Occupational Therapy Approaches Research Articles

Characteristics of natural environment use by occupational therapists working in mental health care: a scoping review.

The objective of this review was to identify and characterize the use of the natural environment/outdoor space by occupational therapists working in mental health care. This included consideration of the characteristics of the environment used, interventions, mental health conditions being treated, and the outcomes being used. Research has demonstrated the link between human health and the environment. The benefits appear to be particularly relevant to people with mental health conditions. Occupational therapists already consider the environment when assessing and developing interventions, and therefore are well placed to consider and use the natural environment in mental health practice. However, the use of the natural environment by occupational therapists working in mental health is unclear. The scoping review included any publication relating to the use of the natural environment/outdoor space in mental health occupational therapy practice. All forms of the natural environment or outdoor space were included, such as hospital gardens and local parks. There were no geographical, gender, or age restrictions. All mental health diagnoses were eligible for inclusion. Seven databases were searched: Embase (Ovid), Emcare (Ovid), MEDLINE (Ovid), PsycINFO (ProQuest), AMED (Ovid), Trip Database, and CINAHL (EBSCOhost). Gray literature was also searched using a selection of websites and digital repositories. Papers written in English were searched, with no time limit set on publication. Titles and abstracts were screened by 2 independent reviewers for assessment against the inclusion criteria, followed by a full-text review and data extraction. Data were extracted using the data extraction tool developed by the authors. Findings were presented in a tabular format, accompanied by a narrative summary describing how the results relate to the review objectives and question. Of peer-reviewed publications, 7 papers used qualitative methods and 7 used mixed methodology. The remaining sources included conference abstracts, unpublished works, a book chapter, and a website article. The environments used included forests, beaches, gardens, and parks. A variety of interventions were delivered in these environments, including gardening and nature-based activities, physical activities, and animal-assisted interventions. Such activity-focused interventions are largely delivered in a group context, thus providing a social element. A diverse range of mental health conditions were treated. Several methods were used to consider the outcomes on the individual, including both qualitative measures and quantitative outcome measurement tools. The review highlights many characteristics of how the natural environment is being used across mental health services by occupational therapists. A variety of conditions are targeted for such interventions, and several outcome measures have been used to understand impact. This review can support further development and implementation of nature-based approaches in mental health occupational therapy.

The experiences of occupational therapists supporting children with self-regulation needs: A qualitative descriptive study.

Occupational therapists support children with self-regulation needs to engage in meaningful occupations at home, school, and in the community. However, little is known about how Australian practitioners perceive their role working with children with self-regulation needs in the Australian healthcare context. Therefore, we explored the contemporary practice experiences of Australian occupational therapists working with children 4-12 years referred for self-regulation support, to better understand elements constituting efficacious service delivery to enhance occupational engagement. A qualitative descriptive design, underpinned by constructivism and relativism, was implemented to address the research aim. Occupational therapists were recruited online to participate in audio-recorded focus groups and interviews. The audio recordings were anonymised, transcribed verbatim, and analysed through reflexive thematic analysis. No consumers were involved in the study design or analysis. Four themes were generated, encapsulating the experience of 13 occupational therapists working with children with self-regulation needs: (1) navigating the complexities of self-regulation, (2) intervening to support the child and surrounding systems, (3) bringing the occupational therapy perspective to the self-regulation puzzle, and (4) working within an evolving practice context. Themes 1-3 describe specific processes that all occurred within the context of Theme 4. Overall, participants detailed successful practice to support children with self-regulation needs to participate in meaningful occupations that required person-centredness, collaboration, coaching, and adaptability of therapists responding to different stakeholder demands. Self-regulation is a complex area of practice, and occupational therapists have a key role in supporting occupational engagement by balancing the child's needs with those of family, other stakeholders, and funding bodies. Findings support occupational therapists and decision-makers advocating for the unique role of occupational therapy in supporting self-regulation in childhood as part of a collaborative, multi-disciplinary approach. Specific consideration must also be given to ways that current funding schemes in Australia enable occupational therapy services for children with self-regulation needs. Controlling emotions and behaviours is sometimes called 'self-regulation'. Some children find this hard and need help from an occupational therapist, who knows a lot about the body and the systems within it. A lot of occupational therapists in Australia help children with their self-regulation. There is not much known about how these therapists see their role in working with these children. We wanted to understand what it is like for occupational therapists who help children, between 4 and 12 years old, with their self-regulation. We interviewed 13 occupational therapists from across Australia and analysed what they said. The data showed four main points: (1) understanding the challenges of self-regulation, (2) helping the child and their environment, (3) using an occupational therapy approach to solve self-regulation issues, and (4) working in a changing practice environment. The therapists described how important it is to focus on the child, work together with many people like caregivers and teachers, and being flexible. They talked about how they balance the needs of the child, family, and funding bodies, which could sometimes be tricky. The study shows the things that therapists are doing when working with children who need help with their self-regulation and the things that therapists find hard working in this space. The results of the study can be used by people who advocate for services that help children and by people who make decisions about Australia's healthcare. One way the study can be used is to think about how current funding schemes do or do not allow different people and professions to work together to support children's self-regulation. Even though there were some limitations, such as a low response rate due to the stress of the COVID-19 pandemic, we did interview therapists from different parts of Australia who work in different settings to each other.

