How to empower carryover using a strengths-based approach?
“In a strengths-based approach to intervention, the strengths of the child and family are identified and become the building blocks for skill development and optimal participation.” (Case-Smith & O’Brien, 2014). Therapists seek what the child does well and how to leverage that as they plan a program of support (Dunn 2011).
Using a strengths-based approach to carryover empowerment means that therapists can implement simple guidelines throughout the phases of carryover empowerment that will increase family compliance with the program. It helps to view carryover empowerment along three basic steps: develop the program together, review adherence and offer feedback & adaptions.
Develop the program together
Program development is when therapists work in collaboration with caregivers to design the home program that best fits both the customized intervention, and the family’s routines and culture. In a strengths-based approach therapists harness strengths first when they design program that expands competencies and participation (Dunn, 2011). Here are simple strengths-based strategies therapists can follow during program development:
- Pair a therapeutic intervention to a family routine that works well for the family.
- Expand an existing activity the child is good at, to incorporate interventional value.
- Leverage settings that are easiest for caregiver and child to practice new activities.
- Maintain a balance: don’t use up all the family’s favorite times together…
Carryover empowerment program needs to be reviewed by therapist in order to relay its importance to the family. Studies have shown that reviewing home program is the single most important thing therapists can do to increase compliance (Bryant et al, 1999). There is value in reviewing the program standalone of offering any feedback or making adaptations to the program. This separation helps maintain a non-judgmental approach to the review – the therapist does not have to say anything or offer any feedback. Here are simple strengths-based strategies therapists can follow during program review:
- Therapist can pre-review adherence measurements alone, and focus on positive outcomes in the joint review.
- Reviews with higher adherence rates can be given more time and attention.
- Poor adherence can lead to seeking the glass half full. E.g. there was less need to comply because the child was more independent in self-care. (Baranek et al 2002).
Offer feedback and adaptions
Carryover program is dynamic. It evolves with therapy and with family’s engagement level. If it stays static, there will be an inevitable drop in adherence, so it is the therapist’s role to preempt such situations by keeping the program dynamic. This can be done directly or by using a coaching methodology to guide parents towards parent-initiated solution finding (Graham et al, 2009). Either way, in a strengths-based approach feedback and adaptations therapists can build on previous success. Here are simple strengths-based strategies therapists can follow during feedback and adaptation phase:
- Identify activities that worked last time, and expand their interventional value.
- Replicate things that worked into new interventional activities.
- Show parents the relationship between compliance and their desired targets.
- When addressing activities that were not implemented, try to pair the interventional activity to a different family routine that has a better strengths-based context.
- Constantly seek for new strengths to keep the program relevant: e.g. “what does the family like about this upcoming holiday?”
Strengths-based approach to pediatric therapy leads therapists and parents on a quest for finding child and family strengths. Carryover empowerment structure helps guide therapists and families towards the ‘holy grail’ of generalization and participation in the child’s natural environment. Embedding strengths-based principals into the carryover empowerment process significantly increases the chances of a successful journey!
Case-Smith, J., & O’Brien, J. C. (2014). Occupational therapy for children and adolescents. Elsevier Health Sciences.
Dunn, W. (2011). Best practice occupational therapy for children and families in community settings. Thorofare, NJ: Slack.
Bryant, M. J., Simons, A. D., & Thase, M. E. (1999). Therapist Skill and Patient Variables in Homework Compliance: Controlling an Uncontrolled Variable in Cognitive Therapy Outcome Research. Cognitive Therapy and Research, 23, 381-399.
Baranek, G. T., Chin, Y. H., Hess, L. M. G., Yankee, J. G., Hatton, D. D., & Hooper, S. R. (2002). Sensory processing correlates of occupational performance in children with fragile X syndrome: Preliminary findings. American Journal of Occupational Therapy, 56(5), 538-546.
Graham, F., Rodger, S., & Ziviani, J. (2009). Coaching parents to enable children’s participation: An approach for working with parents and their children. Australian Occupational Therapy Journal, 56(1), 16-23.
Oren Steinberg is co-founder of SensoryTreat, providing a carryover empowerment platform for pediatric therapists and caregivers of children with Autism and other developmental disabilities.