A model of human occupation, Part 4. Assessment and intervention

Occupational therapy's oversight: How science veiled our humanity

BACKGROUND

Occupational therapy's connection to positivist science predates the profession's formal beginning, with important contributing knowledge sources coming from mathematics, physics, psychology, and systems theory. While these sources of objective knowledge provide a rational, defendable position for practice, they can only explain a portion of what it means to exist as an occupational being.

AIMS/OBJECTIVES

This article aims to reveal some of the history of science within occupational therapy and reveal the subjective, ontological nature of doing everyday activities that the profession's preoccupation with positivist science has obscured.

METHODS

This research used a history of ideas methodology to uncover how occupational therapy perceived people and how practice was conceptualised and conducted between 1800 and 1980s, as depicted in writing of the time.

CONCLUSION

Analysis showed that, through history, people were increasingly categorised and delimited. Practice also became systematically controlled, moving occupational therapy into a theoretical, scientific, and abstract realm.

SIGNIFICANCE

The emphasis placed on objectivity diminishes the attention given to human ways of practicing, where the subjective experience is central to our thinking.

"Metacognitive Reflection and Insight Therapy" (MERIT) for the Occupational Therapy Practitioner

Background. Metacognitive Reflection and Insight Therapy (MERIT) is a manualized, evidence-based approach that supports occupational participation through its focus on the inter-related constructs of meaning making, positionality, and self-definition (Lysaker et al., 2020). MERIT's core tenets parallel the fundamentals of occupational therapy, making it an ideal guiding methodology for mental health occupational therapy practice. Purpose. We outline key constructs of MERIT and detail how occupational therapy practitioners can apply MERIT to support occupational engagement. Key Issues. Few manualized, evidence-based interventions exist to guide occupational therapy mental health practice (Kirsch et al., 2019). Detailing MERIT and its application in occupational therapy is an important first step in future studies of its feasibility, acceptability, and effectiveness in this context. Implications. MERIT provides a clear methodology for delivering mental health occupational therapy services that is amenable to large-scale hybrid implementation and effectiveness studies, thereby supporting practice and rigour in research.

The influence of meaningful activities in the quality of life and functional autonomy of adults with intellectual disability: A prospective study during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic might negatively impact the quality of life and functional autonomy of Spanish adults with intellectual disability, and meaningful activities could prevent this negative progression.

METHODS

This is a prospective cohort study in Spanish adults with intellectual disability during the COVID-19 pandemic. Quality of life, functional autonomy and functional independence were measured. The meaningful activities studied were structured-leisure, community self-management, and occupational and physical activities.

RESULTS

Seventy-three participants were included in the study. Quality of life and functional autonomy significantly deteriorated during the COVID-19 pandemic (all p > .001). Greater participation in community self-management activities before COVID-19 was associated with less detriment to quality of life (ß = -.312; p = .008), while greater participation in occupational and physical activities was associated with less detriment to the performance of instrumental activities (ß = -.317; p = .016; and ß = -.285; p = .030, respectively).

CONCLUSION

People with intellectual disability living in residential homes experienced a decrease in their quality of life and functional autonomy during the COVID-19 pandemic. Their involvement in community self-management activities and physical and occupational activities before the pandemic had preventive effects on the detriment to the quality of life and functional autonomy.

Inclusive Environments: Home, Work, Public Spaces, Technology, and Specialty Environments within Occupational Therapy Practice

This position statement describes the role and importance of occupational therapy practitioners in integrating inclusive environments into their professional services and into their underlying science. Primary documents that define the occupational therapy profession clearly support its role in creating and ensuring inclusive environments.

The making of occupation-based models and diagrams: History and semiotic analysis

BACKGROUND.

Models provide a structure for organizing knowledge and facilitating learning and are upheld by occupational therapy as epitomizing the cornerstones of its practice.

PURPOSE.

This article briefly examines the scientific history of occupation-based model development in the 1950s before addressing the process of conceptual model making in occupational therapy. Using the theory of semiosis, it explains and takes a critical perspective on conceptual model building in occupational therapy.

