Nutrition knowledge and influence on diet in the carer–client relationship in residential care settings for people with intellectual disabilities

People with intellectual disabilities generally have poorer health outcomes compared with those who do not, including outcomes related to nutrition-related non-communicable diseases. Carers support people with intellectual disabilities in many aspects including habitual shopping and preparation of food, but their own nutrition knowledge and the influence this may have on dietary intakes of clients is unknown. We explored the nutrition knowledge of carers of people with intellectual disabilities in residential care settings, their dietary habits and their influence on clients' food shopping and preparation and therefore the diet consumed by their clients. Ninety-seven carers belonging to a large independent care sector organisation specialising in the care of people with an intellectual disability completed a validated general nutrition knowledge and behaviour questionnaire. Seventeen carers from the residential care settings were interviewed to contextualise practice. Knowledge about key dietary recommendations scored highly. Carers who had more work experience were found to have higher scores in ‘making everyday food choices’ (p = 0.034). Daily consumption of fruit and vegetables (at least one portion per day) was observed (for fruit by 46% of the carers and for vegetables by 60% of the carers), whilst most carers reported avoiding consuming full-fat dairy products, sugary foods and fried foods. The concept of a healthy diet; typical dietary habits of clients; role in food acquisition; and training in nutrition emerged as themes from the interviews. Carers discussed various topics including the importance of a balanced diet, cooking fresh foods and control of food portion sizes for clients relative to the care philosophy of a client-centred approach, which encapsulates client autonomy. Gaps in knowledge around specific nutrients, making healthy choices and cooking skills remain. Carers have an influence on clients' dietary choices; they are able to provide healthy meals and share good dietary habits with clients. Further training in nutrition is recommended for impact on clients' health.     

Client Perspectives on Occupational Therapy in Rehabilitation Services

The purpose of this qualitative study was to explore clients’ perspectives on the outcome of occupational therapy practice in rehabilitation and, furthermore, to look at certain components of practice and explore whether and how they may influence clients’ practice experience. Data were gathered through open, unstructured interviews with 20 adult clients after discharge from rehabilitation institutions in Iceland. Analysis of data was performed using both the constant comparative method and the coding procedures of the grounded theory approach. Results emerged around three interwoven categories: balance and enjoyment, enabling everyday life, and building a new future. Although mainly positive, people did also offer some negative points of view. Positive outcomes of occupational therapy are experienced at different levels and enhanced by organization of the therapy process, purpose and meaning of occupations, and the relationship between client and therapist. It is concluded that occupational therapists working in rehabilitation may have to pay more attention to their clients’ occupational issues and needs and involve them more in a goal-directed therapy process. Occupations used in therapy should be more balanced to meet the different needs of men and women and reflect the whole occupational spectrum of each individual.     

Menstrual management and intellectual disability: New perspectives

Assessment and education in self-care, ‘activities of daily living’ (ADL) have provided a traditional focus among occupational therapists. Available literature supports the teaching of self-care skills to clients who have severe and profound intellectual disability. Although some programmes have been developed to deal with menstrual management for women with mild and moderate intellectual disability, studies addressing the needs of women with more severe disabilities (high support needs) are sparse, and generally involve only small numbers of women. A menstrual management project based at the University of Queensland developed a model of intervention to assist with menstrual management for women with high support needs. Case studies illustrate three key areas of intervention: (1) assessment of the women's actual or potential menstrual management skills; (2) increasing awareness of attitudes towards menstruation for women who have intellectual disability, among people assisting them; and (3) provision of a range of information, processes and resources to assist educators, families and others providing personal assistance, with informed menstrual management for these women. Positive gains made by four women with high support needs are presented. Relevant issues and difficulties are discussed.     

Meeting the needs of elderly with bathing disability

Background/aims: Difficulties with bathing are frequent among older people and are associated with an increasing need for societal support. As loss of independence has a negative impact on health and wellbeing, it is important to study interventions that can provide the required support for people to be able to remain independent. Occupational therapy interventions can improve clients’ abilities enabling them to bathe themselves, thus reducing the need for other, more long‐term societal support from, e.g. a home help. In this study, two groups of elderly people with difficulties in bathing were compared; the clients in the intervention group were engaged in occupational therapy. Methods: A quasi‐experimental non‐equivalent control group design was used, in which participants with reported difficulties in bathing were recruited consecutively from two municipalities. The clients in the intervention group routinely received occupational therapy, whereas clients in the control group received assistance from a home help for bathing. Activities of daily living, quality of life and home‐help allocation were assessed at the baseline and after 15 weeks. Results: Clients in the intervention group received less than three home visits on average, with majority of interventions consisting of graded activity and the use of an encouraging approach. Seventy per cent of the interventions were adaptive. Activities of daily living and quality of life of both groups improved, but the differences of being allocated a home help were significant. Conclusion: Occupational therapy interventions seem beneficial in terms of supporting older people in becoming independent of home help in bathing but the results must be interpreted with caution as there were differences at baseline between the groups.     

