Mechanisms of Change in Nature-Based Pediatric Occupational Therapy: The Ecology of Change in Outdoor Therapy Model.

The purpose of this qualitative constructivist grounded theory study was to develop a model to explain potential mechanisms of change in the nature-based pediatric occupational therapy process, based on analysis of the perspectives of occupational therapy practitioners currently engaging in nature-based practice with children. Using 27 photos and interview data from 22 participants the Ecology of Change in Outdoor Therapy (ECO-Therapy) Model was developed. The model suggests mechanisms of change in nature-based pediatric occupational therapy may involve six iterative phases: Longing for Freedom, Embarking on Adventure, Dancing with Nature, Claiming Self-Agency, Braving Real-Life Challenges, and Growing Adaptive Capacity. The practitioner and child experiencing these phases throughout the nature-based occupational therapy process may lead to improved participation and performance in the child's daily life.

"You've Got to Do Something": Developing Occupational Therapists' Role in End-of-Life Care.

Occupational therapists support the occupational participation of people who are dying yet remain underutilized in end-of-life care. The purpose of this article was to explore how occupational therapists develop their role in end-of-life care to provide strategies to address underutilization. Using a grounded-theory method, semi-structured interviews were conducted with 21 occupational therapists. Three themes emerged which demonstrate participants' role development process. Participants' experiences with dying (Close Experience of Loss) often instilled the importance of end-of-life care. Led by these convictions (Willing to Do It), participants developed skills for end-of-life care. Reflecting on their experiences and treatment outcomes (Making a Difference), participants self-validated their role. The Model of Occupational Therapists' Role Development in End-of-Life Care captured this process. Personal experiences and critical self-reflection may provide an adaptive means to drive role development and appropriately increase end-of-life care occupational therapy utilization.

Occupational adaptation as a social process for dementia care teams.

BACKGROUND: Few studies have examined a group's collective experience of occupation using occupational therapy theoretical models. Dementia caregiving requires a diverse team of caregivers who learn and work together to resolve shared challenges. An Occupational Adaptation (OA) theory-based training program for dementia care teams was developed to better understand the team's adaptive process inherent in cooperative caregiving. AIM/OBJECTIVES: Describe how the team learned together and how the training impacted their teamwork. MATERIALS/METHODS: Fourteen employees at one continuing care retirement community underwent OA-based training. During the program, the team analysed and resolved challenging dementia care cases. Participant observations, participant journals, open-ended surveys, and follow-up semi-structured interviews were analysed. RESULTS: The thematic framework included five steps: unite around a shared challenge, tap the collective adaptive repertoire, collaborate on case-specific plans, implement with teamwork, and return for ongoing problem solving and integration. The program enhanced appreciation for teammates' knowledge, skills, and experiences, learning from each other, and integration of team-centered OA process. CONCLUSION/SIGNIFICANCE: The OA-based program appears to have facilitated adaptation that was complex, social, and generalisable. OA theory is enriched with a social view of occupational adaptation opening new opportunities for therapists and researchers to understand and facilitate adaptation among teams.

Occupational Therapy in Primary Health Care for Underserved Populations: A Scoping Review.

The aim of this scoping review was to identify what current and potential opportunities exist for occupational therapy in primary healthcare for underserved populations. Search phrases were utilized across several databases and Occupational Therapy specific journals were hand searched. Nineteen articles met inclusion criteria: English, 2009-2021, services delivered by occupational therapy practitioners or supervised students, for underserved populations/individuals, in community-based care, and primary health care settings. Five synergistic themes emerged from the literature are discussed: Client-centered, team collaboration, holistic and preventative health and wellness, evidence-based program evaluation, and innovative service delivery.

Novice Occupational Therapy Practitioners' Use of Occupation in Practice: A Scoping Review.

An occupation-centered perspective is a foundational component defining occupational therapy practice. A scoping review was conducted of research studies from 2002 - 2020 describing novice occupational therapy practitioners and occupation. Ten articles met the inclusion criteria. Novices acknowledged that using occupation was a source of professional tension, describing a mismatch between their education and workplace expectations. The cognitive load of occupation-centered practice influenced novices' avoidance of occupation. Few articles address novices' experiences using occupation in their practice. Existing research primarily addresses barriers limiting novices' use of occupation such as lack of supervision and confidence.

