Occupation: the keystone of a curriculum for a self-defined profession

The idea of occupation is proposed as the basis for constructing a curricular renaissance for occupational therapy in preparation for a new millennium. Implementing an occupation-centered curriculum could create a more integrated profession in which practice, ideas, scholarship, and education nurture and support one another, increasing the autonomy of both the occupational therapy profession and recipients of its services. A practice-oriented rationale for curricular design includes explication of the idea of occupation, a view of the person as an occupational being embedded in that concept, and the thought process of occupational therapy. Recommendations are provided to create an integrated curriculum that will contribute to future-oriented practice and a self-defined profession.

The complexities embedded in family-centered care

The recent movement toward family-centered care, which has been propelled by the implementation of the Education for All Handicapped Children Amendments of 1986, poses considerable challenges to professionals trained in client-centered models of service delivery. These challenges are compounded by the fact that our understanding of family-centered care lags considerably behind our attempts to implement responsive and efficacious services. When practitioners include family members more integrally as collaborators in pediatric treatment, their perceptions about families and the nature of the therapeutic experience is affected. In this article, we present a number of critical dilemmas that are based on data drawn from ethnographic research, descriptive studies, and training seminars we conducted with pediatric practitioners and parents of children with special health care needs. These dilemmas highlight the complexities involved in building effective partnerships among all the key players, the influence of multiple cultural worlds on everyday practices, and the need to provide supports to practitioners for the emotional and social dimensions of practice. Implications for practice and future research are presented.

"Doing" in mental health practice: therapists' beliefs about why it works

OBJECTIVE

The purpose of this study was to explore the beliefs of occupational therapists working in mental health regarding the therapeutic value of "doing" as a treatment modality. Doing was defined as any activity or action-oriented approach that was identified and used by the participating therapists.

METHOD

Eleven occupational therapists working in a variety of mental health areas were observed as they conducted 3 to 6 regularly scheduled therapy sessions. They were then interviewed about their activity-related beliefs. Audiotapes of the 44 treatment sessions and 11 interviews were transcribed and then coded to identify emergent themes and categories of beliefs about activity.

RESULTS

Participants used a variety of activities in both task-based and verbally based treatment sessions. Multiple reasons for activity use were cited, particularly in relation to the task-based sessions. Two main themes related to the value of activity were (a) benefits of activity for the client and (b) benefits in facilitating the process of therapy. Categories of client-related benefits included skill development; impairment reduction; self-awareness; positive self-concept; interaction or connection with others; healthy, balanced routines; pleasure; and enhancement of occupational role performance. Perceived effects on the therapeutic process included creating a therapeutic context, enhancing client readiness, facilitating communication, and providing an organizing framework.

CONCLUSION

Occupational therapists working in mental health hold diverse beliefs about the value of doing in treatment. Basing practice on clearly identified and evidence-based beliefs will assist in ensuring a viable and valued future for the profession in this important domain of health services.

What can be done about home health fieldwork?

The literature indicates that health care is moving away from institutional care and specialization to the community and home where providers need generalist competencies. As educators strive to prepare students for this environment, fieldwork experiences in the community and home are opportunities for students to develop generalist competencies. Because of the current scarcity of fieldwork sites, in general, scheduling placements is difficult. As educators seek new sites, home health settings and therapists who provide home health care as a component of their service need to be considered. Home health occupational therapy requires a practitioner to adopt a holistic perspective in order to assist clients to function optimally in their home environment. Because a large number of students work in addition to taking classes, they can be encouraged to find jobs as home health aides or chore providers as part-time employment before and during their didactic education. This work experience can help them to acculturate to the home setting. By encouraging students' participation in home health experiences, educators are helping to facilitate generalist competencies.

Occupational therapists' beliefs and practices with regard to spirituality and therapy

OBJECTIVE

What is the role of occupational therapists with regard to clients' spirituality? What activities address spirituality in occupational therapy? Whom do practitioners think should be responsible for helping clients with their spiritual needs? The objectives of this study were to address these and other related questions by validating a previously used questionnaire and establishing a baseline of occupational therapists' opinions and practices about spirituality and therapy on which future research can be built.

