The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach.

What is this approach and who is it for?

Introduction

The CO-OP approach is a child centred, performance-based, problem-solving approach that enables skill acquisition through the process of strategy use and guided discovery (Polatajko & Mandlich, 2004). It is a top-down approach this means that instead of working on performance components such as manual dexterity, you work on the actual task eg using cutlery or tying laces. The approach involves collaboratively setting a goal with the child, analysing the performance and then achieving success with the task using guided discovery. The aim is to guide the child to independently discover and develop their own strategies to carry out the task- as opposed to directly teaching them. The child learns a four step strategy;

1. Goal – What do you want to achieve?
2. Plan – How are you going to do it?
3. Do – Just do it! Carry out the plan.
4. Check – How well did the plan work?

The child is encouraged to define each of these steps and then we use simple examples to demonstrate how the strategy works. This ‘global strategy’ is designed to support the child in the acquisition of many new skills –essentially the aim is to teach the child how to learn new skills and problem solve independently. The child learns quickly that when they are unsuccessful with a task it is the plan that has failed and not them- they simply need a new plan. It encourages the child to self-evaluate and create their own way of completing a task they are struggling with.

Naturally, if an individual sets their own goal they are more motivated. This is especially important with children. Our aim is to give the child a strategy they can use when learning any new skill. The skill or ‘goal’ we pick when learning the process is not overly significant. Parents and their children will always have different values and interpretations of what is important so particularly in the beginning of this process it is paramount that we follow the child’s lead and allow them to set their own goals.

“Each time one prematurely teaches a child something that he could have discovered himself, that child is kept from inventing it and consequently from understanding it completely” (Piaget 1970)

Key Features

There are 7 key features involved in implementing this strategy these include;

1. Child chosen goals
As mentioned above when a child chooses their own goal they will be more intrinsically motivated to achieve it. For example, giving a child a handwriting goal to work on when they hate handwriting is not a good place to start. Encourage the child to identify what is meaningful to them. Using a picture card sort can be helpful for children to identify what they find difficult and would like to be better at. The Canadian Occupational Performance Measure (COPM) could also be used to identify a meaningful goal. After the child has identified the goal, ask them where the task is going wrong and how they would rate their current performance- this is a good starting point.

2. Dynamic Performance Analysis
The first thing to consider when evaluating the performance is if the client is motivated. Motivation is key to persistence and success. The child and therapist also need to consider the following questions; what is their knowledge of the task?, are they trying to improve a skill or learn a new one from scratch?, what is their current level of ability at completing the task?

3. Cognitive Strategy Use
This involves introducing the global strategy of GOAL, PLAN, DO, CHECK. Practising and becoming familiar with how the strategy works using easy tasks first will help the child become confident with the terms and will help them to remember and understand each step clearly.

4. Guided Discovery
This key feature is extremely important and probably one of the most difficult for parents and therapists to follow. Using guided discovery, we encourage children to problem solve and learn how to complete activities on their own. Key points to remember about Guided discovery:
• One thing at a time: This means addressing only one component or problem area at a time. Encourage the child to identify where the task is breaking down. When they identify the problem ask what they are going to change in their plan to get round this. There may be more than one component of the task that needs to be adapted but by addressing only one difficulty at a time makes it more manageable. For example if the task was handwriting, the sentence may be poorly spaced, too large and incorrectly placed on the line; but one should only work on one of these aspects at a time.
• Ask, don’t tell: As opposed to telling the child what is going wrong, ask them what they think. Encourage them to self-analyse by posing the right questions. Draw their attention to what is going right as well as what’s going wrong. Refer back to goal, plan, do, check to help formulate your questions. If you are about to tell the child where something is going wrong- think of a way to rephrase it as a question.
• Wait: Hold back and watch, allow the child to run into the problem and give them time to process and problem solve before you ask your next question. It is important that we allow the child to make mistakes so they can identify and fix these themselves when we are not there.
• Coach, don’t adjust: Do not make any changes to the task that the child is doing instead coach them to do so themselves. We want the child to experience the success and a sense of achievement themselves. When we involve ourselves in the task we take this sense of achievement away from them.
• Make it obvious: Without directly telling the child we can make it very obvious where a task is going wrong or how it should be done. Modelling or demonstrating a task to a child can be a good way to make it clear.
• Playing dumb: Play along with the child in their journey of discovery and pretend you are learning or becoming familiar with the task only as they do.

5. Enabling Principles
For the strategy to be successful you need to remember some simple steps in particular with children – it has to be fun! We want the child to take ownership of their goal and ultimately experience a great sense of achievement when they complete it. When the child achieves the skill we need to support them to ‘generalise’ it, this means that they may be able to tie their laces in a therapy room but can they manage it in a busy classroom environment. When the child has ‘generalised’ the skill we look at transferring it to any other context for example tying a bow.

6. Parent and Significant Other Involvement
It is important that the parent has a good understanding of the approach and how to implement and carry it out at home. Speaking with a Therapist who is trained in this approach will help as the therapist can coach you as a parent, they can model your role and they can also observe you supporting and offer advice on strategies you can use.

7. Intervention Format
The therapist will support the family with the necessary materials. The therapist will also ensure the child is confident and demonstrates a good understanding of the strategy before using it for more difficult tasks.

Who can it be used with?

There is evidence to support the use of this strategy with Developmental Co-ordination Disorder (DCD), Autism Spectrum Disorder (ASD), Cerebral Palsy, Dystonia, stroke and Traumatic Brain Injury (TBI). If the child has no previous experience or idea how to complete a task CO-OP may not be appropriate. The child needs to be able to select or be involved in the goal setting process to insure they are motivated to complete the task.

References

Polatajko, H. & Mandich, A. (2004). Enabling occupation in children: The cognitive orientation to daily occupational performance (CO-OP) approach. Ottawa, ON: CAOT Publications.
Polatajko & Mandich (2010). Cognitive Orientation to daily Occupational Performance (CO-OP).

More Information

Further information is available from the book Enabling Occupation in Children: The Co Op Approach, available from Sensational Kids Child Development & Learning Store

Written by

Laura Kelly, Occupational Therapist at Sensational Kids

The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach