The OT Coaching pilot was informed by the Occupational Performance Coaching (OPC) evidence base.

OPC is an approach which focuses on ensuring families/parents are listened to and understood, in order for them to feel empowered and confident in achieving what they need and want to do as a family. OPC is based upon providing families and parents/caregivers opportunities to feel confident, competent to create and use new ideas and strategies with the guidance and support from an Occupational Therapist.

In December 2021, bounceOT were lucky enough to receive £10,000 grant funding from the Scottish Government’s Community Mental Health & Wellbeing Fund.

Information about this fund, and what we were going to do with the funding, was blogged about at the start of this year. You can read it here –

bOunceT to share in £400,000 Mental Health fund

The wider project was evaluated and a report was produced – link to blog about this

In addition, a report specifically about the OT Coaching sessions was produced by Callum MacKinnon (Founder & Lead Occupational Therapist) and Euan Scott (Occupational Therapist). This will be linked soon.

It all started from when Andraya (Student Occupational Therapist) previously created a guide about OPC as part of her final year research project.

microsoft-teams image

This manual was previously ‘approved’ by the author of the OPC manual, Fiona Graham from New Zealand, and acts as the foundation to implementing OPC in practice at bounceOT.

Furthermore, Lois, another Student OT, had taken this forward and began delivering OPC-type OT sessions with families.

You can read about Lois’ experience in more detail here!

So, when bounceOT recieved funding to deliver a specific pilot with 10 local families, Euan was recruited to the post of Occupational Therapist.

The intervention of OT Coaching met at least 1 of the 5 outcomes proposed by bounceOT (within the initial funding application) –

Parents & Carers to have a non-judgemental, safe, and confidential space to express
their feelings and concerns about their children and/or the people they support.

About OPC

Occupational Performance Coaching OPC has been described in literature as “an
intervention for working with parents to achieve occupational performance goals for
themselves and their children” (Graham & Rodger, 2010, p. 212).

Although adopting a Coaching approach in clinical practice is something that may have previously been considered by OT’s previously, the structured intervention we call OPC was originally conceptualised in
2010 by a team of OT’s in Otago University, New Zealand.

The ultimate objective of OPC is to enable occupational performance in the areas identified as goals and improve caregivers’ skills to independently manage future occupational performance barriers

(Graham et al., 2013, 2014)

In this approach, the practitioners guide parents in developing strategies and supports to meet self-identified goals related to their family’s needs. These sessions adopt a solution focused, strengths-based approach to enabling parents and carers to be the professionals – relying less on external support from others in future situations they find challenging (e.g. at home or in the community with their children).

The potential for OPC in clinical practice

OPC is person-centred, and family-centred, by nature which matches the holistic working we want to achieve at bounceOT. This intervention sounded like something that would fill a much needed gap in service provision for the community we support.

It is well documented across research, and from direct feedback by parent carers, that those supporting children and young people with disabilities are at a higher risk of suffering mental health challenges. This is a result of the significantly increased parenting role, and the shift from ‘parent’ to ‘carer’ which often challenges parents’ self-identity.

Furthermore, despite statutory services offering some direct interventions to parent carers it is well noted that this support can: a) be education focused or purely information ‘workshops’ to learn about their child’s condition/needs ; b) feel ‘patronising’ as parents are taught ‘how to be better parents’ (as some have stated) ; c) still be for the overall benefit of their child (instead of aiming to improve the health and wellbeing of the parent carers themselves).

It appears that across statutory services the whole family’s needs are not considered within therapy – mainly due to demand and capacity. For example, when services provide support to children and young people another referral would need to be made to another team (with their own processes and capacity challenges) to support parents and carers. Therefore, holistic working and adopting a person-centred culture is, unfortunately, still not the norm for our community.

OPC has the power to be so much more than an educational approach, or simply giving parents the tools for self-management. OPC enables the therapist to work directly with – and alongside – parent carers to overcome challenges and set meaningful goals they choose (e.g. how they deal with a challenging situation – for their benefit – instead of only thinking about what needs to be in place for their child).

OPC has the potential to view the parent carer as a person again [out with their role as a ‘parent’ or ‘carer’] with their own likes/dislikes, interests, motivations, and wants/needs.

The pilot project

This pilot supported 10 parent carers over 8 x 1 hour (weekly) Coaching sessions. These sessions were completed on a one-to-one basis with Euan (Specialist Occupational Therapist) virtually via Microsoft Teams or Telephone, as per the needs and wishes of each parent carer.

Prior to starting the sessions, Euan spoke with the parent carer informally to make sure they fully understood the purpose and process of the sessions, finally confirming they wished to proceed. This meeting also encouraged discussions around their expectations, whilst Euan confirmed that OPC would not be a ‘quick fix’ or ‘treatment’.

