Occupational Therapy Perspective Research Articles

Interoception and emotional regulation in autistic children through an occupational therapy perspective: A literature review

Understanding the interplay between interoception and emotional regulation is critical for advancing occupational therapy practices for autistic children and adolescents. These individuals often experience interoceptive processing difficulties, hindering emotional management, daily functioning, and societal participation. This review examines the relationship between interoception and emotional regulation and addresses relevant interventions to support these skills. To explore the relationship between interoception and emotional regulation and identify effective interventions that can inform occupational therapy practices for autistic individuals. A comprehensive search was conducted across three central electronic databases— PubMed, PsycINFO, and Google Scholar to identify studies that examined the relationship between interoception and emotional regulation in individuals with autism. Studies were conducted from 2013 to 2024. The search combined database-specific controlled language with keywords related to interoception, emotional regulation, occupational therapy, and autism spectrum disorder. A total of 49 studies meeting inclusion criteria were included. The review highlights the intricate connections between interoception and emotional regulation in autistic children, emphasizing challenges such as alexithymia and reduced interoceptive awareness. Interventions include cognitive behavioral therapy, mindfulness-based approaches, and specialized programs like the Aligning Dimensions of Interoceptive Experience and the Interoception Curriculum. These strategies can potentially enhance emotional well-being, self-regulation, and occupational engagement. Interoception and emotional regulation are foundational elements in the clinical reasoning of occupational therapists. Tailored, neurodiversity-affirmative interventions can promote emotional resilience and improve participation in daily activities for autistic individuals. Further research is necessary to develop inclusive and ethically aligned interventions that meet the needs of both clinicians and autistic people. This study underscores the significance of integrating interoceptive-based interventions into therapeutic practices to address emotional regulation challenges in autistic children, fostering their holistic development and societal inclusion.

Common Right Upper Limb Conditions and Treatment Strategies: A Physiotherapy and Occupational Therapy Perspective

Common Right Upper Limb Conditions and Treatment Strategies: A Physiotherapy and Occupational Therapy Perspective Abstract Introduction: Allied Health Professionals (AHPs) in the NHS often specialize in treating patients with conditions affecting specific anatomical regions. Physiotherapists (PTs) and Occupational Therapists (OTs) working in upper limb specialities have unique AHP perspectives on common conditions and treatment strategies. Purpose: This study explored the common right upper limb conditions and treatment strategies used by PTs and OTs working in upper limb specialities. Method: A qualitative design using semi-structured interviews with PTs and OTs was conducted. Thematic analysis was used to identify themes and sub-themes. Results: Four themes were identified: 1) Common Conditions 2) Treatment Strategies 3) Service Delivery Considerations and 4) Professional Differences. Discussion: Participants frequently treated patients with rotator cuff pathology, nerve entrapments, and post-operative trauma. Exercise was integral across most conditions and professional groupings, although OTs prioritised activities of daily living. This study adds to the understanding of common conditions treated and treatment strategies used by PTs and OTs. Further research is warranted to examine perspectives from other AHPs.

Impact of Long COVID symptoms on individuals in Hong Kong: Implications for occupational therapy practices

Introduction: From occupational therapy perspective, this study investigates the nature and impact of Long COVID symptoms on individuals in Hong Kong according to their gender, age, and occupation and to understand their treatment needs Method: A total of 193 participants with an acute COVID-19 episode 3 months ago and having recovered from it who were experiencing subjective symptoms of Long COVID were recruited through snowball sampling from local COVID-19 support groups and healthcare facilities to participate in a cross-sectional design via an online survey assessing their symptoms and the impact on daily activities, and exploring their treatment preferences. Findings: Respiratory, systemic, sleep, and cognitive symptoms were found to be the most prevalent, with significant variations in symptom severity and impact on daily life across different age and occupational status groups. The treatment preference was quite strongly inclined to traditional Chinese medicine. Conclusion: This study has uncovered the critical and yet recognized roles of occupational therapy in managing Long COVID impact by identifying the potential gaps of occupational therapy in its management and calling for advocating promotion in the community and interdisciplinary collaboration with traditional Chinese medicine. Implications about occupational therapy management and the healthcare policies for tailoring treatment programs are discussed.

