OZ OT EBP 21C: Australian occupational therapy, evidence-based practice and the 21st century

Occupational therapy in Australia is entering the 21st century as a dynamic and growing profession. The adoption of evidence-based practice is an important feature to ensure the profession's continued success. There are also other issues evident in Australian occupational therapy today that need to be considered to ensure the profession's continued growth. These are: the terminology that is and could be used in occupational therapy; the possibility of 'collateral damage' to occupational therapy concepts and processes if deterministic elements of evidence-based practice predominate; and the importance of making explicit our national position on occupational therapy core concepts and processes. Regarding the latter, the author proposes that this position is best described as 'finding unity in diversity'. This position reflects the national heritage, character and social/health priorities facing Australian occupational therapy. The implications of these issues are explored.     

Interprofessional vs. interdisciplinary services in school-based occupational therapy practice

Interdisciplinary or transdisciplinary service is strongly advocated in school-based occupational therapy practice. The terms, interdisciplinary and transdisciplinary, however, are not accurate in their use. This paper examines the difference between the terms of discipline and profession and recommends the more precise and appropriate use of interprofession and transprofession related to school-based occupational therapy practice. Occupational therapy is a profession, not a discipline. Using the terms of interprofession and transprofession can benefit the occupational therapy profession by increasing language use precision, facilitating professionalism, and improving interprofessional interactions and collaborations based upon accuracy.     

The illusion of client-centred practice

Abstract

Aim: A critical analysis of occupational therapy practice in the corporate health care culture in a free market economy was undertaken to demonstrate incongruence with the profession’s philosophical basis and espoused commitment to client-centred practice. Findings: The current practice of occupational therapy in the reimbursement-driven practice arena in the United States is incongruent with the profession’s espoused philosophy and values of client-centred practice. Occupational therapy differentiates itself from medicine’s expert model aimed at curing disease and remediating impairment, by its claim to client-centred practice focused on restoring health through occupational enablement. Practice focused on impairment and function is at odds with the profession’s core tenet, occupation, and minimizes the lasting impact of interventions on health and well-being. The profession cannot unleash the therapeutic power of human occupation in settings where body systems and body functions are not occupation-ready at the requisite levels for occupational participation. Conclusion: Client-centred practice is best embodied by occupation-focused interventions in the natural environment of everyday living. Providing services that are impairment-focused in unfamiliar settings is not a good fit for client-centred practice, which is the unique, authentic, and sustainable orientation for the profession.     

Client-centred practice in occupational therapy: Critical reflections

Abstract

Aims: The occupational therapy profession has long proclaimed its commitment to a client-centred philosophy of practice and the assumption that occupational therapists consistently practice in a client-centred manner has become central to the profession's self-image and public rhetoric. However, client-centred practice has been subjected to little critical reflection within the occupational therapy profession. The aim of this paper is to foster critical reflection concerning the authenticity and veracity of the profession's commitment to client-centred practices. Major findings: Client-centred practice is defined without evident reference to clients' perspectives. Few occupational therapy researchers have sought clients' perceptions of the client-centred nature of their occupational therapy services. Occupational therapy research is neither consistently undertaken in a collaborative manner, nor are the profession's theories developed through explicit reference to a diversity of clients' perspectives. Professional practices and service evaluations do not consistently seek clients' viewpoints. Client-centred rhetoric is politically expedient and may be a professionalizing strategy employed to increase status and entrench power. Practice conclusion: Although exemplary client-centred occupational therapy practices exist, evidence suggests that the profession does not adhere consistently to its espoused client-centred principle in all its practices. The client-centred practice of occupational therapy should be subjected to assiduous critical reflection.     

Adolescent Development

Adolescence is a period of development considered by most to be transitory. It is often viewed as filled with storm, rebellion, and conflict. Although the profession of occupational therapy has developed special practice areas and generated research in the areas of pediatrics and gerontology, little focus in our literature has been placed on adolescents and their special needs in development and treatment. This paper presents an overview of normal development in adolescence. The model of human occupation is used as structure to organize research from other fields to provide therapists with useful guidelines for treatment.     

