Choice,Knowledge, and Utilization of a Practice Theory: A National Study of Occupational Therapists Who Use the Model of Human Occupation

Objective. To identify how therapists choose and use the Model of Human Occupation (MOHO). Method. A systematic random sample of 1,000 occupational therapists was surveyed as to whether they used MOHO in their practice. Those who were using MOHO were then sent a detailed questionnaire; 259 therapists responded to the survey questionnaire, forming a response rate of 60.2 percent. Results. A total of 80.7% of therapists indicated that they had used MOHO in their practice. A number of factors influenced therapists' choice to use MOHO. The most frequently cited factors were therapists' judgment that MOHO fit their own practice philosophy and their clients' needs. Most therapists used multiple means of learning about MOHO, and the number of means they used was related to both self-reported levels of knowledge and utilization of this model. Many therapists are also actively engaged in sharing their knowledge and utilization of this model. Conclusion. Multiple factors contribute to therapists' choice and use of MOHO. Therapists actively make a decision to use MOHO in practice and put forth substantial efforts to learn and share their knowledge of MOHO.     

Comparing and Using Occupation-Focused Models

ABSTRACT

As health care moves toward understanding the importance of function, participation and occupation, occupational therapists would be well served to use occupation-focused theories to guide intervention. Most therapists understand that applying occupation-focused models supports best practice, but many do not routinely use these models. Barriers to application of theory include lack of understanding of the models and limited strategies to select and apply them for maximum client benefit. The aim of this article is to compare occupation-focused models and provide recommendations on how to choose and combine these models in practice; and to provide a systematic approach for integrating occupation-focused models with frames of reference to guide assessment and intervention.     

Developing professional values: perceptions of francophone occupational therapists in Quebec,Canada

Objective Recent literature shows growing interest in the values displayed by occupational therapists. Yet, none of these writings has so far examined the factors that contribute to the development of occupational therapists’ professional values. These factors are important, since values play a pivotal role in forging professional identity, which in the case of some occupational therapists remains somewhat ambiguous. This article proposes possible answers to the following question: What do Quebec Francophone occupational therapists perceive as the building blocks of their professional values? Methods Using a phenomenological qualitative method, the subjective experience of occupational therapists in Quebec, Canada was examined. Twenty-six occupational therapists took part in the study. Results As intended, their professional experience was varied. According to the participants, four factors contributed significantly to their professional values: professional experience, university training, personal experience, and professional development. However, fewer than 50% of the participants cited six other factors (workplace, family upbringing, personal development, personality and abilities, professional normative framework, and sociocultural background). Conclusions Most of these results are consistent with those documented in existing works. They point to the relevance of discussing professional values during university training and continuing professional development, as well as encouraging occupational therapists to become exemplars for their colleagues and interns. This study constitutes an initial step in understanding how occupational therapists’ axiological identity is formed.     

The Use of Standardized Assessments in Occupational Therapy in the United States

ABSTRACT

The purpose of this study was to investigate the use of standardized assessments in occupational therapy practice. Five-thousand surveys were mailed to recipients of ADVANCE for OT who indicated their primary role to be a “clinician.” With a response rate of 16%, 794 responses were analyzed. Results include occupational therapists in a pediatric practice setting reporting using standardized assessments more frequently to determine eligibility of services than do adult setting practitioners. Respondents also perceived they have the highest knowledge or skill level in their ability to communicate the results of standardized assessments to their clients and other health professionals, but lacked knowledge or skill level in knowing the difference between criterion and norm-referenced measures. Implications for practice, research, as well as academic and continuing professional education are discussed.     

The values of occupational therapy: Perceptions of occupational therapists in Quebec

Objective: Recently, there has been increasing interest in the values of occupational therapy and the values held by occupational therapists. A wide range of values has been reported in the literature. Furthermore, despite the fact that values are an important part of professional identity, empirical studies have demonstrated that several occupational therapists possess an ambiguous professional identity. This study was undertaken to explore the values of Canadian occupational therapists, specifically French-speaking occupational therapists in Quebec. Methods: Semi-structured interviews were conducted with 26 occupational therapists. Their narratives were subject to hermeneutic analysis, a method of textual analysis common in philosophical research. Results: A total of 16 values were identified in the discourses of the occupational therapists interviewed: autonomy; human dignity; occupational participation; social justice and equity; professionalism; holism; partnership, environment, or ecological approach; quality of life; solicitude; honesty; integrity; health; creativity; professional autonomy; effectiveness; and spirituality. Conclusions: The results of this study are, in general, consistent with those reported in the few other empirical studies that have documented the values perceptions of occupational therapists. Finally, the explanation of the values of occupational therapists may reinforce their professional identity and favour best, or at least desirable, professional practices related to ethics and culture.     

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.     

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.     

