These researchers wanted to explore whether Occupational Performance Coaching, or OPC, could work effectively when delivered online to UK families. Much of the previously published research focuses on OPC in person, and in a post covid world where many services have developed their online arm it is important to understand whether existing treatments can transfer online and still achieve outcomes.

Study Aims

The researchers were aiming to answer the following three questions: 

1. How acceptable is the coaching programme to parents and therapists in the United Kingdom?
2. How feasible is coaching programme delivery for parents and therapists in the United Kingdom?
3. What changes occurred in parent-reported occupational performance, occupational satisfaction and parenting stress levels?

Methods

This was a mixed-methods feasibility study – so they combined quantitative outcome measures with qualitative interviews to get the full picture. To address the first research questions, they interviewed parents and completed a focus group with occupational therapists. They used the COPM fidelity measure to address the second study aim, and also reviewed cast notes and training information. This was completed by reviewing video recordings of the coaching sessions. The Canadian Occupational Performance Measure and Parenting Stress Index were used to evaluate child and parent progress pre/post the sessions.The COPM was completed in the first and last sessions, and the parents completed the stress index in their own time and returned it to the team.

Participants

Eight UK families took part during April-July 2021. They were recruited through social media and university websites. The parents’ ages ranged from 35 to 53 years old, and their children were aged from 2 years to 13 years old, 5 of them were autistic. 

Intervention

Parents received between 4 to 8 coaching sessions via video conferencing, with each session lasting about 49 minutes on average. The coaching was delivered by four experienced paediatric occupational therapists who received 8 hours of online OPC training plus additional mentorship throughout the study period

The Results

Parents views

The findings were really encouraging from multiple perspectives. Parents reported positive experiences with the coaching. In interviews, they described it as “a shared journey” where they felt supported to break down overwhelming challenges into manageable steps. One parent beautifully captured it by saying “it was like I reached the goal by myself, but I know I didn’t do it by myself.”

Parents were also really positive about the online delivery. They valued the autonomy it gave them over timing and location, and many mentioned how much time it saved compared to traveling to appointments. One parent noted how being in their own space reduced anxiety – they could have their cat on their lap and didn’t worry about tidying up for visitors. 

The parents also reported positive changes to the family as a whole.

Therapist views

The main views from the therapists were that the benefits of delivering coaching via telehealth outweighed the challenges and they valued having support from mentors to deliver the coaching approach. This links to a lot of work that suggests one off training doesn’t necessarily give professionals the skills they need to implement interventions or approaches and going support with practical implementation is valuable.

Fidelity

Despite therapists reporting they valued the support received from their mentors, the fidelity of intervention sessions ranged from 43%-81% with an average of 64%. To meet OPC fidelity, an 80% score is recommended, however other research has shown this is difficult to meet, with only 25% of sessions in other work meeting this benchmark. So, although the therapists didn’t meet fidelity of delivery, this is not uncommon. However, it does mean that the results need to be interpreted with some caution as technically the therapists were not delivering all aspects of OCP with fidelity.

Changes in COPM and stress index

• COPM scores post intervention showed statistically significant improvements in both occupational performance and satisfaction scores. The mean improvement was 3.29 for performance and 3.99 for satisfaction. There was a big range within the scores with some families increasing by only 1 point and others by 5 or 6. 
• Six parents also showed reduced stress levels, with the biggest improvements in the parental distress subscale on the parenting stress index.

Practical takeaways

Online support is acceptable to parents support with parents. This also makes sense from a practical perspective, particularly in rural areas or for parents who are usually juggling school pick ups, work and household responsibilities. Reducing travel time for appointments would be a real help. So, if you need to justify the use of online approaches with parents, this study gives you some evidence for that

Emerging evidence that online occupational performance coaching could be a valuable addition to our toolkit, particularly for supporting families to help with self-care skills at home. 

It is difficult to meet the fidelity for OPC, as OTs, particularly those of us with many years of experience, are used to providing support and solutions. 

This is a really timely piece of research that addresses something many of us are grappling with in practice—how do we support more families effectively when resources are stretched thin? The researchers explored whether Occupational Performance Coaching, which is usually used as a one-to-one approach, could work when delivered to groups of parents. The intervention specifically looked at using OPC with mothers of children with sensory differences using an online approach. 

Study Aims

The team had three main aims for this pilot:

1. First, they wanted to explore whether the group intervention format was actually acceptable to families—would mothers engage with it, and would they find it helpful?
2. Second, they aimed to evaluate whether there were changes in children’s occupational performance following the intervention.
3. Third, they wanted to investigate the impact on maternal stress and mothers’ sense of competence of the participating mothers.

