'Patient' or 'professional'? Negotiating accommodations and identity in fieldwork education.

INTRODUCTION: Despite legislation mandating accommodation policies in postsecondary education, support for students with disabilities is often not implemented within health and human services (HHS) education programs, particularly in fieldwork settings. As part of a Canada-wide study exploring the experiences of disabled students in 10 HHS programs, we examined how HHS students described their experiences accessing accommodations in fieldwork to understand how conceptions of disability relate to students' fieldwork experiences. Using a critical disability studies framework, we explored how HHS fieldwork education understands disability, accommodations and professional competence and what those understandings reveal about the discrepancy between mandated accommodations and what happens in practice. METHODS: Thirty-five students requiring accommodations in HHS fieldwork education participated in interviews. Through a critical interpretive analysis of interview data, we developed first-person composite narratives to show the richness and complexity of the students' diverse, yet similar, subjective experiences with fieldwork accommodations. FINDINGS: Two composite narratives demonstrate how conceptions of disability incommensurate with professional competence expectations influenced student experiences with disclosing disability and obtaining accommodations in fieldwork. Fear of stigma and having one's competence questioned, or having accommodation requests denied for being misaligned with professional expectations, demonstrate how HHS fieldwork education and practice are upheld by ableist systemic structures. DISCUSSION: The dominant medical model of disability in HHS education creates institutional barriers that require students to constantly (re)construct their 'professional' identity in relation to their 'patient' identity. This patient-professional identity construction relates to HHS professional competency standards and assumptions about what makes a 'good' professional. Suggestions include reworking competency standards and implementing critical pedagogical approaches to teach future and current HHS professionals to question both personal and practice assumptions. With institutional backing, such changes may support diversity within HHS and a culture shift toward more equitable education and health care.

Digital citizenship of children and youth with autism: Developing guidelines and strategies for caregivers and clinicians to support healthy use of screens.

LAY ABSTRACT: Children and youth with autism use screens in their daily lives and in their rehabilitation programs. Although parents and clinicians experience specific challenges when supporting positive screen time use of children and youth with autism, no detailed information for this group exists. Therefore, this study aimed to develop clear guidelines that are agreed by expert clinicians and parents of children and youth with autism. Using a method called Delphi, 30 experts-20 clinicians and 10 caregivers, who have experience working with or caring for children and youth with autism were invited to complete a series of three surveys. In each round, the experts had to rate their agreement with statements regarding screen time management. The agreement level was set to 75%. The final themes to be included in the guidelines were accepted by more than 75% of the panel. The final guidelines included six main sections: (1) general principles, (2) considerations for timing and content of leisure screen time use, (3) strategies for caregivers and clinicians to monitor and regulate screen time use, (4) behaviors to monitor for screen time overuse, (5) additional guidelines for clinicians, and (6) resources. The new guidelines developed in this study can provide potential guidance on how to further the development of digital citizenship for children and youth with autism and provide strategies to families to help manage screen time use.

Inclusive Community Aquatics Programming for Children with Developmental Challenges: A Community Participatory Action Research.

BACKGROUND: Children who are neurodiverse have traditionally been segregated from their peers in community-based programs, despite evidence of health benefits of inclusive education. OBJECTIVES: This community-initiated project aims to explore barriers and facilitators to inclusive aquatics programming for children with developmental and/or mental health challenges. METHODS: Using a participatory-action research methodology, semi-structured interviews and focus groups were conducted with 14 participants from various stakeholder groups, including parents of children who are neurodiverse, helping professionals, and community programmers. RESULTS: Participants described unique definitions of inclusion, from integration with neurotypical peers, to individualized goal-setting and achievement. Major facilitators include adequate resources, flexibility around accommodations, and motivated staff. Major barriers include social stigma, financial limitations, and lack of communication between caregivers and service providers. CONCLUSIONS: Participants felt strongly about the need to improve inclusion practices within aquatics-and other community-based-programs. Increased collaboration between families, community programmers, and helping professionals can foster better inclusion and outcomes for children who are neurodiverse. By incorporating various perspectives into the design of future programs, program administrators can ensure more equitable access such that all children are able to participate.

