Community-based Occupational Therapy Research Articles

Developing a Referral Protocol for Community-Based Occupational Therapy Services in Taiwan: A Logistic Regression Analysis

Because resources for long-term care services are limited, timely and appropriate referral for rehabilitation services is critical for optimizing clients’ functions and successfully integrating them into the community. We investigated which client characteristics are most relevant in predicting Taiwan’s community-based occupational therapy (OT) service referral based on experts’ beliefs. Data were collected in face-to-face interviews using the Multidimensional Assessment Instrument (MDAI). Community-dwelling participants (n = 221) ≥ 18 years old who reported disabilities in the previous National Survey of Long-term Care Needs in Taiwan were enrolled. The standard for referral was the judgment and agreement of two experienced occupational therapists who reviewed the results of the MDAI. Logistic regressions and Generalized Additive Models were used for analysis. Two predictive models were proposed, one using basic activities of daily living (BADLs) and one using instrumental ADLs (IADLs). Dementia, psychiatric disorders, cognitive impairment, joint range-of-motion limitations, fear of falling, behavioral or emotional problems, expressive deficits (in the BADL-based model), and limitations in IADLs or BADLs were significantly correlated with the need for referral. Both models showed high area under the curve (AUC) values on receiver operating curve testing (AUC = 0.977 and 0.972, respectively). The probability of being referred for community OT services was calculated using the referral algorithm. The referral protocol facilitated communication between healthcare professionals to make appropriate decisions for OT referrals. The methods and findings should be useful for developing referral protocols for other long-term care services.

일본의 원격의료현황과 지역사회작업치료의 역할

일본의 원격의료현황과 지역사회작업치료의 역할

A goal-directed woodwork group for men in community rehabilitation--A pilot project.

Male clients who attend community rehabilitation programs often have low engagement in meaningful occupations and thus suffer a disconnect with their community. The primary aim of this mixed methods study was to explore the feasibility of using a therapeutic woodwork group to engage male clients in community rehabilitation. In the context of a community rehabilitation setting, fourteen clients attended an 8-week woodwork group to engage in meaningful projects developed with an occupational therapist to achieve specific goals. The group also aimed to encourage male peer support and interaction in an outpatient group setting. Clients identified three rehabilitation goals which guided their rehabilitation intervention. Goal achievement was rated pre- and post-group using the Goal Attainment Scale; one of two Quality of Life scales were administered to measure change in self-reported quality of life. Participants were interviewed pre- and post-group to measure woodwork experience and the group process. Results from the pilot project indicate that 85.7% of clients attained their expected level of goal achievement or higher on set rehabilitation goals. Consistent positive feedback was received from those who attended the group, particularly in the area of skill development and socialisation, although patients reported minimal changes in quality of life from baseline to end-of-group (P > 0.05). There remains an unmet need for meaningful engagement for men in the community who are not currently engaged in paid work. Community-based occupational therapy programs have the opportunity to play an important role in engaging clients in meaningful occupations, including woodwork, which was shown to increase socialisation and lead to goal attainment in our small sample. Future research should explore if rehabilitation woodwork groups can assist people to transition to participate in community-based Men's Sheds.

Predictors of Social Skills and Problem Behaviors in Homeless and Low-Income-Housed Preschool Children

Abstract Date Presented 4/16/2015 Low-income preschool child social skills/problem behaviors predicted by sensory processing, mother sense of competence, and housed/homeless status provide evidence for community-based occupational therapy practice models for early identification/intervention to enhance children’s social participation and learning.

Client-centred practice: Perspectives of persons with a traumatic brain injury

Background: Client-centred practice is well established as a core foundation of occupational therapy; however, there is little research evidence concerning the client experience. Objectives: To understand client-centred practice from the perspective of adults with a traumatic brain injury (TBI) participating in community-based occupational therapy. Methods: Six adults with a moderate–severe TBI participated in two semi-structured, qualitative interviews each. In total 12 interview transcripts and additional data were coded using constructivist grounded theory methods. Results: Data analysis produced three main themes and sub-themes: (i) Experiencing the client–therapist relationship: Seeing me as the person I was; Getting to know me in the now; Making a positive connection; (ii) Actively participating in therapy: Valuing the therapist; Being partners in therapy; and (iii) Finding my place in life: Adjusting to who I am now and Sharing my journey. Conclusion: The results present a framework for understanding client-centred practice as a person-centred process of engagement between the client and the therapist, as informed from the client perspective. Significance: Occupational therapists are encouraged to value and invest in the development of relationships with clients whilst the importance of seeking and integrating the client perspective into practice and research is affirmed for the profession.

