Staff perceptions of organisational performance measurement implementation in a health charity.

The non-acute health charity sector forms part of the global health services industry. Organisational Performance Measurement (OPM) is fundamental for modern business to achieve sustained excellence yet is under-utilised by non-acute health charities. The Non-Acute Health Charity Performance Implementation Framework (NCPI Framework) was developed to support non-acute health charities undertaking OPM. A non-acute health charity case study undertook a 12-month OPM implementation process using the NCPI Framework. This study had three aims. Firstly, to understand the perceptions of staff employed by the case study organisation regarding their experience of the 12-month NCPI Framework implementation process, secondly to identify whether an interrelationship existed between the NCPI Framework's implementation elements and the staff's perspectives, and thirdly, identify areas of strength and improvement which could enhance the NCPI Framework's effectiveness. Data were collected post implementation and analysed thematically from open-ended question responses from an anonymous survey and semi-structured interviews. Participants supported the introduction of OPM and valued the NCPI Framework's structured implementation guidelines. Six interrelated themes were identified: clarity, adaptability, alignment, transparent communication, capability and accountability. Participants suggested adaptations to enhance the NCPI Framework's impact. A culture aligned with organisational learning was identified as potentially having a positive impact on the NCPI Framework's implementation. The NCPI Framework may also have relevance and application to the non-profit industry beyond non-acute health care and for use in program development and service quality initiatives.

Occupational therapists' practice with complex trauma: A profile.

INTRODUCTION: Many children in Aotearoa (New Zealand) and Australia experience complex trauma and its developmental impacts. Internationally, occupational therapists work with complex trauma and use sensory-based, integrative, and functional approaches. The practices of occupational therapists in Aotearoa and Australia with children experiencing complex trauma have not previously been described. METHODS: This article reports the quantitative results of a mixed-methods study which profiled occupational therapists' practice in Aotearoa and Australia with children aged 0 to 12 years old who experienced complex trauma. Twenty-five participants completed the survey. The average age of participants was 43 years (SD = 10.65), all were female (n = 25), and most identified as New Zealand European (n = 11) or Australian European (n = 9). A survey was distributed via Occupational Therapy New Zealand - Whakaora Ngangahau Aotearoa and Occupational Therapy Australia. RESULTS: The majority of participants had a bachelor's degree (64%) and worked in community settings (76%). Fourteen participants (56%) used sensory approaches. The most common assessments used were those of sensory processing (n = 12, 48%) and observation (n = 12, 48%). The Sensory Profile was the most popular standardised assessment (n = 8, 32%). The most common interventions used with children experiencing complex trauma were sensory (n = 13, 52%) and play based (n = 13, 52%). Most participants reported not adapting their practices for Maori or Aboriginal children. Most participants felt somewhat prepared (n = 15) for working with complex trauma, with most reporting a lack of experience in this area (n = 10). Supervision was suggested by 92% (n = 23) of the participants. CONCLUSION: Sensory-based practices were most common among occupational therapists in Aotearoa and Australia who worked with children experiencing complex trauma. The participants suggested supervision, social support, and practical training when working with complex trauma. Advocacy and research are required within this subspecialty, and further professional engagement in the application of culturally safe practice.

O uso da Avaliação do Brincar de Faz de Conta Iniciado pela Criança - ChIPPA: uma revisão de escopo / The use of the Child Initiated Pretend Play Assessment - ChIPPA: a scoping review