Profiling the Research Activities of Canadian Occupational Therapy and Occupational Science Faculty Members.

Background. There is a lack of knowledge on the scope and nature of the research by faculty members in occupational science (OS) and/or occupational therapy (OT) programs in Canada. Purpose. To describe the research activities of faculty members in these programs and directions. Method. A cross-sectional survey was distributed to 173 faculty members across all 14 Canadian OT that addressed: 1) research topics and methods, 2) populations, and 3) funding. Findings. Based on respondents (N = 121), research is focused on a range of topics and populations with most conducting qualitative research. Many conduct research examining the effectiveness of interventions, with few respondents focused on OS research. Federal and provincial grants agencies were the largest source of funding. Implications. Research topics studied were not always proportional to practice although emerging areas were being investigated that can expand the evidence base and scope of practice. Despite limited occupation-specific funding options, respondents were accessing funding from varied sources. Collaborations among faculty members, clinicians, and individuals with lived experience can create priorities for future OS and/or OT research in Canada.

Negotiating legitimacy and belonging: Disabled students' and practitioners' experience.

INTRODUCTION: People with disabilities are underrepresented in health professions education and practice. Barriers for inclusion include stigma, disabling discourses, discriminatory programme design and oppressive interactions. Current understandings of this topic remain descriptive and fragmented. Existing research often includes only one profession, excludes particular types of disability and focuses on one aspect of the career journey. To expand understanding, we examined the recurrent forms of social relations that underlie the participation of disabled individuals in learning and practice contexts across five health professions. METHOD: We analysed 124 interviews with 56 disabled health practitioners and students. Participants were interviewed up to three times over 1.5 years. Using constructivist grounded theory, authors used a staged analytic approach that resulted in higher level conceptual categories that advance interpretations of social processes. Finally, the authors compared and integrated findings among students and practitioners. RESULTS: Participants experience challenges to their sense of legitimacy and belonging as health providers. They describe tensions within the health education and practice between the commitment to inclusion and the day-to-day realities experienced by disabled participants. We identified six distinct, but related, conditions underlying these tensions: (i) validity and transparency of competencies' evaluation; (ii) the social and physical contexts; (iii) integration of inclusive practices; (iv) boundaries between personal and professional identities; (v) vulnerability to authority figures; and (vi) dynamic person-level factors. DISCUSSION: If we are to commit to health practitioners and students with disabilities experiencing an overall sense of legitimacy and belonging, priority needs to be given to system-level practices and policies to support inclusion. Attention to the day-to-day marginalisation of students and practitioners with disabilities in the health professions is also needed. Additionally, inclusive and transparent delineation of competency requirements is needed. Finally, educational actions are needed to increase understanding of disability in the health professions, with particular attention to promoting social relations that foster collective responsibility for supporting inclusion.

Social support experiences of students and clinicians with disabilities in health professions.

Social support is vital in promoting the health, well-being, and performance of students and clinicians in health professions. Health settings' demanding and competitive nature imposes unique challenges on students and clinicians with disabilities. This paper aims to explore the trajectories and experiences of social support interactions amongst students and clinicians with disabilities in health professions. In a qualitative longitudinal study, 124 in-depth semi-structured interviews were conducted with 27 health students and 29 health clinicians with disabilities. Data analysis was informed by grounded theory as an adapted analytic approach involving constant comparisons. A few main characteristics of social support and trajectories in which social support is negotiated emerged from the data: (1) The need to be accepted and not questioned when asking for support, (2) Support interactions that do not heighten otherness, (3) Failure to acknowledge the challenges, (4) Interactions that support the process of disclosure (5) Interactions that allow mobilization of social support without strain or an extra effort. These findings have important implications for designing more supportive health professions, educational programs, and workplaces for people living with disabilities.

Bringing disability experiences front stage: Research-based theatre as a teaching approach to promote inclusive health education.