Effectiveness of a training package for implementing a community-based occupational therapy program in dementia: a cluster randomized controlled trial

Objective: Evaluate the effectiveness of a training package to implement a community occupational therapy program for people with dementia and their caregiver (COTiD). Design: Cluster randomized controlled trial. Subjects: A total of 45 service units including 94 occupational therapists, 48 managers, 80 physicians, treating 71 client-caregiver couples. Interventions: Control intervention: A postgraduate course for occupational therapists only. Experimental intervention: A training package including the usual postgraduate course, additional training days, outreach visits, regional meetings, and access to a reporting system for occupational therapists. Physicians and managers received newsletters, had access to a website, and were approached by telephone. Main measures: Primary outcome: The intended adherence of therapists to the COTiD program. This was assessed using vignettes. Secondary outcomes: clients’ daily functioning, caregivers’ sense of competence, quality of life, and self-perceived performance of daily activities of both clients and caregivers. Between-group differences were assessed using multilevel analyses with therapist and intervention factors as covariates. Results: No significant between-group differences between baseline and 12 months were found for adherence (1.58, 95% CI −0.10 to 3.25), nor for any client or caregiver outcome. A higher number of coaching sessions and higher self-perceived knowledge of dementia at baseline positively correlated with adherence scores. In contrast, experiencing more support from occupational therapy colleagues or having conducted more COTiD treatments at baseline negatively affected adherence scores. Conclusion: The training package was not effective in increasing therapist adherence and client–caregiver outcomes. This study suggests that coaching sessions and increasing therapist knowledge on dementia positively affect adherence. Clinical trial number: NCT01117285

Client perception of a client-centered and occupation-based intervention for at-risk youth

Background: A community-based occupational therapy program aims to provide client-centered and occupation-based interventions to at-risk youth. Objective: This pilot study explores how at-risk youth experiencing psychosocial and environmental barriers to occupation respond to client-centered and occupation-based occupational therapy in the community. Method: One-on-one semi-structured interviews were conducted with five youth participants receiving individual therapy interventions through a community-based occupational therapy program. The transcript data were analyzed qualitatively. Results: Three themes emerged: (i) client-centered and occupation-based OT interventions, (ii) the youths’ increased self-advocacy, and (iii) the enhancement of youths’ perception of their future. Conclusion and significance: The youth in this study described OT interventions exemplifying client-centered and occupation-based therapy, a non-prescriptive approach that validates the individual and may prove especially effective in serving the at-risk youth population.

Three Case Studies of Community Occupational Therapy for Individuals with Human Immunodeficiency Virus

ABSTRACTThree case studies illustrate the complexities and opportunities in providing community-based occupational therapy services to persons with HIV. An infectious disease physician recommended three clients for therapy sessions in both the home and community. The Model of Human Occupation (MOHO) in conjunction with the Conceptual Framework for Therapeutic Occupation (CFTO) was used to guide the therapeutic process. Assessments measured challenges to clients and client progress in the following areas: leisure, mobility, organization, problem solving, community involvement, transitioning to independent living, fatigue, childcare/play, and home management. This paper describes the three cases with findings suggesting that community-based occupational therapy has potential to address important issues such as habits, roles, and volition in the HIV/AIDS population.

Investigating the experiences in a school‐based occupational therapy program to inform community‐based paediatric occupational therapy practice

A collaborative approach with teachers is required when providing community-based occupational therapy to educationally at risk children. Collaborators share common goals and interact and support each other but challenges arise in providing collaborative occupational therapy in settings outside the school environment. The aim of this study was to capture experiences of teachers and occupational therapists working within a school-based occupational therapy program to determine if their experiences could inform collaborative practice. In this pilot study, participant responses to questionnaires (n = 32) about their experiences formed the basis for focus groups and individual interviews. Two focus group were conducted, one with teachers (n = 11) and one with occupational therapy participants (n = 6). Individual interviews were conducted with the supervising occupational therapist, school principal and two leading teachers. Descriptive statistics were used to analyse the data from closed questions, and thematic analysis using a constant comparison approach was used to analyse open ended questions, focus groups and interviews. Three main themes emerged: (i) the need for occupational therapists to spend time in the school, to explain their role, build relationships, understand classroom routines and the teacher role; (ii) occupational therapists need to not see themselves as the expert but develop equal partnerships to set collaborative goals and (iii) occupational therapists advocating for all parties to be informed throughout the occupational therapy process. The pilot study findings identified teacher and therapist experiences within the school setting that could inform improved collaborative practice with teachers and community-based occupational therapists and these findings warrant further investigation.

