Needs Assessment

To guide the development of this doctoral capstone project, a needs assessment was conducted to identify, understand, and prioritize the needs of the various stakeholders involved in the integration of OT into pediatric primary care. Two surveys, which included multiple choice, Likert scale, and open-ended questions, were created to explore PCP and parent perceptions of well-child care and occupational therapy. Both surveys were created and distributed using Qualtrics and completed electronically by 68 parents and 19 pediatric PCPs. Refer to Table 1 for inclusionary criteria and recruitment strategies.

Needs Assessment Findings

The needs assessment guided the development and refinement of this doctoral capstone project. While the review of literature indicated a clear need for education for PCPs on OT’s scope of practice and role in primary care, the needs assessment survey results further supported that claim and shed light on the need to educate parents, too. Based on the open-ended responses from parents, it appeared that several parents perceived OT as only being beneficial for children with disabilities, rather than understanding OT’s role in health promotion and prevention. For example, one parent expressed that their son “does not qualify for OT anymore”; another parent stated that their child is “beyond the age for OT”; and another parent stated that they have “healthy children and have never had any concerns, thus no need for other healthcare professionals.” These responses exemplify the misconceptions of OT as a purely rehabilitative service, and signify the need to advocate for OT by educating parents on OT’s full scope of practice.

Fifteen parents reported that they have had a concern about their child’s development that was not addressed by their pediatric PCP during their well-child visit. Forty-five parents reported that they spend less than 20 minutes with their child’s PCP during a well-child visit. Halfon et al. (2011) found that visits that lasted longer than 20 minutes were more likely to include developmental assessments, questions asked by parents, and higher parent satisfaction with the clinician.

Based on the information obtained regarding referrals made to occupational therapy, there is a need to not only educate PCPs on OT’s role in primary care, but also to provide education on when to refer patients to OT by providing resources to help PCPs more comprehensively identify patients who would benefit from OT services. Of the 19 PCPs who took the survey, 18 expressed at least some interest in having a tool that helped them identify patients in their practice who would benefit from OT services (seven extremely interested; five very interested; three moderately interested; three slightly interested; one not at all interested). When asked about reasons PCPs refer patients to OT, it appeared that the top five most prevalent reasons were diagnosis or deficit-driven (i.e. behavioral concerns, eating/feeding concerns, fine/gross motor concerns, sensory processing concerns, Autism Spectrum Disorder). This indicates a need to educate PCPs on OT’s role in health promotion and prevention when disease or disability may not be present.

Of the 26 parents who reported that their child has received OT services, only three were referred by their child’s PCPs. While a physician referral is not required to obtain OT services, well-visits with a PCP are an ideal time for early identification of developmental delays and recognizing the need for services. Of the 19 PCPs, 10 reported being dissatisfied with their ability to track referrals to ensure that their patients connect with the provider. This finding is consistent with several parent’s suggestions:

More help with acquiring services for speech, OT and other therapies. They recommend therapies but parents are left to figure it all out. Most often then to find long waiting lists and therapists not in-network.

I would really like to see pediatricians more proactive in guiding parents into getting their children the services that are out there. The process can be overwhelming and scary, the pediatrician is a good place to make sure that the children are getting the services available.

Overall, 68% of parents reported interest in receiving OT services as part of their well-child visit (38% very interested; 30% somewhat interested) while only 17% were neutral and 14% reported being either not very interested or not at all interested. Several parents felt that OT would be beneficial in the pediatric primary care setting for addressing early concerns, assessing their child’s development, and educating parents on developmental milestones. In terms of PCP interest in incorporating OT on their pediatric primary care team, 17 out of 19 expressed at least some interest (four extremely interested; six very interested; four moderately interested; three slightly interested) while two PCPs reported being not at all interested. See Appendix A for the parent and PCP needs assessment surveys and results.