Missed Opportunities to Ease Suffering: An Explanatory Model of Occupational Therapy Utilization in End-of-Life Care.

Background: With disease progression, a terminally ill person may experience loss of physical and cognitive skills required to perform everyday activities. Such functional loss can erode autonomy and cause existential suffering. Supported engagement in everyday activities may help terminally ill people stay involved in living and cope with dying. Occupational therapy enables people to engage in valued activities at the end of life, yet remains under-utilized. Objectives: To address the perceived under-utilization of end-of-life care occupational therapy, the authors investigated how utilization of occupational therapy in end-of-life care is determined from the perspective of decision-makers and occupational therapists and then developed a model of the process. Methods: Using a grounded theory method, authors conducted two semi-structured interviews with 20 decision-makers and 21 occupational therapists. Theoretical sampling followed by paradigm analysis, yielded a data-grounded model. Results: The authors developed The Model of Occupational Therapy Utilization in End-of-Life Care. Service utilization was primarily contingent upon the decision-makers' awareness of occupational therapy's role in end-of-life care and further influenced by place of care cost constraints and participants' ability to adjust focus of the occupational therapy to accommodate the patient's dying process. Conclusion: Limited awareness of occupational therapy's role in end-of-life care warrants research on whether modification of model constructs may increase awareness and utilization. Education is indicated to teach providers about suffering due to functional loss and how to adjust focus of occupational therapy to sustain occupational participation through decline, across different care settings, and along a range between rehabilitation-focused to participation-focused outcomes.

Home safety evaluation - getting it right.

PURPOSE: Comprehensive and efficient home safety assessments are needed to provide quality interventions for community living. This study explores early career and experienced home evaluator perspectives on content and usability of HESTIA, a home safety assessment app. METHOD: Four early career and five experienced practitioners rated the HESTIA app using the uMARS usability evaluation and then participated in focus groups. Data were analysed using a key concept analytic approach. RESULTS: Results include "how to do" home safety evaluations and how prompts and training help practitioners "get it right." Early practitioner participants viewed the step-wise processes of the app as necessary whereas the experienced evaluators relied on own knowledge and experiences. CONCLUSIONS: Gobet and Chassy's TempT theory provides insight into the development of expertise in practice for rehabilitation professionals. The procedural complexities of assessment and ethical responsibility to provide competent, quality service to clients with disabilities are integrated into discussion of the development of professional intuition and ethical practice as guided by HESTIA.IMPLICATIONS FOR REHABILITATIONHome safety evaluations and home modifications are essential in helping persons with disabilities to live at home.Mobile applications such as HESTIA can serve as beneficial supports in facilitating effective decision making processes for rehabilitation practitioners conducting home safety evaluations.Technology driven assessments through mobile applications (apps) can help improve proper decision making and client outcomes, as well as aid in the development of intuition in students and early-career practitioners.Decision making support systems can help practitioners uphold their ethical responsibility to provide competent and quality rehabilitative services.

Outcomes of Team-Centered, Occupational Adaptation-Based Versus Traditional Dementia Workforce Training.

Background. Dementia workforce training aligned with Occupational Adaptation (OA) theory may facilitate teams resolving challenges in the care environment more than traditional skills-based (SB) training, although comparisons are needed. Purpose. This pilot study compared effectiveness of an OA and SB program on relative mastery and team development for dementia care teams at a continuing care retirement community. Method. In a quasi-experimental study, employees underwent nine sessions in an OA or SB program. Relative Mastery Measurement Scale and Team Development Measure results were collected pre-, mid-, post-intervention. A 3 × 2 ANOVA determined differences in group score changes across time. Findings. Data from 28 employees (14/group) showed group-by-time interaction reached statistical significance for both relative mastery (F = 3.17, df = 2, p = .05) and team development (F = 8.38, df = 2, p = .001). Implications. OA-based training may improve dementia care teams' collaborative mastery over real-world challenges. While preliminary findings inform program developers, further research must explore clinical effectiveness.

