Occupation-centered practices with infants and children necessarily involve parents. Although the importance of parent-therapist collaboration is recognized, there is little research demonstrating how collaboration is enacted. This article describes the therapy process between Erin, a NICU therapist, and Carmen and her infant, Mikala. These findings demonstrate how Erin, through the therapeutic strategies of scaffolding and narrative reinterpretation was able to facilitate the development of Carmen's competence and confidence in feeding Mikala, ultimately fostering their attachment and progress toward becoming a family. This article not only illustrates what was done-the procedural techniques-but how it was done through therapeutic use of self, a central aspect of occupation-based practice. These data strongly support understanding family patterns and perspectives through treating the infant as a developing occupational being within the context of co-occupations with the parents. The findings suggest that therapists must see parents as clients who must learn to nurture and manage their infant's ongoing medical and social needs as a member of the nuclear and human family. These findings provide therapists with an example on which to reflect on their own practices with infants and families and evidence-based theory through which to articulate and practice from an occupation-based approach.
Importance: What occupational science (OS) knowledge may be essential to occupational therapy practice has not been systematically explored. Objective: To identify and gain expert consensus on OS concepts viewed as essential to occupational therapy practice. Design: A complex, convergent mixed-methods Delphi design with an international panel of OS experts randomly assigned to two parallel groups. In Round 1, each group generated OS concepts; in Rounds 2 and 3, they rated the degree to which each concept was essential to occupational therapy. Data were analyzed separately for each group. A fourth round combined the two groups and used carefully merged concept definitions from both groups to validate consensus on essential concepts arising from the prior rounds. Participants: Fifty-two nominated experts from 22 countries who met a priori criteria participated in the 14-mo study. Results: Of 62 experts invited, 52 (Group A = 24, Group B = 28) participated in the first round, and 42 (81%) completed the full-group final round. Eleven concepts met the consensus threshold (≥70%) established for the study. Additional analysis compared parallel- and full-group results to carefully discern conceptual similarities and differences, especially with near-consensus concepts. Conclusions and Relevance: Substantial expert agreement was established for several OS concepts viewed as essential, providing a basis for future studies to refine the concepts for occupational therapy education and practice. What This Article Adds: The results of this research provide a systematically derived preliminary basis for selecting OS content for occupational therapy educational programs and preliminary concepts for organizing OS knowledge germane to occupational therapy practice.
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