Relationships: the key to effective occupational therapy practice with urban Australian Indigenous children

The aim of this exploratory study was to investigate what constitutes a socially and culturally appropriate occupational therapy service for urban Indigenous Australian families in Brisbane, Queensland. A qualitative methodology was used with data collected in two distinct parts. Part 1 comprised interviews and focus groups with 25 stakeholders in a newly established occupational therapy service for Indigenous children. Part 2 consisted of semi-structured questionnaires completed by 50 occupational therapists in Queensland. Results revealed guidelines for developing culturally relevant practice around 5 main themes. These were the need to: 1. develop effective relationships, 2. develop particular personal qualities, 3. understand the background of both the client and the therapist, 4. both gain and give knowledge, and 5. address logistical issues of service delivery. This study was limited to an evaluation of one service and included only teachers, parents and health service personnel. These practice guidelines could be applied to other settings with other Indigenous children, and their effectiveness evaluated from the perspectives of Indigenous children.     

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.     

Older people: The enigma of satisfaction surveys

Background and Aims:  Health and social care reforms have emphasised the need for health and social care professionals to monitor user satisfaction. Obtaining the opinions of clients is an important mechanism for improving quality in health and social care. This paper discusses methodological issues in measuring satisfaction among older service clients.
Methods and Results:  Examples will be used from the authors' own experiences of conducting research with older people to ascertain opinions and levels of satisfaction. The strengths and weakness of methods used to collect the opinions of older clients using interview and non-standardised questionnaires are critically considered. The authors suggest that occupational therapists need to understand the methodological issues that can impact upon older clients' responses to satisfaction questions.
Conclusion:  If occupational therapists are committed to the ethos of client-centred practice, then clients must not only be consulted and involved in service delivery, but also in the design and implementation of satisfaction surveys.     

Governing the Majority World? Critical reflections on the role of occupation technology in international contexts

Background:  Within occupational therapy, increasing attention has been focussed on international development work. However, many have critiqued the focus of knowledge development within occupational therapy and occupational science, arguing that it is focussed on Western values. Questions arise about how occupational therapy and occupational science, and the knowledge and therapeutic technologies that are associated with these communities, will affect the 'developing' world, which, recently, some have described as the Majority World.
Aim and method:  Using Foucauldian analytical tools, this paper reflects on specific discourses that are foundational for development work. Specifically, this paper attempts to better understand how concepts like 'occupational justice' and the 'occupational being' are presented in the literature and relate to practices in international contexts. Within this analysis, attention is focussed on how practices associated with occupational development work might also be enmeshed in power dynamics.
Results:  This paper outlines how occupational discourses may shape and order life in particular ways and challenges researchers and practitioners to develop a better understanding of how power can operate through occupational discourses and occupational therapy practices. This paper also adds to the literature through the interpretation and explication of various theories that may underpin work in international contexts.
Conclusions/future directions:  Suggestions for future directions that will enable the development of more politically and culturally sensitive knowledge and practices are also explored. It is crucial that as a community we become more aware of how our theoretical frameworks may impact and shape practice.     

Managing alcohol‐related problems among Indigenous Australians: what the literature tells us

Objective: To contextualise and provide an overview of two review papers – prepared as part of a larger research program – dealing with different aspects of the treatment of Indigenous Australians with alcohol‐related problems. Method: The papers were reviewed thematically and compared to identify key issues raised in them. Findings: Together, the papers highlight the paucity of the evidence base for the provision of treatment for Indigenous Australians with alcohol‐related problems. Among the key issues identified are: the need to engage with clients in culturally safe ways; practitioner, organisational and client barriers to engagement; the contexts in which Indigenous drinking and treatment take place; the need to develop rigorous methods of evaluation more appropriate to Indigenous cultural and service provision settings; and the importance of effective partnerships in the provision of services. Conclusion: For those working in the field, the reviews direct attention to the need to review and interrogate our current practice. They also provide clear directions for future research.     

