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Importance: Limited research has described the timing of acquisition of the broad range of skills required for the transition to adulthood., Objective: To describe the timing of the shift of responsibility for daily tasks from parent to child., Design: This study used an existing data set of parent responses to 49 items in the Responsibility domain of the Pediatric Evaluation of Disability Inventory Computer Adaptive Tests., Participants: A U.S. nationally representative sample of 2,205 typically developing children and youth ages 0 to 20 yr., Outcomes and Measures: Descriptive analyses focused on two ages: (1) starting age (when >50% of parents reported their child was taking at least some responsibility for a task) and (2) full responsibility age (when >50% of parents reported their child was taking full responsibility for the task)., Results: The process of shifting responsibility for daily life tasks from parent to child typically occurred over a long period. Many task items had an interval of 5 yr from starting age to full responsibility age; the longest interval was 15 yr. Youth began assuming responsibility for more complex tasks and tasks that involved more risk at ages 10 to 15., Conclusions and Relevance: Results can serve as a reference for the timing of the transition to greater self-management of daily life tasks across childhood and adolescence. Timing of responsibility shifts may reflect a combination of development of underlying capacities and social transitions. Executive functioning may be especially relevant for management of the more complex tasks required in daily life in adulthood., What This Article Adds: The transfer of responsibility for managing tasks of daily life from parents to children often extends over a period of many years. Clinicians may find the results helpful when discussing the future with parents of young people with disabilities and other chronic conditions and the tasks that their children must learn to manage for independent living as an adult., (Copyright © 2021 by the American Occupational Therapy Association, Inc.)

Importance: No study has directly investigated which variables are associated with the shift of responsibility for managing daily tasks from parent to child in the transition to adulthood., Objective: To examine characteristics associated with responsibility for managing daily life tasks in youth with and without disabilities., Design: A secondary data analysis of parent-report data on typically developing (TD) youth and youth with disabilities., Setting: An online panel that has regularly participated in online surveys., Participants: A nationally representative sample of 2,205 TD U.S. children and youth, ages 0 to 20 yr, 11 mo (about 100 children per age year) and a sample of 617 children and youth with disabilities, ages 0 to 20 yr, 11 mo., Outcomes and Measures: The dependent variable was the Responsibility domain scaled score (from the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test), which reflects the extent to which responsibility for daily tasks has shifted from parent to youth., Results: Youth with higher levels of responsibility were older in age, reported to be more focused, and youngest in birth order (TD, R  2 = .79; disability, R  2 = .35). Youth with developmental delay, intellectual disability, autism spectrum disorder, or orthopedic or movement impairments had assumed less responsibility., Conclusions and Relevance: Other personal characteristics in addition to disability may have important influences on parents' decision making as they prepare their children to manage daily life tasks., What This Article Adds: Clinicians who work with adolescents in the process of transition to adulthood need to consider the potential influence of the personal characteristics, such as birth order and child temperament, on preparation for adulthood., (Copyright © 2020 by the American Occupational Therapy Association, Inc.)

Throughout the years, leaders in the profession have challenged us to affirm the value of occupational therapy and to substantiate what we do. Occupational therapy practitioners have always focused on what most matters to clients in what is now called client-centered or patient-centered practice. We have also focused on client function to enable participation in everyday life. In a welcome shift, society's views about health and meaning-making are becoming more congruent with the long-standing ideals of occupational therapy. Now, more than ever, we have a powerful opportunity to communicate our competence. But how do we assert our competence and the complexity of occupation with confidence? This lecture draws on the conceptual foundations of theories about competence and confidence and provides examples from the research literature, and a practitioner and client narrative to illustrate the factors that enable us to effectively demonstrate the value of occupational therapy., (Copyright © 2019 by the American Occupational Therapy Association, Inc.)

