The VOTIS, part 1: development and pilot trial of a tool to assess students' interprofessional skill development using video-reflexive ethnography.

This paper explores the development and evaluation of the video Observation Tool for Interprofessional Skills (VOTIS). We describe the development of an authentic interprofessional assessment tool that incorporates video reflection and allows formative and summative assessment of individual learners' interprofessional skills within an authentic interprofessional context. We then investigate its validity and reliability. The VOTIS was developed using a modified Delphi technique. The tool was piloted with 61 students and 11 clinical educators who completed the VOTIS following team meetings where students interacted about their interprofessional clinical work. The following were calculated: internal consistency; students' proficiency levels; inter-rater reliability between students and clinical educators; and inter-rater reliability between clinical educators and an independent rater. Results indicate that the VOTIS has acceptable internal consistency and moderate reliability and has value in evaluating students' interprofessional skills. Study outcomes highlight the need for more explicit wording of tool content and instructions and further clinical educator training to increase the utility and reliability of the VOTIS as a learning and assessment tool.

The VOTIS, part 2: Using a video-reflexive assessment activity to foster dispositional learning in interprofessional education.

Effective interprofessional collaborative practice (IPCP) requires a new way of working characterized by distributed leadership skills, shared decision-making, and the adoption of uniprofessional and interprofessional identities. Health professional educators are tasked with preparing clinicians for IPCP through interprofessional education (IPE). Numerous IPE teaching interventions have been developed, ranging in length from hours to semesters, designed to introduce students to interprofessional ways of working - usually evaluated in terms of student satisfaction, perceptions of other disciplines and conceptual knowledge. However, working interprofessionally also requires integrating dispositional knowledge into one's emerging interprofessional habits and values. In this paper, we describe a learning activity, inspired by a new video-reflexive methodology, designed to foster dispositional learning of interprofessional skills using a video-based assessment tool: the Video Observation Tool for Interprofessional Skills (VOTIS). Based on focus group and interview data, we suggest the activity's usefulness in fostering conceptual, procedural and dispositional knowledge, as well as reflexive feedback literacy. Overall, our qualitative evaluation of the VOTIS suggests the merits of drawing on video-reflexive methodology and pedagogical theory to re-imagine IPE as a dynamic process, requiring the development of interprofessional skills that must be appropriated into students' emerging (inter)professional identities.

Assessments of Functional Cognition Used with Patients following Traumatic Brain Injury in Acute Care: A Survey of Australian Occupational Therapists.

This study aimed to describe how occupational therapists working in acute care settings in Australia assess cognitive function in patients with TBI, the influences on assessment choice, and clinician perceptions of performance-based assessment. An online survey was completed by 81 occupational therapists. The most common method of cognitive assessment was reported as non-standardized observation of functional tasks (94.7%), followed by carer-report / self-report (93%). Despite their being positive perceptions of performance-based assessment there was limited use in practice. Assessment use was impacted by practical and organizational constraints including access to assessment resources, time and the built environment in acute care.

Reflecting on culturally responsive goal achievement with indigenous clients using the Australian Therapy Outcome Measure for Indigenous Clients (ATOMIC).

INTRODUCTION: Appropriate evaluation of health services for First Australians demands culturally responsive goal setting tools that can be used by inter-professional teams. The Australian Therapy Outcome Measure for Indigenous Clients (ATOMIC) is a purpose-designed tool for measuring therapy outcomes for First Australians. The aim of this study was to establish the clinical utility of the ATOMIC by investigating its alignment with the practice perspectives of an inter-professional First Australian health service. METHODS: Using action research cycles, 12 occupational therapists and 8 speech pathologists applied two successive versions of the ATOMIC in practice. Focus group feedback after use of the first version (ATOMICv1) prompted adaptations to the tool (ATOMICv2). Therapists participated in four focus groups, two after using ATOMICv1 and two after using ATOMICv2. Focus group transcripts were analysed inductively using a qualitative description approach. RESULTS: Challenges in setting SMART goals early in therapy and defining specific measurement increments in ATOMICv1 led to therapists favouring skill-based goals that were easier to measure rather than broader daily life goals, thereby impacting on occupation- and client-centred practice. ATOMICv2 allowed goal setting at any point in therapy, evaluated goals using visual analogue scales, and gathered evidence for rating goal achievement throughout the therapy process. Therapists found the ATOMICv2 to be a culturally responsive tool that aligned with practice perspectives by foregrounding relationship building, facilitating clinical reasoning, documenting daily life changes, and providing integrated inter-professional care. CONCLUSION: The ATOMIC demonstrated good clinical utility in an inter-professional service for First Australian children. It aligned with a culturally responsive practice perspective and captured goal achievement in daily life contexts. Further research is needed to gain client perspectives across the lifespan and to investigate its application by other health professions.

