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Implementing Parent Coaching in Hospital-Based Pediatric Occupational Therapy: A Multisite Quality Improvement
Kelly Tanner1, Sara O'Rourke2, Kristin Cunningham3
1Kelly Tanner, PhD, OTR/L, BCP, is Clinical Therapies Research Scientist, Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH; kelly.tanner@nationwidechildrens.org.
Insights
Parent coaching (PC) is vital for children with cerebral palsy (CP). A quality improvement initiative successfully increased PC use in occupational therapy to nearly 80%, demonstrating the effectiveness of a toolkit approach.
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.
Importance:
Parent coaching (PC) is a best practice for young children with, or at high risk for, cerebral palsy (CP). Occupational therapy practitioners in outpatient settings encounter barriers to implementing PC.
Objective:
To increase the documented use of PC in outpatient occupational therapy visits for children younger than age 2 yr with, or at high risk for, CP from 0% to 80%.
Design:
Multicenter quality improvement (QI) initiative with a time-series design.
Setting:
Three pediatric tertiary-care institutions, each with multiple outpatient occupational therapy clinics.
Participants:
Practitioners in the outpatient clinics and patients <2 yr old with, or at high risk for, cerebral palsy.
Intervention:
Plan-do-study-act cycles included interventions packaged as a toolkit: education sessions, quick references, electronic medical record (EMR) supports, and site-specific strategies.
Outcomes And Measures:
The primary outcome measure was the use of PC in outpatient sessions. Process measures included pre- and posteducation practitioner knowledge scores and an EMR checklist. Balancing measures (ensuring that changes do not cause problems in other areas) of parent satisfaction/experience and practitioner productivity were measured pre- and postintervention.
Results:
The primary outcome measure goal (80% documented use of PC in sessions) was attained in the seventh month of the study, sustained for 4 mo, and settled at 79.1% for the remaining 6 mo. Practitioner knowledge scores increased from 83.1% to 87.9% after initial education sessions, t[56] = 3.289, p = .001. Parent satisfaction/experience and practitioner productivity scores did not change.
Conclusions And Relevance:
QI methodology can support PC implementation in pediatric outpatient practice. What This Article Adds: This multisite QI initiative shows that outpatient occupational therapy practitioners can implement PC as a best practice with the use of a toolkit. Results suggest that education alone does not result in changes to practitioner behavior and that QI methods can help when implementing best practices in a clinical setting.
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