Healthcare Education: Can Literary Narratives Address Occupational Therapy's 'Incongruence' in Values?

Occupational therapy may be facing an incongruence in values. A growing body of literature, based on occupational therapy documentation and the perspectives of clients, suggests the profession is more focused on productivity and institutional demands than the individualized needs of clients. A proposed solution in occupational therapy education is the critical reading of literary narratives with qualities of complex characters, sensory evoking language, and the subjective truths of the individual experience. This is proposed because empathy has been shown to improve client outcomes and the reading of literary narratives has been shown to improve levels of empathy. Instruction through literary narratives, versus medicalized case studies or videos, may help occupational therapists practice with consilience, regain what is threatened, and provide more impactful and empathic-centered care.

Barriers and facilitators of assistive technology service delivery process (AT-SDP) in South Korea

PURPOSE

To describe the barriers and facilitators of the assistive technology service delivery process (AT-SDP), based on the perspectives of assistive technology service professionals (ATPs) and assistive technology (AT) service users.

METHODS

We conducted semi-structured interviews with nine AT users and eight ATPs in South Korea. The data were analyzed using a constant comparative approach based on the grounded theory.

RESULTS

AT users and ATPs identified common barriers in the assessment, matching, and implementation of the AT-SDP. In the assessment process, the preparation of detailed selection criteria was suggested for assistive technology devices (ATDs). Insufficient linkages on assessments among institutions providing AT services was a reported barrier, and standardized evaluation tools were suggested to address this issue. In the matching process, to meet users' needs, versatility in the characteristics or type of ATD was highlighted. In the implementation process, participants emphasized the need to shorten the time required during the delivery process. Along with these facilitators, institutional support, including staffing securement, the establishment of AT centres, and funding policies were recommended to facilitate the AT-SDP.

CONCLUSIONS

Our results highlight the importance of government support and considering realistic funding levels to overcome the barriers reported by AT users and ATPs.

A call to resist occupational therapy's promotion of ableism

BACKGROUND

Critical occupational therapists have exhorted their profession to engage with disability studies' scholarship, curtail occupational therapy's promotion of ableism and amend its disabling practices. These appeals have largely been ignored despite their importance for a profession that researches, theorizes, assesses, and intervenes in the lives of disabled people.

AIMS AND OBJECTIVES

To interrogate occupational therapy's collusion with an ableist neoliberal agenda; and call for occupational therapists to resist their profession's disabling practices.

MATERIAL AND METHODS

This paper draws from critical disability scholarship to expose, critique and contest the ableist ideology underpinning occupational therapy.

RESULTS

Interlinked with racism, heteronormativity and gender binarism, ableism upholds certain bodies as normal and appropriate. Ableist values shape occupational therapy, with clients classified according to their proximity to 'normality', and exhorted to minimize their occupational performance deviations from dominant norms.

CONCLUSIONS

Collusion with colonialism's binary classificatory systems and neoliberal ableist norms, and avowed aspirations to improve bodies, 'normalize' performances, promote individualism, self-reliance, independence, self-care, and productivity contribute to the perception that ours is a disabling profession.

SIGNIFICANCE

This paper calls for occupational therapists to resist their profession's promotion of ableism, and refuse to collude with colonial practices that contribute to the oppression of disabled people.

Mobility Tool Use Relates to Disability Affirmation among Adults with Visual Impairments

