Neuro-behavioural changes after acquired brain injury: The role of the occupational therapist; the interventions they use and why.

INTRODUCTION: Almost half of the people living with acquired brain injury experience behavioural changes, yet there is lack of clarity both in the literature, and through major stakeholders internationally, regarding how occupational therapists contribute to neuro-behavioural rehabilitation and what their role is in this context. METHODS: This study answers the research question: What do occupational therapists perceive as their role in behavioural rehabilitation with adults living with acquired brain injury, and what treatment approaches, if any, are they using to promote occupation? A national, qualitative, bounded case study design using semi-structured interviews was used to explore what the role of the occupational therapist is in neuro-behavioural rehabilitation across subacute brain injury units in Australia. FINDINGS: Four themes were identified which provide clarification on the role of the occupational therapist in neuro-behavioural rehabilitation: You change the task, you change the environment, change the person; build a safe rapport; the sensory stuff is huge and, finally, owning how we think. CONCLUSION: This bounded case study provides insight into how occupational therapists perceive their role and the interventions they use to promote occupational engagement. The lack of recognition of the occupational therapist role is a barrier to providing appropriate neuro-behavioural rehabilitation. This case study identified sensory approaches, building safe rapport and adapting the environment as the main interventions used in neuro-behavioural rehabilitation by occupational therapists.

Service and demographic factors, health, trauma exposure, and participation are associated with adjustment for former Australian Defense Force members.

Approximately 50% of transitioning service members report difficulty adjusting to civilian life. However, there is limited research exploring factors that influence adjustment for former Australian Defence Force (ADF) members. The aim of this study was to investigate the influence of demographic and service-related characteristics, trauma exposure, health, and participation in meaningful occupations on adjustment for former ADF members. One hundred and ninety-eight former ADF members completed a voluntary, online survey containing validated self-report measures for adjustment, health, and exposure to combat and military sexual trauma. Participation in meaningful occupations was assessed using open-ended questions and a rating scale for frequency of participation. A more difficult adjustment was reported by participants who had completed operational service, reported exposure to combat and/or military sexual trauma, had poor physical health and were discharged for medical reasons. Other characteristics associated with a difficult adjustment included emotional distress, involuntary discharge, age category 30-49 years, final rank of Senior Noncommissioned Officer/Warrant Officer or below, and discharge 6-8 years previously. Employment, voluntary work and care, and social and community interaction were associated with an easier adjustment. Screening tools that consider health, age, deployment type, final rank, type of discharge and exposure to combat or military sexual trauma may be helpful to identify and refer high risk individuals to employment, rehabilitation or transition support programs.

Rural former service members participate in meaningful occupations to 'fill the void' after military service.

INTRODUCTION: Over 50% of former service members report debilitating health conditions and difficulty adjusting to civilian life. Former service members living in rural areas are even more likely to experience poor health outcomes and have decreased access to specialist health-care services. Participation in meaningful occupations can support health and adjustment after military service. However, little is known about rural former service members' perspectives and experiences of participating in occupations after separating from military service. This study explored rural former service members' experiences of participating in occupations during their transition and their perceptions of how these experiences influenced their health and adjustment. METHODS: Purposive sampling was used to recruit 10 rural former Australian Defence Force members discharged from service between 1 July 2013 and 1 July 2018. Former service members participated in a series of semi-structured interviews. Interpretative phenomenological analysis was used to determine themes for individual participants and then overarching themes that characterised the experiences of the group. FINDINGS: A single overarching theme, 'It can't all be for nothing': Searching for ways to fill 'the void' through meaningful occupational participation, reflected rural former service members' experiences. The different ways that participants sought to fill 'the void' after military service were interpreted through two sub-themes: (1) 'You can't heal if you're still in a battlefield': Participating in occupations to re-establish safety and wellbeing, and (2) 'I was in a uniform and I could still do well': Participating in occupations to reconnect with self and continue the mission to serve. CONCLUSION: Rural former service members participated in various occupations to establish safety, wellbeing, and reconnection after transitioning from military service. The findings point to the need for further research to inform the development of consumer-led occupation-based interventions that are sensitive to individuals' service history, environmental context, and trauma recovery needs.