Resumo Introdução O brincar é uma importante ocupação infantil e sua avaliação deve fazer parte do processo terapêutico para analisar o desempenho ocupacional da criança e planejar intervenções embasadas nessa ocupação. A Avaliação do Brincar de Faz de Conta Iniciado pela Criança (ChIPPA) já foi traduzida, adaptada transculturalmente e validada para a população brasileira. Objetivo Realizar uma revisão do escopo sobre a ChIPPA e identificar como tem sido descrita e abordada na literatura nacional e internacional. Método Entre janeiro e junho de 2021, foi realizada a busca dos artigos nas bases de dados PubMed, Scopus, BVS, ERIC, CINAHL, Web of Science e PsycInfo, usando estratégias de busca com diferentes sintaxes de acordo com o método de cada base: Chippa OR "Child-Initiated Pretend Play Assessment", ChIPPA OR "Child-Initiated Pretend Play Assessment" OR "Avaliação do faz de conta iniciado pela criança", Chippa OR "Child-Initiated Pretend Play Assessment" AND Publication Type: Journal. Resultados Foram localizados 25 artigos, entre 2000 e 2021, envolvendo 971 crianças entre 3 e 12 anos de idade, com desenvolvimento típico e atípico, desenvolvidos em estudos analíticos observacionais (transversais e de coorte) e experimentais; metodológicos (validação do instrumento e de adaptação cultural de instrumento); e descritivos. Conclusão A ChiPPA tem sido descrita na literatura como uma avaliação que permite correlacionar o faz de conta e as habilidades verbais, sociais, acadêmicas e de processamento sensorial de pré-escolares. É uma medida de desfecho eficaz, válida e confiável, permitindo avaliar crianças típicas e atípicas em diferentes contextos e países, inclusive no Brasil.

Abstract Introduction Playing is an important child occupation, and its assessment should be part of the therapeutic process to analyze the child's occupational performance and plan interventions based on this occupation. The Child-Initiated Play Make-A-Play Assessment (ChIPPA) has already been translated, cross-culturally adapted, and validated for the Brazilian population. Objective To review the scope of ChIPPA and identify how it has been described and addressed in national and international literature. Method Between January and June 2021, articles were searched in the PubMed, Scopus, BVS, ERIC, CINAHL, Web of Science, and PsycInfo databases, using search strategies with different syntaxes according to the method of each. basis: Chippa OR "Child-Initiated Pretend Play Assessment", ChIPPA OR "Child-Initiated Pretend Play Assessment" OR "Child-Initiated Pretend Play Assessment" OR "Child-Initiated Pretend Play Assessment", Chippa OR "Child-Initiated Pretend Play Assessment" AND Publication Type: Journal. Results 25 articles were found, between 2000 and 2021, 971 children between 3 and 12 years of age, with typical and atypical development, developed in analytical observational (cross-sectional and cohort) and experimental studies; methodological (validation of the instrument and cultural adaptation of the instrument); and descriptive. Conclusion The ChiPPA has been described in the literature as an assessment that allows correlating pretend to play with preschoolers' verbal, social, academic, and sensory processing skills. It is a practical, valid, and reliable outcome measure, allowing the assessment of typical and atypical children in different contexts and countries, including Brazil.

The process of Learn to Play Therapy with parent-child dyads with children who have autism spectrum disorder.

INTRODUCTION: Learn to Play Therapy aims to build children's ability to spontaneously initiate pretend play. The purpose of this study was to explore evidence for this therapy for children with autism spectrum disorder by investigating the changes in a child's pretend play and key techniques used in the process of therapy. METHODS: Six children with a diagnosis of autism spectrum disorder (mean age = 3.8 years; SD = 1.2 years) were engaged in therapy sessions with a parent. Four therapy session videos for each child were selected across four time points from 15 videos of each child, representing 6 months of therapy. Retrospective video analysis was used to investigate the changes in the child's ability by coding six play skills and enjoyment of play. Key techniques in the process of Learn to Play Therapy were analysed by frequency of occurrence during sessions. RESULTS: There was a significant increase in the child's pretend play ability for play scripts (p = .042), sequences of play actions (p = .043), object substitution (p = .043), doll/teddy play (p = .028), social interaction (p = .043) and enjoyment (p = .026). There was a mirroring of the therapist, parent and child for all key techniques, with parents showing increased frequency rates after Time 1. Repetition with variation decreased by Time 4. Challenging the child showed higher rates in Times 2 and 4. Focussed attention remained stable, and the child's talk during play had the highest total frequency. CONCLUSION: Learn to Play Therapy is an effective therapy in building pretend play ability in children with autism, with parents increasing their involvement in using the key techniques after Time 1. The results inform therapists on how the key techniques were used within the therapy sessions to increase the child's pretend play ability.

