Abstract
Generalization and caregiver involvement are core concepts of the CO-OP approach; however, no research to date has studied the interplay between them. Caregivers of children who received CO-OP intervention participated in an approach-specific training program that aimed to increase their self-efficacy in assisting their child to acquire new skills and measure their child’s ability to generalize the learned strategies to the home.
Primary Author and Speaker: Rebecca Pierpont
Additional Authors and Speakers: Eliza Berman
Contributing Authors: Mary Hildebrand
The Cognitive Orientation to daily Occupational Performance (CO-OP) approach is a dynamic intervention which was developed to help individuals acquire skills through use of a global cognitive problem-solving strategy: Goal-Plan-Do-Check. Using this strategy, with an occupational therapy (OT) practitioner, individuals learn to solve performance-based problems. CO-OP is client-centered, focusing on the accomplishment of goals chosen by each client. The three main objectives of CO-OP are to acquire skills, develop cognitive strategies, and promote generalization of learned skills and strategies into an individual’s natural environment. These objectives are intended to be achieved through utilization of CO-OP’s seven key features: client-chosen goals, dynamic performance analysis, cognitive strategy use, guided discovery, enabling principles, intervention format, and parent (caregiver) involvement. Learning theorists have highlighted in the importance of parental involvement in helping their children independently utilize and generalize learned skills. While both caregiver involvement and generalization are hallmarks of the CO-OP approach, no research to date has studied the interplay between them. This pilot study aimed to explore change in caregiver self-efficacy after participating in a CO-OP training program and determine the extent to which caregivers observed and reported generalization of CO-OP in their children’s natural environments. Using a convenience sample, three female caregivers of children who were receiving CO-OP OT services volunteered for the study. All participated in four 1-hour individual CO-OP training sessions consisting of education, observation, and hands-on implementation with their child. Throughout this time, caregivers were asked to track their child’s use of CO-OP at home. Using a mixed methods design, quantitative data was obtained pre- and post-intervention using the Being a Parent Scale and a survey created by the authors to observe self-efficacy in relation to CO-OP. Data was analyzed using a Wilcoxon signed-rank test to compare and determine possible significance between pre- and post-intervention scores on both questionnaires. Post-intervention qualitative data was collected via semi-structured interviews after the caregivers had completed the training program. The semi-structured interviews were recorded, transcribed, and coded for thematic detection. While change in self-efficacy was not statistically significant, seven themes were identified as a result of being involved in CO-OP intervention and training: carryover of skills, caregiver facilitated global strategy use, increased child confidence, increased caregiver confidence, three common barriers to implementation, shift from asking to telling, and importance of observing CO-OP sessions. Findings indicate that active caregiver participation in CO-OP is an important component of its success and ability to generalize. Caregivers may benefit from CO-OP training; however, more research is required to fully understand advantages of parent involvement and its impact on generalization of CO-OP. The importance of increasing caregiver self-efficacy to assist their children is supported by their role in helping them generalize CO-OP and further learn new skills. As children will not receive OT for each new skill, using the approach in natural environments is vital for achieving independence.
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