bluuebunny/crossref_metadata_2025 huggingface dataset:
What Managerial Skills Do Newly Graduated Occupational Therapists Need? A View from Their Managers
Authors: Adamson Barbara J , Cant Rosemary V , Hummell Jill
Published: April 2015

Ninety-four occupational therapy managers, representing a response rate of 59%, completed a questionnaire examining perceptions of the relative importance of various managerial skills for new graduates in occupational therapy. The set of skills perceived to be the most important related to the management of future planning and skills; within this set, time management, prioritising work tasks and planning goals for a work team were emphasised. The second most important set of skills related to organisational practices, such as being an advocate for the department/unit, and the third most important set of skills related to team leadership skills. Just over half of the occupational therapy managers who responded (55%) agreed that managerial skills should be taught at undergraduate level. The implications of these findings for curriculum development in undergraduate occupational therapy courses are discussed.
A Guide to Organising a Professional Conference: Learning from Experience
Authors: Bannigan Katrina
Published: April 2015

In a climate of lifelong learning, more and more continuing professional development events, such as conferences, are being organised. Organising a conference is a time-consuming endeavour, demanding a high degree of professionalism. There is little information readily available to guide the novice through this process. This article provides an introductory guide to organising a conference for occupational therapists, based on the author's experiential learning.
Using Qualitative Research to Inform the Client-Centred Evidence-Based Practice of Occupational Therapy
Authors: Hammell Karen Whalley
Published: April 2015

Demands for increased accountability for health care expenditure, and recognition of clients' rights to interventions and methods of service delivery that are grounded in sound evidence, are compelling occupational therapists to use research findings to inform their clinical decision making. Occupational therapists also state that they embrace a client-centred orientation to practice, yet this espoused ethic seems rarely to influence decisions concerning what research is undertaken and how it is undertaken or what counts as evidence for practice. Given the widely divergent perspectives, priorities and values between health care professionals and their clients, practice based upon therapist-centred research may be neither relevant nor valid.

This paper explores the philosophical underpinning of methods used to develop theory, proposing that occupational therapy's evidence-based practice must be ethically consistent with its espoused client-centred philosophy to avoid a tendency towards hypocrisy. It explores issues concerning client-centred practice and evidence-based practice and suggests that qualitative research methods may be the most appropriate tools to identify and address client priorities. While traditional quantitative research approaches render client voices silent, qualitative methods may enable occupational therapists to explore the complexities of clinical practice and of living with a disability, thereby informing a more client-centred, evidence-based practice of occupational therapy.
The Efficacy of Neurodevelopmental Treatment in Paediatrics: A Systematic Review
Authors: Brown G Ted , Burns Scott A
Published: April 2015

Neurodevelopmental treatment (NDT) is widely used by clinicians when working with children diagnosed with neurological dysfunction, such as cerebral palsy, high-risk/low-birthweight infants or traumatic brain injury. The objective of this project was to determine the efficacy of NDT, used with a group of paediatric subjects diagnosed with a neurological dysfunction, through the completion of a systematic search and review of the relevant published research literature.

Using a computerised literature search strategy of nine databases, expert consultation, and a hand search of 14 relevant journals and reference lists, 147 relevant citations were identified for consideration. Of the 147 articles reviewed, 17 met the inclusion criteria for further review. These studies were assessed for concealment of treatment allocation (Shulz et al 1995), quality assessment of randomised clinical trial using the Jadad scale (Jadad et al 1996) and level of evidence using the Sackett scale (Sackett 1989). A level of agreement between the two independent reviewers was calculated for each step of the systematic review process using the kappa statistic (κ). Tables containing the details and status of the 17 studies are included.

Overall, the results regarding the efficacy of NDT were largely inconclusive since there were a similar number of published research studies supporting the benefit of NDT intervention (n=6) as compared with no benefit (n=9). One study did not specifically address the efficacy of NDT, while another study was unclear as to whether or not NDT was beneficial. The studies that included the use of NDT with paediatric subjects diagnosed with cerebral palsy also had inconsistent results regarding the efficacy of NDT. The studies that included the use of NDT with high-risk/low-birthweight infants did not support the usefulness of NDT with this paediatric client group. A detailed description of the systematic review process used in the completion of this paper is also included.
Studying Clinical Reasoning, Part 2: Applying Social Judgement Theory
Authors: Harries Priscilla A , Harries Clare
Published: April 2015

Part 1 of this paper (Harries and Harries 2001) examined the reasoning studies of the 1980s and 1990s and critiqued the ethnographic and information-processing approaches, based on stated information use. The need for an approach that acknowledged the intuitive nature of experienced thinkers' reasoning was identified.