America's housing affordability crisis: Perpetuating disparities among people with disability.

America's housing affordability crisis has had various indirect costs on health and safety among people living with disability. The skyrocketing housing prices have exponentially increased with the onset of the COVID-19 pandemic leaving many people at risk for eviction after federal and local moratoriums providing protection during the pandemic expire. Americans with disabilities have been particularly affected by the affordability crisis and it is expected that this major public health problem will only grow as government-provided protections and supports wane. It is critical that both government and various housing organizations consider ways to support affordability, quality, and accessibility in this particularly hard-hit population.

Comparing Occupational Adaptation-Based and Traditional Training Programs for Dementia Care Teams: An Embedded Mixed-Methods Study.

BACKGROUND AND OBJECTIVES: With a growing demand for a dementia-capable workforce, attention shifts from disseminating knowledge of care strategies to facilitating teams translating knowledge into practice. Occupational Adaptation (OA) is a theoretical framework used to facilitate people resolving real-world challenges through active problem-solving, using relative mastery as its measure. This pilot study evaluated if and how OA-based training improves dementia care teams' relative mastery and team development more than a skills-based (SB) program. RESEARCH DESIGN AND METHODS: We report results of an embedded mixed-methods study with 28 employees of a continuing care retirement community (2 groups randomly assigned to 9-week programs). Data collection entailed 2 surveys conducted pre-, mid-, and postintervention; observations; journals; and follow-up interviews. We extended beyond quantitative and qualitative analyses with cross-cutting analyses exploring exemplar and exceptional cases. RESULTS: The OA group reported significantly greater improvements in relative mastery and team development (p < .05). Qualitative data supported the statistical findings and illuminated processes that led OA to outperform SB. OA participants, those who analyzed real cases and alternated collaborative planning with cooperative action, were more likely to indicate pre-post differences in relative mastery and team development. DISCUSSION AND IMPLICATIONS: We identified features of the OA program that diverse participants deemed effective; features that suggest how OA could underpin clinically relevant learning for workers. Further research is required to develop evidence of clinical effectiveness; however, our findings have relevance for agencies wishing to promote knowledge translation and collaborative problem-solving in dementia workforce training.

Home Environmental Assessment Protocol-Revised Initial Psychometrics: A Pilot Study.

Efficient home assessments are needed for persons with dementia and their caregivers. Pilot studies to establish a content validity index (CVI), measure concurrent criterion validity, and examine test-retest reliability of the Home Environment Assessment Protocol-Revised (HEAP-R). Six experts reviewed the tool and scored content validity items. Twenty-one caregiver/person with dementia dyads engaged with HEAP and HEAP-R to examine concurrent criterion validity. Seventeen occupational therapists viewed 10 videos of home environments to examine reliability. The CVI score was .980. Concurrent criterion validity for domains: hazards (r =.792), adaptations (r = .742), clutter (r = .843), and comfort (r = .958). Test-retest reliability: hazards (r = .820), adaptations (r = .887), visual cues (r = .487), and clutter (r = .696). Pilot data suggest the HEAP-R has preliminary content and concurrent criterion validity and test-retest reliability. Robust psychometric analysis is needed prior to use in clinical practice.

Measuring the Efficacy of Occupational Therapy in End-of-Life Care: A Scoping Review.

