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What Is the Role of Occupational Therapy in Early Intervention?

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What Is the Role of Occupational Therapy in Early Intervention? The American Occupational Therapy Association Frequently Asked Questions (FAQ): What is the Role of Occupational Therapy in Early Intervention? In early intervention, occupational therapy practitioners 1. What are the core principles of occupa- promote the function and engagement of infants and tod- tional therapy service provided within early dlers and their families in everyday routines by addressing intervention and how do they link to the EI areas of occupation, including activities of daily living, rest principles? and sleep, play, education, and social participation. Practitio- While the purposes and outcomes of early intervention ners enhance a family’s capacity to care for their child and occupational therapy may vary based on the settings and promote his or her development and participation in natural funding source, there are core principles that guide all environments where the child and family live, work, and services and supports (Occupational Therapy Practice play. Framework: Domain and process, 3rd Edition (American Early intervention services and supports are typically Occupational Therapy Association [AOTA], 2014b). These provided to children under the age of 3 years and their include: families. In some states, these services may extend to chil- n Participation: Occupational therapy services support a dren through 5 years of age. Occupational therapy services child and family’s meaningful participation in occupa- are most often provided through provisions of the federal tions such as activities of daily living (ADLs), instru- Individuals with Disabilities Education Improvement Act mental activities of daily living (IADLs), education, of 2004 (IDEA) or in hospitals and outpatient clinics. work, play, leisure, rest and sleep, and social participa- Although each state can develop their early intervention pro- tion. This relates to the following Key Principles of gram based on state needs and resources, there are minimum Early Intervention: components (see 20 U.S.C., § 1435a) that each state must include in their program. • “Infants and toddlers learn best through everyday In 2008, a cross-disciplinary workgroup of the OSEP TA experiences and interactions with familiar people in Community of Practice-Part C Settings developed a mis- familiar contexts.” (EI principle 1) sion and a statement, Key Principles for Providing Early n Occupation: Occupations are the “daily life activities Intervention Services in Natural Environments. These key in which people engage” (AOTA, 2014b, p. S6). Occu- principles (EI principles) are reflected in this document and pations are meaningful and purposeful. Infants and the practice of occupational therapy in early intervention toddlers engage in occupations including self-care (e.g., (Workgroup on Principles and Practices in Natural Environ- eating, dressing), rest and sleep, play, social participa- ments, 2008). tion, and education (e.g., pre-literacy, adaptive, cogni- tive, communication, physical, social and emotional development) (Frolek Clark & Kingsley, 2013). 1 Co-occupations are especially important for infants and n Natural Environment: Services under IDEA Part C toddlers and their families. Co-occupations are occu- must be provided in settings that are typical for the pations or activities that are shared between children, child’s peers of comparable age, to the extent practica- family members, peers and other adults, and implicitly ble. Whenever possible for the child and family, ser- involve two or more individuals. Examples of co- vices should be provided in a family and/or community occupations include feeding and eating, caregiver-child setting. Occupational therapy practitioners understand play, dressing, bathing, and hygiene. This relates to the and analyze the interrelated conditions of context and following Key Principles of Early Intervention: environment and the influence on participation and per- • Learning opportunities must be functional, based on formance. This relates to the following Key Principles child and family interest and enjoyment. (Based on EI of Early Intervention: principle 1) • “Infants and toddlers learn best through everyday n Family-Centered: The family-centered philosophy is a experiences and interactions with familiar people in model whereby the family defines the priorities of the familiar contexts” (EI principle 1). intervention. It is based on the premises that families n Family Routines and Rituals: The Occupational know their children best, that optimal developmental Therapy Practice Framework: Domain and Process, 3rd outcomes occur within a supportive family and commu- Edition (AOTA, 2014b) defines routines as “patterns of nity environment and that each family is unique. This behavior that are observable, regular and repetitive, and model aligns with the occupational therapy client-cen- that provide structure for daily life” (p. S27). Occupa- tered approach and the value that occupational therapy tional therapy practitioners promote the participation practitioners place on collaborating with families of children and their families in everyday activities or throughout the service delivery process (e.g., evalua- occupations, such as morning, bedtime, bath time, and tion, intervention, outcomes) (AOTA, 2014b). Occupa- playtime routines. When there is a particular area of tional therapy practitioners collaborate with the family concern, the occupational therapy practitioner can create and other individuals who have knowledge of a child in an individualized strategy based on the specific needs order to identify a child’s strengths and challenges. This and priorities of the child and family in order to pro- relates to the following Key Principles of Early Inter- mote successful participation in daily routines (AOTA, vention: 2013a). Rituals add meaning and purpose and help • The consistent adults in a child’s life have the greatest families build strong relationships. This relates to the influence on their learning and development—not EI following Key Principles of Early Intervention: providers. (Based on EI principle 2) • “The early intervention process, from initial contact n Family Capacity and Resources: Occupational therapy through transition, must be dynamic and individu- practitioners support and respect each family’s capac- alized to reflect the child’s and family members’ ity and resources. Family capacity includes the knowl- preferences, learning styles and cultural beliefs.” (EI edge and skills the family has to support their child’s principle 4) development and meet their child’s needs. Capacity is n Culturally Sensitive: Occupational therapy practitio- the amount of physical, emotional and spiritual energy ners recognize and support the value and importance necessary to support the development of a child, and of culturally sensitive practice. Occupational therapy it directly influences the sense of competency a fam- practitioners support a child and family’s engagement ily member experiences when caring for a young child. in culturally meaningful occupations and recognize that Resources include various supports that the family has culture influences the choice of activities in which an developed and can use to meet their family and child’s individual engages (AOTA, 2013b). This relates to the needs (e.g., medical, home, financial). This relates to the following Key Principles of Early Intervention: following Key Principles of Early Intervention: • Each family’s culture, spiritual beliefs and activities, • All families are resourceful, but all families do not values and traditions may be different from those of have equal access to the resources. Supports need to the service provider. Service providers should seek to build on strengths and reduce stressors so families are understand, not judge. (Based on EI principle 4) able to engage with their children in mutually enjoy- n Evidence-Based: Occupational therapy is a science- able interactions and activities. (Based on EI principle driven profession that applies the most up-to-date 2) research to service delivery. Evidence supports the • “The primary role of a service provider in early inter- effectiveness of adding an occupational therapy practi- vention is to work with and support family members tioner to a treatment plan and the Individualized Family and caregivers in children’s lives.” (EI principle 3) Service Plan (IFSP) team (Case-Smith, 2013a; Case- Smith, 2013b; Case-Smith, Frolek Clark, & Schlabach, 2 2013; Frolek Clark & Schlabach, 2013; Howe & Wang, tional regulation is an important aspect of the infant’s 2013; Kingsley & Mailloux, 2013). Interventions are mental health and develops within the context of the pri- directed at the outcomes developed collaboratively with mary caregiver relationship (Koomar, 2009). Emotional the families and IFSP team members. Effective inter- regulation occurs when the caregiver is responsive to ventions are used to promote health, well-being, and the needs of an infant or child and responds to his or her participation. Intervention approaches may be focused emotional states appropriately during both stressful and on the environment, an activity, or the child or family or non-stressful events. both. ( See examples of these approaches on the Evi- Occupational therapy practitioners support caregiv- dence-Based Practice page of our website.) This relates ers by emphasizing the strengths of the family and by to the following Key Principles of Early Intervention: identifying strategies to build their capacity for resiliency, • “IFSP outcomes
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