Encuesta a terapeutas ocupacionales del ámbito pediátrico sobre la práctica escolar: ¿se necesita mayor formación en España? / A survey from paediatric occupational therapists about school based practice: is more training needed in Spain?

Objetivos: explorar el conocimiento sobre terapia ocupacional en la escuela, desde la perspectiva de terapeutas ocupacionales pediátricos, para poder identificar fortalezas y debilidades y proponer acciones futuras de desarrollo. Métodos: as personas participantes se reclutaron por muestreo no-probabilístico de conveniencia y bola de nieve, a través de colegios y asociaciones profesionales. Noventa y dos participantes superaron el cribado inicial y se seleccionaron para analizar sus respuestas. Resultados: veintinueve participantes (31,5%) trabajan en las escuelas y sesenta y tres (68,5%) tienen relación con colegios, pero no trabajan en educación. Cuentan con excelente formación en enfoques individuales, y se centran preferentemente en abordar dificultades sensoriales y motoras. El 35,9% (n=33) están involucrados en algún proyecto educativo, financiado principalmente por cada escuela. La mayoría posee escasa formación sobre enfoques actuales de terapia ocupacional escolar, respaldados por la evidencia, y creen necesario impulsar el desarrollo de esta área en España. Conclusiones: este estudio muestra que se requiere formación específica sobre terapia ocupacional escolar en España y ulteriores cambios legislativos. Además, es preciso aclarar las funciones del (de la) terapeuta ocupacional en la escuela y los modelos de prestación de servicios en los contextos educativos, para comprender cómo contrastan con los enfoques clínicos tradicionales.(AU)

Objective: This study aimed to explore current school-based occupational therapy practice in Spain from the perspective of paediatric occupational therapists, identify strengths and weaknesses, and propose future development actions. Methods: Through colleges and professional associations, participants were recruited by non-probabilistic convenience and snowball sampling. Ninety-two participants passed the initial screening question, and their responses were selected for analysis. Results: Twenty-nine participants (31.5%) work in schools, and sixty-three (68.5%) are related to schools but do not work in education. They have excellent training in individual approaches and preferentially focus on addressing sensory and motor concerns. Thirty-three respondents (35.9%) are involved in some educational projects financed mainly by each school. Most participants have little training on current evidence-based approaches to school-based occupational therapy. They believe it is necessary to promote the development of this area in Spain. Conclusions: This study shows that specific training in school-based occupational therapy in Spain is required in addition to legislative changes. Besides, the roles of the occupational therapist in schools and service delivery models in educational settings need to be clarified to understand how they contrast with traditional clinical approaches.(AU)

Terapia ocupacional: explorando los laberintos y los dilemas, para impulsar un cambio en la sociedad / Occupational therapy: exploring labyrinths and dilemmas to drive change in society

La terapia ocupacional se adentra en los laberintos y dilemas para catalizar un despertar y generar un cambio en la sociedad. A través de su enfoque holístico, esta disciplina busca comprender y abordar los desafíos que enfrentan las personas en su participación ocupacional. Desde la rehabilitación física hasta la promoción de la salud mental, la terapia ocupacional se compromete a mejorar la calidad de vida y fomentar la inclusión. Mediante la implementación de intervenciones basadas en la ocupación, la terapia ocupacional trabaja para empoderar a las personas, promover la autonomía y cultivar un impacto transformador en la sociedad.(AU)

Occupational therapy delves into the labyrinths and dilemmas to catalyze awakening and bring about change in society. Through its holistic approach, this discipline aims to understand and address the challenges individuals face in their occupational engagement. From physical rehabilitation to mental health promotion, occupational therapy is committed to improving quality of life and fostering inclusion. By implementing occupation-based interventions, occupational therapy works to empower individuals, promote autonomy, and cultivate a transformative impact on society.(AU)

Occupational value outcomes among people with mental health issues participating in activity-based interventions - The importance of internal and external factors.

