Profile of paediatric occupational therapy practice in Australia

Background:  The purpose of the present study was to describe a profile of Australian paediatric occupational therapy practice in terms of theories, assessments and interventions used with the most frequently seen client groups.
Methods:  An ex post facto survey design was utilised. A purpose-designed survey was mailed to 600 occupational therapists identified by OT Australia as working in paediatrics.
Results:  The response rate was 55% ( n =  330). Respondents in the sample worked chiefly with children with developmental delays, learning disabilities, neurological impairments, and infants/toddlers. Theoretical models used by paediatric clinicians that were common to the most frequently seen client groups focused on sensory integration/multisensory approaches, occupational performance, and client-centred practice. Assessment tools most frequently used were the Test of Visual Motor Integration, Sensory Profile, Bruininks-Oseretsky Test of Motor Proficiency, Handwriting Speed Test, and Motor-Free Visual Perception Test. The most often used treatment methods across the four most frequently seen client groups were parent/caregiver education, sensory integration/stimulation techniques, and managing activities of daily living.
Conclusions:  Paediatric occupational therapists appeared to draw on a range of theoretical models. With the exception of the Sensory Profile, the assessment and treatment methods most frequently used are not congruent with the most commonly used theoretical models. It is critical that the assessment and treatment methods used are conceptually consistent with the theoretical models that guide practice. Occupational therapists need to examine the evidence and determine whether their clinical practice is grounded in the best contemporary theoretical models, assessments and interventions.     

Maternal Role Preparation

The Maternal Role Preparation (MRP) project demonstrates an innovative occupational therapy approach to increasing maternal competence in first time mothers. This four session program provided women with discussion, demonstration, practice and written materials covering topics concerning their infants (attachment, sensory systems, developmental abilities) and themselves (acquiring a new role as mother). Theoretical constructs from Behavioral Pediatrics, Sensory Integration and Occupational Behavior were evaluated for their compattbility and combined under the unifying framework of Occupational Behavior. The program represents an opportunity for occupational therapists to combine sensory integration theory and practice with other compatible treatment perspectives and approaches.     

Exploration of the link between conceptual occupational therapy models and the International Classification of Functioning, Disability and Health

Background and Aim:  Because occupational therapy focuses on occupations and activities of daily living in the context of the environment, conceptual occupational therapy models might be closely related to the International Classification of Functioning, Disability and Health (ICF). The purpose of this paper is to explore the link of conceptual occupational therapy models to the ICF.
Methods and Results:  A structured literature search was performed. The concepts on which the models are built were linked to the ICF categories and components according to 10 established linking rules. Three conceptual occupational therapy models were identified in the literature: the Model of Human Occupation, the Canadian Model of Occupational Performance and the Occupational Performance Model (Australia). The majority of the concepts from the three models could be linked to the ICF.
Conclusion:  By applying the conceptual models, occupational therapists might add an additional perspective to multidisciplinary teams that use the ICF.     

Overseas Occupational Therapists in Australia: the Issue of Recognition

The Australian government established the Council on Overseas Professional Qualifications (COPQ) in 1969. In response to approaches by the occupational therapy profession, an Expert Panel in Occupational Therapy was established in 1979 in order to develop a screening examination to be used in assessing the competency of overseas trained occupational therapists. This paper describes the development of the COPQ examination for all overseas qualified occupational therapists wishing to work in Australia; the experience of candidates since its inception in 1983; and the problems associated with achieving recognition of the COPQ examination throughout Australia given the lack of uniform recognition procedures in the various States and Territories. The need for a consistent national approach to the policy of recognition and employment of overseas trained occupational therapists is addressed, with stress placed on the need for all employer groups, in both the public and the private sectors, to cooperate with COPQ's assessment procedures.     

Reliability of the Perceive, Recall, Plan and Perform System of Task Analysis: A criterion-referenced assessment

Objective:  To conduct preliminary examination of the rater and test-reliability of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis, an ecological measure designed to assess task-embedded information processing capacity during occupational therapy assessment of confused and agitated adults following traumatic brain injury.
Methods:  Occupational therapists observed and scored client performance using the PRPP System of Task Analysis. Correlational analysis and measures of agreement were performed to determine interrater and intrarater reliability. Test procedures were examined for reliability and internal consistency.
Results:  Interrater and test reliability considered three factors: therapists, clients and tasks. A moderate level of interrater reliability was achieved between trained therapists (intraclass correlation coefficient (ICC) = 0.60). Test procedures were highly reliable (ICC = 0.88). Across two measurement occasions, therapists showed a tendency towards harder rating on the second test occasion (      –4.5%; 95% confidence interval for     : –10.67%→ 3.17%).
Conclusion:  The findings of this study support the use of criterion-referenced tests in the area of occupational performance measurement. Occupational therapists achieved moderate interrater reliability when measuring the performance of adults with brain injury on various activities of daily living. Test procedures were found to be highly reliable in measuring the occupational performance of adults demonstrating confusion and agitation typical to the stage of post-traumatic amnesia following head injury.     

