Participant Outcomes and Facilitator Experiences Following a Community Living Skills Program for Adult Mental Health Consumers.

Outcomes from participating in a six-week small-group living skills program, periodically implemented over two years with twelve adult mental health consumers, are reported as a case study. Occupational therapy and recovery-oriented approaches underpinned the development and implementation of the program thus it was important that outcome measures aligned with these perspectives. Data were gathered pre and post program using the Canadian Occupational Performance Measure (COPM) and the Life Skills Profile-16 (LSP-16) in each iteration of the program. Two occupational therapy program facilitators were interviewed about their experience of running the program and using these measurement tools. COPM occupational performance (p = 0.001) and COPM satisfaction (p = 0.004) scores indicated significant change at post-program whereas the LSP-16 total and subscale scores did not (p = 0.132 for total scores). Facilitator insights into the experience of implementing the living skills program and the perceived alignment of the COPM and LSP-16 with recovery-oriented practice are reported.

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.

Placement replacement: A conceptual framework for designing simulated clinical placement in occupational therapy.

Simulation is increasingly used to supplement clinical placement in preregistration health professional programs. However, there are no conceptual frameworks to guide the design of these learning experiences when replacing a clinical placement. In the present study, the conceptual framework for simulated clinical placements (CF-SCP) is presented. Evolving from an iterative process of synthesizing learning and simulation theory, findings from the empirical literature, and the perspectives and ideas from experts in occupational therapy practice, education and simulation-based learning, the CF-SCP aligns principles and processes of workplace and simulation learning. The application of the CF-SCP is described in the context of a 1 week full-time SCP. The CF-SCP provides a structure for organizing, understanding, and applying the principles and processes to design a simulated placement to be a "placement replacement" experience. Articulating a conceptual framework for the design of simulated placement experiences to replace actual clinical placement hours in the allied health sector is important if these experiences are to be tested for validity, efficacy, and transferability to a range of occupational therapy practice areas and other health disciplines.

Economic evaluation of simulated and traditional clinical placements in occupational therapy education.

INTRODUCTION: This economic evaluation complements results of the randomised controlled trial that established non-inferiority of the learning outcomes of a one-week simulated clinical placement (SCP) in occupational therapy qualifying degrees in comparison to an equivalent traditional clinical placement (TCP). This companion study presents detailed cost analyses of two placement alternatives and a cost-benefit study to assess the value for money of SCP. An economic evaluation of simulated versus traditional placements has not previously been conducted in Australia. METHODS: Nine SCP/TCP rounds were conducted by six Australian universities. Costs were collected using study-specific instruments. Public health sector costs were sourced from available literature. Willingness-to-pay for SCP/TCP was estimated using both a Discrete Choice Experiment and a Contingent Valuation method. These methods were employed to assess a comparative 'value' of SCP/TCP from the perspective of heads of occupational therapy departments (N = 28), who were asked to put a monetary value on the broader range of benefits associated with SCP/TCP. RESULTS: From the universities' perspective the average cost per student ranged from AUD$460 to AUD$1511 for simulated and AUD$144 to AUD$1112 for traditional placement. From the health care sector perspective, the difference in costs favoured simulated placements for four implementations and traditional placements for five. In the Discrete Choice Experiment respondents preferred traditional rather than simulated placement and would pay additional AUD$533. The estimated monetary value of simulated placements from a contingent valuation ranged from AUD$200 to AUD$1600. CONCLUSIONS: For universities that procure TCPs predominately at public health care facilities and sustain high administrative overheads, the SCP program could be a cost-saving alternative. From a broader value-for-money perspective, respondents favoured TCP over SCP, yet placed importance on placement availability and opportunity to demonstrate competence for students during the placement. Results should be interpreted with caution and further research with larger sample sizes is required.

Simulated versus traditional occupational therapy placements: A randomised controlled trial.

BACKGROUND/AIM: Professional practise placements in occupational therapy education are critical to ensuring graduate competence. Australian occupational therapy accreditation standards allow up to 200 of a mandated 1000 placement hours to include simulation-based learning. There is, however, minimal evidence about the effectiveness of simulation-based placements compared to traditional placements in occupational therapy. We evaluated whether occupational therapy students completing a 40 hour (one week block) Simulated Clinical Placement (SCP) attained non-inferior learning outcomes to students attending a 40 hour Traditional Clinical Placement (TCP). METHODS: A pragmatic, non-inferiority, assessor-blinded, multicentre, randomised controlled trial involving students from six Australian universities was conducted. Statistical power analysis estimated a required sample of 425. Concealed random allocation was undertaken with a 1:1 ratio within each university. Students were assigned to SCP or TCP in one of three settings: vocational rehabilitation, mental health or physical rehabilitation. SCP materials were developed, manualised and staff training provided. TCPs were in equivalent practice areas. Outcomes were assessed using a standardised examination, unit grades, the Student Practice Evaluation Form-Revised and student confidence survey. A generalised estimating equation approach was used to assess non-inferiority of the SCP to the TCP. RESULTS: Of 570 randomised students (84% female), 275 attended the SCP and 265 the TCP (n = 540, 94.7% retention). There were no significant differences between the TCP and SCP on (i) examination results (marginal mean difference 1.85, 95% CI: 0.46-3.24; P = 0.087); (ii) unit score (mean (SD) SCP: 71.9 (8.8), TCP: 70.34 (9.1); P = 0.066); or (iii) placement fail rate, assessed using the Student Practice Evaluation Form-Revised (100% passed both groups). CONCLUSION: Students can achieve equivalent learning outcomes in a 40 hour simulated placement to those achieved in a 40 hour traditional placement. These findings provide assurance to students, educators and professional accreditation bodies that simulation can be embedded in occupational therapy education with good effect.

