Psychometric Properties of the Parents as Partners

in Intervention (PAPI) Questionnaires

Amiya Waldman-Levi, Idit Hirsch, Galia Gutwillig, Shula Parush

This article describes two studies that focused on parents’ expectations and satisfaction with occupational
therapy intervention for their children (N 5 208). The first study determined the psychometric properties of the
Parents as Partners in Intervention (PAPI) Questionnaire set (n 5 146). The 2nd study examined parental
expectations, satisfaction, and perception of their child’s functional gains from individual- (n 5 30 parents) and
group- (n 5 32 parents) based interventions. Overall, the results of these studies further support the PAPI
Questionnaire set’s validity and reliability and suggest that parents’ expectations are high and not necessarily in
line with their actual satisfaction with the outcomes of their child’s intervention and functional gains.

Waldman-Levi, A., Hirsch, I., Gutwillig, G., & Parush, S. (2017). Psychometric properties of the Parents as Partners in
Intervention (PAPI) Questionnaires. American Journal of Occupational Therapy, 71, 7102220020. https://doi.org/
10.5014/ajot.2017.020289

Amiya Waldman-Levi, PhD, OTR/L, is Adjunct

Lecturer, Occupational Therapy Program, School of Health
and Natural Sciences, Mercy College, Dobbs Ferry, NY,
O ver the past 30 years, Family-Centered Practice (FCP) has become a wide-
spread treatment approach within the range of pediatric occupational therapy
services. FCP emerged in the second half of the 20th century, in parallel with family
and Fellow Researcher, Research Institute for Health and
Medical Professions, Ono Academic College, Kiryat Ono, therapy, a theoretical and practical model in the field of psychology and psychiatry
Israel; awaldmanlevi@mercy.edu
(Elizor & Tyano, 2006). The fundamental conceptualization underlying FCP
Idit Hirsch, MsC, OT, is Senior Occupational Therapist, involves the acknowledgment of the family as the constant supportive component
Maccabi Healthcare Services, Child Development Center, in the child’s life (National Center for Family-Centered Care, 1990). Moreover,
Jerusalem, Israel. FCP relies on the assumptions that parents want to achieve the best for their
children, that each family is different and unique and shares varied cultural and
Galia Gutwillig, MsC, OT, is Director of Occupational
Therapy Services, Sharon Shomron County, Clalit Health moral perceptions, and that children develop best and thrive in the context of a
Services, Netanya, Israel. supportive and caring family. In light of these premises, an alliance is established
between occupational therapy practitioners and families throughout the in-
Shula Parush, PhD, OT, is Professor, School of
Occupational Therapy of Hadassah and the Hebrew
tervention process, starting in the evaluation and decision-making phase (Case-
University, Jerusalem, Israel. Smith & Nastro, 1993; Rosenbaum, King, Law, King, & Evans, 1998). Such an
alliance enables an efficient communication exchange with the family and allows
the occupational therapy practitioner to identify the family’s strengths to promote
the child’s growth (Lyons, O’Malley, O’Connor, & Monaghan, 2010).
Studies in the field of occupational therapy have demonstrated that addressing
parents’ expectations of therapy and engaging them in their children’s inter-
vention process have a direct effect on their satisfaction with therapy outcomes
(Carrigan, Rodger, & Copley, 2001; King, King, & Rosenbaum, 1996). How-
ever, an examination of various outcome measures designed to assess parental
satisfaction with medical services given to their children revealed that they do not
address several important issues. These issues include parents’ expectations for
and satisfaction with their child’s performance as well as their perceived en-
gagement in the therapeutic process (Fingerhut, 2013; McPherson, Sachdeva, &
Jefferson, 2000; Moumtzoglou et al., 2000; Yagge & Arnetz, 2001). Therefore, it
is vital that an outcome measure with adequate psychometric properties be

