"If you want to work, let's work out how to make this happen": An interpretive description study of occupational therapists' perspectives of supporting young adults experiencing psychosis with their employment.

Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain?

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

Occupational Therapy Is a Vital Member of the Interprofessional Team-Based Approach for the Management of Rheumatoid Arthritis: Applying the 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis.

Introduction Evidence-based practice (EBP) is a global movement that fosters the use of research evidence, clinical expertise, the patient’s values and circumstances, and information from the practice context. It aims to support high quality practice through providing and using sound evidence for decision making, thereby enhancing the client’s outcomes. Occupational therapists have been challenged to advance the profession and adopt EBP as a global approach. Although EBP has been increasingly promoted and applied in occupational therapy over the last twenty years, there is a scarcity of research conducted in developing countries, and evidence-based occupational therapy is not yet a worldwide reality. Chile, a developing country graduating an increasing number of occupational therapists, provides a useful case for exploring EBP. The aim of this study was to investigate which sources of information are accessed by occupational therapists in Chile, and how knowledge is built and integrated in paediatric practice. Methods Interpretive description served as the methodological framework for this study. Ten Chilean occupational therapists, who had diverse demographic profiles and worked in a variety of paediatric settings, were recruited. Participants completed in-depth interviews regarding their decision-making in daily practice. Interviews were conducted in Spanish, transcribed verbatim in Spanish, and then translated into English. Data were rigorously coded and analyzed thematically. To enhance credibility of the data analysis, preliminary conceptualizations and interpretations were returned to the participants for their critical consideration. Feedback provided by participants strengthened the initial interpretations developed by the research team. Two main themes strongly emerged and pervaded across codes: factors that influenced decision-making and strategies used by Chilean occupational therapists to build their body of knowledge. Findings Chilean occupational therapists rely on intuition and clinical expertise when making decisions, regardless of the length of their professional experience. Cultural factors influence the passive role played by clients and their families. Participants face limited access to continuing professional development, research knowledge and information about contemporary occupational therapy practice. The limited development of research culture in Chile, lack of research training programs, limited awareness of the information available, and barriers such as lack of proficiency with the English language, could contribute to these findings. To build knowledge, occupational therapists use personal and professional networks, trusting in the available information, which has not always undergone quality evaluation. The professional training available strongly influences all aspects of their practice. Discussion Scarce access to research knowledge, precarious development of a research culture and lack of connection with the global scientific community can lead occupational therapists to rely on information that has not undergone quality evaluation. In Chile, the absence of regulatory bodies represent an additional risk to the profession , as there are no formal procedures to oversee the quality of professional practice, the standards of continuing professional development nor educational programs. Practitioners may benefit from developing a clinical reasoning framework based on evidence to guide their decision-making, in order to improve quality of practice and client outcomes. The establishment of a clinical reasoning framework based on evidence might be particularly relevant at this time, due to the increasing number of educational programs offering occupational therapy training in Chile. The status of the profession may be enhanced through empowering the professional association, to support high quality and updated professional training, promote research culture, and enhance the standards of practice among Chilean occupational therapists. Occupational therapists in developing countries could be encouraged to create scientific knowledge locally to contribute to the growth of occupational therapy globally. Conclusion The current climate in healthcare demands occupational therapists in Chile to align with the principles that have been guiding the global development of the profession, regarding the adoption of evidence-based practice and use of critical thinking. Multidimensional and systematic strategies could be implemented in relation to occupational therapists’ education, practice and research in Chile. Advancing the profession in this way will require powerful leadership, and occupational therapists who are strategically positioned to generate change. It will also demand the creation of international networks with key figures who are currently leading the development of occupational therapy around the world.

This paper summarizes the history of the development of Chinese mental health system; the current situation in the mental health field that China has to face in its effort to reform the system, including mental health burden, workforce and resources, as well as structural issues; the process of national mental health service reform, including how it was included into the national public health program, how it began as a training program and then became a treatment and intervention program, its unique training and capacity building model, and its outcomes and impacts; the barriers and challenges of the reform process; future suggestions for policy; and Chinese experiences as response to the international advocacy for the development of mental health.

2020 vision: promoting participation, mental health and wellbeing through occupational therapy - what are we doing and where are we heading?