BACKGROUND: Perceived occupational value is an important treatment outcome but is still relatively unexplored as a phenomenon. AIM: To evaluate whether the Balancing Everyday Life (BEL) intervention for people with mental health issues was effective compared to Standard Occupational Therapy (SOT) regarding improvement on three dimensions of occupational value (concrete, socio-symbolic and self-reward), and how internal factors (self-esteem and self-mastery) and external factors (sociodemographics) were related to occupational value. METHODS: The study was a cluster RCT (n = 226) and used self-report questionnaires on three occasions (baseline = T1, completed intervention = T2, six-month follow-up = T3). RESULTS: No differences between the groups were seen in occupational value change scores. Within-group analyses (T1-T3) indicated a change in the BEL group on concrete value and self-reward value. No change was indicated in the SOT group. Associations showed that self-esteem and self-mastery were correlated with all three aspects of occupational value. Having children was negative for experiencing occupational value, whereas having a friend was positive. None of the correlates could predict changes in occupational value. CONCLUSION: Self-related factors appeared to be integral in occupational value. SIGNIFICANCE: Since occupational value is essential for a meaningful life, therapists should consider such factors and peer support when supporting people with mental health issues.

Using Practice-Based Inquiry to Enact Occupation-Centered, Justice-Oriented Practice in an Acute Mental Health Setting.

IMPORTANCE: Occupational therapy practitioners working in mental health settings in the United States are faced with challenges and barriers to implementing justice-oriented, occupation-centered practice. Research situated in the practice context with practitioners as coresearchers may provide an avenue for changing practice. OBJECTIVE: To describe the reconceptualization and redesign of occupational therapy services by a community of occupational therapy practitioners in an acute mental health setting in the United States. DESIGN: Practice-based inquiry, a form of practitioner-generated action research with a community of practice scholars (CoPS), guided the redesign of practice. SETTING: Acute mental health service in a large teaching hospital system. PARTICIPANTS: Nine occupational therapists comprised a CoPS and served as coresearchers and participants in the study. DATA COLLECTION AND ANALYSIS: Practitioner scholars' experiences of daily practice captured in individual reflections and collective research discussions were the source of data. Data collection, analysis, and action was an iterative process. Coresearchers coded and categorized findings and then developed themes reflecting changes enacted in practice. FINDINGS: The data analysis resulted in two themes characterizing how the CoPS reconceptualized and redesigned practice to reflect their commitment to occupation-centered and justice-focused occupational therapy: (1) occupational opportunities through direct services and (2) occupational opportunities through system-level change. CONCLUSIONS AND RELEVANCE: For this CoPS, engaging in a practice-based inquiry facilitated a reconceptualization of their practice and widened their occupational lens, thus strengthening their identity as occupational therapists. Given the barriers to demonstrating occupational therapy's unique contribution to mental health practice, this research provides a valuable tool for practitioners. What This Article Adds: Occupational therapy practitioners who engage in context-specific, action-oriented research experience a transformative process that empowers them to address barriers often encountered in mental health practice and enact occupation-centered and justice-focused practice.

An Evaluation of a Clinic-Based Low Vision Device Lending Library.

As the efficacy of low vision service provision is facilitated by clients' access to and proper use of low vision devices, the objective of this study was to evaluate an outpatient clinic-based low vision device lending library program and the functional and psychosocial impact that device use had upon clients. Twenty individuals borrowed portable video magnifiers during the study period. Line items from the Revised-Self-Report Assessment of Functional Visual Performance and the Reading Behavior Inventory were analyzed before and after device loan at two months. The Psychosocial Impact of Assistive Devices Scale-10 and a semi-structured interview were also completed at two months. Reported improvements in reading performance and satisfaction levels on the Reading Behavior Inventory were significant (p<.001). The Revised-Self-Report Assessment of Functional Visual Performance indicated improved independence in reading medications, bills and labels. Higher scores in happiness, independence, sense of control and adaptability on the Psychosocial Impact of Assistive Devices Scale-10 indicated device retention at two months. Qualitative themes included improved independence, time needed to acclimate to the device, personal appraisal impacting motivation and challenges specific to low vision. This article provides occupational therapists a model to facilitate access, person-device fit and successful use of low vision devices to promote therapy outcomes.