Individual and Environmental Implications of Working Alliances in Occupational Therapy

Introduction: The therapeutic alliance is constituted of two predominant actors, the client and therapist, and is embedded within a rich environment that may both facilitate and restrict the alliance development. Method: A mixed-methods, prospective, multiple case study approach was used to compare the contextual characteristics and experiences of the working alliance over the course of a community-based occupational therapy intervention by four dyads, each composed of an occupational therapist and client. Findings: The findings of this study suggest that there are a variety of therapist, client, and environmental factors that interact with one another, each having a different impact on the process of alliance development. Conclusion: Although therapists must shoulder the responsibility of creating a therapeutic atmosphere conducive to sound working alliance development, there are also elements having an impact on the alliance that are outside the therapist's control. Although these findings point to development potentials for therapists to consider, related to the therapeutic use-of-self, there is also a need for vigilance in relation to career health in assuming responsibility for elements that therapists cannot always mediate.

Meeting the re-integration needs of individuals with spinal cord injury: Effectiveness of community-based occupational therapy

Meeting the re-integration needs of individuals with spinal cord injury: Effectiveness of community-based occupational therapy

Relocating to retirement living: An occupational perspective on successful transitions

Older adults are increasingly relocating to alternative housing options, such as retirement villages. Relocations can be stressful and these environmental transitions can cause significant disruption to the person-environment and occupational fit, thus influencing health, well-being and quality of life. There is a lack of literature from an occupational therapy perspective in relation to healthy older adults seeking to relocate. This study aimed to identify issues healthy older adults face when relocating to retirement living, what strategies they used during this process, how they maintained a sense of home, and the potential for occupational therapy involvement. Sixteen semi-structured, in-depth interviews were conducted with participants recruited from retirement living facilities across three stages of relocation; 'Decision', 'Early Days', and 'Established'. A grounded theory approach was used to code and analyse the data. Having control over the decisions surrounding relocation, being proactive rather than reactive and preparing sufficiently for the move all contributed to a positive post-location adjustment. Four main themes emerged from the narratives: timing of decision making, new beginnings, continuity, and strategies for change. This study contributes to literature surrounding how older adults occupy and make meaning of the spaces they call home and also enriches literature regarding environmental transitions. Relocation can be a disruptive process and occupational therapists are uniquely placed to facilitate healthy ageing throughout this transition using preventative and community-based occupational therapy.

Examining the Sensory Profiles of At-Risk Youth Participating in a Pre-employment Program

The purpose of this study is to use Dunn’s model of sensory processing to investigate the sensory profiles of youth participating in a community-based occupational therapy pre-employment program. The youth participants had been involved in the juvenile justice system and were placed on probation. The study analyzed data from the Adolescent/Adult Sensory Profile (AASP) questionnaires (Brown & Dunn, 2002) completed by 79 youth participants. Analysis of the participants’ scores on the AASP showed statistically significant differences from the norm in two quadrants; the delinquent youth scored lower in Sensation Seeking and higher in Sensation Avoiding. The delinquent youth participants demonstrated a high prevalence of atypical sensory processing patterns. Implications for further investigation and practice are discussed.

Voices of Community-Practicing Occupational Therapists: An Exploratory Study

ABSTRACTChanging health care delivery systems increasingly demand community-focused care; however, little research has been done exploring the experiences of the limited numbers of occupational therapists in community practice. Therefore, the purpose of this exploratory descriptive study was to better understand the challenges and rewards of community-based occupational therapy. Ten occupational therapists in varied practice settings were interviewed and the data were analyzed qualitatively. Findings suggest a need to understand the experience of community-based occupational therapists and to increase educational and professional support for this important practice area.