Occupational Therapy Approaches in Supporting Students With Sensory Disorders in Islamic Education

Occupational Therapy Approaches in Supporting Students With Sensory Disorders in Islamic Education

‘Finding the play’ – exploring with occupational therapists practice possibilities in the context of Irish schoolyards

Background Research has identified diverse constraints to the adoption of school-based occupational therapy approaches and a lack of attention to addressing the barriers to children’s play opportunities. Critical contextualised research is advocated to inform practice possibilities. Aims/Objectives This inquiry aimed to explore with occupational therapists their existing practices in Irish schoolyards to generate practice possibilities concerned with play, as an issue of occupational justice. Materials and Methods Using the theory of practice architectures, six occupational therapists from diverse sites of practice participated in the first phase of a critical action research process using dialogical focus group and occupational mapping methods. Results Three themes were generated (1) Existing practices as situated (2) (Re)mattering play and practices as occupations and (3) Practice possibilities – ‘Finding the play’ between responsiveness and responsibilities. A further interrelated dimension was how the research methods provided mechanisms of raising consciousness. Conclusions, and Significance Alongside constructing knowledges on existing practices in an Irish context, this inquiry contributes to understandings of practices as socially embedded generative processes of ‘finding the play’, highlighting ethical responsibilities to make visible inequities reproduced in habitual practices and engage in relationships of solidarity to (re)construct alternative shared practices.

Acceptability and usability of assistive equipment and technology by individuals with multiple sclerosis: A qualitative study with occupational therapists

Introduction: Assistive equipment and technology (AE&T) is often part of occupational therapy practice for individuals with multiple sclerosis (MS). We aim to explore the acceptability and usability of AE&T by people with MS from the perspective of occupational therapists. Methods: Our study applied a qualitative descriptive design, using semi-structured interviews conducted with five qualified occupational therapists with at least 6 months of experience in providing occupational therapy to adults with MS. Reflexive thematic analysis was used for data analysis. Findings: Three developed themes describe the occupational therapists’ experiences: ‘The cognitive impact of the illness rather than the physical’, ‘There’s a drive to not let the MS win’ and ‘They have to experience it by doing’. Therapists perceive cognitive changes, the meaning of technology and a person-centred approach as elements influencing the acceptability and usability of AE&T. Conclusion: Our findings highlight the importance of using core occupational therapy principles and approaches to best support people with MS in using AE&T effectively.

Socio-Pedagogical Strategies in Occupational Therapy for Children with Autism and Learning Difficulties

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition with varying symptomatology that affects individuals throughout their lives. This paper explores the intersections of sociology, pedagogy interventions, and occupational therapy in addressing the needs of individuals with ASD. Sociological perspectives offer insights into social determinants of health, the construction of disability, and family dynamics, informing holistic interventions.Pedagogical strategies are focused on individualized approaches, multi-sensory techniques and social skills development to create inclusive learning environments. Occupational therapy interventions focus on functional skills development, promoting independence, and enhancing participation in daily activities. Collaborative efforts between professionals, educators, families, and individuals with ASD are essential for implementing effective interventions and promoting social inclusion. Future research directions include longitudinal studies, technology integration, and culturally responsive practices to optimize outcomes. By integrating sociological, pedagogical, and occupational therapy approaches, professionals can allow people with ASD to reach their full potential and lead fulfilling lives.

