Community Occupational Therapy Services Research Articles

Evaluation of an assessment model to reduce waitlist times for occupational therapy in a rural community health setting.

Community occupational therapy services have seen an increase in demand over the last three years, resulting in longer waitlist times for service provision, particularly in rural areas where it is difficult to recruit experienced occupational therapists. Utilising a demand management model, the Basic Assessment Model Pre-Screening Tool was developed by a team of Occupational Therapists and allied health assistants to decrease client waitlist times at one rural community health service. An evaluation of the implementation of an assessment model with comparison of quantitative data pre and post intervention. Rural Community Health Service in Victoria, Australia PARTICIPANTS: 456 clients that were registered as community-based clients requiring occupational therapy services. Following the implementation of the newly developed Basic Assessment Model the number of occupational therapy assessments increased and there was a decrease in the median wait time that clients were on the waitlist in comparison to pre implementation. There was a statistically significant decrease (p<0.001) in the median number of days spent on the waitlist for the post intervention group (80 days) compared to the pre intervention group (105 days). The results of this study suggest that waiting lists for community occupational therapy services can be reduced by implementing this basic assessment model ultimately improving the health outcomes of clients.

Proactive Community Occupational Therapy Service for Social Participation Development of Thai Adults with Depression: A Grounded Theory Study from Occupational Therapists' Perspective.

Introduction Depression in adulthood decreases social participation in the workplace, family, and community, which further results in decreased work performance and cessation and social isolation. There is a high statistic of outpatient consultation and readmission of Thais with depression, yet the mental health support for remission in community life and social participation remains limited and unclear. Further, due to the lack of mental health professional resources, particularly occupational therapists, there is much to be known regarding how such therapists work to support the development of social participation in Thai adults with depression. Objective This research was aimed at understanding the process of how occupational therapists work to redevelop the social participation of community-dwelling Thai adults with depression. Method The grounded theory methodology was used in this study. Data were collected through interviews and nonparticipatory observations of 14 participants who had experience providing mental health care in community services. The constant comparative analysis method was employed. Result Three concepts illustrated a proactive community occupational therapy service for depression (PCOTS-D), namely, integrating depression care in community occupational therapy service (COTS), supporting meaningful participation, and forming collaborative networks. The PCOTS-D supported the reconnection of social participation by leading from proactive depression care service to COTS and then working to support meaningful participation toward the patient's self-management and building collaborative networks with inter- and intraprofessional teams simultaneously. Conclusion The PCOTS-D presented a holistic view of working with community-dwelling Thai adults with depression by considering the importance of the community and researchers' network to redevelop social participation, promote health and recovery, build teams in depression care, and encourage research evidence to enhance the supportive advocacy policy for Thai people with depression.

Community-based participatory research remodelling occupational therapy to foster older adults' social participation.

Occupational therapists who provide community-based services are well positioned to foster older adults' social participation. However, community occupational therapists rarely address social participation and require support to change their practice. This study initiated a remodelling of community occupational therapy services by (a) selecting practices fostering older adults' social participation and (b) identifying factors that could affect their integration. A community-based participatory research study was conducted in a large Canadian city. Four focus group meetings and seven individual interviews were held with 28 key informants. A continuum of emerging practices was identified, including personalized, group-based, and community-based interventions. Potential enablers of these practices included clinical support, better communication, and user involvement. Organizational and systemic barriers were related to the institutional culture and performance indicators. These results point to innovative ways to foster older adults' social participation and identify potential enablers and barriers affecting their integration.

Community occupational therapy for people with dementia and their family carers: A national survey of United Kingdom occupational therapy practice

Introduction A national survey was conducted with United Kingdom (UK) occupational therapists to scope occupational therapy service provision for people with dementia and their family carers in the community. Method This was an online questionnaire with topics on occupational therapists’ roles, service provision, referral, assistive technology and assessment tools. Recruitment was through direct invitation, and promotion via occupational therapy networks, websites and newsletters. Results A total of 197 responded. Occupational therapy referrals most commonly came from the multidisciplinary team. Over half primarily undertook profession-specific work, with occupational therapy assessments the most common profession-specific task. Two-thirds of referrals for initial assessments were for people with mild-to-moderate dementia. A median of 2.5 hours for assessment/intervention was spent for each person with dementia. Almost two-thirds used the Model of Human Occupation Screening Tool. Most could prescribe personal activities of daily living equipment and Telecare, with few able to prescribe equipment for reminiscence or leisure. Conclusion This national survey increases knowledge of UK community occupational therapy practice and service provision for people with dementia and their family carers. It informs occupational therapists about national trends within this practice area, and development of the community occupational therapy intervention (COTiD-UK) as part of the Valuing Active Life in Dementia research programme.