‘It’s like someone is holding your hand, an invisible hand’: A grounded theory study of participation and personal recovery in Flexible Assertive Community Treatment

Background Participation in everyday life and personal recovery is often adversely affected for individuals with complex mental health needs. Flexible Assertive Community Treatment (FACT) is a recovery-oriented service targeting participation in everyday life and personal recovery and is thus important to understand from the perspectives of service users. Aim To explore how service users experience the care and support they receive from FACT as facilitating processes of participation in everyday life and in their personal recovery process. Materials and Methods A constructivist Grounded Theory approach was employed, involving 14 in-depth interviews conducted from January to November 2023 with FACT service users (9 women, 5 men; 23-55 years) within the Swedish adult general Mental Health Services. Results The process of Building genuine relationships between participants and FACT team members enabled Doing as a way of recovering. This was facilitated by how FACT was organised, promoting continuity and flexibility in care and support. Conclusions and significance This study contributes to a greater understanding of how genuine relationships between FACT service users and team members provide opportunities for participation and doing as a means for personal recovery. The results underscore the significance of incorporating an occupational therapy perspective into recovery-oriented services.

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.

Mobile Application Applied for Cognitive Rehabilitation: A Systematic Review.

The COVID-19 pandemic has increased the demand for home rehabilitation services, leading to the development and rising demand for cognitive rehabilitation apps. However, a comprehensive analysis of the content and effectiveness of these apps is needed. This study systematically reviewed and analyzed the literature on mobile apps for cognitive rehabilitation. One researcher and an external expert conducted the study selection, data extraction, and quality assessment following the PRISMA Checklist 2020 guidelines. Our review of 18 studies identified 8 randomized controlled trials (RCTs) (44.44%) of high quality and 10 non-RCT studies (55.56%) of moderate quality. Overall, 16 of the 18 studies (88.88%) demonstrated positive clinical implications for cognitive function after using cognitive rehabilitation apps. Eight studies showed a correlation between app use and improved cognitive function, and four highlighted the potential for cognitive function evaluation through apps. All studies employed various occupational therapy (OT) intervention approaches, with prevention being the most common (100%), followed by establishment and restoration (83.33%), maintenance (77.77%), and creation and promotion (38.88%). This study clinically validates the effectiveness of cognitive rehabilitation mobile applications from an occupational therapy perspective.

Long-Term Impact of an Occupational Therapy Intervention for Children With Challenges in Sensory Processing and Integration.

Research is limited regarding parent-caregiver perspectives of occupational therapy (OT) intervention for children with challenges in sensory processing and integration and whether changes immediately following OT intervention are sustained over time. To evaluate whether changes in identified goals are maintained following OT intervention and to determine what aspects of OT intervention parents-caregivers perceive to be most valuable. A mixed-methods research design. A large midwestern pediatric hospital, with follow-up telephone interviews with parents-caregivers. Sixteen children with sensory challenges and their parents-caregivers. Children participated in 1-hr OT intervention sessions, 3 days per wk, for 6 to 7 wk. Parents-caregivers of children who completed OT intervention were interviewed via the telephone 6 to 12 mo after the intervention. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were used to determine whether changes were made and sustained over time. Qualitative data on caregiver perceptions of OT intervention were collected via open-ended questions during phone interviews. COPM and GAS scores before intervention were statistically significant compared with scores immediately following intervention and at 6- to 12-mo follow-up. Five themes emerged from the qualitative data. Children with sensory challenges made significant changes related to occupational performance following OT intervention, and goal achievement was sustained over time. Parents-caregivers valued many aspects of the OT program, including the increased frequency of therapy services, the occupational therapist's advanced knowledge and skills, and the education and information provided during the program. Plain-Language Summary: This study supports the results of previous studies on OT intervention for children with challenges in sensory processing and integration. The study also adds to the body of knowledge that shows that changes and progress toward goals that result from skilled OT intervention can be sustained over time. The study showed that children participating in OT intervention made statistically significant changes while receiving OT services and maintained progress after intervention ended; however, the children did not continue to make significant progress toward goals once skilled OT services ended. Parents and caregivers of children with sensory challenges reported that they found OT intervention to be beneficial. Other important factors influencing the effectiveness of OT intervention that were identified by parents-caregivers included the education provided by the occupational therapist, the increased frequency of therapy services, and the increased knowledge and skills of the occupational therapists who provided the intervention.

Perspectives of Occupational Therapy Graduates on Sentinel Events During Transitions to Practice: A Phenomenographic Study

Perspectives of Occupational Therapy Graduates on Sentinel Events During Transitions to Practice: A Phenomenographic Study

The impact of a residential fire on occupational engagement and performance: A reflexive narrative approach

Residential fires are a devastating and stressful life event. The high number of residential fires per year and significant associated stressors impacts all aspects of daily life. This reflexive narrative approach highlights gaps in inpatient and outpatient burn care for those who have suffered a residential fire from an occupational therapy perspective. The findings show that healthcare professionals need to consider social support systems, use therapeutic listening, provide stress management techniques and be advocates throughout the recovery process.