Spirituality as a Neglected Core in Occupational Therapy Practice: An Iranian Exploratory Survey.

Spirituality has received more attention in recent decades from different health disciplines. Occupational Therapy (OT), as a health discipline, believes that all aspects of human experience, including physical, psychological, social, and spiritual, are considered essential aspects of health. OT supports the fact that incorporating spirituality can promote health, well-being, and quality of life. Various researchers have attempted to investigate and explain occupational therapists' views on spirituality. In Iran's OT curriculum, spirituality has not been incorporated directly. The purpose of this study is to acquire information about the knowledge and opinions of Iranian occupational therapists about spirituality. This is a cross-sectional exploratory descriptive survey study in which 125 occupational therapists participated through convenience sampling. Inclusion criteria were, namely (a) at least one-year clinical experience of OT, (b) being educated in Iran, and (c) working in Iran. The Occupational Therapy Assessment of Spirituality (OTAS) questionnaire was used for data collection. The answers to the quantitative questions were analyzed through descriptive statistics. Most of the participants believed that spirituality should be incorporated by occupational therapists, but more than half of the participants disagreed that formal education prepared them to pay any attention to spirituality in their practice. Analyzing qualitative data by frequencies of their repetitions, led to four categories and sixteen subcategories, accordingly. The four categories are (1) the barriers to applying spirituality in OT, (2) the need to acquire knowledge and apply spirituality in OT, (3) the benefits of incorporating spirituality for a client, and (4) the benefits of incorporating spirituality for the occupational therapist. The findings indicate that academic education has failed to prepare Iranian occupational therapists to meet spiritual needs of their clients. However, OTs tend to get information about spirituality from other sources and find it helpful for themselves and their clients. There are also barriers to applying spirituality; therefore, an educational package is needed to address these problems.

Implementing an occupational therapy specific mental health intervention in a multi-professional context - the case of Balancing Everyday Life (BEL).

BACKGROUND: The occupation-based intervention Balancing Everyday Life (BEL) was found effective under controlled conditions but should also be studied in a natural clinical practice context. AIM: The aim was to study the implementation process of BEL when provided in a multi-professional mental health team. The focus was particularly on how BEL was received and functioned. METHODS: This qualitative study was based on manifest content analysis and used semi-structured telephone interviews with 13 occupational therapists and three managers. RESULTS: Three themes were identified: '1 - Conditions and opportunities in the setting', '2 - Putting the BEL intervention into practice' and '3 - Experiences of practicing BEL'. BEL was a welcomed alternative, as stated by managers and occupational therapists. The team helped to recruit BEL participants, but the occupational therapists had to give rigorous information to team members and prospective participants for this to work. The social, physical and political contexts were essential for the implementation. CONCLUSIONS: Successful implementation of an occupational therapy-specific intervention such as BEL requires a reasonable match between existing team policies and the underpinnings of the intervention. It is crucial to repeat information to all stakeholders and make the intervention a matter of urgency for the whole team.

Volunteering as a Meaningful Occupation in the Process of Recovery From Serious Mental Illness: A Qualitative Study.

IMPORTANCE: Volunteering is an activity that facilitates social welfare, a sense of connection to others, and the construction of links with other people and the community. OBJECTIVE: To describe the experience of a group of people with serious mental illness (SMI) who engaged in community volunteer work. DESIGN: Qualitative, phenomenological study using purposeful sampling and an inductive thematic analysis. SETTING: Several mental health community centers in Madrid and Catalonia, Spain. PARTICIPANTS: People with SMI engaged in community volunteer work. Outcomes and Measures: In-depth interviews were used to collect data. RESULTS: Two themes, with four subthemes each, emerged from the data: (1) engaging in a meaningful occupation enhances the recovery process (subthemes: undergoing positive experiences, performing or resuming a meaningful occupation, living in the present moment, and relating with one's social and family environment) and (2) a process of mutual support (subthemes: in helping others, you help yourself; helping others on the basis of one's first-person experience; recover before you can help others; and role of professionals in volunteering). CONCLUSIONS AND RELEVANCE: Volunteering is perceived as a meaningful occupation. Helping others generates a reciprocal benefit that favors the recovery process and contributes to the establishment of personal and social bonds. What This Article Adds: This study provides a basis for understanding the potential of volunteering to be a meaningful occupation in the recovery process of people with SMI. It can help occupational therapy practitioners develop volunteer-based intervention programs that support the recovery process.

