Occupational Therapy Summaries (Year 1) - PDF

O c c u p a t i o n a l Th e r a p y C o r e Learning Outcomes: To describe different services offered within occupational therapy To describe the occupational therapy process Define occupational performance in relation to life roles Evaluate major...

O c c u p a t i o n a l Th e r a p y C o r e Learning Outcomes: To describe different services offered within occupational therapy To describe the occupational therapy process Define occupational performance in relation to life roles Evaluate major current theoretical approaches Knowledge and skills related to outcomes: Analyse three definitions of OT Describe all OT core skills Explain the role of OT in relation to health, well-being and person-centred practice To explain the origins, development and regulation of OT over the 20th and 21st century Occupational Therapy is… A goal-directed activity that promotes independence in function. The therapeutic use of everyday life activities (occupations) with individuals or groups for the purpose of participation in roles or situations in home, school, workplace, community and other settings. → OT services are provided for the purpose of promoting health and wellness and to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation or participation restriction. → OT addresses the physical, cognitive, psychosocial and other aspects of performance in a variety of context to support engagement in everyday life activities that affect health, well- being and quality of life. OT is making sure that patients can get back into their occupations. Introducing new occupations → And when OT’s talk about occupations we ‘re not just talking about work we’re talking about all the things people do like showering and dressing and things like that. OT’s: Are experts in occupation Enable occupation Promote health through occupation Enhance occupational performance 1 Occupational Performance: The ability to carry out activities of daily life → Including the activities in the area of daily occupation. The doing of occupation in order to satisfy life needs. The ability to choose, organize and satisfactorily perform meaningful occupations that are culturally defined and age appropriate for looking after one’s self, enjoying life and contributing to the social and economic fabric of a community. Occupation is… Everything that we do in life, including actions, tasks, activities, thinking and being. A central aspect of the human experience and unique to each individual. Engagement in occupation describes the interaction with the individual with their self-directed life activities. Areas of Occupation: Activities of daily living Instrumental activities of daily living Purposeful Activity: Education An activity that is used in treatment that Work is goal-directed and that the client sees Play as meaningful or purposeful. Leisure Social participation Different levels of the OT practitioner Occupational Therapy practitioner refers to two different levels of clinicians namely: → The occupational therapist (OT); or → An occupational therapy assistant (OTA). The OT has more extensive training and education in both breadth and depth than the OTA. → The OTA works under supervision of the OT. Often the OT is referred to the “professional”. → The OTA is referred to as the “technical” level of practice. OT’s must graduate with a degree in SA and a Masters in OT in the USA. → OTA’s must successfully complete a two-year associates degree program. What does an OT practitioner do? Works with clients of all ages and diagnosis. The goal of OT intervention is to increase the ability of the client to participate in everyday activities including feeding, dressing, bathing, leisure, work, education and social participation. 2 OT practitioner’s interaction with client: Assesses existing performance Set therapeutic goals Develop a plan Implement intervention to enable the client to function better in his or her world Advocate for client Make or modify equipment Provide hand-on experiences to help people reengage in life. Records progress and communicated treatment specifics to family, other professionals, insurance agencies. Do OT’s do things to or for people? Guides the person to actively participate in intervention Important to establish rapport (a relationship of mutual trust) with the client The therapeutic relationship has value and plays a key role in the intervention process. Do OT’s help people get jobs? Although the term occupation commonly refers to jibs in which individuals get paid, it also encompasses the many things people do that are meaningful to them. → OT practitioners help clients engage in occupations (meaningful activities). Why do we refer to both ‘client and ‘patient’? Occupational therapy services are provided to people in many different settings. The term used to those served varies, depending on the setting. → For example, in a hospital or rehabilitation setting the term patient is used, but in a mental health facility or training centre professionals often use the term client. In some settings individuals may be referred to using terms such as resident, participant or consumer and in other places clients are referred to by name. Personality characteristics best suited for OT as career choice Desire to help others Genuinely like people Able to relate to both individuals and groups of people Appreciate diversity - Interest in working with people in diverse contexts Value people’s ability to change Creative thinkers who enjoy hands-on work Skilled problem solvers Ability to handle their own problems and feelings before trying to help others Empathize with client, yet expect and demand effort from them 3  A strong constitution – exposure to many medical problems in the field → Open wounds, generative diseases Interest in teaching clients → Education and instruction of clients and caregivers a key component of our job Flexibility and adaptability As OT is a lifelong profession, commitment and dedication are important Personally – growing in the field and maintaining competency Good communication skills Knowledge of biology and physiology, psychology and or sociology Who are the people served? The mandate of the OT profession is to help clients engage in occupations. The recipients of OT include people who have problems that interfere with their ability to function, The range of problems include genetic, neurological, orthopaedic, musculoskeletal, immunological and cardiac dysfunction, as well as psychological, social, behavioural or emotional disorders. OT practitioners thus help people with functional disabilities, increasing their abilities to do the everyday things they wish to