Occupational balance: What tips the scales for new students?

The open question, ‘What prevents you from reaching occupational balance?’, was posed within a questionnaire aimed at exploring the meanings of occupation, health and wellbeing with a cohort of first-year occupational therapy students during their initial few weeks at university. Their written responses to the question about occupational balance were analysed and are discussed in this paper. Not surprisingly, occupational balance appeared to be achieved by only a few and more by chance than design. People, time and money factors were identified as the main impediments to achieving occupational balance, with psychological and emotional pressures being at the forefront. Interestingly, despite these barriers, the overall educational benefit of considering the occupational balance question in this way raised the students’ awareness of its relationship to health and wellbeing. This increased awareness might have longer-term health benefits, both personally and professionally, which would be worthy of further research

Sustaining a focus on occupation in community mental health practice

Occupational therapists working in community mental health teams (CMHTs) are often challenged to justify their unique approach to health through occupation, within an environment that tends to press for generic working. Such a challenge requires practitioners to identify and communicate evidence that supports their unique occupational contribution. In the absence of extensive robust and relevant research evidence, it is suggested that the contribution of theoretical evidence be considered. This paper, therefore, explores the potential of occupational justice and its related concepts to provide the profession with a theoretical justification for occupational therapists adopting an occupation-focused role in CMHTs. It begins with an overview of how CMHTs, generic working and occupational science have evolved. The concept of occupational justice and its related risk factors are then analysed in relation to practice. The potential conflict between the professional commitment to client-centred practice and the generic worker model is also discussed. The paper concludes with recommendations for further exploration and consideration

Can disability studies contribute to client-centred occupational therapy practice?

Occupational therapists frequently cite a ‘client-centred’ approach as a fundamental aspect of their practice. However, there are many examples in the narratives of disabled people that suggest that the health and social care services they experience do not quite meet this aspiration. The authors propose that an understanding of disability from disabled people’s perspectives is elemental to client-centred practice and that knowledge of the academic discipline of disability studies can contribute to authentic client-centred occupational therapy

Online course to expand occupational therapy practice: education and implementation of occupational therapy in primary care

Primary care within the United States’ health care system is evolving to address increases in chronic conditions across the lifespan that impact individuals’ daily lives, and the health care system’s performance and cost. Even as interprofessional primary care teams aim to manage a large majority of health needs over time, these teams often lack the skilled professionals necessary to address function in daily life. Occupational therapy’s distinct value as experts in evaluation and intervention for health-related occupational development, adaptation, prevention and management can address this problem. However, continued education and additional tools are necessary in order for occupational therapists to increase their knowledge of the profession’s role in primary care, increase self-efficacy in promoting occupational therapy to stakeholders, and increase self-efficacy to utilize resources for research and establishing occupational therapy in primary care settings. The proposed online course "Occupational Therapy in Primary Care: What, Why, Where, & How?" is specifically targeted to occupational therapists to addresses these outcomes. Theoretical and historical evaluation of occupational therapy in primary care in the United States and Canada supports understanding the problem and mechanisms that can help navigate efforts to include occupational therapy in primary care. Diffusion of Innovations and Adult Learning Theory guide the course’s two-phases of development and dissemination. This project is a timely contribution to the emerging area of occupational therapy in primary care that supports the Institute for Health Care Improvements’ (IHI) Triple Aim to improve the individual experience of care, health of populations and reduce per capita cost of care

Reliability reconsidered: Cronbach's alpha and paediatric assessment in occupational therapy