BACKGROUND: Despite efforts to promote inclusion of people living with disabilities in health and human service education and professions, students and clinicians living with disabilities continue to face powerful barriers, arising most notably from the stigma and negative attitudes of their peers. Increased awareness of these lived experiences are needed to affect attitudinal changes and reduce barriers to participation in those professions. To achieve this, information (stories) must be presented to learners in a way that promotes emotional engagement and highlights these issues from multiple perspectives. The following study measures the impact of a Research based Theatre play, based on the collected experiences of people living with disabilities in health and human service professions, as a teaching approach for knowledge and attitudinal change among audiences. METHOD: This mixed-methods study (pre and post surveys, groups and individual interviews) aimed at measuring the impact (knowledge and attitudinal change) incurred among audience members. In total, a 174 students, faculty, staff, and clinicians in health and human service professions across two major Canadian cities completed the surveys before and after witnessing the play. Of these, 20 participants also participated in follow-up interviews. Two-way repeated measures ANOVA was used to compare the pre and post surveys while thematic content analysis was used for the interviews. RESULTS: Two main themes emerged from combined analysis of both the quantitative and qualitative data. First, quantitative data revealed a significant change in participants' attitudes towards people living with disabilities which was corroborated by interview participants who expressed more comfort in their interactions with students and clinicians living with disabilities. Second, learners also reported meaningful and statistically significant change in their knowledge about the experiences of health and human service professionals living with disabilities. CONCLUSIONS: The results of this study support applying Research-based Theatre as a teaching approach that can promote knowledge and attitudinal change among audiences and increase the inclusion and equity of people living with disabilities in health and human service education. Future research in this area might investigate Research-based Theatre's pedagogical impact using a randomized control design and measuring longer term impact.

Barriers and facilitators for Indigenous students and staff in health and human services educational programs.

Indigenous Peoples are underrepresented in many of the Health and Human Services Educational Programs (HHSEP, e.g.: Nursing, Social Work). As various studies have reported the benefits of diversifying HHSEP, the barriers and facilitators of increasing the number of Indigenous Peoples in these professions must be identified. The purpose of this exploratory study is to identify and understand the barriers and facilitators Indigenous Peoples face when entering, learning or working in HHSEP. A narrative approach was used in the facilitation of culturally safe sharing circles with Indigenous students and staff to collect perspectives based on their individual experiences in HHSEP. Inductive thematic analysis was used to identify emerging themes in participant experiences and the impact of those experiences on participation in learning and working at the university in these educational programs. Results from this exploratory study identified current academic structures and ideologies rooted in colonialism, that act as barriers for engagement and inclusion of Indigenous students, staff, and clinical and academic faculty. These findings shaped the main themes of this study including negotiation of identity in different spaces, negotiating colonial structures in HHSEP, and negotiating changes and transitions in HHSEP. We anticipate these preliminary results will act as a catalyst for uncovering further changes to be made regarding attitudes, procedures, and practices present in an academic environment that limit the inclusion of Indigenous Peoples in HHSEP.

Health Care Students' Perspectives on Artificial Intelligence: Countrywide Survey in Canada.

BACKGROUND: Artificial intelligence (AI) is no longer a futuristic concept; it is increasingly being integrated into health care. As studies on attitudes toward AI have primarily focused on physicians, there is a need to assess the perspectives of students across health care disciplines to inform future curriculum development. OBJECTIVE: This study aims to explore and identify gaps in the knowledge that Canadian health care students have regarding AI, capture how health care students in different fields differ in their knowledge and perspectives on AI, and present student-identified ways that AI literacy may be incorporated into the health care curriculum. METHODS: The survey was developed from a narrative literature review of topics in attitudinal surveys on AI. The final survey comprised 15 items, including multiple-choice questions, pick-group-rank questions, 11-point Likert scale items, slider scale questions, and narrative questions. We used snowball and convenience sampling methods by distributing an email with a description and a link to the web-based survey to representatives from 18 Canadian schools. RESULTS: A total of 2167 students across 10 different health professions from 18 universities across Canada responded to the survey. Overall, 78.77% (1707/2167) predicted that AI technology would affect their careers within the coming decade and 74.5% (1595/2167) reported a positive outlook toward the emerging role of AI in their respective fields. Attitudes toward AI varied by discipline. Students, even those opposed to AI, identified the need to incorporate a basic understanding of AI into their curricula. CONCLUSIONS: We performed a nationwide survey of health care students across 10 different health professions in Canada. The findings would inform student-identified topics within AI and their preferred delivery formats, which would advance education across different health care professions.

