Therapist Perspectives Research Articles

A Mixed-Method Analysis on the Impacts of a System-Driven Implementation of Multiple Child Evidence-Based Practices on Community Mental Health Providers.

Initiatives to scale up evidence-based practices (EBPs) in routine care are likely to have myriad impacts on community providers, but these impacts have not yet been examined in depth. This is especially true within the context of simultaneous implementation of multiple evidence-based practices. The aim of this study was to characterize the multifaceted impacts on community mental health therapists within a system-driven implementation of multiple EBPs for youth and families. Semistructured interview and survey data were gathered from 60 therapists at 11 agencies contracted with the Los Angeles County Department of Mental Health to deliver EBPs within the Prevention and Early Intervention initiative. Therapists' accounts of impacts varied, and were either predominately negative, predominantly positive, or mixed-valence. Mixed-methods analyses using Kruskal-Wallis tests showed therapist valence groups varied on mean levels of self-reported burnout on surveys. Themes from qualitative data revealed several favorable (e.g., increased EBP knowledge, structure) and unfavorable (e.g., distress, feeling constrained by EBPs) impacts of county-contracted EBP implementation. These findings inform the development and implementation of future system-driven EBP initiatives that consider therapist perspective to optimize positive impacts and minimize negative impacts on therapists.

'The hand belongs to someone': a therapist perspective on patient compliance

Background : Compliance is considered to be a central element of effective health systems. In terms of rehabilitation, both nonattendance and non-compliance of patients with hand injuries in South Africa have been reported. This study explored how occupational therapists practicing in the field of hand therapy, understand compliance and its perceived barriers and supports. Methods : A qualitative descriptive research design was employed. Nine occupational therapists who routinely treat patients with have conditions were purposively sampled. In-depth interviews were conducted, transcribed and inductive thematic analysis undertaken. Result s: Therapists’ understanding of compliance demonstrated elements of consensus and difference. Four themes captured participants’ views of barriers and supports: compliance is enabled when a powerful collaboration exists between the client and the therapist. For this to be possible, the therapist needs to understand the life and times of an injured hand, co-constructing therapy on the foundation of understanding the patient as an occupational being. Powerful collaboration is further enabled by effective communication for collaboration, and lastly the characteristics of systems and services that work hold power to hinder or enhance compliance. Conclusio n: Results suggest that collaborative co-authoring of the hand rehabilitation process is central to enabling compliance. Therapists require a robust understanding of the person they are treating and the complex context in which the person participates. Accessible communication, effective education and enabling systems and services are also vital. Furthermore, the way in which occupational therapists conceptualise compliance matters. Critical reflection is necessary to interrogate the philosophical assumptions that underpin the terminology that occupational therapists choose and how power is navigated in relationships with patients with hand injuries. Key words : Hand therapy, adherence, shared decision making, low to middle income country

What educational strategies and mechanisms facilitate EBP use? A mixed methods examination of therapist perceptions within a system-driven implementation of multiple EBPs.