A journey of living well: a participatory photovoice study exploring recovery and everyday activities with people experiencing mental illness.

BACKGROUND AND AIM: Engagement in everyday activities has been identified as an important element in personal recovery from the experience of mental illness and a key priority for service-users. This study explored the role of everyday activities in recovery. METHOD: This study used a photovoice participatory research. Twenty-one participants experiencing mental illness were recruited from a community-managed mental health service in Melbourne, Australia. Data collection included individual interviews and photovoice courses. The courses included group discussions and required participants to take photographs about their everyday activities that support recovery. A lived experience co-facilitator contributed to development and delivery of the course. The interviews and group discussions were transcribed verbatim and analysed using constant comparative methods. RESULTS: Recovery as a "journey of living well" was identified as the central theme that encompasses three interlinked categories: (1) living a life on hold; (2) choosing to recover; and (3) learning and navigating strategies. CONCLUSIONS: The findings suggest that recovery involves a range of experiences embedded in people's everyday lives. Recovery-oriented practice should provide opportunities for engagement in meaningful activities, to help consumers identify their potential and strategies to live well, and to adopt co-production at all levels.

Supporting the Sharing of Mental Health Challenges in the Workplace: Findings from Comparative Case Study Research at Two Mental Health Services.

Personal experience with mental health (MH) challenges has been characterized as a concealable stigma. Identity management literature suggests actively concealing a stigma may negatively impact wellbeing. Reviews of workplace identity management literature have linked safety in revealing a stigma to individual performance, well-being, engagement and teamwork. However, no research to date has articulated the factors that make sharing MH challenges possible. This study employed a comparative case study design to explore the sharing of MH challenges in two Australian MH services. We conducted qualitative analyses of interviews with staff in direct service delivery and supervisory roles, to determine factors supporting safety to share. Workplace factors supporting safety to share MH challenges included: planned and unplanned "check-ins;" mutual sharing and support from colleagues and supervisors; opportunities for individual and team reflection; responses to and management of personal leave and requests for accommodation; and messaging and action from senior organizational leaders supporting the value of workforce diversity. Research involving staff with experience of MH challenges provides valuable insights into how we can better support MH staff across the workforce.

Participation in occupations, health and adjustment during the transition from military service: A cross-sectional study.

Participation in meaningful occupations is central to health, well-being, and adjustment during the transition from military service. The aim of the present study was to identify what occupations transitioning Australian Defence Force members participate in for the purpose of improving their health and well-being. A secondary aim was to identify if participation in various occupations was associated with better self-reported health and/or adjustment outcomes. One hundred and ninety-eight former Australian Defence Force members discharged on or after January 1, 2004 responded to a cross-sectional survey measuring adjustment, physical and mental health, and participation in occupations. Occupations were coded using the Time Use Classification system developed by the Australian Bureau of Statistics. An easier adjustment was reported by former service members who participated in employment-related activities, domestic activities, voluntary work and care activities, and social and community interaction (MD = -0.63 to -0.45, d = .37 to .52). Participation in employment-related activities, social and community interaction, and sport and outdoor activity was associated with better physical health (MD = 3.20 to 3.73, d = .34 to .40). Participation in employment-related activities was also associated with better mental health (MD = -3.75, d = .54). This research indicates that participation in occupation is a factor that may be utilized with former service members to positively influence health and adjustment during military transitions. Given differences in participation and outcomes among different sub-groups, it is recommended that occupation-based programs be tailored to individual preferences and transition needs.

Factors Affecting Mental Health Professionals' Sharing of Their Lived Experience in the Workplace: A Scoping Review.