The American Journal of Occupational Therapy 7102220020p1

developed to assess parents’ expectations of and satisfaction and it includes the structure, process, and results of the
with occupational therapy intervention. Such a tool will intervention. The term intervention structure refers to the
enable clinicians to examine whether parents’ expecta- actual setting in which the intervention is delivered: its
tions of occupational therapy intervention conform availability and accessibility, the related administrative
with their perceptions of their involvement in the child’s processes, frequency, duration, wait list, and costs (King,
therapeutic process, functional gains, and ultimately their Cathers, King, & Rosenbaum, 2001). Intervention process
satisfaction with the intervention. To support clinical de- refers to the actual delivery of the intervention and in-
cision making, assessment tools must demonstrate reliability cludes the practitioner’s professional and personal qualities,
and validity. Moreover, a clinically meaningful outcome interpersonal relationships, respect, supportiveness, atten-
measure must also manifest responsiveness, that is, it must be tiveness, and collaboration with his or her clients. These
capable of measuring changes that are important to the client factors have a significant effect on the results of the in-
over the course of intervention (Beaton et al., 2001; Chen tervention with regard to the client’s health status and
et al., 2015; Moran, 2016). relevant functioning (Donabedian, 1988).
The literature presents several elements that relate
to a client’s satisfaction: the client’s personality, life
Expectations
experience, education, and socioeconomic status (Hall &
Expectations are defined as a person’s beliefs that a certain Dornan, 1988; Kane, Maciejewski, & Finch, 1997; Ware
behavior or outcome will occur as a result of a specific event & Hays, 1988); the practitioner’s personality, pro-
(Fishbein & Ajzen, 1975; Kravitz, 1996). Thompson and fessional and communicative capabilities, and willingness
Suñol (1995) claimed that clients’ expectations are influenced to help (Carrigan et al., 2001; Donabedian, 1988; Hall &
by both personal and social components related to health Dornan, 1988); the nature of the client–practitioner re-
care services. The personal component can be described as a lationship; and the type, availability, accessibility, and
person’s set of needs, values, and desires as well as his or costs of the intervention provided (Carrigan et al., 2001;
her capabilities and commitment to act on a desired goal. Kane et al., 1997; King et al., 2001). A supportive and
The social component includes a person’s sociodemographic respectful attitude, confidentiality, the sharing of in-
characteristics, social demands that relate to the desired goal, formation, provision of feedback, and collaborative
and sense of justice. Additional factors may affect clients’ decision making provide the basis for an optimal re-
expectations of these services, and the most influential factor lationship (Carrigan et al., 2001; King et al., 1996).
may stem from the specific nature of the relationship be-
tween a practitioner and a client (Kravitz, 1996). Association Between Satisfaction
A successful intervention should relate to the child’s and
and Expectations
his or her family’s everyday functioning (Cohn, Miller, &
Tickle-Degnen, 2000; Gerkensmeyer, Austin, & Miller, Research has shown that the client’s expectations represent
2006). Cohn et al. (2000), in qualitative research of parents one of the central factors that relate to his or her satis-
of children with sensory modulation disorders, examined faction with the intervention (Linder-Pelz & Struening,
the expectations and hopes parents had regarding the in- 1985; McNaughton, 1994; Thompson & Suñol, 1995).
tervention delivered to their child. They found that parents’ Linder-Pelz and Struening found that clients who had
expectations included two main elements: (1) expectations positive expectations and perceived their intervention as a
related to their child’s social functioning, self-modulation, positive experience were significantly more satisfied than
and self-efficacy, which relate to parents’ desire that the clients who had positive expectations and a negative ex-
intervention help their child fully integrate and participate in perience. Locker and Dunt (1978) suggested that expec-
life despite his or her difficulties, and (2) expectations related tations might change as a result of the way clients perceive
to family life, such as learning new ways in which they can the intervention experience, which in turn influences their
help their child and better understand his or her behavior. overall sense of satisfaction. Carrigan and colleagues
(2001); King and colleagues (1996); and Ödman, Krevers,
and Oberg (2007) determined that parents’ satisfaction
Satisfaction was clearly influenced by addressing their expectations and
Satisfaction is defined as clients’ emotional responses to conducting a collaborative intervention process between
the gap between their wishes for and expectations of the the parents and the intervening practitioner. Lyons and
intervention and their perception of what they actually colleagues (2010) performed a qualitative study based on
received or gained from it (Gerkensmeyer et al., 2006), pre- and postintervention focus groups and discovered that

7102220020p2 March/April 2017, Volume 71, Number 2

parents expected their children to progress in relation to and spina bifida and developmental syndromes such as
their functional difficulties and that they would receive autism and cognitive delays were excluded. Parents were
guidance from the intervening practitioners. recruited from a developmental center in Israel, where
Professional changes within the field of occupational children were referred by teachers or by their parents for
therapy have significantly influenced the type and char- child-related services. The children’s age range was 2.11–
acteristics of service delivery (Cohn et al., 2000; Hinojosa, 8.10 yr (mean [M] 5 5.70, standard deviation [SD] 5
Sproat, Mankhetwit, & Anderson, 2002; Wilkins, 8.71), and 120 were boys (82.2%) and 26 were girls
Pollock, Rochon, & Law, 2001). Currently, pediatric (17.8%). Ninety-six children (65.8%) received group-
practitioners lack a reliable and valid assessment that can based intervention, and 47 (32.3%) received individual
be used to inform them about parents’ expectations of intervention. The type of intervention received was not
and satisfaction with occupational therapy services pro- reported for 3 participants (1.9%).
vided to their children (Wilkins et al., 2001). A set of three Measures. Three measures were administered to the
questionnaires was designed to elicit parents’ expectations participants: (1) a demographic questionnaire, (2) the
of intervention before initiation and their satisfaction with COPM, and (3) the PAPI Questionnaire set. The de-
the service during and after intervention (Nachum, 2009; mographic questionnaire developed for this study was used
Parush, Hirsch, & Waldman-Levi, 2005). to collect demographic information such as parental edu-
We conducted two separate studies with the shared cation and occupation, religious orientation, and the child’s
purpose of establishing the psychometric properties of the developmental history.
Parents as Partners in Intervention (PAPI) Questionnaire The COPM is an individualized, client-centered
set (Nachum, 2009; Parush et al., 2005). In both studies, measure designed for use by occupational therapy prac-
we examined the potential relationships between parental titioners to detect change in a client’s self-perception of
expectations and satisfaction regarding their involvement occupational performance over time. It was designed for
in their child’s intervention process and their child’s use as an outcome measure for clients with a variety of
disabilities across all developmental stages. It has a
functional gains.
semistructured interview format and a structured scoring
method, and its administration requires approximately
Study 1 20–40 min. The psychometric properties investigated
Method include clinical utility, validity, and responsiveness. The
COPM is appropriate for use among a wide array of
Study 1 was a nonexperimental methodological study client populations in a variety of different settings and
designed to examine the psychometric properties of an has been found to be responsive to change.
outcome measure, the PAPI Questionnaire set. The three The PAPI Questionnaire set comprises three ques-
study hypotheses were as follows: tionnaires: (1) the Parents’ Expectations Questionnaire
1. The PAPI Questionnaire set will demonstrate a high (PAPI–I), (2) the Parents’ Satisfaction During In-
level of internal consistency, thus supporting its tervention Questionnaire (PAPI–II), and (3) the Satis-
reliability. faction Post-Intervention Questionnaire (PAPI–III).
2. The results on the questionnaires will significantly These questionnaires were developed by experienced
correlate with those of the Canadian Occupational pediatric occupational therapists from the Maccabi
Performance Measure (COPM; Law et al., 2005), Child Developmental Center in Israel in collaboration
demonstrating their criterion validity. with faculty members of the School of Occupational
3. Significant correlations will be found between parents’ Therapy at Hebrew University. Each questionnaire
expectations and satisfaction (as measured by the consists of 18 items that relate to parents’ involvement
PAPI Questionnaires) throughout the course of the in the intervention process and their perception of their
intervention, demonstrating their responsivity. child’s function, and each is composed of two composite
Participants. A sample of 146 parents was deemed indexes: (1) Child’s Function and (2) Parental Involve-
sufficient based on the methodology of Miller, Polatajko, ment. Responses are rated on a 5-point Likert scale. Face
Missiuna, Mandich, and Macnab’s (2001) study, in and content validity have been established by a table of
which 122 participants were needed to achieve a power of specifications completed by 12 experienced pediatric
0.8 and significance level of .05. This convenience sample occupational therapists.
included children with mild developmental delay. Chil- Procedure. Permission for the study was attained from
dren with severe physical disabilities such as cerebral palsy the Maccabi Health Services institutional review board.

