Methodology

Project Design

The objectives of this Doctoral Capstone Project were to: 

1. Educate pediatric primary care providers on occupational therapy’s scope of practice and role in the primary care setting

2. Educate parents/guardians on the scope of occupational therapy services available for their children 

3. Educate occupational therapy practitioners, educators, and students on their role in primary care and provide action steps to take to promote integration into primary care.

Education for Pediatric Primary Care Providers

Educational Content 

An educational resource booklet titled, The Well-Child: Occupational Therapy in Pediatric Primary Care, was created (see Appendix B). The booklet includes three sections: 1) Introduction to Occupational Therapy in Primary Care, 2) Occupational Therapy’s Role in Pediatric Primary Care, and 3) Reimbursement and Funding Mechanisms. 

The first section, Introduction to Occupational Therapy in Primary Care, describes the benefits of OT in pediatric primary care for patients and providers, provides a brief description of OT’s philosophical base, explains the OT’s domain and process, and outlines 18 objectives from Healthy People 2030 for infants, children, and adolescents that could be addressed by OT practitioners and PCPs within the pediatric primary care setting. 

The second section, Occupational Therapy’s Role in Pediatric Primary Care, explains three levels of collaboration (integrated, co-located, coordinated off-site) between OT practitioners and PCPs, describes referral models and processes that can be used by PCP’s to refer their patients to an onsite OT practitioner, and provides several clinical vignettes that demonstrate OT’s role in a pediatric primary care setting for various patient needs. The doctoral student observed sessions at ABC Pediatrics, a pediatric primary care clinic, in order to create the clinical vignettes based on common patient visits and parent concerns that would benefit from OT services. 

The third section, Reimbursement and Funding Mechanisms, outlines potential CPT codes to be used and an estimated daily revenue for an OT in pediatric primary care. Other reimbursement and funding models are presented including independent billing models, Federally Qualified Health Centers (FQHCs), partnering with an OT education institution, and grant funding. 

Participants 

Participants were recruited via social media platforms and through the use of snowball sampling. Inclusionary criteria required participants to be a pediatric primary care provider (physician, physician assistant, nurse practitioner) or a student pursuing any of the aforementioned professions. The recruitment flier (see Appendix C) outlined the inclusionary criteria and provided a brief explanation of what participation in the educational opportunity entails. Participants who were interested in participating in the educational opportunity were instructed to contact the doctoral student. A total of two pediatric primary care providers (see Table 2) participated in this educational opportunity. 

Outcome Measure 

There were no existing outcome measures that fit the needs of this project so the doctoral student developed a pre- and post-test to assess the project outcomes (see Appendix D). The outcome measure was reviewed by a content expert. 

One goal of this project was that “PCPs will be able to identify at least two examples of how an OT can contribute to their pediatric primary care team.” Therefore, the pre- and post-tests each had an open ended question that asked PCPs to provide two examples of how an OT can contribute to their pediatric primary care team. Another goal of this project was to “increase PCPs familiarity of OTs domain of practice.” Therefore, both the pre- and post-tests presented lists of 30 areas of OT’s domain of practice (using language from the Occupational Therapy Practice Framework, 4th Edition) and instructed the PCPs to rate their level of familiarity for each (American Occupational Therapy Association, 2020a). To increase sensitivity of the measure, a four-point Likert scale (not at all familiar, somewhat familiar, moderately familiar, very familiar) was used in order to detect change between pre- and post-test responses. 

There were five additional questions on the post-test. Two questions asked PCPs to indicate the extent to which the educational resource changed their understanding of, 1) OTs scope of practice, and 2) OT’s role in pediatric primary care. These two questions used a five-point Likert scale (My understanding significantly decreased - My understanding slightly decreased - No change in understanding - My understanding slightly increased - My understanding significantly increased). The third question asked PCPs if the educational resource changed their interest in incorporating an OT as a member of their interprofessional primary care team using a seven-point likert scale (I am much less interested - I am less interested - I am slightly less interested - No change in interest - I am slightly more interested - I am more interested - I am much more interested). The final two questions were open-ended and asked PCPs to indicate new reasons (if any) they may refer a patient to OT and to indicate which aspects (if any) of OTs scope of practice or role in pediatric primary care they still need clarification on. 