Open letter to Minister Helen Morton.

This letter was sent to the Honourable Helen Morton by Emma Campbell after the Occupational Therapy Australia National Conference. A number of members of First Australian and Australian OTs online were keen to show their support for Emma's letter and share this with other OT colleagues.

Impact of the Learn to Play program on play, social competence and language for children aged 5-8 years who attend a specialist school.

INTRODUCTION: The aim of this study was to investigate the change in the relationship between play, language and social skills of children aged 5-8 years pre and post participation in the 'Learn to Play' program. The Learn to Play program is a child led play based intervention aimed at developing self-initiated pretend play skills in children. METHODS: All 19 participants attended a specialist school, with 10 of the 19 children having a diagnosis of autism. The play, language and social skills of the children were assessed at baseline and at follow up. Children were assessed using the Child-Initiated Pretend Play Assessment, the Preschool Language Scale and the Penn Interactive Peer Play Scale. Follow up data collection occurred after the children had been participating in the Learn to Play program for 1 hour twice a week for 6 months. RESULTS: After 6 months in the program, typical indicators of play accounted for an increase of 47.3% in shared variance with social interaction and an increase of 36% in shared variance for social connection. For language, object substitution ability accounted for 50% of the shared variance, which was an increase of 27% from baseline. CONCLUSION: The 'Learn to Play' program was associated with increases in children's language and social skills over a 6-month period within a special school setting, indicating the Learn to Play program is an effective intervention for children with developmental disabilities. This paper presents an example of how the Learn to Play program can be adapted into a classroom setting.

Effectiveness and cost-effectiveness of embedded simulation in occupational therapy clinical practice education: study protocol for a randomised controlled trial.

BACKGROUND: Clinical placements are a critical component of the training for health professionals such as occupational therapists. However, with growing student enrolments in professional education courses and workload pressures on practitioners, it is increasingly difficult to find sufficient, suitable placements that satisfy program accreditation requirements. The professional accrediting body for occupational therapy in Australia allows up to 200 of the mandatory 1000 clinical placement hours to be completed via simulation activities, but evidence of effectiveness and efficiency for student learning outcomes is lacking. Increasingly placement providers charge a fee to host students, leading educators to consider whether providing an internal program might be a feasible alternative for a portion of placement hours. Economic analysis of the incremental costs and benefits of providing a traditional versus simulated placement is required to inform decision-making. METHODS/DESIGN: This study is a pragmatic, non-inferiority, single-blind, multicentre, two-group randomised controlled trial (RCT) with an embedded economic analysis. The RCT will compare a block of 40 hours of simulated placement (intervention) with a 40-hour block of traditional placement (comparator), with a focus on student learning outcomes and delivery costs. Six universities will instigate the educational intervention within their respective occupational therapy courses, randomly assigning their cohort of students (1:1 allocation) to the simulated or traditional clinical placements. The primary outcome is achievement of professional behaviours (e.g. communication, clinical reasoning) as assessed by a post-placement written examination. Secondary outcomes include proportions passing the placement assessed using the Student Practice Evaluation Form-Revised, changes in student confidence pre-/post-placement, student and educator evaluation of the placement experience and cost-effectiveness of simulated versus traditional clinical placements. Comprehensive cost data will be collected for both the simulated and traditional placement programs at each site for economic evaluation. DISCUSSION: Use of simulation in health-related fields like occupational therapy is common, but these activities usually relate to brief opportunities for isolated skill development. The simulated clinical placement evaluated in this trial is less common because it encapsulates a 5-day block of integrated activities, designed and delivered in a manner intended to emulate best-practice placement experiences. The planned study is rare due to inclusion of an economic analysis that aims to provide valuable information about the relationship between costs and outcomes across participating sites. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12616001339448 . Registered 26 September 2016.

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.

An investigation of bilateral isokinematic training and neurodevelopmental therapy in improving use of the affected hand in children with hemiplegia.

Motor impairment in children with hemiplegic cerebral palsy leads to a predominance of use of the unaffected hand. This impedes development of bimanual skills and deprives the affected side of the stimulus needed for normal growth. Occupational therapists aim to improve use of the affected hand, traditionally using Neurodevelopmental Therapy. Empirical evidence is needed to support this treatment choice. Studies examining interlimb coupling in children with hemiplegia and other studies in adult stroke support a bilateral treatment approach. These single-case time-series experiments examined the effects of Neurodevelopmental Therapy and Bilateral Isokinematic Training on hand use in three children with hemiplegic cerebral palsy. Two of the three subjects displayed positive changes in use and movement of the affected hand in some tasks with Bilateral Isokinematic Training. Bilateral Isokinematic Training might be a potentially useful means of increasing frequency of use of the affected hand in some children with hemiplegic cerebral palsy.

Growing pains: a personal development program for students with intellectual and developmental disabilities in a specialist school.

A personal development program, entitled 'Growing Pains', was developed for 11-to 15-year-old students with intellectual and developmental disabilities in a specialist school. Seven topics were identified as important in supporting students through the physical and emotional changes of adolescence. A single-group, non-experimental outcome evaluation was conducted on a 20 week trial program. Teacher-developed checklists of observable skills were completed pre-and post-program for 68 participants yielding individual 'personal development' scores and whole group 'topic' scores, graphed to observe pre-post differences. Parents and teachers completed feedback questionnaires. Graphed data showed positive trends in individual personal development and most topic scores. The topic 'personal hygiene' showed almost no change across the group but parent and teacher feedback identified it as highly important. Causality cannot be established using this design; however, positive trends justified persisting with the program. Future studies might investigate effective means of teaching personal hygiene skills.