Exploring student perceptions of the learning environment in four health professions education programs.

The desire to support student learning and professional development, in combination with accreditation requirements, necessitates the need to evaluate the learning environment of educational programs. The Health Education Learning Environment Survey (HELES) is a recently-developed global measure of the learning environment for health professions programs. This paper provides evidence of the applicability of the HELES for evaluating the learning environment across four health professions programs: medicine, nursing, occupational therapy and pharmaceutical sciences. Two consecutive years of HELES data were collected from each program at a single university (year 1 = 552 students; year 2 = 745 students) using an anonymous online survey. Reliability analyses across programs and administration years supported the reliability of the tool. Two-way factorial ANOVAs with program and administration year as the independent variables indicated statistically- and practically-significant differences across programs for four of the seven scales. Overall, these results support the use of the HELES to evaluate student perceptions of the learning environment multiple of health professions programs.

The Impact of COVID-19-Related Restrictions on Social and Daily Activities of Parents, People With Disabilities, and Older Adults: Protocol for a Longitudinal, Mixed Methods Study.

BACKGROUND: The COVID-19 pandemic has led to wide-scale changes in societal organization. This has dramatically altered people's daily activities, especially among families with young children, those living with disabilities such as spinal cord injury (SCI), those who have experienced a stroke, and older adults. OBJECTIVE: We aim to (1) investigate how COVID-19 restrictions influence daily activities, (2) track the psychosocial effects of these restrictions over time, and (3) identify strategies to mitigate the potential negative effects of these restrictions. METHODS: This is a longitudinal, concurrent, mixed methods study being conducted in British Columbia (BC), Canada. Data collection occurred at four time points, between April 2020 and February 2021. The first three data collection time points occurred within phases 1 to 3 of the Province of BC's Restart Plan. The final data collection coincided with the initial distribution of the COVID-19 vaccines. At each time point, data regarding participants' sociodemographics, depressive and anxiety symptoms, resilience, boredom, social support, instrumental activities of daily living, and social media and technology use were collected in an online survey. These data supplemented qualitative videoconference interviews exploring participants' COVID-19-related experiences. Participants were also asked to upload photos representing their experience during the restriction period, which facilitated discussion during the final interview. Five groups of participants were recruited: (1) families with children under the age of 18 years, (2) adults with an SCI, (3) adults who experienced a stroke, (4) adults with other types of disabilities, and (5) older adults (>64 years of age) with no self-reported disability. The number of participants we could recruit from each group was limited, which may impact the validity of some subgroup analyses. RESULTS: This study was approved by the University of British Columbia Behavioural Research Ethics Board (Approval No. H20-01109) on April 17, 2020. A total of 81 participants were enrolled in this study and data are being analyzed. Data analyses are expected to be completed in fall 2021; submission of multiple papers for publication is expected by winter 2021. CONCLUSIONS: Findings from our study will inform the development and recommendations of a new resource guide for the post-COVID-19 period and for future public health emergencies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/28337.

"I Can Understand Where They're Coming From": How Clinicians' Disability Experiences Shape Their Interaction With Clients.

Students and clinicians with disabilities are underrepresented in the academic health programs and professional clinical settings. Disability studies foregrounds the unique ways of knowing and being that clinicians with disabilities can offer. Based on a larger grounded theory study of the experiences of students and clinicians with disabilities, this article examines the role that clinicians' abilities to draw on their personal experiences of living with a disability have on their interactions with clients. The analysis of semistructured interviews with 55 students and clinicians with disabilities from different fields contributes to the development of a theory of epistemic connection. The theory is informed by the following three themes: (a) building rapport through understanding, (b) from understanding to advocacy and creative approaches, and (c) between professionalism and disability. The findings emphasize not only the importance of diversifying the health care workforce but also incorporating disability epistemology into the health care culture.