Real gains: development of a tool to measure outcomes for urban First Australian children accessing culturally responsive interprofessional therapy.

Healthcare services are accountable to their clients, communities, governments and funding sources to clearly demonstrate the effectiveness of interventions. A First Australian children's therapy service delivering culturally responsive, interprofessional collaborative practice aimed to evaluate their service. However, this process was constrained by available outcome measures which lacked the flexibility necessary for meaningful use within the dynamic and relational nature of their service delivery. This paper outlines an action research process in three cycles which was used to develop the Australian Therapies Outcome Measure for Indigenous Clients (ATOMIC) with the aim of evaluating therapy outcomes for urban First Australian children engaged in culturally responsive interprofessional therapy. Interrater reliability values of 0.995 and 0.982 were established for ATOMIC pre- and post-therapy measures, respectively, during a pilot phase involving 16 participants. Participants in the main study were 80 First Australian children aged two to 16 years who attended between two and nine interprofessional therapy sessions with occupational therapists and speech pathologists. Pre- and post-therapy ATOMIC scores confirmed progress on pre-determined functional goals across a range of skill domains. Outcomes of this study demonstrated that real gains are being made in urban First Australian children's lives following interprofessional collaborative service provision.

Strategies occupational therapists use to engage children and parents in therapy sessions.

Occupational therapists implicitly rely on tacit knowledge to inform the strategies they use to engage children and parents in a therapy session. OBJECTIVE: To identify strategies occupational therapists use in a therapy session to engage children and parents. METHODS: A qualitative approach was employed using interpretive description methodology. This involved seven therapy session observations with six occupational therapists (involving child, parent and therapist) and a key informant interview with the therapist after each session. Thematic analysis was undertaken. RESULTS: Two themes emerged. (a) 'Engaging the child' included 'building a connection', 'attending to feelings', 'thoughts and behaviours', 'structuring or designing the session', 'giving choice and respecting their choice', 'use of self', 'helping the child feel success' and 'helping the child understand and explore'. (b) 'Engaging the parent' included 'connecting', 'listening', 'explaining', 'demonstrating anddiscussing', 'including the parent and valuing their input' and 'collaborating'. CONCLUSIONS: The strategies therapists used to engage children and families can be mapped with autonomy, relatedness- and competence-supportive strategies of Self-Determination Theory. Therapist attunement and responsiveness to the child as well as collaboration with the parent were strategies that represented all aspects of SDT.

New Graduates' Experiences in Paediatric Private Practice: Learning to Make Intervention Decisions.

Background. Challenges with clinical decision-making are common among new graduate occupational therapists. There is limited research exploring their experiences of learning to make intervention decisions. Purpose. To explore new graduates' experiences of learning to make intervention decisions in pediatric private practice. Method. A case study approach, involving a range of data sources, explored the experiences of 11 new graduates and three experienced occupational therapists working in Australian private practices. Data were analyzed using inductive thematic analysis. Findings. Themes pervading new graduates' decision-making experiences were: "being seen as capable and competent," "similar and familiar," and "specialist versus generalist positions." Contextual influences contributed to new graduates utilizing their support networks and personal experiences in addition to workplace supports. Implications. It is vital to balance private practice business demands with opportunities for new graduates to engage with experienced occupational therapists and professional communities of practice to assist their learning to make intervention decisions.

