Purpose:
Illustrate the use of DDDM to develop parent-identified goals for occupational therapy and to identify underlying sensory integration factors hypothesized to be impacting participation

Bull, OTS, Eric D.

Burke, PhD, OTR/L, FAOTA, Janice P.

Cohn, ScD, OTR/L, FAOTA, Ellen S.

Doria, OTS, Denise G.

Dumont, OTS, Rachel L.

Frank, OTS, Jamie A.

Grady, OTS, Jenna R.

Kauper, OTS, Sarah E.

Miller, OTS, Amy L.

Schaaf, PhD, OTR/L, FAOTA, Roseann C.

Truong, OTS, Phoi

English

Name not available

Parents\u27 Goals: An Analysis of Therapist Reasoning

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsDepartment of Occupational Therapy Posters andPresentations Department of Occupational Therapy4-17-2015Parents' Goals: An Analysis of Therapist ReasoningAmy L. Miller, OTSThomas Jefferson University, amy.miller@jefferson.eduRachel L. Dumont, OTSThomas Jefferson University, rachel.dumont@jefferson.eduJanice P. Burke, PhD, OTR/L, FAOTAThomas Jefferson University, janice.burke@jefferson.eduEllen S. Cohn, ScD, OTR/L, FAOTABoston UniversitySarah E. Kauper, OTSThomas Jefferson University, sarah.kauper@jefferson.eduSee next page for additional authorsLet us know how access to this document benefits youFollow this and additional works at: https://jdc.jefferson.edu/otpresentationsPart of the Occupational Therapy CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inRecommended CitationMiller, OTS, Amy L.; Dumont, OTS, Rachel L.; Burke, PhD, OTR/L, FAOTA, Janice P.; Cohn, ScD,OTR/L, FAOTA, Ellen S.; Kauper, OTS, Sarah E.; Schaaf, PhD, OTR/L, FAOTA, Roseann C.; Bull,OTS, Eric D.; Doria, OTS, Denise G.; Frank, OTS, Jamie A.; Grady, OTS, Jenna R.; and Truong,OTS, Phoi, "Parents' Goals: An Analysis of Therapist Reasoning" (2015). Department of OccupationalTherapy Posters and Presentations. Paper 25.https://jdc.jefferson.edu/otpresentations/25AuthorsAmy L. Miller, OTS; Rachel L. Dumont, OTS; Janice P. Burke, PhD, OTR/L, FAOTA; Ellen S. Cohn, ScD,OTR/L, FAOTA; Sarah E. Kauper, OTS; Roseann C. Schaaf, PhD, OTR/L, FAOTA; Eric D. Bull, OTS;Denise G. Doria, OTS; Jamie A. Frank, OTS; Jenna R. Grady, OTS; and Phoi Truong, OTSThis poster is available at Jefferson Digital Commons: https://jdc.jefferson.edu/otpresentations/25Parents’ Goals: An Analysis of Therapist Reasoning Amy L. Miller, OTS1; Rachel L. Dumont, OTS1; Janice P. Burke, PhD, OTR/L, FAOTA3; Ellen S. Cohn, ScD, OTR/L, FAOTA2; Sarah E. Kauper, OTS1; Roseann C. Schaaf, PhD, OTR/L, FAOTA1 with contributions from:  Eric D. Bull, OTS1; Denise G. Doria, OTS1; Jamie A. Frank, OTS1; Jenna R. Grady, OTS1; Phoi Truong, OTS1 1Thomas Jefferson University, School of Health Professions, Department of Occupational Therapy 2Boston University, Sargent College of Health and Rehabilitation Sciences, Department of Occupational Therapy 3Thomas Jefferson University,  School of Health Professions  Background   •  Difficulty processing and integrating sensation is highly prevalent in children with ASD and has been shown to impact participation (Ben Sasson, et al, 2008).   •  Parents’ goals for their child with ASD often focus on independence in ADLs (Schaaf  et al., 2014) and social participation (Cohn, Kramer, Schub, & May-Benson, 2014) •  Occupational therapists have a unique skill set to address these goals and, when appropriate, may use a sensory integrative (OT/SI) approach. •  There is a paucity in the literature describing how OT/SI therapists use assessment data to link SI factors to participation challenges.   -  Data Driven Decision Making (DDDM) provides structure to guide therapist’s clinical reasoning in interpreting assessment data, developing goals and planning interventions (Schaaf, 2015) -  SI factors chosen based on literature (Ayres, 1977, 1989; Ben-Sasson et al., 2008; Mailloux et al., 2011; Reynolds, Lane, & Thacker, 2012)  •  Use of  the systematic DDDM process addresses the AOTA Centennial Vision of  science-driven and evidence-based practice (AOTA, 2007). Findings Methods •  Parent-identified goals for OT/SI most frequently focused on areas related to ADLs, play, and social participation. •  Forty-seven percent of  the goals were classified at the participation level of  the ICF framework, 50% at activity level, and 3% at the body structure-function level.   •  Sensory reactivity (over- or under-reactivity) was the most frequently hypothesized SI factor followed by somatopraxis and sensory perception contributing to goals.  •  ADL’s were most frequently impacted by sensory reactivity and somatopraxis •  Social participation was most frequently impacted by sensory reactivity, perception, and somatopraxis.  Participants Children ages 4-8 years with ASD (n=32) from a RCT evaluating outcome of  occupational therapy using sensory integration (Schaaf  et al., 2014).   ASD diagnosis confirmed through ADI-R and ADOS.   Acknowledgements: This study’s original RCT is funded by Autisms Speaks Foundation Findings 1.  One hundred and sixty goals were identified and developed in collaboration with parents; they were then confirmed by parents for accuracy and rated by importance and relevance. 2.  Using the DDDM process, goals were analyzed to identify underlying SI factors (sensory reactivity, sensory perception, vestibular-bilateral integration, and somatopraxis). 3.  Goals were organized in categories according to OTPF 3 (AOTA, 2014) area of  occupation (e.g. ADLs, Rest and Sleep, Education, Play, or Social Participation). 4.  ICF category (body structure-function, activity, participation) also identified. 5.  Frequency counts of  each area of  occupation, SI factors, and ICF category 6.  Goals were organized into pictorial representations to identify the SI factors impacting each goal area.  Purpose Illustrate the use of  DDDM to develop parent-identified goals for occupational therapy and to identify underlying sensory integration factors hypothesized to be impacting participation. Table 2: Sample of  Parent-Identified Goals, OT Practice Framework Area, Hypothesized SI Factors, and ICF Area Figure 1: Pictorial representation of  patterns of  variation in SI factors impacting OTPF area of  occupation Conclusions Findings emphasize the value of  addressing parents’ goals and the need to identify the factors that may be impacting these goals.  DDDM can be used to guide an occupational therapist’s reasoning when identifying and analyzing goals. •  A comprehensive assessment of  sensory integration is an important component of  the occupational therapy process for children with ASD when parent-identified goals relate to ADLs, play, or social participation in daily routines.  •  Parent-identified goals for occupational therapy focused on activity and participation-related outcomes of  ICF framework highlight the importance of  these areas in the daily lives of  children and families with ASD. •  Through systematic clinical reasoning and analysis of  assessment data, therapists should consider that parent identified goals may have a sensory basis.  •  Sensory reactivity is found to be an impactful SI factor, which is congruent with  parents’ identification of  poor self-regulation of  behavior as an explanation for seeking OT/SI intervention (Cohn et al., 2014) •  The use of  DDDM provides a roadmap for occupational therapists to explicitly use assessment data to link parent-identified goals to hypothesized SI factors impacting occupational performance. -  Use of  data to customize interventions to address and measure outcomes at the SI factor level (proximal outcome) and the participation level (distal outcome) Interpretation and Implications Goal OT Practice Framework Area Hypothesized SI Factors (based on assessment data) ICF Area JM will decrease oral-tactile sensitivity as a basis for ability to brush his teeth for 1 minute, one time per day. Activity of Daily Living Sensory Reactivity Activity RB will improve body awareness and motor planning as a basis for parallel play with other children for 5 minutes on 3/5 days per week.  