Program to Support Child Sleep from the Occupational Therapy Perspective during the COVID-19 pandemic.

Introduction. Here we describe the interim results of the Program to Support Child Sleep from the Occupational Therapy Perspective (Programa de Acompañamiento al Sueño en la Infancia desde Terapia Ocupacional, PASITO) for children with neurodevelopmental disorders (NDDs) aged 3-10 years with insomnia, conducted between June 2020 and September 2021. Population and methods. Pre- and post-intervention quasi-experiment in an intervention group and a control group using the Sleep Habits Questionnaire (SHQ) and the Consensus Sleep Diary (CSD). Results. A total of 22 children with NDDs participated, 8 in the control group. The overall SHQ score for the intervention group improved (p < 0.001) from 54.9 (SD: 5.5) to 48.4 (SD: 4.5) and moved closer to the reference range of 42.6 (SD: 4.9). The CSD showed an increased sleep duration, earlier sleep onset, and fewer night wakings. Conclusion. These interim favorable results demonstrate that the PASITO may be a possible intervention to manage sleep problems in children with NDDs.

Perceptions of Hand Surgery Patients About Occupational Therapy

Occupational therapists provide holistic health care and social care and seek to promote health through occupation. This study measured how hand surgery patients who received referrals for occupational therapy perceive occupational therapy and occupational therapists. A cross-sectional online survey was designed to determine the meaning of an occupation, the role of occupational therapists, the services and benefits provided by occupational therapists, the populations served, and the work settings of occupational therapists. This study included 634 patients who responded to the survey (three-fourths were women). Most participants were uncertain about the professional environment of occupational therapists. Approximately one-third of the respondents believed that occupational therapists work at general hospitals. Most participants believed that occupational therapists manage orthopedic conditions and hand injuries; however, the least participants believed that occupational therapists manage cases involving cardiorespiratory conditions. No significant correlation was noted between the participants' overall awareness of occupational therapy and their sex or age. However, a notable statistical relationship was found between the comprehensive knowledge of occupational therapy and the educational level of the participants. To receive the benefits of occupational therapy, it is necessary for the population to be aware of those benefits. Patient perspectives of occupational therapy can help in patient's education and their treatment plan.

Designing and Implementing an Integrated Occupational Therapy Foundations Course: Occupational Science and Occupational Therapy Perspectives

Designing and Implementing an Integrated Occupational Therapy Foundations Course: Occupational Science and Occupational Therapy Perspectives

Sensory integration from an occupational therapy perspective

An analysis of Sensory Integration in the view of Occupational Therapy (OT) in Neonatal Intensive Care Units (NICUs), which is important for the development of newborn babies, considering the medical and surgical involvement, and the excessive sensory stimuli to which these babies are subjected at a stage when they should be in an intrauterine environment. Occupational Therapy (OT) is fundamental to Sensory Integration as it combines theoretical concepts, the needs of preterm babies, their families and the environment, with practice. An interview script was used to gather information about the units, and nine health professionals who worked in the area, or in pediatrics with premature babies, took part. It was found that there is a great shortage of professionals in the NICU teams, essentially in rehabilitation, and that OT is proving to be an asset in the rehabilitation process of this population.

Feasibility and Implementation Determinants of a Structured Goal Setting and Goal Management System.

There is no evidence-based system to guide occupational therapists in implementing theory-based, client-engaged goal setting and goal management. A new system is needed to support high-quality goal setting and goal management. To determine the acceptability, appropriateness, feasibility, credibility, and expectancy of a new structured theory-based, client-engaged goal setting and goal management system, called MyGoals, for occupational therapists. We explored MyGoals' implementation determinants, potential positive outcomes, and comparative advantages. This was a mixed-methods feasibility study. Community. Occupational therapists (N = 7). Acceptability, appropriateness, and feasibility were assessed using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Credibility and expectancy were assessed with the Credibility and Expectancy Questionnaire (CEQ). Semistructured 1:1 interviews were conducted to explore occupational therapy perspectives on MyGoals and its implementation-related factors. MyGoals had high AIM (M = 18.1, SD = 1.9), IAM (M = 17.9, SD = 2.2), FIM (M = 17.3, SD = 2.1) scores and high CEQ Credibility (M = 22.1, SD = 5.0) and Expectancy (M = 20.6, SD = 4.3) scores. Interview data revealed suggestions to improve MyGoals, implementation determinants across the individuals involved, inner setting, and intervention characteristic domains, client- and clinician-related potential positive outcomes, and comparative advantages. MyGoals is an acceptable, appropriate, feasible, credible, and promising system to guide occupational therapists in implementing theory-based, client-engaged goal setting and goal management for adults with chronic conditions in community-based rehabilitation. What This Article Adds: MyGoals is an easy-to-use, appealing, and helpful system to support occupational therapists in delivering theory-based goal setting and goal management components and to enable adults with chronic conditions to actively engage in their rehabilitation. This study supports the usefulness of MyGoals in community-based rehabilitation to improve goal setting and goal management quality and personally meaningful rehabilitation goal achievement in this population.