Many strategies may be used by external consultants (such as treatment developers and trainers) and internal program leaders to support evidence-based practice (EBP) implementation. The goal of this study was to identify which educational implementation strategies are considered by therapists to be most helpful, through which mechanisms, and whether these strategies are linked to EBP use. Semi-structured interviews were conducted with 60 therapists, and 826 therapists completed surveys regarding their perceptions of educational implementation strategies and reported delivery of EBPs within a system-driven, multiple-EBP implementation effort. Using sequential QUAL → QUAN mixed methods, we first identified qualitative themes. Next, we conducted a multilevel logistic regression to examine how quantitative survey items corresponding with qualitative themes predicted EBP use. Initial qualitative thematic analyses revealed four implementation strategies perceived as essential for EBP delivery: connection to a community of trained therapists, ongoing consultation/supervision, availability of internal supervisors trained in the EBP, and access to EBP materials and resources. Quantitative results showed strategies related to connections with a community of trained therapists (i.e., percentage of other therapists at an agency with EBP training and delivery experience as opposed to those who are only trained in the EBP), ongoing consultation/supervision, and having an internal supervisor trained in the EBP (receiving EBP-specific in-house supervision) were significantly associated with EBP use while receiving EBP boosters was not. The closest quantitative indicator corresponding to access to EBP resources, EBP web-based training, was not associated with EBP use. Therapist reported these strategies supported EBP delivery through exposure to other therapists' cases, guidance/feedback, emotional support, and removing logistic barriers to EBP use. These findings demonstrate how considering therapist perspectives and creating a network of EBP support via supervisors, consultants, and a community of therapists experienced in the EBP may be particularly critical to EBP delivery. Public mental health systems are increasingly implementing multiple evidence-based practices (EBPs). There are many strategies that may be used by external consultants (such as treatment developers and trainers) and internal program leaders to support EBP implementation. The goal of this study was to identify which of these internal and external implementation strategies are considered by therapists to be most helpful and how these strategies are linked with continued use of EBPs. First, qualitative interviews with therapists revealed the following strategies are key for supporting their delivery of EBPs: (1) connections to a community of trained therapists, (2) ongoing consultation/supervision, (3) having an internal supervisor at their program who was trained in the EBP, and (4) access to EBP materials and logistic resources. Next, quantitative analyses of survey data examined whether any of the strategies therapists identified as most helpful predicted the continued delivery of EBPs by therapists after initial training. Results confirmed that strategies involving connections with a community of therapists trained in and experienced with the EBP, ongoing consultation/supervision, and having an internal supervisor trained in the EBP were each significantly associated with EBP use. Therapist reported these strategies supported EBP delivery through exposure to other therapists' cases, guidance/feedback, emotional support, and removing logistic barriers to EBP use. These findings can assist systems and programs in prioritizing implementation strategies to support the sustained delivery of EBPs.

Supplemental Material for Determined to Improve: An Exploration of Therapist Perspectives About Their Development

Supplemental Material for Determined to Improve: An Exploration of Therapist Perspectives About Their Development

Beginning power mobility: parent and therapist perspectives

Purpose To explore parent and therapist experiences of early power mobility following participation in a Power Mobility Day – a 60–90 min play-based session where children with mobility limitations (<6 years of age) experienced four different early power mobility devices. Method Participants were purposefully selected from parents and therapists who took part in Power Mobility Days as part of a larger cross-sectional study. One semi-structured interview with each participant was conducted via telephone. Interviews were audio-recorded, transcribed, and analyzed using a content analysis approach. Results Of 35 adults approached, 11 parents and 11 occupational or physical therapists completed interviews averaging 20 min (range 10–45 min), one week to three months after the session. Participants were parents or therapists of children aged 12 to 48 months of age with a variety of neuromotor diagnoses from different areas of the province. The overarching theme Empowering Children and Families to Explore was developed from themes: Earlier Experiences; A Novel Introduction; and Moving Forward. Conclusion Power Mobility Days provided a welcoming and inclusive child- and family-led introduction to power mobility. This novel approach may help change both therapists’ and families’ perception of child potential and perspectives on power mobility as an intervention. IMPLICATIONS FOR REHABILITATION: Exploratory sessions can provide a novel introduction to power mobility interventions. Child enjoyment has a reciprocal impact on family engagement with early power mobility. Experiential child- and family-led learning can increase awareness of power mobility options and possibilities.

‘It’s just a different dimension’: Music therapists’ experiences of hearing loss

This study explores the lived experiences of qualified music therapists who identify as having hearing loss. The risk of hearing loss for professional musicians is widely acknowledged in literature, with one study demonstrating an increased risk of hearing loss for music therapists. No current literature, however, explores the experiences of hearing loss from the perspective of the music therapist, in a profession in which hearing and listening could be seen as central to the work. For this study, qualitative research methods were employed, involving semi-structured interviews with six music therapists experiencing different levels of hearing loss. Verbatim transcripts were then analysed, using interpretative phenomenological analysis (IPA), resulting in the identification of three principal themes across the data set: 1) Listening is exhausting: Identity as a music therapist with hearing loss; 2) Impatient or intrigued? Stigma versus support; and 3) How I manage: Strategies for coping. These themes are discussed in-depth, in light of existing theory and implications for practice. The analysis supports existing research demonstrating that acquired hearing loss does not impede musical ability. Barriers to proficiency arise from other areas. Implications are discussed, including recommendations for hearing-protection training within music therapy training programmes.

