Cluster Randomised Controlled Trial of an Occupational Therapy Group Intervention for Children Designed to Promote Emotional Wellbeing

Background: Children’s mental health is a growing focus in health promotion. Current treatments focus primarily on modifying internal cognitions with insufficient effect on functional outcomes. Occupational therapists can promote health and wellbeing by enabling children to design and build health-promoting routines and make healthy occupational choices. There was no evidence for the use of occupational therapy as an intervention to promote mental health or increase participation and wellbeing in a preventative context. The aim of the current study was to investigate the effectiveness of a preventative occupational therapy group intervention (Kia Piki te Hauora: Uplifting our Health and Wellbeing©) designed to reduce symptoms of anxiety and depression and improve self-esteem and participation in children aged 11-13 years, by completion of the intervention, and the sustainability of any improvements after a follow-up period of 8-9 weeks. Methods: The study used a pragmatic, cluster-randomised controlled trial design with two arms: intervention and (waitlist) control. The sample size calculated was 126 participants from 14 clusters, based on a conservatively estimated intra-cluster coefficient (ICC) of 0.05 and a design effect (0.81) to account for the clustering and adjusting for covariates in the analyses. Fourteen clusters (schools), equating to 151 participants, were stratified by school decile-rank category and constrained stratified block randomisation was applied. Blinding of participants post-randomisation was not feasible; however, outcomes assessors were blinded. Outcomes were measured at baseline, after the parallel and crossover phases, and at follow-up and were anxiety symptoms (primary), depression symptoms, self-esteem, participation and wellbeing. Data from intervention participants were compared to waitlist-control participants who later went on to receive the intervention: resulting in the crossover phase of the trial. Data were analysed using an intention-to-treat approach to analysis. A mixed design Repeated Measures Analysis of Covariance was conducted to enable adjustment for the clusters and to statistically control for covariates identified. Per protocol, unadjusted and sub-group analyses were also performed. Results: This trial found significant positive effects of the intervention on child-rated satisfaction with their occupational performance and teacher-rated child anxiety. No evidence was found to support the effect of the intervention on anxiety and depression symptoms, self-esteem and wellbeing. However, there was evidence that the child-rated anxiety and depression symptoms 8-9 weeks after the intervention were no worse and possibly improved as compared to immediately post-intervention. Discussion: The current study has provided no new evidence to support the theory that participation in meaningful, positive occupations can impact on mental health symptoms. Strengths of the study included a fully pre-specified statistical analysis plan, robust efforts to minimise biases and sufficient sample size. Limitations included not being able to blind participants and personnel, lack of an attention-control intervention and qualitative data collection. Having a short follow-up period and low parent and teacher response rates also limited findings. Recommendations are made to redesign the intervention as an embedded intervention in the classroom, co-taught by teachers and including parental involvement. Contribution of new knowledge: This was the first known cluster-randomised controlled trial to investigate an occupational therapy intervention promoting emotional wellbeing in a non-clinical sample of children

Educating a culturally competent health workforce for Pasifika communities: A Wintec/K'aute Pasifika clinical partnership project