Pretend play ability in preschool-aged children with an acquired brain injury.

INTRODUCTION: This study compares the self-initiated pretend play abilities of preschool-aged children with an acquired brain injury, with the self-initiated pretend play ability of their neurotypical peers. METHOD: A non-experimental group comparison was conducted between 22 preschool-aged neurotypical children (M = 52.8 months, SD = 7.1 months) and 21 children with an acquired brain injury (ABI, M = 50.5 months, SD = 11.9 months), who had been discharged from inpatient rehabilitation and who were able to engage in a play session. The children were assessed individually using the Child-Initiated Pretend Play Assessment (ChIPPA). RESULTS: The children with an ABI had significantly lower scores in pretend play ability than their neurotypical peers as measured by the percentage of elaborate play actions in both the conventional (P < .000) and symbolic (P < .000) sections of the ChIPPA, as well as the number of object substitutions (P < .000). The children with an ABI completed significantly less of the play time required compared with their neurotypical peers (P = .001); 66% could not play for the required time. There was no significant difference in the ChIPPA scores of the children with an ABI injured before and after the age of 18 months, nor between children with a severe or moderate injury. CONCLUSION: The quality and the quantity of pretend play of preschool-aged children with an ABI are significantly below that of their neurotypical peers. Assessment of pretend play ability and direct intervention in ABI rehabilitation by occupational therapists is essential to enable children with an ABI to participate in pretend play and garner the developmental benefit this affords.

Can children's play themes be assessed to inform play therapy practice?

In play therapy with children, identifying play themes is key to understanding the meaning within sessions, and allows therapists to systematically track therapeutic change. This study investigated if play themes could be identified using a time limited, standardized assessment, for children aged 5-7 years. A descriptive, observational mixed methods, non-experimental study with 30 typically developing children was conducted, with participants assessed individually on one occasion using the Child-Initiated Pretend Play Assessment (ChIPPA). Play themes were able to be identified for 26 of the 30 participants. Of these 26 children, a range of primary and subthemes were observed. These findings indicate that a baseline measure of both play ability and play themes can be integrated to prescribe and align the model of play therapy with the needs of the child. Play themes were not identified for four participants which may be due to limited pretend play ability, indicating that deficits in play ability may need to be addressed in the first instance.

Construct validity of the Child-Initiated Pretend Play Assessment-For 3-year-old Brazilian children.

INTRODUCTION: Play is an indication of children's development and how they function. In occupational therapy it is regarded as an important occupation of childhood. Assessment of a child's play should be included in the test batteries of occupational therapists, who understand the construct validity of the assessment they have chosen. Our aim was to provide evidence of reliability, internal consistency and hypotheses testing of the construct validity of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment. METHODS: Two hundred typically developing Brazilian children aged 3 years were evaluated individually using the Child-Initiated Pretend Play Assessment. RESULTS: The internal consistency showed a Cronbach's alpha coefficient to Percentage of Pretend Play Actions (PEPA) of 0.86 and NOS of 0.81. There were significant differences between the younger children (aged 36-41 months) and the older children (aged 42-47 months) for elaborate play across both conventional-imaginative play (p = .002), symbolic play (p = .012), and the combined score (p = .005). There were significant differences between younger and older girls for elaborate play with symbolic play materials (p = .009) and elaborate play overall (p = .039). There were significant differences between young and older boys for elaborate play with conventional toys (p = .006) and elaborate play overall (p = .025). There were no significant differences for object substitution or imitated actions. CONCLUSION: The measurement properties of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment for 3-year-old Brazilian children identified evidence for response processes, internal structure, with discussion of consequences of testing for 3-year-old Brazilian children.