Part 2 describes such an approach ± social judgement theory ± and presents a pilot application in occupational therapy research. The method used is judgement analysis. The issue under study is that of prioritisation policies in community mental health work. The results present the prioritisation policies of four occupational therapists in relation to managing community mental health referrals.
An Introduction to Q Methodology, a Research Technique
Authors: Corr Susan
Published: April 2015

In an attempt to develop the range of research methodologies within the occupational therapy profession, it is necessary to consider methods that may be appropriate to use in studies. Q methodology has been used in the United States, and to a lesser extent in the United Kingdom, by a broad range of researchers, including psychologists, social scientists, educationalists, political scientists and other health care professionals. It is basically a quantitative method for analysing qualitative data, based on viewpoints.

The process involves developing a Q sort pack (a number of items representing the range of ideas on a topic), administering the sort (asking participants to rank the ideas with reference to their own views), analysing the data (looking for patterns in the way that individuals respond) and interpreting the results. This approach has a number of potential uses in occupational therapy. It is recommended that this method is given consideration as a research tool when attempting to identify the perceptions of clients, colleagues, students or others on any service or educational issue.
An Investigation into Occupational Therapy Referral Priorities within Kensington and Chelsea Social Services
Authors: Wright Caroline , Ritson Elizabeth
Published: April 2015

Thirty-two out of 33 occupational therapy services within London operate priority systems (Scott 1999), but there is a scarcity of published research into the accuracy of such systems. A study by Leonard (1993) identified discrepancies between priorities allocated before and after assessment, while Grime (1990) discussed the decision-making processes employed by community occupational therapists. Recognising that demand for services will continue to grow in the new millennium, this study investigated whether cases were prioritised appropriately within a team and identified the factors within referrals that influenced prioritising decisions.

The referrals (n=45) were prioritised by the team leader, who then allocated the cases to the occupational therapists without revealing the priorities. The occupational therapists reprioritised the cases after the initial assessments; the priorities were then compared and the influencing factors identified. The results indicated that 56% (10 out of 18) of the lower priority cases were inaccurately prioritised, with a tendency to underestimate the priority.

The service's referral-taking procedure was reviewed and the study replicated. The second study indicated that the accuracy of prioritising improved following revision of the guidelines, although further issues around service user involvement were highlighted.
Depression and Lability: The Effects on Occupation following Stroke
Authors: George Stacey , Wilcock Ann A , Stanley Mandy
Published: April 2015

Case study methodology was used to explore the effect of emotional changes following a stroke on engagement in occupation. Two people who had had a stroke, and their partners, were interviewed. The participants' medical case notes from acute, rehabilitation and outpatient treatment were also reviewed. As a result of the stroke, one participant experienced depression and the other lability.

The case studies illustrate the impact that emotional changes can have on the performance of occupations. They also illustrate the reverse, that perceived competence in the performance of occupations can affect emotions, either negatively or positively. The results point to a need for occupational therapists to take an occupational perspective, if wellbeing is to be maximised, as they consider and address the effects of emotional changes with people who have had a stroke.
The Casson Memorial Lecture 2001: A New Synthesis — The Emergent Spirit of Higher Level Practice
Authors: Roberts Gwilym Wyn
Published: April 2015

The Casson Memorial Lecture 2001, given on 6 July at the 25th Annual Conference of the College of Occupational Therapists, held at the University of Wales, Swansea.
Reform of the Mental Health Act 1983: Implications of Safety, Capacity and Compulsion
Authors: Carr Julie
Published: April 2015

The Mental Health Act 1983 was written for a predominantly hospital-based service. The closure of mental health institutions reduced the number of inpatient beds available and created a community-based service.

The move to community care was followed by a small number of high profile cases involving people with a mental illness. Media involvement incited a belief that mentally ill people were a dangerous sector of the community; as a result, public safety and compulsion for patients to accept treatment became powerful drivers to a review of the Act.

In November 1999, the report of the Expert Committee appointed to review the Act was published alongside the Government's Green Paper Reform of the Mental Health Act 1983 – Proposals for Consultation (Department of Health [DH] 1999a,b). The report advised that incapacity should be central to the recommendations for changing the existing legal framework. Despite the expression of concern by professional bodies and individuals, the Government chose to reject the notion of incapacity from the White Paper, Reforming the Mental Health Act (DH 2000). There is, however, a strong emphasis on the role of compulsion for the patient to accept treatment.