Proving the Effectiveness of Community Occupational Therapy in the Equipment and Adaptation Setting Using the Canadian Occupational Performance Measure

The Community Occupational Therapy Service (Equipment and Adaptations) at Worcestershire Health and Care National Health Service Trust, Redditch and Bromsgrove Locality identified the need to find an outcome measure that would determine its effectiveness. The Canadian Occupational Performance Measure was chosen as a client-centred, reliable, and validated outcome measure that was integrated within existing paperwork. The process followed is outlined in this practice analysis. The service completed 1,869 Canadian Occupational Performance Measure scores, which showed a statistically significant increase in client ratings of performance and satisfaction in 90% of clients, illustrating the effectiveness of the service. The aim of this practice analysis is to explain the process that this service followed to integrate the Canadian Occupational Performance Measure into practice and, thus, share the benefit of using it as an outcome measure with colleagues who work in a similar setting. The authors highlight the importance of continuing with the Canadian Occupational Performance Measure and look to develop its use further.

Independent living centre occupational therapy (OT) versus routine community OT

Aim To determine whether the occupational therapy service from an independent living centre (ILC) was more or less effective than the routine community occupational therapy service. Methods This study is a pragmatic, pilot RCT, following a parallel group design where we randomized the participants to receive either occupational therapy (OT) services from the ILC (intervention) or routine community OT services (control). An automated randomization system allocated participants into one of the two groups. Intervention group participants usually received the intervention during a one-off visit to the centre of approximately 1.5 hours. Community OT assessments varied in length between 0.5 to 2 hours. The same researcher performed outcome assessments at 3 and 12 months after randomization, with one follow-up telephone contact and a further letter, if required. The primary outcome used to assess dependency was the Community Dependence Index (CDI). Secondary outcomes included a measure of quality of life, the EQ-5D. Results On average, the CDI increased (improved) at 3 months, for both the intervention group and control group, by two to three units on the CDI measure. This implies a small change in dependence were it to have been a real effect. Conclusion Our results found no difference between the two forms of care, but should be treated with caution due to the small sample size.

Exploring Wait List Prioritization and Management Strategies for Publicly Funded Ambulatory Rehabilitation Services in Ontario, Canada: Further Evidence of Barriers to Access for People with Chronic Disease

Timely access to publicly funded health services is a priority issue across the healthcare continuum in Canada. The purpose of this study was to examine wait list management strategies for publicly funded ambulatory rehabilitation services in Ontario, Canada. Ambulatory rehabilitation services were defined as community occupational therapy (OT) and physiotherapy (PT) services. A mailed self-administered questionnaire was sent to all 374 Ontario publicly funded sites. Descriptive statistics were used to explore management strategies. The response rate was 57.2%. Client acuity was the most common method used to prioritize access across all settings. The most frequently reported methods to manage wait lists included teaching self-management strategies (85.0%), implementing attendance policies (69.5%) and conducting wait list audits (67.3%). Ambulatory rehabilitation settings have implemented a number of strategies for wait list management. The results of this study suggest that an increasing number of Ontarians encounter barriers when accessing publicly funded ambulatory rehabilitation services.

Occupational Therapy in the Integrated Elderly and Community Support Services for the Elderly in Hong Kong

The Integrated Elderly and Community Support Service supported by the Social Welfare Department in Hong Kong has been in operation since November 2000. This paper is a brief review on the provision of community occupational therapy services for the elderly in Hong Kong and sheds light on their development in future.

Occupational Therapy in the Integrated Elderly and Community Support Services for the Elderly in Hong Kong

The Integrated Elderly and Community Support Service supported by the Social Welfare Department in Hong Kong has been in operation since November 2000. This paper is a brief review on the provision of community occupational therapy services for the elderly in Hong Kong and sheds light on their development in future.