Introduction The connection between Wintec and K’aute Pasifika is long standing through health and education and the time is right for collaboration that lifts both organisations is the strongest possible partnership. Significant opportunity exists for Wintec’s CHASP/CSSHP and K’aute Pasifika to work together in developing innovative strategies to enhance opportunities for student engagement in the delivery of services offered through K’aute Pasifika and to evaluate these. Literature review Pacific Islanders typically have lower health status and life expectancy than other New Zealanders. Implementation of Māori initiatives are not always appropriate for Pasifika peoples and there is a need to develop Pacific-specific initiatives. Evidence suggests tailored teaching and learning interventions may be required to promote participation and academic success of underrepresented minority groups in New Zealand, such as Pasifika. However, the focus needs to be on more than just Pasifika students and also on increasing non-Pasifika student capacity to work with the Pasifika community in a culturally acceptable and competent manner. There is a consistent shortage of Pacific primary health care workers in New Zealand and Pasifika are underrepresented across all health occupations. The literature identifies a complex range of factors that may contribute to this including high levels of mobilization in the skilled professional workforce and blurring of boundaries. Student-led placements with Indigenous populations have been identified as a feasible and meaningful way of developing a workforce ready to serve Indigenous and minority populations. Method A mixed method study design incorporating Talanoa was implemented to address the following key objectives: 1. Map current Wintec student placement provision within K’aute Pasifika against regional population health needs 2. Identify educational opportunities available at K’aute Pasifika through consultation with K’aute Pasifika staff 3. In collaboration between Wintec and K’aute Pasifika, develop a 5-year strategic plan for enhancement of cultural competence of Wintec staff and students in working with Pasifika people Findings Our Talanoa identified three major themes through which current and potential student placements could be better understood: the student experience, vā/relationships, and transformation. The first theme, student experience, was divided into subthemes, which expressed how students are valued, quality experiences for students are important to K’aute Pasifika staff, cultural practices are significant in placements at K’aute Pasifika, authentic experiences and interprofessional practices are essential and readily occur at K’aute Pasifika. The second theme, vā/relationships, was conceptualised as a network, with K’aute Pasifika at the centre, surrounded by the relevant partnerships. Equally as important as who those partners were, was the connections and space - or vā - between them. The third theme, transformation, was divided into three sub-themes: growth, capacity for more, and workforce development. These themes were understood in the context of the health data to create a clearer picture of the health needs for the Pasifika community in Kirikiriroa/Hamilton. Recommendations A clear action plan for 2021 is outlined which was co-constructed and agreed between K’aute Pasifika and Wintec and derived from the Strategic Plan

Leaping hurdles: pilot study into the effectiveness of an occupation-based group for anxious and depressed children

This research evaluated the acceptability and effectiveness of Leaping Hurdles: an occupation-based anxiety and mood management group intervention for children aged 10-14 years, (alongside a parallel parenting group). The intervention was conducted at a government-funded Child and Adolescent Mental Health Service (CAMHS) and children referred to the group as clinically indicated were invited to participate in the research (n=34). The research used a quasi-experimental, repeated measures design with no randomisation. Self- and parent-rated clinical measures were used: Beck Youth Inventory-II (BYI), Child Behaviour Checklist (CBCL), and Occupational Questionnaire (OQ); as well as the clinician-rated Children’s Global Assessment Scale (CGAS) and Health of the Nations Outcome Scale for Children and Adolescents (HoNOSCA). Measurement tools were administered at waitlist, pre-group, post-group, and three months follow-up to allow for comparison to a control group (waitlist) and exploration of retention of change. Data was examined using descriptive analysis, repeated measures t-tests, one-way ANOVAs and analysis of correlation coefficients. This was further extended through exploration of six case studies. The power calculations were low (<.74) and the effect sizes moderate or higher. No difference in self- or parent-rated symptomology was reported between waitlist and pre-group measurements. Descriptive analysis found a trend of improvement pre- to post-group in anxiety and depression symptoms as reported by the children. A significant improvement in pre- to post-group symptomology and level of functioning as reported by the parents and clinicians was also found. Descriptive analysis of the follow-up findings indicated the self- and parent-rated outcome measures continued to improve. A summary of the case studies suggested that males and those engaged in treatment as usual for less time - prior to commencing the group - were more likely to attain better outcomes. This research study was not randomised so it cannot be stated conclusively that the intervention was responsible for the changes found. However, early indications with the small sample size suggest that Leaping Hurdles impacted on reducing symptomology and increasing functioning: further research with a larger sample size is indicated

Development and content of a school-based occupational therapy intervention for promoting emotional wellbeing in children

The development and content of an occupational therapy intervention promoting emotional well-being, for children with subclinical anxiety, is described. Development and trialing followed a four-step process: (1) reviewing theory, (2) reviewing evidence, (3) incorporating expert opinion, and (4) trialing. The intervention consists of eight group sessions, led by an occupational therapist, over 8 weeks of an academic term. Its proposed outcomes will be achieved by providing children with knowledge about health promoting occupations and how to participate in, balance, and sustain these. This article offers a guideline for the development and description of similar interventions to facilitate more robust evaluation of clinical practice

