An Occupational Perspective on Psychedelic Therapy: A Scoping Review

Background. Interest in the use of psychedelics for mental health therapy is burgeoning. Qualitative research methods are increasingly used to understand patient's experiences; however, there is a lack of literature that explores psychedelic use from an occupational perspective. Purpose. To conduct a scoping review of qualitative literature on the experiences of psychedelic use for the purpose of mental health therapy, through an occupational lens. Key Issues. Wilcock's occupational perspective of health was employed to analyze the use of psychedelics in mental health from an occupational perspective. Despite heterogeneous therapy contexts and substances used, patients reported comparable benefits regarding occupational engagement, such as increased mindfulness and autonomy in doing, a renewed sense of being, greater motivation to grow and become, and an improved sense of connection and belonging. Implications. This review demonstrates how psychedelic use in the context of mental health support can be experienced as a meaningful occupation and may contribute to overall health. In turn, this review highlights the utility of an occupational perspective for "non-sanctioned" or stigmatized occupations like psychedelic use, as well as the need for more research on psychedelic use from an occupational perspective. Using an occupational perspective of health can help to de-stigmatize psychedelic use as a meaningful occupation, rather than a deviant one, and shed light on how psychedelics may also positively impact one's participation in everyday life and overall health.

Understanding home modification outcomes from the perspective of older people and people with a disability: informing home modification evaluation

PURPOSE

There is limited evidence to guide therapists in home modification outcome evaluation. Involving consumers in evaluating home modifications is critical to progressing practice. This study investigated the home modification experience and outcomes most valued by older adults and individuals with a disability in Australia.

MATERIALS AND METHODS

An interpretive description approach was used. Twenty participants aged 24-93 who had received major home modifications were interviewed and transcripts were analysed thematically.

RESULTS

Two major themes emerged: life before and during modifications - "it was all hard," and life after modifications - "to have a life." People's prior experience of home, the circumstance of and time to plan modifications, the perceived value of the modifications, and the home modification process and funding influenced perceptions of outcomes. Valued home modification outcomes included those that enable people to experience emotional and physical health, and safety; do what they want; maintain the image of the home; and plan for the future. Experiences and perceptions of modifications ranged from supportive to disruptive.

CONCLUSIONS

These findings point to the need for therapists to deeply understand and evaluate their clients' experiences of home and life as an initial and critical step in the home modification process.Implications for rehabilitationMajor home modifications result in broad and meaningful outcomes of importance to clients.Occupational therapists need to partner with clients to understand their life before and during modifications to achieve positive outcomes.Evaluation of major home modifications needs to be integrated and prioritised in daily practice.

Professional voices on risk and accidents in home care – a Swedish survey study

Purpose

The purpose of this study is to find out what knowledge and experience of occupational therapists, personal assistants and public health nurses/nurses in Sweden can contribute concerning the vulnerability of residents to injury in different residential care-settings.

Design/methodology/approach

This study is based on an online survey. A total of 832 individuals responded to the survey. The data were analyzed from a mixed-method approach, using descriptive statistics, correlations and textual-analysis.

Findings

More than one in four representatives of these professions had witnessed accidents. The results show that bedrooms and bathrooms are the rooms in which accidents are most likely to occur in homes.

Research limitations/implications

One limitation of the study is that the impact of educational initiatives on the different professions was not investigated, so it is not possible to ascertain what effect this may have had on risk identification and accident prevention measures in residential care-settings.

Originality/value

To the best of the authors’ knowledge, no prior study of these issues has been conducted. This study is deemed to have significant social benefit because of the steadily increasing need for care in residential settings. No other study has addressed the importance of the physical environment in this context. Collaborations involving researchers from various disciplines, professional organizations and public and private sector employers involved in personal assistance have contributed specific knowledge.

Constrained Outlines: A Method for Creating Access Guidelines for Individual Wheelchair Users

A novel method of identifying solutions for wheelchair access problems is presented. This method was developed in response to difficulties in identifying manoeuvring space requirements, particularly of wheelchair users with large or nonstandard wheelchairs. A simple theoretical model of wheelchair manoeuvring is used. This model allows scaled drawings of the wheelchair outline to be constrained on an adaptation plan, in a way that provides a useful representation of the space required during individual wheelchair manoeuvres. The method can allow speedier assessments, encourages the identification of novel and individual solutions and provides a simple visual account of decision making.