The potential role of occupational therapy in the treatment of avoidant/restrictive food intake disorder.

Most individuals with avoidant/restrictive food intake disorder (ARFID) never receive treatment, and treatment needs far exceed the current capacity of mental health services. Occupational therapy (OT) focuses on enhancing function in daily activities, including eating and feeding. Given OT's rich history in mental health and pediatric feeding disorder treatment, we spotlight the potential role of OT in ARFID treatment, current knowledge, and opportunities for future research. Through a preliminary exploratory inquiry involving a review of current literature and clinical practice, we investigated OT's current involvement, knowledge, and interprofessional collaborative practice gaps in ARFID treatment. While many occupational therapy practitioners (OTPs) engage in ARFID treatment, interventions lack rigorous evaluation, and there is limited evidence defining OT's distinct role in interprofessional ARFID treatment. OTPs are uniquely positioned to provide interventions for individuals with ARFID across the lifespan, though research is needed to evaluate the efficacy of OT interventions. Future research suggestions include standardizing OT approaches to ARFID treatment and conducting single-case experiments and randomized controlled trials to compare OT approaches with alternative methods. Recommendations to address practice gaps include enhancing ARFID education for OT students and practitioners and fostering a greater understanding of OT's role on the interprofessional team. PUBLIC SIGNIFICANCE: Individuals with ARFID face barriers to eating that impact their health and function. On a multidisciplinary team, OTPs can treat diverse client populations by identifying and addressing barriers to daily participation, such as physical impairments, trauma history, and environmental barriers. More research is needed to evaluate the efficacy of OT practices in ARFID treatment.

Energy Management Education in Persons with Long COVID-Related Fatigue: Insights from Focus Group Results on Occupational Therapy Approach.

Long COVID is a growing condition among individuals, with fatigue being one of the main symptoms experienced. Energy Management Education (EME) is a structured occupational therapy group intervention that aims to reduce the impact of fatigue in daily life. This study utilized focus groups to explore the experiences of individuals with post-COVID-related fatigue who participated in the EME program. Six participants engaged in discussions about the program immediately after its completion and again two months later. Additionally, five occupational therapists shared their experiences. Former participants reported implementing strategies learned in the program to manage their condition effectively. They emphasized the importance of understanding fatigue and found the support provided by the peer group valuable. Occupational therapists highlighted the unique challenges faced by individuals with post-COVID-related fatigue compared to other populations with similar fatigue symptoms. Furthermore, insights were obtained regarding the ways individuals live and cope with post-COVID-related fatigue. EME participants were involved in a dynamic and complex occupational therapy process and were experiencing a slow change towards having more control over their daily routines. The study gathered valuable feedback and suggestions from participants and occupational therapists which can be used to optimize the EME program.

Aproximações à sexualidade na infância a partir da terapia ocupacional

Abstract This article consists of a bibliographical review that aims to describe the different factors that influence the development of child sexuality to understand it from Occupational Therapy (OT). The problem raised addresses the invisibility of the natural and normative components of sexuality in early and second childhood and how OT approaches these factors in its intervention. To carry out this bibliographic search, various databases and journals of Occupational Therapy were used, in order to find texts that were related to the objective and proposed problem, which were filtered according to exclusion and inclusion criteria. From the results it is obtained that there is limited academic information regarding how the components of child sexuality are directly related to the areas of work of the OT. From the foregoing, it is concluded that the discipline is recently incorporating the approach to this issue and the urgent need to reconstruct the conceptualization of child sexuality is raised, from a base of children's rights, moving away from the hegemony of a heteronormative culture, and adult centric. The different factors that influence the development of child sexuality are considered, understanding it not only as an occupation but also as a fundamental part of occupational identity, whose components are bodily autonomy, socio-affective development, pleasure and enjoyment, gender and occupational choices, which would guide the occupational therapy approach.

Feasibility and efficacy of an early sensory-motor rehabilitation program on hand function in patients with stroke: a pilot, single-subject experimental design.

