Consensus Statements for Screening and Assessment Tools

Occupational therapists, both generalists and specialists, have a critical role in providing services to senior drivers. These services include evaluating fitness-to-drive, developing interventions to support community mobility, and facilitating the transition from driving to non-driving when necessary for personal and community safety. The evaluation component and decision-making process about fitness-to-drive are highly dependent on the use of screening and assessment tools. The purpose of this paper is to briefly present the rationale and context for 12 consensus statements about the usefulness and appropriateness of screening and assessment tools to determine fitness-to-drive, within the occupational therapy clinical setting, and their implications on community mobility.     

Community occupational therapists' clinical reasoning: identifying tacit knowledge

Background: Occupational therapy interventions in the community, a fast expanding practice setting, are central to an important social priority, the ability to live at home. These interventions generally involve only a small number of home visits, which aim at maximising the safety and autonomy of community‐dwelling clients. Knowing how community occupational therapists determine their interventions, i.e. their clinical reasoning, can improve intervention efficacy. However, occupational therapists are often uninformed about and neglect the importance of clinical reasoning, which could underoptimise their interventions. Aim: To synthesise current knowledge about community occupational therapists’ clinical reasoning. Method: A scoping study of the literature on community occupational therapists’ clinical reasoning was undertaken. Results: Fifteen textbooks and 25 articles, including six focussing on community occupational therapists’ clinical reasoning, were reviewed. Community occupational therapists’ clinical reasoning is influenced by internal and external factors. Internal factors include past experiences, expertise and perceived complexity of a problem. One of the external factors, practice context (e.g. organisational or cultural imperatives, physical location of intervention), particularly shapes community occupational therapists’ clinical reasoning, which is interactive, complex and multidimensional. However, the exact influence of many factors (personal context, organisational and legal aspects of health care, lack of resources and increased number of referrals) remains unclear. Conclusion: Further studies are needed to understand better the influence of internal and external factors. The extent to which these factors mould the way community occupational therapists think and act could have a direct influence on the services they provide to their clients.     

New Doors: A Community Program Development Model

SUMMARY

The need to provide occupational therapy services across a continuum of care has stimulated interest in moving into community-based arenas of practice. Limited job opportunities and lack of awareness of the benefits of occupational therapy are common barriers to this movement. This case study illustrates the “New Doors Model” and describes how a partnership between the university, master clinicians, students, and community agencies can result in (1) expanding occupational therapy services to facilities that have not historically interacted with occupational therapy, (2) training occupational therapists and occupational therapy students, and (3) promoting employment of occupational therapists by community organizations, and (4) a scholarship of practice that studies and supports the development of occupation based practice in community settings. The New Doors Model begins with exposing new sites to occupational therapy through level I fieldwork, progressing to level II fieldwork, and ending with creation of permanent occupational therapy positions     

Australian occupational therapy practice in acute care settings

Anational sample of occupational therapists was surveyed to explore the nature of Australian occupational therapy practice in acute care settings. Self-care was the major client need that therapists reported they addressed, with an initial interview being the most common assessment procedure. Client education was the most frequently used intervention. The most important skills therapists reported for effective practice in acute care were time management, quick clinical reasoning and lateral thinking. Important workplace characteristics included a cooperative healthcare team and early referral. Therapists reported that their most important resources were supportive senior therapists and a well-resourced equipment pool. Three attitudinal factors emerged. Therapists in interdisciplinary teams and those with more experience had more positive attitudes. Younger therapists experienced more concern about not being able to do more for their patients. Results suggest a need for graduates to be better prepared in some skill areas and to have more realistic expectations of practice in this area. Department managers need to ensure younger therapists receive adequate support from senior therapists. Further research is needed to determine how best to provide this support and to further examine the influence of the education experience on practice expectations.     

Understanding Occupational Therapy: Nursing and Physician Assistant Students' Knowledge About Occupational Therapy

Until very recently, occupational therapy services have been provided in institutional settings and have followed the medical model. The escalating costs of hospital care have been the primary incentives for moving patients out of acute settings and thus increasing the need for occupational therapy services in the community. Yet, relatively few therapists have moved from the medical model even though the need exists and legislation encourages that service be provided in the least restrictive alternative. Further, occupational therapists have been slow to adopt distinct strategies for planning with patients for their roles and needs after treatment even though the heart of the occupational therapy philosophy centers on adaptation to life roles. This paper explores the current trends away from institution-based health care and towards a continuum of health and social services, and the roles for occupational therapists in community settings. Occupational therapists are urged to act as facilitators in assisting patients to move successfully from active treatment to independence in whatever settings they find themselves.     

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 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.     

Refugee settlement workers' perspectives on home safety issues for people from refugee backgrounds

Background/aim: Refugees experience higher levels of emotional, psychological and physical distress than the general migrant population during settlement in a new country. Safety in the home can be a major concern and is an issue of which occupational therapists should be aware. Occupational therapists working with refugees in many contexts feel unprepared and overwhelmed. As refugee settlement workers attend to home safety of refugees during the settlement process, this study aimed to develop an in‐depth understanding of their perceptions of this issue. Such information can contribute to occupational therapists’ knowledge and practice when working with refugees. Methods: An exploratory qualitative case study approach used 16 semi‐structured interviews and observation of a settlement worker assisting newly arrived refugees. Participants were settlement service staff (an occupational therapist, case coordinators and cultural support workers). Results: Three themes are reported: considerations for safety in the homes of refugees; factors influencing home safety for refugees; and sensitivity to culture. Participants described tailoring home safety‐related services to each individual based on factors that influence home safety and sensitivity to culture. Conclusion: Awareness of home safety issues can increase cultural competence and inform practice and policy.     

