Understanding Policy Influences on Health and Occupation Through the Use of the Life Course Health Development (LCHD) Framework.

Life course health development (LCHD) is a framework that considers the transactional nature of risks and protective factors along the life trajectory and how this context influences health. Public policies, from health care to education to social services to labor laws, have many goals, including lessening and eliminating health disparities, yet inequities in health services and outcomes remain. Policy is a contextual factor that may be overlooked when examining influences on health and occupation. As such, the LCHD framework may assist occupational therapy practitioners in understanding the influences of policy-both successes and failures-on occupation. In this article, we introduce the principles of LCHD and use this framework to illustrate analysis of a policy example of paid family leave, demonstrating how gaps in or unintended consequences of policy may contribute to disparities in health and occupation for certain populations.

Examining Intraprofessional Competencies for Occupational Therapist and Occupational Therapy Assistant Collaboration.

This study examined competencies perceived by occupational therapists and occupational therapy assistants as important for intraprofessional collaboration. While interprofessional practice is well defined, less is known about collaboration within professions with varied levels of practice credentials. Occupational therapy practitioners (N = 351) rated 20 competencies in four domains (Intraprofessional Teamwork, Roles/Responsibilities, Communication, and Values/Ethics) through an online survey. A high percentage of respondents perceived all competencies as important or very important. There were significant differences between occupational therapists and occupational therapy assistants in ratings of five competencies, including: seeking information/support from the team partner, flexibility for effective partnership, engagement in professional development for collaboration, communicating ideas, and providing feedback about performance. Outcomes contribute to understanding intraprofessional collaboration for occupational therapy practice. Competencies can serve as guidelines for education and professional development.

Expanding the Implementation of the Americans With Disabilities Act for Populations With Intellectual and Developmental Disabilities: The Role of Organization-Level Occupational Therapy Consultation.

The Americans With Disabilities Act (ADA) provides standards and guidance for accessibility and accommodations that remove barriers to facilitate community social participation for individuals with disabilities. However, ADA implementation does not yet fully address the diverse access needs of people with intellectual and developmental disabilities (IDD), who continue to face barriers to community social participation. This article explores the potential for occupational therapy practitioners to provide organization-level consultation as a means of maximizing community social participation among people with IDD. Case examples of occupational therapy practitioners working with community organizations are presented to illustrate organization-level consultation that addresses access needs across diverse community contexts. The relevance of supporting community social participation within the context of health equity is discussed, and key next steps, including developing population-based outcome measures, addressing reimbursement considerations, and developing best practices for organization-level consultation, are outlined.

Life Course Factors Associated with Initiation and Continuation of Exclusive Breastfeeding.

INTRODUCTION: Exclusive breastfeeding (EBF) benefits the life course health development of infants, families, and society. Professional health associations recommend EBF for 4 months, and many now recommend EBF for 6 months. Yet only 18.8 % of US infants born in 2011 were exclusively breastfed. Numerous studies on breastfeeding are published, but few describe EBF. This study describes characteristics of women who initiated EBF and examines the associations of those factors with EBF lasting ≥4 months. The Life Course Health Development (LCHD)framework was used to structure the analysis and interpret results. METHODS: Data collected through the Infant Feeding Practices Study II survey (2005-2007) were used to identify a cohort of women (n = 1226) practicing EBF at the time of hospital discharge and their sociodemographic, health, work, and child care characteristics. Associations of these characteristics with EBF lasting ≥4 months were studied by bivariate and logistic regression analyses. RESULTS: College education [odds ratio (OR) 2.14, 95 %confidence interval (CI) 1.58-2.89] and marriage (OR2.19, 95 % CI 1.43-3.37) were associated with greater odds of EBF lasting ≥4 months, whereas the plan to return to work after birth (OR 0.57, 95 % CI 0.43-0.74), living in the south (OR 0.67, 95 % CI 0.47-0.95), and postpartum depression risk (OR 0.43, 95 % CI 0.28­0.66)were associated with lower odds of EBF lasting ≥ 4 months. DISCUSSION: Several factors associated with disparities in continued EBF were identified. The application of the LCHD framework furthers understanding of the multiple and interacting risks associated with early discontinuation of EBF.

Client Centeredness and Health Reform: Key Issues for Occupational Therapy.

Health reform promotes the delivery of patient-centered care. Occupational therapy's rich history of client-centered theory and practice provides an opportunity for the profession to participate in the evolving discussion about how best to provide care that is truly patient centered. However, the growing emphasis on patient-centered care also poses challenges to occupational therapy's perspectives on client-centered care. We compare the conceptualizations of client-centered and patient-centered care and describe the current state of measurement of client-centered and patient-centered care. We then discuss implications for occupational therapy's research agenda, practice, and education within the context of patient-centered care, and propose next steps for the profession.

Capstone projects as scholarship of application in entry-level occupational therapy education.

Capstone projects are integrative student learning experiences used in higher education. This article describes the value and merit of capstone projects as scholarship of application within an entry-level occupational therapy education program. The capstone process is outlined and roles and responsibilities of student, faculty members, and community mentors described. Summative curricular evaluation from 5 years of capstone projects indicated that project characteristics and objectives aligned with the theory and desired outcomes of applied scholarship in the areas of student learning, faculty practice and development, and community service. Challenges identified can further inform development of the capstone experience in occupational therapy education.

Durable medical equipment reuse and recycling: uncovering hidden opportunities for reducing medical waste.