Background / aim: Using reliable outcome measures is a necessity for the occupational therapy profession in enabling valid assessments of clients. Although Cronbach’s alpha is the most widely applied index of internal consistency reliability, there are misconceptions about its use and interpretation. This paper aims to guide assessment developers in paediatric occupational therapy, as well as practitioners who are evaluating outcome measures in using and interpreting the Cronbach’s alpha estimates appropriately. This will enable them to decide on the tools’ clinical value and incorporate them into their practice with children. Method: Previously published papers reporting on internal consistency issues of outcome measures in paediatric occupational therapy were searched through the Allied and Complementary Medicine database. These papers were used as a basis to discuss possible reasons for reporting of low internal consistency. Results: The analysis demonstrates that Cronbach’s alpha reports are not always interpreted in a sound way. The paper emphasises that one should be cautious about judging estimates of internal consistency. Low size of the coefficient alpha might not always indicate problems with the construction of the tool; whereas large sizes do not always suggest adequate reliability. Instead, these reports might be related to the data characteristics of the construct. Conclusion: In judging an outcome measure’s internal consistency , researchers and practitioners in occupational therapy should report and consider the nature of data, the scale’s length and width, the linearity and the normality of response distribution, the central response tendency, the sample response variability and the sample size

An overview of barriers, facilitators, and themes associated with occupational therapy practice in Canada

Background To advance occupational therapy practice, we need to understand factors that support and hinder occupational therapists’ engagement in health services and better understand how occupational therapy is being represented in practice. With respect to factors that support and hinder occupational therapy practice, the first objective of this thesis was to identify barriers and facilitators to the integration of occupational therapists into primary care services in Canada and provide recommendations from the literature supporting occupational therapist inclusion in primary care. With respect to understanding occupational therapy practice, the second objective of this thesis was to identify the roles/activities of occupational therapists present in the Canadian and Australian literature. Methods An environmental scan was conducted to address the first objective. Data were gathered from three sources: Cumulative Index to Nursing and Allied Health Literature Plus with Full Text (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Canadian Journal of Occupational Therapists (CJOT). For the second objective, an environmental scan and gap analysis were performed. Data for objective 2 were gathered from the database: Cumulative Index to Nursing and Allied Health Literature Plus with Full Text (CINAHL). Results With respect to the first objective, six barriers and three facilitators were found. The six barriers were: 1. a lack of understanding amongst health care professionals, policy makers and occupational therapists regarding an occupational therapist’s roles and services provided in primary care; 2. limited research involving an occupational therapist's integration within primary care; 3. a lack of funding for occupational therapy services within primary care; 4. a lack of understanding amongst health care professionals, politicians, and the public of the effectiveness of occupational therapy services; 5. a lack of shared understanding amongst occupational therapists regarding the distinction between primary care and primary health care; and 6. limited interactions between the primary care teams and occupational therapists. The three facilitators were: 1. occupational therapists’ engagement in interprofessional practice; 2. occupational therapists’ broad scope of practice (the generalist role); and 3. advocacy for occupational therapy roles in primary care. Regarding the second objective, Australia was identified as a comparison country for Canada. One hundred sixty-seven descriptors of occupational therapy roles/job titles/positions were identified in the Canadian and Australian literature and were categorized into nine themes for occupational therapy practice. These nine themes were: providing direct client care; leadership within the profession; liaison between client, family, and health professionals; occupational therapists providing education; research in occupational therapy; advocate for the client; professional practice; advocate for profession; and leadership outside the profession. Of these nine themes, the three most prevalent were: providing direct client care; leadership within the profession; and liaison between the client, family, and health professionals. Conclusions This thesis provides essential information that can be used to improve the utilization of occupational therapists working within Canada's primary care setting. Interprofessional practice is an essential facilitator to the integration of occupational therapists within primary care. It is essential to foster understanding of occupational therapy practice amongst the public, other health professionals, and occupational therapists as this will be vital to occupational therapists’ inclusion in health care practice. Moreover, advocating for the profession and educating others on occupational therapy practice is vital for occupational therapists both within and outside of practice. Increasing health professionals' exposure to occupational therapists’ roles and services within primary care, is necessary to foster a greater understanding of how occupational therapists fit within primary care. Occupational therapy research, advocacy, leadership, and interprofessional practice are essential resources for creating awareness and understanding regarding the profession’s roles and scope of practice. This work draws attention to occupational therapy roles/activities represented in the Canadian and Australian literature. Based on our research, there are several opportunities for occupational therapists to increase awareness amongst the general public, health professionals, and politicians regarding occupational therapy roles and services in Canada primary care. These opportunities involve occupational therapists directly addressing key barriers and facilitators to occupational therapist integration into practice