Although the White Paper is unsatisfactory in some aspects, those involved in the care of mentally ill people recognise that there remains a need for a legal framework within which to operate. This article discusses the issues of safety, capacity and compulsion covered by the White Paper, Reforming the Mental Health Act (DH 2000). Attention is drawn to the dilemmas for and impact on occupational therapists working with patients being treated under this Act.
Examining the Evidence Base for Occupational Therapy with Clients following Stroke
Authors: Unsworth Carolyn A , Cunningham Delia T
Published: April 2015

In order to conduct occupational therapy services that are evidence based, studies are urgently required which demonstrate the effectiveness of interventions offered. This paper presents the findings of a study undertaken to determine occupational therapy outcomes for clients with stroke during inpatient rehabilitation.

The participants were 43 clients with stroke and four occupational therapists. Therapy outcomes for personal activities of daily living were measured using the Functional Independence Measure (Adult FIMSM); instrumental activities of daily living were measured using the Assessment of Living Skills and Resources (ALSAR); and quality of life was measured using the Quality of Life Index (Q-L Index) and a semi-structured interview. The semi-structured interview was also used to understand clients' perceptions of the outcome of their participation in occupational therapy. The data were collected at client admission, discharge and 3 months' follow-up.

The results indicated that the clients believed that their ability to perform activities of daily living (Adult FIMSM t (38) = −7.80, p = 0.000, and ALSAR t (35) = 4.82, p = 0.000) and their quality of life (Q-L Index t (39) = −7.23, p = 0.000) improved over the course of their inpatient rehabilitation. The therapists also rated the clients as improving during their rehabilitation in relation to activities of daily living (Adult FIMSM t (42) = −9.71, p = 0.000, and ALSAR t (40) = 7.75, p = 0.000) and quality of life (Q-L Index t (39) = −11.20, p = 0.000). Many of the clients interviewed attributed these gains to participation in the occupational therapy programme.

In conclusion, this study demonstrated that a triangulated approach to data collection and analysis was useful in providing evidence that occupational therapy, as part of comprehensive rehabilitation, made a difference to the lives of many of the clients studied.
The Effectiveness of Splinting as Perceived by the Parents of Children with Juvenile Idiopathic Arthritis
Authors: Schroder Natalie , Crabtree Merrill J , Lyall-Watson Sarah
Published: April 2015

Juvenile idiopathic arthritis (JIA) is an important disease of childhood with far-reaching effects on the child and family. Splinting is a major treatment modality used by occupational therapists for children with JIA. Parents play a central role in whether, when and how splints are used with their children on a daily basis. This paper describes a qualitative research project, which was undertaken to evaluate an occupational therapy service for children with JIA whose treatment had involved splinting. Using semi-structured interviews, the study investigated five mothers' perceptions of the effectiveness of splinting for their children.

The interviews revealed five major points. First, the informants generally believed the splinting to be effective. Secondly, the children involved generally resisted wearing splints because they were physically uncomfortable and made them feel different to other children. Thirdly, the mothers used a variety of strategies to ensure that their children wore the splints. Fourthly, the perception of having a positive and supportive relationship with the therapist enhanced the mothers' ability to adhere to splinting. Lastly, the mothers' grief at having a child with JIA influenced their ability to understand and attend to information about specific interventions such as splinting. Practical responses to these findings are outlined.
Challenges Facing Health Professional Education in the Changing Context of University Education
Authors: Higgs Joy , Edwards Helen
Published: April 2015

Many challenges face educators in health professional programmes, for instance, consumer expectations, the quality movement, globalisation and using flexible delivery. This paper considers these challenges arising from the changing context of university education and presents strategies that address them. The strategies include setting appropriate curriculum goals, cooperation in educational programmes and making relevant choices.
A World Apart: How Occupational Therapists, Nurses and Care Managers Perceive Each other in Acute Health Care
Authors: Atwal Anita
Published: April 2015

Multidisciplinary teamwork is one of the key processes through which care is managed in the British National Health Service. Working in a multidisciplinary team requires many skills, which include understanding not only one's own role but also that of other professionals. The aim of this paper is to provide an understanding of occupational therapists', nurses' and care managers' perceptions of each other and how these influence interprofessional relationships.

In total, nine occupational therapists, nine care managers and 19 nurses within an acute physical health care setting were interviewed using the critical incident approach. The findings revealed that the interprofessional relationships between nurses, care managers and occupational therapists were often problematic owing to role confusion and competing priorities, which influenced communication.

