Caregiver-Directed Therapy to Promote Independence in Self Care: Working in the Setting Where Self Care Naturally Occurs Allows the Therapist to Gain an Understanding of the All the Factors Influencing the Situation. Then the Therapist's Recommendations Can Directly Address the Specific Challenges, and the Recommendations Can Be Fully Implemented

Article excerpt

Caregivers of children with special needs can direct an at-home occupational therapy program to promote independence in self-care tasks.

By the age of eight, most children in western cultures are independent in self-care tasks (eating, toileting, dressing, and grooming). This independence allows children to fit in with peers. When working toward independence, children develop a variety of skills including physical abilities, problem solving, attention, and patience. In contrast, children with special needs might experience delays in gaining independence. Needing and receiving help over time may cause difficulties. For the child, not being independent in self care may contribute to feelings of inadequacy, shame, and, in the extreme, learned helplessness. Learned helplessness occurs when an individual senses that his/her actions will not result in desired outcomes and therefore stops putting forth effort. For caregivers, providing the extra help with self care can be a source of time constraint, increased emotional stress, and physical burden.

Learning self-care skills depends on practice. Occupational therapists often make the recommendation to have the child practice self-care tasks regularly at home or they may provide home exercise programs to address the needed skills. However, either of these can often be challenging for caregivers. Caregivers may have difficulty finding time within their family routines. Caregivers might not be able to analyze and problem solve the specific problem(s) that the child is having.

In-home occupational therapy services might be better suited to address self care. Working in the setting where self care naturally occurs allows the therapist to gain an understanding of the all the factors influencing the situation. Then the therapist's recommendations can directly address the specific challenges, and the recommendations can be fully implemented. However, in-home therapy services can be difficult to obtain through the usual service providers (schools and outpatient rehabilitation centers) because of limitations in areas of service (school-based therapy must be educationally relevant), reimbursement through insurance, or productivity demands on therapists. Alternatively, caregivers may wish to pursue in-home therapy services privately. Considering the cost, preparation will reduce the number of visits needed and ensure that the family's needs are met.


The most critical factor to be considered is the therapist's willingness to take direction from the caregivers. The therapist should demonstrate creative problem solving. Asking the therapist to describe some past challenging situations and the solutions may allow the caregivers to judge the therapist's communication skills, knowledge, and experience. Last but not least, the therapist's personality is important to consider. He/she should be comfortable in the family's home. He/she should interact with the caregivers as colleagues, not as clients. He/she should be warm and engaging with the child.

The therapist should carry the state's professional credentials (licensure or certification) and professional liability insurance--caregivers may request documentation. Finally, the caregivers and therapist should mutually agree on the terms of payment for service. To negotiate these, caregivers can gather information about hourly rates from their medical insurance providers and local service providers.


One approach for choosing the tasks to focus on may be to prioritize those that are the most problematic. For example, caregivers can note which tasks take the longest, which task the child needs most help with, and which create the most frustration. However, caregivers must be wary of dismissing tasks that they themselves "don't mind doing." Should the child have, or nearly have, the skills to do these tasks for him/herself, having the caregiver's repeated assistance may contribute to feelings of helplessness. …


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