OTs delivering the P4C model provide services that result in increased child participation and success at school. One of the most powerful ways to convey what the P4C service looks like is to present a true story of one child in this study. * Names have been changed.
The P4C OT was invited into Ms. Marsh’s Grade 1 class in October 2013 to observe the students participating in varied motor-based activities, including printing and gym. A few students were having challenges with printing, scissor use, organizing their belongings, ball catching and/or movement in gym. The P4C OT and teacher decided it would be helpful if the OT modelled strategies to incorporate when teaching motor-based tasks. The P4C OT taught two full class lessons on letter formation using a multisensory approach, with step-by-step verbal instructions, hands-on materials and visual demonstration. Ms. Marsh began to use these strategies as she supported her students in developing their printing skills.
Trevor continued to struggle, holding the pencil in an awkward manner with a slight tremor, exerting excessive pressure, forming the letters in inefficient ways, having a slouched posture at his desk. He struggled with organizing his work on the lines and on the page. In gym, the P4C OT observed Trevor to frequently fall, bump into other students and have difficulty with throwing and catching a ball. The P4C OT noticed that Trevor’s “cubby” was disorganized, with many items on the floor rather than on the hooks, and that he was the last one into the classroom after outdoor time. The P4C OT reviewed these “red flags” for Developmental Coordination Disorder (DCD) with Ms. Marsh and provided her with some reading material. They decided together that the P4C OT should contact the family to determine if there were motor concerns at home, and to obtain informed consent for the P4C OT to work more closely with Trevor, his teacher and family to support his motor development and successful participation at school and home. The family confirmed challenges with Trevor’s ball skills, use of tools such as scissors and dressing skills. Throughout Grade 1, the P4C OT worked with Trevor in the classroom to trial strategies to support the development of scissor skills, typing and printing skills, ball skills in gym and independence with clothing, lunch and knapsack management. The P4C OT shared successful strategies with Ms. Marsh and his family through regular discussions and the provision of written resources, tips and strategies.
In Grade 2, concerns increased about Trevor’s impulsivity and his ability to attend and focus. The P4C OT was asked to consult around self-regulation strategies. The Sensory Profile was completed and additional strategies were implemented, including frequent movement breaks, a cushion on his chair to provide movement when seated, the use of fidget toys and a quiet area for work completion. The P4C OT provided an equipment recommendation to the school identifying the appropriate sensory tools for Trevor. She continued to support Trevor, implementing strategies such as changing the location of his desk to improve visual access to the board, modifying his agenda with adapted paper, continuing to support the development of his written productivity with paper/pencil and use of technology.
Comparing the P4C Service with Typical Service Provision
In the traditional model, the earliest Trevor would be referred for P4C OT support would be in Grade 1. The teacher would present his case to an in-school team meeting and complete a package of information to accompany the OT referral to the CCAC. He would remain on a 1-2 year wait list for service, likely not seeing an OT until late Grade 2 or more likely Grade 3.
Over the two years when he was receiving P4C service, Trevor completed Grade 1 and 2. The P4C OT worked with Trevor in the classroom or gym on curriculum-based activities on 16 occasions. She consulted with educators on 12 occasions and with Trevor’s mother in person or on the telephone on 11 occasions. Successful strategies were shared, Trevor’s progress was monitored and collaborative problem-solving and coaching were part of these consultations in order to build the capacity of Trevor’s mother and teacher to manage new challenges as they arose. Issues that were addressed spanned all areas, including:
- self-care tasks such as teaching shoelace tying and managing the zipper on his knapsack
- written productivity including strategies such as use of adapted paper, multi-sensory teaching techniques and the introduction of technology and keyboarding
- organization of materials through the use of colour coding, and graphic organizers
- sports and leisure through step-by-step instruction for new motor skills in gym, and the recommendation of a summer camp to master bike riding
- sensory tools and strategies to support self-regulation, focus and attention
- environmental changes including location of locker and desk
On the Movement Assessment Battery for Children-2, which was administered in April 2015 (end of Grade 2) as part of this research project, Trevor scored below the first percentile, indicating a definite motor impairment. The P4C OT identified these motor challenges early in Grade 1 through observation and dynamic performance analysis in the classroom, hallways and gym; supported educators and family in understanding the impact on Trevor’s participation and performance at school and home; and worked collaboratively to identify strategies and accommodations to support Trevor’s performance.
At the end of the project, Trevor’s mother reported that she had received information from the OT verbally and in writing which increased her understanding of her son’s needs. She also shared resources with other family members. On a scale of 1 (not at all) to 7 (to a very great extent), Trevor’s mother gave a score of 7 to the question “Were you satisfied with the Partnering for Change Occupational Therapy Service?” Trevor’s Grade 2 teacher wrote “The OT was amazing. She provided great tools and resources to support Trevor. She was very patient and consistently concerned about his progress. She communicated with mom on a need-to-know basis and provided strategies for the home. We were very lucky to have her in our school for support!”