Hand and upper limb functional impairments following stroke lead to limitations in performing activities of daily living. We aimed to investigate feasibility and efficacy of an early sensory-motor rehabilitation program on hand and upper limb function in patients with acute stroke. A pilot, single-subject experimental, A-B-A study. Stroke unit of an educational hospital and an outpatient occupational therapy clinic. A convenience sample including five people with acute stroke. Participants received 3h of an intensive hand and upper limb sensory and motor rehabilitation program, 5days per week for 3months (15-min mental imagery, 15-min action observation, 30-min mirror therapy, 1.5-h constraint-induced movement therapy, and 30-min bilateral arm training). Activities were chosen based on the task-oriented occupational therapy approach. An assessor blinded to intervention program measured sensory and motor functions using action research arm test, box and block test, Semmes-Weinstein monofilaments, and upper extremity section of Fugl-Meyer assessment. Assessment data points in intervention and follow-up phases compared to baseline were in higher levels, sloped upwardly, and increased significantly for all participants in all outcome measures. The present pilot study showed that a package of nowadays evidence-based rehabilitation methods including mental imagery, action observation, mirror therapy, modified constraint-induced movement therapy, bilateral arm training, and task-oriented occupational therapy approach is able to improve sensory and motor functions of the hand and upper limb in patients with acute stroke.

Occupational therapy in the management of haemophilia patients: A scoping review.

Haemophilia is a haematological disease, although most haemorrhages occur in the locomotor system. Patients are physically disabled from an early age and have a poorer perception of quality of life. In the day-to-day lives of patients and their families, psychosocial well-being, the disease's physical, personal, and social impact, as well as work-related problems are the most complicated aspects of the disease that need to be addressed. To identify the role of occupational therapy in managing patients with haemophilia and to analyse the therapeutic potential of occupational therapy in treating these patients. A scoping review was conducted to identify the role of occupational therapy in managing patients with haemophilia and to analyse the therapeutic potential of occupational therapy in treating these patients. The review was registered in the international registry PROSPERO (Id: CRD42022319637). The databases consulted were SCOPUS, PubMed, PsycINFO, Web of Science and Science Direct, including all studies published until 14 August 2023. No single study was found that specifically developed an occupational therapy intervention for patients with haemophilia. Measurement instruments have been identified, specific for patients with haemophilia and generic, that can be useful for the functional evaluation of these patients in the occupational therapy approach. Different studies showed the importance of multidisciplinary treatment, including occupational therapy. The use of occupational therapy could be effective in improving autonomy and quality of life in haemophilia patients. Therefore, it is of paramount importance to conduct research studies within the field of occupational therapy.

Complementary Health Approaches and Integrative Health in Occupational Therapy.

This AOTA Position Statement describes the use of complementary and integrative health approaches in occupational therapy practice and presents ethical and pragmatic matters, including diversity, equity, inclusion, cultural humility, continuing competence, standards of practice, and supporting evidence.

발달장애인의 도전적 행동(Challenging Behavior) 완화를 위한 작업치료 중재에 대한 체계적 고찰

Objective: This study aimed to find the effects of occupational therapy (OT) as a way to alleviate challenging behaviors for persons with developmental disabilities. Methods: Literature published from January 2000 to July 2022 was searched in Pubmed, CINAHL, ERIC, Cochrane Library, EMBASE, and RISS. The search terms were “Behavioral disturbance” OR “Problem behavior” OR “Maladaptive behavior” OR “Aberrant behavior” OR “Behavioral abnormalities” OR “Challenging behavior” AND “Occupational therapy” AND “Developmental disability” OR “Autism” OR “Intellectual disability.” Both Korean and English were used. The searched literature was systematically analyzed according to the PICO format. Results: A total of 14 papers were selected for review. Sensory therapy, play therapy, and therapeutic mediation therapy approaches were shown to be effective in alleviating challenging behaviors, but demonstrated no improvements in other functions. A cognitive learning approach and a positive behavior support approach were effective in alleviating challenging behaviors and improving the school performance. In addition, parental education was effective in alleviating the challenging behaviors in children, although there was a limit in extending the therapeutic effects on improving their daily life functions. Conclusions: It was found that various OT approaches have been used to mediate challenging behaviors. Future research should highlight the generalized effects in daily life and school performance rather than emphasizing only the mitigation of challenging behaviors.

Chinese guidelines for the rehabilitation treatment of knee osteoarthritis: An CSPMR evidence-based practice guideline.