IMPORTANCE: Underutilization of hospice occupational therapy may be attributable to a lack of evidence on efficacy. OBJECTIVE: To conduct a scoping review of occupational therapy outcome studies to ascertain how efficacy is captured in the literature. DATA SOURCES: PubMed, CINAHL, MEDLINE, Scopus, Directory of Open Access Journals, Web of Science, OT Search, and Google Scholar. STUDY SELECTION AND DATA COLLECTION: Search terms: hospice, palliative care, occupational therapy, rehabilitation, outcome measure, and assessment. Inclusion criteria: research studies in English, centered on adult hospice care, published between January 1997 and September 2017, and investigated occupational therapy efficacy with an outcome measure. Exclusion criteria: systematic reviews, participants not at terminal disease end stages, or intervention program reviews lacking differentiated occupational therapy outcomes. FINDINGS: Seven articles met the inclusion criteria. Findings include frequent use of noncontrolled, quasi-experimental, prospective research designs; a focus on occupational performance; and no generally accepted hospice occupational therapy outcome measure. CONCLUSION AND RELEVANCE: Outcome measures of participation in end-of-life occupations and environmental influences on occupational engagement are needed to effectively support occupational therapy practice and research with people who are terminally ill. WHAT THIS ARTICLE ADDS: Occupational therapy in end-of-life care is growing in complexity yet remains low in utilization. This review adds insights into current practice and future research foci for the profession.

Associations between self-generated strategy use and MET-Home performance in adults with stroke.

Self-generated strategy use has substantial potential for improving community living outcomes in adults with impaired executive function after stroke. However, little is known about how self-generated strategies support task performance in people with post-stroke executive function impairments living in the community. We explored strategy use among home-dwelling persons with stroke and neurologically-healthy control participants during the Multiple Errands Test-Home Version (MET-Home), a context-specific assessment with evidence of ecological validity designed to examine how post-stroke executive dysfunction manifests during task performance in the home environment. For persons with stroke, significant associations were identified between planning and tasks accurately completed on the MET-Home. Significant associations were also identified among the control participants for self-monitoring, multitasking, and "using the environment" strategies. These associations are related to enhanced MET-Home performance on sub-scores for levels of accuracy, passes, and total time. Rehabilitation interventions that focus on reinforcing self-generated strategy use may support community living outcomes in persons with post-stroke executive function impairments, but this area needs additional investigation.

In-home contextual reality: a qualitative analysis using the Multiple Errands Test Home Version (MET-Home).

Adults with stroke frequently experience executive dysfunction. Despite the range of assessments that examine the effects of executive dysfunction on daily tasks, there remains a paucity of literature that examines the influence of the environment on performance in the community. The MET-Home is an ecologically valid assessment for examining post-stroke executive dysfunction in the home environment. This qualitative study explores the relationship between the environment and MET-Home performance among home-dwelling adults with stroke and matched controls. Using a descriptive qualitative approach, we analysed video, interview, and observation notes from a MET-Home validation study. An overarching theme of interplay between everyday task performance and the home environment produced further themes: naturalistically emerging supports and barriers and environment as strategy. Within naturalistically emerging supports and barriers, five contextual sub-themes were discovered: physical environment, social environment, temporal context, virtual context, and personal context. Within environment as strategy, we identified four sub-themes: reducing distractions, using everyday technologies, planning in context, and seeking social support. These findings extend the conceptualisation of how we evaluate executive dysfunction in the context of the community to also consider the inherent influence of the environment.

Development, Reliability, and Validity of the Multiple Errands Test Home Version (MET-Home) in Adults With Stroke.

OBJECTIVE: Our objective was to perform initial psychometric analysis of the Multiple Errands Test Home Version (MET-Home), which was designed to assess the influence of poststroke executive dysfunction on in-home task performance. METHOD: We examined the reliability and validity of the MET-Home in adults with stroke (n = 23) and individually matched control participants (n = 23). All participants completed a series of assessments during a single in-home visit. RESULTS: Notable differences in MET-Home subscores were discovered between participants with stroke and control participants. Participants with stroke omitted more tasks, broke more rules, passed by tasks more often, and were less efficient than matched control participants. The MET-Home demonstrated evidence of adequate internal consistency, excellent interrater reliability, and significant moderate associations with several tests. CONCLUSION: This preliminary study suggests that the MET-Home differentiates between adults with stroke and matched control participants. The MET-Home provides evidence of initial reliability and validity among adults with stroke.

Reliability of the Participation and Sensory Environment Questionnaire: Teacher Version.

