Consumer empowerment through occupational therapy: the Americans With Disabilities Act Title III

Developing Client Self-Advocacy in Occupational Therapy: Are We Practicing What We Preach?

Background

Developing client self-advocacy is in occupational therapy's (OT) scope of practice; however, there is limited understanding of if, or how, occupational therapists learn about self-advocacy interventions as well as implement self-advocacy into clinical practice.

Objective

This study sought to identify if and how therapists learn about self-advocacy intervention approaches and identify if and how therapists implement self-advocacy into their work with clients.

Method

A survey was distributed via email to academic and professional listservs in the United States, and data were collected using REDCap survey software. Descriptive statistics were analyzed data using REDCap/SPSS. Comparative statistics, Kruskal-Wallis's tests, Chi-square tests for independence, and Pearson's correlation tests analyzed differences across groups of respondents.

Results

Practicing and licensed occupational therapists (n = 138) across the United States completed the survey. Findings indicate a majority (59.5%) of occupational therapists not learning strategies for addressing or developing client self-advocacy. Of significance, 21.7% of participants had never been exposed to concepts of client self-advocacy in academic or clinical education. Practitioners who did address self-advocacy did so indirectly through teaching-related skills (76.6%).

Conclusion

Many clients of OT will need self-advocacy skills in order to address issues of exclusion and discrimination that prohibit full participation in society. Occupational therapists must prioritize incorporating client self-advocacy into curricula and clinical practice.

Inclusive Environments: Home, Work, Public Spaces, Technology, and Specialty Environments within Occupational Therapy Practice

This position statement describes the role and importance of occupational therapy practitioners in integrating inclusive environments into their professional services and into their underlying science. Primary documents that define the occupational therapy profession clearly support its role in creating and ensuring inclusive environments.

Occupational performance coaching: goal barriers and beneficial facilitators

Background/aims

Occupational performance coaching is a family-centred approach that helps mothers who have children with occupational performance challenges. This study sought to identify the barriers and facilitators to goal achievement and engagement with occupational performance coaching based on the experiences of mothers of children with cerebral palsy who were receiving occupational performance coaching.

Methods

This qualitative study was embedded within a randomised control trial. Twelve mothers of children with cerebral palsy who had received occupational performance coaching were interviewed using a semi-structured interview technique. Their responses were analysed using inductive content analysis.

Results

The most important barriers to goal achievement and engagement with coaching were societal, family-related and mother-related factors. The facilitators were new resources, family cohesion, mother-related factors and child-related factors.

Conclusions

Different factors can affect the outcomes of occupational performance coaching based on the viewpoint of mothers of children with cerebral palsy. Occupational therapists should consider societal, family and individual factors when using this intervention with clients.

Empowerment and Participatory Evaluation of a Community Health Intervention: Implications for Occupational Therapy

Community-based organizations have experienced an increased demand for new and expanded programs, as well as pressure from private and public sources of funding to document the impact of their services and programs. This article highlights the importance of a participatory and empowerment approach to evaluating a community health intervention. A five-phase approach to implementing an empowerment and participatory evaluation process is described using a research study. The five phases included developing a partnership and planning the evaluation, developing a logic model, identifying the methodology and data collection, interpreting and reporting findings, and monitoring and utilizing evaluation findings. In this research study, a WebTV community intervention was implemented to assist community residents in accessing health information and resources through the project's home web page and the Internet. A group of citizen leaders was provided with a WebTV unit, training, and ongoing support and assistance. Citizen leaders used the unit as a tool to obtain health information and resources and to advocate and support community action. Implications of empowerment and participatory evaluation of this type of community intervention are discussed for community occupational therapy, including occupational therapists as agents of change and facilitators of skills building and organizational capacity.

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.

A model of occupational empowerment for marginalized populations in community environments

Globally there are individuals who are marginalized from mainstream society due to problems such as physical or psychological impairment, poor socio-economic circumstances, and occupational deprivation. Many develop learned helplessness syndrome, rendering them unable to control their lives and their destinies. This paper proposes a Model of Occupational Empowerment for providing services to these community populations. The model, a grounded theory, emerged from our work at a homeless shelter for women and children. Disempowering environments in the past had caused learned helplessness in the women at the shelter. Occupational engagement was used to empower them. We contend that the model may be used to guide occupational therapy practice with marginalized individuals and families in a number of community environments.

Predicting barriers to primary care for patients with disabilities: a mixed methods study of practice administrators

BACKGROUND

People with disabilities continue to be identified as a group who experience disparate health/health care. They are less likely to engage in some health care services. Structural barriers are often identified as one of the reasons for the underutilization of some health care services by people with disabilities. However, to date no study has been conducted to understand why structural barriers persist twenty years after the Americans with Disabilities Act (ADA) became law.

OBJECTIVES

We examined the relationship between primary care practice administrators' knowledge of the ADA and the number of accessibility barriers that patients with mobility disabilities might encounter.

METHODS

Primary care practice administrators who were members of a medical management organization were surveyed between December 20, 2011, and January 17, 2012. A mixed methods research design was employed. Data were analyzed using a Guttman scale, linear and multiple linear regression.

RESULTS

ADA knowledge questions conformed to a valid Guttman scale. There was a significant inverse relationship between practice administrators' knowledge of the ADA and the number of barriers reported in their clinics. Age of the administrators and buildings built before 1993 were also significant predictors of the number of barriers.

CONCLUSION

This study helps to identify medical practices that are more likely to have access barriers and have the greatest need for ADA compliance interventions. Results from this study highlight practice administrators' need for specific knowledge of the ADA as it applies to their medical practice. Efforts are needed to improve disability training for health professionals.