The Partnership for Change (P4C) model emphasizes the therapists’ partnership with the educators and parents to change the life and environment of a child who has motor difficulties (or developmental difficulties). The partnership focuses on the collaboration of building capacities for the teachers and parents in enhancing daily environment for the child. The core activities of occupational therapists under the P4C model are relationship building and knowledge translation with the school and parents. It consists of three steps. The first step is universal design for learning. It focuses on enhancing the teachers’ knowledge (e.g., typical motor development) to build their capacity to understand and work with children. The concept generalizes from the child to the classroom where the teachers can apply the skills (e.g., motor based skills) to all children. Occupational therapists also work in the classroom to optimize classroom layout, designing activity centers, etc. The second step is differentiated instruction. After professional collaboration has been created in optimizing classroom environment, the therapists and teachers look more closely at the learners who experience difficulties in motor based activities. The therapists bring knowledge about person-environment interaction, and skills in observing and analyzing daily occupation skills, into the classrooms, hallways, and gymnasiums. The therapists may also suggest ways for the teachers to differentiate the process (activity), product (accomplishment that follows an activity), or evaluation methods (e.g., written/oral approach). The teachers may be able to identify children who are experiencing motor challenge, and so the therapists step in and identify the cause of motor challenge. The third step is accommodation. The therapists can use dynamic performance analysis to observe and identify performance problems. It focuses on the demands of the task and the environmental barriers and facilitators. Then the therapists identify and modify changeable things in the task or environment. Using the P4C model, after environmental modification, the therapists communicate with the teachers and parents on how these changes could facilitate the children to participate, which in turns enhance the teachers’ and parents’ capacity to use and implement similar strategies in another time or with another student.
Domain of occupation
The model aims to build educators’ and parents’ capacities to change life of children who are struggling at activities and to create a supportive daily environment for the children.
Missiuna, C. A., Pollock, N. A., Levac, D. E., Campbell, W. N., Whalen, S. D., Bennett, S. M., Hecimovich, C. A., Gaines, R., Caimey, J., & Russell, D. J. (2012). Partnering for change: An innovative school-based occupational therapy service delivery model for children with developmental coordination disorder. Canadian Journal of Occupational Therapy, 79, 41-50.
This frame of reference identifies functions and dysfunctions in five areas of handwriting for children, including proximal posture, components, use of writing tools, grasp, and handwriting. Good proximal control is required for functional and effective distal control of the writing tools. Either excessive postural stability or lack of postural stability during writing tasks is considered as dysfunctions. Components including ocular-motor skills, attention, and memory are considered as essential.
The Conceptual Model for Performance in Handwriting views that handwriting is important for one’s work and/or education domains of occupations. It considers the performance components, performance areas (functional performance), performance contexts, and the interactive relationship among them. Prerequisites to handwriting include performance components in sensory, perceptual, motor cognitive, and language functions, as well as integrations of these components.
The Sensory Integration (SI) frame of reference focuses on how the interaction between the sensory systems including auditory, vestibular, proprioceptive, tactile, and visual systems, provides integrated information that contributes to a child’s learning and adaptive behaviors. The key consideration is that children have the abilities to make adaptive responses to constantly changing sensory environments. The sensory integrative abilities include sensory modulation, sensory discrimination, postural-ocular control, praxis, bilateral integration, and sequencing.
The social participation frame of reference emphasizes the power of emotion to motivate and engage children’s social participation. Early relationship with parents provides the foundation for children’s social development, because children give meaning to their own emotions and learn strategies in regulating their emotional states based on how others and environment responses to their emotions. At the same time, the children regulate the caregivers’ behaviors and then they learn how to regulate their own and others’ emotions during future social interactions.
This model of practice is based on the theoretical concepts relating to the child, environment, task, and the interaction among these key factors and the child’s participation in different occupations. A goodness-of-fit of those factors is necessary for successful participation in occupations.