The American Journal of Occupational Therapy 7102220020p3

Consenting parents of children receiving occupational Table 1. Homogeneity Between the Items in Each Parents as
therapy services between December 2003 and December Partners in Intervention (PAPI) Questionnaire

2004 in a community-based health center in central Israel PAPI Questionnaire n a

were asked to complete the questionnaires. The children PAPI–I
were the recipients of either individual- or group-based Parental Involvement 107 0.62
Child’s Function 93 0.67
occupational therapy intervention. Both types of intervention
PAPI–II
delivery focused on learning and improving motor and Parental Involvement 48 0.58
cognitive skills, and social skills training was included in the Child’s Function 25 0.82
group-based intervention. The study’s purposes and proce- PAPI–III
dures were explained to the parents before they were asked Parental Involvement 123 0.48
to sign the consent form. At Time 1, parents completed the Child’s Function 69 0.80

demographic questionnaire, the PAPI–I, and the COPM.

At Time 2, the halfway point of the intervention process, Satisfaction during (PAPI–II) and after (PAPI–III) inter-
parents were asked to complete the PAPI–II (after eight vention, t(56) 5 22.08, p < .04, as well as in the com-
treatment sessions). At Time 3, during the final session, posite score of Child’s Function, t(56) 5 22.73, p < .01;
parents completed the PAPI–III and the COPM. see Table 2.
Statistical Analysis. The statistical analysis was carried Significant, positive, and low correlations (r 5 .30,
out using IBM SPSS Statistics (Version 22; IBM Corp., p < .05, n 5 60) were found between the total scores on
Armonk, NY). The composite scores for Parental In- the PAPI–I, PAPI–II, and PAPI–III (r 5 .21, p < .05,
volvement and Child’s Function were computed, after n 5 134). For the two composite indices, Parental
which the change in parental satisfaction (PAPI–III Involvement and Child’s Function, no significant corre-
score 2 PAPI–II score) for the composites of Parental lations were found among scores on the PAPI–I, PAPI–II,
Involvement and Child’s Function was calculated. Mean and PAPI–III. A significant, positive, and low correlation
scores for the Satisfaction and Function scales were was found between composite scores on Child’s Func-
calculated for each of the COPM questionnaires. The tion for the PAPI–I and the PAPI–III (r 5 .19, p < .05,
pre- and postintervention change in satisfaction and n 5 134). These findings are also suggestive of the tool’s
function was calculated by comparing the COPM scores responsiveness.
at those two data points (PAPI–I, PAPI–II, and PAPI–III
responsiveness). Descriptive statistics were conducted for
the following demographic variables: age, gender, type of Study 2
intervention, and all PAPI and COPM scores (i.e., PAPI–I,
Method
PAPI–II, and PAPI–II scores; COPM pre and post items,
composites, and change scores). Study 2 was an exploratory intervention with a pretest–
posttest study design in which we examined the psycho-
Results metric properties of the PAPI Questionnaires as reflected
As presented in Table 1, the composite score for Child’s by parents’ perceptions of the individual- and group-
Function reached a higher a coefficient value than did based interventions their child received. Specifically, we
that for Parental Involvement. This finding supports the
homogeneity of the items within each of the composites, Table 2. Differences in Parental Satisfaction in Relation to
thus establishing the questionnaires’ construct validity. Parental Involvement and Child’s Function
A significant, positive, and moderate correlation was PAPI Questionnaire M SD df t p
found between the PAPI–III (satisfaction at the end of the Total score
intervention) and the COPM difference score relating PAPI–II 4.77 0.56
to changes in the Child’s Function composite (r 5 .43, PAPI–III 4.90 0.51 56 22.08 .04
p < .001, n 5 83). A significant, positive, and moderate Parental Involvement
correlation was found between the PAPI–III (satisfaction PAPI–II 5.12 0.51
PAPI–III 5.16 0.46 56 20.70 .49
at the end of the intervention) and the COPM difference
Child’s Function
score for changes in parents’ satisfaction (r 5 .45, p < .001, PAPI–II 4.43 0.69
n 5 84). These findings support the criterion validity PAPI–III 4.66 0.66 56 22.73 .01
of the PAPI Questionnaires. In addition, a significant Note. df 5 degree of freedom; M 5 mean; PAPI 5 Parents as Partners in
difference was found between the total scores on Parents’ Intervention; SD 5 standard deviation.

