Introduction
Caregivers of young children, particularly those with developmental or behavioral challenges, frequently encounter barriers to accessing supportive services. These barriers often include limited financial and educational resources, cultural and linguistic differences, and competing demands related to employment and caregiving responsibilities (Sapiets et al., 2021). Such stressors contribute to caregiver burden, encompassing both objective demands such as daily logistical tasks and subjective emotional strain, including guilt, frustration, and exhaustion (Herrero et al., 2024). If left unaddressed, caregiver burden can negatively affect parental well-being, disrupt parent–child relationships, and diminish overall family quality of life (Azeem et al., 2023; Ozturk et al., 2021). Families from underprivileged communities experiencing homelessness, reentry from incarceration, or recovery from addiction and substance use often face compounded social and environmental stressors that limit access to health, education, and social services (Azeem et al., 2023).
To address these concerns, the primary investigators developed and implemented a virtual OT-based parent education program with an additional training component for early childhood educators in partnership with a local non-profit organization, VOALA, serving families with young children with special needs. The Model of Human Occupation ([MOHO], Kielhofner, 2008) provided the theoretical framework for caregiver workshops, supporting participants in understanding how volition, habituation, and environmental contexts influence occupational performance. Recent studies have demonstrated MOHO’s effectiveness in improving motivation, role competence, and occupational engagement among individuals facing psychosocial and socioeconomic challenges (Lee & Park, 2022; Park et al., 2020). The workshops applied MOHO principles by enhancing motivation for occupation, promoting skill development, and adapting environmental supports to foster caregiver confidence, competence, and self-care.
The program also integrated developmental milestones and ASI concepts to enhance caregivers’ and educators’ understanding of typical and atypical development, sensory processing and its impact on children’s participation and emotional regulation. ASI-based interventions have been shown to improve adaptive responses, attention, and engagement in daily routines for children with sensory and developmental challenges (Parham et al., 2019; Schaaf et al., 2022). Educators received additional training in applying ASI-informed strategies within the classroom to better identify sensory needs and create supportive learning environments. Parent education modules included instruction on developmental milestones, sensory strategies, and self-care practices to promote skill generalization and strengthen family–child interactions. By combining MOHO and ASI frameworks, the program aimed to empower both caregivers and educators to foster developmental progress, enhance self-efficacy (Eltanamly et al., 2023), and promote sustainable family resilience (Wachspress et al., 2025).
Methods
Design
This study used a mixed-methods, pre–post design without a control group to evaluate the impact of an OT-based educational intervention on caregivers’ knowledge, confidence, and well-being. Quantitative data were collected through pre- and post-intervention surveys and the WHOQOL-BREF, while qualitative data were obtained through open-ended survey responses and participant feedback.
The program was developed collaboratively using an evidence-informed process guided by needs assessment data from caregiver surveys, mental health professionals, and classroom observations. Identified priorities included caregiver stress, limited access to child-development resources, and the need for enhanced school–home collaboration. Early childhood educators were also identified as needing additional training to strengthen their understanding and application of ASI principles and thus were included in the intervention component of the program.
Sample
The target population consisted of caregivers and early-childhood educators of children from birth to age five affiliated with VOALA, which provides early education and family support services to underserved families, including those experiencing homelessness, reentry from incarceration, and recovery from substance use. VOALA serves multiple areas within Los Angeles (LA) County, including Santa Clarita, the San Fernando Valley, North Hollywood, East LA, South LA, and South Bay. All participants were located across these regions.
Participants were recruited through printed flyers, digital announcements shared via a school-parent communication application, and direct referrals from educators. A total of 90 individuals attended at least one session; 34 participants completed all three workshops and both the pre- and post-surveys, forming the analytic sample. Inclusion criteria included (a) being a caregiver of a child aged birth to five or an early-childhood educator serving this population, and (b) attendance at all workshop sessions.
Procedure
The intervention, CAR, was designed to strengthen caregivers’ understanding of child development, sensory regulation, and behavior management while supporting self-care and educator capacity. Six one-hour virtual workshops were delivered biweekly between January and February 2024, in both English and Spanish, to ensure linguistic accessibility.
Connect: Focused on introduction to OT, developmental milestones, distinctions between typical and atypical development, and caregiver self-care. Participants learned the role of OT, developmental milestones, the distinction between typical and atypical development; emotional, physical, and mental self-care strategies, such as boundary setting, journaling, physical activity, and time-management techniques.