KEY ISSUES.

Since the surge of development in the mid-1970s, models have grown and undergone some revision. However, while the profession has often contested the definitions of its core terms, it has not challenged the accepted models and diagrams that present the constituents of practice.

IMPLICATIONS.

Examining the processes of conceptual model development from a critical, semiotic point of view foregrounds models in the historico-theoretical literature and brings into scrutiny a model's relevancy in current practice.

Burden and Quality of Life of Family Caregivers of Stroke Patients

The purpose of this study was to identify the level of burden and quality of life of family caregivers of stroke patients and to investigate the correlation between burden, quality of life (including physical, social, psychological, and environmental domains), age of caregivers, and the care period. A descriptive correlational cross-sectional study was performed, with a convenience sample of family caregivers (n = 30) of stroke patients in São Paulo, Brazil. Data were collected using a questionnaire on participants' characteristics, the Zarit Burden Interview Scale (ZBIS), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument. A descriptive analysis was performed, and correlations between variables were analyzed using Pearson's product-moment correlation coefficient. The average burden score on the ZBIS was 29.6, representing a moderate burden, and the average overall quality of life score on the WHOQOL-BREF was 62.06%, which indicates moderate quality of life. A significant weak negative correlation was observed between burden and environmental domains (r = -0.470; p =.009), quality of life (r = -0.414; p =.023), and physical domains (r = -0.394; p =.031). No significant correlations were found between burden and quality of life, and variables in the psychological and social domains, age of caregivers, or care period. Caregivers for stroke patients presented with moderate levels of burden and reduction in quality of life. Levels of burden correlated negatively with environmental domains, quality of life levels, and physical domains; however, these correlations were weak, indicating the possible interference of other factors.

Occupational Therapy for the Head and Neck Cancer Patient

Occupational therapy is a health profession concerned with promoting health and well-being through occupation. A diagnosis of head and neck cancer (HNC) often invokes fear and anxiety because of the potential negative impact of the diagnosis and/or treatment on lifestyle and well-being. Occupational therapists perform a unique and important role in addressing quality of life concerns for HNC patients through applied expertise in lifestyle management, facilitating the use of positive coping strategies and daily routine management. Occupational therapy concurrently assists HNC patients to effectively manage the debilitating stress and anxiety associated with HNC diagnosis, treatment, and recovery while facilitating a return to prior or adapted daily routines.

The Model of Human Occupation: An Overview of Current Concepts

The model of human occupation has evolved since it was first published. A number of important changes and refinements have been made. These changes reflect research findings, new interdisciplinary theory and insights encountered in practice. This article provides an overview of the current theoretical arguments. These concepts attempt to offer a way of understanding how human occupation is motivated, organised, performed and influenced by the environment. This is followed by a discussion of how occupational therapists can use this framework in their clinical practice.

Social Role Valorisation and the Model of Human Occupation: A Comparative Analysis for Work with People with a Learning Disability in the Community

This article presents overviews of Social Role Valorisation as proposed by Wolfensberger and the Model of Human Occupation as suggested by Kielhofner et al, and contrasts their underlying fundamental beliefs related to people with a learning disability. It discusses why an occupational therapist should encompass Social Role Valorisation as a sound philosophy for service provision together with the Model of Human Occupation. This provides a unique role for occupational therapy which complements other disciplines and facilitates people with a learning disability to achieve maximum functioning and independence over their own lives for as long as they wish to do so.

The Model of Human Occupation: A Developing Conceptual Tool for Clinicians

This article discusses the evolution and current development of the model of human occupation, a conceptual tool designed to enhance the clinical reasoning skills of occupational therapists. A brief overview is provided of a number of conceptual forces in American occupational therapy which preceded and led up to the development of the model; this is followed by a description of the model, its intended clinical use and its implications for British occupational therapy.

