The purpose of this mixed-methods study was to answer the question “How are caregivers of children ages 3–5 years engaged during outpatient occupational therapy?”

Co-occupations between caregivers and children are important for establishing competence in daily childhood activities. This implies a need to engage caregivers during intervention to promote child participation in daily occupations. By age 3, the child is increasingly participating in occupations in the community with a continuing emphasis on family-centered services before age 5. The efficacy for mutually engaging caregiver and child to increase participation across environments as well as promote a variety of childhood occupations is increasingly reported in the literature. To support quality childhood co-occupations and family-centered practice, research needs to explore methods of engaging caregivers. This study explored how caregivers are currently engaged during outpatient occupational therapy for children ages 3–5.

This mixed-methods study included collection of descriptive data quantifying existing practice behaviors as well as phenomenological analysis of interviews.

Study participants were occupational therapy clinicians providing direct services to children ages 3–5 yr in community-based clinics. Five occupational therapists were recruited from regional pediatric clinics. Therapist availability was the primary factor in determining the sample size.

Participants were provided a grid to collect data daily for 2 wk to track if caregivers were involved during therapy sessions and how the caregiver was involved. The clinicians then participated in an interview, reviewed the interview transcript, answered follow-up questions, and participated in theme checking. Personal memos and procedural memos were completed throughout data collection.

Descriptive statistics were used to analyze data from the data collection grids. Phenomenological methodology was used to analyze the interviews, including line coding. Discrepancies were reviewed and discussed until the two investigators reached agreement. The analysis concluded when participants agreed on the identified themes.

Participating clinicians most frequently reported engaging caregivers through home programs, transitions, caregiver discussions and observing the session. Forty-seven sessions were reported by clinicians with children ages 3–5 yr; a caregiver was present for 39 of the sessions.

Four themes were identified from the interviews on how caregivers are engaged during occupational therapy practice. Although professional literature and research indicate the clinician and caregiver are partners, the study participants emphasized providing education to the caregiver with less evidence of collaboration. Clinicians agreed context influences occupation performance, and participation in occupations includes caregivers. However, clinicians may have difficulty with collaborative decision making and shared power when engaging caregivers.

Of the actions most frequently reported by the clinicians on the data collection grid, the use of home programs and conversations were discussed by all of the participating clinicians during their interview. Clinicians recognized their ability to influence the level of caregiver involvement, but they also identified several barriers for engaging caregivers. The ability to use strategies and overcome these barriers depended on their ability to overcome professional personal factors. Understanding how caregivers are engaged by therapists in the real-world conditions of daily practice informs future studies and initiatives for providing effective family-centered intervention and client-centered occupational therapy practice.