Implicit play or explicit cognitive behaviour therapy: The impact of intervention approaches to facilitate social skills development in adolescents.

INTRODUCTION: Early adolescence is a time of increased social interaction with peers. Social competence is related to pretend play ability in younger children, but a lack of pretend play ability in childhood may also be associated with social challenges in early adolescence. Adolescents who find social situations challenging experience alienation from peers resulting in lowered self-regard. This paper presents an exploratory study comparing an Implicit group intervention (age-appropriate play based group (PB)) to an Explicit group intervention Cognitive Behavioural Therapy (CBT) to increase social ability in adolescents. METHODS: Six adolescents, three female and three male, were in the Implicit group (PB; mean age 12.3 years, SD = 1.21). Six male adolescents were in the Explicit group (CBT; mean age 13.3 years, SD = 1.03). All participants were assessed pre- and post the 8-week intervention for social competence, cognitive flexibility and narrative ability. The Implicit group (PB) was assessed through an age appropriate play assessment. Seven participants had a formal diagnosis, including autism spectrum disorder, and all were in mainstream high schools. RESULTS: The Explicit group (CBT) showed a medium effect for social engagement, total social skills, emotional engagement and a large effect for a decrease in flexible thinking. The Implicit group (PB) showed a large impact for narrative ability with increases in ability to sequence events, initiation and creation of plot, understanding character roles and total movie score, with medium effects for generation of problems, precise vocabulary and use of symbols. The Implicit group (PB) maintained cognitive flexibility, and decreased in social self-scoring which showed medium effects for externalising and internalising. CONCLUSION: This paper contributes to evidence that the choice of social skills intervention impacts different skill sets. For neuro-diverse adolescents, the cognitive intervention impacted social and emotional engagement and the play-based intervention impacted a wider range of abilities related to narrative social interaction.

Relationship between screen-time and hand function, play and sensory processing in children without disabilities aged 4-7 years: A exploratory study.

INTRODUCTION: Screen-time has become a regular occupation for young children at home and school, with little evidence of its impact on children's developmental skills. This study explored the association between children's screen-time, fine motor, in-hand manipulation (IHM), visual-motor integration (VMI), sensory processing (SP) and parent-reported play skills. METHOD: The fine motor, IHM, VMI, SP and play skills of a sample of 25 Australian children without disabilities (M age = 6.2 years, SD = 1.03; 64% girls) were assessed using the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, Test of In-Hand Manipulation-Revised, Berry Buktenica Developmental Test of Visual-Motor Integration Sixth Edition, Sensory Processing Measure-Home Form and Pretend Play Enjoyment Developmental Checklist (PPEDC). Parents completed a week-long log of their child's screen-time. Spearman's rho correlations and linear regressions with bootstrapping were used for data analysis. RESULTS: Statistically significant moderate level negative correlations were found between Total Screen-Time (TST) and VMI skills (r = -.67, p < .01); Interactive Screen-Time and IHM abilities (r = -.46, p < .05) and TST and bilateral coordination skills (r = -.42, p < .05). There were significant negative correlations between SP ability and both TST (r = -.53, p < .01) and Watching Screen-Time (r = -.66, p < .01). When the PPEDC Object Substitution variable was entered into a regression model as a co-variate of hand function, it appeared to lessen the impact of TST as an independent predictor variable of children's VMI and bilateral coordination skills (p < .23 and p < .61). CONCLUSION: Playing with toys and using object substitution in play (e.g. a child uses an object for something else other than its intended use when playing with it) potentially appear to be a moderating factor of the impact of children's screen-time on their bilateral coordination and VMI skills. Clinicians can encourage children's active and dynamic involvement in games and play pursuits to counteract the potential impact of increased use of devices that involve screen-time.

Longitudinal evaluation of a knowledge translation role in occupational therapy.

