Implementing Parent Coaching in Hospital-Based Pediatric Occupational Therapy: A Multisite Quality Improvement...

Area of Science:

• Pediatrics
• Occupational Therapy
• Quality Improvement

Background:

• Parent coaching (PC) is a critical intervention for young children with or at high risk for cerebral palsy (CP).
• Occupational therapy practitioners in outpatient settings face challenges in consistently implementing PC.
• There is a need to improve the integration of evidence-based practices like PC into routine clinical care.

Purpose of the Study:

• To significantly increase the documented use of parent coaching (PC) in outpatient occupational therapy for children under two years old with or at high risk for cerebral palsy (CP).
• The target was to raise PC utilization from 0% to 80% in documented outpatient visits.

Main Methods:

• A multicenter quality improvement (QI) initiative employing a time-series design.
• Interventions were delivered through a toolkit including education, quick references, EMR support, and site-specific strategies, utilizing plan-do-study-act cycles.
• The study involved pediatric tertiary-care institutions and outpatient occupational therapy practitioners serving children under two years old with or at high risk for CP.

Main Results:

• The primary goal of 80% documented PC use was achieved by the seventh month and sustained, settling at 79.1% over the study period.
• Practitioner knowledge scores improved significantly after initial education (83.1% to 87.9%, p = .001).
• Key balancing measures, including parent satisfaction/experience and practitioner productivity, remained unchanged, indicating no adverse effects.

Conclusions:

• Quality improvement (QI) methodologies are effective in supporting the implementation of parent coaching (PC) in pediatric outpatient occupational therapy.
• A toolkit approach, combined with QI methods, enabled outpatient practitioners to integrate PC as a best practice.
• Findings suggest that education alone is insufficient for behavior change; QI strategies are crucial for implementing best practices in clinical settings.