Why am I Tying the Students Shoelaces?
My name is Marie Frentzen, and I have been an Occupational Therapist since 2016. During my time as as OT in a private practice in Germany, I was asked to “deliver” a group program at a primary school, as an after-school activity for students with difficulties in motor activities, learning difficulties and social interaction. In Germany it is unusual that OT´s are asked to work at primary schools. I was happy to get the chance and said of course I would “deliver” such a program (even if it sounded quite old school).
I started with two groups of six students, aged between six to ten years old. As asked by the school, I started with a functional training program for motor skills and social interaction. Soon I found myself frustrated in the middle of a group of frustrated students doing frustrating things! While I was tying several shoelaces for the students at the end of the class, I heard my OT-voice saying: “This can´t led to any improvements and if so, this would not lead to any generalization or transfer! And why am I tying all their shoes laces??” I really wanted the students to benefit from the extra class and so an idea came alive.
I am educated in the Netherlands and the CO-OP Approach was part of the educational program at Zuyd University. Rianne Jansens was my mentor at university, so it is not surprising that I got enthusiastic about the CO-OP Approach quite early. As an OT I feel at home in the CO-OP Approach and I gain so much pleasure working with the children, guiding them towards their own solutions. In my opinion the best part of the CO-OP Approach is not only about finding the suitable strategy with the child, but also more about believing in the child that they CAN FIND their own solution.
In an individual setting I had good experiences with the CO-OP Approach, and so I was wondering whether this would work with the group of students at the primary school.
I had a GOAL: Try out the CO-OP Approach with a group of students.
Now I needed a PLAN: How can I use the CO-OP Approach in groups?
1) Find out about the student’s goals.
2) Work on these goals.
Let's DO it: Sounded easy, but it was not!
CHECK: By simply asking the students about their goals, I did not get the response I hoped for. So, I changed the PLAN: I became more directive and asked the students who was able to tie shoes and whether they would like to learn how to do it. One of them knew how to tie shoes and the others were motivated to learn it. I picked this as a first GOAL for the students.
Now we had to work on this GOAL. I can´t even remember in detail how things went, but I introduced the global strategy to the students, and we carried out the DPA together for each student, we compared the student´s performance and the one student who already knew how to tie shoes gave advice to the others. We identified breakdown points and they gave themselves hints. At the end of the class, each student had developed a strategy to tie their own shoes and to practice at home.
I CHECKED what had happed. Was that really CO-OP? The global strategy seemed to be usable in group setting, but what is about the enabling principles? Was that really guided discovery? Was it too directive, especially because of the specific hints the students gave each other? Also, we worked on a specific goal, chosen by me as therapist. But how do I get to know about the students’ goals? And what if not all students have the same goals to work on? Do they have to work on the other students goals as well? How do I create generalization and transfer? How do I include parents and teachers in the process? And of course: How do I handle the group by myself, especially if the group process is not always working so smoothly.
Sometimes things have to go just like that. At the same time all this happened, I was searching for a topic for my Master Thesis. So here it was!
For the CO-OP Approach in group setting, there does not exist an intervention format, so the idea of a scoping review came up. Great thanks to Rianne and Rose Martini, who supported me a lot during this time! I started a structured literature search about the CO-OP Approach for children with DCD in a group setting, which led to seven suitable, published articles. The data extraction was mainly based on the structural and essential elements of the CO-OP Approach to get a comprehensive overview about how the CO-OP Approach was implemented in group settings as described in the included publications. Based on these findings, comparison with further literature of the original CO-OP Approach and about group therapy in general, I proposed some adaptations to the intervention format, described by the CO-OP Approach. However, the main questions could not be answered: How (in detail) can the enabling principles be implemented in a group setting and which adaptations have and can been done, without losing the mindset of CO-CO Approach?
I did not find the answers to all the questions and there still is no intervention format for group settings. However, I am very happy that now a group of bachelor students at Zuyd University (the Netherlands) are carrying out a Delphi-Study. This is based on my proposal for the intervention format and will hopefully confirm the findings and take us a step closer to the answers and the GOAL of: Using the CO-OP Approach in group setting for children with DCD.
I am looking forward to the new findings and as I hear from Rianne (speaking for the members of ICAN), I am not alone with my curiosity. We hope to publish the findings of the scoping review together with the results of the Delphi study very soon. I am glad that I had the chance to work on a topic of such an interest and I am so grateful for all the support I got from Rianne and Rose.