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.

Study on How Occupational Therapy Practitioners Across Different Health Care Settings Use Occupation in Their Clinical WorkOccupational therapy practitioners rely on the use of occupation in their interventions to achieve desired outcomes. However, there is no universally agreed definition of occupation-based practice (OBP) and what it involves. This study explored how 65 occupational therapy practitioners across six different practice settings in the United States defined and enacted OBP in their respective practice settings. Researchers conducted 12 focus groups (two focus groups for each practice setting) and asked participants to take photographs of images on what they thought represented OBP in their practice setting. Visual and focus-group data were first analyzed individually by each researcher, then on a group basis through discussions. Study findings illustrated the importance of contextual factors, the client's status, and temporality in how occupational therapy practitioners defined and carried out OBP. Thinking more about these aspects of OBP may help practitioners and researchers advocate for its importance in health care.

Politics, policies, and patient care: Rehabilitation therapists' experiences during the COVID-19 Pandemic.

The year 2020 represents a historically turbulent period for the United States marked by the COVID-19 pandemic, a contentious political season, and heightened awareness of racism among citizens. This intersection of medicine, politics, and social unrest generated a demanding clinical environment for healthcare workers, including understudied groups such as physical therapists, occupational therapists, and speech-language pathologists. This descriptive qualitative study focused on experiences and perspectives of clinical rehabilitation therapists working in inpatient rehabilitation and acute-care units from September to November, 2020. Thirteen participants completed individual, semi-structured interviews focused on clinical practice and coping strategies. The analysis included a multi-step, inductive process. Four interconnecting factors chronicling participants' experiences emerged: sociopolitical, institutional, hospital unit, and personal. Stressors and buffers were noted that further shaped individual experiences. Utilization of an ecological framework provided a way to recognize the impact of a complex range of social and environmental factors affecting participants' experiences on personal and professional levels. Awareness of rehabilitation therapists' experiences enriches understanding of the pandemic's effect on healthcare workers and presents clinical implications for healthcare systems to promote therapist well-being.

Roles of Caregivers of Autistic Adults: A Qualitative Study.

IMPORTANCE: Understanding the roles of caregivers of autistic adults is important given the increasing number of autistic adults and their ongoing need for various supports. OBJECTIVE: To address the following question: What roles do caregivers enact to support autistic adults? DESIGN: This study had a descriptive qualitative design. Caregivers completed a two-part interview. Data analyses included extracting narratives and a multiple-step coding process that resulted in the identification of three main caregiving themes. PARTICIPANTS: Thirty-one caregivers of autistic adults. FINDINGS: Three main themes that reflected caregiving roles were identified: (1) managing daily living needs, (2) obtaining services and supports, and (3) providing invisible supports. Each theme comprised three subthemes. The roles were enacted regardless of the autistic adults' age, gender, adaptive behavior scores, employment status, or residential status. CONCLUSIONS AND RELEVANCE: Caregivers enacted many roles to support their autistic adult to participate in meaningful occupation. Occupational therapy practitioners can support autistic people across the lifespan in areas such as daily living, leisure, and executive function strategies to decrease the need for caregiving or services. They can also support caregivers as they manage the present and plan for the future. What This Article Adds: This study provides descriptions that illustrate the complexity of caregiving for autistic adults. With an understanding of the many roles that caregivers enact, occupational therapy practitioners can provide services that support both autistic people and their caregivers. Positionality Statement: We recognize that use of person-first versus identity-first language is a source of debate and controversy. We have chosen to use identity-first language, for two reasons. First, studies indicate that person with autism is the term least preferred by autistic people (e.g., Botha et al., 2021). Second, autistic is the term used by the majority of our participants during interviews.

Using Practice-Based Inquiry to Enact Occupation-Centered, Justice-Oriented Practice in an Acute Mental Health Setting.