Methods

This was a pre-test post-test pilot study design—so no control group, which the authors acknowledge as a limitation. They collected outcome measures one week before the intervention and up to two weeks after. The outcome measures were:

• Canadian Occupational Performance Measure, each mother identified three child occupational goals they were planning to work on over the intervention.  
• Parenting Stress Index Short Form to measure parent’s stress levels. This assessment gives you subscales for parental distress, parent-child dysfunctional interaction, and difficult child behaviors, plus a total stress score. 
• Parent Sense of Competence scale, to measure maternal sense of competence, this tool captures satisfaction and efficacy in the parenting role. 
• They also collected qualitative feedback through a semi-structured questionnaire, asking mothers about their experience of the format, what was helpful, and what could be improved.

Participants

The researchers recruited eleven mothers. All children scored with sensory differences on the Sensory Processing Measure and most of these children had co-occurring diagnoses—73% were autistic, 55% had ADHD, and 55% had anxiety. Only one child had no formal diagnosis. The mean age of the children was 8 years old. The mothers themselves had varied educational backgrounds, and about a quarter were single parents. 

The Intervention

The mothers were divided into two groups of five to six participants each. Before the group sessions started, each mother had an individual session to complete the pre-assessment, set goals, and get oriented to the process. Then the mothers attended four sessions, each lasting 90 minutes, delivered via Zoom, over four weeks delivered by the primary author who is a very experienced occupational therapist trained in OPC. The OPC fidelity measure was also used to review the fidelity of the OPC delivery and a rate of 72-74% was reached.

Each session followed an OPC structure where mothers would share updates on their goals, engage in reflective questioning to analyse situations, and identify action steps for the coming week. The additional benefit of the group format was that other mothers could share their experiences related to the goal being discussed, adding that peer-to-peer learning element.

After the four sessions, the post-assessment was completed by a different occupational therapist to increase the validity of the results.

The Results

Mother’s feedback

• The attendance was excellent—attendance was 89% across all sessions. When mothers couldn’t attend, it was due to practical barriers like medical appointments or wifi issues, not disengagement.
• All nine mothers who completed feedback forms rated the usefulness of the group as 10 out of 10. They also felt it would be useful for other parents—again, 10 out of 10. 
• In their qualitative feedback, mothers said they valued the shared experience and social support. 
• The online format worked well for everyone. The parents also reported that they would like more follow up sessions, which suggests that they found the group coaching helpful.

Child Occupational Performance:

The goals mothers set covered the full range of daily occupations we see in practice—in order of frequency, they were: participation in meals, washing, self-regulation, school skills, toileting, sleep, dressing, chores, travel, play with others, and swimming.

The average COPM performance scores increased from 2.72 to 4.94 and satisfaction increased from 2.18 to 5.12, 58% of goals had an increase of 2 points or more on performance and 70% of goals had the same for satisfaction. These changes were also statistically significant, meaning it is unlikely that they occurred by chance. Again, we need to remember it’s a small sample size and without a control group it is harder to know if the change was definitely the intervention.

Maternal Stress:

For maternal stress, the results here are nuanced. Three of the four Parenting Stress Index subscales showed statistically significant improvement: parental distress, parent-child dysfunctional interaction, and difficult child. The total stress score improved but didn’t quite reach statistical significance. 

What’s clinically significant, though, is that six mothers reported reduced total stress, and four of them actually moved out of the clinically significant range—from above the 90th percentile to below the 80th percentile.

Maternal Sense of Competence:

This is where the results diverged from previous one-to-one OPC studies. The Parent Sense of Competence scores showed improvement, but it didn’t reach statistical significance. The authors suggest this might indicate that something about the brief, group, or online nature of the intervention didn’t provide quite the right context to address maternal sense of competence. However, although the questionnaire scores did not reflect significant change, during the feedback interviews, mothers described positive changes in confidence and perspective. So while the quantitative measure didn’t capture it, there were shifts in how mothers perceive themselves.

Practical Takeaways

The group format had the added benefit of creating a peer network and is a cost effective use of therapist time.

This study suggests that group-based coaching can be an effective way to support families while managing our time constraints. 

The online format worked. All the mothers in this study found it acceptable, and the outcomes were comparable to in-person individual coaching. This opens up possibilities for reaching families who might struggle to attend in-person sessions—whether that’s due to work commitments, childcare challenges, or geographic barriers.

The peer support element present in the group format seems to be genuinely valuable. Mothers didn’t just benefit from working on their own goals—they gained ideas and felt validated by hearing others’ experiences. One mother specifically mentioned that even when someone else’s goal wasn’t her focus, she still got ideas from listening. That’s an added benefit you don’t get in one-to-one work. 

The sensory focus mattered to families parents valued receiving help with sensory issues.