METHOD

A previously piloted questionnaire was revised to investigate the opinions of 500 U.S. registered occupational therapists about spirituality and therapy. The 54% return rate yielded a sample of 270 respondents.

RESULTS

Nearly 79% of the respondents agreed that the questionnaire accurately measured their opinions about therapy and spirituality. Spirituality is an important part of life for 89% of the respondents, helps 79% with daily job responsibilities, and is viewed as a very important dimension of health and rehabilitation by 84%. However, 63% were either undecided or disagreed that addressing spirituality was within the scope of occupational therapy practice.

CONCLUSION

In general, the respondents reported that spirituality is important and helpful in their personal lives and a very important dimension of the health and rehabilitation of their clients. However, less than 40% of the respondents indicated that addressing clients' spiritual needs was within the scope of their professional practice, and the majority (82%) reported that their academic training did not prepare them to address the spiritual needs of clients. The questionnaire, now validated with a national sample, may be used for follow-up studies to further investigate the role of spirituality in health and rehabilitation.

Geriatric occupational therapy: the uncertain ideology of long-term care

The search for the good life is used as a framework for understanding the meaning of geriatric practice to occupational therapists. Data consisted of a subset of phenomenological interviews drawn from a nationwide study of 148 occupational therapists in all areas of practice. Narratives of satisfying and dissatisfying experiences with older clients were analyzed to understand the uniqueness of therapists' lived experiences in geriatrics. The realities of practice with older clients--the settings, the meanings and symbols of continuity in old age, and the older client's uncertain future--merge to create an uncertain ideology in geriatric occupational therapy. We suggest that a fundamental task of occupational therapists in geriatrics, as they seek the good life for themselves and their older clients, is to reconcile the realities of practice with traditional rehabilitation ideologies by redefining themselves and their roles in practice.

Generalist versus specialist occupational therapists

The issue is not generalist versus specialist, bachelor's degree versus master's degree, or even registered occupational therapist versus certified occupational therapy assistant. The issue is: What is each professional's product? What is the process by which each produces it? What knowledge, skills, and judgment do each need to competently produce the product? And, under what circumstances and conditions and at what point are each required to assure a quality product? The delineation of the requisite knowledge and skills as well as the delineation of generalist and specialist will flow from the answer to these questions.

[Rehabilitation of psychiatrically ill and handicapped patients--historical, conceptual and scientific aspects]

Since the early days in the 19th century, psychiatry has been dealing with chronic courses of illness and mental disabilities. The 1975 German "Psychiatry Enquete Report" has played a major role in achieving progress in the care system, allowing mentally ill patients with impending or established handicaps to be rehabilitated or to have long-term care of varying intensity and even at home. In particular, differentiated and graduated systems of sheltered accommodation, a sheltered labour market and leisure-time support have been created. Rehabilitation may induce a response in the disabled patient and improve his skills. It may, however, also be aimed at finding or structuring an adequate living environment to enable the patient to cope. A distinction must also be drawn between early and late rehabilitation: late rehabilitation applies primarily to those patients whose disabilities have become relatively irreversible after protracted illness. The objective in this case is to maintain social integration. Early rehabilitation is desirable today if functional deficits and impairments are found to occur in conjunction with a mental illness. If a substantial disability remains in spite of intensive efforts towards rehabilitation, adequate re-integration of the affected patient may be achieved by adapting the living environment. Although the practical state of development is promising, a large number of theoretical and scientific problems remains unsolved. The topic of psychiatric vocational rehabilitation in particular is raising more and more questions. There is a lack of information on the number of chronically mentally ill patients in the community and their needs, i.e. on the number of potential users. Further studies are needed to investigate the effects, the efficacy and the course of psychiatric rehabilitation.