BACKGROUND: In 2014, a large metropolitan mental health service in Australia developed a senior role (Lead Research Occupational Therapist) to address an identified need for greater research and knowledge translation, and associated capacity building. The aim of this study was to evaluate the impact, in the first 2.5 years, of this role across a range of variables. METHODS: Multiple methods were used to gather a comprehensive range of data. Workforce surveys were completed both online and in hard copy in early 2014 (n = 42) and late 2016 (n = 44). Research key performance indicators (academic, research production and cultural) were also identified for measurement over time. The data from these surveys were analysed using descriptive and inductive analysis, and also with social network analysis. RESULTS: This role has demonstrated positive outcomes across a range of variables. There was a medium effect on the quantity of participation in quality assurance and knowledge translation activities by the workforce. Most knowledge translation behaviours were occurring regularly, although several were absent. An improving trend in attitudes towards evidence-based practice was recorded, and perceptions of the knowledge translation role were generally positive. The Lead Research Occupational Therapist moved from the periphery to the centre of the evidence based practice social network. Improved awareness of other clinicians deploying evidence based practice was observed, and the frequency of interaction between clinicians increased. The role has met all key performance indicators, across the academic, research production and cultural domains. CONCLUSIONS: The shift in focus of this role from research to knowledge translation has produced tangible outcomes for the occupational therapy workforce. These achievements have had a positive impact on the sustainability of the role, which will be continued for at least another two years. An ongoing challenge is to directly measure the impact of this role on outcomes for people with mental illness and their carers.

Advancing towards contemporary practice: a systematic review of organisational performance measures for non-acute health charities.

BACKGROUND: Organisational performance measurement is a recognised business management tool and essential for survival and success. There is a paucity of methodological studies of organisational performance measurement relating to non-acute healthcare charities and this study is the first to suggest a set of evidence-informed organisational performance measures for the sector. METHODS: This study was designed using a two-staged approach. A systematic review of peer-reviewed journal literature between 2003 and 2016 was conducted according to the twenty-seven (27) point checklist of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) complemented by a thematic analysis of eligible data using a cutting and sorting technique to generate a set of common measures of organisational performance for non-acute health charities. RESULTS: Not one study was found relating to organisational performance of non-acute healthcare charities however four records met eligibility criteria relating to non-acute or primary healthcare services with charitable fundraising capability. Three were case studies of specific organisations that related their approach to organisational performance measurement, while the fourth compared a case study organisation to a public service. Three different organisational performance frameworks and 20 organisational performance measures were used across the four studies. CONCLUSIONS: The study concluded that (1) demonstration of organisational performance is relevant to non-acute health charities; (2) organisational performance measurement is feasible in this sector; (3) an evidence-based organisational performance measurement framework for the sector has not yet been developed nor has an existing organisational performance measurement framework been adapted for the sector, although the Balanced Scorecard is likely to be an effective option and (4) five leading measures - Quality of Service; Finance; Stakeholders (Customers and Clients); People and Culture; and Governance and Business Management; could be used to determine organisational performance in these sectors. Finally, 'Mission and Purpose' could be explored as a potential measure. Further research to understand why there is such limited published organisational performance evidence for the sector could be useful. Case studies of organisational measurement strategies of successful non-acute healthcare charities and research into important factors for organisational performance implementation in the sector may contribute to greater uptake and knowledge dissemination.

Relationship Between Sensory Processing and Pretend Play in Typically Developing Children.

OBJECTIVE: We sought to investigate the relationship between sensory processing and pretend play in typically developing children. METHOD: Forty-two typically developing children ages 5-7 yr were assessed with the Child Initiated Pretend Play Assessment and the Home and Main Classroom forms of the Sensory Processing Measure (SPM). RESULTS: There were significant relationships between elaborate pretend play and body awareness (r = .62, p < .01), balance (r = .42, p < .01), and touch (r = .47, p < .01). Object substitution was associated with social participation (r = .42, p < .05). CONCLUSIONS: The sensory processing factors (from the SPM)-namely, Body Awareness, Balance, Touch, and Social Participation-were predictive of the quality of children's engagement in pretend play in the home environment. The results indicated that, to engage and participate in play, children are involving sensory processing abilities, especially body awareness, balance, and touch.