To prevent role ambiguity, occupational therapists must define their role clearly. It is suggested that multidisciplinary team members need continuing interprofessional education in order to understand the changing roles in the National Health Service.
Views from the Inside, Part 3: How and Why Families undertake Prescribed Exercise and Splinting Programmes and a New Model of the Families' Experience of Living with Juvenile Arthritis
Authors: Britton Carrie A , Moore Ann
Published: April 2015

This is the final article in a trilogy that reports an ethnographic study about the insiders' experiences of families that include a child with juvenile idiopathic arthritis (JIA). The overall aim of the research was to explore and describe the experiences of families of children with JIA. The first article introduced the disease and the routes to diagnosis and presented the methodology of the study in detail. The second article reported the different experiences of the children with arthritis and their siblings, mothers, fathers and grandparents.

This article presents the families' perspectives about prescribed programmes of daily exercises, splinting and medication. The article also introduces a dynamic model of the families' experiences. It concludes with recommendations for future health care service development and for individual practitioners who work with either this specific user group or the families of children with other long-term conditions.
Home Adaptations: User Perspectives on the Role of Professionals
Authors: Picking Clare , Pain Helen , Picking Clare , Pain Helen
Published: April 2015

People with disabilities often carry much of the responsibility for the process of making adaptations to their homes and look to the professionals involved for support. The study described in this article asked people with disabilities whether they believed that they received appropriate professional support, information and practical help when adapting their homes and sought to learn more about their feelings about the adaptation process.

A qualitative research method, using three focus groups in different geographical areas, was carried out with a purposive sample of participants who had received adaptations to their homes and had been assisted by their local authorities. The groups comprised participants from urban and rural populations, who had a mix of housing tenure and a variety of professional support. The findings demonstrated that this method was appropriate as a means of both discovering how people felt about the process and identifying what they found to be the most helpful assistance from the professionals involved.

The study suggested that when problems arose or delays were experienced during the building process, an occupational therapist was not the only appropriate professional to provide support because this could be given in a variety of ways by different professionals and helping agencies. The study also suggested that, given sufficient information and choice, some people with disabilities preferred to organise their own adaptations, could manage with minimal professional intervention and should be empowered to do so.
Do Mainstream Schoolchildren Who Were Born Preterm Have Motor Problems?
Authors: Foulder-Hughes Lynda , Cooke Richard , Foulder-Hughes Lynda , Cooke Richard
Published: April 2015

Children who are born preterm now have improved survival chances owing to major changes in obstetric and neonatal intensive care. Previous studies have indicated that such children who are attending mainstream school have an increased risk of long-term motor impairment when compared with those who were born at full term. The present study describes the motor outcome in a geographically defined population born at or below 32 weeks of gestational age, alongside a group of full-term children who were matched for age, gender and school. Motor skills were assessed using the Movement Assessment Battery for Children (Movement ABC) and the Developmental Test of Visual Motor Integration (VMI), in addition to a detailed perinatal history.

A total of 280 preterm children were assessed alongside 210 controls. There were highly statistically significant differences between the preterm and full-term cohorts on both the Movement ABC (p<0.001, Mann-Whitney U) and the VMI (p<0.001, independent sample t-test), with the preterm group performing considerably worse than their peers. Using the 5th percentile on the Movement ABC, 30.7% of the preterm group were impaired compared with 6.7% of the controls.

Occupational therapists may find increased referral levels of preterm children because of motor difficulties and associated functional problems.
Research Priorities in Forensic Occupational Therapy
Authors: Duncan Edward A S , Munro Karen , Nicol Margaret M
Published: April 2015

National research priorities have been developed and published by the College of Occupational Therapists (Ilott and White 2001). Such an exercise, however, cannot provide the specific research priorities of a particular area of practice. A questionnaire survey was undertaken to ascertain the specific research priorities of forensic occupational therapists. The survey had three parts: determining research priorities, examining outcome measures and exploring the use of protocol-driven group work.

Three specific research priorities were clearly defined by part one of the survey: the development of appropriate outcome measures, the development of rigorous and effective group-work programmes and the development of effective risk assessment tools. The nominal group technique was used in order to triangulate the data. The survey also examined the participants' use of outcome measures: a high number of the participants (62%, 44/71) stated that they used outcome measures in practice. The participants' responses to the third aspect of the survey, regarding the use of protocol-driven groups, were more varied. The majority of the groups reported by the participants were ‘home grown’, with little research base underpinning their implementation.

The methodological weaknesses of undertaking such a survey are examined. The paper concludes that having identified clinicians' priorities in forensic occupational therapy research, the challenge is how best to gather robust evidence for practice.
Motor-Free Visual Perception Test — Revised: An Overview and Critique
Authors: Brown G Ted , Rodger Sylvia , Davis Aileen
Published: April 2015

Paediatric occupational therapists often assess and treat school-age children and youth presenting with visual perceptual dysfunction. It is, therefore, important that occupational therapists use visual perceptual instruments that possess sound measurement properties (such as validity, reliability, responsiveness and clinical utility). The Motor-Free Visual Perception Test – Revised (MVPT-R) is an instrument frequently used by paediatric occupational therapists. Clinicians need to be cognisant of the measurement properties of the assessments they use in order to provide the best level of care for the paediatric clients they serve. Therefore, a review and critique of the MVPT-R is presented.