IMPORTANCE: Occupational therapy practitioners working in mental health settings in the United States are faced with challenges and barriers to implementing justice-oriented, occupation-centered practice. Research situated in the practice context with practitioners as coresearchers may provide an avenue for changing practice. OBJECTIVE: To describe the reconceptualization and redesign of occupational therapy services by a community of occupational therapy practitioners in an acute mental health setting in the United States. DESIGN: Practice-based inquiry, a form of practitioner-generated action research with a community of practice scholars (CoPS), guided the redesign of practice. SETTING: Acute mental health service in a large teaching hospital system. PARTICIPANTS: Nine occupational therapists comprised a CoPS and served as coresearchers and participants in the study. DATA COLLECTION AND ANALYSIS: Practitioner scholars' experiences of daily practice captured in individual reflections and collective research discussions were the source of data. Data collection, analysis, and action was an iterative process. Coresearchers coded and categorized findings and then developed themes reflecting changes enacted in practice. FINDINGS: The data analysis resulted in two themes characterizing how the CoPS reconceptualized and redesigned practice to reflect their commitment to occupation-centered and justice-focused occupational therapy: (1) occupational opportunities through direct services and (2) occupational opportunities through system-level change. CONCLUSIONS AND RELEVANCE: For this CoPS, engaging in a practice-based inquiry facilitated a reconceptualization of their practice and widened their occupational lens, thus strengthening their identity as occupational therapists. Given the barriers to demonstrating occupational therapy's unique contribution to mental health practice, this research provides a valuable tool for practitioners. What This Article Adds: Occupational therapy practitioners who engage in context-specific, action-oriented research experience a transformative process that empowers them to address barriers often encountered in mental health practice and enact occupation-centered and justice-focused practice.

Sensory Processing and Community Participation in Autistic Adults.

Background: Sensory processing differences have been shown to impact involvement in community activities. However, relatively little is known about how these differences affect community participation in autistic adults. Objective: The objective of this study was to explore how sensory processing patterns of autistic adults impact community participation, including where people go, what they do, the amount of time in the community, and preferred locations. Methods: We used data gathered from six autistic adults and their caregivers who participated in two studies. From Study 1, we reviewed results of the Adolescent and Adult Sensory Profile (AASP) and transcripts from interviews with caregivers. From Study 2, we reviewed GPS tracking data and transcripts from structured interviews with autistic adults focused on community participation. We read transcript data, identified quotes related to sensory processing and community participation and constructed individual participant narratives which linked findings from interviews, AASP, and GPS tracking. Results: Participants included three males and three females ranging in age from 29 to 51. Each participant had a unique sensory processing profile that influenced where they went, the activities in which they engaged, how much time they spent in the community, and their preferred locations. Those whose sensory processing patterns indicated sensory sensitivity and sensory avoiding described the experience of certain environments as overwhelming and fatiguing and thus spent less time in the community and visited fewer places than those with other sensory processing patterns. Conclusion: Results highlight the importance of sensory processing, especially as it impacts participation in the community. Sensory processing patterns should be considered along with other personal and contextual factors when assessing community participation and personal sensory processing patterns should be matched with activities and environmental demands.

A Life Course Perspective on Growing Older With Cerebral Palsy.

Despite most children with cerebral palsy (CP) now living within typical life spans, little is known about how the effects of CP unfold across the life course and impact participation in everyday life during adulthood. In this study, we explored the experiences of 38 adults growing older with CP. Data were gathered using semi-structured interviews focused on participants' engagement in activities in their community and analyzed using a life course perspective to deepen our understanding of the experiences of our participants. We found that individual agency, family and social contexts, as well as larger sociocultural contexts all shaped participants' experiences as they grew older. The findings highlight the usefulness of the life course perspective for understanding how the effects of a diagnosis of CP unfold over time. Further use of this perspective can better inform health care services to meet the needs of adults with CP aging with a lifelong disability.

Novel approaches to measuring community integration in adults with cerebral palsy.

Purpose: Rehabilitation goals often focus on increasing community integration for adults with disabilities and are measured by objective assessments. Research methods have lagged behind in capturing current conceptualizations of community integration as a multidimensional construct that incorporates participation, social supports, and feelings of belonging in the community. This paper addresses this challenge by describing a multi-method approach to assessing community integration for adults with cerebral palsy.Methods: Measures include standardized questionnaires, qualitative methods, measures of function and physical activity, and geospatial measures using Geographic Information System mapping and Global Positioning System tracking. These objective and subjective data are used to determine where adults spend time and are most active, and which activities and social connections are associated with feeling integrated into the community.Results: Two case examples highlight the importance of using a multi-method approach to assess community integration for adults with cerebral palsy. Results of objective clinical measures were comparable among case examples; however, actual experiences of feeling connected to the community were vastly different.Conclusions: Multiple measures are required to capture the complexity of community integration. Relying solely on objective measures may not provide a complete picture of community integration.IMPLICATIONS FOR REHABILITATIONCommunity integration is a complex construct that incorporates participation, socialization, and feelings of belonging in the community.New methods and measures are needed to assess the many aspects of community integration in adults with disabilities.A multi-method approach is recommended to provide a richer characterization of community integration in individuals with disabilities.A combination of quantitative and qualitative measures addressing the physical, social and psychological aspects of community integration should be used.