During the initial coaching session, Euan and each parent carer identified areas of their child’s performance (in daily tasks) and/or behaviours which could be used to ‘focus’ conversations across all sessions. Alternatively, parent carers could identify areas of challenge in their own lives, or daily tasks, because of their (often stressful) role as both ‘parent’ and ‘carer’.

The Canadian Occupational Performance Measure (COPM) was followed as a standardised outcome measure from the first, to final, Coaching sessions. The COPM allows the parent carer to rate their satisfaction levels against the performance – or participation – in ‘XYZ’ (any task or activity). The satisfaction could be related to their own – or their child’s – independence in completing self-care tasks, the number of times they complete an activity, or how well challenging situations and/or behaviours are controlled. Obviously, these will depend on what areas of challenge has been identified by each parent carer.

Once each parent carer had decided upon what is of greatest importance to them and their child, Euan facilitated analytical conversations across various 1:1 sessions to help the parent carer identify the challenges or barriers to what they felt was satisfactory performance. Through reflective discussions prompted by the therapist using the coaching approach, all parent carers felt empowered to plan actions (by themselves, with as minimal direction as possible) to help them overcome the challenges/ barriers they identified.

The process of identifying challenges/barriers to satisfactory performance through reflective conversations, paired with the planning of actions to overcome said barriers provided a regular structure for the coaching sessions.

Case Study – M

M currently operates his day in a very rigid schedule. There is little to no flexibility within it and deviation from this has the potential to trigger strong emotional responses.

  • M is heavily dependent on parents to dress/undress socks and shoes – despite being physically able to perform this activity independently.
  • Parent’s eager to explore increasing flexibility within M’s routine, to hopefully reduce
    pressure on M’s anxiety and improve wellbeing for the whole family.
COPM Score [Start]

Importance of Mitchel’s independently putting on his shoes and socks – 9
Performance – 2
Satisfaction – 1
Importance of M’s flexibility in daily routine – 8
Performance – 4
Satisfaction – 1

COPM score [Final]

Importance of Mitchel’s independently putting on his shoes and socks – 9
Performance – 8
Satisfaction – 10
Importance of M’s flexibility in daily routine – 8
Performance – 8
Satisfaction – 10

Ensuring consistency and best practice…

Euan was able to follow guidance from Getting It Right For Every Child (GIRFEC) and ensure
the key people and services providing support to M were made aware of updates from
Coaching sessions.

Euan was invited along to these multidisciplinary meetings by M’s parents and shared
feedback alongside them, to other professionals and services.

This was to ensure that all providers were aware of the support M’s parents had received from
us, and to discuss how learning from this intervention can be used in conjunction with the
current support M is receiving. This holistic approach encourages much-needed consistency in
M’s support, especially since the challenges his parents experience are routine related.

Parent carer reflections…

“Now, we can all enjoy ‘family fun time’ and experience ‘normal, everyday activities’ with less
stress and anxiety.”

M’s parents have reflected about how meaningful the Coaching sessions have been for them on two different levels. First, they feel M is less anxious and can function better throughout his day and across different environments.

Naturally, they are much happier their son is happier and healthier. However, arguably more importantly, M’s parents feel their own health and wellbeing has significantly improved. They have developed skills needed to continue implementing strategies by themselves at home (when other challenges arise in the future), and they feel they have more time for themselves – and their other child who can often ‘fade into the background when trying to support M’.

Evaluation of the project

Overall, Euan (Specialist Occupational Therapist) supported 10 parent carers across the pilot – but 3 did not complete the full 8 x1 hour sessions due to their personal needs arising at the time. Ironically, most barriers stopping engagement with Coaching were challenges related to managing their child’s behaviours and/or finding time to speak (as they were busy or too burnt out to participate).

For those parent carers who progressed through the block of assessment and review meetings with Euan, they all began to develop clarity around the challenges/ barriers to their child’s occupational performance, whilst independently developing strategies they could adopt to support them and/or their child.

The image below has been taken directly online from the feedback survey –

Again, 100% of parent carers reported that skills developed over the course of the sessions
would be carried forward in their daily lives.

Other direct, qualitative feedback from parent carers highlights they do not want any changes
to how Coaching is delivered by Euan – but some would appreciate more time in between
sessions. It was proposed that fortnightly review meetings with Euan would be more beneficial
than weekly, to allow more time to implement the strategies discussed, and
reflection/evaluation time for the parent carers themselves. Similarly, 50% of parent carers
suggested they would be open to in-person Coaching sessions – with appropriate COVID
measures in place.
When asked ‘how’ has the sessions helped, answers included:

  • “I have a much better understanding of why my sons behaviours were presenting in this
    way.”

100% of parent carers surveys would recommend Coaching sessions to other parents and carers.

Key words used to describe Coaching:

Supportive; Empathetic; Professional; Informative; Positive; Enriching; Clarifying; No Pressure; Very Detailed

Related Posts

Leave a Reply