Even though the MVPT-R has been revised recently, little has been done to address issues related to its reliability and validity. Evidence of criterion-related validity and construct validity, in particular, is still lacking. The rationale for measuring motor-free visual perception is also not well developed and needs to be expanded in the MVPT-R manual. In addition, the issue of summing the scores from the five MVPT-R subscales is questionable. What the final MVPT-R summed score really measures in terms of a screening evaluation or diagnosis is also lacking. At this stage, this instrument should be used and interpreted by occupational therapists with caution.
Evidence-Based Practice in Mental Health: A Cause for Concern for Occupational Therapists?
Authors: Mairs Hilary
Published: April 2015

This opinion piece considers the profile of occupational therapy within the literature informing the evidence base for current mental health practice. It highlights a number of concerns for occupational therapists practising in this field and advocates that it is time to engage with the available evidence base and generate a research agenda to support the activity of mental health occupational therapists.
Wheelchair Needs for Children and Young People: A Review
Authors: Cox Diane L
Published: April 2015

This work was commissioned by a charity, the Physical Disability and Sensory Impairment Forum, owing to local parental concerns relating to the assessment for and provision of mobility equipment. The project was set up as a preliminary investigation to consider those concerns. A literature review was carried out in order to establish current practice in the National Health Service wheelchair service in England, the role of the wheelchair in children's mobility, the wheelchair and seating needs of children and the met and unmet need. A questionnaire was distributed to children and their parents to gain their views. The response rate was disappointingly poor and, therefore, the results are not presented. However, the full report is available from the author.
Engaging People with Enduring Psychotic Conditions in Primary Mental Health Care and Occupational Therapy
Authors: Cook Sarah , Howe Amanda
Published: April 2015

For people who have enduring psychotic conditions, interventions need to improve social functioning as well as reducing clinical problems. There is also a need to engage and keep in touch with general practitioner (GP) patients who have fallen out of contact with specialist psychiatric care.

A new model of service was designed to engage this patient group: an expanded primary care team in an inner-city area. The team extended the GP role, provided occupational therapy and care management and used liaison psychiatry. A case study design with mixed methods was used to investigate the new service. This article reports the quantitative investigation of engagement, clinical and social outcomes and cost consequences.

The results showed that, at the start of the study, 37 people with psychotic conditions were in the sole care of their GPs; of these, 34 (92%) engaged with the new service. The sample of 28 receiving 12 months' interventions started with low levels of social functioning, which required intervention. Following interventions, they showed significant improvements in social functioning, clinical symptoms and Health of the Nation Outcome Scales (HoNOS). The costs were favourable when compared with similar services. The study suggests that expanded primary care, with occupational therapy and care management, can be a feasible service to improve people's engagement and functioning.
Disabled Facilities Grants: Are they Meeting the Assessed Needs of Children in Northern Ireland?
Authors: O'Brien Páraig
Published: April 2015

Emerging evidence from the literature suggests that the Disabled Facilities Grant means test may result in some families withdrawing from the grants process because they cannot afford to proceed with the essential housing adaptations recommended by occupational therapists for their children. A preliminary investigation was undertaken by occupational therapists in Northern Ireland to identify both the scale of this phenomenon and the issues relating to the monitoring of withdrawals. It found that families are withdrawing from the Disabled Facilities Grant system for both financial and non-financial reasons and that an interagency study with appropriate housing providers is required to assess fully the scale and outcome of unmet need.
A Clinical Audit of the Outcome of Occupational Therapy Assessment and Negotiated Patient Goals in the Acute Setting
Authors: Welch Amanda , Forster Susan
Published: April 2015

The increasing emphasis on quality and effectiveness in the National Health Service requires occupational therapists to provide evidence of accurate assessment and of the outcomes of interventions, supported by clear and concise documentation. With the merging of two acute hospitals came the opportunity for the occupational therapy services of Newcastle upon Tyne Hospitals NHS Trust to audit the process of functional assessment and documentation.

A review of the occupational therapy service was undertaken. Standards were set to combine the Modified Barthel Index with negotiated patient goal setting. Practice was then changed to meet the standards. A subsequent audit considered the outcome of occupational therapy.