Usability Evaluation of a Distributed User Interface Application for Visuomotor Organization Assessment.

Background This article describes the development and evaluation of a distributed user interface (DUI) application to assess visuomotor organization ability. This application enables therapists to evaluate the acquired brain injury (ABI) on patients, and patients, to perform the assessment on a touch screen while therapists can observe the assessment process in real time on a separated monitor without interfering patients during the process as in traditional methodologies employing physical elements. Objectives The main goal of this research is the evaluation of the quality in use of DUIs in the Pegboard Construction assessment with patients with ABI from the therapist perspective in the area of occupational therapy. Methods To evaluate our system, we have performed a usability evaluation following the ISO/IEC 25010 and ISO/IEC 25062 standards to evaluate software usability and quality and it was conducted in collaboration with therapists and psychologists that have previously worked with people with ABI in diagnostic and assessment tasks. Results We show the results of the evaluation collected in a table that shows the completeness rate for each user for both, assisted (i.e., the percentage of tasks where participants performed with test director assistance) and unassisted tasks (i.e., the percentage of tasks where participants completed tasks autonomously), the total time participants required to complete proposed tasks, the number of mistakes participants performed during the session, and the number of assists they required to finish proposed tasks. In addition, we also evaluated the user satisfaction regarding our application using the system usability scale. Conclusion The use of information technologies in this field enables therapists to perform these evaluations in a simpler, efficient, and automated way. This proposal enables patients to perform the assessment as it is performed traditionally using paper providing them with a touch screen in which they can easily insert a set of pins into the holes. The usability evaluation of the proposal meets the appropriate design standards for applications of this type, and this is demonstrated by the high degree of satisfaction of the participants.

Проблема реабілітації осіб із сенсомоторною афазією внаслідок гострого порушення мозкового кровообігу з позиції фізичного терапевта

Мета. Розглянути проблему реабілітації осіб із сенсомоторою афазією внаслідок гострого порушення мозкового кровообігу з позиції фізичного терапевта. Методи. Теоретичний аналіз і узагальнення сучасних науково-методичних літературних даних про реабілітацію осіб із сенсомоторною афазією. Висновки. Наявність сенсомоторної афазії визначає прогноз щодо функціонального відновлення хворого після мозкового інсульту та суттєво впливає на тактику і стратегію ведення пацієнта. На сьогодні основним доведеним підходом в реабілітації таких пацієнтів залишається терапія мови та мовлення (логотерапія). Робіт, які б надавали обґрунтування саме особливостям фізичної терапії пацієнтів із сенсомоторною афазією внаслідок мозкового інсульту у доступній літературі не виявлено, проте наявні попередні дослідження, які свідчать про перспективність розвідок у напрямку виявлення найбільш ефективних стратегій застосування заходів фізичної терапії у пацієнтів із афазією.

Early Rehabilitation Following Saddle Pulmonary Embolism: Perspective From Physical Therapist as Patient

Purpose: Pulmonary embolism (PE) is a complication associated with the condition of deep vein thrombosis (DVT). Together, DVT and PE comprise the condition of venous thromboembolism (VTE). The presence of PE is a life-threatening acute complication, with the risk of death being 18-fold higher than that in patients with DVT alone. The long-term effects of VTE may influence a patient's ability to maintain appropriate levels of physical activity, resulting in impaired functional mobility, quality of life, and overall health and wellness. Physical therapists frequently work with patients who are at risk for or have a history of VTE across all practice settings and are often responsible for mobilizing patients after VTE. However, little guidance exists regarding optimal timing for initiation and intensity of treatment to combat the negative sequalae associated with PE. Methods: This case report describes the experience of a physical therapist who suffered an unprovoked submassive saddle PE. Results: The patient self-initiated and self-administered an exercise program with successful outcomes. The case provides a unique perspective of a physical therapist who used his clinical knowledge to make decisions, while experiencing the event through the lens of a patient. Conclusion: Evidence is provided to support the role of early physical therapy–directed progressive mobility to maximize long-term outcomes following PE.

Outpatient Orthopedic Rehabilitation in New York State During the COVID-19 Pandemic: Therapist Perspectives.