The Participation and Sensory Environment Questionnaire-Teacher Version (PSEQ-TV) is a teacher-report questionnaire to assess the impact of the sensory environment on participation of preschool children with autism spectrum disorder (ASD). Many children with ASD have sensory processing differences, although these differences are frequently examined from the standpoint of the person. The PSEQ-TV provides a single assessment to examine both participation and the sensory environment for preschool aged children with ASD. This study established the reliability of the PSEQ-TV including internal consistency of 0.98 and test-rest reliability of 0.70. The results indicate initial reliability of PSEQ-TV as an instrument that can be used to identify sensory environmental barriers within the preschool setting to target during interventions to increase participation.

Caregiver Perceptions of a Telehealth Wellness Program.

OBJECTIVE: We sought to understand caregivers' experience of an education-based wellness program delivered using telehealth. METHOD: In this qualitative pilot study, 4 caregivers participated in a focus group after completing a 6-wk telehealth program. Data analysis involved open coding, thematic analysis, and coding triangulation. RESULTS: Two major themes emerged. The first, "I feel like I am now prepared," included the subthemes of strategies for caregiver self-maintenance, the understanding that caregiving is a normal process, and the value of a group experience. The second theme, "It was just a good interaction," included the subthemes of benefits of telehealth, challenges of telehealth, and process of learning the technology. CONCLUSION: Participant discussion of the content learned and the value of group support indicated that telehealth was effective in both promoting learning and facilitating relationships. Even with challenges, participants reported an overall positive experience. Telehealth holds promise for increasing access to health promotion programs.

Psychometric Evaluation of the Occupation-Centered Intervention Assessment.

A challenge of intervention research is the lack of a means to identify and measure clinical practice from an occupation-centered approach. The objective of this study is to establish basic psychometric properties of the Occupation-Centered Intervention Assessment (OCIA). The study is approached by establishing content validity and utility through expert panel and two focus groups. Interrater reliability (IRR) was determined through standardized video analysis and Krippendorff's alpha. Results from the expert panel and focus groups indicated an overall agreement that the OCIA was able to capture the full range of elements of rehabilitation-focused interventions for older adults (occupational, contextual, and personal relevance) and a good fit with the occupational therapy intervention process model. IRR found adequate level of agreement (α = .76). The OCIA has demonstrated initial basic psychometrics for observation of rehabilitation-focused interventions with older adults.

Embedding technology into inter-professional best practices in home safety evaluation.

PURPOSE: To explore inter-professional home evaluators' perspectives and needs for building useful and acceptable decision-support tools for the field of home modifications. METHOD: Twenty semi-structured interviews were conducted with a range of home modification professionals from different regions of the United States. The interview transcripts were analyzed with a qualitative, descriptive, perspective approach. RESULTS: Technology supports current best practice and has potential to inform decision making through features that could enhance home evaluation processes, quality, efficiency and inter-professional communication. CONCLUSIONS: Technological advances with app design have created numerous opportunities for the field of home modifications. Integrating technology and inter-professional best practices will improve home safety evaluation and intervention development to meet client-centred and societal needs. Implications for rehabilitation Understanding home evaluators technology needs for home safety evaluations contributes to the development of app-based assessments. Integrating inter-professional perspectives of best practice and technological needs in an app for home assessments improves processes. Novice and expert home evaluators would benefit from decision support systems embedded in app-based assessments. Adoption of app-based assessment would improve efficiency while remaining client-centred.

Home Modifications for People With Alzheimer's Disease: A Scoping Review.

OBJECTIVE: The purpose of this review was twofold: (1) to gain insight into what is known from the literature about home modifications for people with Alzheimer's disease (AD) and (2) to identify gaps in the literature that could lead to opportunities for research. METHOD: A systematic scoping review of peer-reviewed articles published from 1994 through 2014 explored home modifications and AD. RESULTS: Seventeen articles met the inclusion criteria. The three major findings pertain to (1) the caregiver role and caregiver training, (2) a client-centered collaborative approach to assessment and intervention, and (3) modifications for safety and function. Home modifications involved the physical and social environments as well as cognitive strategies at the task level. CONCLUSION: Opportunities exist for the development of assessment procedures, the exploration of home modifications in the later stages of AD, and the study of home modification needs of people with dementia who live alone.