Community-Based Occupational Therapy Services for Children: A Quebec Survey on Service Delivery

ABSTRACT.Community-based occupational therapy (OT) services are intended to promote social integration and minimize disability. The objective of this study was to describe community-based OT services for children in the province of Quebec, Canada. Specific aims included (a) to determine the proportion of Centres Locaux de Services Communautaires (CLSCs) that provide OT services to children, (b) to describe the nature of the services offered, and (c) to identify factors that are associated with the availability of these services. Surveys were sent to all CLSCs where at least one OT was employed. The response rate was 80%. Only 12% of CLSCs offered OT services to children on a regular basis (≥ 1 day/week). Home adaptations were the most frequent service offered, whereas health promotion was rarely addressed. Perceived obstacles to servicing children included prioritization of services to the elderly, limited funding, and shortage of OTs. CLSCs in rural areas and those with a psychologist had significantly more dedicated OT time spent for services to children. The findings suggest that community-based OT services for children in Quebec are poorly developed, which may negatively impact upon timely access to specialized rehabilitation services and may increase activity limitations and family burden.

Qualitative Exploration of a Client-Centered, Goal-Directed Approach to Community-Based Occupational Therapy for Adults With Traumatic Brain Injury

We explored the clinical application of goal-directed therapy in community-based rehabilitation from the perspective of clients with traumatic brain injury (TBI), their significant others, and their treating occupational therapists. Twelve people with TBI and their significant others completed an outpatient, goal-directed, 12-week occupational therapy program. Semistructured interviews with 12 participants, 10 significant others, and 3 occupational therapists involved in delivering the therapy programs explored their experiences of goal-directed therapy. Participants, their significant others, and therapists described goal-directed therapy positively, expressing satisfaction with progress made. Goals provide structure, which facilitates participation in rehabilitation despite the presence of barriers, including reduced motivation and impaired self-awareness. A therapist-facilitated, structured, goal-setting process in which the client, therapist, and significant others work in partnership can enhance the process of goal setting and goal-directed rehabilitation in a community rehabilitation context.

Belonging to a community‐based football team: An ethnographic study

This study considered the benefits derived from participation in a community-based Australian Rules Football league in Melbourne, Australia. The RecLink league deliberately tackles the social and occupational disadvantages associated with mental illness, addictions, unemployment and homelessness. An ethnographic methodology was used to study one team from the RecLink football league throughout an entire season. Fieldnotes were written following participant observation at training, games and events, and five in-depth interviews were conducted and transcribed. A constant comparative approach to data analysis was adopted. Three major themes were identified: a spirit of inclusion, team-building and meaning of team involvement. The first describes how members were accepted, welcomed and given the opportunity for team involvement, with the expectation that they 'had a go', and 'tried their best'. The second illustrates how the team collectively fostered a culture of friendship, cooperation and support. The third examines the significance of being part of the team, incorporating personal contributions and gains, and meanings attributed to team involvement. These findings demonstrated how football can be used as non-clinical, community-based occupational therapy: enabling participation in a personally meaningful and culturally valued occupation. Occupational therapists are challenged to explore further how such community-based sports programs may complement existing clinical and welfare-based approaches to social disadvantage.

Community‐based occupational therapy improved daily functioning in people with dementia

The article presents a study on the effectiveness of community-based occupational therapy on the daily functioning of people with dementia in Australia. The study found that participants receiving the therapy had better outcomes than those who did not. In addition, caregivers for this therapy achieved higher competence scores than those in a control group. The study suggests outcome measures that may be sensitive and adaptable enough for clinical use for dementia patients and their caregivers.

A Pilot Randomized Controlled Trial of Community-Based Occupational Therapy in Late Stroke Rehabilitation

Chronic participation deficits are common following stroke. We hypothesized that a brief period of occupation-focused, client-centered occupational therapy would lead to improved participation in valued activities for individuals who had experienced strokes 6 or more months previously. Sixteen individuals were randomized to the intervention or no-treatment control group. All participants identified up to five activities in which they wished to improve. Following intervention, both groups rated their performance of these activities similarly. However, those who received the intervention rated their satisfaction with these activities significantly higher than did the participants who did not receive the occupational therapy intervention. There were no differences between postintervention measures of well-being or overall participation. Further evaluation of such a program of late stroke rehabilitation is recommended.

Community-based occupational therapy improved daily functioning in older patients with dementia

Community-based occupational therapy improved daily functioning in older patients with dementia