Mental health has been an Australian national priority since 1996 with the health of Australians living in rural and remote regions needing particular attention (AIHW, 2014). Recent government initiatives such as the ‘Mental Health Services in Rural and Remote Areas’ (Commonwealth of Australia, 2015) identify allied health as an essential service and offer strategies to increase access. The needs are immense. Some factors influencing the mental health of rural and remote Australians are at a global level but with local impacts: climate change is proposed to relate to the increased number of natural disasters being experienced in rural areas including enduring droughts, and the increased occurrence of floods and cyclones. Changed international and national economic conditions also affect rural and remote communities. These factors place enormous stress on individuals and communities living outside urban areas and can put mental health at risk. High rates of suicide for young males living in remote Australia (Kolves, Milner, McKay & De Leo, 2012), substance abuse particularly involving alcohol and methamphetamine (Hodges, O'Brien & McGorry, 2007), and higher rates of mental illness for rural indigenous populations (Hunter, 2007) highlight the need for mental health services in these areas. But access to mental health services, particularly specialist services for rural people is extremely difficult – the rural mental health workforce is inadequate or absent and distances to the services that exist create cost and time barriers to care. There is a need to expand the Australian mental health workforce. The Australian occupational therapy profession must make rural mental health a high priority. The time is right. Mental health services in rural areas have been criticised as lacking capacity and vision to ensure high quality care, particularly for people with low prevalence disorders (Harris, 2005). There are also problems in recruitment and retention of allied health staff including occupational therapists to rural and remote areas. But many positive developments are underway and occupational therapists have much to offer rural people with mental health issues. The directive by the Commonwealth Government for mental health services to take a recovery-oriented approach (Australian Health Ministers Advisory Council, 2013), is an opportunity for occupational therapists. Recovery-oriented care compliments occupational therapy philosophy and frameworks. A recovery-oriented approach can transform mental health services as it requires them to be consumer centred (Shepherd, Boardman & Slade, 2008). Occupational therapists working with people with mental illness can instil a sense of hope of recovery and a focus on their strengths rather than the chronic symptoms of mental illness that impede occupational performance and participation. Assisting those with mental illness to return to productive and leisure occupations is an important aspect of recovery-oriented service provision. Apart from the tyranny of distance, and the additional time and cost this implies to access mental health services, people living in rural and remote areas also face additional barriers (Handley et al., 2014). These include: stigma, concerns relating to confidentiality and not wanting to be seen attending a mental health service. Rural community attitudes to coping and stoicism can also prevent people seeking help when services are present, particularly in early or preventative stages. There is a dearth of occupational therapists working in regional and rural mental health services. The role of mental health occupational therapy is not fully understood or appreciated in rural health services and usual rural workforce issues of low recruitment and poor retention are also evident (AIHW, 2014). To overcome workforce shortages, the following strategies are being implemented but could be expanded: Retention of mental health occupational therapists in rural settings also requires consideration. Support for early career occupational therapists through the provision of quality supervision and continuing professional development is often lacking in rural settings. While occupational therapists may take up generic mental health positions, similar to other professions such as psychology and social work, occupational therapists need discipline specific supervision and ongoing education. Occupational therapists should be confident and comfortable enough to request this no matter what their work setting is. The Australian Occupational Therapy Journal is doing its part to raise awareness of mental health as a practice and professional priority by releasing a themed special issue (Volume 62, Issue 5). This issue showcases research relating to mental health practice, and highlights the significant contribution occupational therapists make to the individuals, families and communities experiencing mental health issues. What part will you play?

Commemorative Editorial: The Legacy of Franklin Stein, PhD, OTR/L, FAOTA.

Young adults experiencing psychosis have the same plans for work and future careers as their peers; however, many find themselves unable to participate. While there is research available about interventions used to support employment of young adults with psychosis, there is little evidence regarding the experience of occupational therapists working in this field and the vocational rehabilitation interventions and practices they use. A descriptive qualitative study using semi-structured interviews was used to explore the perspectives of occupational therapy practitioners who support young adults experiencing psychosis with employment. Qualitative data analysis was guided by cross case inductive thematic analysis. This study did not include consumer and community involvement. There were nine participants, two male and seven females (average 14.7years mental health experience and age 39 years). All occupational therapists in this study were providing employment support interventions to young adults experiencing psychosis. These ranged from support with career exploration and job seeking to support with keeping and changing jobs. Thematic analysis generated five themes that characterised their experience including psychosis can make securing employment harder for young adults, young adults' pathways to work, and employment destinations of young adults. Finally, employment support interventions and strategies for young adults experiencing psychosis and the service system context-providers, problems, and possibilities for change were described. Young adults experiencing psychosis can miss out on the employment support they need when services are not accessible and evidence-based interventions, such as individual placement and support and early intervention, are not available. Occupational therapists prioritise employment when working with young adults experiencing psychosis. Occupational therapists with their person-centred, consumer-directed, and occupation-focussed approach can provide a range of employment support interventions to enable young adults experiencing psychosis to reach their work and career goals. Nine occupational therapists shared how they help young people with psychosis find jobs. Not having transport or work experience can make it hard for young people to work. The occupational therapists talked about how it can be hard to work when you have psychosis. They shared ways to find a job. They shared stories of young people finding their own jobs, starting their own companies or getting jobs from family and friends. Sometimes young people wanted help, and they were having trouble getting someone to help them. Occupational therapists were trying to help young people get a job if they asked for help. For example, they helped young people think about jobs they would like to do and helped them with job applications. Young people need all the services and people they work with to help them with finding and keeping their jobs.

