An exploratory study into the application of psychological theories and therapies in Australian mental health occupational therapy practice: Challenges to occupation-based practice

Practitioner Perspectives on Occupation-Based Practice Across Varied Settings

Occupation-based practice (OBP) is considered a cornerstone of occupational therapy practice. However, there is no consensus-based definition of OBP, let alone agreement on its mediators across practice settings. To describe how OBP is currently conceptualized and enacted across different practice settings, a descriptive qualitative approach of focus groups and elicitation of visual data (e.g., photographs, video recordings) was used with 65 participants. Multiple rounds of qualitative data analysis were used to identify codes and themes. Three themes were identified: (a) contextual factors of OBP, (b) client status, and (c) temporal characteristics of OBP. OBP is influenced by institutional, historical, and temporal aspects of practice settings, with further exploration needed across different practice settings and occupational therapy pedagogy styles. Considering the influence of contextual aspects may support occupational therapy practitioners and researchers' efforts to support their advocacy for occupation as a foundational concept in the profession.

Implementing an occupational therapy specific mental health intervention in a multi-professional context - the case of Balancing Everyday Life (BEL)

BACKGROUND

The occupation-based intervention Balancing Everyday Life (BEL) was found effective under controlled conditions but should also be studied in a natural clinical practice context.

AIM

The aim was to study the implementation process of BEL when provided in a multi-professional mental health team. The focus was particularly on how BEL was received and functioned.

METHODS

This qualitative study was based on manifest content analysis and used semi-structured telephone interviews with 13 occupational therapists and three managers.

RESULTS

Three themes were identified: '1 - Conditions and opportunities in the setting', '2 - Putting the BEL intervention into practice' and '3 - Experiences of practicing BEL'. BEL was a welcomed alternative, as stated by managers and occupational therapists. The team helped to recruit BEL participants, but the occupational therapists had to give rigorous information to team members and prospective participants for this to work. The social, physical and political contexts were essential for the implementation.

CONCLUSIONS

Successful implementation of an occupational therapy-specific intervention such as BEL requires a reasonable match between existing team policies and the underpinnings of the intervention. It is crucial to repeat information to all stakeholders and make the intervention a matter of urgency for the whole team.

The shaping of professional identity and education of occupational therapist students in Denmark – a qualitative study

BACKGROUND

Few studies are available regarding occupational therapist students' experiences relating to their professional identity during their education.

AIM

The aim was to gain knowledge about the process that occupational therapist students undergo in the shaping of their professional identity.

METHOD

Semi-structured interviews were conducted with nine participants divided into two phases: a phenomenological phase, followed up by a hermeneutical phase. The data was analysed with the use of thematic analysis.

RESULTS

Three themes emerged: study environment, responsibility, and choice of internships. As a part of the first theme study environments, the relations among the students were important for the shaping of a professional identity.

CONCLUSION

The occupational therapy students undergo an increasing sense of responsibility throughout the education programme. Particularly, the clinical practice was found to have a positive impact on the shaping of professional identity.

IMPORTANT FINDINGS

The findings in the study can contribute to clarifying students' perspectives on the shaping of their professional identity. Based on these findings the occupational therapist education programmes could integrate these elements as a part of their curriculum.

Occupational therapists’ experiences of implementing occupation-based practice in neurology, and its impact on professional identity

Introduction

Facilitating engagement in meaningful occupations underpins occupational therapy intervention. Occupation-based practice, while linked to improved professional identity and job satisfaction for occupational therapists, is challenging to implement, particularly in hospital settings. This study aimed to explore occupational therapists’ perceptions of their role, and facilitators and challenges to implementing occupation-based practice in neurology.

Method

This qualitative descriptive study included semi-structured interviews with seven occupational therapists working in Australian acute/sub-acute neurology settings.

Findings

Three themes identified: Conceptualisation versus implementation of occupation-based practice; Use of occupation-based practice impacts role satisfaction; Promoting the profession. Participants described using occupations in their practice as important, however, reported that the challenges of the neurology environment hindered their ability to carry out occupation-based practice.

Conclusion

This study provides insights into occupational therapist’s perceptions regarding occupation-based practice in neurology settings, finding there is a need for occupational therapists to promote their role and use of occupations in neurology settings, and that occupation-based practice impacts job satisfaction. The study highlights occupational therapists working in neurology settings would benefit from a number of approaches including student interprofessional activities, potential buddy system for new graduates and experienced clinicians, and increased support by the profession to maintain their identity as occupation-based specialists.

Understanding professional identity in occupational therapy: A scoping review

INTRODUCTION

A strong professional identity helps occupational therapists maintain professional values and thrive when facing work-related challenges and opportunities including generic, blurred or emerging roles, funding pressures and a push for outcome evidence. A scoping review will build understanding of professional identity and how to maintain it in such circumstances.

OBJECTIVES

To scope what is currently understood of professional identity in occupational therapy and factors which influence ability to maintain this and adapt in challenging work environments.

METHODS

Using Arksey and O'Malley's scoping review framework three databases were searched using the terms 'occupational therap*' and 'professional identity'. Data extraction and thematic analysis highlighted the extent and nature of current literature and mapped key concepts.

RESULTS

89 papers were included. Professional identity was revealed as a multidimensional construction. Four themes emerged: developing a shared ontology, embracing the culture, enacting occupational therapy, and believing in occupational therapy. Factors which influenced development and maintenance of professional identity included occupation-centred practice, ontological reflexivity, linking theory to practice and professional socialization.

CONCLUSIONS AND SIGNIFICANCE

The enhanced understanding of professional identity and factors which preserve or enhance it can help the profession identify how to position itself to remain resilient and adaptive in an ever-changing environment.

Evaluation of the construct and internal validity of the Professional Identity Questionnaire: A Rasch analysis

BACKGROUND/AIM

It has been suggested that occupational therapy practitioners with a poor sense of professional identity experience more difficulties in the workplace and may be less likely to implement evidence-based, occupation-focused interventions. Poor sense of professional identity has also been linked to increased risk of burnout. Although professional identity is considered important, few measures are available and none have been rigorously evaluated. The project was established to evaluate the construct and internal validity of one such measure, the Professional Identity Questionnaire (PIQ).

METHODS

The PIQ includes 10 questions, each rated on a 5-point Likert scale. Rasch analysis was used to evaluate several aspects of construct and internal validity of the PIQ. These included rating scale validity, unidimensionality, statistical validity, differential item functioning, overall construct validity and person response validity. Correlations were also calculated to explore the relationship between the Professional Identity Questionnaire and a commonly used measure of burnout, the Oldenburg Burnout Inventory (OLBI).

RESULTS

A total of 118 occupational therapists working in mental health completed the PIQ and OLBI. Initial analyses suggested that the rating scale validity and targeting of item difficulties to person abilities were not optimal. Revision of the rating scale structure improved the overall rating scale validity and item targeting. Analyses using the revised scale structure showed generally good alignment with quality control criteria established for this study. Fit statistics for one item were less than optimal and some differential item functioning was present. Correlations between PIQ and OLBI total scores were -0.53 for the original PIQ rating scale structure and -0.46 for the revised rating scale structure.

CONCLUSIONS

Results from this study provide preliminary evidence for the construct and internal validity of the PIQ, especially when using the revised scale structure. However, further research is required before the PIQ can be recommended for widespread use.