School should be an exciting, fun and stimulating time for all children, but for some it can be daunting, challenging and confusing. Things that some children seem to grasp easily can present as a baffling mystery to others. Practical tasks such as tying shoe laces or working out how to put on a jumper that’s turned inside out, which others do with ease, if you cannot master these skills can be a barrier to enjoying PE and provide unde anxiety and stress. Not understanding the unspoken subtle school rules – how to line up without bumping into other children, how to sit still in carpet time, not fidgeting when everyone else is working or just being able to concentrate at the right time to hear the teachers’ instructions, to some children, these can seem like major obstacles and at worst can be a huge barrier to success. Most children work through this without specialist help, but for others - they need something extra.
Occupational Therapy is concerned with enabling people to participate in daily life so they can do the things they need to do, want to do or are expected to do. School life places lots of expectations on children, as an adult you can choose not to have spaghetti in a restaurant, but for children they have to join the queue to jump over the gym horse. For children who have difficulty with daily occupations, it can have a huge impact on their success and enjoyment of school.
Daily life is made up of many occupations, such as :
- self care – looking after themselves as they grow up, dressing, using the toilet, participating at mealtimes
- being productive – school work, using school equipment such as scissors, writing,
- Play and leisure – making friends, socialising in the playground, going to scouts,
Traditionally the health service has been based on medical referrals into services. This has meant that access to the right services at the right time can be challenging at the best of times. When demand is high, individual referrals to services working only at specialist levels can create waiting lists – and for a child with a difficulty in school today, this is frustrating at best and unacceptable at worst. The good news is that times are changing. Services are responding to demand and new flexible approaches to occupational therapy service delivery are being adopted so that occupational therapists work with children on different levels.
The universal level.
This is where the occupational therapist would work on a whole school approach and not necessarily for children with an identified difficulty. This could be working with teachers to improve handwriting legibility or activities to promote lifestyle changes such as preventing obesity. The key factor is up-skilling those who work with children to provide better services for all children. Occupational therapists might provide training for nurseries so children can learn to dress themselves in readiness for school, or provide training and support for a school to help children develop early writing skills and develop handwriting policies.
The targeted or selected service level
Here occupational therapists work with school and parents to offer support and intervention for children identified as having some difficulty with an element of daily life which impacts on their occupations. This might be through a group such as a life skills programme to improve self management to deal with social behaviours such as anger management issues, a group just for children with developmental coordination difficulties to address their needs, or running groups to support handwriting, scissor use, ruler use, co-ordination for PE at school.
The specialist level.
Here services are provided for children with identified mental, physical emotional or behavioural needs. Specialised assessment and intervention is provided. This might include contributions to the new school Education, Health and Care Plans, providing equipment or adaptations for to the environment for access or daily living or individualised intervention approaches through groups or on a one to one basis.
One service in Scotland has even turned the notion of a referral on its head. They now accept “requests for assistance”. This allows for a new flexibility in approaches to intervention.
The importance of working together
The child and those around the child are key players in enabling the child to participate in their chosen occupations. Occupational therapists help by working with the child, school and family to identify and understand what difficulties the child or young person faces. Occupational therapists consider three elements – the person, the environment and the occupation (or task). If a child is having difficulty completing his maths, it may be that the child is having difficulty with setting out the sum on the page, or it may be the environment that needs adapting - being seated by the colourful art display is distracting or perhaps the task needs breaking down to smaller steps. The occupational therapist can suggest ideas and advice on alternative ways of working, adapting the environment or different techniques.
So how can OT facilitate and support children to be able to self-manage their difficulties and to participate in the occupations that they are required and expected to do at school, or enjoy the things that they want to do?
Firstly helping the child set goals and outcomes that are meaningful to them. Then with the child agree a plan to achieve this, with the child to work out strategies to overcome the difficulties. Afterwards review to see how well it worked and use the learning from that to move forward. Cognitive strategies can successfully improve performance and focussing on enabling participation is a very effective intervention technique (COT 2014). Whether it is riding a bike, tying a tie or coping in the playground, the important thing is that the child chooses the occupation to be mastered.
Using resources wisely and flexibly and working with everyone involved to provide different levels of service ensures greater reach and better outcomes. Working so that children and young people can be equipped and confident to take over their own management - that is surely the greatest success of all. For further reading please see this interesting article on the BBC www.bbc.co.uk/cbeebies/grownups/article/children-with-dyspraxia
Head of Professional Practice
College of occupational Therapists
College of Occupational therapists Evidence Fact Sheet: Maximising the potential of children and young people through occupational therapy 2014