Introduction: Research is beginning to support the association between positive disability identity and well-being among individuals with disabilities, including those with visual impairments (i.e., blindness and low vision). To enhance practitioner understanding of how to support individuals with visual impairments, research is needed to examine how disability identity attitudes may vary based on disability characteristics in this population. Methods: Using multiple linear regression, the author examined the association between impairment-related factors and personal disability identity (PDI; i.e., disability affirmation and disability acceptance) and group disability identity (GDI) in a sample of 212 adult U.S. residents with visual impairments. Results: Results of this study indicated that participants who use a mobility tool (cane, dog guide, or both) have higher self-reported disability affirmation ( p = .001)—an identity construct related to feelings of disability pride versus shame—after controlling for age, gender, and impairment-related factors (e.g., severity indicators). The Cohen’s f 2 value for the affirmation model was .15, a medium effect size (Cohen, 1988). The regression on GDI indicated that younger participants, in general, reported higher feelings of connection to the disability community (i.e., higher GDI; p = .001); Cohen’s f 2 was .13, a small effect. The regression on disability acceptance yielded non-significant findings. Discussion: Researchers and practitioners working with adults who have visual impairments should consider the relationship between an individual’s disability affirmation and decision-making regarding mobility tool use and training . Future research should also examine hypotheses regarding the negative association between age and GDI among adults with visual impairments. Implications for practitioners: Practitioners within the field of visual impairment may benefit from a consideration of consumer disability identity, including disability affirmation and disability group affiliation.

Collaborative Relationship-Focused Occupational Therapy: Evolving Lexicon and Practice

BACKGROUND.

Client-centred practice has been part of occupational therapists' identity for several decades. However, therapists have begun to question whether the term obstructs critical relational aspects of therapy.

PURPOSE.

The purpose of this article is to summarize critiques of the use of the term client-centred and propose an expanded descriptor and a fundamental shift in how occupational therapists engage with individuals, families, groups, communities, and populations.

KEY ISSUES.

Three themes summarize critiques of how client-centred practice has been envisioned: (a) the language of client-centred, (b) insufficient appreciation of how the therapist affects the relationship, and (c) inadequate consideration of the relational context of occupation. We propose collaborative relationship-focused practice that has key relational elements of being contextually relevant, nuanced, and safe, and promotes rights-based self-determination.

CONCLUSION.

We argue that these essential relational elements, along with a focus on occupations, are required to promote occupational participation, equity, and justice.

Impact of Occupational Therapy Education on Students' Disability Attitudes: A Longitudinal Study

IMPORTANCE

Discrimination based on disability-ableism-is pervasive and affects the opportunities of people with disabilities to fully engage in society.

OBJECTIVE

The aim of this study was to explore the impact of occupational therapy graduate education on students' explicit and implicit disability attitudes throughout their graduate education.

DESIGN

Longitudinal observational study, measuring occupational therapy students' attitudes on an annual basis.

SETTING

Three Midwestern graduate occupational therapy programs.

PARTICIPANTS

Occupational therapy students (N = 67). Outcomes and Measures: Participants completed the Symbolic Ableism Scale (to measure their explicit disability attitudes) and the Disability Attitude Implicit Association Test (to measure their implicit disability attitudes) on an annual basis, from when they entered their occupational therapy program to when they graduated.

RESULTS

The students' explicit attitudes decreased (i.e., became more favorable) throughout their education; however, their implicit attitudes did not change. In fact, most students (68%) were implicitly ableist at graduation.

CONCLUSIONS AND RELEVANCE

Occupational therapy education programs have an important role to play in terms of intervening with students' beliefs and preconceived assumptions about disability. Our finding suggests that occupational therapy programs may fail to intervene with students' ableist attitudes. What This Article Adds: Little longitudinal research has examined how students' implicit disability bias may be affected by their academic experience. Our findings about ableism among occupational therapy students should open the door for further dialogue on the existence of ableism in program content, its potential impact on future client interactions, and the development of approaches to address it.

Empowering Caregivers of Children With Disabilities in Zambia: A Photovoice Study

IMPORTANCE

Families with a child or children with a disability (CWD) living in low- and middle-income countries (LMICs) are a marginalized population experiencing multiple contextual factors within a social model of disability that contribute to decreased occupational participation.

OBJECTIVE

To understand the advocacy messages that caregivers of CWD, living in an LMIC, wanted their community to learn about CWD.

DESIGN

Photovoice methodology was used with 10 parents of a CWD. Photographs, accompanying narratives, and focus group session transcripts were analyzed using Wang and Burris's (1997) original Photovoice technique.

SETTING

Urban subdistrict of Lusaka, Zambia. A community venue was used for the focus group, and the community photograph exhibition occurred in the subdistrict.