OBJECTIVE: Research has suggested that some mental health professionals (MHPs) continue to hold stigmatized beliefs about persons with emotional distress. These beliefs may be amenable to contact-based interventions with similar peers. To inform future interventions, policy, and research, this scoping review examined existing literature to identify factors that affect disclosure of lived experience by MHPs to colleagues and supervisors. METHODS: A systematic search was conducted of four online databases, gray literature, and the reference lists of included articles. Primary research studies of any design conducted with MHPs with lived experience of emotional distress and their colleagues were included. The findings of included studies were inductively coded within the themes of enabling, constraining, and intrapersonal factors influencing disclosure. RESULTS: A total of 23 studies were included in data extraction and synthesis. Factors that influenced MHPs' sharing of their lived experience in the workplace were categorized into five overarching themes: the "impaired professional," the "us and them" divide, the "wounded healer," belief in the continuum of emotional distress, and negotiating hybrid identities. MHPs with lived experience described feeling conflict between professional and service user identities that affected the integration and use of their clinical and experiential knowledge. Enabling factors reflected best-practice human resource management, such as organizational leadership, access to supervision and training, inclusive recruitment practices, and the provision of reasonable accommodations. CONCLUSIONS: Findings of this scoping review suggest that organizational interventions to support MHPs in order to share their lived experience may improve workplace diversity and well-being, with implications for service users' experience.

Global citizenship: Defining capabilities for speech-language pathology.

Purpose: This paper outlines the findings of a scoping review of the literature relating to global citizenship. The purpose of the review was to develop a working definition and associated capabilities for assessing global citizenship among speech-language pathologists (SLPs), which may also prove helpful to other health professionals and for educating tertiary students. Method: Using Arksey and O'Malley's scoping review framework, key databases were searched, namely Medline, CINAHL, PsycINFO, the Cochrane Library and Google Scholar. Subsequently the Medical Subject Heading (MeSH) terms were applied for coding and categorising initial research findings. Articles were individually appraised using the Critical Appraisal Skills Programme tool (CASP). Result: Of the 2126 articles identified, 21 articles were determined to satisfy the search criteria. The literature revealed nine capabilities associated with global citizenship appropriate for health professionals including SLPs. Conclusion: Based on the findings, a working definition is determined for assessing professional global citizenship capabilities, which will prove useful for improving occupational standards, for charting competencies, and ultimately enhancing professional capability.

Defining sensory modulation: A review of the concept and a contemporary definition for application by occupational therapists.

BACKGROUND: Sensory interventions are prevalent amongst adult mental health practitioners and are supported by major stakeholders and policy makers across the world. The term commonly used by occupational therapists applying sensory practices is sensory modulation, however this term has evolved. AIMS: This paper aims to investigate and clarify the definition of 'sensory modulation' for application by occupational therapists. METHOD: A framework guided this concept analysis on sensory modulation. A summative content analysis approach was employed to code results. RESULTS: Six conceptual themes for sensory modulation were identified. 81% of authors defined sensory modulation as consisting of more than one of these themes. 18% of authors defined sensory modulation as both a neurophysiological process and means to regulate behaviour. CONCLUSION: The concept of sensory modulation has evolved in occupational therapy practice. The authors summarise with the following proposed definition of sensory modulation for contemporary occupational therapy practice: 'Sensory modulation is considered a twofold process. It originates in the central nervous system as the neurological ability to regulate and process sensory stimuli; this subsequently offers the individual an opportunity to respond behaviourally to the stimulus'. SIGNIFICANCE: A contemporary definition of 'sensory modulation' has been identified for occupational therapy practice.

Place for being, doing, becoming and belonging: A meta-synthesis exploring the role of place in mental health recovery.

BACKGROUND AND AIM: The role of place in mental health recovery was investigated by synthesizing qualitative research on this topic. METHODS: Using a meta-ethnographic approach, twelve research papers were selected, their data extracted, coded and synthesized. FINDINGS: Place for doing, being, becoming and belonging emerged as central mechanisms through which place impacts recovery. Several material, social, natural and temporal characteristics appear to enable or constrain the potential of places to support recovery. CONCLUSIONS: The impact of place on recovery is multi-faceted. The multidimensional interactions between people, place and recovery can inform recovery-oriented practice. Further research is required to uncover the role of place in offering opportunities for active engagement, social connection and community participation.

Recovery as an occupational journey: A scoping review exploring the links between occupational engagement and recovery for people with enduring mental health issues.

