Participatory Research with Persons who Experience Mental Illness in Occupational Therapy: A Scoping Review

Background. Persons who experience mental illness also face stigma and discrimination that frequently lead to a loss of ability to exercise autonomy and agency in their lives. Purpose. The range and breadth of literature exploring participatory research with persons living with mental illness are unknown in occupational therapy and occupation science. We initiated this study to fill this gap in the existing occupational therapy and occupational science literature. Method. Using the method of Arksey and O'Malley, we have conducted a scoping review to identify the range and breadth of literature. A qualitative content analysis was performed. Findings. A total of 34 articles were included in the narrative synthesis. The content analysis led to three related themes from the included studies: (1) coming together; (2) unique potential of participatory research; and (3) challenges in conducting participatory research. Conclusions. This review highlights that participatory research is well suited to research conducted with persons living with mental illness to support meaningful engagement and minimize stigma throughout the research process. This review can guide future participatory research and practice in occupational therapy and occupational science with persons living with mental illness.

Understanding How Newly Implemented Rehabilitation Best Practices Are Sustained: A Realist Review

OBJECTIVE

We conducted a realist review to understand how (mechanism) and in what circumstances (context) evidence-based practices are sustained in rehabilitation (outcome).

DATA SOURCES

MEDLINE, Embase, reference lists, and targeted websites.

STUDY SELECTION

Two independent reviewers calibrated study selection; then 1 reviewer screened all titles and abstracts, while the second reviewer screened a random 20%. We repeated this process for full texts. We included 115 documents representing 61 implementation projects (8.9% of identified documents). Included documents described implementation projects in which physical therapists, occupational therapists, and/or speech-language pathologists were the target users of an evidence-based practice.

DATA EXTRACTION

Two reviewers repeated the independent process described in study selection to extract basic study and sustainability characteristics as well as context, mechanism, outcome, and strategy text.

DATA SYNTHESIS

Using basic numerical analyses, we found that only 54% of evidence-based practices in rehabilitation are sustained. Furthermore, while authors who reported sustainability planning sustained the practice 94% of the time, sustainability planning in rehabilitation is rare (only reported 26% of the time). Extracted text was synthesized using the realist technique of inductive and deductive retroduction in which context, mechanism, outcome, and strategy text are combined into narrative explanations of how sustainability works. To inform these explanations, we applied normalization process theory and the theory of planned behavior. Collectively, the 52 identified narratives provide evidence for 3 patterns: (1) implementation and sustainability phases are interconnected, (2) continued use of the evidence-based practice can be interpreted as the ultimate sustainability outcome, and (3) intermediate sustainability outcomes (ie, fit/alignment, financial support, benefits, expertise) can become contextual features influencing other sustainability outcomes.

CONCLUSIONS

Implementation teams can use the narrative explanations generated in this review to optimize sustainability planning. This can sustain practice changes and improve quality of care and patient outcomes. Future research should seek to iteratively refine the proposed narrative explanations.

Evaluating the use of the Model of Human Occupation Screening Tool in mental health services

Introduction

While the Model of Human Occupation Screening Tool has undergone psychometric development and testing and is widely used in mental health practice, only a few small-scale studies to date have examined its use in clinical practice.

Method

A national survey was conducted with United Kingdom occupational therapists working in mental health settings to evaluate the use of the Model of Human Occupation Screening Tool. The survey included the modified version of the Usefulness, Satisfaction, and Ease of Use (USE) questionnaire and two open-ended questions. The latter were coded through inductive content analysis and all responses were analysed using Statistical Package for the Social Sciences software.

Results

n=105 questionnaires were analysed. The Model of Human Occupation Screening Tool was found to be a useful tool, with most therapists scoring it favourably on the usefulness (74.7%), ease of use (76.1%), ease of learning (81.2%) and satisfaction (80.6%) subscales. It was praised as a valuable outcome measure, guiding interventions and providing a comprehensive overview of assessed individuals. Time consumption, inaccessible terminology and lack of sensitivity to change were indicated as possible downfalls.