Participation in Occupations: Some Experiences of People with Parkinson's Disease

Evidence suggests that people with Parkinson's disease can experience difficulties participating in occupations. This article describes a qualitative study that explored how seven people with Parkinson's disease perceived their participation in occupations.

The analysis of the semi-structured interviews led to the identification of three themes: changes, addressing changes and perspectives on living with Parkinson's disease. Many findings supported the existing literature; for example, difficulties with self-care occupations and the desire to maintain normality. The new findings included the participants describing positive changes in their lives that were attributable to having Parkinson's disease and using occupations purposefully to enhance wellbeing.

The results support the use of a client-centred approach to consider the implications of participation in occupations for people with Parkinson's disease, because this may encourage clients to use their own expert knowledge to enhance existing coping strategies. The recommendations for further research include an investigation as to whether the themes identified apply to a larger population and including people with Parkinson's disease in designing future research questions about the impact of occupational participation on wellbeing.

Enabling Older People to Stay at Home: How Adaptable are Existing Properties?

A multiprofessional research project examined in detail the factors that affect the adaptability of existing housing and explored issues relating to the introduction of assistive technology into the existing homes of older people in order to provide them with the opportunity to ‘stay put’. The research reported here investigated the feasibility of adapting the existing stock of social housing and the resulting costs and outcomes of introducing assistive technology.

This paper outlines that part of the project that examined in detail the adaptability of 82 properties representing a variety of property types to accommodate the needs of seven notional users, characterising the most common range of impairments of older people. The factors that affect a property's adaptability include property type and specific design and construction features. The implications for housing providers, clients and occupational therapists are discussed.

The research identified the unique expertise of occupational therapists, spanning the areas of housing, older people and assistive technology, and it introduced methods and tools that can help to determine best housing outcomes as well as cost implications. It is crucial that the profession is proactive in contributing to the development of housing policies that address the needs of an ageing population effectively.

A best space for assisted wheelchair users

Introduction

Occupational therapists lack manual-handling sensitive tools to assist individual adaptation specifications for assisted wheelchair users, for example, corridor-room turns for extra-long wheelchairs.

Method

Engineering-based methods identified an experimental set-up. This provided a useful representation of possible manoeuvres in five tasks and proposed a turn difficulty order. Experienced wheelchair assistants ( n = 22) selected their maximum comfortable wheelchair weight for each turn.

Results

Some participants (3/22) were insensitive to turning-space but all other participants (19/22) chose their lowest maximum comfortable weight for the tightest turning-space and 17/19 chose their highest weights for space permitting a slow turn. Mean percentage weight increased by 30% from tight to slow turning-space. Results are statistically significant and clinically important. Experimental set-up was similar to assisting in confined spaces; participants were experienced in working in spacious environments and had recent manual-handling training so results are supported by good manual-handling practice. Assistant-size impact on easiest (highest weight) turning-space is small. Results are applicable to all floor coverings and wheelchair sizes but not to self-propelling wheelchair users. Results are incorporated into a tool, demonstrated by case study.

Conclusion

Tool-use specifies a best adaptation.

Understanding the dimensions of home for people returning home post stroke rehabilitation

Introduction

Home is a meaningful and important place and the transition to home from hospital is considered a significant point in recovery for people after stroke. Six dimensions of the home environment have previously been described as important for well-being and contributing to one's experience of home: the physical, social, personal, temporal, occupational and societal dimensions. The aim of this study was to understand the experience of home for people with stroke after discharge to home from hospital rehabilitation.

Method

A secondary template analysis applied the dimensions of home to semi-structured interviews that explored the transition to home experience for seven participants with stroke at 4–6 weeks post discharge.

Results

All six dimensions were present in the descriptions of returning to home from stroke rehabilitation. The social, personal and occupational dimensions appeared to be the most prominent and often centred on loss or change.

Conclusion

People returning home after a stroke enter a different home environment than the one they experienced prior to stroke, with changes experienced in all dimensions of home. Closer attention to the dimensions during discharge preparation may enhance the transition experience.

Adaptation Planning Guideline and Constrained Outline for Shower Chairs and other Four-Caster Vehicles

Introduction:

No research-based guidelines for adaptation planning for shower chairs and other vehicles with four casters exist, despite the manual handling nature of the manoeuvring task and the occupational therapy responsibility to plan for such vehicles.