Parents often focus on independence in activities of daily living and social participation when setting goals for their children with autism spectrum disorders. Occupational therapy practitioners use clinical reasoning to translate these goals to define occupation-based outcomes. This article describes an exploratory analysis of 160 parent-identified goals for children with autism. We identified sensory integrative factors hypothesized to influence each goal and then categorized the goals using the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health (ICF). Most goals were at the ICF participation and activity levels. Activities of daily living were the most common area of occupation identified, followed by social participation and play. Sensory reactivity and somatopraxis were the most frequently occurring sensory integrative factors. The value of addressing parent goals using a systematic reasoning process to identify factors affecting participation and the importance of measuring participation outcomes are discussed., (Copyright © 2015 by the American Occupational Therapy Association, Inc.)

We describe an integrated master of science in occupational therapy curriculum and a coordinated sequence of evidence-based practice (EBP) courses that incorporate systematic, pragmatic teaching strategies to develop students' EBP skills and habits of reasoning. The EBP courses focus sequentially on the occupational lives of clients and methods for gaining information about occupational performance and needs; appraising the internal, external, and statistical validity of intervention evidence; and generating evidence from one's own practice to answer questions about individual or group client outcomes. All EBP courses use facilitated learning processes that encourage graduate students to take responsibility for their own learning, guided by a carefully structured series of assignments. The integrated curriculum scaffolds the translation and application of previously learned knowledge and skills, including EBP knowledge, into different contexts. Student survey data suggest that graduating students view EBP as an integral part of the clinical process and begin to internalize the habits necessary to be evidence-based practitioners., (Copyright © 2014 by the American Occupational Therapy Association, Inc.)

PURPOSE. To describe parents' concerns and hopes for their children who would be receiving occupational therapy using a sensory integration approach. METHOD. Content analysis of 275 parental responses to three open-ended questions on developmental-sensory history intake forms. FINDINGS. Parents' descriptions of why they sought for their children were categorized into four overarching concerns about their children's challenges: self-regulation, interacting with peers, participating in skilled motor activities, and self-confidence. Parents often linked these concerns together, revealing explanatory models of how they make sense of potential relationships among their children's challenges and how these challenges affect occupational performance. Parents hoped occupational therapy would help their children develop self-understanding and frustration tolerance to self-regulate their behavior in socially acceptable ways. IMPLICATIONS. Assessment and intervention should explicitly focus on links among self-regulation, social participation, skills, and perceived competence to address parents' expectations., (Copyright © 2014 by the American Occupational Therapy Association, Inc.)

Objective: We developed a reliable and valid fidelity measure for use in research on Ayres Sensory Integration (ASI) intervention., Method: We designed a fidelity instrument to measure structural and process aspects of ASI intervention. Because scoring of process involves subjectivity, we conducted a series of reliability and validity studies on the process section. Raters were trained to score therapist strategies observed in video recordings of adult-child dyads. We examined content validity through expert ratings., Results: Reliability of the process section was strong for total fidelity score (ICC = .99, Cronbach's alpha = .99) and acceptable for most items. Total score significantly differentiated ASI from four alternative interventions. Expert ratings indicated strong agreement that items in the structural and process sections represent ASI intervention. CONCLUSION. The Ayres Sensory Integration Fidelity Measure has strong content validity. The process section is reliable and valid when scored by trained raters with expertise in ASI.

Goal attainment scaling (GAS) is a methodology that shows promise for application to intervention effectiveness research and program evaluation in occupational therapy (Dreiling & Bundy, 2003; King et al., 1999; Lannin, 2003; Mitchell & Cusick, 1998). This article identifies the recent and current applications of GAS to occupational therapy for children with sensory integration dysfunction, as well as the process, usefulness, and problems of application of the GAS methodology to this population. The advantages and disadvantages of using GAS in single-site and multisite research with this population is explored, as well as the potential solutions and future programs that will strengthen the use of GAS as a measure of treatment effectiveness, both in current clinical practice and in much-needed larger, multisite research studies.