The audit findings reaffirmed the acute occupational therapy focus on activities of daily living. The service identified that patients had low levels of disability according to Modified Barthel Index scores on discharge. Importantly, it was found that the reliability and validity of goal setting as a basic outcome measure was dependent upon therapists' ability to write specific quantifiable goals. The practice benefits included promoting patient involvement, enhancing the evidence base to practice, promoting consistent and effective functional assessment and documentation and reaffirming the unique contribution of occupational therapy as that of assessing a patient's level of function in activities of daily living objectively.
Implementing the Assessment of Motor and Process Skills (AMPS) in the Workplace: A Comparison of the Experiences of Occupational Therapists and New Graduates
Authors: Chard Gill
Published: April 2015

Learning to use new skills through continuing professional education courses is an important part of continuing professional development, contributing towards the evidence of competence to practise. Few studies have examined how such new learning is used in professional practice.

This study investigated the experiences of occupational therapists when learning to use the Assessment of Motor and Process Skills (AMPS) and whether years of experience or clinical area affected how the AMPS was used in practice. Twenty-three occupational therapists who undertook a 5-day AMPS course completed three questionnaires over a 10-month period. Thirteen were senior level occupational therapists and 10 were new graduates about to commence employment in their first post.

Significant differences between the two groups were found in three areas: the new graduates experienced more difficulties when starting to use the AMPS, completed fewer assessments and found workplace difficulties more time consuming. The two groups shared many difficulties when learning to use a new skill and implementing it within workplace teams, but the analysis of the ranking of these difficulties using the Mann-Whitney U test demonstrated no overall difference between the two groups. Successful implementation of the AMPS for all the participants depended on having sufficient time for new learning to take place and on support from managers so that they could change elements of practice to accommodate the use of new skills.
The Casson Memorial Lecture 2004: The Fascination of the Difficult
Authors: Butler Jenny
Published: April 2015

The Casson Memorial Lecture 2004, given on 11 June at the 28th Annual Conference of the College of Occupational Therapists, held at the Harrogate International Centre, Harrogate. The conference theme was ‘Occupation Matters’.
Disease Models of Mental Illness and Aftercare Patient Education: Critical Observations from Meta-Analyses, Cross-Cultural Practice and Anthropological Study
Authors: McGruder Juli
Published: April 2015

This paper examines critically the idea of educating mental health service users in the frame of neurobiological psychiatry as a way of understanding their experience. This idea is compared with the findings in five broad areas of the literature on schizophrenia: psychopharmacological research, psychosocial rehabilitation, first person accounts, international epidemiology and familial expressed emotion research. This literature, which includes reports of five meta-analyses, is used to highlight ethnographic findings from the author's original research. The implications of the argument made about aftercare education for the practice of occupational therapists in hospital and community psychiatry conclude the article.
Using an Evidence-Based Approach to Enable People with Mental Health Problems to Gain and Retain Employment, Education and Voluntary Work
Authors: Davis Melanie , Rinaldi Miles
Published: April 2015

Employment provides an economic means, gives social status and promotes social inclusion. While people with mental health problems attach a high priority to gaining employment, they face many barriers that inhibit their ability to gain and retain employment. This paper describes how a mental health trust actively promoted vocational rehabilitation through implementing evidence-based principles within the clinical teams. It reports how the trust acknowledged the unique contribution of occupational therapy in partnership with vocational services to enable its clients to access competitive employment, mainstream education and voluntary work.
Counselling Skills in Occupational Therapy: A Grounded Theory Approach to Explain their Use within Mental Health in New Zealand
Authors: Whitcher Kirsty , Tse Samson
Published: April 2015

There is much confusion in the occupational therapy literature surrounding the use of counselling and counselling skills in the profession and debate about whether they have a role in occupational therapy. This study used the qualitative research method of grounded theory to explore how counselling skills are used in occupational therapy in the area of mental health. The data were collected via a four-phase study involving nine occupational therapists to ascertain their views on the use of counselling skills in mental health. The emerging theory revealed that even though occupational therapists sometimes say that they use ‘counselling skills’, they usually keep a focus on occupation.
Quality of Life for People with Motor Neurone Disease: A Consideration for Occupational Therapists
Authors: Foley Geraldine
Published: April 2015

Motor neurone disease (MND) is a rapidly progressive neurological disease of unknown cause, which results in relentless loss of function and, conversely, high levels of disability. There has been a significant increase in quality of life (QoL) literature in recent years and the philosophy of the occupational therapy process may be considered consistent with the QoL construct. However, little is documented in occupational therapy literature that promotes consideration of the QoL construct in practice. This may be explained by the profession's adherence to the medical model of health care intervention.

