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Sue Delport MSc OT Lecturer Cardiff University School of Healthcare Studies Heath Park Cardiff CF14 4XN Tel: 02920 87790

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Presentation on theme: "Sue Delport MSc OT Lecturer Cardiff University School of Healthcare Studies Heath Park Cardiff CF14 4XN Tel: 02920 87790"— Presentation transcript:

1 Sue Delport MSc OT Lecturer Cardiff University School of Healthcare Studies Heath Park Cardiff CF14 4XN Tel: 02920 87790 Email:

2 Outline of presentation Rationale for study Methodology Results Recommendations

3 Rationale for Study Prevalence of Developmental Coordination Disorder (DCD) is 5 - 8% of childhood population (Polatajko et al., 1995) Long term effects of DCD on 10 year follow up include both significant motor difficulties as well as a variety of other psychological problems (Losse et al., 1991, Smythe and Anderson, 2000) It is the responsibility of the teacher in the first instance to meet the childs needs within the schools resources (Special Educational Needs (SEN) Code of Practice for Wales, Welsh Assembly Government (WAG), 2004)

4 Pressure on Paediatric OT services Dunford and Richards (2003) determined that the mean waiting times for a child with DCD to receive an OT assessment was 46 weeks. WAG (2007) set a directive to reduce this waiting time to 14 weeks by March 2009. Paediatric OTs face a difficult dilemma: how to provide prompt, effective intervention with limited resources

5 Dilemmas Teachers could be assisted by OTs to give timely and appropriate help to these children, only referring the more complex cases From experience, assistance by OTs is not always received and recommendations not followed through in the classroom. This raises many questions as to why support is not used. Are teachers just too busy? Do they not really understand the programmes? Do they think these issues are not really that important? Are the programmes presented in a format that are useful to teachers? Are teachers concerns listened to, and their views respected?

6 Research Question What needs to be considered from a teachers perspective before programme material is recommended, selected or adapted for their use by OTs to assist children with coordination difficulties in a school setting?

7 Aim of project To explore teachers perceptions of their role in assisting children with coordination difficulties in a school setting To identify the type of programme material that is most appropriate to assist teachers in this role.

8 Objectives Main objectives are to: Investigate teachers perceptions of how coordination problems affect children within the classroom setting. Understand teachers views of their roles with these children. Explore the barriers and challenges for teachers assisting these children. Elicit teachers views of a range of coordination programmes that are currently available for classroom use in Wales. Elaborate upon teachers perception of the role of the occupational therapist in addressing coordination problems within the school context.

9 Methodology Choice of methodology should be determined by the principal research question (Silverman, 2005). Qualitative methodology selected, because the research question sought to understand human experience within a particular context (Patton, 2002; Guba and Lincoln, 2005). The collaborative relationship between the client and therapist (Sumsion, 2000) may be compared to the relationship between the participant and the researcher within the qualitative paradigm.

10 Method Questionnaires, interview, participant observation and focus groups considered (Rapport, 2004). Focus groups chosen as method of data gathering (Krueger and Casey, 2000), as they would offer the most natural form of data collection in that the teachers would form a group of shared experience which would contribute to the depth and richness of the data.

11 Focus Groups A carefully planned series of discussions designed to obtain perceptions on a defined area of interest in [a] permissive, non-threatening environment (Krueger and Casey, 2000:5). The dynamics within the group are a powerful medium to elicit interaction and ideas (Flick, 1998; Greenbaum, 2000; Fern, 2001) Advantages: Can reach a wider range of people in a relatively short space of time, therefore cost effective. Disadvantages: Group think may dominate over individuals opinions (Hollis et al, 2002). Transcribing the discussions and analysing the data may be complex and cumbersome.

12 Focus Groups - recommendations Recommended size is between 5 – 10 participants (Krueger and Casey, 2000) Familiar environment (Bloor, et al, 2001) Free from interruptions (Kitzinger and Barbour, 1999) Three t0 five groups, to achieve data saturation and to clarify ambiguities (Morgan, 1998). Use of an observer to make note of non-verbal communication and to give feedback to the moderator (Sim, 1998; Carter, et al., 1999). Verbatim transcription of audio-taped groups (Braun and Clarke, 2006).