Quality and reporting of cluster randomised controlled trials evaluating occupational therapy interventions: A systematic review

Growing use of cluster randomized control trials (RCTs) in health care research requires careful attention to study designs, with implications for the development of an evidence base for practice. The objective of this study is to investigate the characteristics, quality, and reporting of cluster RCTs evaluating occupational therapy interventions to inform future research design. An extensive search of cluster RCTs evaluating occupational therapy was conducted in several databases. Fourteen studies met our inclusion criteria; four were protocols. Eleven (79%) justified the use of a cluster RCT and accounted for clustering in the sample size and analysis. All full studies reported the number of clusters randomized, and five reported intercluster correlation coefficients (50%): Protocols had higher compliance. Risk of bias was most evident in unblinding of participants. Statistician involvement was associated with improved trial quality and reporting. Quality of cluster RCTs of occupational therapy interventions is comparable with those from other areas of health research and needs improvement

Patient Outcomes from Student-Run Health Services:An Integrative Review

BACKGROUND: Student-run clinics (SRCs) offer an innovative approach to expand healthcare access and equity and increase clinical placement opportunities for students. However, research on the health benefits and/or outcomes of such clinics is currently fragmented. METHODS: An integrative review was conducted to capture and synthesize findings across a range of study types involving varied student disciplines, student delivered intervention types, and health conditions addressed or care areas of focus. Only published and peer reviewed studies were included. Studies needed to report outcomes in a defined study group measured over time, or report SRC data with explicit comparisons to non-SRC settings. Data were analyzed using inductive content analysis to identify major themes and natural clustering of health outcomes measured. RESULTS: Fifty-one articles were selected for review based on the eligibility criteria. Studies were predominantly from the United States, and most (n = 34, 67%) adopted a case review methodology for measuring outcomes. Health outcomes were evaluated in relation to a range of health conditions that, for the purposes of this review, were considered to naturally cluster into eight categories: diabetes, hypertension, functional health/quality of life, depression, hospital utilization, substance use, weight, health screening/vaccinations, and others. CONCLUSION: This integrative review sought to evaluate the health outcomes accrued by patients in student-run health clinics. Taken as a whole, the literature suggests positive health outcomes resulting from student-run clinics across a range of health conditions. Greater confidence in care-related findings would be achieved from future research utilizing more robust and prospective study designs

Development and Content of a School-Based Occupational Therapy Intervention for Promoting Emotional Well-Being in Children

The development and content of an occupational therapy intervention promoting emotional wellbeing, for children with subclinical anxiety, is described. Development and trialling followed a four-step process: (1) reviewing theory; (2) reviewing evidence; (3) incorporating expert opinion; (4) trialling. The intervention consists of eight group sessions, led by an occupational therapist, over 8 weeks of an academic term. It is proposed outcomes will be achieved by providing children with knowledge about health promoting occupations and how to participate in, balance and sustain these. This paper offers a guideline for the development and description of similar interventions to facilitate more robust evaluation of clinical practice. KEYWORDS Health promotion, mental health, occupational therapy, school-based, wellbein

Student-led clinics in Aotearoa New Zealand: A scoping review with stakeholder consultation

Background: Student-led clinics have gained increasing attention as a mechanism for students across various health professions to gain authentic interprofessional clinical place-ment experience during their educational programme. Purpose: This scoping review is designed to identify and describe experiences relating to student-led clinics in Aotearoa New Zealand. Methods: The review involved five key steps: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results. Discussion: Student-led health clinics present invaluable educational opportunities for authentic collaborative practice and capacity to improve population health and well-being, especially in marginalised and disadvantaged communities. Clinic establishment and operation require consideration of a complex set of factors. Conclusion: Community consultation (including with Indigenous populations) should precede establishment of clinics. There is scope for more reporting and objective evaluation to ensure best practice is being determined, developed, and achieved