Return to work following traumatic brain injury: An exploration of using the Brannagan Executive Functions Assessment to increase self-awareness in practice

Aim and Background: The Brannagan Executive Functions Assessment is an occupation-based approach for increasing self-awareness. This study explores the application of the Brannagan Executive Functions Assessment in traumatic brain injury return to work intervention. It describes changes in self-awareness, goal achievement and perspectives of occupational therapy and people with brain injury. Methods: Case study design using a mixed-methods approach: with pre-post evaluation of outcomes and semi-structured interviews. Participants with traumatic brain injury completed the assessment with two occupational tasks related to return to work. Primary outcomes were self-awareness (Self-awareness Deficits Interview and Awareness Questionnaire) and Goal performance/satisfaction using the Canadian Occupational Performance Measure. Mood was a secondary outcome. Analysis was descriptive for quantitative data, thematic for qualitative data. Results: Two participants with brain injury, two support people and one occupational therapist were recruited. One participant with brain injury had an increase in self-awareness scores. Brain injury participants and the occupational therapist identified benefits including an increased awareness of needing to incorporate planning to meet goals. Conclusion: The Brannagan Executive Functions Assessment offers benefits to practice in brain injury rehabilitation, facilitating a structured occupational approach to self-awareness and participation in meaningful return to work tasks.

פרויקט שילוב טיפול באמצעות בובות לאנשים עם דמנציה בבית אבות - קידום מעורבות בפעילות משמעותית

Occupational therapy treatment for people with dementia in nursing homes faces two major issues: Coping with challenging behaviors, such as shouting and wandering, and finding activities residents can engage in over time. There is preliminary evidence that doll therapy can address these issues. The article describes a project, led by occupational therapists, of integrating doll therapy in a nursing home in Jerusalem. The project aimed to improve the quality of life of residents living with dementia by reducing challenging behaviors and encouraging engagement in meaningful activities. There were two phases to the project: A preparation phase during which the management was recruited to support the project and staff members were trained, and an execution phase during which the treatment was administered. The article provides guidelines for implementing the project in nursing homes. Our experience from this project suggests that the treatment resulted in a reduction in challenging behaviors. In addition, it improved communication and facilitated engagement in activities. As doll therapy might raise objections among staff and family members, it is imperative that the issue be addressed when this treatment is implemented as part of the implementation. In the discussion, we addressed the ethical issues related to the use of a doll as a mean of treating people living with dementia. In addition, we discussed possible explanations for the treatment's beneficial effects from an occupational therapy perspective. The importance of the project is in providing an additional tool for occupational therapists and nursing home staff that can also be used in cases of advanced dementia. Doll therapy is an accessible, affordable, and easy-to-implement method for improving quality of life for people living with dementia.

The Therapeutic Benefits of Hippotherapy: Occupational Therapy Perspective

Bu derleme makalede, Ergoterapi bakış açısı ile atların ritmik salınımları ve vücut sıcaklığının binicinin lökomotor ve duyusal faaliyetlerini etkilemesi esasına göre çalışan bir rehabilitasyon yaklaşımı olan hippoterapinin terapatik yararlarının ortaya konulması amaçlanmıştır. Son yıllarda hippoterapi ile ilgili yapılan araştırmaların çoğu, özellikle postür, denge, kuvvet, koordinasyon ve sensorimotor programlamayı içeren fiziksel engellere uygulanan rehabilitasyon faydaları üzerine olmuştur. Fiziksel hedeflere ulaşma sırasında hippoterapi uygulamalarının benzersiz yaklaşımı beraberinde sosyal, billişsel, akademik, davranışsal, psikolojik ve iletişim alanındaki sonuçları da etkilemektedir. Hippoterapi uygulamaları sırasındaki tedavi yaklaşımı çok yönlü olup, tüm vücut sistemlerinde olağanüstü etkiler göstermektedir. Hippoterapide doğru yöntem, doğru at ve profesyonel bir ekip ile birçok hastalığın tedavisi ve problemlerinin giderilmesinin mümkün olabileceği görülmektedir. Hippoterapi uygulamalarında profesyonel ekibin içerisinde yer alan Ergoterapistler sağlığı ve refahı aktiviteler yoluyla geliştirirler. Ergoterapistler günlük aktivitelerde motor kontrolü, koordinasyonu, dengeyi, dikkati, duyusal süreçleri ve performansı iyileştirmeyi hedeflemektedir. Bu hedeflerine atın ritmik ve dinamik hareketinden, dokusundan ve sıcaklığından yararlanarak ulaşırlar. Ülkemizde hippoterapinin önemi hekimler ve terapistler tarafından daha derinden anlaşıldıkça daha fazla hasta ve ailelerinin bu tedaviden fayda göreceği öngörülmektedir.

