Physical & Occupational Therapy in Pediatrics, 34(2):132–137, 2014 C 2014 by Informa Healthcare USA, Inc. Available online at http://informahealthcare.com/potp DOI: 10.3109/01942638.2014.903060
COMMENTARY
Evidence to Practice Commentary New Evidence in Coaching Interventions Iona Novak Cerebral Palsy Alliance, School of Medicine, University of Notre Dame, Darlinghurst NSW, Australia
Coaching has become a widely popularized strategy for improving one’s work performance and life accomplishments. As well as, being considered fundamental to successful sporting and athletic achievements. Coaching is a training or development process that supports an individual to achieve a competence, result, or goal (Wikipedia, 2014, para. 1). Since the origin of the word coaching comes from transportation, the meaning has evolved to describe, “the process used to transport people from where they are, to where they want to be” (Wikipedia, 2014, para. 4). The early childhood field has long established tradition of recommending parent coaching in early learning and parent–child attachment as a strategy for optimizing child outcomes and building social capacity. In the last decade, coaching has also been adopted as an intervention for both children with disabilities and for parents of a child with a disability. Coaching provides a solution-focused approach to helping children and parents achieve goals that are uniquely meaningful to them. The purpose of coaching for parents and children with disabilities is: “to increase knowledge, skills, and competence . . . to enable participation in the context of the family’s daily life” (Foster et al., 2013, p. 254). Coaching is different to traditional therapy in that therapists do not tell the parent or child what to do, but rather help the parent or child to solve problems and find possible solutions, using self-directed learning that enhances the individual’s capabilities (Foster et al., 2013). Coaching involves (a) emotional support; (b) information exchange; and (c) a structured learning process involving (i) goal-setting; (ii) exploring options; (iii) planning action; (iv) carrying out plans in real-life environments; (v) checking performance through analysis and reflection; and (vi) generalization (Graham et al., 2010). Mother’s believe that good coaching involves a collaborative relationship with the therapist characterized by open communication, knowledge sharing, reflection, and critical analysis (Foster et al., 2013). If the reflection and analysis components Address correspondence to: Iona Novak, PhD, A/Professor Iona Novak, Head of Research, Cerebral Palsy Alliance, School of Medicine, University of Notre Dame, PO Box 560, Darlinghurst NSW 1300, Australia (E-mail:
[email protected]). (Received February 2014; accepted March 2014)
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Evidence to Practice Commentary
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of coaching are successful, parents and children experience mindfulness and self-efficacy as a consequence (Foster et al., 2013). What is the evidence for coaching? A structured literature search was conducted in the MEDLINE and CINAHL databases using an answerable question framed in PICO format (Sackett et al., 2000): What is the effectiveness of coaching for improving outcomes in parents of children with disabilities or in children with disabilities? (Population = Parents of children with disabilities OR children with disabilities; Intervention = coaching; Comparison = unspecified as any alternative intervention was considered; and Outcome = unspecified as all outcomes were of interest). Table 1 summarizes the articles retrieved with outcome data and the corresponding critical appraisal using the Oxford Scale (OCEBM, 2011) and the GRADE system (Guyatt et al., 2011). Figure 1 is a bubble chart providing evidence-based guidance about what clinicians might consider doing based on the GRADE and Evidence Alert Traffic Light System ratings (Novak, 2012). The method of how to combine these tools to produce quick clinical answers has been described elsewhere (Novak et al., 2013). It is important to note that other relevant articles may exist in the literature, as hand searching of the grey literature and conference abstracts were not conducted since this was a clinical evidence query, not a full systematic review. There is high-quality evidence that parent coaching is effective for improving educational outcomes in children at risk of developmental delay (McCormick
FIGURE 1. Coaching interventions traffic lights. Green (Shaded as Black) = Effective and preferentially use; Yellow (Shaded as Grey) = Measure individual outcomes as more research is recommended; Red = Ineffective therefore discontinue use.
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Prepost case series
Pre-post case series
Wentz, 2012
Behavioral disorders Graham, 2010
RCT
Ruble, 2013
4
4
2
n = 3 children with behavior disorders
n = 5 youth with ADHD &/or autism, and n = 13 parents
n = 49 teachers & children with autism
Youth with autism
2
RCT with 20-year follow up
Walker, 2011
1
n = 129 growth retarded infants
2
RCT with 18-year follow up
Mc Cormick, 2006
Systematic review
n = 985 low birth weight preterm infants
1
Systematic Review
Case-Smith, 2013
Autism Nicholas, 2014
n = 46 high risk for developmental disorders Children at risk for disability
Participants
2
Design
At risk for developmental delay Blauw-Hospers, RCT 2011
Citation
Oxford Level of Evidence
TABLE 1. Search Results for Coaching Intervention Effectiveness
Child occupational performance Coaching
Child coaching face-to-face and using social media
Youth employment coaching vs. supported employment placements Child coaching (face-to-face) vs. coaching (videoconferencing) vs. placebo
Parent coaching vs. touch-based interventions vs. naturalistic preschool interventions vs. social behavior instruction Parent coaching in early education via a home-visit based program for the first year of life vs. control Parent coaching in parent-child interactions vs. nutritional supplementation
Parent COPCA coaching vs. NDT
Intervention
Coaching led to: • New knowledge about positive behavior • Improved behavior at home
Coaching of either type led to: • Higher academic performance Coaching led to: • Improved self esteem • Improved quality of life
Results favored supported employment
Coaching led to: • Higher academic performance • Higher adult IQ • Less violent behaviors
Coaching led to: • Higher academic performance
COPCA and NDT led to: • Improved motor abilities NOTE: Underpowered Coaching led to: • Improved social emotional development
Outcomes
Very low
Very low
Moderate
Very low
High
High
Low
Low
Grade Quality
135
4
RCT with 1-year follow up
Shin, 2009
3
n = 169 parents of children with learning difficulties
n = 30 children with intellectual disability
Parent coaching vs. counseling vs. control
Coaching and counseling led to: • Lowered parental stress
Coaching led to: • Decreased infant “fussiness” • Improved developmental outcomes Coaching led to: • Better motor outcomes • Higher function NOTE: Underpowered
Parent coaching in parent-child interaction vs. control
Teachers coaching parents at home in the Portage educational program and in individual academic objectives vs. control
AAC Coaching led to: • Greater vocabulary acquisition
Coaching led to: • Improved function • Improved parental self-competence Group and individual coaching led to: • Improved functional goal achievement of life skills meaningful to the youth
Coaching led to: • Higher motor outcomes • Greater generalization
Coaching led to: • Improved behavior
Child AAC coaching vs. speech training
Youth life skills coaching individually vs. life skills coaching in a group
n = 50 youth with cerebral palsy, spina bifida, acquired brain injury, or autism
n = 68 children with language develop-mental delay n = 40 parents of infants with develop-mental delay
Child and parent occupational performance Coaching
Child motor learning coaching vs. NDT
Parent coaching in functional communication training
n = 29 children with performance concerns and n = 28 mothers
n = 78 infants with cerebral palsy
n = 17 children with autism and a behavior disorder
Low
Low
Low
Moderate
Low
Low
Moderate
Very low
AAC = Augmentative and Alternate Communication; ADHD = Attention Deficit Hyperactivity Disorder; COPCA = Coping With and Caring for Infants With Special Needs; NDT = Neurodevelopmental Therapy; RCT = Randomized Controlled Trial.
Learning disability Danino, 2012 Controlled Trial Nonrandomized
3
Controlled Trial Nonrandomized
Seifer, 1991
2
2
Developmental disability Romski, 2010 RCT
Prepost case series
Keenan, 2014
2
4
4
RCT
Multiple baseline design
Childhood disability Graham, 2013 Prepost case series
Cerebral palsy Bar-Haim, 2010
Wacker, 2013
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Novak
et al., 2006; Walker et al., 2011). There is moderate quality, single study evidence, that child coaching is effective for: (a) improving educational outcomes in children with autism (Ruble et al., 2013), (b) improving motor outcomes in children with cerebral palsy if a motor learning approach is used (Bar-Haim et al., 2010); and (c) improving vocabulary development in children with developmental delay if an AAC coaching approach is used (Romski et al., 2010). There is lower quality evidence suggesting coaching might be effective for: (a) improving function and life skills in children with disabilities (Graham et al., 2013; Keenan et al., 2013); (b) improving developmental, motor and language skills in children with developmental disabilities (Seifer et al., 1991; Shin et al., 2009); and (c) reducing parental stress in parents of children with learning difficulties (Danino et al., 2012). In this issue of the journal, we learnt that a life skills group and individual coaching seems to lead to improved functional goal achievement of life skills meaningful to youth with disabilities (Keenan et al., 2013). In addition, Keenan’s 2013 paper confirms earlier studies (Graham et al., 2010; Graham et al., 2013; Ruble et al., 2013) showing that Goal Attainment Scaling (GAS) and the Canadian Occupational Performance Measure (COPM) are practicable and responsive measures for measuring the effects of coaching intervention. The take home message for clinicians, is to use the COPM or GAS to measure clinical change, when using coaching interventions for indications where the evidence-base is not yet fully known (e.g., life skills coaching for youth; behavior management; developmental skills training for children with developmental disabilities; and stress management for parents of children with learning disabilities). In such situations the GAS and COPM outcome measures provide a method for jointly determining with the family whether the coaching intervention is helping them to achieve their goals. Declaration of Interest: The author reports no declaration of interest. The author alone are responsible for the content and writing of this article.
ABOUT THE AUTHOR Iona Novak, PhD, MSc (Hons), BAppSc (OT), Associate Professor, Head of Research, Cerebral Palsy Alliance, School of Medicine, University of Notre Dame, Darlinghurst NSW, Australia.
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