The COVID-19 pandemic has had a strong impact on the care of orthopedic patients. This impact has been particularly difficult in New York State, which experienced the largest number of COVID-19 cases and led to a state- mandated pause on all elective surgeries. As a result, physical and occupational therapists became the principal providers of care and had to adjust their workflow to ensure quality care. Understanding the perspectives and needs of therapists relative to the circumstances created by COVID-19 is critical to safe and effective care. The goal of this study was to define the perspectives of therapists in New York State regarding the impact of COVID-19 on their work. An email-based 20-question survey was distributed to 250 therapists from all 10 regions of New York State who treated outpatient orthopedic patients during the peak of the pandemic in early April 2020. The survey collected demographic and practice information as well as responses regarding several clinical practice issues. The results provide insight into the concerns of therapists regarding the delivery of care, and responses clarify indications for therapy and for the use of telemedicine to achieve goals during the pandemic. The COVID-19 pandemic is profoundly impacting the work of therapists worldwide. Therapists responded to this survey expressing concerns about the safe delivery of care, access to personal protective equipment, use of telemedicine, and their role within health care during the pandemic. The results of this study can be used to establish guidelines for safe, effective, and efficient therapy during the pandemic. [Orthopedics. 2020;43(5):292-294.].

Gaps Between Parent and Therapist Perspectives on Family-Centered Care as a Factor of Service Setting

Abstract Date Presented 03/27/20 The purpose of this study was to evaluate gaps between parent and provider perceptions of the family-centeredness of services, and the contribution of the service setting (outpatient versus schools) to these gaps. Findings indicated significant gaps between parents and providers, and between practice settings, in all assessed domains. These gaps suggest areas of opportunity for OTs to enhance their practice in order to foster more effective partnerships with parents. Primary Author and Speaker: Liat Gafni Lachter Additional Authors and Speakers: Shaimaa AlSaaed Contributing Authors: Ayelet Ben-Sasson

Prioritising Patient’s Safety in Hospital, Home and Outdoor Premises by Minimising Architectural Barriers: A Physical Therapist Perspective

Physical therapy is a branch of science which treats patients by means of physical agents to reduce their sufferings from impairments and disabilities. It processes cost efficient mode of treatments which help to reduce the unwarranted burden on patient’s personal economy to a vast extent. Hence, it is improvised to improve the overall quality of life. Physical therapy is been in existence since World War II. Over the decades, extensive research led to advancement in assessment and therapeutic intervention to take Physical therapy to its current stature. In this article, the author would like to concentrate on a single parameter which should significantly be given prior most importance while assessing and rehabilitating a patient. These are addressed as “Safety measures”. Safety concern for patient from the moment of stepping in for consultation to return to his personal premises should be prioritised as they play a vital role in developing positive mental setup which improves psychological wellbeing leading to early disbursement of disability.

Implications of Physical Therapy to Aid Weight Loss in Individual Suffering from Obesity: A Physical Therapist Perspective

Obesity is referred when Body Mass Index of an individual is greater than 30. Making it clearer, individuals with Body Mass Index between 25 to 30 are termed ‘overweight’ while more than 30 are ‘obese’1 . Till recent years, obesity was considered to be a problematic condition restricted only to developed countries2 . But, over the course of time with negligence towards dietary habits and lack of physical activity, obesity also started to entrap population of developing countries. India is no exception to it. As per latest statistics, Obesity has emerged as a crucial health problem among Indian population of varied age groups (children, adolescent, middle aged and elderly). Obesity are treated by implementation of therapies via a multi-disciplinary team consisting of Physician, Endocrinologist, Dieticians/Nutritionist, Physical Therapist/Physiotherapist, Psychiatrist/ Psychologist while in severe Obesity, surgery is usually advised.

