Restricted and Repetitive Behaviour in Persons with Autism (Ages 0-18): An Integrative Review of Treatment Related to Occupational Therapy

Objective: To identify evidence-based behavioural interventions used to decrease restricted and repetitive behaviour (RRB) in children with autism (ages 0-18); to understand the application of these strategies within the PEO (Person, Environment, Occupation) Model of Occupational Performance and the role of the occupational therapist in addressing this limitation. Background: RRB is a core feature of autism that often impedes functional behaviour. Decreasing RRB to enable functional behaviours is central to the occupational therapist’s role with this population. Many interventions identified as effective for this impairment are based on the principles of applied behaviour analysis (ABA). Method: An integrative review of the literature was completed to identify interventions targeting RRBs. Those found to be effective are described within an ABA framework and within the PEO Model of Occupational Performance.  Results: This review identified twenty-eight effective interventions used to treat RRBs in autism relevant to the field of occupational therapy. Categorization of interventions using an ABA framework and the PEO Model allowed comparison between approaches and application to occupational therapy practice. Conclusion:A functional behaviour approach (FBA) used in combination with the PEO model will enable greater understanding of RRBs and provide a more comprehensive approach to the treatment of RRBs in children with autism

Work-based Learning for Adolescentswith Learning Disabilities:Creating a Context for Success

This paper describes cases of two adolescents with learning disabilities working in automotive repair businesses as part of a workbased education program. Neither adolescent was judged to have been successful by the workplace supervisors. The frameworks chosen for analyzing these cases draw upon recent work in selfdetermination, workplace learning, and negotiating accommodations for workers with disabilities. Data for the qualitative cases consist of interviews and detailed observations. Analysis, using a contextualist perspective, provides descriptions of the contexts for the two co-operative education placements and yields four themes that appear central to success in work-based education experiences for adolescents with learning disabilities: negotiating accommodations, routines, expectations, and preparation

Work-Based Education as a Pathway to Resilience

The purpose of this study was to explore the potential of work-based education (WBE) as a pathway for enhancing resilience among youth-at-risk for disengaging from school. For students who have experienced traditional academic school as an adverse context, the decision to pursue an alternative path to high school completion, for example WBE, can be interpreted as agentic. We propose that WBE may have the requisite features of an educational context that fosters resilience in at-risk youth. We used a multipleperspective case study method involving three young people in their final stages of secondary school. The students were the focal participants in each case. Each was interviewed and observed on multiple occasions. We interviewed teachers and workplace supervisors associated with each student for additional perspectives. Cases were analyzed individually, followed by cross-case analyses utilizing a resilience framework. Our study revealed evidence that for the three youth we studied, WBE had many elements that appear to enhance resilience in a way that academic programs did not. WBE kept these students engaged in the school context and contributed to the eventual successful completion of secondary school for all three. Choosing WBE as a pathway to secondary school completion can be an agentic act by at-risk youth to achieve graduation. Engagement in WBE also appears to enhance resilience. WBE may foster resilience in at-risk youth, who despite academic adversity, progress to completion. Graduation from secondary school is frequently identified as a positive outcome and a predictor of success in productive occupation and adult life

What We Learned about Mentoring Research Assistants Employed in a Complex, Mixed-Methods Health Study