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.     

昆明市五华区持证残疾人基本情况及康复需求调查分析

目的通过分析昆明市五华区持证残疾人目前面临的基本问题和康复需求,为今后全市的残疾人康复工作收集一些参考数据,为康复政策的制定提供理论依据。方法对五华区的7 537名持证的残疾人现状与康复需求进行问卷调查。结果男性有4 175名,占55.4%,女性3 362名,占44.6%;年龄3~99岁,平均50岁,肢体残疾占较大比例42.9%,其次视力残疾者(16.2%),智力残疾(12.2%),精神残疾(10.1%);49.4%的残疾人无劳动能力,39.2%能从事轻体力劳动;生活需求方面:对康复救助的需求最多(23.3%),其次是社会救助(17.2%)和申请低保(17.5%);在康复需求方面:视力残疾人主要的康复需求主要为视力功能训练(91.5%)、盲人定向行走训练(83.4%)和辅助器具需求(80.6%);听力残疾人主要的康复需求为听觉言语能力训练(80.2%);语言残疾人主要对听觉言语能力训练的需求(88.1%);肢体残疾人主要需求为运动功能训练(92.0%)、生活自理训练(64.0%)、作业治疗训练(79.4%);智力残疾人主要需求为感知认知能力训练(90.7%);精神残疾人主要需求为感知认知能力训练(32.0%),多重残疾人对各项康复训练都有需求。不同残疾类型残疾人对生活和康复的需求有所不同。结论昆明市五华区持证残疾人涵盖各类残疾,残疾人就业范围局限,就业率偏低,不同残疾类型的残疾人对生活和康复的需求有所不同,残疾人的生产生活水平偏低,需要政府和社会根据不同残疾人的康复需求给予全方位救助。     

Seeing white: a critical exploration of occupational therapy with Indigenous Australian people

This paper aims to critique current occupational therapy practice and theory using Indigenous Australian people as a case example. Critical race theory will be used to help question the privileged position of an occupational therapist from a dominant Westernized culture. In-depth interviews were conducted with 15 (eight female and seven male) Indigenous Australian young people about their perspectives of health and physical activity. In addition, the Kawa model was used as an alternative data-collection tool and detailed field notes and researcher reflections were used as data sources. Preliminary analysis of data is used to illustrate the ways in which critical race theory can inform occupational therapy practitioners and researchers about the ways Indigenous Australian young people view their health. Methodological dilemmas are also discussed. The paper is based on preliminary findings and further analysis needs to continue. Cross-cultural research is inherently complex but can offer those from the dominant culture valuable insights into their taken-for-granted assumptions. Further use of critical race theory may prove useful as the occupational therapy profession continues to evolve its understanding of cultural safety.     

Psychiatric occupational therapists' verbal interaction with their clients

This study reports from a survey investigating psychiatric occupational therapists' (n=292) use of verbal interaction on a regular basis with their clients. Among predefined areas of verbal interaction, routine occupations, self-image and ego-strengthening interventions were among the most frequently given alternatives. Verbal interaction with clients was more common among occupational therapists in outpatient care than among those in inpatient care. Verbal interaction with clients was also more common among occupational therapists with advanced education in psychodynamically oriented psychotherapy. The respondents' use of theoretical frames of reference was related to the focus of their verbal interaction with clients. Interventions to reach certain goals emerged as the most common category of verbal interactions. It was concluded that verbal interaction with clients is essential to the occupational therapy process. Future research needs to investigate the interplay between verbal and non-verbal components of interaction in occupational therapy and how patients benefit from these elements.     