"No! You can't have it": Problematizing choice in institutionalized adults with intellectual disabilities.

Institutionalized adults with profound intellectual disabilities (ID) face significant challenges to having their choice-making cultivated and supported. Based on observational and interview data from an institutional ethnographic study, this article explores how choice-making during mealtimes is acknowledged and problematized by staff. First, we suggest that Foucauldian problematization offers a lens through which to better understand how mealtime intervention plans passed down over time become embodied restrictive practices. Second, we provide examples and analyses of mealtime negotiations between staff and residents. Analyses revealed staff infantilize and misrepresent residents' choice-making during meals as manipulation; additionally, analyses suggest that past experiences of staff with residents and historical meal plans color how they acknowledge and interpret residents' choices. Our argument is an attempt to move forward discussions concerning the implementation of quality habilitation services by highlighting the ways contemporary institutional systems perpetuate misrepresentations of nonverbal behaviors in adults with profound ID.

Understanding self-determination as a crucial component in promoting the distinct value of occupational therapy in post-secondary transition planning.

School-based occupational therapists are well-equipped to prepare adolescents to transition from the education system to work and live in their communities, but they report challenges in securing their place on post-secondary transition planning teams. We argue that occupational therapists' efforts to advocate for their role in post-secondary transition could be strengthened by a deeper engagement with what is considered 'best practice' in transition planning: improving students' ability and opportunity to exercise self-determination. In this commentary, we review the self-determination evidence-base; identify congruence between the underlying philosophies of self-determination and occupational therapy; and highlight gaps in existing self-determination models that occupational therapists are uniquely posed to fill by focusing on self-determination as they support transition age students.

"Thrust into adulthood": Transition experiences of young adults with cerebral palsy.

BACKGROUND: The transition to adulthood, the gradual change in roles and responsibilities, is identified as a challenging time for adolescents and young adults with physical disabilities, including those with cerebral palsy. Health care, education, employment, independent living, and community engagement have been identified as areas of concern. However, relatively little research has been done to understand the experiences, perceptions, and needs of individuals with cerebral palsy as they transition toward adulthood. OBJECTIVE: The objective of this study was to explore the transition experiences, perceptions, and needs of young adults with cerebral palsy living in one state in the southeastern United States. METHODS: Focus groups with nine young adults with cerebral palsy (19-34 years) were conducted. The focus group interview explored the preparation for transition and experiences navigating adulthood. The audio-recorded groups were transcribed and analyzed using thematic analysis. RESULTS: Young adults with cerebral palsy identified numerous challenges associated with navigating adulthood. The main themes were: 1) being thrust into adulthood; 2) navigating systems and services; 3) understanding and managing my body; and 4) dealing with stereotypes and prejudice. CONCLUSIONS: The findings highlight the need for a holistic approach to transition with a focus on building capacity and empowerment. To navigate complex systems of care, "navigators" or "facilitators" are needed. Additionally, practitioners and service providers in adult systems need further education about cerebral palsy.

Looking Backward, Thinking Forward: Occupational Therapy and Autism Spectrum Disorders.

As autism spectrum disorders become more prevalent and comprise a growing percentage of occupational therapists' caseloads, it is important to examine trends in the literature. The purpose of this scoping review is to provide a historical analysis to illuminate changes and gaps in the occupational therapy literature related to autism spectrum disorders to inform the direction of research and practice. A total of 115 articles published in five occupational therapy journals in the United States from 1980 to 2013 were reviewed. Publications were coded by article type, with intervention studies coded in detail. Results indicated a consistent increase in number of publications as years progressed. Analysis by decade highlighted a shift from a biomedical focus to an occupation focus. Suggestions for future research include building a stronger evidence base, developing occupation-based assessments and interventions, and addressing needs of individuals with autism spectrum disorders and their families across the life span.

Promoting Healthy Lifestyles to Children at School: Using a Multidisciplinary Train-the-Trainer Approach.

