Reliability and validity of the Canadian Occupational Performance Measure for clients with psychiatric disorders in Taiwan

The purpose of the study was to examine the reliability and validity of the Canadian Occupational Performance Measure (COPM) in Taiwanese clients with psychiatric disorders. The COPM was translated into Mandarin and tested on 141 Taiwanese clients. The average age of the clients was 35.6 years; 94% were diagnosed with schizophrenia. The results of the study showed that the test retest reliability of the COPM was r = 0.842. The COPM identified occupational performance problems that included self-care (37%), productivity (25%), and leisure occupations (20%). Fifty percent of the therapists were receptive in adapting the client-centred approach and applying the COPM in their clinical practice. It was concluded that the COPM can be applied reliably to Taiwanese clients. Furthermore, the COPM was valuable in identifying information related to occupational performance that could not be identified elsewhere. Since 50% of the therapists felt reluctant about the appropriateness of the client-centred approach in their culture, it was important to examine the gap between clients' judgements and actual performance, as well as to evaluate the feasibility of the client-centred concept in clinical practice. Finally, the concept of the client-centred approach needs to be disseminated and communicated to the occupational therapy profession in order that the COPM can be adequately applied in mental health practice.     

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.     

Attitudes of occupational therapy students toward older people in Hong Kong

The main objectives of this survey were to examine the attitudes of Hong Kong occupational therapy students toward older people and their perception of working with older clients. A questionnaire, with 23 statements related to these two areas, was designed and distributed to all three-year occupational therapy students during the first week of the academic year. Results found that the third year students were more positive in perceiving older people and showed greater interest in working with older clients (F=7.681, p<0.001; and F=8.05, p<0.005 respectively). Similar results were also obtained in those students who had clinical experiences with older clients in the above two areas (t=2.40, p<0.01; and t=2.47, p<0.01). Hence, a positive relationship between the education programme (including subjects taught and fieldwork experience) and students' perception of older people was confirmed. However, the feedback mechanism of these two components in the teaching curriculum requires further research.     

Beyond good practice: Issues in working with people with intellectual disability and high support needs

Many more people with an intellectual disability now live in the community as a result of de-institutionalization. Occupational therapy is one service that assists people with intellectual disabilities to participate as fully as possible in their local communities. Despite the potential benefits of occupational therapy, there is little written about the types of interventions used and the effectiveness of their outcomes with people with intellectual disabilities. The present interview study about current occupational therapy practice with people with intellectual disabilities and high support needs was conducted with experienced Australian clinicians. Positive outcomes for clients with high support needs were achieved in two ways: (i) by what therapists do; and (ii) by the features of the therapy relationship. In addition, interventions that indirectly empowered clients and changed others' perceptions were seen to have the most positive effect. The findings are discussed with regard to current occupational therapy literature and implications for occupational practice and education are presented.     

Diversity in occupational therapy: Experiences of consumers who identify themselves as minority group members

Background/Aim:  The occupational therapy profession is in need of self-examination in view of the extent to which culturally constructed meanings of occupation guide its work within an increasingly diverse practice environment.
Methods:  Semistructured interviews were completed with 14 individuals who defined themselves as minority group members in order to gain an understanding of their experience of the occupational therapy process.
Results:  Five themes emerged: the importance of social location, the need for safety and acceptance, avoiding omissions, understanding differences in occupation, and the face of discrimination.
Conclusions:  Cultural and sexual identities influence occupational choices and interface with the social location of the therapist to influence the therapeutic process. Despite holistic and client-centred values, the comprehensive nature of occupational therapy is not experienced by clients of minority groups. Practice models are needed that provide directives for the establishment of alliances with minority clients and that highlight the significance of exploring occupational choices, experiences of oppression and the impact of the therapists' culture on the therapeutic process.     

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.     

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.     

A survey on client-centered practice among danish occupational therapists

Background: In Denmark, the cost of healthcare services comprise 12% of the gross domestic product. A recommended method for optimizing effectiveness of and enhance client satisfaction with healthcare is client-centred practice (CCP), a central component of occupational therapy ideology. However, Danish occupational therapists’ perceptions of CCP, including the facilitators and barriers that may contribute to CCP, have never been examined.

Aim: To examine Danish occupational therapists’ perceptions of CCP.

Methods: A survey was conducted using an electronic questionnaire in a small, but representative sample of Danish occupational therapists from all regions and practices.

Results: Three hundred and forty-six occupational therapists (5%) responded. Of these, 98% rated CCP as important, 97% considered their work client-centred, and 92% were satisfied with their level of CCP. Having time to conduct self-directed work, using assessments to identify clients’ priorities, and CCP education, but not fixed regimes, were positively correlated with CCP.

Conclusion: Danish occupational therapists perceive to practice CCP and appear to have adopted the beliefs, theory and ideals of CCP, perhaps influenced by the egalitarian Danish culture. Self-directed work, means to identify and evaluate their clients’ wishes, and education facilitated CCP. Possible absence of occupational therapists not compliant with CCP makes further research warranted.     

Junior occupational therapists' continuity of employment: what influences success?

Considerable time, effort and expense are spent on educating occupational therapists for practice, yet little is known about the factors influencing the success of this process. This article details a study that investigated the influence of selected personal and environmental variables on British occupational therapists' continuity of employment one year post-qualification. Data were gathered using purpose-designed questionnaires and a semi-structured interview. The results linked respondents' retention in practice to issues of support, resources, success with clients, job satisfaction and the extent to which work matched their personal values. Respondents' withdrawal from practice was linked to issues of support, autonomy and a perceived discrepancy between their expected and actual practice. Their level of perceived responsibility was also cited as influential. These findings provide fuel for discussion and the opportunity to make recommendations for future occupational therapy policy, education and practice. Copyright © 1999 Whurr Publishers Ltd.     