Vocational intervention based on the Model of Human Occupation: a review of evidence

Abstract

Work is a growing concern in disability and rehabilitation fields. Specific evidence related to occupational therapy in the area of vocational rehabilitation is somewhat limited. With increased demands for occupation-focused, evidence-based, and theory-informed practice, this review aims to use clinically relevant questions to organize and synthesize evidence regarding work-related interventions specifically related to an occupation-focused theory, the Model of Human Occupation. A total of 45 published works related to both the MOHO and vocational issues were identified and included in the review. The review demonstrates that there is a range of evidence that supports the use of the MOHO and its tools as a basis for work-based clinical interventions. Evidence supports the conclusion that MOHO-based work assessments have good psychometric properties and are useful in evaluating vocational potential and needs. MOHO-based work programs have been shown to have a positive impact in improving vocational outcomes to a range of clients.     

The self-reported use of research in clinical practice: A survey of occupational therapists in Sweden

Background: Today, healthcare providers and occupational therapists are increasingly required to rely on evidence-based practices. In both outpatient and inpatient settings, the use of research-based practices can be identified using the Research Utilization Measure questionnaire. Aim: This study explores how occupational therapists in Sweden perceive research utilization. Method: The Research Utilization Measure was sent to 807 randomly selected occupational therapists in Sweden, and the response rate was 59% (n = 472). Results: The majority of respondents (56%, n = 256) reported use of research-based knowledge in their practice “very or rather often”, although 49% (n = 225) of the therapists noted that they “very seldom or never” discussed research findings with their managers. Differences in answers for most items were related to degree of education and length of experience. Occupational therapists with higher education levels more often reported use of research in their clinical practice and therapists with greater experience less often reported use of research in their clinical practice. Conclusion: Education seems to influence the degree to which occupational therapists rely on research to inform their practices. A future challenge for managers and occupational therapists is to create strategic discussions on how to implement treatment that is based on current research.     

Application of the enabling occupation II guidelines in a non-Canadian context

Abstract

Background. The Canadian Enabling Occupation II guidelines contain theory and examples of how to apply client-centredness in occupation-based practice. Little information is available about the feasibility of the guidelines in other contexts. For 18 months, nine Dutch occupational therapists participated in a community of practice to explore, together with three researchers, their experiences with the application of the Enabling Occupation II guidelines. Purpose. To understand the experiences of Dutch occupational therapists with the application of the Enabling Occupation II guidelines. Method. A qualitative study using four focus group discussions and content analysis. Findings. Four themes emerged: (1) an indication that the guidelines of Enabling Occupation II are in line with values and norms of Dutch occupational therapists, (2) the meaningfulness of an intensive process of studying, discussing, applying and reflecting, (3) the struggles faced by the occupational therapists with translating English and getting a grip on concepts and (4) the challenges to implementing the guidelines in practice. Implications. Findings indicate that Enabling Occupation II embody values and norms of Dutch occupational therapists. They experience many benefits in their doing, thinking and being when applying the guidelines in practice. Struggles with reading English, getting a grip on concepts and theories, and difficulties in handling obstacles indicate that the application of the guidelines takes effort. An understanding of the philosophy, application, and reflection on professional identity may be prerequisites for appraising the feasibility of adoption of client-centred guidelines cross-culturally.     

Using the Model of Human Occupation to Nurture an Occupational Focus in the Clinical Reasoning of Experienced Therapists

Best ooccupational therapy practice requires a commitment to ongoing learning to enhance clinical reasoning. This paper describes a five-step cooperative learning process to advance clinical reasoning based on the Model of Human Occupation (MOHO). During the five-step process the MOHO concepts and assessments provide opportunities for therapists to develop occupation-focused clinical reasoning and deepen their knowledge of the theory and its application in practice.     

Client-centred occupational therapy with children: A critical perspective

Abstract

Background: Client-centredness is a central theme within occupational therapy; however, its application within clinical practice has not been thoroughly examined within the literature. Aim: The aim of this practice reflection is to provide a critical perspective on client-centredness in occupational therapy practice with children. Methods: Two action points of the Canadian Practice Process Framework (CPPF): Set the Stage and Agree on Objectives and Plan are applied to examine the concept of client-centred practice using a common practice example. Results: There are multiple benefits to using a client-centred approach to goal setting and developing a therapy plan. Practical challenges to client-centred practice include a lack of time, organizational support, and professional autonomy. Therapists may exert power over clients by enforcing institutional policies that prioritize the client diagnosis and organizational processes. Conclusion: The authors support a client-centred approach to occupational therapy practice with children but suggest that therapists may feel conflicted in trying to apply these principles within the current context of rehabilitation for children. Occupational therapists are encouraged to identify opportunities where they can advocate for a client-centred approach to services.     

Psychometric evaluation of the Finnish translation of the assessment of communication and interaction skills (ACIS-FI)

Abstract

Background: The Model of Human Occupation (MOHO) is a widely used conceptual practice model in Finland. Therefore, Finnish translations of valid and reliable MOHO assessments are needed.

