The Tree Theme Method as an intervention in psychosocial occupational therapy: Client acceptability and outcomes

Background/aim:  The Tree Theme Method (TTM) is an intervention in which the client paints trees representing certain periods in his/her life. The intervention comprises five sessions, using trees as a starting point to tell one's life story. This study, which is part of an implementation project, aimed to examine the therapeutic alliance and client satisfaction, in relation to perceptions of everyday occupations and health-related factors, with clients going through a TTM intervention.
Methods:  Nine occupational therapists recruited 35 clients, at general outpatient mental health care units, for the TTM intervention. Self-rating instruments, targeting therapeutic alliance (HAq-II), different aspects of daily occupations (Canadian Occupational Performance Measure, Satisfaction with Daily Occupations), health-related factors (Sense of Coherence measure, Mastery Scale, Symptom Checklist-90-R) and client satisfaction (Client Satisfaction Questionnaire), were administrated before and after the intervention.
Results:  A good initial therapeutic alliance, experienced by both therapists and clients, was correlated to increased changes regarding occupational performance and self-mastery. According to the therapists' ratings, a good initial therapeutic alliance was correlated to increased sense of coherence and a decreased level of psychiatric symptoms. The results showed positive significant changes in occupational performance and health-related factors. High ratings of the therapeutic alliance by the therapists were also related to high client satisfaction.
Conclusions:  The TTM seemed to function well in psychosocial occupational therapy, but there is a need for further implementation studies to deepen our understanding of the treatment process, comprising both technique and formation of the therapeutic alliance.     

Job satisfaction in occupational therapy: a qualitative investigation in urban Australia

Background:  Job satisfaction has been shown to affect levels of staff retention and work productivity, but few studies have been conducted with occupational therapists in an Australian setting.
Methods:  Using a hermeneutical phenomenological approach, the findings from a study examining the factors that contribute to job satisfaction in occupational therapists working in Australia, are reported.
Results:  Job satisfaction in occupational therapy was derived from the sense of achievement felt when providing effective clinical care. Job dissatisfaction stemmed from the poor profile and status of the profession.
Conclusions:  Based on the study findings, there is an imperative that the profession of occupational therapy continue to use research findings to support clinicians in providing effective health care, and improve the community understanding of occupational therapy.     

Understanding where we come from: Occupational therapy with urban Indigenous Australians

Background:  This article outlines issues of service provision for Indigenous families in Brisbane, Australia. It presents guidelines for the development of a socially and culturally appropriate occupational therapy service for urban Indigenous children.
Methods:  A mixed methodology was used in two independent components of the research. Part 1 comprised a survey of paediatric occupational therapists in Brisbane. Part 2 consisted of focus groups and interviews with recipients of a newly established occupational therapy service for Indigenous children.
Results:  Survey findings indicated that very few Indigenous families access mainstream occupational therapy services. Issues and strategies for developing culturally appropriate practice emerged around five main themes. These were the need to develop effective relationships, develop particular personal qualities, understand the background of both the client and the therapist, both gain and give knowledge, and address logistical issues of service delivery.
Conclusions:  Service providers need to understand the social and cultural context of both their Indigenous clients and themselves. Recommendations for future education and practice are provided.     

What older people do: Time use and exploring the link between role participation and life satisfaction in people aged 65 years and over

Objectives:  Data on time use and role participation can provide rich information that can help occupational therapists better understand older people's lives. This study aimed to (i) describe the time use and role participation of community-dwelling people aged 65 years and older, (ii) analyse whether time use and role participation changed with increasing age, and (iii) determine if there is a link between maintenance of role participation and life satisfaction in older age.
Methods:  Using a cross-sectional design, interviews including the Activity Configuration, Role Checklist and Life Satisfaction Index-Z were used to collect data on 195 participants (mean age 75 years, 58.5% female).
Results:  Participants spent most of their time on sleep (8.4 h/day), solitary leisure (4.5 h/day), instrumental activities of daily living (3.1 h/day), social leisure (2.7 h/day) and basic activities of daily living (2.6 h/day). The most common roles were friend (96.4%), family member (95.4%) and home maintainer (87.2%). Participants aged 75 years and older spent significantly more time on solitary leisure and less time on paid work and transport compared to those aged 65–74 years. Role maintenance was significantly related to greater life satisfaction in participants aged 75–84 years.
Conclusion:  Older people's occupations and roles are diverse, and increasing age does not appear to reduce occupational or role engagement. The value of roles is not always reflected in the amount of time devoted to them and facilitating continued participation in valued roles may be important for older people's life satisfaction.     