Purpose: The purpose of this study was to investigate hospital practices for the management of unwanted durable medical equipment (DME) and to understand how health care providers conceived of their role in preventing DME waste. In order to fully identify opportunities for DME waste prevention, we began this study at the point where health care providers prescribed patients DME.Methods: We conducted a basic interpretive qualitative study in a large regional health care system in the United States employing semi-structured interviews and a focus group. Study informants included clinicians, physicians and others involved in prescribing patients DME as well as those who played a role in environmentally sustainable health care. Informants were targeted at the patient and health care systems levels. Data were analysed using conventional qualitative content analysis.Results: Analysis of data revealed some of the hospitals were implementing sustainability practices to reduce their output of DME waste such as breaking down unwanted DME into its core components for recycling. In addition, one hospital was operating a DME reuse programme for low-income uninsured and underinsured patients. While a concern for the environment seems to have been embedded in the day-to-day operations of these hospitals, we found that health care providers were not educating patients on options for DME reuse and recycling.Conclusion: These findings may point to a disconnect between practices to prevent DME waste at a health care systems level and clinical decision-making for patient care and merits additional investigation.Implications for rehabilitationDME reuse and recycling is likely to have environmental as well as economic and social benefits.The management of DME waste should include rehabilitation providers.Rehabilitation providers should be trained in environmentally sustainable health care practices.Rehabilitation providers should educate patients on how to sustainably manage their unwanted DME.

Instilling positive beliefs about disabilities: pilot testing a novel experiential learning activity for rehabilitation students.

PURPOSE: To develop and test a novel impairment simulation activity to teach beginning rehabilitation students how people adapt to physical impairments. METHODS: Masters of Occupational Therapy students (n = 14) and Doctor of Physical Therapy students (n = 18) completed the study during the first month of their program. Students were randomized to the experimental or control learning activity. Experimental students learned to perform simple tasks while simulating paraplegia and hemiplegia. Control students viewed videos of others completing tasks with these impairments. Before and after the learning activities, all students estimated average self-perceived health, life satisfaction, and depression ratings among people with paraplegia and hemiplegia. RESULTS: Experimental students increased their estimates of self-perceived health, and decreased their estimates of depression rates, among people with paraplegia and hemiplegia after the learning activity. The control activity had no effect on these estimates. CONCLUSIONS: Impairment simulation can be an effective way to teach rehabilitation students about the adaptations that people make to physical impairments. Positive impairment simulations should allow students to experience success in completing activities of daily living with impairments. Impairment simulation is complementary to other pedagogical methods, such as simulated clinical encounters using standardized patients. Implication of Rehabilitation It is important for rehabilitation students to learn how people live well with disabilities. Impairment simulations can improve students' assessments of quality of life with disabilities. To be beneficial, impairment simulations must include guided exposure to effective methods for completing daily tasks with disabilities.

A pilot IPE workshop integrating OT, pharmacy, PT, and PA programs.

BACKGROUND AND PURPOSE: This article describes the development, implementation, and evaluation of an interprofessional education (IPE) experience. EDUCATIONAL ACTIVITY AND SETTING: The IPE experience included 53 student learners from occupational therapy, pharmacy, physical therapy, and physician assistant programs at the University of the Sciences (USciences). This experience used an icebreaker activity and a stroke case-based activity as the activities within the workshop. The core faculty utilized the jigsaw technique to increase student confidence with uni-profession and interprofessional discussions of the patient case. Learners were asked to evaluate their perceptions of the IPE learning experience. FINDINGS: Results from a summative quality improvement evaluation indicated that learners had positive perceptions of this curricular innovation. DISCUSSION: This pilot IPE workshop illustrates the possibilities for collaboration among health professional programs at USciences, a private health sciences university without an affiliated medical center. SUMMARY: Discussion of the process to create, implement, and evaluate this pilot IPE activity is imperative due to increased expectations within professional accrediting guidelines in regards to IPE.

Expanding client-centred thinking to include social determinants: a practical scenario based on the occupation of breastfeeding.

BACKGROUND: Client-centred thinking in occupational therapy underemphasizes the influence of social determinants and societal-level factors on occupation across the life course. When client-centred thinking focuses solely on the local or immediate contexts of individuals, therapists may not fully recognize or understand how social determinants can create barriers to occupational participation and performance. AIM/OBJECTIVES: This article critically examines gaps in traditional thinking concerning client-centredness and demonstrates how the complex interplay between social determinants and societal-level factors may lead to occupational injustices. MATERIAL AND METHODS: A practical example from a recent study on breastfeeding and accompanying scenario is used to examine limitations in current client-centred reasoning. The Life Course Health Development framework, a theoretical framework examining contexts of health disparities, is applied to illustrate the opportunity to expand thinking about client-centredness. RESULTS: The Life Course Health Development framework may be a useful addition to client-centred thinking about social determinants of occupation. CONCLUSION AND SIGNIFICANCE: Expanding client-centred thinking to include awareness, understanding, and respect for social determinants of occupation may enhance therapist-client interactions and outcomes of the occupational therapy process, and address gaps in current thinking that may contribute to occupational injustices.

Occupational therapy and breastfeeding promotion: our role in societal health.

Occupational therapists are part of multidisciplinary teams supporting infants with feeding and eating difficulties, including problems related to initiation and continuation of breastfeeding. We have the opportunity to expand our role in breastfeeding promotion by also defining breastfeeding as a child-rearing and health management and maintenance occupation and broadening our clientele to include health and wellness populations. The use of a health promotion approach enables occupational therapy practitioners to better address environmental and contextual barriers to engagement in breastfeeding, barriers also encountered by healthy populations. Healthy People 2020 calls for increased rates of exclusive breastfeeding in the United States, given evidence of the health benefits of breastfeeding for infants, women, and society. Occupational therapists are well positioned to assist individuals, organizations, and populations in establishing habits and routines supportive of continued breastfeeding while lessening environmental and contextual barriers. Occupational therapists should consider emerging practice opportunities as consultants for breastfeeding promotion.