Knee osteoarthritis (KOA) is the most common degenerative joint disease in China, causing a huge economic burden on patients, families, and society. Standardized KOA rehabilitation treatment is an important means to prevent and treat the disease and promote the development of high-quality medical services. This guideline is updated on the basis of the 2016 and 2019 editions. Clinical questions regarding rehabilitation assessment and treatment were selected through clinical questions screening and deconstruction, and multiple rounds of Delphi questionnaire consultation. The International Classification of Functioning, Disability and Health (ICF) was used as the theoretical framework, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to grade the quality of evidence and recommendations. The reporting of this guideline followed the standard of Reporting Items for Practice Guidelines in Healthcare (RIGHT). Taking into account patients' preferences and values and the needs of Chinese clinical practice, a total of 11 clinical questions and 28 recommendations were established. The clinical questions were grouped into two categories: KOA assessment (body function, body structure, activity and participation, quality of life, and environmental factors and clinical outcomes assessment, resulting in 9 recommendations) and KOA treatment (health education, therapeutic exercise, therapeutic modalities, occupational therapy, assistive devices, and regenerative rehabilitation approaches, resulting in 19 recommendations). This is the first evidence-based guideline for KOA rehabilitation in China utilizing the ICF framework. This guideline provides key guidance for developing systematic, standardized, and precise rehabilitation protocols for KOA across various healthcare settings.

Occupational therapy approach in a specific case of extensor tenorrhaphy in zone VII

Introduction: Hand is an important structure for the performance of all Activities of Daily Living and for its perfect functioning it is necessary all its anatomical structures in complete harmony. Tendon injuries caused by agents such as glass and knives are very frequent in hand injuries and their sequelae generate incapacity for work performance and Activities of Daily Living. These are associated with lesions of the skin, nerves, and arteries. Anatomical knowledge of the hand is essential because lesions can progress to complex sequelae if not treated properly. Objective of the study: The objective of the present case study is to reflect on the intervention of Occupational Therapy in a hospital context with a patient submitted to tenorrhaphy of zone VII extensors, during a period of 13 consecutive weeks. Methods: It is intended to carry out a prospective case study of mixed analysis, in which a patient who performed OT at the Physical Medicine and Rehabilitation Service of the Centro Hospitalar Universitário do Algarve (CHUA) – Portimão Unit. Results: The treatment performed at the level of edema, scar, pain, muscle strength, range of motion and performance and satisfaction of the activities identified as significant by the patient, provided an improvement in the sensorimotor recovery of the extensors in zone VII of the hand with optimization of functional gains. Conclusion: The Occupational Therapy approach contributed to the patient's recovery, avoiding major complications and a faster and more favorable return to their usual activities. Although extensor tendon injuries are frequent, there is a lack of scientific evidence on the subject. Therefore, further studies in hand therapy, to validate the therapeutic techniques comparing the data with the existing ones, must be conducted.

Impact of occupational therapy on comprehensive care in pediatric oncology.

e22018 Background: Children with cancer can experience difficulties in performing and engaging in their usual activities and the families can also experience interruptions to their daily routines as well as family dynamics. Yet, current cancer rehabilitation tends to focus more on the aspect of bodily repair and functional restoration. This study intends to illustrate the impact of occupational therapy approaches that were identified to have positive influence on the children with cancer and their family. Methods: Three cases of children with brain tumor of age 1, 4 and 16 were reviewed and their caregivers were interviewed. Family education on disease progression, caregiver burden, unhealthy caregiving style, and activity participation facilitation, and coping strategies for the teenaged survivor were included in the regular occupational therapy sessions. Results: Of the three cases, two families of the younger clients who later deceased, reported being supported with the occupational therapy service from emotional support to facilitating activity participation. The other case was reported to have resumed activity participation both in the hospital and at home following a client-centered occupational therapy approach. Conclusions: Although it is important to facilitate functional restoration or preservation, it does not facilitate activity participation on children with cancer if psychological and/or contextual factors are not taken into consideration. It is equally important to meet children’s developmental needs and educate their caregiver/family to provide the proper care they need. Coping is required for both child survivor and their caregiver/family. Client-centered approach that is used in occupational therapy can provide comprehensive care to both children and their family in meeting the needs of the child and family and facilitating activity participation.

An Examination of Occupational Therapy Telehealth Service Delivery Among Novice Users During the COVID-19 Pandemic.