Wait Times for Publicly Funded Outpatient and Community Physiotherapy and Occupational Therapy Services: Implications for the Increasing Number of Persons with Chronic Conditions in Ontario, Canada

Timely access to publicly funded health services has emerged as a priority policy issue across the continuum of care from hospitals to the home and community sector. The purpose of this study was to examine wait lists and wait times for publicly funded outpatient and community occupational therapy (OT) and physical therapy (PT) services. A mailed self-administered questionnaire was sent in December 2005 to all publicly funded sites across Ontario that deliver outpatient or community OT or PT services (N = 374). Descriptive statistics were used to describe the study sample and to examine wait lists and wait times by setting and client condition. Overall response rate was 57.2% (n = 214). More than 10,000 people were reported to be waiting for OT or PT services across Ontario. Of these, 16% (n = 1,664) were waiting for OT and 84% (n = 8,842) for PT. Of those waiting for OT, 59% had chronic conditions and half were waiting for home care rehabilitation services. Of those waiting for PT, 73% had chronic conditions and 81% were waiting at hospital outpatient departments. Individuals with chronic conditions experience excessive wait times for outpatient and community OT and PT services in Ontario, particularly if they are waiting for services in hospital outpatient departments.

Wait Times for Publicly Funded Outpatient and Community Physiotherapy and Occupational Therapy Services: Implications for the Increasing Number of Persons with Chronic Conditions in Ontario, Canada

Wait Times for Publicly Funded Outpatient and Community Physiotherapy and Occupational Therapy Services: Implications for the Increasing Number of Persons with Chronic Conditions in Ontario, Canada

Clients using community occupational therapy services: Sociodemographic factors and the occurrence of diseases and disabilities

Purpose: The aim of this study was to describe sociodemographic factors and the occurrence of diseases and disabilities among a representative sample of clients who were using community occupational therapy services in Norway. Method: A postal survey of occupational therapists about their last clients (n=168) was carried out in 2001. A survey questionnaire based on the International Classification of Functioning, Disability, and Health (ICF) was developed. Diagnoses were coded according to the International Classification of Primary Care (ICPC-2). Results: This study showed that more than half of the clients were adults, youths, or children. Only 17% of adults participated in “ordinary working life”, and of those approximately 10% were on sick leave and 62% were on disablement pension. A predominance of neurological diseases such as multiple sclerosis and Parkinson's disease was found (24%). Stroke was the most common principal diagnosis (19%). Musculoskeletal (16%) and mental diseases (13%) were also frequently reported. “Movement impairments” (96%) were most common in the body function component. Frequent problems in several domains of the activity and participation components were reported, in particular in “education, work and employment” (93–94%) and “recreation and leisure” (94%). Conclusion: Clients using community occupational therapy in Norway had numerous types of chronic and severe diseases, and a high occurrence of musculoskeletal impairment, activity limitations, and participation restrictions.

Home and Community Occupational Therapy for Children and Youth: A before and after Study

There has been an increased focus on home care service provision in recent years, yet there are few data available about the provision of home and community occupational therapy for children and youth. To evaluate key elements of a service provision model for home care occupational therapy in terms of occupational performance outcomes, perception of care and cost. Eleven centres in Ontario and Quebec recruited 167 children and youth up to 18 years of age to a before and after study of occupational therapy services in the home and community. Occupational performance, quality of life and costs were measured at baseline and study end. Perception of care was measured at study completion. A statistically and clinically significant improvement in occupational performance was demonstrated (p < 0.001). The clients' families gave high ratings to the process of care provided by the occupational therapists. These data did not demonstrate a clear relationship between amount of service, cost and occupational performance outcome. Children receiving home and community occupational therapy services change in their occupational performance abilities. These changes are not directly related to the amount or focus of the occupational therapy services.

