An evaluation of services for preschool children presenting with developmental coordination difficul

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An evaluation of services for pre-school children
presenting with developmental coordination
difficulties
Presented by Susan Butler Alisha Sinnaeve
Funded by
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Overview

• Background information
• The Developmental Coordination Team
• Description of the evaluation project
• (key questions)
• Referral Source Survey
• Chart Review
• Parent Survey
• Recommendations and Conclusion

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Background Information

• KidsAbility, Centre for Child Development has
  been servicing pre-school children presenting
  with developmental coordination difficulties
  since 2002
• Children presenting with developmental
  coordination difficulties often do not have the
  motor coordination needed to perform many
  age-appropriate activities.
• Prior to 2002, a research project was completed
  at KidsAbility to help develop a service delivery
  model, along with developing a process for the
  early identification of these children

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Developmental Coordination Team (DCT)

• DCT consists of an occupational therapist and
  physiotherapist at each of the Waterloo,
  Cambridge, and Guelph KidsAbility sites
• Specific eligibility criteria exist
• Assessment include standardized measures, parent
  interview, and observations of functional tasks
• Parent identified goals
• Children are seen for an 8-10 week treatment
  block
• Sessions are goal-focused using a variety of
  strategies (e.g. cognitive and problem solving)
  and parent education

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The Current Project

• This project was developed with funding from the
  Cloverleaf Foundation to evaluate components of
  the KidsAbility DCT program
• Two clinical therapists at KidsAbility and an
  external research consultant were supported to
  work on this evaluation project
• A program logic model was developed to guide the
  evaluation

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Three Key Questions

• Is the referral process for DCT working
  effectively?
• Are the intervention strategies provided
  positively impacting identified goals?
• Are parents satisfied with the services and
  education they received in the DCT program at
  KidsAbility?

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The Evaluation

• To help answer the key questions, the following
  three areas were reviewed
• Referral source survey
• Chart Review
• Parent Satisfaction Questionnaire

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Referral Source Survey
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Referral Source Survey

• Survey developed, pilot tested, and distributed
  to speech language pathologists (SLPs) and
  community partners regarding the referral process
  to DCT
• Survey included
• - Knowledge of how and when to refer
• - Knowledge of the team
• - Referral rate
• - Use of screening tools provided
• - Suggestions for improvement

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Referral Source SurveyResults

• Response Rate 67 (average across sites)
• 67 of respondents attended information sessions
  at KidsAbility and the majority found these
  sessions helpful
• 54 of respondents felt they had sufficient
  knowledge to make a referral to DCT
• 46 had referred to the DCT at KidsAbility
• Minimal use of screening tools

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Referral Source SurveyResults

• Majority would like more information on referring
  and the DCT (i.e. screening tools, when to refer,
  case examples, video of a child with coordination
  difficulties, what happens in therapy)
• Mixed reviews regarding the use of the Parents
  Evaluation of Developmental Status (PEDS)
  screening tool
• Guelph referral rates are lower, as compared to
  Waterloo and Cambridge. In part, because the
  Guelph SLP program is external to KidsAbility
  (through WeeTalk)

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Chart Review
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Chart Review

• List generated of clients serviced by the DCT
  between the years 2002-2005 using the KidsAbility
  statistical program, WinCIS
• 54 clients were identified and used for the chart
  review
• Occupational therapy (OT) and physiotherapy (PT)
  sections of the clients files were obtained from
  Health Records, including the referral form and
  any assessment score sheets that were completed

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Chart Review

• Three reviewers (two OTs and one research
  student)
• 10 charts pilot reviewed together and data
  inputted into an Excel spreadsheet
• Remaining 44 charts were divided to review
• One therapist then compiled and analyzed the data
  in the spreadsheet

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Chart ReviewResults

• The majority of DCT referrals were made
  internally by KidsAbility speech language
  pathologists (77)
• Of the 54 clients identified, 70 were
  appropriate for OT intervention and 46 were
  appropriate for PT intervention (following the
  initial DCT assessment)
• 74 of OT clients and 92 of PT clients had
  clearly stated goals
• Goal achievement was often difficult to determine
  as few outcome measures were used

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Chart ReviewResults

• Based on chart review, the following was
  determined for goal achievement
• OT clients 61 of clients had met at least 50
  or more of their identified goals
• PT clients 55 of clients had met at least 50
  or more of their identified goals
• The majority of clients were discharged due to
  age/eligiblity criteria (63 of OT clients, and
  68 of PT clients). Other reasons for discharge
  were that goals were met or there was loss of
  contact with the family

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Chart ReviewDiscussion

• Every child may not have been identified, as the
  coding in the statistical system, WinCIS, may
  have been different or not entered during the
  initial phases of the program
• Due to time constraints, not able to triangulate
  the data. Three different researchers reviewed
  charts independently with no member checking to
  verify findings
• Often difficult to pull needed information from
  treatment notes, so interpretation was used, or
  assumptions were made (specifically in terms of
  goal setting and goal achievement)

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Parent Survey
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Parent Survey

• Parent survey used to measure parent satisfaction
  with the DCT services and education
• Survey developed through input from the team
  members and a research consultant, as well as
  reviewing existing satisfaction surveys
• Both quantitative and qualitative data was
  obtained
• A 7-point likert scale was used for most
  questions (1 strongly disagree to 7
  strongly agree)
• One question used a 10 point scale to look at
  overall satisfaction with the program

