A cross-cultural test of the validity of occupational therapy assessments with patients with schizophrenia.

The validity and use of psychosocial assessments in occupational therapy are ongoing concerns (Moyer, 1984) and were the focus of this study. Fifty African patients with schizophrenia and 10 nondysfunctional African volunteers took an an assessment battery that included the Schroeder, Block, Campbell Adult Psychiatric Sensory Integration Evaluation (SBC) (Schroeder, Block, Trottier, & Stowell, 1978), a daily activity, work, and leisure activity interview based on the Model of Human Occupation (Kielhofner, 1985), and a culture-specific test of functional performance. Data on subjects' psychiatric histories and demographics were collected. Rationale for the assessments used, methods for devising the functional assessment, methods and procedures for data collection, and analysis are presented. A stronger relationship was found to exist between subjects' performances on the SBC and the functional activity test than between interviews based on the Model of Human Occupation and the functional activity test, both for patients and for the whole sample. All assessments were found to differentiate between patients and nonpatients, although the SBC was the best discriminator. Among psychiatric history variables, the strongest relationships were between measures of seriousness of illness and both the SBC and functional activity assessment. The most effective way to measure performance dysfunction and seriousness of illness in persons with schizophrenia was to measure the underlying sensorimotor impairment or to use a culture-specific test of functional performance.     

The model of human occupation and adults with HIV infection and AIDS

HIV infection affects all aspects of a person's occupational functioning. This article examines the application of the Model of Human Occupation (Kielhofner & Burke, 1980) to adults with HIV. An occupational therapy assessment battery based on the model is introduced. Given the physical, psychosocial, and environmental needs of persons with HIV, the assessment must be comprehensive to fully evaluate the effect of HIV on occupational behaviors. Goal planning and treatment follow the assessment process. A case example illustrates the integration of the Model of Human Occupation with clinical practice.     

Culture, theory, and the practice of occupational therapy in New Zealand/Aotearoa.

In the context of contemporary New Zealand, this paper discusses the need for occupational therapy to substantiate its claims of being a holistic profession with particular reference to the Maori, the indigenous people of New Zealand (referred to by the Maori as Aotearoa). In this era of accountability and consumer choice, occupational therapists need to more effectively meet the cultural needs of their clients through an understanding of both the material and nonmaterial aspects of their cultures. However, for New Zealand occupational therapists, cultural sensitivity is not enough to contribute to changing the diminished life chances of the Maori. It is proposed in this paper that the Model of Human Occupation (Kielhofner, 1985; Kielhofner & Burke, 1980), when combined with the work of radical community educators such as Freire (1972), could provide the sociopolitical dimension to New Zealand practice. The Model of Human Occupation is examined in light of current occupational therapy practice in New Zealand. It is argued that this model, when accompanied by a broader understanding of the sociopolitical processes informing monoculturalism, could be seen as a suitable framework for understanding cultural differences in New Zealand and could assist in the move toward providing culturally appropriate occupational therapy for indigenous peoples such as the Maori.     

Internal-external control and temporal orientation among southeast Asians and white Americans.

This study examined ethnic group differences with the use of the Model of Human Occupation (Kielhofner, 1985b). Three groups--immigrants from Thailand, immigrants from Cambodia, and white Americans--were contrasted on two constructs--internal versus external control and temporal orientation. The study attempted to identify whether nonpatient subjects have an internal locus of control and a strong future orientation, as the Model of Human Occupation would predict. No differences were found with the use of the Internal-External Scale (Rotter, 1966). The Thai and white Americans differed significantly on the Time Reference Inventory (Roos & Albers, 1965b). The Thai selected more items referring to the past, and the white Americans chose more statements applying to the present. There were no differences for past or future time extensions between groups. All the groups had a greater past extension than future extension. It was proposed that a larger future time perspective was not a requisite for functional temporal adaptation.     

Formulating a role for occupational therapy in child psychiatry: a clinical application

Occupational therapy is in need of role clarification within the specialty of child psychiatry. The literature reveals that occupational therapy is often undelineated or unrecognized by child psychiatry, has limited efficacy research, and may be at risk for losing its practice with children hospitalized for psychiatric disturbances. This paper outlines steps for the formulation of a specialized role for occupational therapy within this specialty. The Model of Human Occupation (Kielhofner, 1985) is suggested as a basis for conceptualizing this role. A clinical study focused on the evaluation of adaptive functioning with use of the Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984, 1985) is presented as an example of a way in which occupational therapy can provide assessment data valuable to the interdisciplinary clinical team. The role of occupational therapy in both short-term and long-term hospitalization of children with psychiatric disturbances is described.     

A critical analysis of the Model of Human Occupation

The aim of this paper is to begin a dialogue regarding the use of the Model of Human Occupation (MOHO) (Kielhofner, 1995). Three questions formed the basis for discussion: 1. Is the MOHO consistent with the values and beliefs of occupational therapy?; 2. Does the MOHO support the intervention process in occupational therapy? and; 3. Is the MOHO consistent and applicable to the current regulations and societal values in Sweden? The authors propose that the MOHO must be further developed in order to support assessment and intervention in occupational therapy. Specifically, they find the MOHO lacking with regard the influence of the environment on human behaviour, appreciation of the dialectic process between the human and the environment, and of the importance of the subsystem volition in the intervention process.     