The Nature of Theory Used in Practice Education: A Scoping Review.

Background. Placements are key contexts for occupational therapy students to connect theoretical knowledge (theory) with practice. Theory relates to the prevailing ideas and concepts used by a profession. It can be derived within and outside the profession (discipline-specific knowledge and related knowledge, respectively). Purpose. This scoping review aimed to identify what is known about the nature of theoretical knowledge used in occupational therapy practice education. Method. A search of 4 electronic databases identified 19 relevant publications, data from which was extracted deductively. Findings. Inconsistent descriptions related to discipline-specific knowledge while related knowledge was often presented as not integrated with, or complementing, discipline-specific knowledge. Some authors referred to educational knowledge and methods informing student's theory use during placements. Implications. Educational methods need to provide a foundational platform, enabling novice learners to structure their thinking about ways discipline-specific and related knowledge can be used within an occupational framework on placement.

Facilitating student occupational therapists' mastery of occupation-centred approaches for working with children.

BACKGROUND: Student occupational therapists experience particular challenges in the learning and practicing of occupation-centred practice (OCP) techniques with children. PURPOSE: This study aimed to identify factors that facilitate mastery of OCP from both students' and practice educators' perspectives. METHODS: Nine student occupational therapists and two practice educators participated in three interviews at intervals across the students' fieldwork experiences. Observation and document review assisted data triangulation. FINDINGS: Students experienced distinct turning points in their understanding and use of OCP after encountering challenges and then experiencing success. Factors that assisted students' mastery of OCP included modelling and practice opportunities; individualised, performance-specific debriefing; specific learning and teaching styles; and structured learning tools for observation and reporting. IMPLICATIONS: Key quality teaching and learning practices can be used by practice educators and universities to promote mastery of OCP approaches. Further opportunities for practice and guided reflection on OCP are needed.

The Clinical Challenges Experienced by New Graduate Occupational Therapists: A Matrix Review.

BACKGROUND.: The transition from student to new graduate occupational therapist is recognized as stressful. Current literature has not specifically drawn together the challenges new graduates face when learning to work with clients. PURPOSE.: This review aimed to synthesize common challenges that new graduate occupational therapists face when working with clients. METHODS.: Searches of online scholarly databases located research articles. Content related to working with clients in practice was charted using the Matrix Method. FINDINGS.: From 21 articles, four categories of challenges were identified: "reasoning and decision-making," "using knowledge and skills in practice with clients," "the context of service provision," and "managing caseload and priorities." "Having self-doubt" was a theme that pervaded the data. IMPLICATIONS.: New graduates often do not feel fully prepared for all aspects of occupational therapy practice. As they may not have access to substantial workplace support, exploring personal resources and professional support may assist this challenging transition.

Information used by an expert paediatric occupational therapist when making clinical decisions.

BACKGROUND: Occupational therapists use a range of types and sources of information when making clinical decisions. It is unclear how this information is integrated. PURPOSE: This paper describes an exploratory qualitative case study that identified the types and sources of information accessed by one experienced paediatric therapist and how this information was combined and prioritised when making clinical decisions. METHODS: . Data were collected using observations of therapy sessions, key informant interviews, and semi-structured interviews. Data were analysed thematically. FINDINGS: To inform clinical decisions, the participant prioritised information about each child in his or her context when making decisions. Other types of information from text books and journals, professional development activities and professional and personal experience, expanded her unique body of knowledge over time. IMPLICATIONS: Re-conceptualisation of how information use supports clinical decision making and expands a therapist's unique body of knowledge over time can support client-centred practice in occupational therapy.

Occupational therapy students' experiences in learning occupation-centred approaches to working with children.

