What needs to be done? Occupational therapy responsibilities and challenges regarding human rights

Background: Addressing human rights issues brings forth ethical and political responsibilities for occupational therapists and requires new epistemological and educational approaches. The way occupational therapists have faced these challenges has depended upon historical, cultural and social contexts. Aim and method: By means of literature review and historical analysis, this paper reflects on how occupational therapists have dealt with human matters issues and on the contemporary changes within the profession. Results and discussion: The paper portrays how Latin American occupational therapists have engaged in social transformation by choosing not to transform ethical and political problems into technical matters. Taking into account experiences and views from South Africa, Brazil and Chile, the paper outlines the importance of developing political literacy and interdisciplinary professional/postprofessional education to prepare the new generation of occupational therapists to engage in social transformation. Addressing issues of invisibility and lack of access to human rights, the paper reflects on the need of developing conceptual tools and strategies for change, and discusses the transformations being produced in contemporary occupational therapy. Conclusion: Occupational therapists and scientists need to be attentive to human rights issues. They also need to answer the call for interconnectedness in the present‐day complex societies, and engage in networking and a cross‐bordering dialogue. Nevertheless, although necessary and welcome, international cooperation requires a permanent exercise of cultural sensitivity, political awareness and self‐awareness.     

Occupational Therapy's Work Assessment in the 1980's

This article records the findings of a study into current Australian occupational therapy practice for clients desirous of entering or returning to employment. Sixty-six therapists were surveyed through occupational therapy associations in order to determine their familiarity with current work assessment tests and the areas of work assessment causing them concern. This constitutes a preliminary study, carried out in conjunction with an Institute of Industrial Engineers' Task Force to ultimately determine the educational needs of the occupational therapists practising in the area of work assessment.     

The contribution of occupational therapy to the fabric of Australian rural and remote communities

Social justice has provided a basis for the underlying values of occupational therapy in Australia. In the 1990s, changes in health issues and delivery of services are causing occupational therapists to reconsider their values and the ways they deliver their services. By any measure, the health status of individuals in rural and remote communities of Australia is poorer that their urban counterparts. The issues associated with the poor health status of these communities will best be addressed through a combined strategic approach by governments, organizations and professional groups, including occupational therapy. Identification of some of the key issues affecting the supply of occupational therapists in rural and remote communities and how they might be addressed are discussed. It is proposed that the development of cohesive national strategies and actions aimed at enhancing the contribution of occupational therapy to rural and remote communities ought to include, among other things, adoption of the primary health care approach, fundamental changes in the education and preparation of practitioners for practice, and identification of competencies and standards for effective rural and remote practice.     

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.     

Language, identity and representation: occupation and occupational therapy in acute settings

Aim:   This article presents findings from a participatory action research study into the experience and use of occupation, theory and evidence in the everyday practice of a group of occupational therapists working in a large metropolitan hospital delivering a range of acute services, in Melbourne, Australia.
Methods and findings:   Narrative data gathered from 11 individual interviews and 10 group discussions were analysed through numerous iterative cycles to explore research issues and evaluate research actions. This article discusses why the participating occupational therapists chose to change the language they used to describe their practice from a focus on 'function' to a focus on 'occupation'. This change improved the therapists' levels of confidence, strengthened their professional identities and provided for a sense of renewed empowerment within the organisation.
Conclusions:   The findings suggest that occupational therapists in acute settings can utilise language more effectively to augment their ability to promote the vital and unique contribution that occupational therapy has to make. Such small, yet powerful changes can empower occupational therapists to address long-standing dilemmas of representation and enable transformative practices.     

