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As physical, occupational and speech therapists working with children with complex needs (and too often) exhausted families and disconnected teams that don't always see eye-to-eye, we recognised the need for clinical discussions that go beyond what we can gather from textbook and published guidelines.

Empowering Conversations: A Deep Dive into Occupational Performance Coaching for PTs and OTs

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In the evolving landscape of pediatric neurorehabilitation, the emergence of therapeutic coaching has marked a paradigm shift. This approach, which marries therapeutic principles with the empowering dynamics of coaching, is designed to effect profound, tangible changes in the lives of children and their families. Occupational Performance Coaching (OPC) is a distinctive coaching methodology that positions families and goal setting at the heart of therapeutic interventions.

The mind behind this transformative approach is Dr. Fiona Graham (Fi), an occupational therapist who has developed, taught, and researched OPC. Her work presents a mix of deep expertise and a passion for supporting children's success in everyday life.

If you've ever wondered about the potential of therapeutic coaching in pediatric neurorehabilitation, this interview is a must-listen. Dive into this conversation with me as I explore the nuances, challenges, and benefits of an evidence based approach to therapeutic conversations, coaching and therapy in neurodisability.


For handy links to things we've discussed in this interview,  scroll down to the Resources Section at the bottom of the page.

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Podcast Highlights

  • Developing OPC 4:02

  • Bottom up vs Top Down 6:17

  • Participation vs Body Structure and Function 9:22

  • The benefits of a coaching approach 11:16

  • Changes in outcomes 13:35

  • Doing clinical research 21:32

  • Implementing OPC in the real world 26:24

  • Barriers, stumbling blocks and a case study 28:02

  • OPC pearls 32:45

  • Goal conflicts 35:11

  • Don't be the expert expert 39:03

  • But don't abdicate responsibility 46:35

  • The value of clear goals 49:24

  • The value of relationships 51:07

  • OPC vs other coaching models 1:05:17



clickable links to take you right to the information you're looking for click here

Find out more about Dr Fiona Graham >> LINK

OPC Resources >> LINK

OPC Research >> LINK


OPC Scite Summary

Scite uses AI to search up to date published literature and create referenced summaries and more in seconds (find out about Scite HERE)

Occupational Performance Coaching (OPC) is an intervention approach that aims to improve the occupational performance of individuals with various challenges. OPC is a parent-directed and family-centered intervention that focuses on enabling individuals to achieve their occupational performance goals (Kessler & Graham, 2015; Graham et al., 2014). It combines coaching processes with occupation-centered reasoning and specialist developmental and disability knowledge (Kessler & Graham, 2015). OPC has been found to be effective in assisting parents in achieving their goals for their children, such as improving school readiness and independent use of cutlery during mealtimes (Graham et al., 2014).

Research has also explored the effectiveness of OPC in specific populations. For example, a study examined the use of telerehabilitation to deliver OPC to children with autism spectrum disorder (ASD). The study found that occupational performance coaching delivered through telerehabilitation improved children's occupational performance, behavior problems, and prosocial behavior, as well as parental self-efficacy and quality of life (Jamali et al., 2021). Another study focused on stroke survivors and found that telerehabilitation occupational performance coaching was feasible, acceptable, and effective in improving performance and satisfaction with performance of goals (Kessler et al., 2021).

OPC has also been applied in educational settings. A study conducted in a university setting explored student-led occupational performance coaching and found that clients made significant progress on their academic, health, social, and vocational goals through the coaching process (Egan et al., 2023).

Ensuring fidelity to the OPC intervention is important for its effectiveness. Fidelity refers to the accurate implementation of the intervention and adherence to its principles. Studies have emphasized the need for systematic evaluation of the fidelity of OPC interventions and have provided guidance on establishing fidelity processes and measures (Dunn et al., 2017; Graham et al., 2017).

In addition to its effectiveness, research has also examined the factors that influence the outcomes of workplace coaching, including coaching format, external versus internal coaching provision, and job complexity (Jones et al., 2018). Understanding these factors can help optimize the outcomes of coaching interventions in the workplace.Overall, research on Occupational Performance Coaching has demonstrated its effectiveness in improving occupational performance and achieving goals in various populations, including parents and children, individuals with ASD, stroke survivors, and university students. The use of telerehabilitation has also shown promise in delivering OPC interventions. Ensuring fidelity to the intervention and considering factors such as coaching format and job complexity can further enhance the outcomes of coaching interventions. Further research is needed to continue exploring the mechanisms of action and effectiveness of OPC in different contexts (Kessler et al., 2018; Ogakwu et al., 2023).


  • Dunn, W., Little, L., Pope, E., & Wallisch, A. (2017). Establishing fidelity of occupational performance coaching. OTJR: Occupation, Participation and Health, 38(2), 96-104.

  • Egan, M., Toal-Sullivan, D., Kessler, D., Kristjansson, E., & Bel, M. (2023). Student-led occupational performance coaching in a university setting. British Journal of Occupational Therapy, 86(6), 413-422.

  • Graham, F., Rodger, S., & Ziviani, J. (2014). Mothers' experiences of engaging in occupational performance coaching. British Journal of Occupational Therapy, 77(4), 189-197.

  • Graham, F., Ziviani, J., Kennedy-Behr, A., Kessler, D., & Hui, C. (2017). Fidelity of occupational performance coaching: importance of accuracy in intervention identification. OTJR: Occupation, Participation and Health, 38(1), 67-69.

  • Jamali, A., Zarei, M., Sanjari, M., Akbarfahimi, M., & Saneii, S. (2021). Randomized controlled trial of occupation performance coaching for families of children with autism spectrum disorder by means of telerehabilitation. British Journal of Occupational Therapy, 85(5), 308-315.

  • Jones, R., Woods, S., & Zhou, Y. (2018). Boundary conditions of workplace coaching outcomes. Journal of Managerial Psychology, 33(7/8), 475-496.

  • Kessler, D. and Graham, F. (2015). The use of coaching in occupational therapy: an integrative review. Australian Occupational Therapy Journal, 62(3), 160-176.

  • Kessler, D., Anderson, N., & Dawson, D. (2021). Occupational performance coaching for stroke survivors delivered via telerehabilitation using a single-case experimental design. British Journal of Occupational Therapy, 84(8), 488-496.

  • Kessler, D., Egan, M., Dubouloz, C., McEwen, S., & Graham, F. (2018). Occupational performance coaching for stroke survivors (opc-stroke): understanding of mechanisms of actions. British Journal of Occupational Therapy, 81(6), 326-337.

  • Ogakwu, N., Ede, M., Manafa, I., Ede, K., Omeke, F., Agu, P., … & Okereke, G. (2023). Occupational health coaching for job stress management among technical college teachers: implications for educational administrators. Medicine, 102(1), e32463.


Other Mentions:

  • Canadian Occupational Performance Measure (COPM) >> LINK

  • Motivational interviewing >> LINK

  • CO-OP >> LINK

  • Acceptance and Commitment Therapy >> LINK

  • Comparing Coaching Approaches research

  • The problem with Family Centered Care


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