Employer-sponsored occupational therapy professional development in a multicampus facility: A quality project

Aim:  To critically assess and develop recommendations for professional development (PD) for occupational therapists in a multisite specialist cerebral palsy occupational therapy service.
Method:  Quality improvement project based on principles of participatory action research: audit of PD resources/activity; stakeholder consultations and literature review.
Results:  The PD program goal, resources, strategies, activities and evaluations conducted at the centre were identified and described. Areas for improvement were identified by critically considering the PD program in the context of reviewed literature. There was an assumption that personal change through PD would help attain the organisational goal of clinically competent practitioners who use evidence-based practice in a family-centred context.
Recommendations:  Future PD plans and evaluations need to explicitly address this assumption. The use of structured reflection and the 'clinical reasoning' conceptual framework was recommended as one way to help personal change from PD to have workplace impact. This project provides a precedent and guide to occupational therapy PD planners regarding a whole-of-organisation approach to developing and maintaining competence through PD.     

Conducting case study research in occupational therapy

Background:  Case study research has been used increasingly in psychology and sociology in recent years. It provides researchers with an opportunity to explore a situation involving one individual or several individuals over time from multiple points of view.
Methods:  This literature review explains case study research as a method and summerises its scientific merit, also providing an example of its use.
Results:  Case study research offers occupational therapists a scientific methodology that can be used to understand and develop occupational therapy practice.
Conclusion:  This paper argues that case study research should be used more extensively by occupational therapists as the method respects the basic principles of occupational therapy.     

Cultural awareness among Queensland undergraduate occupational therapy students

Aim:  Australia's cultural diversity generates substantial challenges and implications for students and health-care professionals. This study investigated the cultural perceptions and self-rated level of cultural competence of undergraduate occupational therapy students in Queensland, Australia.
Results:  Two hundred and ninety-three students completed the Cultural Awareness Questionnaire. The findings indicated that the majority of students have a positive attitude towards cultural differences and influences on occupational therapy services. Students also recognised the importance of cultural awareness and highlighted the need for increased incorporation of cultural information and experience throughout the undergraduate course.
Conclusion:  The implications of this study are discussed with reference to the future academic planning of culturally sensitive occupational therapy course and fieldwork experiences.     

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.     

Injured workers' perspectives of their rehabilitation process under the New South Wales Workers Compensation System

Aim:  Occupational injury and the process of rehabilitation can impact significantly on an individual's life. Research on the perspectives of injured workers, and their perceptions of the occupational therapy role, is limited.
Method:  A qualitative, phenomenological study explored the experiences of six injured workers, from a large regional area health service, who had undergone occupational rehabilitation within the NSW Workers Compensation System. Data were collected through the use of in-depth, semistructured interviews and were analysed inductively.
Results:  Injured workers have a limited knowledge and understanding of the rehabilitation process, feel unsupported throughout the process, have unsatisfying return-to-work duties and often experience negative attitudes from key stakeholders.
Conclusion:  The results highlight the opportunity for occupational therapists to increase their role within occupational rehabilitation; however, they need to adopt a more holistic approach to their practice.     

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.     

Key considerations in delivering appropriate and accessible health care for rural and remote populations: Discussant overview

Objective:  To provide an overview of papers discussing optimal service delivery models for rural and remote Australia.
Design:  A synthesis of overarching considerations guiding rural and remote health service policies.
Setting:  Small rural and remote communities in Australia.
Participants:  Invited delegates attending the Inaugural Rural and Remote Health Scientific Symposium in Brisbane 2008.
Main outcome measures:  Key issues underpinning health service provision for small rural and remote communities.
Results:  The formulation and implementation of effective health service provision policies must be underpinned by overarching health goals, agreed health service requirements, recognition of how rural and remote health contexts impact upon health service provision and the constraints limiting health service responses.
Conclusion:  Systemic change is required in order to ensure equitable access to health care services in small rural and remote communities.     

Understanding an Aboriginal and Torres Strait Islander child’s journey through paediatric care in Western Australia

Objective: To explore caregiver perspectives of their children’s journey through the specialist paediatric service, the Aboriginal Ambulatory Care Coordination Program (AACC), and non‐AACC services at the Perth Children’s Hospital. Methods: Eighteen semi‐structured interviews with families of Aboriginal children were completed. Indigenous research methodology and a phenomenological approach guided data collection and analysis. Results: Four key themes were identified from interviews: hospital admissions, discharge and follow‐up outpatient appointments; communication; financial burden; and cultural issues. Our findings suggest Aboriginal children and their caregivers using the AACC program had more positive and culturally secure experiences than those using non‐AACC services. However, barriers relating to health providers’ understanding of Aboriginal cultural issues and lived experience were commonly discussed, regardless of which service families received. Conclusions: Australian Aboriginal children have an increased use of tertiary hospital care compared to non‐Indigenous children. Healthcare programs specifically designed for Aboriginal children and their families can improve their experience of care in hospital. However, improvements in cultural awareness for other hospital staff is still needed. Implications for public health: Dedicated Aboriginal programs in mainstream services can successfully improve cultural care to their clients, which is fundamental to improving service delivery for families.     

