Occupational Therapy for Children in Saskatchewan Resource Document 2020 OCCUPATIONAL THERAPY FOR CHILDREN IN SASKATCHEWAN – Resource Document 2020 About This Publication No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, except by members of the Saskatchewan Society of Occupational Therapists (SSOT), for the purposes described in the publication. All other persons may seek permission for use of this publication by inquiring to: Saskatchewan Pediatric Occupational Therapy Practice Network (SPOT) [email protected] Disclaimer: The authors and publishers of this document have done their best to verify all facts and figures in this document from the most current and reliable sources available during the time of this writing. It is not the intent of this document to present any method or practice approach as more effective or superior to any other; rather the document is intended as a collection of evidence and data that can be used to inform decision-making by qualified professionals, administrators, and concerned members of the public. There is no intention on the part of the authors or publishers to provide a substitute for occupational therapy expertise in any setting where such expertise is requested or warranted. If citing this document, please use the following: Blight, M., Lundell, L., Clark, L., Britz, E., Dinsdale, K., Gervais, A., & Bitz, K. (2021). Occupational Therapy for Children in Saskatchewan - Resource Document 2020. Saskatchewan Society of Occupational Therapists and Saskatchewan Pediatric Occupational Therapy Practice Network. © SSOT May 2021 © SPOT May 2021 Learn more at: www.ssot.sk.ca www.saskspot.ca Cover art photo by Landon Parenteau on Unsplash. 1 OCCUPATIONAL THERAPY FOR CHILDREN IN SASKATCHEWAN – Resource Document 2020 CONTENTS Opening Remarks 6 Preface 6 Introduction 7 1 Occupational Therapy 9 The Profession of Occupational Therapy 9 Education of Occupational Therapists 10 The Practice of Occupational Therapy 11 Theory 11 Models 11 Method 13 Registration in Saskatchewan 14 Professional Development Requirements 14 Advancing Knowledge and Skills 14 Practice Networks 15 Summary 15 2 Childhood Development 16 Developmental Progression 16 Person - The Child 16 Physical 16 Cognitive 17 Social-Emotional 17 Spiritual 17 Occupations of the Child 17 Self-Care 18 Productivity 18 Leisure 18 Environment of the Child 18 Engagement of the Child 19 Disruptions in Childhood 20 Perspectives on Disability 20 Saskatchewan Perspective 22 Descriptors of Disruptions in Childhood Development 22 Summary 23 3 The Role of Occupational Therapy with Children 24 Person - The Child 24 Occupations of the Child 24 Self-Care 24 Productivity 25 Leisure 26 2 OCCUPATIONAL THERAPY FOR CHILDREN IN SASKATCHEWAN – Resource Document 2020 Environment of the Child 26 Engagement of the Child 27 Summary 27 4 Occupational Therapy Workforce in Saskatchewan 27 CIHI Data: National and Provincial Comparisons 28 Occupational Therapy Workforce Serving Children by Sector 30 Saskatchewan Health Authorities - Ministry of Health 30 Saskatchewan School Divisions - Ministry of Education 32 Saskatchewan Tribal Councils - First Nations Education 33 Occupational Therapy Private Practices and Companies 33 Workforce Demographics 34 Years of Practice 34 Hours Worked per Week 35 Location of Practice 36 Summary 38 5 Environmental Factors Influencing the Practice of Occupational 39 Therapy with Children Societal Factors 39 Provincial Factors 40 Rurality of Saskatchewan 41 Travel Considerations 42 Managing Travel Time 42 Travel Distance and Time 42 Safety with Travel 44 Workplace Factors 44 Recruitment 44 Retention 45 Satisfaction with Workload Distribution 45 Work Climate 46 Administrative Influences 47 Professional Factors 48 Professional Development 48 Professional Confidence and Identity 48 Client-centeredness 49 Autonomy in the Workplace 49 Summary 49 6 Provision of Occupational Therapy Services for Children in 50 Saskatchewan Organizational Structures Influencing Occupational Therapy Practice 50 3 OCCUPATIONAL THERAPY FOR CHILDREN IN SASKATCHEWAN – Resource Document 2020 Ministry of Health 50 Children’s Therapy Services 50 Larger Urban Centres 51 Smaller Urban Centres 51 Occupational Therapy Services 51 Ministry of Education 51 Student Support Services 51 First Nations Health and Education in Saskatchewan 52 Health 52 Education 52 Ministry of Social Services 52 Inter Ministerial Collaboration 52 Autism Services 53 Acquired Brain Injury Services 53 Agencies Supporting Children and Families 53 Environments where Occupational Therapy Services are Provided 53 Funding for Occupational Therapy for Children 54 Public Funding and Services 54 Ministry of Health 54 Ministry of Education 55 