13 Focus Groups These were held over a period of 4 months with 7 teachers from mainstream education who volunteered to be involved following my appeal at a SENCo meeting. First group: Explored teachers perceptions of the difficulties children with DCD faced and their views on their role Second group: Explored themes that arose from first Third group: Discussed views of programmes issued Fourth group: Reviewed issues discussed

14 Ethical consideration Guidelines by Christians (2005) were used: Informed consent – permission sought from Local Education Authority and from head teachers of the schools with participating teachers. Information leaflets outlining the purpose of the study were given to each potential participant. Non-deception – Aims explained prior to volunteering, and information re possible publication given Right to privacy and confidentiality – use of pseudonyms Protection from harm

15 Data analysis Focus groups were transcribed and the data analysed using NVivo (2007) computer package to manage the data (Dey, 1993, Miles and Huberman, 1994; Bazeley, 2007). Codes were generated, and analysed into broader themes that linked them (Coffey and Atkinson, 1996; Braun and Clarke, 2006)

16 problem then because it is interpreted by other people throughout the school as misbehaving, and I think its very much outside of their control, and they cannot help that. Sally: It does take quite a while, but I think you are having to get to know your child first of all... and then…. Mandy: Yes, yes. Alison: Were talking about the change group as well, because with juniors it tends to be more linked to handwriting than anything else. Mandy: Yes, yes. Sally: But I think when you put all the things together, its difficult to see with the handwriting with some of the younger children, because obviously they havent started writing, but it is quite evident some of the drawings, the drawings are very disjointed with perhaps just the head, arms not attached to anything at all, very tall, long elongated figures, with head at the top of the page because they have very poor spatial awareness these children. Mandy: They are, cant judge the space. Clumsiness interpreted as misbehaviour Intuitive feeling that something is wrong Difficulty over diagnosing and identifying DCD Getting to know the child Observable signs of coordination problems Handwriting an essential skill Observable signs of coordination problems Analysis of what is faulty Observable signs of coordination problems TranscriptCode Extract of Coded Transcript using NVivo

17 Sample of Free Nodes (initial categories) using NVivo (2007) computer package

18 Results Five main themes emerged: The complexity of recognising and understanding coordination difficulties Personal and organisational influences on teachers perception of their role in responding to children with coordination difficulties Obstacles to teachers fulfilling their perceived role in helping children with coordination difficulties Teachers perceptions and experience of programmes and materials Attitudes to occupational therapist

19 First Theme: The complexity of recognising and understanding coordination difficulties Difficulty identifying coordination difficulties Age and stage of child affects teachers ability to recognise coordination difficulties Coordination difficulties not taken seriously I think what might possibly happen is that youve got a child who is keeping at maintenance level within the mainstream school and they have coordination difficulties they might be overlooked because they are not in school terms a problem.

20 Theme two: Personal and organisational influences on teachers perception of their role in responding to children with coordination difficulties Personal factors: Lack of confidence and attitudes Its quite an easy problem to hide. I think the frustration comes when you dont know what to do next. Traditionally I think in mainstream, … weve thought of it as somebody elses problem… theyve referred so its out of their hands and somebody elses responsibility..

21 Organisational Factors: Such as the role of the SENCo, level of support from LSAs, head teachers leadership style Fulltime class is a fulltime class. If you have a fulltime class you dont in theory and in practice have time for anything else. It depends … what value the head teacher puts on special needs in the school and how the special needs budget is spent.

22 Theme Three: Obstacles to teachers fulfilling their perceived role in helping children with coordination difficulties Lack of Training Practical obstacles e.g. not having sufficient time, a lack of access to resources and materials when they needed them, and difficulty finding a suitable venue for intervention activities. Pressures on teaching staff to fulfil multiple roles Red-tape and paperwork Do you really want to go down the road of recognizing this problem because it means that youve got to write a programme for it…

23 Theme Four: Teachers perception and experience of programmes and materials Layout and packaging of programme material - simplicity, attractiveness Content – practical, manageable, and purposeful, for the whole class, needed to fit into the curriculum I mean would you just want to put dry peas into a bottle and screwing on the lid without doing it for a purpose?

24 Theme Five: Attitudes to OT Factors affecting referral to OT – organisational issues, and attitudes to impact of coordination difficulties Factors impacting collaborative work between teachers and OTs: Respect, and relationship building Even if the OT were to spend half an hour, with the class teacher, that would give them so much more information and help...[the face to face time] will cut your [the OT] list and help teachers to feel confident to deal with the child in the school as well.

25 Recommendations OTs need to concentrate on relationship building with teachers to ensure successful collaborative work OTs need to be more aware of the format and the content of the programmes they recommend, determining the teachers preferred learning style (diagrammes or more detailed explanations) Further training of head teachers, SENCos, teachers and LSAs is needed for both identification and management of children with DCD. Further research could investigate the way that OTs, teachers and parents could work together to effectively manage children with DCD.