Measures to assess the performance of an Australian non-government charitable non-acute health service: A Delphi Survey of Organisational Stakeholders.

Organisation performance measurement is relevant for non-profit charitable organisations as they strive for security in an increasingly competitive funding environment. This study aimed to identify the priority measures and indicators of organisational performance of an Australian non-government charitable organisation that delivers non-acute health services. Seventy-seven and 59 participants across nine stakeholder groups responded to a two-staged Delphi technique study of a case study organisation. The stage one questionnaire was developed using information garnered through a detailed review of literature. Data from the first round were aggregated and analysed for the stage two survey. The final data represented a group consensus. Quality of care was ranked the most important of six organisational performance measures. Service user satisfaction was ranked second followed by financial performance, internal processes, employee learning and growth and community engagement. Thirteen priority indicators were determined across the six measures. Consensus was reached on the priority organisational performance measures and indicators. Stakeholders of the case study organisation value evidence-based practice, technical strength of services and service user satisfaction over more commercially orientated indicators.

The pan occupational paradigm: development and key concepts.

BACKGROUND/AIM: Wilcock's Occupational Perspective of Health (OPH) aligns with the profession's re-discovery of its holistic, occupationally focused roots. Its dimensions of occupation-doing, being, becoming and belonging - resonate strongly with therapists on an intuitive, implicit level. However, its documented use in practice to date has been sparse, and several barriers to its implementation have been identified. The aim of this article is to present a renewal of the OPH - the Pan Occupational Paradigm (POP). Method of development: POP was developed using critical analysis, reflection and a comprehensive literature review. Each stage of development is described in detail, including the POP's inherent assumptions. Key concepts: POP retains the four dimensions of occupation, and shows their interdependent role within occupational entities (e.g. individuals, groups or communities). An entity can be approached by occupational therapy at any point and all the dimensions (either directly or indirectly) can be engaged. Occupational entities move along a continuum of wellbeing, and this movement can be in both positive and negative directions over a lifespan. CONCLUSION AND SIGNIFICANCE: POP is a distillation of occupational therapy's unique way of knowing about occupation and the promotion of wellbeing. It is put forward as an updated paradigm for occupational therapy in the 21st century.

Content and cultural validity in the development of the Indigenous Play Partner Scale.

BACKGROUND/AIM: Culturally relevant assessments of Australian Indigenous children's social pretend play do not exist. This study investigated the content validity and cultural validity of the Indigenous Play Partner Scale (I-PPS). METHODS: Six pairs of children (i.e. 12 children) aged four-six years from a remote Australian town were videoed playing in pairs, and 14 community elders and mothers participated across three focus groups. The social interactions between the children were transcribed from the videos. Nineteen verbs, grouped into five categories of social interaction, described the social interactions between the pairs of children. The descriptions of the social interaction verbs were presented to the community elders and mothers in a focus group. RESULTS: The themes from the focus groups were 'background of Indigenous understanding of play' and 'proposed social interaction verbs'. The first theme reflected community collaboration, children playing in multi-aged groups and the role of older children within the play. Guided by the focus group discussion, the videos were re-analysed and 20 social interaction verbs were described that reflected the cultural context of play. CONCLUSIONS: The content and cultural validity of the I-PPS was established through community consultation. Twenty social interaction verbs, which form the basis of the items of the I-PPS, reflected Indigenous cultural values of being non-judgemental of Indigenous children's social interactions during pretend play. Culturally relevant assessments for Australian Indigenous children do not disadvantage this population group and are essential for practice in occupational therapy.

Comparison of a traditional and non-traditional residential care facility for persons living with dementia and the impact of the environment on occupational engagement.