Conclusion

Therapists valued the Model of Human Occupation Screening Tool as an assessment tool, but more importance should be placed on training to overcome some of the limitations identified here. Also, its suitability to the setting in which it is used should be considered before implementation in practice.

A Community of Practice of primary health care occupational therapists: Advancing practice-based knowledge

INTRODUCTION

New contexts of practice demand that professionals engage in critical reflection to handle new situations and to create new knowledge that is responsive to professional practices situated in unique historical and social contexts. Community of Practice offers a framework for professions to reflect together on practice dilemmas and to generate practical solutions.

METHODS

This paper presents a participatory action research project that traces the trajectory of a Community of Practice made up of seven occupational therapists working in primary health care and a researcher team, in Brazil. This study mapped the Community of Practice's trajectory between 2013 and 2017 through a group timeline analysis, which occurred gradually, in a collaborative mode.

RESULTS

Three distinct phases in the trajectory of the development of the Community of Practice were identified: narrative perspectives were utilised as a means to identify dilemmas and difficulties in practice; the investigation of clients' needs and identification of issues was an ongoing process; and the generation of practice-based knowledge through the development of instruments to sustain clinical reasoning was a creative solution to practical dilemmas.

CONCLUSION

Three main aspects were highlighted: the partnership between researchers and practitioners as a potential avenue for the production of knowledge relevant to professional practice; the negotiation of the dilemma of "putting practice into words" in the context of constantly changing local and global perspectives; and the investigation of situated practice as an important element that can strengthen, strain, resist or even modify hegemonic perspectives of knowledge production in our field.

Systematic review of determinants influencing knowledge implementation in occupational therapy

INTRODUCTION

In knowledge translation, implementation strategies are more effective in fostering practice change. When using these strategies, however, many determinants, such as individual or organisational factors, influence implementation. Currently, there is a lack of synthesis concerning how these determinants influence knowledge implementation (KI). The aim of this systematic review was to document how determinants influence KI outcomes with occupational therapists.

METHOD

Following the PRISMA statement, we systematically reviewed the literature on KI in occupational therapy across 12 databases: MEDLINE, Embase, CINAHL, AMED, PsychINFO, Cochrane Library, FirstSearch, Web of Science, ProQuest Dissertations & Theses, ERIC, Education Source and Sociological Abstracts. Eligible studies reported KI strategies specifically with occupational therapists. Selected studies were appraised for quality with the Mixed Methods Appraisal Tool. Using the Consolidated Framework for Implementation Research (CFIR), we categorised reported mentions of CFIR (sub-)constructs to identify the determinants studied most often, how they were documented and what influence they had on outcomes.

RESULTS

Twenty-two studies were analysed for this review. CFIR (sub-)constructs were mentioned 81 times, and seven (sub-)constructs received at least 5% of these mentions (4/81). These were as follows: (i) Adaptability of the practice; (ii) Learning climate; (iii) Leadership engagement; (iv) Available resources; (v) Knowledge and Beliefs about the Intervention; (vi) Individual Stage of Change; and vii) Executing the KI strategy. The Inner setting domain was the most documented and the domain with the most (sub-)constructs with at least four mentions (3/7). Most studies used questionnaires as assessment tools, but these were mainly non-standardised scales. The data were too heterogenous to perform a meta-analysis.

CONCLUSION

Seven (sub-)constructs mentioned most often would benefit from being assessed for salience by researchers intending to develop a KI strategy for occupational therapists. Future research aimed at improving our understanding of KI should also consider using standardised tools to measure the influence of determinants.

