Do Occupational Therapists Enhance Comprehensive Health Assessments for Children in Foster Care?

Background: Developmental health concerns are prevalent among children in foster care. National organizations recommend addressing developmental health as part of comprehensive health assessments. While practice standards indicate that comprehensive health assessment team members could include occupational therapists (OT), there is no data to inform how adding OT to the assessment team contributes to developmental assessment and recommendations. We aimed to describe findings from OT evaluations performed as part of comprehensive health assessments for children in foster care and to determine if OT evaluation influences developmental health recommendations.

Methods: We conducted a retrospective review of records from 2016-18 at an evaluation model clinic for children in foster care. OT perform the developmental component of comprehensive health assessments using tools including history, observation and standardized testing (Beery-Buktenica Test of Visual Motor Integration, Bayley). Our child welfare agency has an Education Support Center (ESC) to advocate for school needs such as Individualized Education Plans (IEP). Developmental history, caregiver developmental concerns, results of standardized tests, OT impressions, and developmental health recommendations were recorded. A subset of children seen at the same clinic did not undergo OT evaluation as part of comprehensive health assessment due to limited OT availability; developmental health referrals were compared between patients with and without OT evaluation. Descriptive statistics, Chi2, Fischer-exact and t-tests were used.

Results: Median age of the 335 children evaluated by OT was 8 years (range 0-19). Of the 296 school aged children evaluated by OT, 20% already had an IEP in place at the time of the comprehensive health assessment. OT assessment noted at least one developmental concern in 69% of evaluated children. Domains with highest prevalence of delays were visual motor (45%), communication (40%) and academic skills (39%) (Table 1). There was discordance between caregiver perceptions of development and OT assessment results for 110/308 (36%) children. There were 72 caregivers who reported no developmental concerns for a child who was noted to have a concern on OT evaluation. There were 38 caregivers who reported developmental concerns for children with no delays noted by OT. OT provided strategies to strengthen development to 74% of evaluated children. Compared to children not evaluated by OT, children evaluated by OT had significantly more developmental referrals overall, to rehabilitation therapists, and to the child welfare agency Education Support Center for IEP advocacy (Table 2).

Conclusion: OT found a high prevalence of developmental delays in multiple domains. OT can play a role in caregiver education about developmental health. OT routinely provided strategies to strengthen development right at the time of comprehensive health assessment. OT evaluations resulted in more developmental referrals, suggesting that OT enhance detection of developmental needs. Our findings support inclusion of OT in comprehensive health assessments for children in foster care.