Impact of the Northern Studies Stream and Rehabilitation Studies programs on recruitment and retention to rural and remote practice: 2002-2010.

INTRODUCTION: A shortage of rehabilitation practitioners in rural and/or remote (rural/remote) practice areas has a negative impact on healthcare delivery. In Northern Ontario, Canada, a shortage of rehabilitation professionals (audiology, occupational therapy, physiotherapy, speech-language pathology) has been well documented. In response to this shortage, the Northern Studies Stream (NSS) and Rehabilitation Studies (RS) programs were developed with the mandate to increase the recruitment and retention of rehabilitation professionals to Northern Ontario. However, the number of NSS or RS program graduates who choose to live and work in Northern Ontario or other rural/remote areas, and the extent to which participation in these programs or other factors contributed to their decision, is largely unknown. METHODS: Between 2002 and 2010, a total of 641 individuals participated in the NSS and RS programs and were therefore eligible to participate in the study. Current contact information was obtained for 536 of these individuals (83.6%) who were eligible to participate in the study. An internet-hosted survey was administered in June of 2011. The survey consisted of 48 questions focusing on personal and professional demographics, postgraduate practice and experience, educational preparation, and factors affecting recruitment and retention decisions. RESULTS: A total of 280 respondents completed the survey (response rate 52%). Of these, 95 (33.9%) reported having chosen rural or remote practice following graduation. Multiple factors predictive of recruitment and retention to rural/remote practice were identified. Of particular note was that individuals raised in a rural or remote community were 3.3 times more likely to work in a rural or remote community after graduation. Recruitment was strongly associated with length of time immersed in rural/remote education settings and to participation in the NSS academic semester. Job satisfaction, professional networking opportunities, and rural lifestyle options were identified as important factors for retention in rural/remote practice areas. CONCLUSIONS: The NSS and RS programs have experienced encouraging recruitment outcomes in the past 10 years. Recruitment and retention of rehabilitation therapists to rural/remote locations appears to be positively and significantly affected by the origins of the health professional. The completion of both academic and clinical education in a rural/remote setting and longer duration of rural/remote education were positively associated with an increased likelihood of choosing to practice in a rural/remote area following entry to practice. These findings have potential implications for admission criteria to rehabilitation education programs with a rural curriculum focus as well as implications for postgraduate mentorship programs and employers in rural/remote areas.

Psychotherapy: a profile of current occupational therapy practice in Ontario.

BACKGROUND: Psychotherapy can be an important part of psychosocial occupational therapy practice; however, it requires specialized training to achieve and maintain competence. Regulation varies by province, and in Ontario, occupational therapists were recently authorized to perform psychotherapy. PURPOSE: The purpose of this study was to explore the psychotherapy practice, training, and support needs of Ontario occupational therapists. METHOD: An online survey was sent to occupational therapists who had clients with mental health or chronic pain issues, asking about their expertise and support needs in relation to nine psychotherapy approaches. FINDINGS: Of the 331 therapists who responded, there were variations in the nature and frequency of psychotherapy practice. Experienced therapists in outpatient settings were more likely to practice psychotherapy, and cognitive-behaviour therapy, motivational interviewing, and mindfulness were the most common approaches. Supervision and training varied, with many therapists interested in occupational therapy-specific training. IMPLICATIONS: Recommendations for a framework of support include education about the nature of psychotherapy, training and supervision guidelines, and advocacy for occupational therapy and psychotherapy.

Small business employers' views on hiring individuals with mental illness.

This study investigated the beliefs of small business employers regarding hiring individuals with mental illness. Fifty-eight participants completed mail-in questionnaires concerning beliefs and willingness to hire persons with mental illness. Employers were most concerned regarding the social and emotional skills of individuals with mental illness. Those employers who reported positive beliefs, had positive interactions with individuals with mental illness, or operated in public/social services, stated greater willingness to hire a person with mental illness. Methods to decrease stigma are discussed.

Becoming a tutor: exploring the learning experiences and needs of novice tutors in a PBL programme.