BACKGROUND: The increasing emphasis on performance outcomes and the use of occupation-centred approaches has implications for practice education. PURPOSE: This study aimed to describe students' experiences of learning to use occupation-centred approaches when working with children within a university clinic. METHODS: Nine occupational therapy students and two clinical educators completed three indepth interviews at intervals across the students' fieldwork experiences. Therapy observations, review of therapy documentation, and tutorial group e-mails informed data triangulation. Thematic analysis was used to identify key themes. FINDINGS: Students described needing to make a theoretical shift in thinking to focus on occupational performance and identified a number of challenges relating to learning complex techniques and strategies. IMPLICATIONS: Teaching methods that assist in making occupation-centred assessment and intervention techniques more explicit and learner-friendly for new users are required. These findings provide valuable new insights in guiding this process.

The Engaged Child in Occupational Therapy.

BACKGROUND.: Achieving optimal outcomes for children in occupational therapy settings is influenced, in part, by their engagement. The nature of child engagement from the occupational therapy perspective remains relatively unexplored. METHOD.: A qualitative research methodology was adopted, using an interpretive description approach. Thirty-two occupational therapists participated in five focus groups and six individual interviews that were thematically analyzed. FINDINGS.: Four themes emerged from the data: (i) signs of child engagement and disengagement; (ii) it's about the child feeling safe; (iii) a sense of meaning and purpose; and (iv) service and therapist factors influencing child engagement. IMPLICATIONS.: Helping the child feel safe; providing meaningful experiences; and being flexible and responsive were key means of connecting with, and supporting, child engagement. Strategies occupational therapists reportedly used to engage the child aligned with the tenets of self-determination theory (autonomy, relatedness, and competence).

Parent engagement and disengagement in paediatric settings: an occupational therapy perspective.

Purpose: This study aimed to understand parent engagement and disengagement in the delivery of occupational therapy to their children.Methods: This study used a qualitative interpretive description methodology. Focus groups and individual interviews were employed. Thirty-two occupational therapists participated in focusgroups or one-on-one interviews. Thematic analysis was used to analyse the data.Results: Thematic analysis of the data revealed two overarching themes which influenced parent engagement and disengagement in therapy: (1) Parent-therapist relationship and; (2) Therapist responsiveness. Within these two themes: parent feelings; time and timing of therapy; levels of engagement and factors influencing parent engagement were evident.Conclusions: Findings contribute to understanding parent engagement and disengagement in therapy. The findings extend current models of therapeutic engagement in occupational therapy informed by self-determination theory (SDT). Autonomy-, relatedness- and competence-supportive SDT strategies to enhance parent engagement in therapy are described.Implications for RehabilitationOccupational therapists reported that parents experience a range of feelings when engaged and disengaged in therapy. These feelings related to hopelessness, having confidence in the therapist and feeling supported, validated and empowered. Parent engagement and disengagement in therapy was described by occupational therapists as occurring at different levels: when it works well (engaged); engaged in the idea of therapy but not engaged in the doing of therapy (middle ground engagement); and when it doesn't work well (disengagement).Occupational therapists reported the importance of being aware of how the factor of time and family, service and therapist characteristics can variously impact parent engagement in therapy.Occupational therapists focus on the parent-therapist relationship and being responsive to parent needs and feelings when engaging parents in therapy.Occupational therapists can draw on principles from self-determination theory to guide them regarding the selection of strategies to engage parents in therapy.

Making interprofessional education real: a university clinic model.

Interprofessional education (IPE) is an emerging focus in the professional training of allied health students. To date, IPE has occurred in classroom teaching or case simulations, rather than in the provision of client services. At the University of Queensland, students in occupational therapy, speech pathology and music therapy participate in both on-campus and community-based IPE clinics conducted by university staff. These clinics are planned and implemented to promote interprofessional learning for students, and to provide integrated service provision for children and young people in the community. An adapted version of Bronstein's model of interdisciplinary collaboration is used to guide IPE processes, including team orientation, joint goal-setting and intervention planning, and integrated delivery of therapy sessions. The development and implementation of these IPE clinics is described, together with challenges to clinical IPE in the university context.