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Parent Survey

• The survey looked at some of the following areas
• If the purpose of the DCT was explained at the
  time of referral
• If assessment results were explained in a clear
  and easy to understand manner
• If there was an opportunity to share parental
  concerns during assessment
• Whether parents felt they were involved in goal
  setting
• If verbal and/or written information was shared
  and if it was helpful

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Parent Survey

• Continued
• Were strategies given to work on identified goals
• Did the DCT make a difference to their childs
  participation in childhood activities
• Access to DCT services past the age criteria of
  five
• Overall satisfaction
• Any parent recommendations or comments

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Parent Survey

• Survey mailed to 54 families whose child was in
  the DCT program from 2002-2005
• A phone call preceded the mail-out to inform the
  families in advance and a follow-up letter was
  sent to those who did not respond by the given
  deadline
• Out of the 54 surveys sent, 9 were completed and
  returned (17 response rate), and 5 were returned
  due to an address change

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Parent Survey Results

• Results of the parent survey revealed high parent
  satisfaction with the DCT program an average
  score of 9.5 on a scale of 10
• 100 indicated that they would recommend the DCT
  to others
• They were very helpful in both a practical sense
  and in the sense that for the first time, we felt
  that there was something that we could do for our
  daughter, that we were not alone
• The staff was excellent. They took care of all
  the concerns that I had about my child

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Parent Survey Results

• 100 of parents indicated that information
  received through DCT increased their
  understanding of their childs motor difficulties
• We sometimes thought he was being lazy or didnt
  want to try. This information helped us to
  understand him and his motor difficulties better
• It allowed me to see the reason behind the
  difficulty and ways to work with it
• It started me with an excellent starting point
  for extensive reading on our own

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Parent Survey Results

• 89 of parents found the treatment strategies
  realistic to carry out on their own
• Some were very simple, even basic verbal
  commands to remind her of a certain function
• Parent perception of their involvement in goal
  setting received lower ratings

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Parent Survey Results

• 89 of parents indicated they would have wanted
  to access DCT services at KidsAbility past 5
  years of age
• Extending the services past the age of 5 is
  vital. Assistance becomes even more essential
  once your child is in school full-time and
  demands increase. Some sort of socialized
  interaction between DCD children would be
  wonderful so they dont feel so isolated
• Parents identified that the program made a
  difference to their childs participation in some
  of the following areas
• School (89)
• Community programs (56)
• Sports (78)
• Friendships (44)

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Parent SurveyDiscussion

• It is important to note that this evaluation was
  retrospective in design, so parents were being
  asked to recall information from one to four
  years ago
• 6 of the 9 surveys that were returned were from
  families who had completed the program within the
  last year, suggesting that more recent families
  had a better recall of the program
• When the program first began in 2002, it was in
  the development phase, and it has changed over
  time

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Recommendations
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RecommendationsReferral Source Survey

• Continue with yearly update sessions to SLPs and
  consider including community partners (include
  case examples, video tapes, screening tools, role
  of team members)
• Process related issues (i.e. orientation of new
  staff, access to referral and program
  information, screening tools)
• Devise methods to increase referrals in
  Guelph/Wellington
• Further education regarding the PEDs
• DCT should provide feedback to the referral
  source

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RecommendationsChart Review

• Consistently use an outcome measure for goal
  setting and measurement (such as the Canadian
  Occupational Performance Measure COPM)
• Clearly identify goals in treatment notes
• Consider extending the age criteria past the age
  of 5 years

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RecommendationsParent Survey

• Extend the age criteria past 5 years for DCT
  services
• Consider specific feedback from individual
  families
• Consider whether continual feedback on this
  program is desired (future parent surveys upon
  completion of program)
• Consistently use an outcome measure (i.e. COPM)
  to set goals and document change

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Conclusion
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Conclusion

• First key question Is the identification
  process for
• DCT working effectively?
• The majority of referrals are appropriate
• Potential for many more referrals to DCT
• Referrals in Guelph are lower than other sites
• Further education on the PEDS and screening tools
  is required

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Conclusion

• Second key question Are the intervention
  strategies
• provided positively impacting identified goals?
• 61 of OT clients and 55 of PT clients met at
  least half or more of their identified goals
• The majority of parents indicated that
  intervention strategies were realistic to carry
  out on their own and to explain to others
  involved in their childs care
• Many parents indicated that the program made a
  difference to their childs participation in such
  areas as school, community programs, sports, and
  friendships

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Conclusion

• Third key question Are parents satisfied with
  the
• services and education they received in the DCT
• program at KidsAbility?
• Results demonstrate that parents are satisfied -
  overall average rating of 9.5 on a scale of 10
• All parents would recommend the program to others
• All indicated that the information received
  increased their understanding of their childs
  motor difficulties

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Future Research Considerations

• To evaluate the intervention approach used for
  pre-school children with coordination
  difficulties
• To repeat a similar program evaluation in 4-5
  years once recommendations have been implemented

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Acknowledgements

• Members of the Developmental Coordination Team at
  KidsAbility
• Lisa Rivard, BSc (PT), MSc, Research Consultant

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Discussion Questions