Practical strategies for working with indigenous people living in Queensland,Australia

Internationally, occupational therapists have recognized the need to provide culturally appropriate services for indigenous people. This study explored experiences, perspectives and practical strategies of occupational therapists working with Aboriginal and Torres Strait Islander people living in rural and remote areas of Queensland, Australia. Semi-structured interviews were conducted with eight occupational therapists who had at least 12 months' experience providing services to Aboriginal and Torres Strait Islander people in health, rehabilitation or education services. Key themes identified in the data focused on strategies for facilitating effective communication with individuals and families, and collaborating with other service providers. The role of Aboriginal Liaison Officers or Indigenous Health Workers was emphasized by participating therapists. Participants identified resources that they perceived as useful in their practice, such as cross-cultural training and access to indigenous health workers. Other resources suggested for further development included information about learning styles of indigenous people and information about cultural variations between specific Aboriginal and Torres Strait Islander communities. The small number of participants limits generalizability of the findings. However, therapists can decide on the relevance of strategies to their own workplaces. Suggestions for further research focused on improving occupational therapy services for indigenous people in Australia. These include an investigation of therapy goals with indigenous people, and interviews with indigenous Australians and indigenous health workers about their experiences and perceptions of occupational therapy.     

Four years after graduation: Occupational therapists' work destinations and perceptions of preparedness for practice

Objective:  The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice.
Design:  Self-report questionnaires and semistructured in-depth telephone interviews.
Participants:  Graduates ( n =  15) from the first cohort of occupational therapists from James Cook University, Queensland.
Main outcome measure:  The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice.
Results:  Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice.
Conclusions:  Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements.     

Development of the activity card sort--Australia

Aims:   To develop the Activity Card Sort (ACS) — Australia as a tool to measure participation in activities of daily living for older adults.
Methods:   Secondary data analysis of activity diaries of older Australians in Brisbane and Adelaide were utilised for item generation. Survey of older adults and cluster analysis was used for item selection and determination of domains for the ACS-Australia.
Results:   The final ACS-Australia is comprised of 82 activity items, falling under the three domains of household activities, social/educational activities and leisure activities.
Conclusions:   The ACS-Australia has robust properties, wide application and provides a culturally relevant tool to measure participation of older Australians, thus will facilitate rigorous clinical and population-based research.     

An interagency service delivery model for autistic spectrum disorders and attention deficit hyperactivity disorder

Background   A multiplicity of government initiatives advocate increasing shared working between services to ensure that holistic and co-ordinated assessment of need and related shared intervention is available to children and families. Concurrently, there is an increasing demand upon services to provide a wide range of support for children with complex difficulties.
Methods   On the Isle of Wight, joint services have been developing shared practice. The inter-agency service was initiated in 2001 through a 3-year project funded jointly between all services on the Island and the government through the 'Invest to Save' initiative. The project initially focused upon developing a combined process of diagnosis of autistic spectrum disorders (ASD) and the co-ordination of intervention at schools, within families and in the child's community. Gradually, the service extended to include children with a much wider range of difficulties, including those of attention deficit hyperactivity disorder (ADHD), developmental co-ordination disorder and co-morbid diagnoses.
Results   There are 19 000 school-aged children on the Isle of Wight. A total of 1101 referrals have been accepted between June 2001 and May 2007. In total, 201 children have been given a diagnosis of ASD. Overall, 392 children have been given a diagnosis of ADHD or ADHD/Co-morbid. Seventy were co-morbid for ASD and ADHD. The current service is rated as 85% satisfactory by its users, in contrast to the high level of complaint which resulted in the bid for the project initially.
Conclusion   Following the successful conclusion of the 3-year government-funded project Education Services, Social Care and The Health Authority shared the ongoing funding of the current service. This has been operating effectively for over 6 years and has highlighted a wide variety of issues around this style of service delivery.