Workers' compensation insurance agents' satisfaction with occupational therapy activities of daily living assessments

Background and Aim:  Little is known about insurance agents' (insurers) satisfaction with the services provided by occupational therapists when they assess injured workers' activities of daily living (ADL). Demonstration of accountability and provision of high-quality services are important to the occupational therapy profession. The aim of this study was to evaluate insurers' overall satisfaction with occupational therapy ADL assessments for injured workers, including communication, timeliness of reports, equipment provision, knowledge of insurers' requirements and the workers' compensation process, and provision of a professional opinion. Relationships between insurers' overall satisfaction with ADL assessments, degree of experience in their job, formal qualifications and roles within their organisation were also investigated.
Method:  A telephone survey was developed and administered to a sample of 40 claims officers and injury management advisors from 10 Victorian Work Cover Authority authorised agents.
Results:  Insurers were generally satisfied with occupational therapy ADL assessments. They were less satisfied with occupational therapists' knowledge of workers' compensation system requirements and how occupational therapists made decisions when recommending household services.
Conclusion:  To improve services to the insurance industry, occupational therapists need to better understand relevant legislative frameworks.     

Do written education materials that use content and design principles improve older people's knowledge?

Background/Aim:  Information may inform and empower clients to engage in their health care. Information can be provided in written form, but it is only effective if it can be read and understood by clients. This study examined whether the knowledge acquisition of participants aged 65 years and older improved more after reading leaflets revised according to content and design principles compared to the leaflets in their original form.
Methods:  Seven participant pairs (mean age was 74 years, 79% were women), matched according to reading ability, read either the original or the revised versions of four leaflets used by occupational therapists with older clients. Knowledge before and after reading the leaflets was measured using true/false tests developed for each leaflet.
Results:  After adjusting for differences in baseline knowledge scores, participants who read the revised leaflets acquired 55.3% more knowledge than those who read the original leaflets. All but one participant preferred the revised versions of the leaflets.
Conclusions:  Simply written and clearly presented written education materials may improve clients' understanding of the content. Further research is needed to determine if one or a combination of the content and design principles used to revise the leaflets is effective in increasing clients' knowledge.     

Queensland extended care services for people with severe mental illness and the role of occupational therapy

Background:  People with serious mental illness in Queensland who require extended rehabilitation may be treated in extended inpatient mental health services. Two of these extended inpatient services, hospital and community-based 'Extended Treatment and Rehabilitation Units (ETRUs) and Community Care Units (CCUs)', are described, including the aims, objectives, philosophy and service delivery.
Methods:  A quality project involving occupational therapists working in these settings, as well as a consumer and carer, provides different perspectives concerning these relatively new health services in Queensland.
Results:  Two main occupational therapy roles were identified: case management and occupational therapy-specific roles (including assessment and intervention). The consumer and carer perspective is also presented.
Conclusion:  These services provide a positive option for people with high levels of functional disability as a result of mental illness and also for their carers. They provide environments with many exciting opportunities and challenges for occupational therapists working in mental health.     

病人满意度的调查与评价

对病人满意度调查与评价过程中研究对象的选择、样本容量、问卷设计、调查的实施方法、问卷的评价等方面存在的常见问题进行了综述。     

Satisfaction with Daily Occupations: Construct validity and test–retest reliability of a screening tool for people with mental health disorders

Background/Aim:  In occupational therapy research and in clinical practice there is a need for valid, reliable and easily administered measures. For research and screening purposes, the Satisfaction with Daily Occupations (SDO) instrument was developed. It addresses work, leisure, domestic tasks and self-care and generates a satisfaction and an activity level score. This study investigated its construct validity, internal consistency and test–retest reliability in 55 clients visiting occupational therapists in outpatient mental health care.
Methods:  The SDO was administered on two occasions with a 1-week interval, and data on the Canadian Occupational Performance Measure (COPM), psychosocial functioning and self-rated health were collected on the first of these occasions.
Results:  In contrast to what was expected, the relationships between the SDO scores and the COPM scores were low. The strongest relationship between the SDO satisfaction score and any other variable was to psychosocial functioning. These variables shared 23% of the variance. Internal consistency for the satisfaction score was acceptable, alpha = 0.75 on the second occasion, and the test–retest reliability was good; r _s   = 0.84 for the satisfaction score and r _s   = 0.92 for the activity level.
Conclusions:  The results indicated that the SDO has satisfactory reliability. The instrument targets a specific construct, as compared to the COPM and the measurements of self-rated health and psychosocial functioning. Thus, the SDO and the COPM satisfaction scale seem to assess different phenomena, probably because the SDO has predefined items, not specifically targeting a certain client's problematic occupations, whereas the COPM is based on self-defined problems. The instruments may therefore supplement each other.     