Adapt: Addressed sensory processing and ASI-based strategies. The content covered sensory modulation, indicators of over- and under-responsiveness, and practical tools, such as tactile and proprioceptive input, the use of calming environments, and sensory routines.
Respond: Emphasized behavior management through preventive and responsive approaches, including environmental structuring, positive language, reinforcement, social stories, and mindfulness.
Each workshop incorporated presentation slides, YouTube-accessible videos, interactive polls, handouts, “check-your-understanding” questions, and live question-and-answer (Q&A) segments.
Early-childhood educators also received a dedicated training component focused on integrating ASI-informed strategies into classroom environments, including sensory-based adaptations, regulation supports, and communication tools for family collaboration.
To support continued learning, all participants received a digital resource binder containing workshop materials, supplemental documents, summarized handouts, developmental milestone guides, sensory activity sheets, and self-care planning templates. These resources were designed to reinforce learning and facilitate carryover at home and school.
Measures
Program outcomes were assessed using both standardized and researcher-developed instruments. Self-developed pre- and post-surveys measured caregiver familiarity and confidence in applying strategies related to child development, sensory and behavioral management, and self-care. The first self-created survey, administered pre- and post-program, included six Likert-scale questions (1 = not familiar/confident, 5 = very familiar/confident) and four open-ended questions. The second survey consisted of seven Likert-scale items and three open-ended questions, mirroring the first survey to facilitate comparison of changes in familiarity and confidence over time.
WHOQOL-BREF evaluated perceived physical, psychological, and social well-being. It comprised 26 Likert-scale questions and one short-answer question. The WHOQOL-BREF has demonstrated acceptable reliability across domains (World Health Organization, 2004; Cronbach’s α = .66–.84).
Educator post-survey measured the perceived usefulness of OT-based ASI strategies in classroom settings and observed changes in parent engagement or behavior following the intervention. Open-ended questions in both caregiver and educator surveys were used to gather qualitative feedback.
Data Collection and Analysis
Quantitative data were analyzed using JASP. Descriptive statistics summarized participant characteristics and central tendencies. Paired-samples t tests compared pre- and post-scores for familiarity, confidence, and WHOQOL-BREF domains. Statistical significance was set at p < .05. Effect sizes were calculated using Cohen’s d to estimate practical significance. The first category, parents’ perception and confidence in parental self-care and wellness, demonstrated clear improvements. The second category focused on parents’ behaviors in implementing learned strategies and yielded positive results.
Qualitative data from open-ended responses were analyzed thematically using a three-stage coding process (open, axial, and selective coding). Themes were validated through independent coding by two researchers, with consensus achieved through discussion. Representative quotations illustrate key themes related to the program’s impact on family dynamics, stress reduction, and practical application of learned strategies.
Results
Quantitative Findings
Analyses indicated statistically significant improvements across multiple domains following the CAR workshops (see Tables 1-3). Participants demonstrated increased familiarity with and confidence in implementing sensory and behavioral strategies (Table 1), as well as greater knowledge of self-care and time-management techniques (Table 2).
Participants demonstrated increased familiarity and confidence in implementing sensory and behavioral strategies following the workshop. Both domains showed statistically significant improvements from pre- to post-test (p ≤ .001), indicating the gains were not due to chance. Mean scores increased from moderate familiarity levels to stronger understanding of strategy use, while decreased standard deviations suggest that participants’ knowledge became more consistent across the group. Although the effect sizes (Cohen’s d = -0.356 and -0.406) indicate small-to-moderate practical impact, the results collectively support that the training effectively enhanced participants’ skills and preparedness to apply these approaches in practice.
Participants demonstrated statistically significant improvements across all self-care domains following the workshops, with post-test scores showing higher confidence and implementation of self-care practices compared to pre-test levels (p ≤ .005). Reductions in standard deviations indicate that participants’ responses became more consistent after the training. Effect sizes ranged from small-to-moderate (Cohen’s d = -0.384 to -0.577), suggesting meaningful practical gains. The largest improvement was observed in the mental and emotional self-care domain, followed by physical and general self-care, reflecting the workshop’s strong influence on participants’ well-being practices and ability to apply strategies that support their own mental health, physical wellness, and daily self-care routines.