Objective: The primary objective of this study was to examine the psychometric properties of the Finnish translation of the Assessment of Communication and Interaction Skills (ACIS-FI) using the many-facet Rasch model approach.

Methods and Materials: Twenty-eight occupational therapists completed an in-person training workshop on the ACIS-FI and participated as raters in this study. One hundred and forty-eight clients were rated using the ACIS-FI. Rating scale functioning, unidimensionality, person validity and rater severity, item targeting, and item and person separation statistics were examined.

Results: The rating scales demonstrated adequate functioning; the rating category ‘deficit’ was infrequently adopted by the raters. The ACIS-FI had satisfactory construct validity, as confirmed by all items exhibiting unidimensionality within a single construct (i.e. communication and interaction skills), and appropriate item fit. Validity was further confirmed through low person misfit (6%) and low rater misfit (3.6%). No ceiling or floor effects were found. The ACIS-FI was able to separate clients into four levels of communication and interaction skills.

Conclusions: This study offers evidence for the validity of the ACIS-FI as a measure of communication and interaction skills in occupational therapy.

Significance: The ACIS-FI offers Finnish practitioners and researchers a valid tool to measure communication and interactions skills that is theoretically grounded in the MOHO.     

Sharing the agenda: pondering the politics and practices of occupational therapy research

Abstract

Aims: Occupational therapists espouse a client-centred philosophy of practice, yet little attention has been given to pondering the politics or client-centred practices of occupational therapy research. The aim of this paper is thus to foster reflection on occupational therapy's commitment to client-centredness in the practice of occupational therapy research. Major findings: Occupational therapy research is not consistently undertaken in a collaborative manner. Power resides in control of the research agenda and participants' priorities can be supplanted by those of researchers. However, examples from the literature and from the authors' research suggest that study participants may wish to influence the research agenda such that their needs and priorities are addressed. Practice conclusion: Client-centred principles appear to require occupational therapists to undertake collaborative research and to ensure that research agendas are informed by clients' priorities. Commitment to client-centred principles demands concerted efforts to identify and address potential barriers to meaningful client participation in the occupation of research. However, it is argued that if researchers and disabled people collaborate, and pool their knowledge and expertise, they may achieve research that is more philosophically compatible with espoused professional values; and that collaborative research may also inform more relevant and useful client-centred clinical practices.     

Re-imagining occupational therapy clients as communities: Presenting the community-centred practice framework

Background: Occupational therapists’ are increasingly working with communities and providing services at the community level. There is, however, a lack of conceptual frameworks to guide this work.

Aim: The aim of this article is to present a new conceptual framework for community-centered practice in occupational therapy.

Material and Method: The conceptual framework was developed from qualitative multi-case research on exemplars of community participation. The first was, a network of Canadian food security programs, and the second, a rural Australian community banking initiative. Key themes were identified from across the case studies, and cross-case findings interpreted using occupational therapy and occupational science knowledge, and relevant social theory. The outcome is a four-stage, occupation-focused, community-centered practice framework.

Findings: The Community-Centred Practice Framework can be used by occupational therapists to understand and apply a community-centered practice approach. The four stages are: (1) Community Identity, (2) Community Occupations, (3) Community Resources and Barriers, and (4) Participation Enablement.

Conclusions: Further research is needed to trial and critically evaluate the framework, to assess its usefulness as a robust, occupation-focused, frame of reference to guide community-centered practice in occupational therapy.

Significance: The proposed framework should assist occupational therapists to conceptualize community-centered practice, and to utilize and apply theory.     

Exploring Arising Moments and Mindfulness in Occupational Therapists Working in Diverse Clinical Practice Areas

ABSTRACT

An online survey was conducted with 72 Canadian occupational therapists to (1) explore if and how occupational therapists were aware of “arising moments” in clinical practice, which are moments that give rise to emotions, sensations, and thoughts, and (2) to examine therapists’ responses to questions related to mindfulness. Participants described arising moments through an open-ended survey question. Framework analysis was used to develop key themes and subthemes. A modified Philadelphia Mindfulness Awareness (PHLMS) subscale with two additional survey questions “understanding of living in the moment and being present, and awareness of mindfulness” (sum = PAM) were used as indicators of mindfulness. There were significant differences in the means of PHLMS mindfulness among therapists working in diverse practice areas (F = 3.63, p = .009). Posthoc analysis revealed that therapists working in mental health had higher mean PHLMS-mindfulness scores than in all other groups. There were no significant differences in PAM mindfulness among the practice areas (ANOVA, F = 2.15, p = .08). However, posthoc tests showed that the participants in the mental health practice area had a significant difference with one group, general physical health. Findings have implications for practice in occupational therapy and education about mindfulness in occupational therapy.