Stimulating Research to Advance Evidence-Based Applications of Telehealth in Occupational Therapy.

Occupational therapy focuses on therapeutic means to address participation in meaningful everyday tasks across the lifespan. No single setting is more conducive to this pursuit than individuals' authentic contexts. Occupational therapists are therefore uniquely suited to lead the charge toward stimulating research and advancing evidence-based application of telehealth. To this end, the American Occupational Therapy Foundation digitally convened their 2020 Planning Grant Collective to focus on the topic of Telehealth. Participants of the interdisciplinary collective collaboratively identified four themes: (1) Using technology to assess and intervene in the everyday context, (2) Partnerships with caregivers, (3) Telehealth delivery, and (4) Uniform data collection. Subgroups explored potential research and funding opportunities in their specialty area while also addressing the centralizing concepts of equity and diversity of telehealth delivery and COVID-19. Here, we provide a summary of the key concepts and recommendations from the 3 days of collaboration.

Electroencephalogram-based neurofeedback training in persons with stroke: A scoping review in occupational therapy.

BACKGROUND: Neurofeedback training targets the relevant brain response under minimal stress. It could be a promising approach for the treatment of patients with brain injury. OBJECTIVE: This review aimed to examine the existing literature to confirm the effectiveness of applied electroencephalogram (EEG)-based neurofeedback training in the area of occupational therapy for upper limb stroke rehabilitation. METHOD: All relevant literature published until July 1, 2020 in five prominent databases (PubMed, CINAHL, PsycINFO, MEDLINE Complete, and Web of Science) was reviewed, based on the five-step review framework proposed by Arksey and O'Malley. RESULTS: After a thorough review, a total of 14 studies were included in this review. Almost studies reported significant improvements as a result of EEG-based neurofeedback training, but this had not always account for the differences in effectiveness between groups. However, the results of these studies suggested that neurofeedback training was effective as compared to the traditional treatment and more effective in combination with EEG than that with simple equipment application. CONCLUSION: This review demonstrated the effectiveness of the combination of occupational therapy and EEG-based neurofeedback training. Most of these treatments are intended for inpatients, but they may be more effective for outpatients, especially if customized to their requirements. Also, such explorations to assess the suitability of the treatment for patient rehabilitation will help reduce barriers to effective interventions. An analysis of the opinions of participants and experts through satisfaction surveys will be helpful.

Rasch analysis of the Self-Efficacy for Therapeutic Use of Self questionnaire in Norwegian occupational therapy students.

BACKGROUND: Research suggested combining modern test theory with classical test theory to achieve comprehensive evaluation of an assessment tool. However, the Norwegian Self-Efficacy for Therapeutic Use of Self questionnaire has not yet been examined by the modern test theory. AIMS/OBJECTIVE: This study aims to examine psychometric properties of the Norwegian Self-Efficacy for Therapeutic Use of Self questionnaire by using Rasch analysis. MATERIAL AND METHODS: One hundred and eleven occupational therapy students from two universities in Norway completed the questionnaire across four time points. Rasch analysis was used to examine the appropriateness of the rating scales, unidimensionality, person response validity, item/person separation, and the Wright map. RESULTS: The ten-point rating scale did not fully maximise the measurement potentials. Unidimensionality was confirmed except for two items. Person response validity needs further investigation. Excellent person/item separation and Wright map were found. CONCLUSION: This study supports the psychometric properties of the Norwegian Self-Efficacy for Therapeutic Use of Self questionnaire in assessing self-efficacy in therapeutic encounters. Further research is needed to address the misfit items and the rating scale issue. SIGNIFICANCE: Rasch analysis showed that the Norwegian Self-Efficacy for Therapeutic Use of Self questionnaire is promising to be used as a reliable and valid tool.