COMUNIDADE DE PRÁTICA E CUIDADO EM SAÚDE MENTAL: UMA REVISÃO SISTEMÁTICA

Resumo O cuidado em saúde mental é dependente de recursos humanos qualificados para responder dinamicamente às necessidades dos usuários dos serviços. A qualificação desse cuidado pela reflexão sobre os processos de trabalho é essencial para a efetivação da mudança para uma perspectiva comunitária e biopsicossocial. A comunidade de prática é um referencial teórico-metodológico que fomenta a aprendizagem colaborativa por meio do engajamento mútuo em projeto comum e da negociação de significados. A pesquisa teve por objetivo sistematizar a utilização da comunidade de prática para melhoria do cuidado em saúde mental via revisão sistemática no Portal de Periódicos da Capes e na Biblioteca Virtual em Saúde, em março de 2015. De 19 artigos encontrados, nove foram selecionados para análise. Os estudos avaliaram positivamente a comunidade de prática para melhorar os serviços oferecidos à população, oferecer capacitação com especialistas e implementar novos métodos de trabalho. Destacaram-se fragilidades (recursos financeiros, desalinhamento inicial entre os participantes, conflitos grupais) e potencialidades (engajamento real dos participantes; participação virtual; acesso a especialistas; integração de profissionais, usuários e familiares num único projeto; necessidades formativas em contexto). Espera-se elucidar possibilidades para a criação de estratégias formativas e investigativas para educação permanente em saúde mental.

The development of a theory-informed workbook as an additional support for students on role-emerging placements

Introduction

During role-emerging placements students require different support as occupational therapy specific supervision is provided periodically and they cannot model their practice on experienced occupational therapists. This paper describes the development and evaluation of a workbook designed to reinforce the integration of theory with practice and provide an additional resource to support students when a supervisor was not present.

Method

A social constructionist perspective and action research methodology were used. Participants were 14 final year occupational therapy students and three off-site occupational therapy supervisors. All participants were involved in role-emerging placements in school settings in England. In-depth, semi-structured interviews across four action research cycles informed the development and evaluation of the workbook.

Findings

While the workbook originally focused on supplementing students’ knowledge of occupational therapy theory, during the action research cycles the focus shifted to consider how educational theory informed workbook design and content. Key features and critical aspects which supported students’ learning were identified.

Conclusion

The workbook was received positively by students and supervisors. Aspects which were particularly valued included the provision of examples and scenarios which contextualised theory within the placement setting. The workbook was proposed to have scope for use in placements beyond school-based practice.

A debate on the professional identity of occupational therapists

Introduction

The issue of occupational therapy’s professional identity has been debated for many years and continues today. Lack of clarity has resulted in occupational therapists’ perceptions of holding a low status and of colleague and public misunderstanding.

Method

A range of international literature was reviewed. Inductive analysis elicited two major themes – reasons for issues with identity and the consequences of issues with identity. The development of communities of practice is discussed.

Results

The analysis of the causes and consequences of issues with professional identity was used to suggest how the profession might become a mature community of practice. Lack of deep knowledge of the profession’s unique beliefs was shown to cause inconsistent messages about its identity. Consequently, practitioners believed they were undervalued. Understanding, owning and reinforcing an occupational paradigm were seen as vital elements for creating professional communities of practice.

Conclusion

To function as a community of practice requires occupational therapists to use a range of strategies that reinforce their unique occupation-based practice. Where all members commit to a single set of values and beliefs this can afford a unique identity, reinforced by the ability to demonstrate and articulate this through a clear, single message.

Research priorities in mental health occupational therapy: A study of clinician perspectives

BACKGROUND/AIM

The evidence to support mental health occupational therapy has proliferated in the early years of this century, but this growth has tended to be organic rather than targeted. Previous efforts to identify research priorities in this area of practice are either out dated, or encompass discrete areas of practice. The aim of this study was to identify priority areas for research in mental health occupational therapy from clinician's perspectives.

METHODS

A Policy Delphi method was used to enable occupational therapists to define and differentiate their perspectives on research priorities. Forty-two occupational therapists took part in the first two rounds of this method, with 69% (n = 29) going on to complete the third and final round of data collection. A Likert scale was used to rate the importance of each priority, and descriptive quantitative analysis undertaken to identify those most consistently identified as being highly important.

