When I first developed Motor-Vation I used what I knew from my clinical experience to create the interventions. Although I did my homework and I did find some evidence as seen in Figure 1, I was not really aware of what the full evidence-based process was at that time.
Figure 1. Evidence for program development.
Fast forward to my master's and doctoral level courses when I learned about EBP, I was then able to apply this approach to determine if my motor program intervention design actually fit into a best practice model.
Sackett in 1996 said, "EBP is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of an individual. It means integrating individual client expertise," which is what I did, "with the best available external clinical evidence from the systematic research." Ineeded to combine those two things in order to discover if my motor program was evidence-based or was actually producing best practice in this setting.
Taking in this new knowledge that I discovered through my higher ed coursework, I needed to decide what my EBP process would actually look like. Although no outcome data was collected during my four years that I implemented Motor-Vation, teachers and parents repeatedly reported to me that they saw increased fine and visual motor skill performance demonstrated in the student's academic tasks. That was good news. Referrals for fine and visual motor concerns decreased, and I was actually able to indirectly support dozens of students that I could never get my hands on before. It was that anecdotal success of Motor-Vation that inspired me to complete an extensive review of the literature and then expand my program idea into my doctoral capstone. This is how I chose to move forward.
These are the questions I asked. How specifically do difficulties in fine motor skills affect a kindergarten student's participation in the curriculum? I really needed to look specifically at those skills. Secondly, I had to ask myself how can I, as the OT, help these students who have fine motor difficulties but really are not eligible for special education services? How do I catch those kiddos before they fall through the cracks?
The next thing I did in my evidence-based process was start searching. What did the research say about this and what should I consider in order to solve the problem?
I then began evaluating. I wanted to look at the evidence and see how strong it is. Does it match my clinical experience with these students and in the classroom?
Finally, I wanted to implement. I wanted to take all of the evidence that I found, make some changes in my practice, and find additional ways in order to meet this need with these students.
Model of Practice Applied
Along with an understanding of the EBP we also know that in order to provide best practice, we must consider what model we want to use. What is our foundational model? We need to use this to approach the perceived problem. I found that The Ecology of Human Performance Model fit best with my program. This approach considers the child as a kindergarten student, you can see here in the center of Figure 2.
Figure 2. The Ecology of Human Performance.
The child is a student and that is their occupation. The next thing to consider is how we can establish or create some type of a program or intervention in order to support their fine and visual motor development. We are going to surround that child with an intervention so that ultimately they can be successful within the context of the classroom or the school setting. I really found that EHP was the best model to lay as my foundation moving forward.
How Can Evidence-Based Process Help You?
My hope is that the information I am going to share with you today, including data from my capstone, will demonstrate how the use of a motor intervention program is not only evidence-based but actually practical and feasible for all school-based OTs. Now that you know the background that led to my study, I will take you through how this became the motor intervention program that I implemented for my actual project.