Opportunities for Occupational Therapy on a Primary Care Team.

IMPORTANCE: Leaders in the occupational therapy profession have called for occupational therapy's inclusion in primary care, but little is known about the occupational needs of patients in this setting. OBJECTIVE: To explore the need for and potential role of occupational therapy in a team-based primary care clinic. DESIGN: A qualitative descriptive study using a convenience sample of clinicians and patients. Meetings and semistructured interviews were recorded, transcribed, and coded by multiple coders using a general immersion-crystallization approach to identify relevant themes. SETTING: Outpatient complex care clinic of an urban academic medical center. PARTICIPANTS: The study included a voluntary sample of clinicians and patients from the complex care clinic. Patients were recruited from a staff-provided list; eligible patients had attended the clinic for at least 1 yr. All patients had multiple chronic conditions and were uninsured or received Medicaid. RESULTS: Researchers attended 10 clinician team meetings and conducted 13 patient interviews and 10 clinician interviews. Four domains of patient need were identified by both patients and clinicians: complex medical management, patients' limited resources, mental health needs, and challenges to occupation. Clinicians also identified cognitive-behavioral challenges affecting care, including lack of engagement and poor problem solving. CONCLUSIONS AND RELEVANCE: The makeup of the clinic team reflected their intent to address medical, socioeconomic, and mental health domains. However, cognitive-behavioral challenges and patients' occupational limitations were not consistently addressed. Thus, patients had unmet needs that occupational therapy practitioners were qualified to address. WHAT THIS ARTICLE ADDS: This study adds to the available literature examining patient needs and clinician challenges in a primary care clinic. Patients have occupational needs that are not being addressed in primary care, indicating a need for occupational therapy in this setting.

Therapy access among children with autism spectrum disorder, cerebral palsy, and attention-deficit-hyperactivity disorder: a population-based study.

AIM: This study examined cross-sectional population-based rates in reported need and unmet need for occupational, physical, and speech therapy services in children with autism spectrum disorder (ASD) compared with children with attention-deficit-hyperactivity disorder (ADHD) and cerebral palsy (CP). METHOD: The 2005-2006 and 2009-2010 (USA) National Survey of Children with Special Health Care data sets were used to compare therapy need and unmet need among children younger than 18 years with ASD (n=5178), ADHD (n=20 566), and CP (n=1183). Bivariate approaches and multivariate logistic regression using imputed data were used to identify associations between child and family characteristics, and access to therapy services. RESULTS: After adjusting for other variables, children with ASD had a significantly greater likelihood of having an unmet therapy need compared with children with ADHD (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.36-2.03), but a similar unmet need as children with CP (OR 1.30, 95% CI 0.97-1.74). Factors associated with unmet need included survey year, younger child age, no health insurance, and increased functional and behavioral difficulties. INTERPRETATION: Children in our sample had greater unmet therapy needs in 2009 than in 2005. Caregiver-reported reasons for unmet need included cost and school resources. Research examining future trends in therapy access are warranted for children with ASD and CP. WHAT THIS PAPER ADDS: Children with complex diagnoses of autism spectrum disorder and cerebral palsy had reported unmet need for therapy services. High costs of therapy were the primary reported reason contributing to reduced access among children.

Outcomes of Introducing Early Learners to Interprofessional Competencies in a Classroom Setting.