Cost‐effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials

A systematic review of the cost‐effectiveness of occupational therapy for older people was conducted. MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library, OT seeker and unpublished trials registers were searched. Reference lists of all potentially eligible studies were searched with no language restrictions. We included trial‐based full economic evaluations that considered both costs and outcomes in occupational therapy for older people compared with standard care (i.e. other therapy) or no intervention. We reviewed each trial for methodological quality using the Cochrane risk of bias tool and assessed the quality of economic evaluations using a Drummond checklist. In the results of this review, we included five eligible studies (1–5) that were randomized controlled trials with high‐quality economic evaluation. Two studies were full economic evaluations of interventions for fall prevention (1 and 2); two studies were full economic evaluations of preventive occupational therapy interventions (3 and 4; one was a comparison of an occupational therapy group with a social work group); one study was a full economic evaluation of occupational therapy for individuals with dementia (5). Two of the studies (one was preventive occupational therapy [3] and the other was occupational therapy for dementia [5]) found a significant effect and confirmed the cost‐effectiveness of occupational therapy for older people compared with the control group. These studies found that occupational therapy for older people was clinically effective and cost‐effective in comparison with standard care or other therapies. With reference to their clinical implication, these intervention studies (using a client‐centred approach) suggested potentially cost‐effective means to motivate clients to maintain their own health. However, this review has limitations because of the high heterogeneity of the reviewed studies on full economic evaluations of occupational therapy for older people. Future studies on the cost‐effectiveness of occupational therapy in older people are strongly warranted. Copyright © 2015 John Wiley & Sons, Ltd.     

Early intervention services in daily family life: mothers' perceptions of ‘ideal’ versus ‘actual’ service provision

Although the occupational therapy and early intervention literature espouses a family-centred approach to intervention, families have rarely been asked about their experiences of these services. This paper describes a qualitative study that aimed to identify and explore parents' perceptions of occupational therapy services and the impact of these services in their daily family life. Ten mothers of children (aged 0–6 years) with disabilities and high support needs completed questionnaires and semi-structured, in-depth interviews. Analysis revealed that mothers thought in terms of early intervention services in general, rather than in terms of occupational therapy specifically. Mothers used early intervention services primarily to enhance their child's abilities, while considering what was best for their family and, as a lesser priority, themselves. Ideally, relaxed and friendly service providers were perceived as having a greater insight into daily family life, and therefore a greater capacity to provide services to meet family needs (e.g., flexible, home-based services). However, the mothers in this study did not experience many ‘ideal’ characteristics of services and service providers, suggesting that changes are needed in occupational therapy practice and in the education of therapists. Implications for occupational therapy education and practice are discussed in the context of the family-centred literature, and recommendations are made for future research with families. Copyright © 1998 Whurr Publishers Ltd.     

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.     

Effects of occupational therapy intervention on activities of daily living and awareness of disability in persons with intellectual disabilities

Aim:  The purpose of this study was to evaluate the effects of an occupational therapy intervention program on activities of daily living (ADL) ability and awareness of disability.
Methods:  Six persons with intellectual disabilities participated in the study, which was based on a single-case design. Assessment of Motor and Process Skills and Assessment of Awareness of Disability were used as evaluation tools.
Results:  Activities of daily living performance improved in five of the six participants after implementation of the program, with improvement across both motor and process skills. However, no clear improvement in awareness of disability was found following implementation of the program.
Conclusion:  It may be concluded from this study that persons with intellectual disabilities can benefit from occupational therapy interventions to improve ADL ability, even in the absence of any change in their awareness of disability.     

Narrativising Envisioned Futures by Adolescents with Significant Intellectual Disabilities

This study sought to understand what the narratives of young people with severe intellectual disabilities revealed about their envisioned future, articulated as desired post-school outcomes. Drawing upon a case study involving in-depth interviews of families and adolescents with intellectual disability attending secondary school in the southern region of the United States, this article highlights ways in which adolescents with intellectual disability are disrupting and subverting master discourses of normalcy that limit their lives by re-articulating their gendered and sexual selves, thereby moving transition research into the little-researched realm of qualitative adult outcomes. This article raises a number of critical questions about the social construction of “disabled adolescence” utilising a disability studies perspective and emphasising nuanced ways of understanding youth voice. The article explores the social construction of gender and sexuality from the standpoint of adolescents with intellectual disability and addresses some of the complexities of “voice” when doing research with young people with severe intellectual disabilities and the contradictions of parents’ roles in the process.     

