Team-based Coaching, Collaboration, and Consultation

Profession-centred, or needs-based?

Attic Therapy values the relationships kids have with their “people.” These people are the ones who are available to them day to day, in their community and home environment. These people include parents, but also extend to the extended family, supportive neighbours and allies, education teams, and various support networks of all sizes and shapes. Kids live in a village, and that village is made up of the individuals who care about those kids and how they are experiencing and accessing their world.

Attic Therapy wants to support the village. We don’t want to insert ourselves into a child’s life unnecessarily, but we do want to provide support, coaching, mentoring, encouragement and validation to those crucial attachment figures who are next to and supporting each child. We believe that building capacity in the caregivers is much more effective than simply pulling out and “treating” a child.

Health care exists in Canada as a publicly funded institution that is available to all citizens of the province of Saskatchewan, and the nation of Canada. However, we know that equitable access to these services is severely limited by roads, weather, distance, and human resource limitations. As licensed health care professionals, we can provide needed health care consultation and intervention at an individual or family level. However, to promote greater participation for each child or youth in the daily activities that have meaning and purpose for them, we need to help the spaces and places adapt to the needs of children and youth as they are. In other words, kids need to experience the ability to feel safe, grow relationships, find delight, learn, have fun, and explore before they are “fixed” and whether or not they ever “get better.”

Many kids are struggling with disabilities that are highly influenced by barriers to engagement or participation to their particular way of being. They may never become “typical,” and maybe that’s not a great goal anyway! Let’s partner together to break down barriers at the level of the environment, and thereby reduce the effect of the disability on each child’s experience of daily life.

In this regard, a profession-centred approach to service delivery is not, in our opinion, the most effective model of support for inclusive services for children. A profession-centred approach starts with a “stable” of various professionals, and carves up needs of the children by the availability and preferred service delivery models of the professionals. It may result in extremely efficient and skilled delivery of care in certain domains, or environments, or at the level of certain problems, but it starts and ends with the professionals as the core decision-making stakeholder. At the level of the child and the caregivers, some needs may remain unrecognized, unheard, and unmet, because of the predetermined nature of the supports, and the predetermined level of importance placed on various supports in relation to each other.

A needs-based model starts with the needs of the child, and the village surrounding the child, and proceeds with flexible and adaptive team construction around those needs, with time factors related to solution-finding, not professional schedules. Professional skillsets may be used, or not, and hierarchical status, available time factors, or preferred service delivery models at the level of the team are not as important in the overall strategy as are the needs of the child. Collaborative solutions are valued, where the people closest to the child are deferred to in terms of their ability to take in help, to utilize it effectively with the resources they have on hand, and where their perception of the outcome matters more than does that of the helping professional ("expert" or not!). In other words, the help must be felt as helpful, for it to be helpful.

Attic Therapy recognizes that not all teams need our professional expertise all the time, and that a model that is not responsive to the team members closest to the child is not likely to be perceived as effective, no matter how we feel we are doing. We propose that we partner with organizations who are attempting to build responsive, needs-based, and flexible team structures to support inclusion at the level of the child’s environment. We propose that we be involved in ways that are based primarily on child-centred outcomes, not predetermined schedules relating to the appearance of well-rounded supports.

If this model of service delivery appeals to you, feel free to contact us for a conversation as to how you would like to partner and what the particular environment or goals of your team are in relation to inclusive supports for children. The following is a template of what we can provide:

I. One-time discussion with a team exploring a topic related to inclusion such as:

   a. Physical barriers to access and participation and some workarounds, or collaborative brainstorming towards short and long-term solutions.

   b. The role of safety – how we build it into a child’s experience of an environment, and how they show us that they feel safe.

   c. Co-regulation for the purposes of building self-regulation – emotional management of large feelings, the problem of overwhelmed nervous systems, and how humans cope together.

   d. Engagement vs. behaviour – how children show us they are able to or not able to engage in purposeful, joint attention in tasks, and what to do to help them settle into focused attention and engagement.

   e. Using movement to support attention, relationship-building, and engagement in goal-directed activities.

   f. The reason that finding delight is so crucial in supporting authentic learning and growth in all children.

II. Coaching relationships with specific care providers, in context:

   a. Collaborating with parents, teachers, or care providers in the environment where the child is living, learning, or playing, to support access and engagement in meaningful tasks.

   b. Coaching relationships with teams – providing targeted in-services, coaching visits, Q and As, mentorship, or other collaborative supports to care providers working to increase access, engagement and participation of children and youth.

   c. Providing thoughtful sounding boards to teams attempting to switch to an inclusive, rather than a medical treatment, model of support.