Powered wheelchair mobility: An occupational performance evaluation perspective

Developments in powered wheelchair technology have opened up a world of opportunities for people with disabilities that affect their mobility. The challenge for occupational therapists is to examine the functional utility of powered mobility relative to individual occupational performance needs. In the absence of a comprehensive evaluation strategy, the present paper examines current practice and proposes the use of the Occupational Performance Model (Australia) as an effective framework for examining powered wheelchair mobility as an enabler of human performance. Discussion of the critical elements affecting mobility performance includes the impact of the environment, life roles, space and time, as well as individual component level performance skills.     

Work-related stress and occupational therapy

Occupational stress and burnout have been studied extensively in the human services. It has been suggested that healthcare professionals in particular are at risk of stress owing to the caring nature of their work. Articles related to occupational therapy and work-related stress were reviewed in regard to practice in Australia, Canada, the United Kingdom, the United States and Sweden. Although the empirical literature is relatively weak for occupational therapy, it has been argued that occupational therapists in health care share risk factors with other healthcare professionals. These risk factors include repeated exposure to distress and difficult behaviour, prolonged interventions and uncertain outcome. Issues such as professional status, staffing issues and the nature of the profession have been identified as additional risk factors for occupational therapists. However, empirical studies that enable burnout rates of occupational therapists to be compared with those of related occupational groups suggest that this may not be the case. Occupational therapists may in fact be protected from some stress and burnout factors. Further research is recommended to clarify the nature of stress experienced by occupational therapists and to identify both risk and protective factors characteristic of the profession.     

Evaluating a school skills programme for Australian indigenous children: A pilot study

The purpose of this study was to evaluate the effectiveness of an occupational therapy skill development programme in improving handwriting, scissor use, visual motor co-ordination and classroom behaviour, in a group of grade-one Australian urban Indigenous students. The sample (N = 13) was randomly assigned to an experimental group or comparison group. Both groups were exposed to the intervention. The experimental group received a six week school skills programme in addition to regular schooling, while the comparison group received regular schooling only. Following this, the comparison group received the same six week programme. Participants underwent pre- and post-testing using Beery-Buktenica's Developmental Test of Visual Motor Integration, Conner's Abbreviated Symptom Questionnaire, and two non-standardized handwriting and scissor skill measures. Results indicated that participants significantly improved in aspects of handwriting, scissor skills, and behaviour, but not visual motor co-ordination, following participation in the programme. The experimental group demonstrated greater improvements only in handwriting ability scores (p = 0.037), compared to a comparison group. It was concluded that a school-based occupational therapy programme was effective in improving handwriting, in a group of grade-one Australian Indigenous children.     

Continuing professional development for occupational therapy emergency department services

Aim: To explore continuing professional development (CPD) resources and needs of Australian emergency department occupational therapists. Method: Australian websites and occupational therapy newsletters were searched to identify CPD resources/opportunities. Occupational therapists with recent clinical experience in Australian emergency departments were surveyed on strengths, weaknesses, opportunities and threats to their service, research information needs, supervision/mentor arrangements and quality assurance activity. Results: No Australian CPD opportunities were identified; 1.3% of the 2008 OT AUSTRALIA conference topics were emergency department specific. Forty‐one Australian hospitals employed a total of 51 occupational therapists of whom 30 responded. Half were supervised by occupational therapists; 20 had occupational therapy mentors; 23 perceived that they were very independent; seven did quality assurance projects; 25 had unmet research needs; 27 thought their service was effective; and service strengths, weaknesses, opportunities and threats to service could be identified by most occupational therapists. Conclusion: Australian occupational therapists in emergency departments need specialised CPD opportunities. The information needs and strengths, weaknesses, opportunities and threats provide a CPD topic planning guide.     

The Occupational Performance History Interview in community mental health case management: Consumer and occupational therapist perspectives

Background/aim:  This study aimed to explore the use of the Occupational Performance History Interview from the perspectives of mental health consumers and occupational therapist case managers in community mental health settings.
Methods:  This qualitative study, based on naturalistic inquiry, involved 10 participants: four occupational therapists who interviewed six mental health consumers, using the Occupational Performance History Interview. All participants participated in follow-up interviews or in focus groups to gain an understanding of their perspectives of this experience. Transcribed data were analysed using the constant comparative method.
Results:  Consumer participants valued telling their occupational stories. Occupational therapist participants described the interview as supporting them to be more occupationally focused within their case management roles.
Conclusion:  The findings suggest that the Occupational Performance History Interview can potentially enhance client-centred and occupationally focused practice in community mental health case management.     