Ministry of Social Services 55 Indigenous Services Canada 55 Publicly Funded Programs and Private Services 55 Jordan’s Principle 55 Individualized Funding for Autism Spectrum Disorders 55 Cognitive Disability Strategy 55 Private Funding not Publicly Sourced 56 Funding Sources for Occupational Therapy Services 56 Occupational Therapy Services for Children in Saskatchewan 57 Service Delivery Models - Foundational Elements 57 Environment of the Child 57 Types of Service Delivery Models 58 Development of Service Delivery Models 58 Communication and Collaboration 58 Commonalities and Differences in Service Provision Across Sectors 58 Occupational Therapy Service Delivery 59 Structure - Service Delivery Models 60 Processes 61 Referral Sources 61 Reasons for Referral 63 Ages of Children Served 64 Profiles of Children Served 65 Outcomes of Occupational Therapy 67 Summary 68 4 OCCUPATIONAL THERAPY FOR CHILDREN IN SASKATCHEWAN – Resource Document 2020 7 Impact of Occupational Therapy for Children 68 Occupational Therapy Skills that are Valued 69 Activity Analysis 69 Adaptability 69 Adaptation 69 Client-Centred Approach 69 Collaboration 70 Transitional Support 70 Holistic Practice 71 Benefits of Utilizing the Skills of an Occupational Therapist 71 Summary 72 8 Practice Changes Related to Occupational Therapy Services for 72 in Saskatchewan Increased Complexity of Needs 72 Higher Caseload and Workload Demands 74 Changes in Service Delivery Models 74 Summary 76 9 Summary of Occupational Therapy for Children in Saskatchewan 76 10 Conclusive Messages with Recommendations 78 Closing Remarks 81 Appendices 82 Appendix A Survey 82 Appendix A1 Survey Development Process 82 Appendix A2 Summarized Questionnaire - Occupational Therapy for Children in Saskatchewan 85 Appendix B Literature Search Process 88 Appendix C Infographic Map – Canadian Institute of Health Informatics 89 Appendix D Occupational Therapy Children’s Services 90 Appendix D1 Ministry of Health 90 Appendix D2 Ministry of Education 94 Appendix D3 Saskatchewan First Nations Education 97 Appendix D4 Private Practice Clinicians and Companies 99 Appendix E Practice Locations as Reported by Survey Respondents 101 References 103 Acknowledgements 113 5 OCCUPATIONAL THERAPY FOR CHILDREN IN SASKATCHEWAN – Resource Document 2020 Opening Remarks Occupational Therapy for Children in Saskatchewan - Resource Document 2020 has been produced through the efforts of a group of occupational therapists, working together with the Saskatchewan Pediatric Occupational Therapy Practice Network (SPOT) and the Saskatchewan Society of Occupational Therapists (SSOT). The document profiles occupational therapy for children with an emphasis on services in Saskatchewan in 2019-2020. The information contained in this document is intended for a broad range of readers and can serve as a valuable resource to occupational therapists as they collaborate with caregivers, colleagues, and partners in supporting the needs of children. Occupational therapists, as a professional community, are responsible for creating, maintaining, and communicating standards of care to the public. We trust that this document is a significant contribution towards our ongoing commitment to providing effective and responsive occupational therapy service delivery for children in Saskatchewan. Preface In 2010, a working group within the Saskatchewan Society of Occupational Therapists prepared Occupational Therapy for Children: Services in Saskatchewan (SSOT, 2010). This document profiled pediatric occupational therapy services in the province and advocated for equitable access to meet the needs of children. Case studies reflected the role of occupational therapy with children in hospital, home, school, and private clinic settings. Since 2010, external and internal forces have impacted the delivery of occupational therapy services for children in Saskatchewan. External forces include changes to structures and systems providing occupational therapy, as well as changes to funding models supporting access to occupational therapy. Internal forces include the evolution of theory and practice approaches, as well as practice changes made by therapists in response to external pressures. Leading up to 2019, several SSOT members approached SSOT council members proposing that the 2010 document be updated to reflect these changes. In 2019, SSOT approved an update to the 2010 document to reflect current practices and services. SSOT approached the newly formed Saskatchewan Pediatric Occupational Therapy Practice Network (SPOT) to consider updating the document as a project. At a SPOT meeting in May 2019, a core group of occupational therapists from across the province volunteered to form