Well-being and occupational rights: An imperative for critical occupational therapy

Abstract

Background: One of occupational therapy's core assumptions is that engagement in occupations influences well-being. Because occupational engagement is integral to human well-being, and because well-being is integral to human rights, this paper contends that the ability and opportunity to engage in occupations is an issue that concerns rights. Aims: To outline well-being and its centrality to human rights; to explore the relationships between well-being and occupation and between well-being and occupational rights; and to highlight the consequent imperative to engage in critical occupational therapy. Key issues: The World Federation of Occupational Therapists asserts that all people have the right to participate in a range of occupations that enable them to flourish, fulfil their potential, and experience satisfaction congruent with their culture and beliefs; and further asserts the human right to equitable access to participation in occupation. Conclusions: If occupational therapists are to take seriously their espoused commitment to enabling equitable access to participation in occupation, the inequitable conditions of people's lives will need to be addressed. Critical occupational therapy is a committed form of practice which acknowledges that well-being cannot be achieved solely by enhancing individuals' abilities, and that consequently endeavours also to address the conditions of people's lives.     

Sharing Stories: Using Narratives to Illustrate the Role of Critical Reflection in Practice with First Australians

This paper aims to fill a gap in existing literature by using examples of reflective practice and how these informed service delivery and development with First Australians within a population health paradigm. Population‐based approaches have been proposed as useful for providing services that reach beyond the individual. They may be particularly helpful in providing a framework for occupational therapists working with First Australians, when modified appropriately. “Healthy Ears” is a statewide ear health programme for First Australians. It is an example of a health promotion programme working to partner with First Australian communities using a community‐driven and strengths‐based approach. The occupational therapy role within this service has been recently established. Collaborative autoethnography was used to produce narrative reflection and discussion between the first and second authors in order to illustrate the role of critical reflection in developing this new occupational therapy service. The narratives presented are based on three main themes, which emerged as important guiding principles; these are core occupational therapy knowledge and skills, partnerships with communities and organizations and cultural safety. Each theme comprises narrative excerpts followed by interpretations based on the literature. The findings from these narratives, whilst limited to a particular context, suggest there is a need for greater professional preparation and support for occupational therapists working cross‐culturally through undergraduate training and professional development opportunities. This paper highlights the usefulness of reflective practice as a tool for developing culturally safe occupational therapy services and emphasizes the importance of relationships with key First Australians as a platform for culturally safe practice. Copyright © 2013 John Wiley & Sons, Ltd.     

Occupational therapists report a low level of knowledge,skill and involvement in evidence‐based practice

This study was conducted to collect information about Australian occupational therapists’ involvement in evidence‐based practice. The study aimed to document: (i) respondents’ level of knowledge and skills; (ii) their level of participation in continuing education; and (iii) perceived barriers to evidence‐based practice. A purposive sample of 85 occupational therapists was invited to complete a questionnaire prior to attending an introductory workshop on evidence‐based practice. Sixty‐seven questionnaires were returned and analysed (78.8% response rate). Half of the respondents rated their level of knowledge and skills required for evidence‐based practice as low (conducting database searches = 50.7%; critically appraising literature = 53.0%). The majority of respondents (79.1%) reported a low level of knowledge about electronic databases. Few respondents had attended education sessions on evidence‐based practice (15.0%). The six most commonly reported barriers to adopting evidence‐based practice were lack of time, a large caseload, limited searching skills, limited appraisal skills, difficulty accessing journals and a perceived lack of evidence to support occupational therapy intervention. The majority of occupational therapists in this sample were entering the first phase of continuing professional development in relation to evidence‐based practice.     

Evidence-based practice and research utilisation: perceived research knowledge, attitudes, practices and barriers among Australian paediatric occupational therapists