RESULTS

Four research priorities were identified as being highly important in this study: (i) working in an occupationally focussed way; (ii) consumer experience of therapy groups; (iii) identifying factors which increase consumer engagement in occupation; and (iv) engaging patients on the inpatient unit in meaningful and positive occupation.

CONCLUSIONS

Two of the priority areas are already the subject of substantial evidence bases, but there has been far less research into consumer experiences of groups and occupational engagement in acute settings. Collaboration between research teams and greater consumer inclusion are recommended for the future.

SIGNIFICANCE OF THE STUDY

This study provides an updated indication of research priorities for mental health occupational therapy in Australia.

A process for developing sustainable evidence-based occupational therapy practice

OBJECTIVE

The purpose of this qualitative descriptive study was to describe how long-term improvement work based on the Occupational Therapy Intervention Process Model (OTIPM) evolved in an occupational therapy unit.

METHOD

Data included written documents related to the improvement work (435 pages in total) from 2001 to 2013 that were analysed using pattern matching.

RESULTS

The findings from the analysis of the documents formed three main patterns describing reorientation towards the OTIPM, establishment of the implementation of the OTIPM, and ensuring the sustainability of the implementation. Each pattern contained a number of phases of the improvement work emanating from different reasons and resulting in different long-term achievements. The transformation between the phases was smooth, and several of the phases became starting points for improvement work that continued throughout the years.

CONCLUSION

The findings showed how an occupational therapy model of practice, such as the OTIPM, can guide an improvement process and keep it going over a long period of time, thereby supporting sustainable improvements in practice.

Evidence-based practice supports among Canadian occupational therapists

Background.

Supports for evidence-based practice (EBP) and research utilization are needed for moving evidence into practice.

Purpose.

The purpose of this study was to identify the presence of individual and organizational EBP supports (based on a previous scoping review) and the attitudes toward the supports in a convenience sample of Canadian occupational therapists.

Method.

A cross-sectional survey was used to collect data from members of the Canadian Association of Occupational Therapists.

Findings.

Data from 368 clinicians (21%) indicated that although factors that have been shown to support EBP, such as student supervision and participation in research and mentoring, were not common practice, attitudes toward these EBP supports were positive.

Implications.

EBP supports, although viewed favourably by clinicians, have yet to be integrated fully into clinical practice. These findings provide researchers with an opportunity to design studies to support clinicians who view EBP in a positive light in integrating evidence into their practice.

Research utilization and evidence-based practice in occupational therapy: a scoping study

Many articles have been written on the barriers to and facilitators of the use of evidence in practice in nursing and medicine, but to date no extensive review has been published of the literature on evidence-based practice (EBP) supports in occupational therapy. This article presents the results of a scoping review that examined factors that support the integration of research into practice. A review of 69 articles revealed four themes: (1) attitudes toward, perceptions of, confidence in, and use of research and EBP; (2) factors that support the use of research in practice; (3) effects of interventions targeting changes in knowledge, attitudes, skills, behaviors, and evidence-based practices; and (4) identification of the processes involved in the acquisition of EBP skills and their application in clinical practice. A process that integrates client-centered practice, structured reflection, case application, and peer consultations within a scholarship of practice model facilitates occupational therapists' evaluation and integration of research evidence.

The Elizabeth Casson Memorial Lecture 2013: Transformational Leadership in Occupational Therapy — Delivering Change through Conversations

The Elizabeth Casson Memorial Lecture 2013, given on 19 July at the 37th Annual Conference and Exhibition of the College of Occupational Therapists, held at the Scottish Exhibition and Conference Centre, Glasgow, Scotland.

Advancing the use of theory in occupational therapy: A collaborative process / Promouvoir l’application de la théorie en ergothérapie : un processus de collaboration

Background.

Theory is important to the growth and evolution of occupational therapy. However, use of theory remains challenging for many therapists.

Purpose.

The aim was to develop a process that occupational therapists could apply to advance theory in practice.