Fortalezas de carácter en pacientes adultos en tratamiento psicoterapéutico

La investigacion que se informa tuvo como objetivos: 1) estudiar las 24 fortalezas de caracter en pacientes adultos que se encuentran en diferentes etapas de un tratamiento cognitivo conductual psicoterapeutico naturalista; y 2) analizar la relacion de las fortalezas con algunas del progreso durante el tratamiento, la alianza terapeutica y la adherencia al tratamiento desde la perspectiva del terapeuta. Se conto con una muestra intencional de 85 pacientes adultos de ambos sexos en tratamiento psicoterapeutico ambulatorio y sus respectivos terapeutas. Se utilizaron: una hoja de datos demograficos y del tratamiento, el Inventario de Fortalezas y Virtudes y una encuesta de opinion para el terapeuta. Los resultados mostraron que los pacientes en la etapa final presentan una mayor fortaleza de Autorregulacion. Los pacientes con depresion presentaban menores fortalezas de apertura mental y capacidad de perdonar, en comparacion con pacientes con trastornos de ansiedad y con trastornos comorbidos ansioso-depresivos. Aquellos pacientes que habian tenido un tratamiento psiquiatrico previo presentaban menores niveles de la fortaleza persistencia. Un mayor tiempo de tratamiento se asocio con mayores niveles de las fortalezas Liderazgo y curiosidad, en tanto que un mayor malestar psicologico se vinculo con una disminucion de una alta cantidad de fortalezas. La fortaleza espiritualidad se hallo significativamente asociada al progreso en el tratamiento segun su terapeuta. Una mayor apertura mental se hallo vinculada a mayor adherencia a horarios, sugerencias y mejor vinculo terapeutico segun la opinion del terapeuta. El estudio del funcionamiento positivo en pacientes permitira enriquecer la psicologia clinica para convertirse en una disciplina mas integradora.

Exploring therapeutic applications for Google Earth VR

Virtual reality (VR) is a technology frequently used for both recreation and healthcare service delivery. Yet, little is known about the applicability and use of specific VR applications in recreational therapy (RT) practice. Google Earth VR is a popular application that allows users to virtually travel to different locations around the world. It could have relevance in patient-centered treatment that addresses a variety of RT treatment goals. Using a focus group of RTs (N = 8), this study examined possible uses of Google Earth VR in RT treatment. Following an education and training session providing an overview of VR equipment and the Google Earth VR application, participants engaged in clinical role play from both a therapist and client perspective. This was followed by a focus group discussion where therapists were asked to identify possible treatment uses for Google Earth VR with the clients they serve. Four main themes emerged, including reminiscing, community integration/leisure education, social skills development, and distraction/pain management. Findings indicate RTs view Google Earth VR as a resource with potential therapeutic applications for new and innovative treatment. The identified treatment focus areas also provide guidance for professional resource development and future research studies.

Processes of Change in Psychotherapy for Narcissistic Personality Disorder.

The present study aims at determining the role for outcome of potential processes of change in psychotherapy for narcissistic personality disorder (NPD). They were examined on three levels: the content, the process, and the relationship. A total of 161 patients suffering with NPD were recruited in a naturalistic setting as part of the present study. They underwent a long- term clarification-oriented psychotherapy. Sessions 15, 20, and 25 were video- or audio-recorded and analyzed with an observer-rated instrument that measures the quality of the interaction processes from the patient's and therapist's perspectives. Different self-report measures were used to assess therapy outcomes. In-session improvement was observed in both patient and therapist processes across sessions. Patient improvement in the three levels of processes was systematically related with outcome. Only partial relationships were found between therapist improvement and outcome. The present study represents the first systematic insight into core changes in patients with NPD undergoing psychotherapy.

The Therapeutic Waiting Room: Therapist and Service User Perspectives on the Psychologically Supportive Dimensions of Architectural Space.

Waiting areas in healthcare settings play an important role in reassuring or potentially further distressing service users. The effects of the designed environment on mental health service users specifically are regarded by health professionals as having a considerable influence on treatment outcomes, experiences, and perceptions of care. The purpose of this article is to explore service user and practicing therapist perspectives of waiting areas in mental health service settings and how the design of these spaces affects anxiety levels, comfort, therapeutic relationships, outcomes, and perceptions of care. The methodology for this exploratory phenomenological study was developed in order to preserve the integrity of participant voices in the essences of experiences, during explorations of their encounters with therapeutic waiting areas. Fieldwork undertaken by the author involved a series of focused in-depth interviews with service users of mental health services and practicing therapists, counselors, and psychologists. Key themes identified through data analysis include (1) space acting as symbolism, (2) interpersonal relations which are threatening, and (3) sensory modulation. Design implications in relation to each theme are presented. This study uncovered a set of findings in relation to symbolic content inferred by spatial design aspects and the ways in which design can afford, or mitigate, development of interpersonal agencies, psychological safety, and negative stigmas. Future transdisciplinary research directions are suggested, including (1) examination of other relationships, beyond the service user-therapist dyad, which may influence waiting area experiences and (2) examination of the applicability of design suggestions to different contexts.