The tutor plays an important role in facilitating learning in a problem-based learning (PBL) curriculum. This paper explored the ways that novice tutors were educated in a PBL programme at McMaster University. Thirteen novice tutors were interviewed in this qualitative, ethnographic study to identify their learning needs and culture at the entry phase of 'becoming a tutor'. Ten tutor guides were also interviewed to provide additional information and perspectives regarding the data generated by the novice tutors. Categories that emerged were: (1) benefiting from the experience, (2) managing the challenges, (3) transitioning to a new role, (4) uncovering learning opportunities, (5) maintaining vigilance, and (6) explicating the implicit. The overarching framework that wove the categories together was that of the theme of storytelling in the teaching-learning process. Implications for practice for tutor training are addressed considering the oral tradition.

Providing meaningful continuing education in a changing long-term care environment.

This article describes the delivery of an innovative continuing education program to all staff in long-term care facilities in Thunder Bay, Ontario. Using techniques ranging from lecture to storytelling, brief 30-minute teaching sessions were developed to facilitate attitude change about depression. The inclusion of all staff encouraged cross discipline learning and a common language of care within the facilities. The format is easy to use and applicable to a variety of continuing education issues.

Growing older: the lived experience of older persons with serious mental illness.

The purpose of this qualitative paper is to describe, from the consumers' perspective, the complex factors involved as persons with serious mental illness grow older in the community. The results consisted of seven major themes subsumed under three categories. The first category, across the lifespan, included three themes: (a) older but wiser, (b) one day at a time, and (c) echoes from the past. The second category, factors impeding participation in the life of the community, also included three themes: (a) on the outside looking in, (b) walk a mile in my shoes, and (c) without a voice. The final category, factors which enhance participation in community life, included only one theme: meaningful activities and productive roles. Findings suggest that service providers must actively involve consumers as primary members of the rehabilitation team to deliver effective, individualized services which are designed around the particular future needs and resources of older persons with serious mental illness. Furthermore, stigma reduction through advocacy and education at the community level must be strengthened.

Collaborative fieldwork education with student occupational therapists and student occupational therapist assistants.

The profession of occupational therapy has a long history of working collaboratively with support personnel. This paper describes the process of a fieldwork education partnership developed between the McMaster University, BHSc (OT) Program and the Mohawk College, Occupational Therapist Assistant and Physical Therapist Assistant Program. Eight student occupational therapists and eight student occupational therapist assistants learned together in a variety of fieldwork settings, either in pairs or in groups. Both groups of students kept weekly journals of the experience and completed a post placement questionnaire. The journals were inductively analysed using a retrospective content analysis. The four emergent themes identified from the data are learning about each other's role, collaborative learning, impact on client care and future practice, and resistance to roles. Recommendations for future collaborations are discussed.

Aging with a serious mental disability in rural Northern Ontario: family members' experiences.

As people with serious mental disabilities grow older, their primary caregivers continue to be family members. This qualitative study explored the life experiences of people aging with a preexisting serious mental disability living in rural Northern Ontario, from the perspective of family members, and it identified the factors which facilitated or impeded their relative's current and future participation in community life. Results included the challenges of rural life, lack of support by health care providers, rural service needs, caregiver responsibility, the impact of aging on the individual and the family, and future concerns. New models for effective rural programs, services, community education, and effective partnerships with family members must be investigated.

Problem-based learning in occupational therapy: why do health professionals choose to tutor?

For over 20 years the occupational therapy programmes offered by McMaster University and Mohawk College, Hamilton, Ontario have used small-group, problem-based learning tutorials as a major component of their curriculum. These programmes were among the first occupational therapy programmes in the world to use a problem-based tutorial format. The inclusion as tutors of both full-time faculty and clinicians, from all clinical practice areas, was central to the design of the problem-based learning courses. A survey of all tutors from the last 20 years collected information about why health professionals are motivated to tutor and what they see as challenges to maintaining this educational role. Three primary themes emerged from the data: being an educator; being a learner and present and future challenges to continuing with the tutoring role. Within the educator theme there was a secondary theme of professional duty or obligation. In addition, the participants identified suggestions for enhanced support and continuing education for tutors. This article summarizes the findings of the survey.