Method:

It was determined from theory that changes in direction for these vehicles, such as from a passageway through a door, could be represented by 13 manoeuvres. Participants (n = 17) carried out 11 (maximum) manoeuvres based on this theory, each with the maximum comfortable occupant weight of their choice (weights represented the occupant).

Findings:

The maximum occupant weight selected as comfortable varied substantially between some of the 11 manoeuvres: there was a 100% difference between the lowest and highest weight selections. This indicated that four-caster vehicles (such as shower chairs) should not be treated as omni-directional for high occupant weights, or for floor materials with high motion resistance, because the manoeuvre direction substantially affects maximum comfortable weight selection.

Conclusion:

The manoeuvre with the highest weight selection is proposed as a guideline when manual handling concerns exist for these vehicles. The guideline can be modified for individual vehicles sizes, occupant and carer anatomy.

Understanding the dimensions of home that impact on home modification decision making

BACKGROUND/AIM

The home environment is a multidimensional and personally meaningful place, and the complexity of this environment often impacts on the home modification process and outcomes. Home modifications can appear as a straightforward solution to safety and occupational performance concerns; nevertheless, clients sometimes reject modifications or are unsatisfied with the completed works. To understand this phenomenon, this study aimed to determine what aspects of the home environment impact home modification decision making.

METHOD

In this qualitative descriptive study, 42 in-depth interviews using a semi-structured questionnaire were undertaken and analysed using a template analysis. The interviews explored the experience of the home modification process, including concerns and the decisions made about the modifications.

FINDINGS

Four dimensions of the home environment were commonly found to affect decision making namely, the personal, societal, physical and temporal dimensions of home as well as social and occupational dimensions.

CONCLUSIONS

An understanding of the dimensions of home that impact decision making provides occupational therapists with a greater appreciation of the experience of home and allows them to enhance the effectiveness and acceptance of home modifications.

Clients' experiences of housing adaptations: a longitudinal mixed-methods study

PURPOSE

To explore clients' experience of the housing adaptations (HAs) over time in relation to housing and health.

METHOD

A multiple longitudinal case study, employing an embedded mixed-method design was used. Four participants were included and data from semi-structured interviews were combined with data from structured survey assessments.

RESULTS

HA made it possible to maintain valuable roles and activities, to continue to live in the participants' own homes and to take part in the society. The participants strived for autonomy and control, and in order to do so they needed different kinds of support, in terms of HA and mobility devices as well as support from professionals. HA also challenged the participants' routines and habits, as well as their perception about how an appealing HA aesthetically. Thus, the decision to apply for a HA was not always straightforward. Instead, the participants were constantly engaged in negotiations with themselves, concerning benefits and drawbacks of different decisions.

CONCLUSIONS

HAs involve complex person-environment-activity (P-E-A) transactions, and enhance clients' activity and independence in spite of functional decline. The knowledge generated is important in order to improve individual HA, as well as improving the efficiency and effectiveness of the intervention.

Home: the place the older adult cannot imagine living without

Background

Rapidly aging populations with an increased desire to remain at home and changes in health policy that promote the transfer of health care from formal places, as hospitals and institutions, to the more informal setting of one's home support the need for further research that is designed specifically to understand the experience of home among older adults. Yet, little is known among health care providers about the older adult's experience of home. The aim of this study was to understand the experience of home as experienced by older adults living in a rural community in Sweden.

Methods

Hermeneutical interpretation, as developed by von Post and Eriksson and based on Gadamer's philosophical hermeneutics, was used to interpret interviews with six older adults. The interpretation included a self examination of the researcher's experiences and prejudices and proceeded through several readings which integrated the text with the reader, allowed new questions to emerge, fused the horizons, summarized main and sub-themes and allowed a new understanding to emerge.

Results

Two main and six sub-themes emerged. Home was experienced as the place the older adult could not imagine living without but also as the place one might be forced to leave. The older adult's thoughts vacillated between the well known present and all its comforts and the unknown future with all its questions and fears, including the underlying threat of loosing one's home.

Conclusions

Home has become so integral to life itself and such an intimate part of the older adult's being that when older adults lose their home, they also loose the place closest to their heart, the place where they are at home and can maintain their identity, integrity and way of living. Additional effort needs to be made to understand the older adult's experience of home within home health care in order to minimize intrusion and maximize care. There is a need to more fully explore the older adult's experience with health care providers in the home and its impact on the older adult's sense of "being at home" and their health and overall well-being.