Icelandic occupational therapists' attitudes towards educational issues

The purpose of this study was to assess the readiness of occupational therapists in Iceland to accept a professional as opposed to a technical view of the profession. Most Icelandic occupational therapists were educated in other countries, with little emphasis on liberal arts, sciences and research. The first Icelandic occupational therapy programme, a university-level programme, was founded in 1997. All Icelandic occupational therapists were surveyed. Eighty-seven questionnaires were sent out and 80 (92%) were returned and used for statistical analysis. The results of the study showed that Icelandic occupational therapists valued academic skills over technical skills, emphasizing occupational therapy theory unique to the profession and research to validate practice. More recognition among other health professionals was considered the most needed change in the profession. The results of the study showed that the clinicians' attitudes confirmed in general what is emphasized in the curriculum and in students' fieldwork. Further research is needed to explore whether the Icelandic occupational therapy profession succeeds in promoting research and recognition by other health professions.     

Client-centred occupational therapy: the importance of critical perspectives

Abstract

Background: The occupational therapy profession has proclaimed itself to be client-centred for over 30 years, but until recently this assertion remained largely unchallenged. Critical thinkers, who have begun to explore client-centred practice in occupational therapy, highlight the necessity for further critical reflection. Aims. This paper aims to define what constitutes “critical” thinking; and to persuade occupational therapists of the importance of employing critical perspectives towards the profession’s assumptions and assertions regarding occupational therapy’s “client-centred” practices. Major findings. Critical thinking is not solely a process of carefully and thoughtfully weighing various arguments or evidence, but of additionally appraising the ideological and structural contexts in which these positions or evidence have arisen. Critical perspectives towards occupational therapy’s client-centred practices identify the ways in which power is exercised by the profession, and culturally specific and disabling ideologies are perpetuated. Practice conclusion. Critical thinking enables occupational therapists to reflect on their own inequitable access to privilege and power, and reduces the potential for the profession to re-inscribe dominant ideologies that devalue disabled people and justify their inequitable opportunities. Because critical thinking demands a readiness to restructure one’s thinking, and decreases the risk of acting on faulty assumptions, it is an essential component of client-centred practice.     

Italian occupational health: concepts, conflicts, implications.

This paper examines Italy's worker-based model for occupational health, especially its key concepts and its relation to social conflict. It briefly reviews the history of three approaches to occupational health in Italy: university-based, industry-based, and government-based. It then analyzes the worker-based approach, which emerged in the late 1960s and early 1970s as worker groups and trade unions mobilized around new concepts of occupational health. Five key concepts are discussed: the workers' homogeneous group; workers' subjectivity; the use of contract language; the development of local occupational health institutions; and the use of occupational hazard risk maps. The analysis illustrates how the social processes of mobilization and institutionalization affected the ideas and structures of Italian occupational health. Worker mobilization in Italy produced ideological changes in the nation's occupational health system, institutional changes in universities and governments, and legislative changes at national and local levels. The institutionalization of reforms, however, created new conflicts and problems and tended to restrict worker participation and promote expert intervention. The paper concludes with a brief outline of the history of occupational health approaches in the United States and then discusses the implications of the five Italian concepts for US occupational health policy.     