PARTICIPANTS

Ten parents of a CWD living in an urban subdistrict of Zambia who were currently participating in a community-based program, Kusamala+, which addressed stigma in the community and supported parents of children with disabilities through training.

RESULTS

Three themes were revealed: (1) "our children with disabilities should be shown love," (2) "our children with disabilities should be well taken care of," and (3) "our children with disabilities need help because they have different needs."

CONCLUSIONS AND RELEVANCE

The findings indicate that a social disability model lens and participatory action research can be used to reveal occupational injustices that hinder parents' engagement in caregiving for their CWD in a marginalized community. Use of visual methodologies can be a powerful advocacy tool for marginalized populations. What This Article Adds: Our findings suggest that occupational therapists can better understand, and provide services to, families living in marginalized communities by using a social model of disability as a framework for evaluation and service provision. By highlighting issues of occupational injustice, occupational therapists can advocate for and empower communities of people with disabilities who face stigma and discrimination.

COVID-19 and the need for disability conscious medical education, training, and practice

The COVID-19 era exposes what was already a crisis in the medical profession: structural racism, ageism, sexism, classism, and ableism resulting in healthcare disparities for Persons with Disabilities (PWD). Early research highlights these disparities, but we do not yet know the full impact of this pandemic on PWD. Over the last 20 years, many medical schools have attempted to develop disability competency trainings, but discrimination and inequities remain, resulting in a pervasive distrust of medicine by the disability community at large. In this commentary, we suggest that disability competency is insufficient because the healthcare disparities experienced by PWD are not simply a matter of individual biases, but structural and systemic factors requiring a culture shift in the healthcare professions. Recognizing that disability is a form of diversity that is experienced alongside other systemic disadvantages like social class, race, age, sex, gender identity, and geographic location, we explore the transformative potential of disability conscious medical education, training, and practice that draws on insights from intersectional disability justice activism. Disability conscious medicine is a novel approach, which improves upon competency programs by utilizing disability studies and the principles of disability justice to guide us in the critique of norms, traditions, and institutions to more fully promote the respect, beneficence, and justice that patients deserve.

Relationships between occupational therapy students' understandings of disability and disability attitudes

Background: Entering occupational therapy (OT) students have established beliefs, informed by sociocultural backgrounds. Understanding how students define and understand disability, and the relationships these understandings have to disability bias, can guide curriculum design decisions to integrate meso and macro level perspectives of disability into clinical reasoning.Aim/Objective: This study's aim was to explore incoming occupational therapy students' (n = 67) understandings of disability and their attitudes towards it.Material and method: An online survey was used to collect data on students' attitudes and definitions of disability. Mixed research methods were used to analyze students' definitions of disability (content analysis) in relation to disability attitudes (Disability Attitudes Implicit Association Test).Results/Finding: Findings reveal students enter curriculums with vast differences in understandings of people with disabilities and these may provide a basis for and contribute to differences in attitudes of disability.Conclusions: OT students have established beliefs of disability as individualized or more socially constructed and these influence disability biases.Significance: Students' education has considerable influence in shaping attitudes and ways of interacting with people with disability. Understanding students' assumptions as they enter a program is a first step to evaluate how curriculum design may influence development of student clinical reasoning strategies.

Deconstructing hierarchies: Service users as co-teachers in occupational therapy education

BACKGROUND

While occupational therapy currently tends to view itself as operating based on a client-centered, collaborative approach, studies often reflect a gap between rhetoric and practice.

OBJECTIVE

This work presents a new pedagogic standard which moves away from the medical model and toward a collaborative, client-centred approach. It functions to support a practice which embraces the respect for, and partnership with, people receiving services and replaces historic patterns which may strengthen the legitimacy of the professional and sustain clients' dependence.

METHODS

This pedagogy develops a therapeutic dialogue which draws from partnerships created in the classroom, where occupational therapy students engage in courses with a co-teacher service user, and examines how the collaboration with service users contributes to the training of occupational therapy students.