BACKGROUND/AIM: Mental health recovery can be defined in variety of different ways. First person accounts of people experiencing mental health issues and qualitative studies of recovery suggest engaging in personally meaningful and socially valued occupations is important during the process of recovering. This scoping review sought to explore how occupational engagement and recovery are interrelated. METHODS: Using Arksey and O'Malley's (2005) framework to guide the scoping review, searches of four electronic databases, manual citation tracking, and key authors' publications were conducted. Seventeen studies, published in the last 30 years, relevant to the topic were identified. Each was reviewed and data extracted to categorise the similarities and differences into themes. RESULTS: Most studies used qualitative, phenomenological and narrative research approaches. Findings across the studies indicate recovery is an ongoing occupational process that seems to involve experiences of gradual re-engagement, engaging within the stream of everyday occupational life, and full community participation. Engaging in meaningful and valued occupations appears to support recovering through fostering connectedness, hope, identity, meaning, and empowerment; establishing structured routines and assisting people in managing illness. CONCLUSION: This scoping review indicates occupational engagement is an important dimension of the recovery process: recovering is experienced through engaging in occupations, which, in turn, fosters personal recovery. Employment and volunteering have received most attention in studies of occupation and recovery. A broader view of the experiences and factors involved in the processes of 'occupational recovery' warrants further exploration to advance theory and inform recovery-oriented occupational therapy practice.

Enabling occupational participation and social inclusion for people recovering from mental ill-health through community gardening.

INTRODUCTION: There is a need for mental health practitioners to understand how inclusive environments that enable participation can be developed. This paper presents the findings from an ethnographic exploration of Mind 'Sprout', a supported community garden situated in inner-city Melbourne. The study explored how this community development project created a socially inclusive environment, and enabled occupational participation among people recovering from mental ill-health. METHODS: Consistent with the ethos of ethnography, data were collected through participant observation and asking questions of people as they participated at 'Sprout'. Six individual interviews and review of organisational documents were also conducted. Qualitative analysis was used to identify the understandings of how the Sprout community was created and experienced by its members. RESULTS: Three interrelated themes were revealed: Sprout community garden enabled social inclusion and occupational participation by creating community, creating a flexible environment that supports participation and creating a learning environment. The way Sprout operated enabled its members to participate together in occupation and to interact socially within the garden community and beyond as part of the local community. CONCLUSION: Sprout has developed a philosophy of active participation. The findings point to the opportunities that community development projects offer for creating environments that enable participation and social inclusion. They also suggest that an opportunity exists for occupational therapists to broaden their practise by leading or collaborating in these projects.

Occupation and its relationship with health and wellbeing: the threshold concept for occupational therapy.

BACKGROUND/AIM: We introduce the educational framework of 'threshold concepts' and discuss its utility in understanding the fundamental difficulties learners have in understanding ways of thinking and practising as occupational therapists. We propose that the relationship between occupation and health is a threshold concept for occupational therapy because of students' trouble in achieving lasting conceptual change in relation to their understanding of it. METHODS: The authors present and discuss key ideas drawn from educational writings on threshold concepts, review the emerging literature on threshold concepts in occupational therapy, and pose a series of questions in order to prompt consideration of the pedagogical issues requiring action by academic and fieldwork educators. RESULTS: Threshold concepts in occupational therapy have been considered in a primarily cross-disciplinary sense, that is, the understandings that occupational therapy learners grapple with are relevant to learners in other disciplines. In contrast, we present a more narrowly defined conception that emphasises the 'bounded-ness' of the concept to the discipline. CONCLUSION: A threshold concept that captures the essential nature of occupational therapy is likely to be (highly) troublesome in terms of a learner's acquisition of it. Rather than simplifying these learning 'jewels' educators are encouraged to sit with the discomfort that they and the learner may experience as the learner struggles to grasp them. Moreover, they should reshape their curricula to provoke such struggles if transformative learning is to be the outcome.

Perspectives of occupational therapists working in primary health promotion.

BACKGROUND/AIM: Given a global reorientation of health services towards upstream, or primary health promotion, there is a need to explore the role of occupational therapy in this area of practice. This study aimed to explore and describe the primary health promotion practice of community health workers with an occupational therapy background. The study highlights their practice working at a community or population (macro) level, rather than at the client service (micro) level, and explores related enablers and barriers to this practice. METHODS: The study utilised the qualitative methodology of narrative enquiry. Five workers with an occupational therapy background were recruited from community health services within Victoria. Data were gathered via in-depth interviews. Individual participant interview data were ordered to form a narrative detailing each participant's experience. These narratives were then analysed to generate themes representing important aspects of participant's experiences. RESULTS: Although some practitioners with an occupational therapy background perform primary health promotion, the findings indicate that a number of barriers deter occupational therapists from engaging in this type of practice, including lack of funding, preparation and limited understanding of the role of occupational therapy in health promotion. Enablers to engagement included undertaking further education, gaining clinical experience and establishing a professional identity. CONCLUSION: This study provides insights into the experiences of occupational therapists who work at a macro rather than micro-level of practice, and emphasises some of the barriers and enablers to embracing the sorts of roles that are emerging as part of a changing health system.

