Table 1.

Comparison of Process and Components of Child-Focused and Context-Focused Approaches

Factor	Context-Focused Approach	Child-Focused Approach
Location	Home or community setting	Outpatient or community setting
Therapist	Physical or occupational therapist (prime therapist model) Only one therapist providing intervention (other therapists available for consultation and development of treatment plan)	Regular physical therapist and/or occupational therapist May have more than one therapist
Goal Identification	Parent defines goals based on identification of transitions using the COPM	Therapist sets goals after discussion with parent, teachers, etc.
Assessment Process	Observe and videotape child performing identified tasks and use the task/context-focused framework for performance analysis to identify barriers and supports to performance. "Top-down" approach starting with identification of functional goals and then identifying specific constraints that are barriers to achievement of functional goal	Assess child's current level of functioning in motor, behavioral, functional areas of performance. "Bottom-up" approach starting with identification of impairments and then identifying functional limitations
Primary Treatment Strategy	First target of intervention is to change constraints identified within the task and/or environment Work always at activity and/or participation level in the ICF model. Use success at task as guide to intervention Different movement strategies are expected in different environments	First target of intervention is a focus on remediation using neurodevelopmental and other regular therapy techniques at the level of body function and structure Work from body function and structure in ICF model thus leading to changes in functional activity Use typical patterns of movement and hierarchical skills as guide to intervention. The movement strategy chosen is expected to generalize across different environments
Frequency	Intermittent and intense, focused on goals identified (typically 3–4 sessions followed by a break before therapy focuses on another task). 18–24 sessions over 6 months.	Regularly scheduled appointments (typically 3–4 times/month). 18 – 24 sessions over 6 months.