CONCLUSIONS

Students and co-teachers can participate in the challenging experience of integrating theoretical knowledge with lived experience, thereby augmenting the development of a new and inclusive knowledge base.

Understanding advocacy in action: A qualitative study

Introduction

Occupational therapists advocate with/for people with disabilities. In the occupational therapy literature, advocacy is mentioned within the context of specific populations or practice settings and thus there is no consistent way of describing advocacy itself. The objective of this article is to describe advocacy in action for occupational therapists who report engaging in advocacy with/for people with disabilities.

Method

In this hermeneutic phenomenological study, 13 occupational therapists were interviewed about their advocacy experiences. Data analysis was completed using a Gadamerian-based approach.

Findings

Advocacy is complex given that the specific tasks, the third party to whom advocacy is directed and the individual(s) advocating with the therapist vary greatly. Many skills used for advocacy are already part of the therapist’s practice, such as defining the problem, acquiring information, communicating and providing education. In this study, occupational therapists describe advocating as assisting clients who are struggling with access to equipment, services or funding. Also, they advocate by fostering the development of self-advocacy, rather than representing people with disabilities on an ongoing basis.

Conclusion

While these findings provide some insights about how advocacy is currently practiced, a detailed framework is needed to further guide therapists through this complex area of practice.

Setting measurable goals with young people: Qualitative feedback from the Goal Attainment Scale in youth mental health

Introduction

Measuring occupational performance is an essential part of clinical practice; however, there is little research on service user perceptions of measures. The aim of this investigation was to explore the acceptability and utility of one occupational performance outcome measure, Goal Attainment Scaling, with young people (12–25 years old) seeking psychological help.

Method

Semi-structured interviews were conducted with ten young people seeking help from a youth mental health clinic. Interviews were audio taped and a field diary kept. Interviews were transcribed verbatim and analysed using content analysis. Results were verified by member checking.

Results

All participants were able to engage in using Goal Attainment Scaling to set goals for therapy, and reported the process to be useful. The participants identified the physical location and ownership of the scale was important to help motivate them to work on their goals.

Conclusion

Young help-seekers see Goal Attainment Scaling as an acceptable tool to facilitate the establishment of functional goals. Young service users were particularly keen to maintain control over the physical location of completed forms.

A macro perspective for client-centred practice in curricula: Critique and teaching methods

BACKGROUND

Client-centred practice is often eclipsed by social, economic, and political inequities. Ignoring these realities obstructs clients' goal attainment.

OBJECTIVES

The author advocates for the integration of a macro perspective inclusive of participation barriers and supports in occupational therapy curricula and seeks to motivate educators to adopt teaching approaches that develop students' abilities to address the complexities of client-centred practice.

METHOD

This article integrates a critical analysis of the literature on client-centred practice with reflexivity on disability studies and autoethnography.

FINDINGS

Educational standards require students to learn about the social, economic, and political contexts that impact on client-centred practice and the need for advocacy to enable participation. Theoretical support of a macro perspective for client-centred practice is strongly evident in the literature. Information on methods for teaching students how to actualize these concepts in practice is scant. Thus, strategies to inform the integration of a macro perspective into curricula and concrete activities to develop students' competencies for empowered client-centred practice are required.

CONCLUSION

Educators have an ethical responsibility to critique their pedagogy to determine whether they are adequately preparing students for client-centred practice. The focus must move from teaching a micro perspective of client-centred practice to a macro perspective that enables occupational justice and empowerment.

Current thinking in qualitative research: evidence-based practice, moral philosophies, and political struggle

In this introduction to the special issue on current thinking in qualitative research and occupational therapy and science, the authors focus on the importance of rigorous qualitative research to inform occupational therapy practice. The authors chosen for this special issue reflect a "second generation of qualitative researchers" who are critical, theoretically sophisticated, methodologically productive, and politically relevant to show that working with disabled clients is political work. Three themes emerged across the articles included in this special issue: (1) recognizing and addressing social justice issues; (2) learning from clients' experiences; and (3) critically reframing occupational therapy's role. These themes can inform occupational therapy practice, research, and education to reflect a more client-centered and politically engaging approach.