Objective: We sought to assess validity of sensory integration outcomes research in relation to fidelity (faithfulness of intervention to underlying therapeutic principles)., Method: We identified core sensory integration intervention elements through expert review and nominal group process. Elements were classified into structural (e.g., equipment used, therapist training) and therapeutic process categories. We analyzed 34 sensory integration intervention studies for consistency of intervention descriptions with these elements., Results: Most studies described structural elements related to therapeutic equipment and interveners' profession. Of the 10 process elements, only 1 (presentation of sensory opportunities) was addressed in all studies. Most studies described fewer than half of the process elements. Intervention descriptions in 35% of the studies were inconsistent with one process element, therapist-child collaboration., Conclusion: Validity of sensory integration outcomes studies is threatened by weak fidelity in regard to therapeutic process. Inferences regarding sensory integration effectiveness cannot be drawn with confidence until fidelity is adequately addressed in outcomes research.

Objective: To understand parents' perspectives about the strategies they use to promote social participation of their school-age children with acquired brain injuries (ABI) in home, school, and community life., Method: A descriptive research design employing a semistructured interview format was used. Interviews were conducted in the homes of 16 families of school-age children with ABI discharged up to 7 years earlier from one inpatient rehabilitation program. Data were examined using content and constant-comparison analyses., Results: Parents needed time to allow the recovery process to unfold for themselves and their children and developed strategies that fit into or assisted with managing family routines. Over time parents developed insight into the activity demands and their child's potential success to participate in desired activities. Based on these insights, parents used "anticipatory planning," which involved previewing upcoming events and activities and using strategies to promote positive and prevent negative experiences for their children. Specific strategies that parents used to promote social participation were classified into three categories: Creating opportunities, teaching skills, and regulating cognitive and behavioral function., Conclusions: Understanding how families use and integrate strategies within the context of their daily lives and what factors influence strategy use may provide practitioners with insights needed to support families in promoting their children's social participation.

Objective: The purpose of this study was to describe and compare the fine motor activities in Head Start and kindergarten classrooms in order to open a dialogue between the two contexts about the fine motor activities children in preschool will face in kindergarten., Methods: Children in 10 Head Start and 10 kindergarten classrooms were observed for 1 day each. Time spent in activities was categorized into four groups: fine motor activities with no academic purpose, fine motor activities with academic purpose, academic activities with no fine motor component, and nonacademic activities with no fine motor component. Percentages of time were calculated and t tests were used for comparison between contexts., Results: Children in Head Start spent 27%-46% (mean of 37%) of the in-class day in all fine motor activities whereas children in kindergarten spent 36%-66% (mean of 46%). For children in kindergarten, 42% of total fine motor activity time involved paper and pencil activities. In contrast, children in Head Start spent 10% of total fine motor activity time in paper and pencil activities., Conclusion: The higher mean percent of time spent in fine motor activities in kindergarten classrooms suggests a developmentally appropriate increase in fine motor demands. The percent of paper and pencil activity time the children engaged in substantially increased from Head Start to kindergarten. The findings describe a difference between the two environments, informing Head Start of the fine motor demands their graduates face in kindergarten.

Occupational therapy is based on core values of altruism, equality, and honoring the dignity of others. Embedded in these values is the ever-present negotiation of power. To honor the concern for the welfare of others, researchers are challenged to think about issues of power throughout the research process. This paper identifies dilemmas and raises questions researchers might ask themselves as they struggle to share power in the interpretive research process.

Perceptions of the Same Site Model (SSM) of fieldwork, where students complete a Level I and Level II fieldwork requirement in the same setting, were examined by survey. The benefits, drawbacks, and implications of the SSM are discussed. Fieldwork educators and students identified gaining familiarity with the setting, increased comfort and decreased anxiety, and preparation for Level II fieldwork as benefits of this model. The SSM survey results suggest that this model may be helpful in decreasing stress associated with fieldwork as experienced by students and fieldwork educators.

This qualitative study explored parents' points of view regarding their children's participation in occupational therapy using a sensory integration approach. Data were collected through parent interviews and were analyzed using grounded theory methods. The parents' perceptions of the benefits of therapy for their children were categorized into three interrelated constructs: abilities, activities, and reconstruction of self-worth. For themselves, parents valued understanding their children's behavior in new ways, which facilitated a shift in expectations for themselves and their children, having their parenting experience validated, and being able to support and advocate for their children. Implications for family-centered intervention and future research are proposed.

