Ten-hour training workshop that was divided into three sessions outside working hours. Coaching one-on-one in the daily routines and natural environment.

Assistants receive ten-hour training workshop that was divided into three sessions outside working hours.

Training workshop and coaching one-on-one

Caregivers identify activities that are problematic for the child. The caregiver rates the child's performance and satisfaction for each participation goal on a 10-point scale, (1=unable to perform, unsatisfied; 10= performs exceptionally well, extremely satisfied). Differences in scores pre-and post-intervention for both performance and satisfaction are determined independently. A 2-points change in these values is considered clinically meaningful.

Clients identify goals and rate their performance on a 5-point Likert scale ranging from -2 (much less than expected) to +2 (much better than expected). In the baseline, clients can score -1 or -2, and the score "0" is the expected level of success. The 4-point Likert scale is used for quantifying importance (ranging from 0= nothing important to 3= really important) and difficulty (ranging from 0= easy to 3= very difficult). Afterwards, the goal's weight is calculated (importance*difficulty). A mathematical formula allows computation to T-score with a mean of 50 and a standard deviation of 10.

The Coaching Practices Rating Scale was utilized as a secondary outcome to measure the fidelity of coaching. Its 14 items are based on adults' learning characteristics and coaching practices to determine how the coach use these practices, on a 5-point Likert scale. The scale accepts the rating through video-tapes and has a high degree of construct validity and internal consistency.

The types of goals and adaptations were classified according to daily living activities, such as using the toileting, eating, feeding, hygiene and grooming, dressing, functional mobility, and others (miscellanea). Accommodations or adaptations to enhance children's participation were registered during and after the intervention as a) not necessary, b) natural for the child or easy to acquire, c) a rehabilitation device, or d) an architectonic/extensive modification. The adaptations were analyzed as an independent element in the goals that improved performance two or more points in the COPM.