We investigated the experiences of research assistants in their dual role as both employees and trainees, when they were employed in a complex, mixedmethods, Canadian study on the everyday experience of living with and managing a chronic condition. A total of 13 research assistants participated in one or more components of this study: a survey (n = 11), focus group interview (n = 7), and/or individual interview (n = 13). Thematic analysis identified two key themes: what faculty mentors should provide to research assistants before they begin their work, and what faculty mentors need to know in order to effectively offer ongoing support to research assistants. Our results provide valuable insights for new and experienced faculty members who employ research assistants and for research assistants employed in funded research projects. Our results can inform the development of regulations to ensure that research assistants have greater protection as both trainees and employees.   Lors d’une recherche canadienne complexe à méthodologie mixte portant sur le quotidien des gens qui vivent avec une condition chronique ou qui doivent en gérer les aspects, nous avons exploré le double rôle des adjoints à la recherche, à la fois comme employés et comme stagiaires. Au total, 13 adjoints à la recherche ont participé à au moins une composante de cette étude : un sondage (n = 11), une entrevue de groupe (n = 7), une entrevue individuelle (n = 13). Une analyse thématique a pu repérer deux thèmes principaux : ce que les mentors du corps professoral doivent savoir afin d’aider efficacement et de façon soutenue les adjoints à la recherche, et ce qu’ils doivent leur fournir avant le début des travaux. Nos résultats fournissent de précieux éclaircissements pour de nouveaux membres et des membres chevronnés du corps professoral qui emploient des adjoints à la recherche, ainsi que pour des adjoints à la recherche qui travaillent à des projets subventionnés. Nos résultats informent les responsables de l’élaboration des règlements afin de s’assurer que les adjoints à la recherche disposent d’une protection élargie en tant que stagiaires et employés

Obligations and Irony in the Workplace Accomodations: A Case STudy in a Large Corporate Office

This paper reports a multiple-perspective case study of a worlcer with a severe visual impairment and the accommodations that she received and made in a workplace that was conszdered a leader in hiring and accommodating workers with disabilities. Data for the study consisted of observations in the offices of this large corporation, interviews with the focal individual as well as with her supervisor, a colleague, and a human resources professional. Standard qualitative analyses were guided by six facets of negotiating accommodations derived from an extensive review of literature across a number of disciplines. The six facets are: (a) access and disclosure; (h) structural affordances; (c) social context; (d) motivation; (e) understanding of social policy; and ( f ) cognitive problem solving. By attending to these six facets, we demonstrate the ironies that abound in workplaces that emphasize providing accommodations, primarily structural accommodations, while ignoring the process of negotiating accommodations proactively. Ironies also arise in the use of technology to provide structural accommodations while ignoring the power of technology to educate coworkers and supervisors about social policy and to enable ongoing collaborative and cognitive problem-solving as a way of negotiating accommodations. Perhaps the policy should promote duty to negotiate as well as duty to accommodate. Cet article analyse sous plusieurs angles le cas d'une travailleuse aux prises avec une dificience visuelle grave en rapport avec les am6nagements effecttks, par l'employeur et elkmgme, dans un milieu de travail considiri comme un chef de file en matisre d'embauche et d'ame'nagements pour les travailleurs handicape's. Les dondes utilise'es dans cette e'tude prouiennent d'observations effectue'es dans les bureaux de cette waste entrepnse, d'entrevues auec h travailleuse concerne'e ainsi qu'avec son superviseur, un colkgue et un professionnel des ressources hurnaines. analyse qualitative standard effectde par l'auteur repose sur six aspects relatifs & h ne'gociation d'am'nagements, e'tablis h la suite d'une minutieuse analyse de la documentation pertinente dans une varie'te' de disciplines. Ces six aspects sont : a) l'accessibilite' et la divulgation; b) les ressources structurelles; c) le contexte social; d) la motivation; e) la compre'hension des politiques; et f) la re'solution de probhe cognitive. En nous appuyant sur ces six aspects, nous avons montre' l'ironie qui rsgne dans certains lieux de travail qui se targuent d'offrir des ame'nagements, principalement d'ordre swucturel, alors qu'ils omettent de ne'gocier des am&nagements de fagon proactive. Cette ironie se manifeste e'galement dans l'utilisation, par les entreprises, de la technologie pour offrir des ame'nagements structurels, alors qu'elles n'ont pas recours h la puissance de cette technologie pour informer les collsgues et superviseurs au sujet des politiques sociales et pour faciliter l'e'tablissement d'un processus coope'ratif et cognitif de re'solution de probkmes visant h ne'gocier des ame'nagements. Les politiques dewaient peut-&me faire la promotion de l'obligation de dgocier paralklement h l'obligation d'effectuer des ame'nagements