Clinical utility of the Handicap Assessment and Resource Tool: An investigation of its use with the aged people in hospital

Aims:  This article presents the findings of a qualitative study investigating the clinical utility of the Handicap Assessment and Resource Tool (HART). Clinicians' perceptions of the HART were explored in its use in acute hospital settings in a regional health service in New South Wales, Australia.
Methods and Results:  The study, which used in-depth, structured interviews with clinicians working in acute aged care, identified key themes, which point to an overall positive perception of the HART's clinical utility. The themes, identified through thematic analysis were: responses to structural features of the HART; processes of administration; perceived benefits for clients; and clinical utility in context. The article concludes with recommendations for the assessment of aged people in acute hospitals and the need for occupational therapists to continue analysing and establishing the clinical utility of the profession's assessment tools.
Conclusion:  The findings of the study support the clinical utility of the HART when used with aged people in acute care settings. Overall, though participants found it time consuming to administer, they judged the HART to be a context sensitive tool that addressed the complex needs of their patients.     

Inpatients' perspectives of occupational therapy in acute mental health

Background:  Research into service users' views of occupational therapy in acute mental health is extremely limited. This collaborative study by the South West London and St George's Mental Health NHS Trust and the Brunel University (UK) obtained inpatients' perspectives of occupational therapy.
Methods:  Service users and occupational therapists were involved in designing a self-report questionnaire and, following training, in recruiting participants and collecting data.
Results:  Sixty-four (28.6%) inpatients responded and most had met an occupational therapist who had explained the purpose of the intervention. The most frequent group interventions were arts and crafts, relaxation, community meetings, cookery, sports and gym, with the latter two rated as the most beneficial. There was much less choice about individual goals and interventions. A highly significant and positive correlation was found between occupational therapy meeting the needs of individuals and it improving the inpatients' daily functioning and quality of their admission.
Conclusions:  Occupational therapists need to provide more individual interventions and more fully involve inpatients in deciding on individual goals. Group interventions, which are meaningful, relevant and with an occupational focus, are most beneficial. Further research examining the effectiveness of cookery and sport and gym and establishing the benefits of engaging in group and individual interventions in acute wards is warranted.     

Perceptions of occupational therapists practising in rural Australia: A graduate perspective

Background:  The difficulty in recruiting and retaining health professionals into rural and remote areas of Australia is well recognised. This study explored the perceptions of occupational therapists practising in rural locations regarding the essential skills necessary for rural practice and the ability of undergraduate education to prepare them for rural practice.
Methods:  A qualitative study using a phenomenological approach was conducted using semistructured in-depth interviews. Participants included occupational therapists who were graduates of James Cook University, who were practising in rural areas in Queensland and Victoria, and academic staff.
Results:  This study demonstrates that it is important for universities to develop both a mindset in their graduates for rural practice, as well as developing broader skills in addition to core discipline-specific skills. While subjects developing core occupational therapy skills are at the centre of undergraduate education, the importance of developing a broader understanding of rural health issues and skills in public health, primary health care and health promotion was emphasised.
Conclusion:  The development of specific skills to become competent rural practitioners and to cope with the challenges of rural practice can be strengthened through initiatives at the undergraduate level. Ongoing commitment from all universities across Australia to include rural curriculum content has the potential to improve recruitment and retention of occupational therapists and other health professionals into rural Australia.     

The introduction and evaluation of an occupational therapy assistant practitioner

Background and Aim:  This paper describes the introduction and evaluation of an extended role occupational therapy support worker, called an 'occupational therapy assistant practitioner'.
Methods and Results:  The evaluation took place within a single health care trust and involved focus groups with four groups of stakeholders: assistant practitioners; their supervisors; managers; and service users. The evaluation identified a lack of access to appropriate training; ambiguous supervision and accountability relationships; and a lack of a clear career direction for qualified occupational therapists, creating uncertainty about which aspects of their job they should be 'giving away'.
Conclusions:  There is a need to clarify career structures and accountability relationships between existing and new staff members and ensure that appropriate training is available to support staff in their new roles.     

