Developing the occupational therapy practice in a local community health team working with adults with learning disabilities : an action research study

Abstract

Background This research study emerged from the on-going quest of a team of occupational therapists to demonstrate that a local occupational therapy practice: was meeting the needs of adults with learning disabilities; was effective and achieving the objectives of the employing organisation; and was complying with the expectations of the College of Occupational Therapists regarding evidence based practice. Purpose The purpose of this study was to seek and to generate evidence on which to evaluate and improve a local community based occupational therapy practice with adults with learning disabilities. Methods Action research methodology was used in which the local occupational therapists were engaged as co-researchers over three stages. Stage one: essential criteria for occupational therapy assessments for adults with learning disabilities were developed. No standardised assessments were identified that could meet all of these criteria. Stage two: perceptions of occupational therapy assessment were gathered from a sample group of adults with learning disabilities, their carers and other stakeholders. Stage three: changes were made to occupational therapy practice in response to the findings of stage two and in order to meet referral to treatment targets imposed by the employing organisation. Data were collected on the changes made to occupational therapy practice, and how they were implemented, through the use of action learning sets and questionnaires. The perceptions of a new sample of participants with learning disabilities and other relevant people involved, about the occupational therapy practice that they had received, were ascertained. Throughout the whole study, data were collected from multiple sources using interviews, questionnaires and co-researcher discussions and reflections. The primary method of data analysis was thematic, with some descriptive analysis. Data from different sources were triangulated to develop key findings. Findings The participants with learning disabilities were able to provide valuable insights about their perceptions of occupational therapy practice. There was evidence that occupational therapists provided occupation focussed assessments and interventions which had a positive effect on the occupational performance of adults with learning disabilities. The occupational therapists used professional reasoning in their assessments and interventions with adults with learning disabilities rather than a standardised, formulaic approach. This ensured a flexible, holistic and person-centred approach which worked in a dynamic community context. Occupational therapists, as a service, creatively adapted their practice in response to organisational demands whilst maintaining occupational therapy principles. Conclusions The practice-based evidence generated from this research study could be relevant and transferable for other occupational therapy services working with adults with learning disabilities and contributes to the occupational therapy body of evidence within this speciality.