The Patient Activation Measure: a validation study in a neurological population

Purpose To assess the validity of the Patient Activation Measure (PAM13) of patient activation in persons with neurological conditions. Methods ‘‘The Everyday Experience of Living with and Managing a Neurological Condition’’ (The LINC study) surveyed 948 adults with neurological conditions residing in Canada in 2011 and 2012. Using data for 722 respondents who met coding requirements for the PAM-13, we examined the properties of the measure using principle components analysis, inter-item correlations and Cronbach’s alpha to assess unidimensionality and internal consistency. Rasch modeling was used to assess item performance and scaling. Construct validity was assessed by calculating associations between the PAM and known correlates. Results PAM-13 provides a suitably reliable and valid instrument for research in patients with neurological conditions, but scaling problems may yield measurement error and biases for those with low levels of activation. This is of particular importance when used in clinical settings or for individual client care. Our study also suggests that measurement of activation may benefit from tailoring items and scaling to specific diagnostic groups such as people with neurological conditions, thus allowing the PAM-13 to recognize unique attributes and management challenges in those conditions. Conclusions The PAM-13 is an internally reliable and valid tool for research purposes. The use of categorical activation ‘‘level’’ in clinical settings should be done with caution.Living with a neurological condition in Canada (LINC

Managing everyday life : Self-management strategies people use to live well with neurological conditions

Objective: This paper uses the Taxonomy of Everyday Self-management Strategies (TEDSS) to provideinsight and understanding into the complex and interdependent self-management strategies peoplewith neurological conditions use to manage everyday life. Methods: As part of a national Canadian study, structured telephone interviews were conducted monthlyfor eleven months, with 117 people living with one or more neurological conditions. Answers to fiveopen-ended questions were analyzed using qualitative content analysis. A total of 7236 statements wereanalyzed. Results: Findings are presented in two overarching patterns: 1) self-management pervades all aspects oflife, and 2) self-management is a chain of decisions and behaviours. Participants emphasizedmanagement of daily activities and social relationships as important to maintaining meaning in theirlives. Conclusion: Managing everyday life with a neurological condition includes a wide range of diversestrategies that often interact and complement each other. Some people need to intentionally manageevery aspect of everyday life. Practice implications: For people living with neurological conditions, there is a need for health providersand systems to go beyond standard advice for self-management. Self-management support is besttailored to each individual, their life context and the realities of their illness trajectory

Preparing at-risk youth for a changing world: Revisiting a person-in-context model for transition to employment

Background: The current global cohort of youth has been called ‘a generation at-risk’, marked by a dramatic rise in youth who are not in employment, education or training programmes. In 2010, youth were three times as likely as adults to be unemployed, with youth unemployment worsening in 2012 and 2013. Accordingly, there is an urgent need to examine educational structures that can promote greater labour market attachment and successful transition into employment for youth worldwide. Vocational and work-based education (WBE) has been identified as one of the most recommended and promising educational structures for curtailing youth under- and unemployment. However, WBE takes many forms, making it difficult to discern which WBE programme is most likely to meet the diverse needs of any individual at-risk youth. Moreover, there has been a dearth of theoretical conceptualisations to explain WBE as a context that promotes resilience for at-risk youth as they transition into the world of work. Purpose: The purpose of this paper is to present a revised model for WBE as an enabling context for at-risk youth in transition from school to employment. Specifically, a person-in-context approach is used, situating youth-related facets (e.g. agency) in relation to systemic facets (e.g. political, cultural) to provide a comprehensive theoretical basis for WBE. The revised model maintains three overlapping domains – the individual, the social-cultural and the economic-political – to address a theoretical gap in the literature on transition systems while providing a foundation for practical efforts to prepare at-risk youth for engaging in a changing labour market. Design and Methods: The model was constructed through a systematic and interdisciplinary integrative literature review that examined empirical, conceptual, policy-based and practice-based literature on at-risk youth transition from school to work. Articles and documents were analysed for both individual and contextual factors that influence transition, in order to contribute towards the development of a robust person-in-context model. Existing models of transition and other systems were also examined that addressed the needs of at-risk youth. A ‘person-in-context’ approach was selected for our model as it enabled representation of both macro- and microcosmic factors that shape effective WBE programming. Conclusions: The model is organised around three critical domains that were identified as being influential for school-to-work transition: the individual domain, the social-cultural domain and the economic-p