Date Presented 04/21/2023

Researchers piloted a 10-session telehealth parent coaching intervention, measuring pre–post changes in family participation, cohesion, and adaptability. Results provide preliminary support for family-level services to augment traditional child-focused OT.

Primary Author and Speaker: Sarah L. Smith

Contributing Authors: Semra Aytur, Elizabeth Humphreys

PURPOSE: Family occupational participation shapes family resilience by cultivating connection to each other and the community (Breitkreuz et al., 2014). For families with Children with Special Health Care Needs (CSHCN), participation often requires intentional planning to ensure that activities are inclusive of all family members. While traditional occupational therapy (OT) services support CSHCN, needed are supports for family-level outcomes. The purpose of this study was to determine the effects of a telehealth parent coaching intervention, the Healthy Families Flourish Program (HFFP), on supporting family occupational participation, cohesion, and adaptability for families with CSHCN. Researchers also examined the relationships between these variables in promoting family participation.

DESIGN: Researchers used a single-group pretest-posttest quasi-experimental design. Participants were recruited using convenience sampling via social media postings and professional email networks. Inclusion criteria were English-speaking families with at least one CSHCN ages 2-17 years who lived at home full time.

INTERVENTION: The HFFP is a 10-session telehealth parent coaching program developed by the primary researcher. Sessions are 45-60 minutes on Zoom and include a family health education topic and parent coaching on individualized family goals (Dunn et al., 2018). The eight educational topics were developed based on prior research (Smith et al., 2017) and include: family identity, connection, intention, balance, communication, awareness/reflection, adaptation, and support systems.

METHOD: Researchers measured changes in family participation using the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS), and changes in family cohesion and adaptability via the Family Adaptability & Cohesion Evaluation Scale (FACES-IV). Data were analyzed using Wilcoxon signed-rank tests, Cohen’s d, and Kendall’s Tau (τb).

RESULTS: Eleven families participated including 17 parents and 27 children. COPM scores improved pre/post intervention (mean difference performance 2.31, p=0.001; mean difference satisfaction 2.86, p=0.002) with large effect sizes (performance d=1.75; satisfaction d=1.92). Average pre/post GAS increased (mean difference 2.09, p=0.001) with large effect sizes (d=3.53). Family cohesion increased pre/post (mean difference 6.64, p=0.001), with moderate effect sizes (d=0.55). Family adaptability improved pre/post intervention (mean difference 8.45, p=0.0166), with moderate effect sizes (d=0.78). Changes in family cohesion correlated positively with changes in COPM satisfaction although not with statistical significance (τb=0.443; p=0.0677). Changes in adaptability significantly correlated with changes in COPM performance (τb =0.623; p=0.0093).

CONCLUSION: The HFFP demonstrates positive effects on family occupational participation, cohesion, and adaptability. A significant relationship exists between family participation and adaptability. Telehealth may offer an ecologically valid service delivery approach to support family occupation.

IMPACT: This novel study examined family unit OT intervention effects rather than traditional child-based outcomes. Findings provide preliminary evidence supporting telehealth parent coaching services and advance empirical evidence of the relationship between participation and health constructs on the family level.


Breitkreuz, R., Wunderli, L., Savage, A., & McConnell, D. (2014). Rethinking resilience in families of children with disabilities: A socioecological approach. Community, Work & Family, 17(3), 346–365.

Dunn, W., Little, L.M., Pope, E., & Wallisch, A. (2018). Establishing fidelity of occupational performance coaching. OTJR: Occupation, Participation and Health, 38(2), 96-104.

Smith, S.L., DeGrace, B., Ciro, C., Bax, A., Hambrick, A., James, J., & Evans, A. (2017). Exploring families’ experiences of health: Contributions to a model of family health. Psychology, Health & Medicine, 22(10), 1239-1247.