7102220020p4 March/April 2017, Volume 71, Number 2

investigated parents’ perception of individual- and group- descriptive and parametric statistics using Pearson corre-
based interventions as manifested by correlations between lation coefficients and paired-sample t tests.
their perceptions of their child’s functional gains and
their level of satisfaction. Results
Participants. Participants included 30 parents whose Individual Intervention. Significant, positive, and mod-
children received individual occupational therapy in- erate correlations were found between the Child’s Function
tervention and 32 parents whose children received group- Questionnaires postintervention and the PAPI–II (r 5 .38,
based occupational therapy intervention. The inclusion p < .05, n 5 30) and the PAPI–III (r 5 .62, p < .01,
criteria for both groups were parents of children who had n 5 30). The PAPI–II and PAPI–III were also sig-
mild developmental delay. The ages of the children in the nificantly correlated (r 5 .43, p < .05, n 5 30).
individual intervention group ranged from 4.0 to 6.4 yr Significant correlations were revealed in composite scores
(M 5 63.7 mo or 5.3 yr, SD 5 6.9 mo). Participants on each of the PAPI Questionnaires and the Child’s Function
included 26 boys (86.7%) and 4 girls (13.3%). The group Questionnaires. The Parental Involvement composite of the
that comprised children receiving group intervention PAPI–II and the Child’s Function preintervention scores
ranged in age from 5.0 to 6.5 yr (M 5 72 mo or 6.0 yr, were significantly correlated (r 5 .37, p < .05, n 5 30). In
SD 5 4.5 mo), of whom 20 were boys (64.5%) and 11 addition, the Parental Involvement composite of the
were girls (35.5%). PAPI–III correlated significantly with the Child’s Function
Measures. Three measures were administered to par- postintervention scores (r 5 .41, p < .05, n 5 30). The
ticipants: (1) a demographics questionnaire (2) the Child’s Child’s Function composite of the PAPI–II and the Child’s
Function Questionnaires and (3) the PAPI Questionnaire Function preintervention scores were significantly correlated
set. A demographic questionnaire was developed for the (r 5 .38, p < .05, n 5 30). Similarly, a significant corre-
purpose of this study. It was used to collect demographic lation was revealed between the Child’s Function composite
information such as parental education and occupation, of the PAPI–III and the Child’s Function postintervention
religious orientation, and the child’s developmental his- scores (r 5 .57, p < .001, n 5 30). Significant
tory. The Child’s Function Questionnaires are based on preintervention–postintervention differences were found
the same items and response scale as the PAPI–I, PAPI–II, for Child’s Function, t(29) 5 24.01, p < .001, and for
and PAPI–III, but they focus on the parents’ perception of parents’ satisfaction, t(29) 5 22.17, p < .05, indicating
their child’s function pre- and postintervention. The PAPI that parents of children receiving individual occupational
Questionnaires were described earlier. therapy intervention felt satisfied with their involvement
Procedure. Permission was obtained from the Clalit in their children’s intervention and with their child’s
Health Services institutional review board. The consenting progress, both during and at the end of the intervention
parents were recruited during 2009–2012 from the oc- process.
cupational therapy clinic at the Clalit Developmental Group-Based Intervention. A significant correlation was
Health center in central north Israel. found between the Child’s Function Questionnaires
Individual-based intervention included 18–20 ses- postintervention and the PAPI–III (r 5 .67, p < .01, n 5 32).
sions, each 45 min long, focusing on improving the An examination of the composite scores on each of the
children’s function in the following four areas: (1) pre- PAPI Questionnaires and the Child’s Function Ques-
academic skills, including fine motor preschool-related tionnaires revealed only one significant correlation, spe-
activities, and metacognitive-related skills; (2) social skills cifically, between the composite of Child’s Function in the
related to both academic and social settings; (3) activities PAPI–III and the Child’s Function postintervention rating
of daily living and instrumental activities of daily living; (r 5 .67, p < .001, n 5 32). A significant difference was
and (4) play in both academic and social settings. Group- found in Child’s Function from pre- to postintervention,
based intervention included 9 sessions, each 90 min long, t(31) 5 23.04, p < .05, indicating that the parents of
focusing on academic skills for first graders in the following these children did not feel engaged in the intervention
two areas: (1) cognitive–organizational skills and (2) social process but were satisfied with their child’s functional
skills in the academic setting. improvement on its completion.
Statistical Analysis. The statistical analysis was carried
out using IBM SPSS Statistics (Version 22; IBM Corp.,
Armonk, NY). First, composite scores were calculated Discussion
for Parental Involvement and Child’s Function for Studies within the field of occupational therapy have
each of the PAPI Questionnaires. Then we calculated demonstrated that addressing parents’ expectations and