Testing a Swedish Version of OCAIRS on Two Different Patient Groups

Occupational Case Analysis Interview and Rating Scale (OCAIRS) is an instrument for assessing occupational performance. Consisting of a semi-structured interview and a rating scale, OCAIRS is based on the Model of Human Occupation (Kielhofner 1985) and has been translated into Swedish. The rater reliability of the Swedish version (OCAIRS-S) was tested on two different populations: acute psychiatric in-patients and patients suffering from chronic muscular pain. The Intraclass Correlation Coefficient and the Percentage Agreement methods were used to calculate the strength of agreement between raters. Content validity was tested using the Percentage Agreement method. Research results indicate that the instrument has a reasonable rater reliability. Although the content validity study produced insufficient information, it nevertheless supports the use of OCAIRS-S as a reliable instrument. Further research and development on the instrument is recommended.     

Occupational therapy in early intervention: a family-centered approach

This article describes a framework for occupational therapy service provision in early intervention settings and presents pilot data aimed at examining the framework's effectiveness. The Family-Centered Framework for Early Intervention is a synthesis of concepts from the Model of Human Occupation (Kielhofner & Burke, 1980) and from the literature on play. It encompasses a systematic, holistic approach that considers the child and the family within the context of their life environments. In this framework, play is used both as an evaluative tool and as an intervention modality that addresses the volition, habituation, and performance of the child and family as well as the strengths and weaknesses of the environment. Play is also used as a primary measure of competence and change. This framework may be useful in defining occupational therapy roles for the early intervention population.     

Perceived and valued roles of adults with severe mental health problems

The purpose of this article is to convey the findings of two studies related to the perception of past, present and future roles, the value attributed to these roles as well as the role patterns. Both studies were conducted with adults who have schizophrenia and are involved in a rehabilitation or work program. Data were collected from two sources: 1) secondary analysis of a study related to the methodology for validating the French translation (Hachey, Jumoorty, & Mercier, 1995) of the "Role Checklist", (Barris, Oakley, & Kielhofner, 1988) and 2) a research project on the perception of roles and quality of life. Results showed that the dominant roles assumed by participants regardless of time were family member, friend, home maintainer and hobbyist. The most valued roles were those of friend, worker, and family member. The discussion will address the questions asked and elucidate the role patterns. The conclusion underlines the importance, for occupational therapists and health professionals, of including roles in the daily lives of their clients, taking into consideration the ones they value most highly.     

Occupational therapy and obsessive-compulsive disorder

The Model of Human Occupation, used as a frame of reference in the assessment and treatment of obsessive-compulsive disorder, helped identify how major disruptions in habituation and volition can affect a person's ability to perform and adapt in his or her environment. Careful application of this model promoted a more holistic view of John's life-style and guided me, as his occupational therapist, in creating a purposeful and meaningful treatment plan.     

Clinical manifestations in persons with multiple personality disorder

Occupational therapists are becoming more involved in the treatment of persons with multiple personality disorder. Occupational therapy literature concerning treatment of this group of patients, however, is sparse. Clinical manifestations of multiple personality disorder include common alter personalities with distinct roles and functions, age-related behavioral patterns, and physiological differences. By recognizing and understanding these differences and characteristics and their relationship to treatment goals, occupational therapists can better use their background in life roles and occupations to increase the functional daily living skills of patients with multiple personality disorder.     

Assessing and Assisting the Persons with Dementia:

This paper acknowledges the difficulties of assessing the patient with dementia and presents three outcome goals of an evaluation. The Model of Human Occupation is presented as a framework within which to interpret assessment data for treatment planning. Specific formal and informal assessment tools are suggested and discussed, including the Barthel Self-care Index and Household Management Screening Assessment.     

Spanish translation of the role checklist.

OBJECTIVE: The purpose of this study was to create a Spanish version of the Role Checklist that is content valid and reliable and to demonstrate usefulness of a translation method. METHOD: A modified version of the translation method of Hachey, Jumoorty, and Mercier was used to translate the English Role Checklist into Spanish. The English and Spanish versions were then evaluated for test-retest reliability at a 2-week interval, using 14 bilingual college students. RESULTS: The intralanguage correlation was .907 for Part I and .798 for Part II. CONCLUSION: A content valid and reliable Spanish version of the Role Checklist was created, using replicable translation methods.     

Applying The Intentional Relationship Model To Persons With Dementia: A Retrospective Analysis

Aims: This retrospective study explored how mechanisms and elements of the Intentional Relationship Model may support volition and engagement in occupation for individuals living with dementia. Methods: Concepts grounded in the Intentional Relationship Model framed a secondary analysis of the experiences of one therapist who examined the volitional expression of persons with moderate dementia according to the Model of Human Occupation. Field notes from thirty-eight hours of therapist interactions with three participants living with moderate dementia were analyzed using thematic analysis. Results: Frequent use of collaborating and encouraging modes appeared effective in supporting volition and engagement in occupation in participants. Interpersonal skills of the therapist that appeared essential for positive interactions with participants were understanding interpersonal characteristics and responding to interpersonal events. Conclusions: Clinical implications related to use of IRM with this population are presented, and suggestions for future research and training of therapists are provided.     