Clients using community occupational therapy services: Sociodemographic factors and the occurrence of diseases and disabilities

Purpose: The aim of this study was to describe sociodemographic factors and the occurrence of diseases and disabilities among a representative sample of clients who were using community occupational therapy services in Norway. Method: A postal survey of occupational therapists about their last clients (n=168) was carried out in 2001. A survey questionnaire based on the International Classification of Functioning, Disability, and Health (ICF) was developed. Diagnoses were coded according to the International Classification of Primary Care (ICPC-2). Results: This study showed that more than half of the clients were adults, youths, or children. Only 17% of adults participated in “ordinary working life”, and of those approximately 10% were on sick leave and 62% were on disablement pension. A predominance of neurological diseases such as multiple sclerosis and Parkinson's disease was found (24%). Stroke was the most common principal diagnosis (19%). Musculoskeletal (16%) and mental diseases (13%) were also frequently reported. “Movement impairments” (96%) were most common in the body function component. Frequent problems in several domains of the activity and participation components were reported, in particular in “education, work and employment” (93–94%) and “recreation and leisure” (94%). Conclusion: Clients using community occupational therapy in Norway had numerous types of chronic and severe diseases, and a high occurrence of musculoskeletal impairment, activity limitations, and participation restrictions.     

Occupational narratives and the therapeutic process

Clients' occupational narratives reveal the overall meaning of life events, signifying their place in a plot that integrates past, present and future. Occupational narratives have also been demonstrated to predict how clients respond to therapy. A closer examination of the details of occupational narratives and how they unfold in the therapeutic context has the potential to give new insights into the experience of therapy by clients. This paper presents narratives of two clients in a vocational program for persons living with AIDS. Comparing their occupational narratives enables us to shed light on the differences between narratives that account for different client outcomes and the extent to which narratives can be impacted upon through occupational therapy intervention.     

A survey of Israeli occupational therapists' definitions of the profession

The broad definition of occupational therapy, its holistic basis and its unifying characteristics enable occupational therapists to treat their clients as whole human beings. Yet, the holistic basis of occupational therapy and the divergence of its specialty areas seem to be polarised. This study explores Israeli occupational therapists' perceptions of their professional role and boundaries, and how it is affected by professional background; 265 Israeli occupational therapists participated in the study. A two-part questionnaire was constructed: (1) an attitudinal questionnaire including statements on issues that concern occupational therapists regarding the definition of the profession and its role; (2) nine items representing the main unifying characteristics of occupational therapy. Results indicate seven factors underlying the main issues concerning occupational therapists in Israel. From the seven factors two main sources of tension were revealed: strong sense of self-value as compared to lack of recognition by others and the advantages and the pitfalls of the holistic definition of occupational therapy. The most unifying characteristic of occupational therapy was the holistic definition, and the least important was the use of arts and crafts. In addition, occupational therapists from developmental disabilities area of specialty were distinct from others in their perceptions of the profession.     

Thinking critically about client-centred practice and occupational possibilities across the life-span

Abstract

Background: Client-centred occupational therapy practice is tacitly guided by prevailing social values and beliefs about what are “normal” occupational possibilities. These values and beliefs privilege some occupations and negate others. Aim: This study aims to identify and problematize assumptions regarding the value of approximating normal occupational possibilities, showing how these assumptions influence and may diminish client-centred practice. Methods: Using empirical research examples it demonstrates how occupational therapists and clients are immersed in contexts that shape values and beliefs about what are considered “normal” occupations and how these taken-for-granted values structure occupational therapy practice. Conclusion: Critique of client-centred practice requires conscious reflexivity, interrogating our own and our clients’ predispositions to value some occupations over others. Engaging in critical reflexivity can help therapists develop new perspectives of how client-centred practice can be applied that includes enabling possibilities for occupations that would be missed altogether in the pursuit of “normal’.     

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

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.     

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.     

Occupational therapy practice with clients from non-English speaking backgrounds: A survey of clinicians in south-west Sydney

Australia is a multicultural society and this has important implications for the health care worker. The aim of this study was to investigate the experiences of occupational therapists who work with clients from non-English speaking backgrounds (NESB). The ‘cross-cultural therapy questionnaire’ was developed by the author and distributed to 65 occupational therapists employed in either the South-Western Sydney Area Health Service or Western Sydney Area Health Service. Issues explored in this questionnaire included barriers to cross-cultural care, strategies employed to overcome these barriers and theoretical models used to guide practice with ethnic clients. It was found that the majority of respondents experienced a number of obstacles to cross-cultural care within occupational therapy practice. An extensive list of strategies for overcoming cross-cultural barriers was compiled. The implications of these results for the profession of occupational therapy are discussed and future research directions are suggested.     

Utilization of the iPad application: Aid for Decision-making in Occupation Choice

The purpose of the study was to develop and evaluate an iPad (Apple) application, Aid for Decision-making in Occupation Choice (ADOC), so as to promote shared decision-making in an occupation-based goal setting. This application involves the client choosing from 94 illustrations describing daily activities related to the category of "activities and participation". One hundred occupational therapy clients evaluated the ADOC for goal setting; the clients and 37 occupational therapists underwent a survey to determine their perceptions of decision-making in the goal setting. More than 90% of the clients felt that they could give their opinions using the ADOC regarding goal setting. The majority of the occupational therapists (>90%) felt that ADOC would be useful in their clinical practice for setting client goals. The results indicated that ADOC is a useful and acceptable tool for both clients and occupational therapists in shared decision-making in occupation-based goal setting.