Exploration of Australian and New Zealand indigenous people's spirituality and mental health

Background:  Spirituality has been defined as an overarching construct that involves personal beliefs or values that provide a sense of meaning and unity with self, people, nature and universe. Spirituality may be experienced within or outside formal religion. At least in English-speaking countries, therapists reported discussing spiritual issues with service users more frequently than before. In the literature, there continues to be debate regarding definitions of spirituality and how spirituality fits with occupational therapy practice models.
Methods and Results:  To advance the discussion, we explore the concept of spirituality among indigenous people of Australia and New Zealand, and use mental health as a practice setting to suggest how occupational therapists can address the spiritual needs of individuals recovering from mental health problems.
Conclusion:  The implications for assessment and interventions to improve coping skills, social support, self-esteem and instil hope of recovery from mental illness are considered.     

Occupational therapy in acute hospitals: The effectiveness of a pilot program to maintain occupational performance in older clients

Background:  Research evidence suggests that during acute hospitalisation, older people may experience reduced occupational performance, reduced quality of life, and an increased length of hospital stay. The aim of this study was to pilot a randomised controlled trial to determine whether an additional occupational therapy program could assist older adults to maintain their occupational performance.
Methods and Results:  A pilot study evaluated 15 clients on admission to and discharge from an acute hospital, using measures of level of independence in performing daily activities, quality of life, and confidence. Participants were randomly allocated to either the control group (those receiving current allied health management) or the experimental group (those receiving an additional program, which included daily self-care, domestic and community activities). Although the differences between the groups on admission and discharge measures only approached statistical significance, several benefits of the program were noted by clinicians and clients, and are highlighted through the presentation of client case studies.
Conclusion:  This pilot has highlighted the need for future research on deconditioning, the timing and nature of occupational therapy interventions, and environmental and cultural influences in acute care for older people.     

Discharge decision-making with older people: The influence of the institutional environment

Background/Aim:  Occupational therapists often participate in decision-making about postdischarge accommodations. This paper presents the findings of a study that identified and explored institutional factors influencing discharge accommodation decision-making with older people, from the perspective of occupational therapists.
Methods:  Qualitative, semistructured, face-to-face interviews were conducted with 10 occupational therapists. Interviews were recorded, transcribed, coded and analysed for the presence and emergence of themes.
Results:  Decision-making processes were influenced by the institutional environment. The medical model and pressure for fast decisions seemed to impede client-centred processes in acute settings.
Conclusions:  When possible, decision-making about long-term care needs to occur in community or longer-stay rehabilitation settings that allow time for negotiated client-centred processes.     

Cultural differences: The experience of establishing an occupational therapy service in a developing community

Aim:  This paper documents the subjective experience of a Western trained occupational therapist as she establishes a service in a community that is developing its health-care services. The community is located in the Dominican Republic.
Method and Results:  Ethnographic interviewing was used to document the tasks and events that occurred during this 6 month project. Challenges arose related to the region's developing health, education and community services, training the local workers and the reaction of the recipients of occupational therapy service. The contrast in beliefs, values and cultural customs between the therapist and the local people contributed to the challenge.
Conclusion:  This study indicates that exporting Western occupational therapy services without any changes causes significant conflict for the professional and the clients. Furthermore, this study demonstrates the importance of understanding cultural differences between the therapist and client, as well as the need for occupational therapy services in communities that seek to improve the health and abilities of the local people requiring rehabilitation services.     

How and why do occupational therapists use the OTseeker evidence database?

Background:  OTseeker is a free online bibliographic database containing systematic reviews and methodological ratings of randomised controlled trials relevant to occupational therapy. The database aims to help therapists efficiently identify high quality pre-appraised research.
Aim:  This study explored the search practices of therapists who regularly used OTseeker, what they did with the information retrieved and their perceptions of the database.
Sample:  A purposive sample of 11 occupational therapists was recruited in 2004. All had visited OTseeker at least five times in the previous 12 months.
Study design:  Qualitative.
Methods:  A semistructured interview was conducted with each participant. Grounded theory methods were used for analysis.
Findings:  Five distinct categories were identified: reasons for visiting OTseeker, learning about OTseeker, search times and locations, using information from OTseeker, and improving OTseeker. Therapists used the database to teach or model evidence-based practice, answer clinical questions and keep up-to-date. Suggestions for improvement focussed on search functionality, access to abstracts and the location of the PEDro rating scale. Only two participants synthesised information from OTseeker into a summary, and/or used it to inform client reports.
Conclusion:  This study suggests that OTseeker is helping to increase research utilisation by occupational therapists. Further research is needed to help therapists apply research evidence to change practice and policy.