Considerations and techniques in the treatment of persons with multiple personality disorder

Occupational therapy intervention with the patient with multiple personality disorder requires an understanding of the complex psychotherapeutic goals for the patient and of the process involved in resolution of the trauma that led to the development of multiple personality. The psychotherapeutic techniques of hypnosis and abreaction affect the provision of occupational therapy services. Hypnotic communication, particularly the use of ideomotor hand signals, often facilitates work with various alter personalities. Occupational therapists may use a developmental approach with both child and adult alter personalities and may also use projective techniques, self-care training, and role and task management techniques. Occupational therapy can act as a stabilizing force for the person with multiple personality disorder through the enhancement of function and competency during the psychotherapeutic process.     

Treatment choices: rehabilitation services used by patients with multiple personality disorder.

This article identifies mental health rehabilitation services for patients with multiple personality disorder. Through the use of a literature review and a retrospective examination of 20 patients' records, the frequency of discipline-specific services is noted in occupational therapy, art therapy, movement therapy, vocational counseling, and recreational therapy. Recommendations for practice and program development include ongoing education about multiple personality disorder and continual assessment of the patient's functional level to identify subsequent treatment needs and services.     

甲亢患者131碘治疗前心理健康水平与人格分析

目的:评估甲状腺功能亢进症(甲亢)患者131碘治疗前心理健康状况及人格特征,分析其与甲亢发病的关系。方法:采用症状自评量表(SCL-90)、艾克森人格问卷(EPQ)对48例131碘治疗前甲亢患者(甲亢组)进行测量并与40例正常成人(对照组)比较。结果:甲亢组SCL-90在F1(躯体化)、F2(强迫)、F3(人际关系敏感)、F4(抑郁)、F5(焦虑)和F10(其他)因子分显著高于对照组(P<0.05),而F6(敌对)、F7(恐怖)、F8(偏执)和F9(精神病性)因子分和总分及阳性项目数与对照组比较差异有非常显著性(P<0.01)。EPQ测量:甲亢组的精神度(P)和神经质(N)分值显著高于对照组(P<0.05或<0.01),甲亢患者多属于抑郁质(内向不稳定型)人格,而对照组多属于多血质(外向稳定型)和黏液质(内向稳定型)人格特质。结论:甲亢患者总体心理健康状况较差;内向不稳定型人格,神经质的人格特征与甲亢的发病有关。     

The Retirement Process in an Occupational Perspective:

The purpose of this study is to review and analyze the literature on retirement from an occupational perspective. Theories are compared and described; whether they have empirical support and whether they incorporate individual and environmental factors is discussed. The Model of Human Occupation is presented as one such model that is able to incorporate both individual and environmental factors when retirement issues are added to the model.     

A literature review of the application of the Geriatric Depression Scale,Depression Anxiety Stress Scales and Post‐traumatic Stress Disorder Checklist to community nursing cohorts

Aims and objectives.  To explore through literature review the appropriateness of three common tools for use by community nurses to screen war veteran and war widow(er) clients for depression, anxiety and post‐traumatic stress disorder. Background.  War veterans and, to a lesser extent, war widow(er)s, are prone to mental health challenges, especially depression, anxiety and post‐traumatic stress disorder. Community nurses do not accurately identify such people with depression and related disorders although they are well positioned to do so. The use of valid and reliable self‐report tools is one method of improving nurses’ identification of people with actual or potential mental health difficulties for referral to a general practitioner or mental health practitioner for diagnostic assessment and treatment. The Geriatric Depression Scale, Depression Anxiety Stress Scales and Post‐traumatic Stress Disorder Checklist are frequently recommended for mental health screening but the appropriateness of using the tools for screening war veteran and war widow(er) community nursing clients who are often aged and have functional impairment, is unknown. Design.  Systematic review. Conclusions.  Current literature informs that the Geriatric Depression Scale accurately predicts a diagnosis of depression in community nursing cohorts. The three Depression Anxiety Stress Scales subscales of depression, anxiety and stress are valid; however, no studies were identified that compared the performance of the Depression Anxiety Stress Scales in predicting diagnoses of depression or anxiety. The Post‐traumatic Stress Disorder Checklist predicts post‐traumatic stress disorder in community cohorts although no studies meeting the selection criteria included male participants. Relevance to clinical practice.  This review provides recommendations for the use of the Geriatric Depression Scale, Depression Anxiety Stress Scales and The Post‐traumatic Stress Disorder Checklist based on examination of the published evidence for the application of these screening tools in samples approximated to community nursing cohorts. Findings and recommendations would guide community nurses, managers and health planners in the selection of mental health screening tools to promote holistic community nursing care.