Survey of Performance Standards of Community Occupational Therapy Service in Hong Kong

This survey was a profession-wide activity that aimed to collect information of different natures and in different formats from community occupational therapy (COT) practices in local settings. The objectives were: 1) to identify and define the scope of service in the practice of COT; 2) to identify common clinical procedures within each scope of service; 3) to document the quantitative standards of identifiable care episodes; and 4) to identify causes of the differences in performance standards, if any. The survery used a sequential case series design, which requires each participating therapist to complete questionnaires for five to 10 consecutive cases within a 3-month period. A total of 48 therapists from 17 centres registered as participants, and 95 survey forms were completed. Seven core service areas were defined as: screening, home modifications, prescription of aids, skills training, making of referrals, community care information, and arrangement of consultations. The processes and procedures were documented and evaluated against the 95 cases. From the findings, there was no correlation between the number of visits paid and the Barthel Index (BI) score of each patient. Nonetheless, the number of visits did correlate with the total number of problems identified ( p = 0.001). The average number of visits per subject was only 1.3. We found that variations in treatment content and time spent were small among therapists. A total average of 3.5 hours were spent for a consultation, with approximately 50% of the time spent at clients' homes. Detailed time standards for each service area are listed for reference.

Clinical Audit of the Outcome of Individualised Occupational Therapy Goals

To reflect on clinical effectiveness and revise practice to ensure quality of patient care, the Community Occupational Therapy Service in Leicester developed an individualised outcome measure and audit system. Audits were undertaken in 1997 and 1998 and the results showed a positive outcome in 88% and 90% of individual goals respectively. Improvements to practice achieved through auditing the outcomes of occupational therapy were increased patient involvement in goal setting, improved documentation and treatment planning and positive marketing of the service to general practitioners.

What Is Community-Based Rehabilitation: An Implication of the Roles of Community Occupational Therapists in Hong Kong

With a world-wide trend in de-institutionalization and community care, community-based rehabilitation is considered to be more cost-effective in covering the needs of persons with chronic illness and their families. Since the inauguration of Hospital Authority in 1990, the emphasis on creating a ‘seamless’ health care system had further reinforced the significance of the development of community-based rehabilitation services in Hong Kong. This also implied the demand for community occupational therapy services as well as the emerging roles of the community occupational therapists. In 1994, Community Rehabilitation Network (CRN) was established as a pioneer service operated on the basis of community-based rehabilitation and with the development of community occupational therapy services. This paper will first review the demand and importance of community-based rehabilitation services, especially for persons with chronic illness in Hong Kong. With an understanding of this background, this paper then describes the goals and scopes of service as well as future development of community occupational therapists, with reference to its specific role in Community Rehabilitation Network.

A Survey of NHS Community Occupational Therapy Services for Adult Physical Disability

This article presents the results of an informal survey to investigate the services that are provided for adults with a physical disability by community occupational therapists within the National Health Service (NHS). The findings include a brief history of the service, staffing, location, referring agencies and range of provision. Respondents' perceptions of the division of responsibility between NHS community occupational therapists and social services occupational therapists are highlighted. Information is also provided on the input of the community occupational therapist to day hospitals for elderly care and to student placement in the community. Finally, innovative schemes provided by community occupational therapists are listed.

Community Occupational Therapy Service

Community Occupational Therapy Service

Community Occupational Therapy: Past Dreams and New Visions

The traditional concept of community occupational therapy services, located in local authorities and developing to meet the needs of the broad range of social services' client groups, is being challenged by the NHS and community care reforms. This article reflects on past aspirations, considers emerging trends and invites community occupational therapists to participate more fully in developing the profession's views on its future.

PROVISION OF MEDICAL AND COMMUNITY SERVICES TO PEOPLE WITH SEVERE ARTHRITIS; AN AUDIT

We have identified severely disabled arthritics who live in the community through social service records. All had either rheumatoid arthritis (RA) or osteoarthritis (OA). The diagnosis influenced referral to hospital, those with RA being referred while only half of those with OA had been referred. Referral was important for both surgical and environmental intervention. Provision of social services and community occupational therapy services was greater if the patients had been seen in hospital departments irrespective of the diagnosis. Recipients of joint surgery had all gained temporary benefit although progression of arthritis or other disabling disease compromised this after several years. There was a substantial minority of people with severe OA living in the community who had not been considered for joint replacement and did not have optimal provision of aids, appliances and environmental adaptation.