The Use of Occupation-Based Coaching and Peer Support to Promote Independence in Foster Youth

A Revitalizing and Non-Traditional Level II Occupational Therapy Master’s Fieldwork Placement, for a Veteran COTA during COVID-19

We go into occupational therapy wanting to help others, but the topics we learn as entry-level practitioners are just the tip of the iceberg, in regards to the knowledge we have to offer the world. Many entry-level practitioners honestly do not have enough experience during their course work to focus on emerging practice areas. This includes surveying a real community and then initiating the development of programs to provide solutions. The point of this article is to provide insight into the prospective non-traditional fieldworks or emerging practice that occupational therapy students can obtain, to satisfy educational requirements, while still having an impact on those we provide services to.

The initial process to determine an under-served population began with a simple needs assessment and identification of current research. Foster youth who have aged out of the foster care system were identified as an underprivileged population within the community. Following the identification of our population and research to support the needs assessment, we utilized the Occupational Therapy Practice Framework, 4th edition (OTPF-4) (AOTA, 2020), to dissect the foster youths' occupations, contexts, performance patterns, performance skills, and client factors. Utilizing the OTPF-4 provided guidelines for the identification of areas of concern and areas of focus for habilitation or skill acquisition.

The most recent research that peered into foster youth transitioning out of foster care dated back to 2001. It documented the changes in social support for youth aging out of the foster care system, suggesting that family support and foster caregiver support remained extremely important (Courtney, Piliavin, Grogan-Kaylor and Nesmith, 2001). This concept was seen with our participant. He continued to have contact with his biological family, remained close with his second foster family and is currently residing with his first foster mother. Courtney, Piliavin, Grogan-Kaylor and Nesmith (2001) documented an average of 76% of participants reporting they had obtained some form of life skills training. Specifically, in activities such as:

(Courtney, M. E., Piliavin, I., Grogan-Kaylor, A., & Nesmith, A., 2001)
 

 When participants were asked where they obtained their knowledge in these skills, 39% reported mostly from their foster parents, 32% from specialized independent living training programs, 7% were child-caring institutions and group homes; the remainder were from various sources (Courtney, Piliavin, Grogan-Kaylor and Nesmith, 2001). We ultimately used this information during our recruitment period, to shift gears and develop a program with a focus on skills required to 'adult'.

Occupational therapists have a lot to offer their clients, although research shows that peer support from those who have similar backgrounds aids in developing a sense of belonging. We did not want our participant to feel isolated during our sessions. Foster youth are already aware of their difference from their counterparts, subsequently leaving them vulnerable to discrimination and social stigma (Rogers, 2017). Social isolation, secondary to multiple residencies, leads to poor connections with peers, due to the inability to maintain long-lasting relationships. The most jaw-dropping comments by Rogers (2017), that supports the use of peer support during our program, was in his findings:

"...for these young people, social relationships with their fostered peers are an adaptive response to the challenge of stigma. They offer protection from the exclusory potential of stigma and serve as a way to preserve and maintain access to relationships and networks, which can subsequently provide them access to social capital" (Rogers, J., 2017).

Foster youth do not advertise their background outside of their social circles. During the recruitment period for our foster youth program, we were able to screen and obtain four mentors, that would ultimately serve as our peer support. Most of them were foster youth with extremely different backgrounds. One participant had over 40 placements during her time in the foster care system. She is now dedicated to aiding displaced foster youth with self-care essentials. Our second mentor was able to provide insight into nutrition, health and wellness. He was adopted as an infant and currently runs a non-profit organization, offering scholarships for foster youth in CrossFit gyms across the United States. Our third mentor, who resides in Canada as well, was a foster youth who now runs a non-profit service, to educate foster youth in building credit and securing safe and affordable housing. The last mentor was a foster youth who had suffered sexual abuse, which resulted in a pregnancy at the age of 15.

The four mentors alone were the backbone to the success of our program, as they had the life experiences we were missing.

We spent approximately three weeks scouring the internet for medical practitioners, families and support programs in the state of Maryland, that would assist us in promoting our program. We focused on providers of Medicaid, Aetna and Blue Cross Blue Shield. This routine was a dead end. The next step was to take our cause to Facebook. In a matter of days, we located four prospective participants for a Foster Youth Group with a focus on 'Adulting'. Virtual meetings were set up, where we realized we had more people who, like us, wanted to help those who are either in foster care or an aged-out youth. Ultimately, we recruited one primary participant for our 'Sessions on Adulting' and a team of mentors who would be featured in each meeting, to directly provide guidance from a professional and personal perspective. These individuals had all been in the care system, emerged to find personal success and were now passionate about helping others, as they age out of care.