Impact of Burnout on Daily Activities from an Occupational Therapy Perspective: A Serial Mediation Model with the IDA Scale.

Burnout syndrome is one of the most frequent health complications among workers. Acknowledging the work perspective as something basic and essential in a person's life means that this disorder can have huge implications in their most basic daily activities. A cross-sectional, quantitative observational design was conducted with data from Spanish workers. A serial mediation model was applied to study the relationship between daily activities and burnout syndrome. For this purpose, the IDA scale was developed. The results show us that peoples' work situation has an impact on their daily life. There is quantitative evidence of the impact on daily life occupations and how it further decreases the levels of health and well-being of the person, on their independence and, consequently, on their quality of life.

P55 Work ready champions for young people: the role of occupational therapy in addressing the pre-vocational and early-employment needs of young people with long term health conditions

Introduction/BackgroundDeveloping a vocational identity is an important part of adolescent development and vocational morbidities have been recognized in young people with long term health conditions including rheumatic disease. Challenges in educational settings and/or workplaces have been reported by young people. Young people have also identified this area to be a research priority. Occupational Therapy (OT) is well placed to assume a lead role in this area, as it is the only health profession that has occupation at the core of its philosophy and practice.Description/MethodThe aim of this study was to explore the pre-vocational and early-employment needs of adolescents and young adults with long term health conditions from the perspectives of OTs and to examine their current and potential role in addressing these needs.MethodsA questionnaire was developed using Qualtrics software and piloted with two OTs and amended accordingly. A snowballing recruitment method via email and Twitter was employed. Initial contact was made via colleagues of the project team and cascaded to OT networks. Data included demographic, involvement in health care planning with education, perceived importance of addressing pre-vocational issues for young people, respondents’ knowledge and confidence, and the role of OT.Discussion/ResultsThe survey received 130 responses, of which 76 responses had complete data available (59%). A complete case analysis approach was taken. The majority of respondents were in clinical roles, primarily working in hospital or community settings and duration in practice ranged from 10 months to 40+ years. The perceived importance of addressing a wide range of vocational issues was consistently greater than the perceived knowledge and confidence of the professionals to address these. The majority of respondents (75%) perceived a need to address vocational issues for young people in their setting although only 22% reported that there was a designated member of their multidisciplinary team who would address these. The majority of such personnel identified by respondents were OTs but also included youth workers, education officer in the youth justice service, social worker.63% routinely assessed productive/vocational occupations such as employment/education. Half of respondents (51%) did not know where to signpost/refer young people for vocational/employment advice. The majority (92%) reported not having any training in addressing vocational/employment issues specifically for young people aged 10-24 years and only 20% reported training in this area with adults. The majority (70%) however did perceive a difference in providing such advice to young people compared to adults. The main perceived barrier to addressing this area in practice was limited clinical time.Key learning points/ConclusionThis study echoes previous calls for vocational issues to be addressed with young people with long-term health conditions and highlights the need for this to be addressed in both training and service provision.

Expanding Occupational Therapy Perspectives with Family Caregivers

Background. Family caregivers are ever-present and crucial collaborators in the work of occupational therapists but are rarely the focus of their efforts. Purpose. This lecture will discuss the greater inclusion of family caregivers in occupational therapy and the exciting possibilities that emerge from this change. Key issues. Family caregivers are a unique client population. This position statement is supported by recent research on occupational therapists’ values and shifts towards an occupational participation approach in the profession. Working with this client population requires a nuanced understanding of their experience. Caregiving can be burdensome, but it can also create positive effects many of which can be identified and understood through a relational lens. Implications. Through a three-fold approach, occupational therapists can work with caregivers to locate and mitigate negative caregiving effects, discover, and build on positive effects, and further develop positive outcomes by encouraging and balancing caregiving and non-caregiving occupations.