Older persons' navigation through the service system towards home modification resources

Home modifications are part of the occupational therapy interventions provided to persons with functional limitations in the home environment. Home modification services often involve many different actors, and persons experiencing a need for home modifications have to navigate through a network of service organizations and professional actors. The aim of this study was to explore and describe how older adults in one Swedish municipality tried to find their way and navigate through the service system in order to receive home modification services that could meet their experienced needs. A case study design was used, including four older adults with different experiences and expectations of home modification services. The relationship between the participants' expectations, experiences, and their ways to navigate through the service system was described through the metaphor of a "geographical map". Satisfaction with the service process was found when there was a match in understandings of responsibilities and eligibility between what could be read from the older persons' map and the professionals' perspective. The findings have implications for client-centred occupational therapy practice, indicating that this match can be achieved when professionals translate clients' experienced problems in everyday life into a terminology that fits into the service system.

The Home and Caregiving: Rethinking Space and its Meaning

Occupational therapists are routinely engaged in the homes of their clients with disabilities, providing consultation on the use and modification of space to improve functional independence. The meaning of home space is currently underexplored. This study describes the meaning and use of home space for mothers who are primary caregivers for a child or adolescent with disabilities and high support needs. This article reports data from two empirical studies of mothers of children and adolescents with disabilities. In-depth interviews were conducted with 80 mothers across the two studies. Interview transcripts were analyzed with a grounded theory approach. Access around the home for a family member with disabilities allowed mothers to combine caring with other home management activities. However, preventing access or excluding the family member with a disability from some areas of the home enabled the mothers to resist the medicalization of their homes and create a personal space for themselves. Full access to the home for the child with disabilities was rarely a desirable outcome. Decisions about the home and how it should be modified to improve function become more complex when the needs of family members are taken into account. Meaning ascribed to space within the home is integral to how the space is used and whether a family member with a disability is included or excluded from the space. For occupational therapists, the meaning that clients and their families ascribe to various spaces within the home is as important as the use of space.

Moving into Housing: Experiences of Developing Specialist Occupational Therapy Posts in Local Authority Housing Departments

The pathways for the delivery of adaptations to the homes of people with disabilities are complex, incorporating social care expertise together with funding and building experience from housing professionals. Integrating the housing and social care departments does not necessarily lead to smoother working. A number of authorities have taken the option of moving or seconding occupational therapists from social care into housing to have better coordination of the delivery of adaptations and improvement of working practice between the disparate professionals involved.

This qualitative study aimed to explore, through semi-structured interviews, the experiences of nine occupational therapists establishing and developing these new posts. Background information about the establishment of these posts was collated. The thematic analysis of data by two researchers taking an interpretive phenomenological perspective identified five themes: practitioner freedom versus isolation, strategic versus operational roles, professional cultural differences, learning and development, and evaluation and aspiration.

For managers founding such posts and for practitioners moving into them, the findings of this study offer insights into what helped and hindered these practitioners, what surprised them and how their development needs were identified, which informed their intentions for the future of their posts.

Does using a hospital bed have an impact on the meaning of home?

During the end of life care of patients with cancer, hospital beds are often introduced into the home setting. The impact of this intervention is not known. Clinical experience of the phenomena indicates that two components may be relevant in this scenario - the preference for home care and the meaning of home. A review of related literature revealed that there is a high preference for being at home at the end of life and that 'home' has multiple meanings for people such as familiarity, control and biography. The meaning of home has implications for community nursing practice.

Carers' Perspectives on their Needs and Local Authority Occupational Therapy Practice

Unpaid family carers are the main providers of care for older people in the community. Local authority occupational therapists are required by law to assess the needs of such carers in their work, targeting their interventions to support carers' roles. This small qualitative study identified the perceived needs of nine family carers of adults with physical disabilities in one English county, exploring the extent to which these needs were met by local authority occupational therapists.

Data were collected from semi-structured qualitative interviews with nine family carers. These interviews were transcribed verbatim and analysed using elements of grounded theory methodology. Six varied categories of carers' needs emerged.

Occupational therapists met the participants' needs for practical assistance and information, but not for respite or financial assistance. Regarding support network issues, the participants reported poorly integrated community services and little initial awareness of occupational therapy. Once seen by an occupational therapist, however, they wished to remain ‘on file’ to gain instant access to a valued source of support. The recommendations made include the generation of family carer targeted occupational therapy information resources, ongoing therapist liaison to raise general practitioners' familiarity with local service provision and additional research.