Co-constructing engagement in pediatric rehabilitation: a multiple case study approach

Abstract

Purpose

To explore engagement principles and contextual conditions in high-engagement therapy sessions involving youth with disabilities and service providers.

Method

From a larger project on therapy engagement, a dyadic case analysis was conducted involving three youth ages 8–15 with disabilities and their service providers. Participants were interviewed about their engagement experiences after high-engagement sessions focusing on speech articulation, transition goals, and physical mobility. Data were analyzed thematically, with an emphasis on engagement principles illustrated by the cases.

Results

There were four service provider engagement principles: (a) clients differ in what engages them and in how they display engagement (Individual Variation Principle), (b) there are multiple ways to engage clients (Personalizing Principle), (c) engagement is cultivated through relationship (Relationship Principle), and (d) it is important to monitor and be attuned to the client’s level of engagement over a session (Monitoring Principle). Service providers’ use of engagement strategies varied due to contextual conditions, including therapy type and youths’ interests and preferences.

Conclusions

The findings indicate the value of providers’ awareness of the dynamics of engagement, their use of personalized strategies to engage clients, and the fundamental importance of cultivating a good relationship and monitoring client engagement during therapy.

IMPLICATIONS FOR REHABILITATION

• Service providers may benefit from being aware of common principles underlying the co-construction of engagement between service providers and clients.

• Service providers can use a variety of personalized strategies to heighten client engagement, and can work to cultivate a positive relationship.

• It is important to monitor clients’ non-verbal and verbal signs of engagement and respond to signs of disengagement during therapy.

• Contextual conditions affecting service providers’ use of engagement strategies include the nature of the therapy being provided and youths’ interests and preferences.

Keywords:

• Case study
• disability
• involvement
• investment
• therapy relationship
• therapy strategies

Acknowledgements

We acknowledge the contributions of other members of the Pediatric Rehabilitation Intervention Measure of Engagement (PRIME) research team (http://primeresearchteam.com), including Roger Ideishi, Jenny Ziviani, and Kate Einarson. We thank the study participants and the organizations assisting with recruitment.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The authors alone are responsible for the content and writing of this paper. This study was funded by an operating grant from the Canadian Institutes of Health Research (CIHR) [MOP-133397]. Gillian King holds the Canada Research Chair in Optimal Care for Children with Disabilities, funded by the Canadian Institutes of Health Research. This chair is supported by matching funds from the Kimel Family Opportunities Fund through the Holland Bloorview Kids Rehabilitation Hospital Foundation.