The American Journal of Occupational Therapy 7102220020p5

engaging them in the intervention process have a direct functional gains, which may reflect that their expectations
effect on their satisfaction with the intervention (Carrigan were met (Lyons et al., 2010). Nevertheless, one should
et al., 2001; King et al., 1996). Thus, the purpose of the consider that the group-based intervention did not fully
current study was twofold: (1) to establish the psycho- engage parents in the intervention process because a col-
metric properties of the PAPI Questionnaires, which were laborative alliance with them was not attained. Our findings
designed to assess both parental expectations and satis- support the fundamental principles underlying FCP, which
faction with occupational therapy intervention for their call for occupational therapy practitioners to establish a
child, and (2) to further examine parents’ perceptions of dialogue with parents, whether in individual or group-based
their involvement in occupational therapy interventions interventions (Ödman et al., 2007). By creating such a
and their satisfaction with their child’s functional gains dialogue, practitioners can determine the nature of parents’
from both individual and group-based intervention. expectations, experiences, and concerns regarding their
According to findings of Study 1, the PAPI–I, PAPI–II, child’s development and their participation in meaningful
and PAPI–III have moderate internal coefficients, such that environments.
the Parental Involvement composites revealed relatively
lower coefficient values. Similar to the principles of the
Limitations and Further Research
FCP (Committee on Hospital Care, American Academy of
Pediatrics, 2003), and the findings of studies conducted by Limitations of our studies include the lack of randomized
Rey, Plapp, and Simpson (1999) and Cohn et al. (2000), sampling and of matching children’s ages between groups.
parental perceptions of involvement include various items In addition, the data from Study 1 were collected across
that reflect specific and crucial characteristics of parental interventions of various lengths, so some of questionnaires
engagement as opposed to global items (Edwards, Millard, were not completed because of participant dropouts. Also,
Praskac, & Wisniewski, 2003; Rosenbaum et al., 1998). the PAPI–II at Time 2 was not administered to children
Significant correlations were found between the Child’s who received a short-term intervention of <10 sessions,
Function composite and the COPM’s Change in Func- resulting in a smaller sample size for this specific ques-
tion and Change in Satisfaction composites. This finding tionnaire. As a result, the statistical analyses were carried
reflects the shared commonalities between these two client- out for a range of sample sizes, some of which were small.
centered questionnaires, thus supporting the criterion Furthermore, the parental perceptions of involvement
validity of the PAPI Questionnaires. The PAPI–I, PAPI– portion of each of the PAPI Questionnaires includes var-
II, and PAPI–III detected a change (scale sensitivity or ious items that may have compromised the consistency of
responsiveness) in parents’ satisfaction at the midpoint and this composite. Thus, our findings should be interpreted
completion of the intervention process, supporting their with caution. Future research should include a larger
use as outcome measures. In summary, the current study’s sample size and children from various diagnostic groups.
findings are in line with those of previous studies, further
suggesting that addressing parents’ expectations of in- Implications for Occupational
tervention and enabling them to participate in the selec-
Therapy Practice
tion of treatment goals contribute to parental satisfaction
(Carrigan et al., 2001; Cohn, 2001; Cohn et al., 2000; The findings from these studies have the following po-
McKinnon, 2000; Sterrett, Jones, Zalot, & Shook, 2010). tential implications for occupational therapy practice:
Study 2 revealed that parents felt satisfied by their • Occupational therapists who work with children and
involvement and their child’s progress, both during and parents should use a family-based perspective to provide
at the end of the individual-based intervention process. sensitive and optimal care by guiding practice and gen-
However, parents’ perceptions of group-based occupa- erating goals that are meaningful to parents and their
tional therapy intervention showed that they did not feel children.
engaged but were satisfied with their child’s functional • The PAPI Questionnaires (I, II, and III) appear to be
gains on its completion. Of interest is that we did not find tools that practitioners can use to better understand par-
any associations between parents’ expectations and satis- ents’ expectations and satisfaction during intervention as
faction in either of the interventions. Locker and Dunt well as to measure occupational outcomes of interven-
(1978) suggested that expectations may change as a result tion. The assessment of parents’ expectations can help
of the perceived experience of the intervention and thus establish a collaborative parent–practitioner partnership,
may affect clients’ overall sense of satisfaction. In our build feelings of trust and rapport, and prompt reflective
studies, parents reportedly felt satisfied with their child’s discussions beyond the scope of the child’s concrete

