How to explain to clients the approach and manage their expectations around shift from treatment with child.
Shifting from an impairment oriented, therapist as expert approach to a coaching approach with a client you have worked with previously is much harder than starting afresh with a client who hasn't known you to work any other way. If you are beginning your coaching journey, you may choose to continue to use your traditional methods with existing clients, while you build your coaching skills and confidence. Remember that therapists vary widely in how they engage with clients and what they offer, so clients are not usually clear on what to expect regarding how a therapist works. They usually just want things to be different in their everyday life, and OPC will certainly help them to achieve that, so focus in on learning more about what is most important to the client. This can be framed as a 'pause and refresh' moment in your work together. For example, 'would you be open to discussing afresh what is most important for you (and your child/loved one) in your everyday life? Coach the client toward an expression of their preferred future vision as 'participation in life', with at least an activity and context specified in the final goal statement. Remember too, that high level research evidence supports the key therapist behaviors of OPC: Client-led, participation focused goal statements that are documented and measured before and during intervention and autonomy supportive communication that situates the client as the primary problem-solver and decision maker. We don't recommend giving a formal explanation of OPC to clients unless they ask for it. If they do ask for an explanation, something brief like: I'm taking an approach with you (and your child/loved one) that puts your goals and priorities at the centre of what we do together. My focus is to coach you to find solutions that work best for you and your family. I 'll ask you some questions about what is important to you and what you've observed happens and helps, and share with you any ideas I've learnt from others.
What does written communication informed by OPC look like?
Our written communication as health professionals seldom captures all our transactions with clients, but they do reflect ad raise our attention to what we see as most important in our work. Written documentation that is designed to be shared with others (e.g., clients, colleagues, other services) convey not just what we have done, but the values that underpin our work. When reporting out work with clients using OPC, we want to convey our respect for and belief in client's agency over their lives and competence to achieve their goals.
Clinical case notes and formal reports following OPC are oriented around client goals and highlight client authority, decision-making, and expertise. As such, OPC documentation emphasizes client strengths, capacity, and resourcefulness. Significant barriers, difficulties, and uncertainties are noted, when necessary, but these are not the central focus of written narratives, consistent with the main focus of OPC and aspired for occupational performance situations, solutions, and possibilities.
Access resources for documentation in our "Tools for implementing OPC"
More information in the 'Occupational Performance Coaching' manual for Practitioners and Researchers.
Does OPC translate across diverse cultures?
OPC has been implemented in New Zealand, Australia, Canada, the United States, Iran, Ireland, the United Kingdom, Germany, and Brazil. OPC has been formally evaluated in a number of these countries. While findings from published studies on OPC across these cultures have been positive, there are many unexplored questions about the cultural translation of OPC.
The majority of publications on OPC occur in English. Some OPC resources have been translated into other languages as interest in OPC expands. With translation of words comes the challenge of translating and adapting concepts across cultures.
More information in the 'Occupational Performance Coaching' manual for Practitioners and Researchers.
Won't clients expect a traditional intervention approach? How do we introduce this approach with them?
Listen to the family and acknowledge what they were expecting. Give them the chance to voice what they would like it to look like. Introduce OPC (You may like to use the visual of the process) and check in with them as to whether this feels like it is the correct approach. Acknowledge that this approach will draw on their knowledge of their child.
Does coaching use more 'therapy time' to implement compared to traditional interventions – what's the evidence?
It does take time to build connections and relationships however our experience is that we are able to build more capacity for families using OPC so that they can generalize the strategies or problem solving to different areas of the child or family's life. Therapists have commented that they find it takes time as they feel they need a full OPC session with the parents and don't feel they have the time. However, if OPC is used at the beginning for on boarding then the family feel heard, and the therapists can support their goals rather than following their own agenda. Evidence from our research indicates that sessions, and episodes of care are shorter when OPC is used compared to therapists' traditional approaches. If therapists attempt to continue to do therapist-led processes of care e.g., routine impairment-oriented assessment as well as coaching, then this does take longer.
What if the client does not choose to prioritize the goals that I think they need?
In OPC our priority is support clients toward participation in occupations and life situations that are meaningful to them. Unless goals are actively causing harm to self or others, it's not for us to judge what a client's goals should be or what we consider would be 'more appropriate' goals. We need to hear the voice of the child and family. Connection before direction.
What if the client selects strategies or plans that are not safe e.g. could lead to child choking?
Where there is a risk of harm to self or others in a selected strategy, this should be openly discussed to ensure the client is aware of the risk. If they decide to use the strategy anyway, document your concern and what was discussed, but don't convey a moral judgement about the client's choice as this will only diminish the clients' trust in you and therefore, future disclosure of what really happens. If they are determined to go ahead with an unsafe strategy, remember, they were going to do that anyway, regardless of if they had shared their behavior with you. It's a positive sign of their trust in you that they shared their intentions with you. Harmful strategies don't generally work that well and by maintaining the relationship you will be able to maintain the client's sense of autonomy as they discover this and drop the strategy. In serious circumstances, where strategies constitute abuse, then the usual processes of involving authorities apply.
As a service leader, how can I support application of OPC?
Support practice change at all levels
Strong leadership, which clearly supports a transition to prioritizing client agency, as required with OPC, makes a substantial different. Leadership support includes advocacy for changes to service design, a reconsideration of the info metrics that indicate quality, efficient services, and supporting staff if formally challenged by other agencies for not executing an impairment-oriented health system agenda.
Mentor new staff
New staff to a service using OPC often have to learn quite different ways of working form what they have previously been used to, in addition to learning how to do OPC. New Staff should be given the opportunity to observe a range of different professionals working with children and families to see how the principles of OPC are applied. New staff can also be provided individual mentoring from colleagues in how to apply OPC.
More information in the 'Occupational Performance Coaching' manual for Practitioners and Researchers.
Can you use OPC with Telehealth?
This very much depends on the family's preferences and what they are comfortable with. Telehealth can enable other family members to be involved in the process who are working or unable to attend clinic appointments. OPC is a relational process so if the family are comfortable telehealth can be very effective.
How does OPC impact on practitioner time use?
OPC can take longer initially compared to more traditional approaches in which practitioners lead analysis and make recommendations. Practitioners have described OPC, however, as "saving time in the long run" (Graham et al., 2018) as clients become independent in self-managing situations more rapidly, initiate exiting services when goals are met, and less frequently seek services in future, when difficulties manifest in new ways.
More information in the 'Occupational Performance Coaching' manual for Practitioners and Researchers.