Expectations and desires continually shift for people with MND and individual-perceived QoL is determined by a continuous process of adjustment to increasing disability. In order to promote wellbeing, occupational therapists must identify what people with MND consider important in their lives.
Older Adults' Perspectives on the Positive and Negative Aspects of Living with Multiple Sclerosis
Authors: Finlayson Marcia , Van Denend Toni , DalMonte Julie
Published: April 2015

This study examined the perspectives of people ageing with multiple sclerosis on the positive and negative aspects of living with this disease. Twenty-seven people with multiple sclerosis aged 55+ years were recruited from the National Multiple Sclerosis Society and were interviewed twice. The first interview was semi-structured and the second involved the administration of standardised scales from the Multiple Sclerosis Quality of Life Inventory.

The positive aspects of multiple sclerosis included social benefits, becoming a better helper, realising potential, strengthening family and discovering resources. The negative aspects included loss of mobility, symptoms, social disadvantages, uncertainty, loss of independence and control, missed opportunities and expense. Physical functioning and social support did not influence the likelihood of reporting any of these aspects of the experience. The people with higher mental health scores were more likely to report social benefits.

The findings point to the importance of a client-centred approach to therapy. They suggest that the use of semi-structured assessment processes may facilitate the identification of the disability experienced, which can be used to build on clients' strengths and positive experiences.
Occupational Therapy and Clinical Research in Mental Health Rehabilitation
Authors: Lloyd Chris , King Robert , Bassett Hazel
Published: April 2015

Practitioners working in Australian mental health services are faced with the challenge of providing appropriate evidence-based interventions that lead to measurable improvement and good outcomes. Current government policy is committed to the development of strategic mental health research. One focus has been on under-researched practice areas, which include the development of psychosocial rehabilitation systems and models that facilitate recovery.

To meet this challenge, an Australian rehabilitation service formed a collaborative partnership with a university. The purposes of the collaboration were to implement new forms of service delivery based on consumer need and evidence and to design research projects to evaluate components of the rehabilitation programme. This article examines the process of developing the collaboration and provides examples of how research projects have been used to inform practice and improve the effectiveness of service delivery. Challenges to the sustainability of this kind of collaboration are considered.
Developing a Vision for Therapists Working within Child and Adolescent Mental Health Services: Poised or Paused for Action?
Authors: Harrison Melanie , Forsyth Kirsty
Published: April 2015

This opinion piece invites a professional debate on the organisation of Child and Adolescent Mental Health Services (CAMHS) occupational therapy in order to deliver the modernisation agenda while sustaining its excellent record for practice development and innovation. In the face of such challenges, there needs to be reflection on whether CAMHS occupational therapy is ‘poised’ or ‘paused’ for action and what strategies would tackle existing challenges and support its growth. The piece puts forward a potential vision involving occupation-focused theory and developing academic and practice partnerships in order to ensure that children with mental health difficulties access occupation-focused, theory-driven and evidence-based occupational therapy services.
Children's Perceptions of the Impact of Developmental Coordination Disorder on Activities of Daily Living
Authors: Dunford Carolyn , Missiuna Cheryl , Street Eddy , Sibert Jo
Published: April 2015

Children with developmental coordination disorder (DCD) have a motor impairment that affects their ability to perform everyday tasks. Although severity of motor impairment can be measured, methods for assessing the perceived impact of DCD on daily activities have not been established. The purpose of this study was to use a child-focused approach to understand children's views of the impact of DCD on the activities that they perform daily.

Children aged 5–10 years, referred with coordination difficulties to occupational therapists, were assessed using the Movement Assessment Battery for Children: children who received scores below the 15th percentile were included. The Perceived Efficacy and Goal Setting System (PEGS), a pictorial scale validated as a method for engaging children with disabilities, was administered to examine the children's perceptions of their competence in performing everyday activities and to identify goals for therapy. Parent and teacher concerns were collected by a questionnaire.

The children, parents and teachers shared many concerns about the impact of DCD on physical tasks and on academic activities such as handwriting. The children expressed additional concerns, however, about their ability to perform daily self-care tasks and leisure activities, which were rarely recognised by the adults. Children require specialised methods to enable them to express their views and the PEGS appears to be suitable for this purpose.
Clinical Reasoning during Community Health Home Visits: Expert and Novice Differences
Authors: Mitchell Robyn , Unsworth Carolyn A
Published: April 2015

Very little is known about the differences between novice and expert clinical reasoning in community health practice. This article presents the findings of a study of the clinical reasoning of five expert and five novice community health occupational therapists (CHOTs) during the conducting of home visits. A head-mounted video camera was used to record the visits, followed by the participants reporting their clinical reasoning verbally using a video-assisted debriefing method. The transcripts from these verbal reports were analysed quantitatively and qualitatively.

