How do we make treatment more client centered for pediatric clients?
It is your role as an occupational therapist to assist in making treatment and goals client centered for everybody involved, including the child, parent or caregiver, referral source, and payor. It may also include the coach in their sport, the teacher who sees them daily, and anybody else involved with the child.
First, we need to determine specifically why they were referred and what outcomes the referral source wants. You should have this part completed before the patient walks in the door. If you are lucky, you also will have a prescription from your physician. Some of the prescriptions only say "OT." We love this because we get to do what we want, but it does not clarify why they are referring the client. You can call the physician to ask more questions if it is not on the referral. You can also wait until that patient and child walk into the clinic and ask them. Make sure you have determined as much as possible what the referral source's goals are before seeing the patient.
How do we make it client centered for the child and parent? We complete an initial interview, and I always ask the child, "Why are you here?" Depending on their age, they may not know or say something like, "I broke my arm, and they told me I have to come here."
My next question is, "What can you do and not do?" The child may say, "They will not let me ride my bike right now," or "They will not let me play sports." If it is an older child, they know what they cannot do. Interestingly, when you ask them what they can do, they usually say they can do everything until you have them show you. When in doubt, ask them to demonstrate it.
You ask broad and specific questions to find out the child's goal. Some may not be sure why they are there if it is a traumatic injury. In these cases, ask the caregivers what they want their child to be able to do or what their child is not doing well. They will usually have information from schools, coaches, and everybody else involved with their child. I ask the parent or guardian their reason for bringing their child to therapy, especially for younger or nonverbal clients. They often say, "I want them to do their normal things again." They may report that the teacher is complaining about their handwriting or other issues. Caregivers can give you an insight into other areas of the child's life.
Regarding being client-centered for the payor, you need to know the appropriate treatment parameters based on diagnoses and what that insurance provider requires. Prior approval may be necessary for treatment. Often with the payor source, you can do the evaluation and then submit for treatment visits. For example, some insurance companies may approve three visits for a traumatic injury, and they want to hear back from you every three visits on how that child is doing regarding progress and goals. Payors can have stringent parameters, so it is essential to be aware of those. Otherwise, you may get denials, and the parents may get a large bill, which is not what you want.
This Ask the Expert is an edited excerpt from the course, Client-Centered Occupational Therapy Pediatric Upper Extremity Treatment To Obtain Outcomes, presented by Valeri Calhoun, MS, OTR/L, CHT.