Job Demands of Occupational Therapy Clinical Placements: A Descriptive Study Using the Practicum Demands Measure©

The purpose of this study was to group and analyze the Practicum Demands Measure© (PDM) data collected over 2 academic years and create a general profile of demands across practicum settings. The data will be used to guide faculty in the most suitable placement of students requiring accommodations for a disability. The study used a secondary analysis design to analyze the 538 participant PDM data collected over the 2017/2018 and 2018/2019 academic years. Most of the sampled students were in fieldwork Level I and worked in mental health settings. The students reported physical demands, such as lifting more than 5kg (65.7%), intermittent sitting (97.6%), and keyboarding (94.6%). They also reported physical environment characteristics, such as exposure to infectious disease (44.6%) and congested working areas (27.5%). Cognitive demands included instant recall (90%) and analytical and clinical reasoning (99.8%). Practicum demands in occupational therapy were similar across other health care profession student placements, such as nursing and physical therapy. Practicum demands need to be studied more extensively to optimize students’ opportunities for success for students requiring accommodations in varied clinical settings

Evaluation of the Quality of Occupational Therapy Fieldwork Experiences

Practice education, or fieldwork as it is referred to in occupational therapy, is a fundamental feature of occupational therapy education, priming students to become competent entry-level practitioners. Factors reported as contributing to poor quality fieldwork experiences include: students not receiving enough feedback; lack of opportunity to develop skills; and not being made to feel welcome in the environment. These are significant contributors to the overall development of competence so it is important to understand the current context of fieldwork experiences being offered in relation to the notion of quality in those learning environments. The purpose of this study was to evaluate the quality of the fieldwork learning environment from the perspective of occupational therapists’ working in one region of Canada. A validated survey, the Quality of Occupational Therapy Fieldwork Experience (QOTFE) tool, was used to identify features of what might constitute quality fieldwork education, and to determine whether there was a difference in quality of fieldwork experience between practice settings or types of practice areas. However, there was minimal variability in scores based on practice setting and practice area variables. These findings indicate a consistent quality of fieldwork experience across practice settings and practice areas. This research presents a picture of the current quality of fieldwork experiences available to occupational therapy students. This may be a starting place for further investigation into the factors that contribute to the quality of practice education learning experience

Addressing Suicide in Entry-to-Practice Occupational Therapy Programs: A Canadian Picture

Worldwide, over 800,000 people die each year by suicide, leaving many behind to grieve the loss. Preventing suicide involves reaching people before they are in crisis (prevention), helping them to navigate a crisis that could result in suicide (intervention), and addressing the aftermath of a suicide loss or attempt (postvention). Healthcare professionals, including occupational therapists, unitedly acknowledge the lack of skills, knowledge, and competence in all facets of suicide awareness and prevention in their professional training and in practice. To improve this situation, suicide prevention skills must be taught in entry to practice programs, so they will filter into the practice of all occupational therapists. Thus, the purpose of this study was to discover how competencies related to suicide prevention are currently taught to student occupational therapists in Canadian universities. A cross-sectional descriptive design was used to survey the 14 Canadian university occupational therapy programs. 12/14 programs responded. All endorsed the use of a range of pedagogical approaches, but there was little similarity from one university to another. Learning activities mainly related to mitigating imminent suicide risk (intervention) and illustrated a lack of attention to the continuum of suicidal behavior (prevention, intervention, and postvention). All universities showed a clear willingness to improve their approach, but there is no current gold standard to strive for. Future initiatives can support research in this regard to ensure student occupational therapists are better prepared to address the full continuum of prevention, intervention, and postvention with explicit attention to an occupational perspective