Participants showed statistically significant improvements across multiple WHOQOL-BREF domains following the program, indicating a positive impact on their perceived quality of life and well-being (all p < .05). Across the psychological, social, and environmental constructs, post-test means were higher than pre-test means, demonstrating enhanced satisfaction with self, relationships, friendships, and access to support resources. Standard deviations decreased slightly in most domains, suggesting greater consistency in perceived benefits across participants. Effect sizes ranged from small to small-moderate (Cohen’s d = 0.261–0.326), reflecting meaningful but modest practical improvements. Additionally, reduced frequency of negative feelings scores further support enhanced emotional wellness after program participation. Educator feedback corresponded with participant outcomes, those reporting increased caregiver involvement also noted improved child engagement and collaboration in the classroom, indicating that strengthened family confidence may translate into broader functional gains within educational environments.
Qualitative Findings
Thematic analysis yielded three overarching themes, which are summarized in Table 4.
Summary of Findings
Both quantitative and qualitative results demonstrated that the CAR program enhanced caregivers’ familiarity with OT-based approaches, improved self-efficacy, and fostered resilience through increased community connection and self-care. Early-childhood educators also reported positive outcomes related to their understanding and implementation of ASI-informed classroom strategies.
Although some areas showed minimal statistical change, participants’ subjective reports indicated meaningful personal and familial benefits. Together, these findings underscore the importance of structured, OT-led, community-based interventions in promoting family well-being and fostering interdisciplinary collaboration.
Discussion
This study contributes to the growing evidence supporting OT–based caregiver education by demonstrating that a virtual program can enhance caregiver practices, well-being, and self-efficacy (Koller, 2022; Montoro-Rodriguez, 2024). Quantitative findings revealed the greatest improvements in caregivers’ familiarity with ASI-informed strategies and self-care practices, areas in which participants initially reported the largest knowledge gaps. In contrast, domains such as child-development knowledge and behavioral reinforcement showed smaller gains, suggesting that outcomes are most robust when program content is individualized and aligned with participants’ perceived needs.
The findings align with the MOHO framework, emphasizing volition, habituation, and environmental influences on occupational performance (Kielhofner & Taylor, 2017). The CAR workshops enhanced caregivers’ motivation and skill development within supportive contexts, promoting occupational adaptation and improved family well-being. Similarly, the integration of ASI principles strengthened caregivers’ ability to interpret and address children’s sensory needs, while the knowledge of developmental milestones guided the scaffolding of skills and routines that support age-appropriate participation. Consistent attendance emerged as a strong predictor of success, underscoring that engagement is as critical as program content.
Qualitative data also revealed that the group format fostered peer connection, normalized stressors, and built mutual support networks, key elements of sustained behavior change.
Collectively, these findings affirm that virtual, OT-led caregiver education can deliver measurable improvements in family function, empowering caregivers and educators to promote children’s participation and regulation in daily routines.
Future program iterations should tailor modules to individual caregiver needs and incorporate hybrid delivery models to balance accessibility with interactive learning. Integrating follow-up sessions or coaching may help maintain engagement and promote generalization of skills. Expanding interdisciplinary collaboration between OTs, educators, and mental-health professionals can further enhance consistency across home and classroom settings. Longitudinal studies with larger, more diverse samples are warranted to evaluate sustained outcomes and clarify which theoretical components contribute most significantly to the progress of caregivers and children.
Conclusion
Incorporating evidence-based strategies grounded in OT practice strengthened family relationships by increasing caregivers’ confidence, knowledge, and skills. These improvements supported positive parent–child interactions, fostered stronger bonds, and enhanced the overall quality of life. Educators also reported that implementing OT-informed approaches improved classroom participation and understanding of children’s sensory and behavioral needs.
The findings underscore OT’s vital role in promoting community wellness and bridging service gaps within nonprofit and early childhood education programs. By equipping caregivers and educators with practical, evidence-informed tools, this program demonstrates how OT-based community interventions can cultivate family resilience, foster interdisciplinary collaboration, and advance equitable access to support services.
Limitations and Future Research
The primary limitation of this study was its short duration and limited frequency of workshops, which may have constrained long-term behavior change and outcome measurement. The virtual format, while accessible, may have restricted opportunities for real-time interaction and hands-on skill reinforcement. Additionally, unequal group sizes across sessions could have influenced participation dynamics and data variability.
Future research should expand the duration and frequency of caregiver education programs, investigate hybrid and in-person delivery formats, and implement strategies to sustain caregiver engagement. Larger, more diverse samples and longitudinal designs are needed to validate these findings and assess long-term effects on family functioning, child participation, and community well-being.