BACKGROUND: Dementia residential facilities can be described as traditional or non-traditional facilities. Non-traditional facilities aim to utilise principles of environmental design to create a milieu that supports persons experiencing cognitive decline. This study aimed to compare these two environments in rural Australia, and their influence on residents' occupational engagement. METHODS: The Residential Environment Impact Survey (REIS) was used and consists of: a walk-through of the facility; activity observation; interviews with residents and employees. Thirteen residents were observed and four employees interviewed. Resident interviews did not occur given the population diagnosis of moderate to severe dementia. Descriptive data from the walk-through and activity observation were analysed for potential opportunities of occupational engagement. Interviews were thematically analysed to discern perception of occupational engagement of residents within their facility. RESULTS: Both facilities provided opportunities for occupational engagement. However, the non-traditional facility provided additional opportunities through employee interactions and features of the physical environment. Interviews revealed six themes: Comfortable environment; roles and responsibilities; getting to know the resident; more stimulation can elicit increased engagement; the home-like experience and environmental layout. These themes coupled with the features of the environment provided insight into the complexity of occupational engagement within this population. CONCLUSION: This study emphasises the influence of the physical and social environment on occupational engagement opportunities. A non-traditional dementia facility maximises these opportunities and can support development of best-practice guidelines within this population.

An intervention to improve social participation for adolescents with autism spectrum disorder: pilot study.

OBJECTIVE: To increase flexible thinking, self-regulation and empathy for adolescents with ASD. METHOD: Five adolescents (M = 13.5 years; SD = 0.84 years; four males) were assessed pre and post intervention for flexible thinking and social competence (as measured by the SSIS). Parents rated their adolescent's social competence pre and post intervention. RESULTS: A large decrease was found in parent rating of their child's level of hyperactivity (12.8, SD = 2.3; 11, SD = 2.2) (p = 0.034) (Cohen's d = 0.95). Parents increased their rating of their child's cooperation and empathy (Cohen's d = 0.71 and 0.56, respectively). A medium effect for flexible thinking was observed in three items (Cohen's d = 0.5 to 0.62) and a large effect for one item (Cohen's d = 1.35). Adolescents decreased self-scoring on the social scale post intervention. CONCLUSION: Improvements were observed in adolescents' flexible thinking and social insights, and parent's perception of their child's self-regulation.

Quality of pre-school children's pretend play and subsequent development of semantic organization and narrative re-telling skills.

PURPOSE: This study investigated if the quality of pre-school children's pretend play predicted their semantic organization and narrative re-telling ability when they were in early primary school. It was hypothesized that the elaborateness of a child's play and the child's use of symbols in play were predictors of their semantic organization and narrative re-tell scores of the School Age Oral Language Assessment. METHOD: Forty-eight children were assessed using the Child-Initiated Pretend Play Assessment when they were aged 4-5 years. Three-to-five years after this assessment their semantic organization and narrative re-telling skills were assessed. RESULT: Results indicate that the elaborateness of a child's play and their ability to use symbols was predictive of semantic organization skills. Use of symbols in play was the strongest play predictor of narrative re-telling skills. The quality of a pre-school child's ability to elaborate complex sequences in pretend play and use symbols predicted up to 20% of a child's semantic organization and narrative re-telling skills up to 5 years later. CONCLUSION: The study provides evidence that the quality of pretend play in 4-5 year olds is important for semantic organization and narrative re-telling abilities in the school-aged child.

In the footsteps of Wilcock, Part two: The interdependent nature of doing, being, becoming, and belonging.

The four dimensions of occupation developed by Wilcock in the Occupational Perspective on Health-doing, being, becoming, and belonging-have evolved. Although the inter-relationships between the dimensions have been explored by clinicians and researchers to some degree, the reciprocal and multidimensional nature of these relationships are rarely explicitly addressed. This article will present a critical analysis of the relationships and interaction between doing, being, becoming, and belonging, initially in dyads and then in a multidimensional way. The article proposes provisional understandings of how they combine and influence each other in occupational engagement. Six observations are made on the dimensions of occupation, along with a discussion of the impact of their interrelationships on research and practice.