Data Analysis 

The first project goal was “PCPs will report an increase in familiarity of OTs domain of practice.” To determine if this goal was met, the following procedures were followed: 

The ‘total familiarity score' for each participant’s pre and post test was calculated by adding up the responses to the 30 areas of OT’s domain of practice. For example, the response “not at all familiar” was scored as a 0, “somewhat familiar” was scored as a 1, “moderately familiar” was scored as a 2, and “very familiar” was scored as a 3. The lowest possible total score was a 0 and the highest possible total score was a 90. A total score of 0 indicated that the participant was “not at all familiar with OT’s domain of practice.” A total score of 1-30 indicated that the participant was “somewhat familiar with OT’s domain of practice.” A total score of 31-60 indicated that the participant was “moderately familiar with OT’s domain of practice.” A total score of 61-90 indicated that the participant was “very familiar with OT’s domain of practice.” The total familiarity scores (0-90) and descriptions (not at all familiar - very familiar) from the pre- and post-test were compared to determine if there was an increase, decrease, or no change. 

The second project goal was “PCPs will be able to identify at least two examples of how an OT can contribute to their pediatric primary care team.” To determine if this goal was met, the following procedures were followed: 

The open-ended responses on the post-test were reviewed and checked to meet the following criteria: two examples are given and both examples are accurate depictions of OTs role in a primary care setting. If the criteria was met, the project goal was achieved by that participant. 

To further analyze this qualitative data, the examples provided by participants on their post-tests were compared with their pre-test responses to determine if there was a change in the clinical language used and the types of occupations or performance skills mentioned. 

Education for Parents/Guardians 

Educational Content

An educational video titled, Occupational Therapy for Children and Adolescents, was created for parents/guardians (see Appendix E). The video is 15 minutes and includes an explanation of occupational therapy’s domain and process and an overview of four pediatric practice settings and services including early intervention, school-based, private/outpatient, and pediatric primary care. The video was embedded into a Qualtrics survey for easy transition between viewing the video and completing the survey. 

Survey

A survey was displayed immediately after the video (see Appendix F). One goal of this project was that “Parents/guardians will report an increase in their understanding of the scope of OT services available for their children.” Therefore, one survey item asked parents/guardians to indicate the extent to which their understanding of OT’s scope of practice decreased, stayed the same, or increased after viewing the video. This survey item used a 5-point Likert scale (my understanding significantly decreased, my understanding slightly decreased, no change, my understanding slightly increased, my understanding significantly increased). Other survey items asked parents/guardians to indicate their interest in receiving occupational therapy services as part of their child’s well-visit if their pediatric primary care clinic offered it and if they had a preference of receiving occupational therapy services in-house (at the primary care clinic) or from an outside provider at a different location. Lastly, parents/guardians were presented with a list of areas within OT’s domain of practice and asked to select the top three areas that they would be interested in receiving an OT practitioner’s support for. 

Participants

Participants were recruited via social media platforms and through the use of snowball sampling. The recruitment flier (see Appendix G) outlined the topics included in the video and QR code that connected participants to the survey and video. A total of 11 parents/guardians viewed the video and responded to the survey (see Table 3).

Data Analysis 

The third project goal was “Parents will report an increase in their understanding of the scope of OT services available for their children.” To determine if this goal was met, the frequency of Likert-scale responses were calculated. If the majority (over 50%) of the parents/guardians selected “my understanding slightly increased” or “my understanding significantly increased,” then the project goal was considered achieved. If the majority (over 50%) of the parents/guardians selected “my understanding significantly decreased,” “my understanding slightly decreased,” or  “no change,” then the project goal was considered unachieved. 

Education for Occupational Therapy Practitioners, Educators, and Students