Method.

Based on a review of the literature and using a qualitative instrumental case study design, 18 student occupational therapists and eight fieldwork educators completed online modules on the theory advancement concepts generated from the literature, wrote journals, and/or participated in online discussions during fieldwork. Following fieldwork, educators were interviewed and students participated in focus groups exploring their experiences. Directed content analysis was used to analyze the data.

Findings.

Based on the data collected, we developed the Theory Advancement Process (TAP). The TAP is composed of four primary contexts, a climate of collaborative relationships with four key elements, and four essential processes.

Implications.

The TAP presents a collaborative process for students, faculty, and therapists to work together to advance the use of theory in practice.

The Usefulness of the Person-Environment-Occupation Model in an Acute Physical Health Care Setting

Background:

Limited evidence is available to illustrate the use of theory to underpin occupational therapy practice in acute physical health care settings in the United Kingdom.

Method:

A generic qualitative method investigated the views, knowledge and perceptions of seven Scottish occupational therapists about the potential usefulness of the Person-Environment-Occupation Model (PEO Model) in acute care. This convenience sample participated in two focus groups: the first to examine and understand the PEO Model and the second to explore further reflections of the strengths and limitations of its use in practice.

Findings:

The PEO Model has the potential to provide a meaningful framework in which to conceptualise patients in an acute physical health care setting.

Conclusion:

The PEO Model offers flexibility regarding the extent to which occupational performance is addressed, in a setting characterised by short hospital admission stays. Also, a range of occupation-focused models was valued to practise effectively in this setting.

Determining the Clinical Utility of the Short Child Occupational Profile (SCOPE)

Objective:

The purpose of this study was to propose a process for the study of clinical utility and to illustrate its implementation in the development of an assessment.

Method:

A mixed methods approach was used to understand the clinical utility of an assessment in development. An exploratory qualitative/quantitative (QUAL?QUANT) approach was used to identify perspectives of the clinical utility of the assessment. The design placed equal status on the two methods used: focus groups and surveys.

Results:

The proposed process for the study of clinical utility resulted in targeted revisions based upon data obtained from 21 practitioners in three focus groups during a systemised examination of clinical utility.

Conclusion:

A mixed methods process can be used to ensure the clinical utility of assessments during the development process.

Practice development efforts impact on mental health rehabilitation: results-based health care implications

Aim: The central aim of this study was to measure the extent of utilization of the Model of Human Occupation (MOHO) according to an existing conceptual framework ( Melton et al, 2010 ) and to examine whether professional development efforts aimed to support the use of this model were associated with a higher degree of incorporation of this model into everyday practice. 4secondary aim was to determine whether certain pre-identified contextual and personal variables influenced the use of MOHO in everyday mental health practice.

Methods: The authors solicited participation from 429 occupational therapy practitioners from six NHS mental health trusts in England using an online survey method and 262 (61.1%) responded.

Findings: A vast majority (92.1%) of the respondents indicated that they used MOHO as a primary treatment approach. Moreover, therapist participation in professional development efforts aimed to increase MOHO use were associated with higher levels of MOHO use, and the extent of MOHO use was associated with positive client (r=0.33, P<0.01), and professional outcomes (r=0.31, P<0.01 and r=0.33, P<0.01). Characteristics of the immediate team context and personal characteristics were linked to the extent of MOHO use among practitioners (r=0.30, P<0.01). Similarly, causal mechanisms that involve MOHO use in building confidence, finding flow, constructing know-how, accumulating reward, conferring with others, and channeling time were also linked with the extent of MOHO use among practitioners (r=0.55, P<0.01).

Conclusion: Findings suggest that there may be a significant payoff for professional development efforts that aim to support client-centered, occupation-focused approaches to mental health rehabilitation practice.

Experiences of Occupational Therapists and Occupational Therapy Students in Using the Assessment of Communication and Interaction Skills in Mental Health Settings in Norway

Introduction:

This study investigated the utility of the Assessment of Communication and Interaction Skills (ACIS) in mental health settings, as experienced by Norwegian occupational therapists and occupational therapy students.

