The Engaged Child in Occupational Therapy

Abstract

Background. 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).

Strategies occupational therapists use to engage children and parents in therapy sessions

“…Existing research that outlines child and parent engagement strategies in occupational therapy is based solely on perspectives gained from interviews (D'Arrigo et al, 2019(D'Arrigo et al, , 2020James et al, 2015;King et al, 2019;Phoenix et al, 2019;Smart et al, 2016). This study aimed to enhance understanding of how engagement strategies manifest when working with children and parents.…”

“…Recent research has identified engagement strategies used in paediatric rehabilitation and developmental settings that are aligned with the tenets of Self-Determination Theory (SDT;D'Arrigo et al, 2019D'Arrigo et al, , 2020Meyns, Roman de Mettelinge, van der Spank, Coussens, & Van Waelvelde, 2018;Smart et al, 2016). According to SDT, three psychological needs (autonomy, relatedness and competence) must be nourished in therapy to promote optimal performance and growth (Ryan & Deci, 2017).…”

“…This was identified by therapists as a "dance" to maintain child engagement. This conceptualisation is linked with recent research which highlighted how therapists perceived that their responsivity and flexibility to the child enhanced child engagement in occupational therapy (D'Arrigo et al, 2020).…”

“…Recent research on the strategies used in occupational therapy to engage with children and parents draws heavily on the perspectives reported by therapists and clients (D'Arrigo et al, 2019(D'Arrigo et al, , 2020James, Ziviani, King, & Boyd, 2015;King et al, 2019;Phoenix, Jack, Rosenbaum, & Missiuna, 2019;Smart, Aulakh, McDougall, Rigby, & King, 2016). While this research has provided information about key stakeholders' perceptions of how to engage children and parents, the ways in which paediatric occupational therapists actually engage their clients has not been supported by direct observations.…”

“…A range of practices documented in occupational therapy literature have been proposed as strategies to enhance child and parent engagement (D'Arrigo, Copley, Poulsen, & Ziviani, 2019; D'Arrigo et al., 2020). The primal importance of developing a therapeutic relationship is well recognised in occupational therapy practice as a means of enhancing patient outcomes (Taylor, 2008).…”