Physical & Occupational Therapy In Pediatrics, 31(4):359361, 2011 C 2011 by Informa Healthcare USA, Inc. Available online at http://informahealthcare.

com/potp DOI: 10.3109/01942638.2011.619090

EVIDENCE TO PRACTICE COMMENTARY

Take Time to Listen: A First Step Toward Collaborative Transition Planning

Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Southern California on 11/24/11 For personal use only.

Debra Stewart
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada

The article in this issue by Tina Mankey about the beliefs and involvement of occupational therapists in secondary transition planning raises some important clinical issues. Through her survey of occupational therapists in the state of Arkansas, Dr. Mankey found that few occupational therapists in school settings are involved in transition planning, despite their beliefs that occupational therapy does have a role to play in this area (Mankey, 2011). These findings are supported by other evidence cited by the author. The two primary barriers to occupational therapy involvement in transition planning in this study were time and the therapists knowledge about the adult transition. Lack of time is a reason given by many people when asked why they do not do something. It is a primary reason cited by therapists who have not shifted their practice to client-centered approaches (Wilkins, Pollock, Rochon, & Law, 2001). Occupational therapists and other rehabilitation professionals working in school settings cite increasing caseloads as the explanation. Perhaps Mankeys discussion offers another explanation. When occupational therapists focus their school-based practice on remedial, task-oriented, and specialized treatment (pg. 354), there is little time left to spend on re-focusing or shifting practice toward evidence-based interventions that are more person-centered. Similarly, the other barrier of lack of knowledge about adult transition processes and needs can be explained in terms of lack of time, to learn about something new. But if therapists believe that clients would benefit from a more person-centered approach that focuses on daily occupations, now and in the future, then we need to find the time to gain the knowledge needed to put this into practice. And the only way to do that is to let something goto stop using treatment approaches that do not have the evidence to support them, and to start taking small steps toward evidence-based practice. Taking small steps, one at a time, is more reasonable and achievable than trying to change everything at once. So where can therapists working in high schools start? Some strategies are offered here to help take that first step.
Address correspondence to: Debra Stewart, School of Rehabilitation Science, McMaster University, IAHS Building, 1400 Main Street West, Hamilton, ON L8S 1C7, Canada (E-mail: stewartd@mcmaster.ca).

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Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Southern California on 11/24/11 For personal use only.

If every therapist who works in a high school takes one treatment session to sit down and ask their clients about their future plans and needs, the clients stories can guide them toward transition planning. For example, if a client identifies a goal to go to university, an occupational therapist can use their knowledge and skills of occupation and task analysis to figure out the steps and demands of university life that the client needs to work toward and the skills they need to develop. This can still be done within the context of high school. For example, if a client needs to learn to direct another person to assist them with self-care in the bathroom, or getting dressed in the morning in order to live in residence, then the occupational therapist can work with the client and the high school educational assistants to facilitate this. This requires education of both client and school staff to understand the importance of directing ones own care, for future self-management in the adult world. I believe that if the focus of therapy remains on the self-identified goals of the client toward future occupations, the occupational therapist can start transition planning right away. The other important first step for occupational therapists to take toward a new practice approach is to communicate their new or revised role to others. As Mankey suggested, collaboration and communication are important strategies for increasing understanding of each others roles. Collaboration sounds simple and is an expectation of all licensed health care professionals. But it becomes more difficult when a clinician from one system (health care) has to collaborate with other professionals in a different system (education). Terminology, definitions, concepts, and the underlying cultures can all be different, and it behooves all team members to spend time learning about each other. Time spent up front in clarifying roles and language will save time later on during transition planning. And perhaps the best way to improve team communication and collaboration, to bridge the differences in language between systems, is to use the clients own words. Person-centered planning means we all listen to the client, find out about their goals, and then, set our unique treatment objectives to facilitate goal attainment. This is the beginning of collaboration. Other strategies to improve collaboration among different team members, and with youth with disabilities and their families (who should be viewed as active team members during transition planning) are offered below, from a study to develop best practice guidelines for the transition to adulthood for youth with disabilities (Stewart et al., 2009). An expert panel in this study reviewed evidence from different sources and recommended a number of different strategies to facilitate collaboration across systems, communities, and people:

Schools, rehabilitation centers and health care agencies should sit down together for a meeting to explore how they can work collaboratively with each other, and other community groups and service providers to begin transition planning early; Build collaboration into the Individualized Education Plan (IEP) process by identifying other people and agencies to communicate with during transition planning; Create co-op experiences and career planning opportunities within the community;

Evidence to Practice Commentary Take Time to Listen

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Form a task group to work together to develop common transition resources and processes, such as one common transition planning form or one common intake package for adult services; Rehabilitation professionals and educators can work with communities, along with youth and families, to develop collaborative community capacity building opportunities. For example, create opportunities for youth to use and test skills in community settings, such as businesses, community centers, and extracurricular clubs or groups as part of preparation; Emphasize shared management (Gall, Kingsnorth, & Healy, 2006) with families within services and schools, and take the focus off just the expertise among service providers. Youth and families should attend planning meetings, and over time a young person can take on some leadership roles; Peer support and word of mouth can bring about collaboration and reduction of barriers between agencies in various sectors and communities. Bring peers together to discuss collaborative initiativesstart with youth peers and family peers, then broaden to service/professional peers.
To summarize, evidence is mounting about the importance of the transition to adulthood for youth with disabilities, and occupational therapists have a role to play in this area. Mankeys article offers evidence about the barriers and strategies for involvement in transition planning. Using a person-centered approach with each client in high school, occupational therapists can naturally start to focus more on occupations that the client needs to, wants to, or is expected to participate in when high school finishes. And through collaboration and communication with other team members in the education system, using the clients own words to set goals and plan for the future, occupational therapists can begin to play an important role in secondary transition planning. Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of this paper.

REFERENCES
Gall, C., Kingsnorth, S., & Healy, H. (2006). Growing up ready: A shared management approach. Physical and Occupational Therapy in Pediatrics, 26, 4762. Mankey, T. (2011). Occupational therapists beliefs and involvement with secondary transition planning. Physical and Occupational Therapy in Pediatrics, 31, 345358. Stewart, D., Freeman, M., Law, M., Healy, H., Burke-Gaffney, J., Forhan, M., et al. (2009). The best journey to adult life for youth with disabilities. An evidence-based model and best practice guidelines for the transition to adulthood for youth with disabilities. Hamilton, ON: McMaster University. Retrieved July 23, 2011, from http://transitions.canchild.ca/en/ OurResearch/bestpractices.asp? mid =2594 Wilkins, S., Pollock, N., Rochon, S., & Law, M. (2001). Implementing client-centred practice: Why is it so difficult to do? Canadian Journal of Occupational Therapy, 68(2), 7079.