Teaching Participation in Occupations to First Year Occupational Therapy Students: An Action Research Study

Introduction:

This article describes the development of a first year occupational therapy module, ‘Participation in Occupations’, and the design and development of a mediating tool, Contexts of Participation: the Critical Thinking Tool, in a British university.

Method:

Using an action research process, the module content, learning and teaching strategy and new conceptual tools were designed to promote an enhanced understanding of the central importance of occupation to occupational therapy and, in particular, the role of participation in occupations in forming and reforming an individual within unique contextual situations. The inclusion of theory from disability studies and the use of a transformative approach to higher education were also investigated.

Findings and discussion:

The study spans 16 cohorts of students and reflects on the findings, which include increased client-centredness and greater appreciation of the complex nature of participation and its role in health and wellbeing.

Client-centred practice in occupational therapy: critical reflections

AIMS

The occupational therapy profession has long proclaimed its commitment to a client-centred philosophy of practice and the assumption that occupational therapists consistently practice in a client-centred manner has become central to the profession's self-image and public rhetoric. However, client-centred practice has been subjected to little critical reflection within the occupational therapy profession. The aim of this paper is to foster critical reflection concerning the authenticity and veracity of the profession's commitment to client-centred practices.

MAJOR FINDINGS

Client-centred practice is defined without evident reference to clients' perspectives. Few occupational therapy researchers have sought clients' perceptions of the client-centred nature of their occupational therapy services. Occupational therapy research is neither consistently undertaken in a collaborative manner, nor are the profession's theories developed through explicit reference to a diversity of clients' perspectives. Professional practices and service evaluations do not consistently seek clients' viewpoints. Client-centred rhetoric is politically expedient and may be a professionalizing strategy employed to increase status and entrench power.

PRACTICE CONCLUSION

Although exemplary client-centred occupational therapy practices exist, evidence suggests that the profession does not adhere consistently to its espoused client-centred principle in all its practices. The client-centred practice of occupational therapy should be subjected to assiduous critical reflection.

The Affirmative Model of Disability: A Means to Include Disability Orientation in Occupational Therapy?

Disability orientation is a missing concept in occupational therapy. Disability orientation describes a person's interpretation of his or her disability experience and his or her perceptions of the meaning of being disabled. One orientation is that of affirmation, which originates in the affirmative model. This takes a non-tragic view of disability and impairment, and rejects the assumption that disability is necessarily negative. Instead, those with an affirmative orientation view disability as difference that can be celebrated and can enrich life. Since occupational therapists may work with people with an affirmative disability orientation, understanding and acceptance of this orientation could support client-centred practice.

Transformative Occupation in Practice: Changing Media Images and Lives of People with Disabilities

Performers with disabilities in the entertainment industry of Southern California work together as a cohesive force for change, challenging common misconceptions about disability reflected in television and movies. This qualitative study was based on videotaped interviews with a cohort of actors and media activists with physical disabilities working in television and film. Narratives, field notes, and reflexive journal entries were coded, analyzed, and interpreted using qualitative methods. Ethnography and grounded theory approaches were combined, offering a conceptual framework suggesting that, for the participants in this study, performance is a transformative occupation or of such primary importance as to substantially organize their lives. A love of acting appears to inspire the creativity, adaptiveness, and motivation necessary to advance their careers despite significant personal challenges and social barriers inhibiting participation within the industry. This study provides evidence of the potential for occupational engagement to change people's lives while also changing society.

Israeli policy toward veterans with disabilities: a snapshot and insights of the proposed reform

The policy toward Israeli veterans with disabilities is based on the Invalids Law (Benefits and Rehabilitation) of 1949 . This legislation has served as the foundation for an intricate disability policy, providing benefits and psychosocial services for veterans with disabilities. Sixty two years later, in light of the emergence of a new social model and disability rights conceptualization, there is a need to reevaluate the current legislation and policy. In this article the authors present the essence of the current Israeli disability policy and explore the applications of a proposed reform aimed at adapting the disability policy and services to the new principles of the social model of disability.