Background/aim: Evidence‐based practice (EBP) and research utilisation (RU) are promoted as ways for clients to receive the best level of care. However, limited research has evaluated the use of these approaches by occupational therapists. This study investigated the knowledge, attitudes, practices of and barriers to EBP and RU of a group of paediatric occupational therapists from Australia. Methods: Questionnaires were received from 138 participants (response rate 46%) who completed the Research Knowledge, Attitudes and Practices of Research Survey, the Edmonton Research Orientation Survey and the Barriers to Research Utilisation Scale. Results: The participants held positive attitudes towards research, and were willing to access new information to guide practice approaches. However, participants were less confident in their research knowledge and practices and implemented research findings into clinical practice. Multiple barriers to RU were perceived, particularly associated with the presentation and accessibility of research. Participants reported limited engagement in conducting research studies, although the majority of the participants reported implementing the findings of research into their clinical practice to some extent. Conclusion: Additional research education and support within organisations would be beneficial to ensure that children and families are receiving occupational therapy services that are based on sound, high‐quality research evidence. The findings of this study provide insight into the perceived research knowledge, attitudes, practices of and barriers to Australian paediatric occupational therapists, enabling specific strategies to be implemented to increase the use of EBP and RU within the profession.     

Occupational therapy and people with intellectual disability from culturally diverse backgrounds

The multicultural nature of Australian society creates a need for occupational therapists to become aware of the issues facing people from culturally diverse backgrounds. People with intellectual disability from culturally diverse backgrounds may experience a 'double disadvantage' due to issues of their culture and their disability. This research aimed to identify the experiences, issues and strategies used by occupational therapists working with people with intellectual disability from culturally diverse backgrounds. A semistructured group interview and three individual interviews were conducted with occupational therapists from both metropolitan and rural locations in Queensland. It was found that communication and residential services present some unique issues for people with intellectual disability from culturally diverse backgrounds. Strategies suggested by therapists to address a range of issues are listed. Implications for occupational therapy are discussed, and suggestions for future research are provided.     

A case against generalisation of mental health occupational therapy in Australia

Background/aim: In 2009, the World Federation of Occupational Therapists International Advisory Group on Mental Health conducted a global survey that yielded data on mental health occupational therapy practice. The Australian dataset reflected aspects of the current situation of the Australian mental health occupational therapy workforce. Of particular interest were resource availability, workforce recruitment and retention, and perception of the future of mental health occupational therapy. Methodology: Using a cross‐sectional survey design, quantitative and qualitative data were gathered electronically over a one‐month period. Manual analysis indicated themes common to mental health occupational therapists across a framework of professional areas. Results: Findings suggested that role blurring negatively affected workforce retention. Workforce recruitment and retention were complicated by resource shortages. Some Federal Government initiatives were perceived as only partially beneficial to the profession. Conclusions: Survey respondents believed that mental health occupational therapy was a potential growth area particularly where occupational therapy specific skills were retained.     

Professional competence for private practitioners in occupational therapy

The aim of the present study was to investigate the meaning of professional competence for occupational therapy private practitioners and their experience of the barriers to professional competence. Semi-structured interviews with 16 key informants from private practice in Victoria elicited diverse opinions and experiences. However, the difficulty of assessing competence, and the lack of standards that identify competent practice for occupational therapy were major themes in the findings. The role of theory in competent practice was evident in discussion but it was not clearly articulated by many participants. Experiences of professional socialisation varied yet participants perceived input from peers as contributing to assuring competence. Major barriers to professional competence were identified as professional isolation, time and finances. The present study highlights the complexity of current attempts to assess professional competence for practising occupational therapists including the implementation of an accreditation program by The Australian Association of Occupational Therapists Inc. (OT AUSTRALIA), the peak body representing occupational therapists.     

Utilisation of strategic analysis and planning by occupational therapy services

Many occupational therapists in practice can testify to the continually changing environments that impact on the delivery of effective services in the modern human service delivery system. It is within this context that occupational therapists are urged to regularly undertake strategic planning to keep track of and deal with these ongoing changes. In the present article, strategic analysis and planning will be discussed as a tool for occupational therapists in practice. The first step in strategic planning is an analysis of the external and internal environments of a particular service. The current article will provide an example of an environmental analysis as first step. This is followed by a discussion of the second step: the consideration of appropriate strategies and models of service delivery. The aim of the present article is to emphasise the importance of critical reflection by practitioners in order to adapt to the environmental changes influencing occupational therapy service delivery .