Play Somatopraxis Participation DS will decrease auditory and tactile sensitivity to remain asleep for 5 hours per night. Rest and Sleep Sensory Reactivity Participation KM will decrease sensory over-reactivity as a basis for decreased self-stimulating behaviors and improved ability to self-calm. Unable to identify OTPF area of occupation Sensory Reactivity Body structure and function Goal Analysis Table 1: Participant Demographics Mean age in months (SD and range)	  71.8 (SD = 12.8; range = 4.0 = 7.11)	  Gender (% male)	   81.25	  Ethnicity (% Caucasian, Asian, and not reported)	  90.6% Caucasian, 6.25% Asian, 3.1% not reported	  Percent of parents with education at 4 year degree or higher	  62.5%	  Non-verbal IQ (range) 	  93.4 (55-119)*	  Mean ADOS autism severity score (range)	  8.08 (5-10)	  !!!!!!Rest%&%Sleep%%(n=8)%Problems%in%Sensory%Reactivity%(n=6)%Problems%in%Sensory%Perception%(n=2)% ! !!!!!!!!!!!ADL’s&(n=81)&Problems&in&Sensory&Reactivity&(n=34)&Problems&in&Sensory&Perception&(n=12)&Problems&in&Somatopraxis&(n=33)&Problems&in&Vestibular&Bilateral&Integration&(n=2)&!! !!!!!!!!!!Social'Participation''(n=38)'Problems'in'Sensory'Reactivity'(n=17)'Problems'in'Sensory'Perception'(n=11)'Problems'in'Somatopraxis'(n=9)'Problems'in'Vestibular'Bilateral'Integration'(n=1)'!! !!!!!!!!!!!Play!(n=24)!Problems!in!Sensory!Reactivity!(n=11)!Problems!in!Sensory!Perception!(n=3)!Problems!in!Somatopraxis!(n=8)!Problems!in!Vestibular!Bilateral!Integration!(n=2)!!!!!!!!!!Education*(n=9)*Problems*in*Sensory*Reactivity*(n=5)*Problems*in*Somatopraxis*(n=3)*Problems*in*Vestibular*Bilateral*Integration*(n=1)*References American Occupational Therapy Association. (2007). AOTA’s centennial vision and executive summary. American Journal of Occupational Therapy, 61(6), 613-614. doi:10.5014/ajot.61.6.613 American Occupational Therapy Association [AOTA]. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48. doi:10.5014/ajot.2014.682006 Ayres, A. J. (1977). Cluster analyses of measures of sensory integration. American Journal of Occupational Therapy, 31(6), 362-366. Ayres, A. J. (1989). The sensory integration and praxis test. Los Angeles, CA: Western Psychological Services. Ben‐Sasson, A., Cermak, S., Orsmond, G., Tager‐Flusberg, H., Kadlec, M., & Carter, A. (2008). Sensory clusters of toddlers with autism spectrum disorders: Differences in affective symptoms. Journal of Child Psychology and Psychiatry, 49(8), 817-825. doi:10.1111/j.1469-7610.2008.01899.x Cohn, E. S., Kramer, J., Schub, J. A., & May-Benson, T. (2014). Parents’ explanatory models and hopes for outcomes of occupational therapy using a sensory integration approach. American Journal of Occupational Therapy, 68(4), 454-462. doi:10.5014/ajot.2014.010843 Mailloux, Z., Mulligan, S., Smith Roley, S., Blanche, E., Cermak, S., Coleman, G. G., Bodison, S., & Lane, C. J. (2011). Verification and clarification of patterns of sensory integrative dysfunction. American Journal of Occupational Therapy, 65(2), 143-151. doi:10.5014/ajot.2011.000752 Reynolds, S., Lane, S. J., & Thacker, L. (2012). Sensory processing, physiological stress, and sleep behaviors in children with and without autism spectrum disorders. Occupational Therapy Journal of Research, 32(1), 246-257. doi:10.3928/15394492-20110513-02 Schaaf, R. C. (2015). Creating evidence for practice using data driven decision making. American Journal of Occupational Therapy, 69(2), 6902360010p1-6902360010p6. doi:10.5014/ajot.2015.010561 Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E., Freeman, R., Leiby, B., Sendecki, J., & Kelly, D. (2014). An intervention for sensory difficulties in children with autism: A randomized trial. Journal of Autism and Developmental Disorders, 44(7), 1493-1506. doi:10.1007/s10803-013-1983-8 

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Parents\u27 Goals: An Analysis of Therapist Reasoning

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