Exploring the alignment between occupational therapy using Ayres Sensory Integration® with children and occupation-centred practice: An observational study.

introductionThere is a longstanding debate about using Ayres Sensory Integration® (ASI) as an occupational therapy approach, fuelled partly by queries about its alignment with the current occupation-centred paradigm. Despite many voicing their opinions, no studies have considered the extent to which occupational therapy using ASI with children might be implemented in a way that aligns with occupation-centred practice. This study was designed to explore that alignment.

methodsThis mixed-methods study involved eight occupational therapists certified to implement ASI. Data collection involved (1) an online survey to gather demographic data and rate structural fidelity elements; (2) a review and rating of a video-recorded session using process fidelity elements and the occupation-centred practice checklist for observable items (e.g. therapist-child collaboration); and (3) a review and rating of semi-structured interview data using the same checklist for non-observable items (e.g. child- or family-chosen goals). Two coders independently analysed the data. CONSUMER AND COMMUNITY INVOLVEMENT: No consumers were involved in this study.

findingsThe extent to which interventions aligned with occupation-centred practice varied among the participants, with partial uptake of several components observed across therapists. Some occupation-centred practice components were more consistently met, including identifying client concerns, developing trust with the child, and considering the child's unique features when planning interventions. Other components were more consistently missed, such as collaborating with caregivers, co-creating and reviewing goals, establishing occupational outcome measures, considering the client's broader context, and drawing on multiple theories and approaches to guide practice.

conclusionSome participants' therapeutic approach was more closely aligned with occupation-centred practice, evidencing the potential for occupation-centred implementation of ASI. Nevertheless, findings underscore the need to strengthen the occupational focus. Therapists may benefit from occupation-centred practice training and using the checklist presented in this study to self-monitor alignment with the profession's paradigm.