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Perceived competence of parents with children receiving occupational therapy services: A qualitative study
Leslie Davidson, PhD, OTR/L, FAOTA; Bonnie Riley, OTR/L, BCP
Rachel Baker, MOTS; Carly Lewis, MOTS; Jennifer Simpson, MOTS; Mary O’Rourke, MOTS; Kate Wallace, MOTS; Nicole Westhafer, MOTS
Shenandoah University Division of Occupational Therapy, 1775 N. Sector Ct., Winchester, VA 22601
Objective/Goals
Literature Review
Methodology Discussion/Conclusion
Recommendations for Future Research
The purpose of this study was to provide a greater
understanding of the various challenges that parents face
when caring for a child with special needs and how
occupational therapists may better support them to
participate in meaningful occupations and feel
competent in their roles. Currently, there is minimal
literature connecting role competence and occupational
therapy support.
Research Questions
1. How do parents of children receiving occupational
therapy services perceive competence in their
parental roles?
2. How can occupational therapists support parents in
their parental roles?
3. What are parental needs related to perceived parent
role competence?
Objectives of Study
1. Understand how parents of children receiving
occupational therapy perceive their competence in
their parental roles.
2. Identify what parents need to feel competent in their
parental roles.
3. Describe how occupational therapists can better
assist parents in their parental roles.
Literature supports collaboration between therapists and parents of
children receiving occupational therapy services to facilitate meaningful
intervention. In addition, parental roles and competence influence parental
stress factors. These stress factors have been found to influence a parent’s
ability to collaborate with therapists successfully. While the literature
addresses barriers to collaboration, caregiver roles, and competence, there
are remaining gaps. Primarily, the gaps are in understanding how
occupational therapists can support parents in their roles and address
barriers to deliver the best possible intervention.
Tools for Successful Pediatric Treatment Outcomes:
● Collaboration with Caregiver: Parents provide understanding of
social/natural environment (Anaby et. al, 2014), perspective of home
life (Hanna & Roger, 2002), and engage in co-occupations (Pickens
& Barnekow, 2009) .
● Roles of Caregiver: Multidimensional factors influence parent’s
stress including role conflict, financial burden, care burden, and
independence. (Ratcliffe, 2002). This supports research into family-
centered care and understanding the roles and influential factors that
affect parent stress
● Competence of Caregiver: Increased competence correlated with
improved occupational performance, performance goals, and mother’s
satisfaction with child performance (Graham et al, 2013).
Barriers to successful Collaboration:
● Time (Novak, 2011)
● Stress (Dabrowska & Pisula, 2010; Herring et al. 2006)
● Satisfaction, adaptability (Bendixon, et al., 2011)
● Beliefs, values, resources (Hanna & Rogers, 2002)
● Other siblings . (Rivers and Stoneman, 2003)
Re-sculpt Questions:
In future studies questions may be re-sculpted with
consideration of the themes found.
Consider Transitional Periods
Future studies may consider how transitions affect
parental roles, so that occupational therapists can better
support families during these time periods. Present
research suggests that parents experience decreased
competence during transitions.
Analyze Length of OT Services/Relationship
Future research may also consider asking parents how
long their children have been receiving occupational
therapy. Potentially the length of time a child has been
receiving services may have an affect on the relationship
established between the occupational therapist and the
parent.
Consider How to Contact Parents
Researchers could also ask what time of day is best for
parents and how they initially wish to be contacted (ie:
email, phone), which may make arranging a time for
interview easier.
Materials
● QuickTime and Microsoft Word programs were used on
MacBook Pro laptops to audio record and transcribe
interviews.
● Excel was also used to store contact information.
Sample
● Participants were required to be parents of children ages
5 to 12 years old receiving occupational therapy.
● Excluded were parents of medically fragile children.
Recruitment
● Participants were recruited through convenience and
snowball sampling methods.
● Flyers were posted in the Winchester and Northern
Virginia area where children receive occupational
therapy services.
Measures and Procedures
● Interviews were completed by telephone following
completion of an online survey through SurveyMonkey
and agreement to participate in a follow-up interview.
● Two members of the research team were present during
each of the interviews. One member conducted the
interview and the other completed field notes.
● Interview information was transcribed and then line-to-
line coded by four separate researchers to identify
categories and themes. These researchers then
triangulated findings.
Interviewers were semi-structured to allow for further
questioning.
1. Share with me your experience as a parent?
2. How has your role as a parent been shaped by your child
who has been receiving occupational therapy services?
3. How do you understand the role of occupational therapy
a. In your child’s life?
b. In the life of your family?
c. In your life as a parent?
4. How do you believe your child’s OT understands your
experiences as a parent?
5. How has the occupational therapist worked with you to
support your parenting skills?
6. How could an OT work with you or other parents to
enhance experiences in your parenting roles?
7. What other things would you like to share with me about
the topics we discussed today?
Throughout interview and analysis, themes emerged
from gaining the perspective of parents. When
collaborating with parents to support engagement in
occupation, the following considerations should be
made:
Perceived Parental Competence:
1. Competence feelings are not linear, but are multi-
dimensional, affected by day-to-barriers, thoughts,
and circumstances.
OT’s Support Parents:
2. OTs can help minimize barriers to engagement in
various roles by focusing on supporting children to
achieve greater independence.
Parental Needs to Competence:
3. Finding a right balance for parents to support their
child & minimizing stress for the parents
Limitations:
● Time constraints
● Only three interviews were completed.
● Lack of diversity in participants: all married women.
● Language barrier
● Lack of saturation in research
Results
Interview Questions
OT ROLE
Parents of children
who receive OT report
their child’s progress
towards independence
has decreased their
parental burden.
Participant #2:
“I notice small things like how he picks up
small piece of paper or a small toy on the
ground. . .Everything, from writing to
picking up things from him dressing. . .It has
really impacted me in a significant way
because it involves everything. ..it has
impacted me to really understand how I can
help him to achieve the goals. . . what
techniques I can use to improve his ability to
do things and life skills.”
Participant #3
”I did not know how to approach. I was
trying to teach him the same way that I was
teaching the older one and that is not
working out for him. That is where
occupational therapy really came into the
picture.”
CONTRIBUTORS
TO COMPETENCE
Parents report the
priorities they have
made for their
children have
contributed to their
current level of
functioning but are
overwhelmed by the
multiple things they
need to manage to feel
competent in all life
roles.
Participant #1
“It’s...very very very difficult trying
to integrate everybody’s schedules
and therapies”…difficult to have
family outings , he is just very set in
his ways”. I stay home with him
which not ideal.” (In terms of
occupational therapy) they would
give us so much to do and it was like
I couldn’t figure out how I could do
all, I would spend my whole day
doing those things…I would feel
guilty, when
I didn’t do all of it”
PARENTAL
PERCEIVED
COMPETENCE
Parents of children
who receive OT
services report feeling
competent in their role
but this feeling of
competence has
evolved over time and
is inconsistent.
Participant #1
“I also feel …in the beginning it was
difficult because we didn’t know what
was wrong with him” Now that we have
one (diagnosis), it’s easier for everyone
to understand why he is like he is.. I see
myself as successful umm… first of all
umm… he knows that he has a family
that loves him, and [crying] sorry, I think
he’s secure and happy.”
Participant #2
“My experience as a parent… its kind of
uh challenging, I would say very
challenging…It (OT) has affected me in
a very positive way… what techniques I
can use to improve his ability to do
things and life skills.”
Participant #3
”I don’t feel successful because
everything is new. It is a constant,
constant learning process for me.”
Themes emerged from two of the three studies, one
interview was an outlier.