The quantitative results demonstrated many differences between experts and novices in terms of the amounts and types of clinical reasoning used. For example, the novices used more procedural reasoning whereas the experts used more conditional reasoning and mixes of different reasoning types. The qualitative results demonstrated that the experts used a free-flowing conversational approach when reasoning during home visits whereas the novices depended on external structures such as assessment forms to guide the process. Given their experience and familiarity with the process, the experts were confident and clear in their reasoning whereas the novices were more awkward and self-conscious. The experts handled sensitive issues whereas the novices seemed to avoid them.

The study findings may provide insights for student and novice therapists concerning expert CHOTs' practice and promote reflection in general on the attainment of expertise in clinical practice.
Valuing Occupational Therapy as a Complex Intervention
Authors: Creek Jennifer , Ilott Irene , Cook Sarah , Munday Charlotte
Published: April 2015

This opinion piece introduces a framework for understanding and valuing occupational therapy as a complex intervention. The nature of complexity, particularly non-linearity and unpredictability, is summarised. The factors that characterise occupational therapy as a complex intervention are then presented. These include the visible actions that constitute the occupational therapy process; the centrality of activities and occupation in the therapist's thinking and actions; the shifts of perspectives in occupational therapy intervention; the client-centred nature of practice; and the importance of the therapist's thinking skills. All these factors elucidate why we should be proud of the complexity of occupational therapy and why a simple definition is unattainable.
The Relationship between Engagement in Occupations and Pressure Sore Development in Saudi Men with Paraplegia
Authors: Cutajar Ruth , Roberts Anne
Published: April 2015

Various research studies have explored the factors that predispose people with spinal cord injuries to pressure sore development. Two hundred risk factors have been associated with pressure sore occurrence. One of the variables commonly reported to affect pressure sore occurrence is a decreased level of activity (Vidal and Sarrias 1991, Fuhrer et al 1993). This concurs with the philosophy of occupational therapy that a reduction in activity can generate pathology (Miller et al 1988).

This research study investigated whether decreased participation in occupational activities (work, leisure and activities of daily living) was related to pressure sore occurrence in paraplegic men. The sample was selected randomly from the occupational therapy discharge files of a rehabilitation facility in Saudi Arabia. The data were collected by means of a telephone questionnaire from a total of 58 men, over a 3-month period.

The study showed that there was a large increase in unemployment in paraplegic men following injury (from 10% to 59%) and, as might be expected, manual workers were more vulnerable than office workers. The study found no significant association between pressure sore occurrence and whether or not the individual was employed. However, it showed a statistically significant association between unemployment and pressure sores severe enough to lead to hospitalisation. The study also found a statistically significant association between individuals' independence in activities of daily living and the number of pressure sores that they had reported in the last 2 years.

These findings indicate the potential importance of clients remaining occupationally active for their wellbeing and the significant contribution that occupational therapists can make by enabling rehabilitation of occupational activities.
Occupational Balance: What Tips the Scales for New Students?
Authors: Wilson Lesley , Wilcock Ann
Published: April 2015

The open question, ‘What prevents you from reaching occupational balance?’, was posed within a questionnaire aimed at exploring the meanings of occupation, health and wellbeing with a cohort of first-year occupational therapy students during their initial few weeks at university. Their written responses to the question about occupational balance were analysed and are discussed in this paper. Not surprisingly, occupational balance appeared to be achieved by only a few and more by chance than design.

People, time and money factors were identified as the main impediments to achieving occupational balance, with psychological and emotional pressures being at the forefront. Interestingly, despite these barriers, the overall educational benefit of considering the occupational balance question in this way raised the students' awareness of its relationship to health and wellbeing. This increased awareness might have longer-term health benefits, both personally and professionally, which would be worthy of further research.
A Comparison of Client Outcomes from Two Acute Care Neurological Services Using Self-Care Data from the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs - OT)
Authors: Unsworth Carolyn A , Duncombe Dianne
Published: April 2015

The 12 scales in the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) have been previously reported as offering therapists a simple and quick outcome measure for use in all practice areas. This short report describes and compares outcomes for a sample of 82 clients with neurological problems from two acute care hospitals who were rated on the AusTOMs-OT Self-care scale. It was found that client outcomes were comparable at the two facilities, although one site had a higher number of occupational therapy contacts and a greater number of clients showed a reduction in their level of impairment. The findings of this study suggest that AusTOMs-OT can be used by services to compare client outcomes. Ultimately, AusTOMs-OT could be used to establish clinical benchmarks against which services could make comparisons.