7102220020p6 March/April 2017, Volume 71, Number 2

 therapy goals. Moreover, the assessment of parents’ sat- Edwards, M., Millard, P., Praskac, L. A., & Wisniewski, P. A.
isfaction with the child’s functional gains can serve as an (2003). Occupational therapy and early intervention: A
outcome measure that can be incorporated into progress family-centred approach. Occupational Therapy Interna-
tional, 10, 239–252. https://doi.org/10.1002/oti.188
and summary reports, used for reimbursement purposes,
Elizor, A., & Tyano, S. (2006). Family therapy. In H. Munitz
and provide evidence for aspects of best practice. Last, an (Ed.), Selective chapters in psychiatry (4th ed., pp. 687–708).
open discussion of parents’ satisfaction can facilitate clo- Tel Aviv: Pappirus.
sure for the established partnership as the intervention Fingerhut, P. E. (2013). Life Participation for Parents: A tool
draws toward completion. s for family-centered occupational therapy. American Jour-
nal of Occupational Therapy, 67, 37–44. https://doi.org/
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Acknowledgments Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention and
Helsinki committees approved both the first (2007034) and behavior: An introduction to theory and research. Reading,
second (0104-08) studies. We owe a great debt of gratitude to MA: Addison-Wesley.
Gerkensmeyer, J. E., Austin, J. K., & Miller, T. K. (2006).
the occupational therapists who were involved in each of these
Model testing: Examining parent satisfaction. Archives of
studies: Hanna Jakobovits, Idit Dahan, Ora Nachmany, Liraz Psychiatric Nursing, 20, 65–75. https://doi.org/10.1016/j.
Infeld, Michal Israeli, Renana Reindorp, Iris Ben-Sira, and apnu.2005.09.001
Limor Yanuv from the Maccabi Child Developmental Hall, J. A., & Dornan, M. C. (1988). What patients like about
Center, Jerusalem, Israel, and Niza Gavan from the Clalit their medical care and how often they are asked: A meta-
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