File
Camden C1, Heguy L2, Changya Baril A1, Demers-Dubuc S1, Couture M1
1Université de Sherbrooke, Sherbrooke, Canada, 2Centre de Recherche du CHUS, Sherbrooke, Canada
Background: Many university programs offer student placements in vulnerable communities. The impact of these placements is rarely evaluated. Our university clinic implemented such a program in collaboration with daycares, the public health office and community partners.
Purpose: To evaluate the impact of the community-based services offered by physical and occupational therapy (PT/OT) students in a low-income neighborhood.
Methods: Design: A cohort study including a review of clinical data.
Context: For either 4 or 7 weeks, third- and fourth-year PT/OT students worked 2 days/week in the community under the part-time supervision of a PT/OT professional.
Participants, intervention, procedures and outcome measures: PT/OT students screened children in daycare groups with the Ages-and-Stages Questionnaire (ASQ-3). Children scoring below ASQ-3 thresholds on the motor scale or for whom motor concerns were observed were fully assessed with the Peabody Developmental Scale (PDMS-2). Whenever applicable, referral for services and recommendations to families and educators were offered. Similarly, whenever feasible, intervention goals were identified via the Goal-Attainment Scale (GAS), interventions were provided to children, and goals were reassessed. Satisfaction surveys and interviews were conducted with families, educators, daycare managers and students.
Analysis: Descriptive statistics were undertaken on all quantitative outcomes. Paired sample Wilcoxon test were computed on pre/post PDMS-2. A thematic analysis was performed on the interviews.
Results: Over 8 months, 113 children were screened by 15 students (6 PT, 9 OT). Of these, 62 children (54.9%) were deemed at-risk for developmental delays, including 18 for motor delays (15.9%). Initially, 26 children were assessed on the PDMS-2 gross motor scale; 16 of these scored below average (61.5%). Overall, for all children at-risk for developmental delays, 41 recommendation programs were made (66.1%), individual- and group interventions were offered respectively to 22 (35.5%) and 15 children (24.2%), and 4 children were referred to a health professional (6.5%). Goals were formulated for 14 children and mostly targeted mobility (78.6%). When reassessed, 50% of the goals were attainted at or above expectations. Children reassessed on the PDMS-2 (n=9) showed improvement in fine motor only (mean improvement of 15 points, SD:10.7; p=0.012). Stakeholders (n=11) were moderately satisfied with the interventions (5.6/10). Most of them (64%) reported an increase in their knowledge about childhood development, and almost all (82%) hoped services would be maintained. They formulated recommendations to ensure more time is spent on intervention and less on screening or assessments. Students formulated similar recommendations.
Conclusion(s): The services provided by the PT/OT students were appreciated by partners. Student placement initiated a community-based collaboration to better support children with developmental delays. The current model of care should however be reviewed to better respond to stakeholder needs.
Implications: Models of care for student placement in vulnerable communities might require a greater emphasis on: 1) early intervention, 2) in-context, capacity-building services, and 3) collaborative approaches grounded in the community. Innovative mechanisms to evaluate services might be required, given the limitations of traditional screening and assessment tools. Student preparation should put a greater emphasis on advocacy and community services.
Keywords: Vulnerable children, Global health, Access to services
Funding acknowledgements: The regional public health office (CIUSSS de l'Estrie-CHUS)
Purpose: To evaluate the impact of the community-based services offered by physical and occupational therapy (PT/OT) students in a low-income neighborhood.
Methods: Design: A cohort study including a review of clinical data.
Context: For either 4 or 7 weeks, third- and fourth-year PT/OT students worked 2 days/week in the community under the part-time supervision of a PT/OT professional.
Participants, intervention, procedures and outcome measures: PT/OT students screened children in daycare groups with the Ages-and-Stages Questionnaire (ASQ-3). Children scoring below ASQ-3 thresholds on the motor scale or for whom motor concerns were observed were fully assessed with the Peabody Developmental Scale (PDMS-2). Whenever applicable, referral for services and recommendations to families and educators were offered. Similarly, whenever feasible, intervention goals were identified via the Goal-Attainment Scale (GAS), interventions were provided to children, and goals were reassessed. Satisfaction surveys and interviews were conducted with families, educators, daycare managers and students.
Analysis: Descriptive statistics were undertaken on all quantitative outcomes. Paired sample Wilcoxon test were computed on pre/post PDMS-2. A thematic analysis was performed on the interviews.
Results: Over 8 months, 113 children were screened by 15 students (6 PT, 9 OT). Of these, 62 children (54.9%) were deemed at-risk for developmental delays, including 18 for motor delays (15.9%). Initially, 26 children were assessed on the PDMS-2 gross motor scale; 16 of these scored below average (61.5%). Overall, for all children at-risk for developmental delays, 41 recommendation programs were made (66.1%), individual- and group interventions were offered respectively to 22 (35.5%) and 15 children (24.2%), and 4 children were referred to a health professional (6.5%). Goals were formulated for 14 children and mostly targeted mobility (78.6%). When reassessed, 50% of the goals were attainted at or above expectations. Children reassessed on the PDMS-2 (n=9) showed improvement in fine motor only (mean improvement of 15 points, SD:10.7; p=0.012). Stakeholders (n=11) were moderately satisfied with the interventions (5.6/10). Most of them (64%) reported an increase in their knowledge about childhood development, and almost all (82%) hoped services would be maintained. They formulated recommendations to ensure more time is spent on intervention and less on screening or assessments. Students formulated similar recommendations.
Conclusion(s): The services provided by the PT/OT students were appreciated by partners. Student placement initiated a community-based collaboration to better support children with developmental delays. The current model of care should however be reviewed to better respond to stakeholder needs.
Implications: Models of care for student placement in vulnerable communities might require a greater emphasis on: 1) early intervention, 2) in-context, capacity-building services, and 3) collaborative approaches grounded in the community. Innovative mechanisms to evaluate services might be required, given the limitations of traditional screening and assessment tools. Student preparation should put a greater emphasis on advocacy and community services.
Keywords: Vulnerable children, Global health, Access to services
Funding acknowledgements: The regional public health office (CIUSSS de l'Estrie-CHUS)
Topic: Education; Paediatrics
Ethics approval required: Yes
Institution: Centre de recherche du CHUS
Ethics committee: Ethic committee of the CR CHUS
Ethics number: 2017-1441
All authors, affiliations and abstracts have been published as submitted.