Project-based fieldwork: perspectives of graduate entry students and project sponsors.

BACKGROUND/AIM: This article builds on an earlier viewpoint regarding the need for project-focussed fieldwork. It presents the findings of an evaluative study into the value of project placements undertaken by final year graduate entry master's students as part of a capstone subject. The authors argue that provision of project placements enable impending graduates to develop and implement macro level strategies to develop prevention, resource and service development skills often required of contemporary occupational therapy practitioners. METHODS: A qualitative approach is adopted. Student cohorts from 2005 and 2006 completed open-ended, written questionnaires, and agency project sponsors were interviewed to obtain their perspectives of the project placement experience. RESULTS: Despite some concern that project placements might be undertaken at the expense of 'clinical' placements these findings reveal that projects managed by students were perceived by services to add great value enabling them to advance important priorities. Students and sponsors highlighted a range of positive learning outcomes, including the ability to work collaboratively with supervisors and develop advanced communication skills and political acumen. The success of such placements depends on supportive supervision from academic staff. CONCLUSIONS AND SIGNIFICANCE OF THE STUDY: The findings promote project placements as a highly authentic aspect of work integrated learning enabling learners to draw together a range of attributes that support the ability to manage complex issues that have occupational relevance at a macro level. In addition, such experiences help learners to develop agency and political acumen both increasingly important capabilities for the contemporary workplace.

A profile of inpatient admissions to an aged psychiatry service in Victoria.

OBJECTIVE: The study aimed to characterize the demographics, diagnostic makeup and aspects of patient management for the inpatient population of a large aged psychiatry service. METHOD: Sociodemographic and clinical variables were retrospectively collated from inpatient files and discharge summaries over a 3-year period. Age, gender, country of birth, diagnostic group, length of stay, involuntary care status and number of admissions were described and analysed. A total of 604 patients were included in the study, with complete data available for 516. RESULTS: Approximately half of the patients were aged 65-75 years and 59.3% were female. More than half had been born outside of Australia. The primary diagnosis was an affective disorder in 39.0% of admissions, dementia in 27.5% and psychotic illnesses in 25.8%. The median length of stay was 28 days; 60.8% had a period of involuntary care and 79.8% had only one admission. CONCLUSION: In the near future, aged psychiatry services will face increased numbers of patients and rising expectations. To best respond to these challenges, we need to have an understanding of current patient and service profiles. The findings of this study illustrate a range of patient, diagnostic and management variables in aged psychiatry practice. This information can be used for comparison with other services and in planning for future development of services.

The challenge of interdisciplinary collaboration in acute psychiatry: Impacts on the occupational milieu.

This paper, based on a larger ethnographic exploration of the acute inpatient environment for older people with mental illness, describes and provides interpretations of staff perceptions and actions in order to highlight tensions between professional groups which adversely affect opportunities for patients to engage in meaningful occupations. Fieldwork conducted in 1999-2000, supplemented by 20 in-depth interviews with a range of mental health professionals, provides the foundation for suggesting that the extent and nature of occupational engagement is significantly impacted by interdisciplinary relations. The skill of occupational therapists to collaborate with their nursing colleagues in a socially complex environment, and the importance of personal leadership skills among our new graduates are discussed.

Mental health care for our ageing Australian population.

OBJECTIVE: In the context of the National Strategy for an Ageing Australia, the aim of this paper was to highlight some of the challenges for aged mental health services as our population ages. CONCLUSIONS: The demand for greater consumer participation in treatment planning and provision, and the increasing complexity of managing medical and psychiatric comorbidity in our 'old-old' population will be major drivers for improving our models of clinical practice and forging stronger partnerships between the public and private sectors.