The COVID-19 pandemic allowed for widespread implementation of telehealth as a delivery method for occupational therapy (OT) services. The purpose of this study was to investigate the perceptions of novice telehealth OT practitioners regarding telehealth as a delivery method for OT services. Quantitative data was collected through a modified version of the Telehealth Usability Questionnaire and analyzed via descriptive statistics. Qualitative data was collected by open-ended questions and analyzed via thematic analysis. OT practitioners' responses revealed four major themes: logistics of telehealth practice, role of client champions, capacity of the OT practitioner, and styles and approaches. The study revealed that OT sessions delivered via telehealth increased access to clients and continuity of services. Client champion engagement, effective coaching strategies, and practitioner flexibility supported the success of OT telehealth sessions.

Evidence for Implementing Tiered Approaches in School-Based Occupational Therapy in Elementary Schools: A Scoping Review.

Internationally, it is suggested that school-based occupational therapy (SBOT) has an important role in supporting inclusion in educational settings. In SBOT, multitiered service delivery models are identified as a way forward to maximize school inclusion. Therefore, identifying evidence for the implementation of tiered interventions in SBOT is vital. To identify and map evidence in the occupational therapy literature relating to SBOT interventions delivered in elementary schools for all children, for those at risk, and for those with identified diagnoses. Peer-reviewed literature published in 14 occupational therapy journals between 1990 and 2020, indexed in the EBSCOhost database. Included studies were those within the scope of SBOT that reported on school occupations and focused on elementary school-age children (excluding kindergarteners or preschoolers). Forty studies met the criteria. Individual-tier intervention studies (n = 22) primarily reported direct interventions with children at risk or with identified diagnoses (Tier 2 or Tier 3), focusing mostly on remedial approaches. None adopted a whole-school approach. Despite handwriting and self-regulation being dominant areas of concern, these studies were not explicitly related to inclusion outcomes. Evidence for implementing multitiered models primarily used indirect, collaborative consultation, embedded in the school context (n = 18). These studies identified positive school staff and child outcomes when collaboration was timely, consistent, and authentic. More rigorous individual-tier intervention studies are required to inform the design and implementation of multitiered interventions in SBOT and to support participation and inclusion in schools. What This Article Adds: This scoping review provides evidence to support occupational therapists' professional reasoning in developing evidence-based, contextual, educationally relevant multitiered models of intervention in SBOT.

Children's Play-Work Occupation Continuum: Play-Based Occupational Therapy, Play Therapy and Playwork.

Introduction: Occupational therapists often use play-based approaches to facilitate children's occupational development and promote participation, for example, play-based occupational therapy, play therapy and playwork. However, where does play occupation fit, within these adult-guided play-based approaches in occupational therapy? Purpose: To examine and discuss the play-work occupation continuum of children to inform occupational therapy practice. Key Issues: Children's play occupations are free-selected, unstructured, internally-controlled, spontaneous and intrinsically-motivated. Yet, occupational therapists often utilize play as a therapeutic modality to support occupational development for occupations other than play. This use of play represents play-based work occupations as they are structured, externally-controlled, adult-guided, goal-focused and extrinsically-motivated. Play occupations then move from being authentic free-play to adult-guided play-based work occupations for children. Implications: When working with children and families, occupational therapists need to balance the use of self-selected, unstructured play occupations with the application of adult-guided, structured, goal-focused play-based work occupations.

Participant Outcomes and Facilitator Experiences Following a Community Living Skills Program for Adult Mental Health Consumers

Outcomes from participating in a six-week small-group living skills program, periodically implemented over two years with twelve adult mental health consumers, are reported as a case study. Occupational therapy and recovery-oriented approaches underpinned the development and implementation of the program thus it was important that outcome measures aligned with these perspectives. Data were gathered pre and post program using the Canadian Occupational Performance Measure (COPM) and the Life Skills Profile-16 (LSP-16) in each iteration of the program. Two occupational therapy program facilitators were interviewed about their experience of running the program and using these measurement tools. COPM occupational performance (p = 0.001) and COPM satisfaction (p = 0.004) scores indicated significant change at post-program whereas the LSP-16 total and subscale scores did not (p = 0.132 for total scores). Facilitator insights into the experience of implementing the living skills program and the perceived alignment of the COPM and LSP-16 with recovery-oriented practice are reported.