Disabled healthcare professionals' diverse, embodied, and socially embedded experiences.

Disabled people are underrepresented within healthcare professions, although their participation has potential benefits for them personally, and for broader society. Disabled peoples' participation in healthcare professions is limited by assumptions about disability. Little research explores how healthcare professions can be organized to support disabled peoples' employment. Within a critical realist paradigm influenced by grounded theory, this study used interviews to explore the experiences of 56 disabled healthcare clinicians and students, and advance a conceptual taxonomy of disability experience within healthcare professions. Participants describe their experiences of disability in the healthcare professional context in terms of characteristics and dimensions of disability-how characteristics interact with factors within healthcare training and practice environments. We profile two particularly salient dimensions of the disability experience: visibility and onset of disability. These are developed to describe complexity and specificity of the experiences of individuals negotiating the healthcare context. Among participants there is extensive heterogeneity related to the experience of disability in healthcare professional contexts. Despite some having similar disability characteristics, no two individuals experience the same combination of characteristics and dimensions of disability. Given the complexity of experiences for disabled healthcare professionals/students, a taxonomy for conceptualizing this experience is presented. Readers are encouraged to consider the taxonomy through which they might conceptualize individual, embodied, and socially embedded experiences of disabled healthcare professionals and students. Stakeholders involved in healthcare professions and education should consider this shift in perspective, with a view to increasing access of disabled people to health professional practice.

Design Elements During Development of Videogame Programs for Children with Autism Spectrum Disorder: Stakeholders' Viewpoints.

Introduction: Research has demonstrated that videogame programs can be an effective intervention targeting social challenges among children with autism spectrum disorder (ASD). Despite the rapid growth in developing videogame programs, incorporation of stakeholders' views has been limited. Objective: This project aimed to identify the design elements that should be considered during development of videogame programs for children with ASD, from the perspectives of stakeholders. Materials and Methods: We involved 26 stakeholders, including parents of children with ASD, youth with ASD, and clinicians working with individuals with ASD in focus groups and interviews. Results: Thematic analysis yielded three themes: (1) addressing heterogeneity and diverse needs; (2) mirroring real world; and (3) teaching strategies. Conclusion: Incorporating these elements during development of videogame programs can help enhance the outcomes for children with ASD. By including stakeholders' voices, it is assumed that the developed videogame programs may serve as user-friendly and engaging tools to potentially complement traditional interventions when overcoming social difficulties in individuals with ASD.

Perceived Barriers and Existing Challenges in Participation of Children with Autism Spectrum Disorders: "He Did Not Understand and No One Else Seemed to Understand Him".

Social participation is one of the most important predictors of the children's physical and mental health. Although it is evidenced that children with autism spectrum disorder (ASD) have restricted social participation, it is unclear which factors play a significant role. This research aimed to uncover perceived barriers of social participation by involving 26 stakeholders including parents of children with ASD, youth with ASD, and clinicians working with individuals with ASD in focus groups and interviews. Using thematic analysis yielded three themes including (a) difficulty understanding social situations; (b) maladaptive behaviours; and (c) conflicting priorities and restricted nature of training. This project was the first study to involve key stakeholders to highlight barriers of social participation among individuals with ASD.

Lower Limb Prosthetic Rehabilitation in Canada: A Survey Study.

Purpose: This study describes prosthetic rehabilitation services provided to individuals who have had a lower limb amputation in Canada. Method: This cross-sectional survey study used an online survey to collect data from facilities that provide lower limb prosthetic rehabilitation; it included questions about approaches and types of service, therapies, focus of service, and health care providers. One representative from each facility was asked to complete the survey. Results: Of the 65 identified eligible facilities, 59 completed the survey (response rate = 90.8%). The majority of facilities (n = 39; 66.1%) indicated that they provided both in-patient and outpatient prosthetic rehabilitation services. All facilities provided balance, coordination, and gait training as well as prosthetic fit education. Most facilities indicated that they had a physical therapist (n = 58; 93.8%), an occupational therapist (n = 52; 88.1%), and a prosthetist (n = 52; 88.1%) on their team. Conclusions: The majority of the facilities surveyed provided both in-patient and outpatient services and had specialized health care provider teams. Future surveys are required to collect more specific information about prosthetic rehabilitation in Canada.