III. Consultation based on a specific question that relates to occupational or physical therapy skills and expertise:

   a. Helping to increase caregiver safety in providing daily supports, including transfers, lifts, handling, and personal care.

   b. Supporting the safe fitting, maintenance, installation, care and application of equipment related to positioning, mobility, access to communication, seating, or feeding.

   c. Answering caregiver questions as they relate to the specific needs of a specific child in attempting to access a specific activity (such as physical education, extra-curricular activities, transportation to and from various locations, pre-vocational experiences, play-based learning, etc.).

IV. Long term relationship-building within a team for the purposes of enhancing inclusive supports:

   a. Embedding ourselves within a team, and an organizational structure, in order to be maximally available and responsive to those people directly serving and caring for children.

   b. Providing full and open access to our combined skillsets to other team members, for the purposes of perspective-sharing, capacity building, joint problem-solving, long-term visioning, etc., all with the aim of supporting inclusion for all children in context.

   c. Working together for and within an organization to achieve aims that correspond directly to values jointly held by Attic Therapy and the contracting structure.



Rates and Fee Schedules

Relationship-based, collaborative coaching, and other needs-based, responsive models of service delivery are hard to quantify for the purposes of billing! Attic Therapy proposes the following structure for teams wishing to access Attic Therapy’s support for their team, in order to facilitate greater inclusion for children:

I. Billing by Day, with breakdowns for partial days down to ¼ day billing increments:

   a. $1000/long day/professional

   b. $800/day/professional

   c. $500/half day/professional

   d. $250/quarter day/professional

   e. – where a long day = 8 hours or more, a day = 6-8 hours, a half day = 2-4 hours, and a quarter day = 0.5 hours to 2 hours

II. Billing by Project - creation of a measurable outcome, agreed to by both parties, by a particular date, and with a total quote provided by Attic Therapy, with half payable in advance, and the remainder upon completion of the outcome or arrival at the end date (whichever comes first):

   a. measurable outcomes to be related to the needs of children to participate in meaningful activities in order to thrive.

   b. Outcomes may be at the level of the child, family, institutional structure, or community.

   c. Outcomes may be adjusted with mutual agreement as Attic Therapy participates in joint problem-solving and trial and error approaches, but the overall aim of the project is measurably advanced by Attic Therapy’s support.

   d. If the project does not succeed in meeting the measurable outcome, or the aim is not measurably advanced by Attic Therapy’s involvement (such that the contracting party is dissatisfied with the result), then the remainder will be forfeited by Attic Therapy.

III. Billing by Month or Year – Attic Therapy partners with the organization in such a way that relationships with co-collaborators are facilitated in an ongoing way, and Attic Therapy’s participation in a team is encouraged as relates to the needs of the child:

   a. Professional fees to be negotiated based on an approximate equivalency with professional counterparts within the organization, taking into account the differences between contractors and employees as per CRA guidelines.

   b. In general, contractors must charge within a certain range in order to manage carrying all the risks of loss of income normally covered by employee benefit packages, as well as the costs of professional development, regulatory licensure, and business expenses.

   c. Attic Therapy minimum billing will be $90/hour/professional (when the total number of hours contracted in a year exceeds 1200 hours/professional). Maximum billing will be $135/hour/professional.

   d. Attic Therapy will participate in team-based practices, travel, meetings, service delivery, communication, etc., with as much collaborative input as negotiated billable time allows, and will attempt to support the team’s mandate, culture, and function, as it relates to inclusion of children in society.

   e. Within the structure, Attic Therapy will use professional reasoning to support the involvement of occupational or physical therapy based on the expressed needs of the team and the corresponding expertise of each professional. Where children are directly involved with Attic Therapy (through observation, handling, intervention, assessment, coaching of caregivers, etc.) consent will be obtained, prior to either professional being involved, by parents or guardians. This consent will be limited to one professional, or extend to both professionals, at the discretion of Attic Therapy.

   f. If the organization prefers to contract only one professional (occupational OR physical therapy), this preference will be reflected by the nature of the contract, and the desired outcomes will be, in the opinion of both the organization and Attic Therapy, best provided by only one professional (i.e. the most qualified).

   g. Alternatively, if only one professional is available for contracting due to time and business constraints, that professional will provide support to the organization but will access the other professional’s expertise remotely, and as possible, to support as much overlap in roles and delivery of services as possible.

IV. Travel fees

   a. Travel time will be billed as equivalent to service delivery time for each professional, when it is for the purposes of reaching the environment of the child or team-based supports.

   b. When Attic Therapy uses their own vehicles, a mileage rate of 0.70/km will be applied for all distances over and above 25 kms from Attic Therapy’s site (at Crutwell, SK - see Google Maps for a pinned location), including in-town travel.

   c. Attic Therapy will use remote access technology where possible to defray travel expenses, if this is not seen by the contracting party as detrimental to the goals of relationship-building and supporting the needs of the child in context.