PROBLEM: Although interprofessional practice is important for improving healthcare delivery, there is little evidence describing interprofessional education (IPE) outcomes beyond changes in attitudes and knowledge of prelicensure learners. More rigorous evaluation of early IPE is needed to determine its impact on teaching interprofessional collaborative practice and providing a solid foundation for applying collaborative skills in the clinical environment. INTERVENTION: First-year students (N = 679) in 7 health professions programs participated in a 4-session series focusing on professional roles and responsibilities, teams and teamwork, and the healthcare system. Interprofessional teams of 5-6 students, from at least 3 professions, were assembled for the duration of the series and created a team charter during their first session to guide their work. Each subsequent session included a brief lecture and interactive exercises. Faculty facilitators from the participating programs provided support to students during the sessions. As a culminating project, each team created a short video depicting a barrier to interprofessional collaboration. Students evaluated the performance of their team members using a web-based peer assessment survey. A course evaluation with an embedded validated attitudinal scale was used to assess changes in student perceptions about IPE. A sample of videos were also scored by 2 faculty using a rubric linked to course expectations. CONTEXT: This educational offering took place on the health sciences campus of a large, mid-Atlantic research university with more than 3,200 clinical learners in schools of allied health professions, dentistry, medicine, nursing, and pharmacy. It was the first interprofessional activity for most of the learners. OUTCOME: There were 555 students who participated in some or all of the sessions. Comments indicated that students enjoyed interacting with their peers and prefer activities allowing them to apply content to their profession over lectures. The assessment measures revealed a disconnect between student ratings targeting interprofessional socialization and faculty ratings targeting the products of their teamwork. Although students provided positive feedback to their teammates through peer assessment, and the attitudinal scale showed a small but significant increase in positive attitudes toward IPE, the videos they created did not demonstrate a deep understanding of barriers to interprofessional practice. LESSONS LEARNED: This large-scale IPE activity for early learners supported progress toward interprofessional socialization, but student learning was inconsistently demonstrated in teamwork products. Course planners should augment self- and peer-reported interprofessional socialization measures with faculty-generated behavioral outcome assessments. Such triangulation produces a more robust data set to inform decisions about curricular revisions and development.

Interrater Reliability and Developmental Norms in Preschoolers for the Motor Planning Maze Assessment (MPMA).

This study established interrater reliability and preliminary developmental score guidelines for preschool children (ages 3-5 yr) on the Motor Planning Maze Assessment (MPMA). We administered the MPMA to 80 typically developing preschoolers and found age effects for Time, Error, and Total scores for each of three mazes. Five-year-olds obtained lower (better) scores than 4-yr-olds, who scored lower than 3-yr-olds. Older children completed the mazes with significantly fewer errors in significantly less time than younger children. Interrater reliability was excellent on the total MPMA score (intraclass correlation coefficient = 0.96) and individual maze scores (0.90-0.98). Results of this study provide evidence that the MPMA can serve as a reliable, objective screening of a preschooler's ability to plan and execute motor movements. A larger reference population is needed to increase generalizability.

Test of Ideational Praxis (TIP): Preliminary Findings and Interrater and Test-Retest Reliability With Preschoolers.

Praxis is the ability of the brain to develop an idea for action and plan, organize, and execute unfamiliar motor actions. It enables purposeful interaction with people and things in the environment. Ideation is central to praxis but has been little researched. This study investigated the reliability of the Test of Ideational Praxis (TIP) and examined ideational praxis in typical preschoolers. TIP performance for 78 preschoolers ages 3, 4, and 5 yr was videotaped and scored by two trained raters. The TIP has strong interrater reliability, supporting earlier findings. Further, we documented test-retest stability over 2 wk. As a group, preschoolers identified 10.6 affordances (ideas) for action on the TIP; no age differences were found. Training is required for accurate scoring of the TIP; following training, clinicians and researchers may find the TIP a useful tool to screen motor ideational abilities in young children.

The Future of Pediatric Speech-Language Pathology in a More Collaborative World.

Examining interprofessional practice through the lens of speech-language pathology identifies a number of challenges to and opportunities for interprofessional practice. While practitioners believe they practice interprofessionally, health services are often distributed across a network within which collaboration can falter. Certain professions, like speech-language pathology, are well-positioned to work across this network and improve care. Barriers to collaboration are interpersonal, structural, regulatory, and governmental. To enhance interprofessional practice, students should receive interprofessional education; practitioners should engage in interprofessional continuing education based on their practice environment; and leaders and researchers should identify frameworks to support better interprofessional practice.

A collaboration among health sciences schools to enhance faculty development in teaching.

Those involved in providing faculty development may be among only a few individuals for whom faculty development is an interest and priority within their work setting. Furthermore, funding to support faculty development is limited. In 2010, an interprofessional, self-formed, faculty learning community on faculty development in teaching was established to promote collaboration on faculty development initiatives that have transference to faculty members across disciplines and to share expertise and resources for wider impact. The organic structure and processes of the faculty learning community created an environment that has not only resulted in an increased offering of faculty development opportunities and resources across the health science campus, but has created a rich environment that combines the knowledge, innovation, and experience to promote collaborative efforts that benefit all. The background, structure, processes, successes, and lessons learned of the interprofessional faculty learning community on faculty development in teaching are described.