26 References Bazeley, P. (2007). Qualitative Data Analysis with NVivo. London: Sage. Bloor, M., Frankland, J., Thomas, M. et al (2001). Focus Groups in Social Research. London: Sage. Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology. 3, 77 – 101. Carter, Y. Shaw, S. and Thomas, C. (1999). An Introduction to Qualitative Methods for Health Professionals. London: Royal College of General Practitioners. Christians, C.G. (2005). Ethics and Politics in Qualitative Research. In N.K. Denzin, and Y.S. Lincoln, (Eds.). The Sage Handbook of Qualitative Research. (3 rd Ed.). London: Sage. pp139 - 164.

27 Coffey, A., and Atkinson, P. (1996). Making Sense of Qualitative Data. Thousand Oaks CA: Sage. Dey, I. (1993). Qualitative Data Analysis. London: Routledge. Dunford, C. and Richards, S. (2003). Doubly Disadvantage: Report of a Survey on Waiting Lists and Waiting Times for Occupational Therapy Services for Children with Developmental Coordination Disorder. London: College of Occupational Therapists. Fern, E.F. (2001). Advanced Focus Group Research. London: Sage. Flick, U. (1998). An Introduction to Qualitative Research. London: Sage. Greenbaum, T.L. (2000). Moderating Focus Groups: A Practical Guide for Group Facilitation. London: Sage.

28 Guba, E.G. and Lincoln, Y.S. (2005). Paradigmatic Controversies, Contradictions and Emerging Confluences. In N.K. Denzin,. and Y.S Lincoln,. (Eds). The Sage Handbook of Qualitative Research. (3 rd Edition). London: Sage. pp191-215. Hollis, V., Openshaw, S., and Goble, R. (2002). Conducting Focus Groups: Purpose and Practicalities. British Journal of Occupational Therapy, 65 (1), 2 – 8 Holloway, I. (Ed). (2005). Qualitative Research in Health Care. Berkshire: Open University Press. Kitzinger, J. and Barbour, R.S. (1999). Introduction: The Challenge and Promise of Focus Groups. In R.S. Barbour and J. Kitzinger. (Eds). Developing Focus Group research: Politics, Theory and Practice. London: Sage Publications. pp 1-20. Krueger, R.A. and Casey, M.A. (2000). Focus Groups: A Practical Guide for Applied Research. (3rd Edition). London: Sage.

29 Losse, A., Henderson, S., Elliman, D., et al., (1991). Clumsiness in Children – Do they grow out of it? A 10-year follow-up study. Developmental Medicine and Child Neurology, 33, 55 – 68 Miles, M.B. and Huberman, A.M. (1994). Qualitative Data Analysis. (2 nd Ed). London: Sage. Morgan, D.L ( 1998). Planning Focus Groups. : Focus Group Kit 2. In D.L. Morgan, and R.A. Kreuger. (Eds). The Focus Group Kit (6 volumes). London: Sage. Patton, M.Q. (2002). Qualitative Research and Evaluation Methods. (3rd Edition). London: Sage. Polatajko, H.J., Fox, A.M., and Missiuna, C. (1995). An International Consensus on Children with Developmental Coordination Disorder. Canadian Journal of Occupational Therapy, 62, (1), 3-6. Rapport, F. (2004). Shifting Sands in Qualitative Methodology. In F, Rapport, (Ed). New Qualitative Methodologies in Health and Social Care Research. London: Routledge. pp 1-17.

30 Silverman, D. (2005). Doing Qualitative Data. (3 rd Edition). London: Sage Sim, J. (1998). Collecting and Analysing Qualitative data: Issues Raised by the Focus Group. Journal of Advanced Nursing, 28, (2), 345- 352. Available Accessed: 2 June 2006 Smythe, M.M.., and Anderson, H.I. (2000). Coping with clumsiness in the school playground: Social and physical play in children with coordination impairments. British Journal of Developmental Psychology, 18, (3), 389-413. Sumsion, T. (2000). A Revised Occupational Therapy Definition of Client-Centred Practice. British Journal of Occupational Therapy. 63, (7), 304 – 309.

31 Welsh Assembly Government (2004). Special Educational Needs Code of Practice for Wales. Cardiff: Welsh Assembly Government. Available from Accessed [16 July 2008] cations/codes_of_practice/special_ed_cop_04?lang=en Welsh Assembly Government (2007). NHS Wales: Annual Operating Framework 2008/2009. Cardiff: Welsh Assembly Government. Available from Accessed [9 June 2008]. HSWalesAnnualOperatingFramework2008-2009[1].pdf

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