Knowledge translation in the context of the Asia Pacific region.

Occupational therapists are an integral part of Australian mental health services. Recent changes in the mental health sector mean that increasing numbers of occupational therapists now work in generic, non-profession-specific roles in non-government organisations. Previous research has identified a range of challenges faced by occupational therapists in generic roles, including reduced satisfaction and loss of professional identity. An exploration of potentially positive aspects and strategies that assist occupational therapists to succeed and flourish within generic roles is lacking. The aim of this study was to explore what assists occupational therapists to thrive within generic roles in Australia's non-government mental health sector. Semi-structured, in-depth interviews were conducted with 12 occupational therapists working in generic mental health roles across three non-government organisations spanning three Australian states. Data were analysed thematically using constant comparative analysis. Thriving was supported in three domains. First, occupational therapists facilitated their own thriving by keeping their occupational therapy lens, and managing ambiguity. Second, workplaces were supportive when their values aligned with occupational therapy core values, they recognised and valued the occupational therapy contribution, and their roles allowed opportunities for therapists to use their profession-specific skills. Third, the broader occupational therapy profession assisted thriving through preparation, validation and ongoing inclusion. Despite some challenges, occupational therapists can and do thrive in generic non-government mental health roles. The preliminary framework of thriving provides valuable insights for those developing university curricula, those providing continuing professional development opportunities and for individual occupational therapists entering this expanding area of practice. Findings also provide insights into how individuals, academic curricula and the profession can respond and adapt to systemic transformations occurring in mental health service delivery.

Improving access to mental health services for youth and parents.

The Campaign for Mental Health Reform: a new advocacy partnership.

Young people’s Sexual and Reproductive Health (SRH) services in Nigeria are limited and there are issues of affordability and accessibility of these health services. Also, there are limited studies in Nigeria on the barriers to accessing and utilizing SRHS in the Nigerian healthcare sector. Furthermore, even when the services are provided they are not sensitive to the needs of young people. Hence, this study aims to assess the barriers to the availability and accessibility of sexual reproductive health services (SRHS) for young people living with sexually transmitted infections (STIs) in Abia State, Nigeria. Study Aim: To make recommendations for removing assess barriers to effective sexual and reproductive health services for young people living with STIs in southeast Nigeria. Methodology: A systematic review of 14 studies comprising 9 qualitative studies, 3 mixed methods, 1 quantitative and 1 cross-sectional study. The inclusion criteria were primary studies written in the English language which assessed barriers to SRH services while the exclusion criteria were the secondary studies and primary studies which did not access barriers to accessibility and availability of SRHS for young people. A total of 4, 705 participants from different African countries formed the sample size. Findings: Results showed that young people have little or no insight into STIs and their services. Moreover, they experienced different levels of barriers ranging from the negative and judgmental attitude of healthcare providers, stigma, cost, availability and accessibility of healthcare services as well as lack of integration of services and privacy and confidentiality. These are the major barriers that discourage young people from accessing SRH services. Also, experiences of fear and shame were reported as common barriers to utilizing care. Conclusion: Sensitizing the SRH needs of young people can enhance access to healthcare services. Therefore, there is a need to improve uptake and address the negative attitude of healthcare providers, as well as the issue of confidentiality, which will help to improve SRH service utilization among young people. Also, it is recommended that teaching health care professionals about these STI prevention centers will be the main solution to improve the preventive practice to reduce STI incidence in young people in Nigeria.

Background: There is an increasing trend of occupational therapists incorporating Dialectical Behaviour Therapy (DBT) in their interventions for Mental Health care Users (MHCUs). Despite its growing popularity, there is a paucity of literature describing how DBT is used within occupational therapy practice. Purpose: The study aimed to describe the current use of DBT-informed occupational therapy by South African occupational therapists working with clients with mental disorders. Method: Using a qualitative design, 17 semi-structured interviews were conducted with South African occupational therapy using the DBT approach in mental health practice. An inductive thematic analysis of the qualitative information generated in the interviews took place. Findings: Three themes emerged from the data analysis: (a) Potential challenges, (b) Why DBT? and (c) Training influences practice. Conclusion: The themes identified in the study highlight both the potential and challenges of incorporating DBT-informed approaches within occupational therapy, emphasising the need for further research in this area. Implications for Practice: It is recommended that occupational therapists who want to use DBT to inform their practice obtain a post-graduate DBT qualification. To remain within the scope of occupational therapy, the occupational therapist should focus their treatment plain on specific skills that the MHCUs need to participate in occupations that are meaningful to them. It is also very important that the occupational therapist communicate their treatment focus to other team members, to avoid confusion or overlap. The occupational therapist who implements the DBT approach should clinically reason from an occupational science approach. This would mean designing a client-centred treatment plan in a manner which is accessible to the MHCU, enabling specific skills that will meet the MHCU's occupational needs. Further research in the use of DBT in occupational therapy is needed.