Method:

An informal draft translation was used to investigate the appropriateness of the assessment for mental health practice. Focus group interviews were conducted with three occupational therapy practice educators working in mental health settings and six occupational therapy students on practice placement, who used the ACIS during an 8-week mental health practice placement in 2009. The focus groups aimed to explore the experiences of using the translated ACIS in working with clients.

Findings:

Three main themes emerged: observing with the ACIS, scoring the ACIS and using the ACIS in clinical practice.

Conclusion:

The ACIS has the potential for making a positive contribution, both for the individual client and for the larger team of multi professional staff, by giving a structure and terminology that supports precise observation and reporting. Questions were raised as to how the therapist's level of engagement during the observation may have an impact upon the client's performance. The process of scoring and giving feedback concerning the client's skills may be emotionally challenging for therapists, students and clients, and issues about how to give feedback to clients require consideration.

Enhancing Professional Reasoning through the Use of Evidence-Based Assessments, Robust Case Formulations and Measurable Goals

The value of therapists documenting their clinical reasoning and negotiating specific and measurable goals is widely acknowledged. However, the literature suggests that practitioners often encounter barriers when implementing best practice.

This article details how occupational therapists in Derbyshire Healthcare NHS Foundation Trust entered an academic partnership, which transformed their communication of clinical and professional reasoning. Having adopted a conceptual model of practice, they established clearly defined processes for assessment, case formulation and goal setting. Service users, carers and team members confirmed that these initiatives enhanced person-centred practice, highlighted occupational issues and made treatment planning more effective for the whole team.

Training Novices to Make Expert, Occupationally Focused, Community Mental Health Referral Decisions

Introduction:

Currently, British health policy requires services to be prioritised according to an individual's level of need. This is particularly necessary for community mental health services, where referral demand far exceeds service availability.

Purpose:

The purpose of this study was to use expert occupational therapists' referral prioritisation policies, derived from judgement analysis, to train novices in the skill of referral prioritisation.

Method:

The therapists' policies chosen were those that supported the occupationally focused practice advocated by the profession. Thirty-seven pre-registration students were asked to prioritise a set of referrals, before and after being trained with graphical and descriptive representations of these experts' policies.

Findings:

Pre-training, the students overvalued the client's history of violence and undervalued the reason for referral and the client's diagnosis, as compared with the experts. Post-training, the students' policies were better matched to those of the experts. The effect of training was demonstrated through several measures: more accurate prioritisation scores when matched with expert ratings on the same referrals, improved consistency on repeat referrals and higher group agreement.

Conclusion:

Decision training may be useful in promoting the type of service that aims to target clients' occupational needs in the field of community mental health.

An Exploratory Study of the Occupation-Focused Models Included in Occupational Therapy Professional Education Programmes

Introduction:

Occupation-focused models are one method of integrating occupation into occupational therapy education programmes. They offer a theoretical basis for practice by providing explanations about the process and practice of the profession.

Method:

This exploratory study used a quantitative research framework to investigate which occupation-focused models are included in occupational therapy programmes, the rationale for their inclusion and how the models are integrated into curricula. A survey was sent to 193 occupational therapy programmes in Australia, Canada, the United Kingdom and the United States.

Results:

The response rate was 33.8% (n = 65). The data showed that each programme included between 3 and 10 occupation-focused models. The Canadian Model of Occupational Performance and Engagement and the Model of Human Occupation were included in 98.5% of all curricula surveyed.

Conclusion:

The educators used a multilayered decision-making process to determine which occupation-focused models to include in a curriculum. The instructional methods varied, but most programmes used practice placement education as a teaching strategy. Further research is required into how curriculum design influences a practitioner's future use of occupation-focused models in practice. A better understanding is needed of how professional practice education affects students' values and attitudes towards the use of occupation-focused models.