MANA: Comparing Occupational Performance Coaching with usual care to Nurture Meaning, Agency and Autonomy in children with neurodisability and their families.

1. NAME Occupational Performance Coaching (OPC) 2. WHY OPC draws on dynamic systems perspectives of enablement, ecological perspectives of learning and behaviour change, and humanist and behaviour change principles to enhance client engagement in rehabilitation toward achieving personally valued occupational/participation goals. 3. WHAT MATERIALS The therapist uses no specialised equipment or materials. No standardised assessments or other assessment of impairments are used. No hands-on or directive (e.g., therapist arranging environment) methods are used with either the client or their dependent unless requested by the client in the context of context of trialling ideas within a coaching exchange. 4. WHAT PROCEDURES OPC commences with questioning to identify clients’ desired future state goals. Goals may not be directly related to health conditions or impairments. Goals are expressed at the level of observable action, comprising statement of an activity in a specific context which reflects personally meaningful change. Therapists consciously express empathy and listen mindfully to enhance the conditions for client trust in the therapist. Therapists engage clients in a reflective discourse to explore potential actions that could lead to goal progress. Therapist questioning positions clients as knowledge holders and decision makers, thus as agents of change. Therapists may provide specialist knowledge to clients only if clients give permission for this, if a knowledge gap is apparent after exploration of what clients already know. Goal progress is evaluated regularly with clients as the evaluator of change. 5. WHO PROVIDED OPC will be applied by physiotherapists, occupational therapists and speech and language therapists with a minimum of 24 hours training in OPC, and with a minimum of 6 months experience on working with children with neurodisability. 6. HOW DELIVERED OPC will be delivered 1:1 through in person, telephone/video conference delivery. 7. WHERE OPC is delivered in a private space such as clients’ home, workplace or clinic setting or via phone or video conferencing. 8. WHEN and HOW MUCH OPC will commence when families are consented to the study and meet study criteria, including having a concern or goal for themselves or their child with neurodisability. OPC frequency is typically weekly or fortnightly but is at clients’ discretion. OPC sessions typically take 45-60 minutes but can range from 20 to 90 minutes. Total number of sessions in research studies ranges from one to 10 sessions. Sessions cease at participant determined goal achievement within a maximum of 12 weeks. 9. TAILORING OPC questioning style is tailored to match clients’ language and cognitive ability and literacy level. For clients with significant cognitive impairment OPC discourse is kept short and interspersed with active practice of goal related activities. Within New Zealand, tailoring of Maori involves inclusion of whakawhanangatanga as per the Hui Process (Lacey, 2011). 10. MODIFICATIONS (During a study in response to study events) None planned. 11. HOW WELL (Planned) Quality of OPC delivery is assessed using the OPC fidelity measure (OPC-FM). Fidelity is assessed by therapists trained in OPC to an advanced level. Fidelity scores of >80% are estimated as required to elicit the desired client response. The OPC casenote audit tool is also used as a proxy fidelity indicator. 12. HOW WELL (Actual) Fidelity scores of audio recorded delivered intervention will be reported with study findings.