Doing, being, becoming and belonging at the heart of occupational therapy: An analysis of theoretical ways of knowing.

Background: Theoretical ways of knowing in occupational therapy include paradigms, conceptual practice models and related knowledge. Despite the diversity of models available to guide practice, there are few examples of analyses which compare and contrast their respective core concepts.Aims: The aims of this paper are to describe how the dimensions of occupation described in the Pan Occupational Paradigm pervade conceptual practice models, and are embedded within case reports of occupational therapy.Materials and Methods: A framework analysis was undertaken, using the dimensions of occupation - doing, being, becoming and belonging - as core concepts. The alignment of concepts from four widely utilised occupational therapy conceptual practice models with these dimensions were investigated and described. Four case reports developed in reference to these specific conceptual practice models were also analysed, and their expression of the core concepts and dimensions discussed.Results: The dimensions of occupation were embedded in all reviewed conceptual practice models and case reports. The dimensions are explained in discrete, relational and embedded forms, with each conceptual practice model adopting a specific terminology and structure to describe them.Conclusions and Significance: The presence of all four dimensions of occupation, regardless of form, terminology or structural arrangement, is proposed as a hallmark of an occupational therapy conceptual practice model.

Transcending the individual: The promise and potential of collectivist approaches in occupational therapy.

BACKGROUND: In a globalised world, with injustices and inequities, occupational therapists have a moral and ethical obligation to use their knowledge and skills to work at a collective level with groups, communities, and populations rather than focus solely on individualistic approaches. OBJECTIVES: To review the literature exploring the question: What do occupational therapists do in their everyday practice that could be characterised as having a collectivist orientation? METHOD: A scoping review with searches on Web of Science, Scopus and CINAHL databases with the keywords 'occupational therapy' AND collectiv*. RESULTS: 161 articles were found and after screening of abstracts and/or full text, 19 were included. Articles were published in English (13) and Portuguese (6), in 12 different journals and one book, from 1988 to 2018. They were categorised as focussing on: social welfare - collectivism (n = 2); collective occupations (n = 11); and collective oriented practices (n = 6). CONCLUSION: A clear definition of collectivist approaches in occupational therapy practice was not found. What was evident, however, was a focus on experiential accounts of working with groups of people and the methods and processes utilised. It is argued that occupational therapy needs to further develop knowledge and practices aimed at injustices grounded in a collectivist epistemology.

Occupational adaptation - analyzing the maturity and understanding of the concept through concept analysis.

Background: Occupational adaptation is a key occupational therapy concept, yet lacks clarity and consensus, impacting on its application in practice, theory and research. Concept analysis is a rigorous methodology which enables identification of unique features, gaps in knowledge, and the need for further concept refinement.Aim: This study aimed to determine the conceptual maturity of occupational adaptation, and identify steps needed to understand and use occupational adaptation.Methods: Four databases were searched using the term 'occupational adaptation' and a principle-based concept analysis was conducted from epistemological, pragmatic, linguistic, and logical perspectives. A mapping of the concept's evolution and analysis of the maturity of its structural features also occurred.Results: Seven hundred and fourty-eight papers were identified, which reduced to 161 after abstract and full-text review. A diverse range of applications and two primary theoretical frames of reference were identified. The definition, attributes, preconditions, outcomes, and boundaries of the concept lacked maturity, limiting clinical utility.Conclusions and significance: Occupational adaptation is a concept applied across many practice and research contexts, yet the concept is not fully mature. Concept refinement is required before further applied research is conducted. A shared understanding of occupational adaptation through refinement and research may consolidate its importance and future utility.