Objectif : décrire les services de réadaptation avec prothèse du Canada pour les personnes amputées des membres inférieurs. Méthodologie : une étude transversale en ligne a permis d'amasser des données auprès d'établissements qui offrent une réadaptation avec prothèse des membres inférieurs. Elle incluait des questions sur les approches et les types de services, les traitements, l'objet des services et les professionnels de la santé. Un représentant de chaque établissement était invité à remplir le sondage. Résultats : des 65 établissements admissibles répertoriés, 59 ont rempli le sondage (taux de réponse = 90,8 %). La majorité des établissements (n = 39, 66,1 %) a indiqué qu'il offrait des services de réadaptation avec prothèse aux patients hospitalisés et ambulatoires. Tous les établissements offraient un entraînement sur l'équilibre, la coordination et la démarche et de l'information sur l'ajustement des prothèses. La plupart des établissements indiquaient qu'ils comptaient un physiothérapeute (n = 58, 93,8 %), un ergothérapeute (n = 52, 88,1 %) et un prothésiste (n = 52, 88,1 %) au sein de leur équipe. Conclusions : la majorité des établissements sondés offraient à la fois des services aux patients hospitalisés et ambulatoires et étaient dotés d'équipes soignantes spécialisées. Il faudra réaliser d'autres sondages pour colliger de l'information plus précise sur la réadaptation avec prothèse au Canada.

Social Stories for Children with Autism Spectrum Disorder: Validating the Content of a Virtual Reality Program.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects socio-emotional skills and perspective-taking abilities. Although social stories in a form of virtual reality program can help children with ASD, developing them and identifying appropriate responses might be subjective and thus challenging. Using Delphi method, and guided by general case training, we involved 63 parents and clinicians of individuals with ASD, in two rounds of online iteration to refine the stories. Scenarios that reached a 75% agreement level were accepted. This project is the first study to develop and validate a library of 75 short socio-emotional stories that illustrate various types and intensities of emotion in three social contexts of home, school, and community as the content of a virtual reality program.

Problem-based learning in occupational therapy curriculum - implications and challenges.

PURPOSE: Problem-based learning (PBL) is an educational method that fosters self-directed study in small groups. The purpose of this study was to describe the Tel Aviv University's occupational therapy (OT) program and the challenges implementing such program. In addition, the study compared the PBL grades obtained by students who are native Hebrew speakers with those students who are native Arabic speakers; and, assessed the correlation between the grades in the PBL course and the grades in the clinical fieldwork studies. METHOD: 166-second year OT undergraduate students participated. All completed three PBL courses and seven weeks of clinical fieldwork studies. Data collection included students' grades in PBL course (based on PBL evaluation forms) and in clinical fieldwork studies (based on preceptor's evaluation and a written assignment). RESULTS: Pearson correlations revealed significant correlations between PBL grades and clinical fieldwork studies grades. T-test analysis between students who are native Hebrew speakers and those who are native Arabic speakers revealed significant differences in PBL grades. CONCLUSIONS: Findings imply partial congruence between students' grades in the PBL course and their achievements in the fieldwork studies. Findings might suggest that adjustments should be made in order to assist students from minorities (challenged by language requirements) in gaining higher grades in the PBL program. Implications for Rehabilitation Problem-Based Learning (PBL) is an educational method, which fosters independent, self-directed study in small groups. PBL studies have the potential to prepare students for their clinical experience during studies. The PBL program should be adjusted for students from minorities (challenged by language requirements and different cultural backgrounds) in order to assist them in gaining more benefits from the program.