do. Recipients of OT Services: Diverse group of human beings → All ages – infants to elders. → Clients with physical, psychological, and/or psychosocial impairments, which may be the result of an accident, trauma, disease, conflict of stress, social deprivation delays or congenital anomalies – birth defects. Kinds of settings OT’s work in: Hospitals Non-governmental organisations Clinics Anywhere Schools Inpatient settings (in hospital) Clients’ homes Outpatient settings (not in hospital) Community Settings Acute care settings Prisons Rehabilitation settings 4 Kinds of activities used during ot interventions Purposeful Activity: Preparatory activities: getting the client ready for therapy → Range of motion exercises, stretching exercises Contrived activities: Used to help simulate the actual activity and may help get the client ready → E.g., using a doll to practice tying of shoelaces Occupation-centred activities: Performed in a natural setting → Preparing lunch in own kitchen Media: The means by which therapeutic effects are transmitted → Toys, games, activities, arts and crafts, equipment etc. OT in Paediatrics: A new-born infant in a hospital neonatal unit A preschool child in an early intervention program A child who has CP and attends a public school Small group work in paediatrics: 5 OT in Adolescent units: Adolescents in drug treatment centres Rehabilitation centres for adolescents with cognitive limitations as the result of brain injury. Spinal cord injuries after a motorcycle accident – adjustment to living with a disability Adult Neurology: OT’s may assist a homemaker who had a stroke in adapting her home so that she may continue caring for her home and her family Clients who experience disability and trauma must learn to embrace and establish their new identity – OT may need to assist with this aspect Clients with psychological diagnoses such as schizophrenia may need help from OT practitioners to learn skills like shopping, keeping a check book or using public transport. An OT might make a splint for a client with a hand injury. Geriatrics: An OT practitioner may work with an elderly person in a skilled nursing facility with An OT practitioner may work in a program that helps an individual learn to use assistive technology and train for a new job after an injury. 6 Group work in geriatrics: Conclusion: The common goal of OT intervention is… To improve a person’s ability to participate in daily living. Ot practice framework: domain and process Occupational Therapy: Client factors: Therapeutic use of everyday life activities (occupations) with individuals or groups and populations for the purpose of Body functions, body structures, enhancing or enabling participation in roles, habits and values, beliefs and spirituality routines → In home, school, workplace, community and other settings OT’s use their knowledge of the transactional relationship among the Motor skills: person’s, his/her engagement in valuable occupations and the context to design occupation-based intervention plans that facilitate change or Motor, process and growth in client factors and motor skills needed for successful social participation participation. OTs enable engagement through adaptations and modifications to the environment or objects within the environment when needed. Occupational therapy services are provided for habilitation, rehabilitation and promotion of health and wellness for clients with disability and non-disability-related needs. → These services include acquisition and preservation of occupational identity for who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction OTs are responsible for all aspects of OT service delivery and are accountable for the safety and effectiveness of the OT service delivery process The OT profession has a core belief that there is a positive relationship between occupation and health and its view of people as occupational beings. The occupational nature of human beings and the importance of occupational identify – emphasized. 7 Aspects of the Domain of Occupational Therapy: Occupations ADL, IADL, rest and sleep, education, work play, leisure, social participation Client Factors Values, beliefs and spirituality, body functions and structures Performance Skills Motor skills, process skills and social interaction skills Performance Patterns Habits, routines, rituals and roles Context and environment Cultural, personal, physical, social temporal, virtual OT Process: Occupational profile: occupational performance Evaluation Intervention plan Intervention implementaion Intervention Intervention review Outcomes Target Outcomes The client-centered delivery of OT services. Focus is on the use of occupations to promote health, well-being and participation in life The OT process is not linear Collective occupational performance abilities of members are considered Direct and indirect services are delivered Clinical reasoning is central to providing a quality OT service Therapeutic use of self Activity analysis 8 Looking back to move forward: a history of occupational therapy Learning Outcomes: Identify major social influences that preceded and gave rise to the field of occupational therapy Identify the contribution of individuals who were involved in the inception of the profession Describe the concepts that have persisted throughout the history of OT How the above concepts have an effect on the current practice of OT Identify and describe key pieces of federal legislation that have influenced the practice of OT Looking back to move forward… There is a general perception that in order to move forward, we should be able to look back, learn from our mistakes or learn from achievements in the past and use that information to move forward. “We exist in the present, yet are future-oriented. To make sense of the present or future we must have knowledge about and an appreciation of the past” Two Threads in the History of OT: 1. Social, political, and cultural thread Human events that have influenced the development of OT through time. The legislative history that influenced the delivery of health care services in general and OT in particular. 