Objective: The purpose of this study was to gain an understanding ofparents'perceptions of outcomes of occupational therapy intervention using a sensory integration approach., Method: Interviews with parents regarding their childrens participation in occupational therapy were analyzed using grounded theory., Results: The parents' experiences of sitting in the waiting room while their children received occupational therapy emerged as a powerful outcome theme. Through their interactions with other parents, this particular group of parents gave and received naturally occurring support for parenting children with sensory integrative dysfunction. Additionally, by virtue of repeated experiences of waiting, parents moved to positions of liminality, shared weekly rituals, engaged in downward social comparison, and reframed their views of their children., Conclusion: Implications are proposedfor expanding the definition of family-centered intervention; attending to the meaning of the cultural world of practice; and directing future research related to how a physical setting, such as a waiting room, might shape naturally occurring support and social interaction.

Occupational therapy, along with other health and rehabilitation professions, is experiencing an increased emphasis on measurement of intervention outcomes. The results of outcomes research are being used to develop practice guidelines, set standards for reimbursement, and justify health care policy. The outcome assessments used by therapists reflect our belief systems and the assumptions about behaviors we expect to influence. Using a sensory integration perspective to illustrate key points, we present a conceptual framework that is based on the disablement framework and Coster's occupational functioning for children model. We highlight the need to examine each of the multiple levels at which intervention may influence child and family function and the links among levels. Sensory integration theory and efficacy studies are reviewed to identify assumptions relative to how sensory integration affects the everyday occupations of children in the context of their families. Potential research methods and assessments are suggested to include the family perspective in outcome studies.

Dreyfus and Dreyfus's (1986) five-stage model of skill acquisition is integrated with findings from the American Occupational Therapy Association/American Occupational Therapy Foundation Clinical Reasoning Study. This model is presented as an organizing framework for staff development. Strategies for the recognition and retention of experienced clinicians who can serve as mentors for newer colleagues are identified.

A model for Level I fieldwork in which students co-led independent living skills (ILS) groups in clinical settings and observed occupational therapy evaluation and treatment was implemented in a curriculum and evaluated for its effectiveness. The evaluation surveys from this study suggest that the model is most effective in courses and clinical settings that deal with adult and young adult client populations. All clinicians in these settings believed that the students provided a service to the clients by co-leading ILS groups, and nearly all believed that student-led groups would be valuable for their clients in the future. The students reported learning about group leadership skills and developing creative activity adaptations to meet different clients' needs. Faculty members want to continue using this model because they think it facilitates students' integration of clinical and classroom experiences.

This paper describes an alternative to the traditional Level II fieldwork program for master's degree students in occupational therapy. In this part-time 9-month program, students complete the fieldwork requirement while simultaneously balancing academic responsibilities. One advantage of this program over the traditional 3-month program is that the extended length of time offers students the opportunity to develop clinical skills beyond the technical level.

The need to teach fieldwork students to critically examine practice has been a recurrent theme in recent occupational therapy literature; however, students need to learn routines and standard clinical skills before they can reflect on their practice. This article proposes a variety of strategies to teach technical skills while simultaneously providing a foundation for clinical reasoning.

Students completing fieldwork are the future of our profession. We can no longer allow our fieldwork educators to develop skills to supervise, teach, and evaluate students on a trial-and-error basis. By allocating resources to develop continuing education materials to be used in developing these skills, the profession will be acknowledging its long-standing espoused commitment to fieldwork. The development of continuing education materials must be based on an understanding of how experienced clinicians reason about their practice and transform occupational therapy theory into clinical practice. Critical analysis of the reasoning process will help us teach this process to students. Additionally, we need to develop self-contained educational materials to prepare our fieldwork educators to design fieldwork programs, supervise students, and handle administrative issues related to fieldwork. Finally, fieldwork educators and academic faculty need to collaborate to provide our future practitioners with an integrated academic and clinical education.