People into Employment: supporting people with disabilities and carers into work

Carers and people with disabilities are two disadvantaged groups at risk of social exclusion. Work is an important route to social inclusion, but carers and people with disabilities are under-represented in the work force. The present paper reports key findings from a new study that evaluated People into Employment (PIE), a pilot employment project in the north-east of England designed to support people with disabilities, carers and former carers in gaining mainstream work. The study aimed to identify what clients, partner agencies and employers perceived to be PIE's most important services, its strengths and areas where there was scope for further development. The study collected quantitative and qualitative data at the mid-point and at the end of the project through two questionnaire surveys, and interviews with PIE clients, the project development officer, partner agencies and employers. Drawing on the 'pathway model', the findings show that PIE's interventions included mobilising, matching, mediating and supporting activities. Key ingredients in PIE's success include: tailor-made job-search activities and training; adjusting the pace at which people move towards sustained employment; recognising and responding to the differing needs of people with disabilities, carers and former carers; confidence boosting; accompanying clients to job interviews; good job matching; and ongoing practical and emotional support for both clients and employers. Rudimentary calculations suggest that the cost per job to the project is less than the cost per job for large national projects. Overall, these findings illustrate how access to employment via flexible job-search services geared up to the local labour market can successfully promote social inclusion for carers and people with disabilities.     

Promoting job safety for workers with intellectual disabilities: the staying safe at work training curriculum

In the United States, approximately 125,000 people with disabilities are employed through Community Rehabilitation Programs in manufacturing, assembly, and service jobs. These jobs have significant hazards and, consequently, the workers are at risk of injury. Training that empowers workers to participate in prevention efforts can help reduce work-related injuries. In general this kind of health and safety training in the United States is limited. It is even more so for workers with intellectual disabilities, in part because there have not been programs for teaching individuals with cognitive challenges health and safety skills, adapted to their learning needs. This paper describes the development and promotion of the Staying Safe at Work curriculum of UC Berkeley's Labor Occupational Health Program, which is designed for use by support agencies and employers of workers with intellectual disabilities. The goal of this program is to teach these workers essential occupational safety and health skills in a manner they can understand.     

Meeting the health needs of older people with intellectual disabilities: exploring the experiences of residential social care staff

Older people with intellectual disabilities often experience high levels of health needs and multiple morbidities but they may be supported by residential care staff with little or no previous experience of identifying and meeting health needs. Little is known regarding how they undertake this health‐related role and this exploratory study seeks to address this gap. A purposive sample of 14 managers of supported living accommodation in Wales were interviewed in 2014 to determine their experiences of supporting tenants in relation to age‐related health needs. The semi‐structured interviews were transcribed and thematically analysed. Three of the emerging themes are reported in this paper: meeting health needs, the consequences of ageing and relationships. Findings indicate that residential care staff support older people with intellectual disabilities with complex and multiple health needs: they monitor health status, support access to healthcare, provide additional support arising from changing health needs and advocate for tenants in the context of healthcare. However, their role is often not understood by healthcare professionals. The importance of staff having a long‐term relationship with those they support was identified as being important to identifying any health‐related changes. The need to develop effective relationships with healthcare staff was also noted. It is concluded that there is a need for better understanding among health staff of the role of residential social care workers and for further research regarding health‐related communication.     

Occupational therapists' practice patterns for clients with cognitive impairment following acquired brain injury: development of a questionnaire

Clients with cognitive impairment following acquired brain injury (CIABI) are a common group to receive occupational therapy services. Research has shown that occupational therapy has a positive effect on occupational performance for these clients, but the exact nature of the interventions is not clearly described and needs to be better understood and defined. The aim of this study was to develop and evaluate an empirically derived questionnaire for the purpose of surveying occupational therapists' (OTs') practice patterns in relation to CIABI. The questionnaire was developed from the results of a former qualitative study. It was evaluated for content validity by a group of six OT researchers with experience in CIABI, using the content validity index (CVI). Reliability was evaluated by a test-retest design with a group of 51 OTs. Data were analysed by non-parametric statistical methods. Initially the questionnaire consisted of 90 items dealing with OT practice and nine demographic questions. After the reliability and content validity process the OT practice items were reduced to 44. The revised questionnaire will be used to survey and explicitly describe occupational therapy practice for clients with CIABI.     

Challenges for safer sex education and HIV prevention in services for people with intellectual disabilities in Britain

This paper reviews progress and competence in HIV prevention work for people with intellectual disabilities in Britain. It identifies key challenges for specialist residential support and sex education services for people with intellectual disabilities, as well as for mainstream health promotion services. The discussion is informed by research and practice evidence and explores ways to develop competence in safer sex education, offering suggestions for HIV risk assessment and risk management. While the paper demonstrates that the politics of sexuality and HIV are difficult for services to manage, the rights of people with intellectual disabilities to information and support for sexuality and sexual health should be put first.