The potential role of occupational therapy in acute care with clients with HIV/AIDS

As medical interventions aimed at prolonging the lives of people with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are implemented, HIV/AIDS is evolving into a chronic disease with associated disability. People with HIV/AIDS can experience numerous occupational performance problems and occupational therapists need to examine and develop their role in helping to meet the needs of this population. Acute-care occupational therapists work with clients with HIV/AIDS who experience multiple admissions and who present with varying levels of occupational function. This paper outlines the potential role of occupational therapy in acute care with clients with HIV/AIDS using the Model of Occupational Performance (Canadian Association of Occupational Therapists, 1991) as a conceptual framework. The results of a retrospective chart review that investigated the role of two occupational therapists working with clients with HIV/AIDS in an acute-care setting are presented and compared with the potential role. Practice and research recommendations to address the discrepancies between the potential and present role are presented. Copyright © 1998 Whurr Publishers Ltd.     

A national evaluation of the Australian Occupational Therapy Competency Standards (1994): A multistakeholder perspective

This paper summarises results from an evaluation of the adequacy and utility of the Australian Competency Standards for Entry-Level Occupational Therapists © (OT AUSTRALIA, 1994a). It comprised a two-part study, incorporating an online survey of key national stakeholders ( n  = 26), and 13 focus groups ( n  = 152) conducted throughout Australia with occupational therapy clinicians, academics, OT AUSTRALIA association and Occupational Therapy Registration Board representatives, as well as university program accreditors. The key recommendations were that: (i) urgent revision to reflect contemporary practice, paradigms, approaches and frameworks is required; (ii) the standards should exemplify basic competence at graduation (not within two years following); (iii) a revision cycle of five years is required; (iv) the Australian Qualifications Framework should be retained, preceded by an introduction describing the scope and nature of occupational therapy practice in the national context; (v) access to the standards should be free and unrestricted to occupational therapists, students and the public via the OT AUSTRALIA (national) website; (vi) the standards should incorporate a succinct executive summary and additional tools or templates formatted to enable occupational therapists to develop professional portfolios and create working documents specific to their workplace; and (vii) language must accommodate contextual variation while striking an appropriate balance between providing instruction and encouraging innovation in practice.     

The myth of participation in occupational therapy: reconceptualizing a client-centred approach

Abstract

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.     

Employment trends for occupational therapists: An analysis of employment advertisements in the Sydney Morning Herald 1984–90

Despite rapid growth in the number of occupational therapy graduates in Australia, almost no data are available concerning the demand and the expectations of employers. This study surveyed 6298 advertised positions available to occupational therapists, social workers, psychologists and counsellors in the state of New South Wales during the years 1984–90. Over this period the demand for occupational therapists grew by 53%, which exceeded the growth in demand for social workers and psychologists, but was less than that for community and mental health workers and counsellors. The employment base was found to be reasonably broad and 8% of jobs were in the private sector. The number of duties required of occupational therapists increased over time, and there was an increase in the demand for programme promotion, administration and supervision skills. The results are discussed in terms of the employment base and defining strengths of the profession, recommendations for strengthening the profession, and implications for the Australian Association of Occupational Therapists.     

The Naomi Wing Awards

This is the third year the Naomi Wing Awards have been offered to occupational therapists, occupational therapy students and to support staff for the design of an aid or piece of equipment which will assist the disabled. The awards were conducted by the Australian Association of Occupational Therapists and again sponsored by Mr Thomas Hurley, an inventor of aids for the disabled. The aim is to provide the profession with an opportunity to share inventiveness and creativity and to prompt interaction and participation. The awards are named after Dr Naomi Wing of Sydney, a renowned medical specialist who has made significant contributions to rehabilitation in Australia. A total of ten awards were presented this year at the 12th federal conference of the Australian Association of Occupational Therapists.     

Validity and Reliability of the Developmental Test of Visual Perception – Third Edition (DTVP-3)

The Developmental Test of Visual Perception – Third Edition (DTVP-3) is a recently published revision of a visual perceptual test from the United States, frequently used by occupational therapists. It is important that tests have adequate documented reliability and validity and are evaluated in cross-cultural contexts. The purpose of the study was to assess the reliability and validity of the DTVP-3 when completed by a group of Australian participants. Thirty-nine typically developing children 6–8 years of age completed the DTVP-3 and the Developmental Test of Visual-Motor Integration – 6th edition (VMI-6). The internal consistency of the DVTP-3 was assessed using Cronbach alpha coefficients and the DTVP-3's convergent validity was examined by correlating it with the VMI-6 and its two supplementary tests. The five DTVP-3 subscales’ Cronbach alpha coefficients ranged from.60 to.80 while its three composite indexes had coefficients all at the.80 level. The VMI-6 was significantly correlated with the DTVP-3 Figure Ground and Visual Closure subscales and the Motor-Reduced Visual Perception Index (MRVPI). The VMI-6 Visual Perception Supplementary Test was significantly correlated with the DTVP-3 Figure Ground, Visual Closure, Form Constancy, MRVPI, and General Visual Perception Index. The DTVP-3 exhibited acceptable levels of internal consistency and moderate levels of convergent validity with the VMI-6 when completed by a group of Australian children.