Dr. Dunn: Good morning everyone. Today we are going to talk about coaching practices. This is an area that has had increasing attention in the OT literature. It is based on evidence from many other disciplines, and it shows some ways that we can support OT.
Names for the Process
There are many names for the process of coaching depending upon who wrote about it. Primary coaching is a word you might be familiar with if you work in early intervention. Rush and Sheldon, 2011, wrote about this related to early intervention programs across disciplines. Jim Knight (2004) is an educator that wrote about instructional coaching, or teachers coaching other teachers. There is material on executive coaching in the literature. If you work in mental health you might use the term, motivational interviewing (Miller, 1983). The principles between executive coaching and motivational interviewing are very similar. In adult rehab, we are starting to see the term guided discovery (Henshaw et al, 2011). The CO-OP (Cognitive Oriented Occupational Performance model), which was developed in Canada, is also an approach that uses some of the coaching principles (Polatajko & Mandich, 2004).
What Is It?
Coaching, motivational interviewing, or CO-OP is an interactive process that facilitates another person's ability to identify solutions to challenges that they have identified about themselves, or their families (Rush, Sheldon, 2011). It is a process that uses reflective questioning and guided discovery to create solutions that the person finds for themselves because we ask really good questions to get them to reflect and have insight.
Literature Review
Briefly I want to show you some of the literature about these different processes.
Effectiveness of Motivational Interviewing (Rubak et al., 2005)
This is an article that looked at the effectiveness of motivational interviewing. This study was a meta-analysis. They found that motivational interviewing outperformed traditional advice-giving services in the mental health area 75% of the time. They also found that the effective motivational interviewing on psychological features was very high (75%), but it was also very effective on physiological conditions, at 72% of the time. They analyzed the details of different articles and found that people did better if they had live encounters with the person. This will be important for one of the studies that I am going to show you in a little while. If there were more than five encounters, people were about 40% effective with one encounter, but as the number of encounters increased, the effectiveness also went up. The developing relationship apparently had a really important part to play here.
They did better in encounters that had about 60 minutes, rather than shorter encounters, although with even less than 20 minutes, there was a 64% benefit of motivational interviewing over other methods. Often when studies did longer follow-up periods, they had a continuing effect. If people followed up for about three months, there was a 36% continuing effect, but if they followed up with people 12 or more months, the effect was 81%. It is not just about talking to a person, but it is talking to them in a particularly reflective way. I will show some examples in a little while. This technique really helps people to gain insights and have some ideas about their own ability to manage their lives.
Effectiveness of Guided Discovery (Dawson et al., 2009)
In a couple of studies related to what they called guided discovery, they found positive effects of metacognitive or problem-solving training. Metacognition is thinking about what has just happened. It is raising people's awareness about what they are doing and the effect it is having. They found that when therapists did that, they had better outcomes with the people they were serving. Verbal self-instruction is the person guiding themselves through a procedure or a sequence by talking to themselves. This was found to be very helpful. It was also effective if the therapeutic ideas occurred in a context where the activity was needed. For example, brushing your teeth in the bathroom when it was time to brush your teeth has a better effect than pretending or simulating the task. Finally, the goals needed to be individualized and meaningful to that person in order for the effectiveness to show up in the studies.
These findings are not surprising to those of us who are OTs. This is how we base a lot of our ideas. However, it is very important to remember that, when we have evidence to support these instincts we have as therapists, this makes our procedures and are our principles even stronger.
Effectiveness of CO-OP in Adult Rehabilitation (Dawson et al., 2009; Henshaw et al., 2011)
The Cognitive Oriented Occupational Performance method was originally designed for serving children, particularly children with developmental coordination disorder. In the last several years, Helene Polatajko and some of her colleagues have started applying this CO-OP approach in adult rehabilitation.