Occupational Role Performance and Life Satisfaction in Elderly Persons

Through occupational roles, individuals structure their time to meet their personal needs and the demands of society. Due to various factors, older adults frequently experience loss of occupational roles, which may decrease the subjective quality of life. The present study used the model of human occupation as a conceptual framework to examine the relationship between the number and meaningfulness of roles performed and life satisfaction in a sample of 112 non-institutionalized elderly persons. The results suggest a positive, significant relationship between life satisfaction and the number of roles performed and the level of involvement in meaningful roles. These findings lend support to the basic premise of occupational therapy, that occupation can maintain and/or restore health.

The Use of Conceptual Models in Clinical Practice

This paper is an introduction to the use of conceptual models in clinical practice. Theoretical terminology is defined using common examples in occupational therapy. The significance of models to clinicians, administrators, and researchers is discussed. Characteristics of a rigorous model are presented in order that the existing models may be assessed for their effectiveness in guiding practice.

The challenges that employees who abuse substances experience when returning to work after completion of employee assistance programme (EAP)

BACKGROUND

Employee assistance programs (EAPs) are responsible for helping employees cope with problems such as: mental distress, alcoholism and other drug dependencies, marital and financial difficulties--in short, the whole host of personal and family troubles endemic to the human condition.

OBJECTIVE

The study explored the challenges that employees who abuse substances experience when returning to work after the completion of an employee assistance program.

METHODS

The study used a qualitative exploratory descriptive research design. Three male participants and two key informants participated in the study. One semi structured interview was conducted with each one of the participants and one semi structured interview with the key informants.

RESULTS

Four themes emerged: 1) Loss of one's worker role identity, 2) Negative influences of the community continues to effect the success of EAP, 3) EAP as a vehicle for change and, 4) Healthy occupations strengthen EAP.

CONCLUSIONS

This study portrayed the following: how substance abuse effect the worker role of individuals employed in the open labor market, the challenges and facilitators experienced by employees who abuse substances when returning to their previous work roles and how occupation based interventions can be incorporated in EAP programs. Occupational therapists could use the health promotion approach, work simplification, energy conservation techniques and ergonomic analysis techniques.

A Practice Development Programme to Promote the Use of the Model of Human Occupation: Contexts, Influential Mechanisms and Levels of Engagement Amongst Occupational Therapists

This study evaluated a multifaceted, organisation-wide practice development (PD) programme in one National Health Service mental health and learning disabilities trust.

Method:

Individual differences in integrating the Model of Human Occupation in occupational therapists' daily practice were examined through in-depth qualitative, multimethod realistic evaluation. A stratified sample of all occupational therapists (n = 74) was achieved using a self-report survey. Semi-structured interviews at three time points, practice observation and documentation audit continued until saturation appeared highly likely and categories were well elaborated (n = 10).

Findings:

The findings indicated that environmental contexts, particularly the support of the immediate team, and the therapist's personal circumstances influenced MOHO use. The mechanisms that acted as catalysts for practice change were Building Confidence, Finding Flow, Accumulating Reward, Conferring with Others, Constructing Know-how and Channelling Time. Four stages of MOHO integration, characterised as In the Hangar, On the Runway, Take-off and In the Air, were identified.

Conclusion:

Most studies of the uptake of PD treat people as relatively homogeneous, but they are not. Greater attention to individual differences, the mechanisms underpinning successful engagement and influencing contexts may result in better outcomes from PD investments. A degree of tailoring PD approaches to individual circumstances would be beneficial.

Assessment of physical functioning: a conceptual model encompassing environmental factors and individual compensation strategies

Commonly studied physical functions include activities such as walking and climbing stairs. Despite the acknowledged role of environmental factors and behavioral strategies to compensate for reduced performance capacity or environmental barriers in characterizing physical functioning, most assessments do not take these factors into account. This article presents a new conceptual model for assessment of relevant physical functioning while accounting for habitual environmental factors and compensation strategies.

