Enabling occupation: the importance of an affirming environment.

Occupational therapists have become increasingly concerned with factors beyond the individual which impact occupational performance. Several recent models propose that the environment is a significant influence on occupational performance and upon its meaningfulness. An in-depth, qualitative study was conducted which explored the meaning of occupational engagement for eight women with mental illness (Rebeiro & Cook, 1999). This study yielded several important insights about the environment, which have recently been replicated by Legault and Rebeiro (2001) and Rebeiro, Day, Semeniuk, O'Brein, and Wilson (In Press). Participants suggested that environments that provide opportunity, and not prescription are more conducive to fostering occupational performance. Participants further suggested that an environment that provides Affirmation of the individual as a person of worth, a place to belong, and a place to be supported, enables occupational performance over time. A series of research studies indicated that the social environment is an important consideration in planning therapeutic interventions which aim to enable occupation. Implications for occupational therapy practice, education and research are offered.

Northern Initiative for Social Action: an occupation-based mental health program.

Northern Initiative for Social Action (NISA) is a consumer-run, occupation-based, nonprofit organization located in northeastern Ontario, Canada. The NISA organization has grown in response to research revealing few opportunities for participation in personally meaningful and socially valued occupation for persons with mental illness living in the community of study. This article describes a mixed-design research study conducted by the ParNorth Research Unit of NISA and an occupational therapist. The study purposes were to (a) better understand the emerging characteristics of the NISA program and identify which the participants found helpful; (b) evaluate whether participation in NISA improved members' quality of life; and (c) ascertain whether participation reduced members' need for more traditional and costly methods of care (e.g., hospitalization, crisis services). Focus groups, daily participant observation, a quality of life interview, a consumer member survey and objective review of hospitalization data were used for data collection. Qualitative results indicated that NISA helped to meet participants' being, belonging, and becoming needs. Quantitative data indicated that overall, NISA members perceive an improvement in their subjective quality of life and sense of well-being. Their perceptions are supported by minimal use of crisis services and hospitalization, improved socioeconomic status, and several members' success in obtaining paid employment either within or outside NISA. Future challenges include the need to clearly describe the evolving NISA model and to ensure that the growth of this new organization does not exceed secured human or fiscal resources.

Client perspectives on occupational therapy practice: are we truly client-centred?

In Canada, the guidelines for the practice of occupational therapy are named and framed as client-centred. Two in-depth interviews were conducted with clients of mental health services about their experiences with a hospital-based occupational therapy service. These occupational therapy clients described their experiences as prescriptive, and as less than client-centred. With the publication of Enabling occupation: A Canadian occupational therapy perspective (Canadian Association of Occupational Therapists [CAOT], 1997) and an increasingly refined focus on being client-centred, these interviews highlight the challenges of a client-centred practice within the current health care environment. These occupational therapy clients raise issues of importance for occupational therapy. The participants stated that the prescription of 'activity', a lack of choice, and a focus upon the illness as opposed to the individual, served to diminish any collaborative partnership with the client and eliminate the client from any decision-making process. This distancing from the client, in their opinion, served to greatly diminish any therapeutic value of occupation. The participants recommended a greater focus upon occupational choice, consideration of the individual within the client, providing accepting, supportive environments, and using professional expertise on occupation to guide the client towards participation in meaningful occupation. These recommendations are strikingly similar to the most recent guidelines for the client-centred practice of occupational therapy in Canada. A discussion of the implications of these findings for the client-centred practice of occupational therapy is offered.

Opportunity, not prescription: an exploratory study of the experience of occupational engagement.

Occupational therapy practice is based upon the belief that the use of occupation-as-means can promote the health and sense of well-being of individuals with disability. Despite a firm commitment to the construct of occupation by the profession, little empirical evidence has been generated which supports the basic tenets of practice. In the psychosocial literature, no studies could be located which directly investigated the use of occupation-as-means to mental health. An exploratory study was conducted with eight participants of an occupation-based, women's mental health group. In-depth interviews and participant observation were utilized to explore the meaning of occupational engagement for these women. The experience of occupational engagement is presented in the form of a conceptual model named occupational spin-off. Occupational spin-off represents conceptually the experience of occupational engagement for the participants in the research study and describes a process of occupation-as-means to mental health. The processes of affirmation, confirmation, actualization, and anticipation collectively contribute to and maintain occupational spin-off. The process of occupational spin-off contributes to an understanding of why these participants have remained out of hospital, and why they are feeling better. Implications of this process model for clinical practice and future research are suggested.

Enabling occupational performance: optimal experiences in therapy.

Occupational therapists believe that engagement in occupation contributes to health through an individually balanced use of time, a positive focus for one's physical and mental energy, and the provision of a sense of purpose. Flow is a construct which describes optimal experiences or enjoyment in everyday activities. A review of the literature suggests that the theory of optimal experience is complementary to occupational therapy beliefs and that an understanding of the flow experience may contribute to our understanding of human occupation. Specifically, flow may be useful in understanding those aspects of the occupation, environment and person that contribute to a "just right" challenge, and to enabling occupational performance through enjoyable, structured and purposeful activity. Occupational therapists are encouraged to explore whether optimal experiences facilitate occupational performance for individuals with a disability. Future research could explore whether the occupational opportunities available to persons with a disability provide the degree of challenge required to elicit the optimal experience. Finally, research could explore whether the client-driven selection of meaningful occupation, and therapist enablement of the "just right" challenge, influences optimal experience, occupational performance, and life satisfaction for those with a disability.