Utopian visions/dystopian realities: exploring practice and taking action to enable human rights and occupational justice in a hospital context

Aim: This article reports some preliminary findings of an Australian action research project that aimed to investigate, and affect, occupational therapists’ understanding of human rights theory and occupational justice philosophy in everyday occupational therapy practice. Method: Over the course of one year, nine therapists from a range of practice areas in a major metropolitan hospital participated in monthly discussion groups. Narrative data was collected through audio‐recording and transcribing the discussions. Data was qualitatively analysed using line‐by‐line coding and theme‐building. Results: Two preliminary themes are discussed herein: the invisibility of human rights issues in an Australian occupational therapy setting and the dissonance between the ideal and the reality of human rights practice in occupational therapy. Conclusion: The authors suggest that through discussion, and with the support of a community of practice dedicated to exploring human rights and occupational justice issues, occupational therapists can increase their awareness of human rights challenges. And, therapists can increase their actions to better enable occupational justice in their practice.     

1982 Sylvia Docker Lecture Occupational Therapists must be Facilitators not Inhibitors of Action

After briefly reviewing the lecturer's 30 years as an occupational therapist, the proposition is discussed that occupational therapists are lucky people because of the role they have played and must continue to play as active people in professional associations and in the community. The need to extend therapists influence more widely in the community both as members of their own profession and of multidisciplinary teams is discussed. Reference is made to new and different areas of concern in South Australia in which occupational therapists have been and are actively involved.     

Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice

ABSTRACT

Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.     

Providing Education and Support Groups for the Ageing Population

This paper highlights the changing services in occupational therapy for the veteran population at the Repatriation General Hospital, Heidelberg, Victoria. This hospital primarily treats entitled veterans of all wars, including Vietnam, and their dependants. The average age of this population is increasing. The authors hope to describe how occupational therapists, in conjunction with other paramedicals, are rising to the challenge of helping to maintain quality of life, self-esteem and dignity for elderly patients and their care-givers. The needs of the elderly veteran population are no different from the needs of the majority of elderly people, so the information presented will be relevant to all occupational therapists working with the elderly.     

Novice occupational therapists' perceptions of readiness to undertake fieldwork supervision

Aim: This study investigated new graduate occupational therapists’ perceived readiness for the fieldwork supervisor role at a metropolitan Melbourne Hospital. Methods: Data from four in‐depth individual interviews and a focus group conducted with seven Grade 1 occupational therapists were analysed thematically. An iterative process was used to develop themes from the categories of data. Results: The new graduate occupational therapists’ perceived readiness for supervising students was strongly influenced by a sense of still learning themselves. High expectations were expressed of the supervisory role. Active support and supervision from the workplace and the university are seen as neccessary. Conclusions: A deeper understanding of the supervisory role and associated skills required for new graduate therapists is needed. Support from senior colleagues and workshops conducted by the university to up‐skill the therapists are recommended.     

National survey of Canadian occupational therapists’ assessment and treatment of cognitive impairment post‐stroke

Aim: This study examined variations in management of cognitive impairment post‐stroke among occupational therapists and factors associated with variations in practice. Methods: Canada‐wide cross‐sectional telephone survey. Clinicians’ practices were examined using standard patient cases (vignettes). Setting: Acute care, inpatient rehabilitation and community‐based sites providing stroke rehabilitation in all Canadian provinces. Participants: Occupational therapists (n = 663) working in stroke rehabilitation as identified through provincial licensing bodies. Main outcome measures: Type and frequency of cognition‐related problem identification, assessment and intervention use. Results: Respectively, 69%, 83% and 31% of occupational therapists responding to the acute care, inpatient rehabilitation and community‐based vignettes recognised cognition as a potential problem. Standardised assessment use was prevalent: 70% working in acute care, 77% in inpatient rehabilitation and 58% in community‐based settings indicated using standardised assessments: 81%, 83% and 50%, respectively, indicated using general cognitive interventions. Conclusion: The Mini‐Mental State Examination was often used incorrectly to monitor patient change. Executive function, a critical component of post‐stroke assessment, was rarely addressed. Interventions were most often general (e.g. incorporated in activities of daily living) rather than specific (e.g. cueing, memory aids, computer‐based retraining).     

Occupational Therapy: Still at Work

Many occupational therapists are moving into the field of occupational health and safety. This move is a reflection of the political and economic climate of Australia as well as the changing legislation related to occupational health. Only New South Wales legislation will, however, be examined in this instance. Occupational therapy's move from a medical model to a holistic conceptual basis has also resulted in an increased awareness of primary prevention strategies and health promotion. The workplace-based strategies which occupational therapists can offer the corporate sector are many and varied and reflect the unique contribution to be made by the profession to occupational health and safety.