.
NelsonA.AllisonH. (2007). Relationships: The key to effective occupational therapy practice with urban Australian Indigenous children. Occupational Therapy International, 14(1), 57–70. doi:10.1002/oti.224
23.
PolatajkoH. J.DavisJ. A.McEwenS. E. (2015). Therapeutic use of self: A catalyst in the client-therapist alliance for change. In ChristiansenC.BaumC. M.BassJ. D. (Eds.), Occupational therapy: Performance, participation, and well-being (4th ed, pp. 81–109). Slack.
24.
QSR International Pty Ltd. (2014). In NVivo qualitative data analysis software version 10.
25.
RodgerS. (2017). Becoming an occupation-centered practitioner In RodgerS. (Ed.), Occupation-centred practice with children: A practical guide for occupational therapists (pp. 21–44). John Wiley & Sons.
26.
RyanR. M.DeciE. L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. Guilford Press.
27.
ShentonA. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22, 63–75.
28.
SmartE.AulakhA.McDougallC.RigbyP.KingG. (2016). Optimizing engagement in goal pursuit with youth with physical disabilities attending life skills and transition programs: An exploratory study. Disability and Rehabilitation, 39(20), 2029–2038. doi:10.1080/09638288.2016.1215558
29.
SolmanB.CloustonT. (2016). Occupational therapy and the therapeutic use of self. British Journal of Occupational Therapy, 79(8), 514–516. doi:10.1177/0308022616638675
30.
TaylorR. R. (2008). A model of the intentional relationship. In TaylorR. R. (Ed.), The intentional relationship occupational therapy and use of self. F. A. Davis Co.
31.
ThorneS. (2016). Interpretive description: Qualitative research for applied practice. Routledge.
32.
TurpinM. J.CopleyJ. A. (2018). Interactive reasoning. In SchellB. A. B.SchellJ. W. (Eds.), Clinical and professional reasoning in occupational therapy (pp. 245–260). Wolters Kluwer.
33.
ZivianiJ. (2015). Occupational performance: A case for self-determination. Australian Occupational Therapy Journal, 62(6), 393–400. doi:10.1111/1440-1630.12250
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