Neuropathology in schizophrenia:

Though our understanding of brain functioning as it relates to schizophrenia is still in a stage of infancy, knowledge of available research can provide insight into the illness and influence treatment decisions. The literature on brain abnormalities and schizophrenia provides a foundation for understanding the functional deficits that ensue. Occupational therapists who work with individuals with schizophrenia must now incorporate biological models into existing theories and possibly alter treatment approaches. A neurorehabilitation approach used by occupational therapists may allow the treatment of patients labeled "chronic" or "treatment resistive." By initially addressing deficits at a cognitive level, patients may improve and take advantage of treatment groups at more complex levels. This paper supports a neurophysiological model for the etiology of schizophrenia and the need to re-adjust mental health treatment strategies with specific implications for occupational therapy. Issues discussed include assessment, types of treatment, and other treatment considerations and strategies for patients with schizophrenia. A case example is presented.

Application of the guidelines for client-centred practice to paediatric occupational therapy

This paper outlines the process of incorporating the "Guidelines For the Client-Centred Practice of Occupational Therapy" into the practice of occupational therapy in an out-patient rehabilitation facility serving young people with physical disabilities. Specifically, the areas of practice addressed are screening and assessment. The process started in 1987 with an identification of the need to find a holistic framework that meets the complex needs of clients with chronic physical disabilities. The conceptual model of occupational performance, as outlined in the Guidelines, provided such a framework. The process of incorporating the Guidelines into the screening and assessment practices of occupational therapists at Erinoak Serving Young People With Physical Disabilities is described, with examples of documents developed by the department. Suggestions are given to integrate the conceptual model of occupational performance into the practice of occupational therapists working with children and adolescents with physical disabilities.

Pre-vocational programming in a pediatric skilled care facility

This article describes a pre-vocational program that was developed in a private residential skilled care pediatric facility, under the guidance of an occupational therapy consultant. This "Special Training Program" was designed to meet the needs of the few higher functioning adolescents and young adults residing within the facility who did not participate in daily community school programs. This paper presents the philosophical issues related to developing a pre-vocational program; the criteria for selecting program participants; the program structure (implementation details, work sample selection, production rate data records, program supervision, participant remuneration, physical set-up and start-up costs); and an evaluation of the benefits and disadvantages of the program following one year of the Special Training Program's initiation date.

Health care systems models and occupational therapy

Health care system models featuring four alternative future scenarios are discussed relative to occupational therapy. Five prevailing theoretical models of occupational therapy practice and three practice systems are described as they interact for service provision. Occupational therapy as an open system is presented as possessing the potential to successfully embrace and negotiate changes a in the health care system as projected for the future.

Occupational therapy in long term psychiatry: what's new?

This paper summarizes the results of a survey of the role of occupational therapy in provincial psychiatric hospitals in Ontario. Occupational therapy was found to provide major programming in three areas: 1) functional skills assessment and training, 2) life skills assessment and training and, 3) self awareness and personal growth. Subjects used a variety of frames of reference, but models based upon Glasser's Reality Therapy predominated. A complementary relationship was found between occupational therapy and vocational and recreational services, with occupational therapy playing a clinical or therapeutic role, while vocational and recreational services provided normalizing experiences. A comparison of occupational therapy programming in the institutions surveyed, with programming reported in the recent occupational therapy literature indicated that techniques and media utilized paralleled those used in acute and community psychiatric programs.

Resources of adaptation for daily living

Occupational therapy addresses the chronically disabled person's adaptation to problems in daily living. Resources of adaptation are those inherent abilities and lifelong learnings which the individual uses to deal with daily living problems. Adaptation is described as flexible behavior to meet the changing needs of a changing environment. A review of the literature from a bio-social frame of reference identifies resources of adaptation. These resources are classified into a conceptual framework of three hierarchical levels corresponding to three time spans of adaptation: evolution, ontogenesis, and immediate learning. The classification of the resources of adaptation has implications for therapeutic evaluation and treatment, including the discovery and assessment of the resources of adaptation, a strategy for resource reorganization, and the environmental management of limited resources by the policy of "mini-max."