Contemporary occupational therapy philosophy and practice in hospital settings.

BACKGROUND: Occupational therapists have sought to reconnect with the foundations of the profession for many years, and a key focus has been the place of occupation in practice. Existing literature suggests that therapists working in acute settings experience difficulties practicing in ways that centralise occupation. AIM/OBJECTIVE: This scoping review aimed to explore the existing literature on contemporary occupational therapy philosophy and practice in acute hospital settings. METHODS: A five step scoping review process was implemented. Four electronic databases were searched using a combination of search terms. Searching reference lists of papers was also completed. Results were summarised using numeric and thematic analysis. RESULTS: Twenty four publications were included. Four themes were identified; attitudes towards occupation-based practice, benefits of occupation-based approaches, challenges implementing occupation-based practice, and strategies to overcome challenges. CONCLUSION AND SIGNIFICANCE: Findings highlighted therapists value occupation as an important aspect of practice, however they experience many environmental and personal challenges in acute settings. Strategies to overcome these challenges related to individual's changing their practice to be more occupation-focussed and changes within the practice context including adapting environments, documentation and intervention protocols to focus on occupation. These strategies may support therapists to align practice with their professional values.

'Choice' in occupational therapy theory: A critique from the situation of patriarchy in India.

Background: Dominant occupational therapy theories assert that people choose their daily occupations, and participate in occupations as autonomous agents; yet scholars insist that choices are socially-structured and inequitably available.Aim: To critically review the concept of choice in occupational therapy theory through an exploration of patriarchy in India.Material and methods: Drawing from scholarly work that addresses patriarchy in India, we employ the commonly-used occupational categories of self-care, productivity and leisure as a framework to explore the real availability of occupational choices for women.Results: Patriarchal ideology perpetuates inequitable power dynamics within Indian society. As a consequence, women, children and non-dominant men have few opportunities to make or enact occupational choices that impact their wellbeing and their lives.Conclusions: The examples provided in this paper challenge those occupational therapy theories that portray occupational engagement as the product of individual volition and unconstrained choice.Significance: Dominant occupational therapy theories are informed by specific Western assumptions that may have little relevance to people in other contexts. Critical approaches to professional assumptions are essential to avoid the imperialistic imposition of irrelevant theories, and the development and delivery of services that may be oppressive for clients who have few opportunities to make occupational choices.

Discourses of service recipients in the context of reablement in Norway.

BACKGROUND: Reablement is a shift from reactive home care to a more preventive model based on active engagement. In this shift, it is interesting to uncover and understand potential discourses that may exist amongst service providers regarding their views of service recipients. AIM: to explore and describe discourses of the view of service recipients in the context of reablement, from the service providers' perspective. METHOD: Participants were service providers working in reablement, with the analysis being retrieved from 13 focus groups. A critical discourse analysis was used in order to gain a broader understanding and to capture service providers' views. FINDINGS: Five discourses were constructed. Three discourses indicated the way participants perceived service recipients included in reablement, namely the competent service recipient, the conventional service recipient, and the perfect service recipient. Two discourses categorised recipients related to whether or not they were included in reablement: the suitable service recipient who was excluded and the unsuitable service recipient who was included. CONCLUSION: Service providers use a variety of different discourses when they talk about service recipients. SIGNIFICANCE: Service providers, including occupational therapists, must be aware of how unconscious discourses can affect those to whom they provide services.

Estigmatização: consequências e possibilidades de enfrentamento em Centros de Convivência e Cooperativas / Stigmatization: consequences and the potential for tackling the problem in Centers for Coexistence and Cooperatives / Estigmatización: consecuencias y posibilidades de enfrentamiento en Centros de Convivencia y Cooperativas