Hospital consultations and jurisdiction over patients: consequences for the medical profession

Advances in biomedical technologies and the increased specialisation of the medical profession have made collaborations among specialty physicians integral to care delivery. As physicians increasingly must share patients, how does this shape the jurisdiction that physicians hold? The sociological literature has extensively documented inter‐professional jurisdictional claims and conflicts to maintain the professional power of physicians in relation to allied occupational groups. However, less is known of intra‐professional avoidance and resolution of conflict over jurisdiction. This case study considers how jurisdictions are shared, maintained and challenged in a single profession. Drawing from ethnographic and interview data collected from September 2010 to October 2012 on the internal medicine service of a teaching hospital in the USA, I demonstrate the variation in jurisdictional conflicts that emerge between internal medicine and other specialties during the consultation process. Ignoring shared jurisdictions and refusing to accept jurisdiction of patients generate disputes among the principal medical and specialist teams. These disputes ensue due to blurred boundaries dividing the various specialties. To avoid conflicts, internal medicine physicians adopt strategies behind the scenes to facilitate smooth consultations.     

Genesis of Occupation: A Philosophical Model for Therapy and Theory

Occupational genesis is an evolutional/developmental theme based on concepts developed by the philosophers of pragmatism, Dewey, James, Meade and Pierce. Their influence on the Chicago community where occupational therapy originated is described. By bringing this philosophy to light as occupational therapy's conceptual foundation, modern theorists and practitioners can be understood to be united in their beliefs despite differences in practice orientations. This concept of pragmatic origin, to which Adolf Meyer adhered, is proposed as occupational therapy's central theme. Occupational genesis describes the development of function through orientations of egocentricity, exocentricity and consensuality, a sequence repeated throughout life in the acquisition of skill. The relationship is described between inherited and acquired automatic behaviour and purposeful activity, and their roles in adaptive development. The relevance of this conceptual system for the profession and for health care is suggested.     

The Nature of Emerging Practice in Occupational Therapy: A Pilot Study

The profession of occupational therapy is responding to changes in the health care system by expanding the contexts and models for service provision, typically referred to as emerging practice. As a pilot study, a survey was completed by 174 occupational therapists to gather information and opinions about emerging practice. Results indicated occupational therapists hold diverse perceptions about emerging practice settings and services as well as the role and significance of emerging practice within the profession. Occupational therapists engaged in emerging practice described numerous rewards and challenges inherent within the process of developing and delivering services. The findings indicate continued professional dialogue and research are needed to support the development and efficacy of occupational therapy services in emerging settings and roles.     

Future of Mental Health Occupational Therapy: Student Perspective and Concerns

Occupational therapy has been gradually slipping away from its foundation in mental health practice. In order to provide the best services to individuals with mental health disorders, the occupational therapy profession must maintain and expand its involvement in this area of practice. The purpose of this paper is to explore the threats and opportunities to promote education and practice in mental health from a student perspective. The authors reviewed the literature, distributed questionnaires, and conducted focus groups with occupational therapy students at a southeastern university. Based on findings in the literature and of the focus groups with students, the authors have drawn a list of suggestions to improve the visibility of occupational therapy in mental health care. These suggestions are for occupational therapy educational programs, mental health practitioners, AOTA, and state associations.     

Deinstitutionalisation of Occupational Therapy and Health Care Administrators Knowledge

Administrators of 100 Brisbane health care agencies were surveyed about their level of knowledge of traditional and nontraditional roles of occupational therapy and other allied health professions. Administrators were found to have reasonable levels of knowledge of the allied health professions, poor knowledge of occupational therapy, and very low levels of knowledge of the nontraditional roles of occupational therapy. Lack of health care administrator awareness of occupational therapy is a barrier to the transition of the profession from institutionally based models of practice to working in community health settings.     

Existentialism in Occupational Therapy: Implications for Practice,Research, and Education

Abstract

As the profession of occupational therapy enters a second century, its growth in an increasingly complex and globalized world requires an adaptive and diverse philosophical foundation. The existentialist school of thought offers a complementary focus, which enhances existing philosophical foundations of the profession and supports two major tenets: (1) humans as self-making beings always in the process of becoming and (2) emotions and feelings as foundations for being-in-the-world. This article explores these two themes both in the context of existentialism and occupational therapy, and then provides an examination of existentialist utility in occupational therapy practice, research, and education.