The participant that we built our peer support program around happened to reside in Canada. This brought about an interesting revelation, even in a socialist country such as Canada; those aging out of foster care are still poorly supported. Due to our participant’s geographical location, we had to shift our mindset, so we transitioned to an occupation-based coaching model. Occupation-based coaching, sometimes referred to as occupational performance coaching, is a method of 'working with parents to achieve occupational performance goals for themselves and for their children' (Gantman Kraversky, 2019).
 

"Occupational therapy research supports Occupation Performance Coaching intervention, as a way to increase participation of children with special needs" (Gantman Kraversky, D., 2019)

 With this approach we were able to guide our participant, while still allowing him to self-identify barriers and solutions; open discussions create a relaxing, trusting and supportive environment. Additionally, a study with 310 youth determined that mentoring was an effective method in contributing to a positive adjustment for foster youth, as they transitioned into adulthood (Ahrens, DuBois, Richardson, Fan and Lozano, 2008). Comparing and contrasting the two articles solidified that we were on the right track to deliver appropriate, meaningful and purposeful coaching to our participants.

Occupational therapy continues to evolve, researching an array of topics to ensure evidence-based practice. Since Genevieve and I are occupational therapy practitioners, we are still driven by outcomes and decided to select an assessment for our program. We determined that the Canadian Occupational Performance Measure (COPM) was the best choice as an assessment for a multitude of reasons. The purpose for selecting the COPM was mainly due to our participant's age and disability; remaining occupation-based also maintained our goal of participation. It was an easy evaluation to administer, with the participant appearing to understand the questions. The best part was that it elicited thoughts and discussions throughout the process, supporting validity. We were then able to learn more about the participant than he had previously disclosed. Our participant already had the volition to seek help with acquiring life skills. He was ready with goals he wanted to achieve during our first meeting. These goals include:

On the second meeting, homework was issued. We utilized the CareerOneStop (2017) Free Skill Matcher, for career exploration (again, our mission is to keep costs low!) We realized that our participant had a narrow view of the many different careers he could obtain, specifically in areas that he has already developed the skills required. He completed it without hesitation and the outcome was beautiful. However, his young mindset led him directly to the salaries of each career of interest. This is where one of our mentors was able to redirect him into understanding that, if you love what you do, then income should not be the only deciding factor in all cases. Another important life lesson for an 18-year-old!

All that mattered was he had volition on his side. Well, we had his volition on our side!

Following five weeks of meetings, he had been flooded with information and support. He was able to learn about: programs in Canada to foster independent living, low-cost cell phone plans for foster youth, building his credit, saving, budgeting, nutrition, fitness and health - and opportunities for him to be able to give back. We readministered the COPM to assess for progress. What we have noticed, however, is that some areas become either more or less important, with very subtle changes in satisfaction. He had extremely limited insight into his satisfaction and importance of participation in occupations during the initial administering of assessment. However, during the week 5 assessment, we noticed improvements in insight when comparing it to verbal communication.

The participant was provided with a Google document following each session, to provide him with visual cues of what occurred that day. Even though this system began as a way to track everything we covered, we initially did not ask our participants the best way they learn and retain information. I did not want to risk information being lost due to an oversight. Our participants' sessions are still ongoing, as I completed my required 12 weeks. We slowly transitioned to include another experienced COTA, OT student and fellow classmate in his session. She had not had as much success in recruitment as my program and my participant was motivated to continue group meetings after my absence. We have seen tremendous improvements with our participant, by slowly guiding and coaching him towards his goals.

Program development is difficult. This is mostly due to all the red tape, in ensuring that all legalities are covered, you are following practice acts, ensuring all safeguards are in place to protect the company and the clients and, most importantly, ensuring you are doing no harm. The overall experience wasn't just a means to an end. What was gained from this experience takes entrepreneurs years to figure out and additional expenses to obtain. It was not all sunshine and roses; research had to be performed, meetings were required with participants and mentors, the development of content that was evidence-based and implementing interventions.

During this fieldwork experience, I obtained autonomy and the ability to take a chance without playing a game of roulette on the outcomes. I gained insight into the struggles entrepreneurs face when trying to advertise and recruit patients and the real-life challenges of keeping costs low, so that those savings can be passed on to patients. I have now found myself with a new outlook, revitalized as a practitioner and actively seeking program development opportunities, in not only my everyday life, but with anything within earshot. If you are like me, interested in going out of your comfort zone and trying your hands at a unique niche in the realms of occupational therapy...
 

I would highly recommend daring to dream big, think outside of the boxes of hospitals and clinics, and set your sights on a non-traditional placement, where you can truly provide the type of care this incredible profession is built upon.