OBJECTIVE: The purpose of the study was to examine the efficacy of a multidisciplinary train-the-trainer model for improving fitness and food label literacy in third-grade students. DESIGN: University student trainers taught ABC for Fitness and Nutrition Detectives, established programs to promote physical activity and nutrition knowledge, to 239 third-grade students in 2 communities over a 6-month period. A total of 110 children were in the intervention group and 129 children in the control group (2 schools each). Outcomes included the Food Label Literacy and Nutrition Knowledge test and the fitness measures of curl-ups, push-ups, 0.5-mile run, and sit and reach. Focus groups were conducted as process feedback. SETTING: Four public schools in 2 different communities. PARTICIPANTS: A total of 200 third-grade students. INTERVENTION: ABC for Fitness and Nutrition Detectives. MAIN OUTCOME MEASURES: Food Label Literacy and Nutrition Knowledge test and the fitness measures of curl-ups, push-ups, 0.5-mile run, and sit and reach. RESULTS: Nutrition knowledge increased in the intervention group by 25.2% (P < .01). Fitness measures in the intervention schools showed greater improvement than those in the controls for curl-ups (P < .01), push-ups (P < .01), sit and reach left (P = .07), and 0.5-mile run (P = .06). Process feedback from 3 teachers and 60 students indicated satisfaction with the program. CONCLUSION: Adaptation of the train-the-trainer approach for Nutrition Detectives and ABC for Fitness was effective for delivering these health-related programs.

Routines of families with adolescents with autistic disorders: a comparison study.

BACKGROUND: Research has consistently shown that families with children with autism spectrum disorders (ASD) have difficulty engaging in family routines, yet little is known about families with adolescents with ASD. PURPOSE: The purpose of this study is to compare the routines of families with adolescents with ASD (FASD) and families with typically developing adolescents. METHOD: Twenty families in each group were compared using the Family Routines Inventory and supplemental questions. Data were analyzed using a Mann-Whitney U and content analysis. FINDINGS: No significant difference between groups was found; however, there was a trending toward significance in the subscale of mealtime routines in both endorsement and adherence. Analysis of open-ended questions revealed differences in how routines were carried out. IMPLICATIONS: Occupational therapists should consider assessing and addressing routines of importance to FASD to increase family health and well-being. Further research is needed to better understand the routines of FASD.

Effectiveness of therapy ball chairs on classroom participation in children with autism spectrum disorders.

A single-subject design was used to assess the effectiveness of therapy ball chairs on classroom participation in 6 boys with autism spectrum disorder (ASD). The sensory processing pattern of each participant was assessed using the Sensory Processing Measure. Data on in-seat behavior and engagement were collected using digital video recordings during Circle Time. During baseline, participants sat on chairs. During intervention, participants sat on therapy ball chairs. Social validity was assessed by means of a questionnaire completed by the teacher. Each child demonstrated a unique response. The ball chair appeared to have a positive effect on in-seat behavior for the child who had the most extreme vestibular-proprioceptive-seeking behaviors. Children with poor postural stability were less engaged when sitting on the therapy ball chair. The results illuminate the complex nature of children with ASD and the importance of using sound clinical reasoning skills when recommending sensory strategies for the classroom.

Attitudes of health care students about computer-aided neuroanatomy instruction.

This study examined students' attitudes toward computer-aided instruction (CAI), specifically neuroanatomy learning modules, to assess which components were primary in establishing these attitudes and to discuss the implications of these attitudes for successfully incorporating CAI in the preparation of health care providers. Seventy-seven masters degree, entry-level, health care professional students matriculated in an introductory neuroanatomy course volunteered as subjects for this study. Students independently reviewed the modules as supplements to lecture and completed a survey to evaluate teaching effectiveness. Responses to survey statements were compared across the learning modules to determine if students viewed the modules differently. Responses to individual survey statements were averaged to measure the strength of agreement or disagreement with the statement. Responses to open-ended questions were theme coded, and frequencies and percentages were calculated for each. Students saw no differences between the learning modules. Students perceived the learning modules as valuable; they enjoyed using the modules but did not prefer CAI over traditional lecture format. The modules were useful in learning or reinforcing neuroanatomical concepts and improving clinical problem-solving skills. Students reported that the visual representation of the neuroanatomical systems, computer animation, ability to control the use of the modules, and navigational fidelity were key factors in determining attitudes. The computer-based learning modules examined in this study were effective as adjuncts to lecture in helping entry-level health care students learn and make clinical applications of neuroanatomy information.