Establishing and measuring treatment fidelity of a complex cognitive rehabilitation intervention: The multicontext approach

Introduction This article describes the process of establishing and measuring treatment fidelity of a complex cognitive rehabilitation intervention that uses a metacognitive strategy framework (the multicontext approach). We adapted treatment guidelines for use within an inpatient rehabilitation setting for people with acquired brain injury; explored training methods and therapist perspectives; developed and examined inter-rater reliability of a fidelity measure; and examined adherence to and proficiency of treatment methods. Method Therapist perspectives of the intervention and training were obtained from written questionnaires and reflections. Inter-rater reliability of 21 treatment components across 22 video-recorded treatment sessions was assessed by examining absolute agreement between two raters using Cohen’s kappa. The proportion of treatment components implemented in individual sessions as well as average proficiency ratings was calculated. Results The fidelity measure demonstrated good inter-rater agreement, ranging from 91–100% for treatment adherence and kappa of .77 to .94 for therapist proficiency. Adherence and proficiency varied between therapists but increased to nearly proficient levels with adjustments to training and procedures. Therapists highlighted the critical importance of video review as a training tool. Conclusion The fidelity measure provides a clinical tool for therapist self-reflection, supervision and training, as well as a tool for future research.

The Emotional Competence of Mothers and the Clinical Quality of Mother-Child Relationship in a Preschool Psychiatric Population

The Emotional Competence of Mothers and the Clinical Quality of Mother-Child Relationship in a Preschool Psychiatric Population The quality of mother-child interaction and relationship is an essential risk factor for the development of mental disorders at preschool age. We examine maternal emotional competence and maternal level of psychopathology as predictors for the quality of mother-child relationship. At the beginning of their treatment a clinical sample of mother-child-dyads at the Child Psychiatric Family Day Hospital in Münster was assessed concerning the emotional competence of mothers (EKF), the maternal psychopathology (SCL) and the mother-child relationship quality, the latter with three different instruments reflecting the mother's, the child's and the therapist's perspective (PIR-GAS, SKEI, M-PCR). The mothers showed decreased results in the EKF scales emotional regulation, recognition of emotions and in the EKF-overall-score and presented a higher level of maternal psychopathology compared to the normal population. There is a direct relation between emotional regulation and the M-PCR scales affective bond and functional-conflict. Besides the direct influence of the maternal psychopathology, the expected moderator effect of emotional expressiveness and the M-PCR scale functional-conflict, reported by mothers, was apparent. Certain aspects of the emotional competence of mothers and their psychopathology show an influence on mother-child relationship quality. The method and the perspective of assessment are crucial to the results.

A meta-analysis of client-therapist perspectives on the therapeutic alliance: Examining the moderating role of type of measurement and diagnosis.

Clients and therapists often have different perspectives on their therapeutic alliance (TA), affecting the process and outcome of therapy. The aim of the present meta-analysis was to assess the mean differences between clients' and therapists' estimations of TA among clients with severe disturbances, while focusing on two potential moderators: client diagnosis and alliance instrument. We conducted a systematic literature search of studies examining both client perspective and therapist perspective on TA in psychotherapy among people with schizophrenia spectrum disorders, personality disorders, and substance misuse disorders. We then analyzed the data using a random-effects meta-analytic model with Cohen's d standardized mean effect size. Heterogeneity analyses (k=22, Cohen's d=-.46, 95% confidence interval=.31-1.1) produced a significant Q-statistic (Q=94.96) and indicated high heterogeneity, suggesting that moderator analyses were appropriate. Our findings show that the type of TA instrument moderates the agreement on TA between client and therapist, but there was no indication of the client's diagnosis moderating the effect. The agreement between client and therapist estimations seems to be dependent on the instrument that is used to assess TA. Specific setting-related instruments seem to result in higher agreement between clients' and therapists' estimations than do more general instruments that are applied to assess TA.