Os efeitos negativos do estigma são um problema significativo em todo o mundo e, para tanto, busca-se aumentar a conscientização e a compreensão das estratégias mais eficazes para combater os estigmas. No âmbito das políticas públicas de saúde, a convivência que promove e intensifica o contato entre as pessoas, com ou sem vulnerabilidades específicas, é intencionalmente promovida pelos Centros de Convivência e Cooperativas (Ceccos). Objetivamos nesse artigo compreender as concepções acerca do processo de estigmatização por meio da visão de profissionais. A análise do discurso resultou em unidades de significação, entre as quais as compreensões em torno de tipos, consequências e possibilidades para o enfrentamento dos estigmas. Não obstante os problemas estruturais e macrossociais presentes, há persistência no trabalho cotidiano diante das possibilidades de transformações observadas no contexto do serviço. (AU)

The negative effects of stigma are a serious problem worldwide and efforts have therefore been made to enhance awareness and understanding of strategies to tackle this issue. Within the scope of public health policy, Centers for Coexistence and Cooperatives promote and enhance interaction between people from both vulnerable and non-vulnerable groups. This study sought to understand concepts of the process of stigmatization through the lens of professionals working in these centers. The discourse analysis resulted in units of meaning that included understandings about the types and consequences of stigmas and how to tackle this issue. Despite structural and macro social problems, there is persistence in the daily work in view of the possibility of transformation observed in the context of the service. (AU)

Los efectos negativos del estigma constituyen un problema significativo en todo el mundo y, para ello, se busca aumentar la concienciación y comprensión sobre las estrategias más eficaces para combatir los estigmas. En el ámbito de las políticas públicas de salud, la convivencia que promueve e intensifica el contacto entre las personas, con o sin vulnerabilidad específicas, es promovida intencionalmente por los Centros de Convivencia y Cooperativas. El objetivo de este artículo es comprender las concepciones sobre el proceso de estigmatización a partir de la visión de profesionales. El análisis del discurso resultó en unidades de significación, entre ellas las comprensiones alrededor de tipos, consecuencias y posibilidades para enfrentar los estigmas. A pesar de los problemas estructurales y macrosociales presentes, existe la persistencia en el trabajo cotidiano ante las posibilidades de transformación observadas en el contexto del servicio. (AU)

Experiences of Intergenerational Trauma in Second-Generation Refugees: Healing Through Occupation.

BACKGROUND.: Trauma experienced in one generation can affect the health and well-being of subsequent generations, such as impairing life skills, personal contentment, behaviour patterns and sense of self. This phenomenon has predominantly been explored with descendants of European refugees and is not fully understood from an occupational perspective. PURPOSE.: This research explores how intergenerational trauma manifests in the occupational lives of second-generation Ilankai Tamil and Vietnamese refugees. METHODS.: Using qualitative narrative inquiry, 12 adult children of Tamil and Vietnamese refugees residing in the Greater Toronto Area participated in semi-structured interviews. Narratives were thematically analysed. FINDINGS.: Findings illustrate how sociohistorical, cultural and familial contexts influence the way second-generation refugees view what they can and should do. Many healing responses to intergenerational trauma include occupations focused on communal care. IMPLICATIONS.: Findings from this study reveal the unique struggles and needs of two understudied populations and the possibilities for healing through occupation.

Making Choices from the Choices we have: The Contextual-Embeddedness of Occupational Choice.

BACKGROUND.: "Choice" is central to occupational therapy's theoretical tradition, which maintains that individuals can impact their well-being through wisely choosing their occupations. However, the assumption that opportunities to choose are universally available is negated by research evidence. PURPOSE.: To review the ideology of "choice" in occupational therapy theory, and to encourage more critical approaches toward determinants of occupational opportunity and choice. KEY ISSUES.: Evidence indicates that within Canada, and throughout the world, opportunities to make occupational choices are inequitably distributed among people of different socioeconomic classes, castes, genders, races, abilities, sexualities, citizenship statuses, and experiences of colonialism. IMPLICATIONS.: Because occupation is a determinant of health and well-being, social injustices that create inequitable occupational choices are unfair violations of occupational rights. The occupational therapy profession's espoused aim of enhancing well-being through occupation demands theories that explicitly recognize the socially structured and inequitable shaping of choice, and consequent impact on people's occupational rights.