2. The people involved People involved in the OT profession and choices that they have made throughout its history. Timelines In our historical reflection, we’ll make use of the following timelines we’ll look at the development or evolution of OT in the: 18th &19th centuries Early 20th century and beginning of OT profession World War 1 Post World 1 through to the 1930s World War 2: 1940-1047 1950-1960s 1970-1980s 1990’s till present 9 18th and 19th Centuries: In the late 1700s and early 1800s – distinguished by an awakening of social consciousness, an awareness that social structures lead to vast inequities → Gap between people who have and people who do not have. Era of moral treatment: → All people are entitled to consideration and human compassion. → Especially the people who are differently abled like those with psychiatric illnesses and those with physical disabilities. Involvement in purposeful activity Philippe Pinel (physician) and William Tuke (Quaker and merchant) – are credited with conceiving the Moral Treatment Movement → Phillipe Pinel – introduced work treatment for the ‘insane’ in the late 1700s → He used occupation to divert the patients’ minds away from their emotional disturbances and toward improving their skills. ▪ Physical exercise, work, music, and literature ▪ Farming as part of institutional life Quakers: Society of Friends William Tuke noticed terrible conditions in an asylum in York, England. → Establishment of York Retreat ▪ Where people could get away from the everyday pressure of having to go to work or living in places that do not support their health and well-being Together with Thomas Fowler he believed that Moral Treatment methods were preferable to restraint and drugs → Their restraints were removed and they were provided with the drugs they needed → They were seen as human beings with feelings and rights and with a need to express themselves. Kindness and consideration – key traits of patient handling → In OT patient handling is of the key focuses of being and OT → We pay attention to what the illness conditions are, what the patients’ capabilities are, what supports their needs Influential Historic Publications: 1901 (Pinel’s work) 1813 (Tuke’s work) Many hospitals in Europe and US implemented reforms In the US Benjamin Rush – the first physician to institute MT practices Participants in the MT movement demonstrated that establishing a structure and having the patients engage in simple work tasks promoted better health, and brought order and purpose to unstructured confinement. 10 Moral Treatment (MT) Movement fading… From the mid-1800s – the MT movement began to fade. Many of the concepts initiated continued. The practice of OT eventually emerged from this humanitarian concern for each human being and from the use of structured activity that stimulated a more normal life for asylum inmates. Early 20th Century and beginning of OT profession: Within the social, political and cultural thread changes took place in science, technology, medicine and industry New modes of communication and transportation accelerated the pace of life Production of goods by machines Era of arts and crafts John Ruskin and William Morris → John Ruskin – English author, poet and artist → William Morris – English poet, designer and social reformist Opposition to the production of items by machines, believing this alienated people from nature and their own creativity They sought to restore the ties between beautiful work and the worker, by returning to high standards of design and craftsmanship not to be found in mass-produced items It was believed that using one’s hands to make items connected people to their work, physically and mentally, and thus was healthier. Arts and craft societies were set up. Consideration of ‘handicapped’ persons Founders of the Profession: Backgrounds in a variety of disciplines including psychiatry, medicine, architecture, arts, crafts, rehabilitation, teaching and social work Their backgrounds served to enrich the breadth and depth of the profession of OT Names during this period of development: → Ergo therapy, activity therapy, occupation treatment, moral treatment, the work cure. Occupation therapy (William Rush Dunton – father of OT) Occupational therapy (George Barton) Herbert Hall George Edward Barton Dr William Rush Dunton Jr Eleanor Clarke Slagle (mother of OT) Susan Tracy Susan Cox Johnson Thomas Kidner (vocational rehabilitation workshops) 11 National society for the promotion of OT: Birth of the profession – 15 March 1917 Aim of the association: “To study and advance curative occupations for invalids and convalescent; to gather news of progress in OT and to use such knowledge to the common good; to encourage original research, to promote cooperation among OT societies, and with other agencies of rehabilitation.” Philosophical base: Holistic Perspective Adolf Meyer – Holistic perspective → Developed the psychobiological approach to mental illness. Each individual should be seen as a complete and unified whole, not merely a series of parts or problems to be managed. Involvement in meaningful activity – a distinct human characteristic. Providing an individual with the opportunity to participate in purposeful activity promoted health Questions for Self-Study: What major social influences gave rise to the field of OT? Who are some of the key people involved in the evolution of the OT profession? What key concepts have persisted throughout the history of OT? How has the profession changed over time? What are some key pieces of federal legislation that have influenced the practice of OT? 12  C a s e M a n a ge m e n t Occupational therapy process: domain and process Analysis of Occupational Performance: The occupational therapists evaluate the areas of occupational performance in which the client hopes to engage in. This is followed by an analysis of the performance skills or client factors interfering with performance This approach differs from reductionistic approaches that analyse components first and subsequently design interventions based upon deficits. The occupational therapy practice framework (OTPF) encourages practitioners to keep occupation central to practice. Components of Performance: Client factors Performance patterns Activity demands Context Client Factors: Include body functions and body structures → E.g., Range of motion, strength, endurance, posture, visual acuity, tactile functions. OT practitioners are skilled at analysing occupational performance at the basic level so that they can help clients fine-tune their skills and obtain the standards they wish. Performance Patterns: Performance patterns refer to the clients’ habits, routines and roles. Three types of habits are described in the OTPF: → Useful habits support occupations; → Impoverished habits do not support occupations; → Dominating habits interfere with occupations. Examining performance patterns helps the OT practitioner understand how occupation is actually accomplished for the individual client. 13 Activity Demands: When choosing an activity to help the client reach their goals the OT also examine the activity demands, which include: → The objects used and their properties, space demands, social demands, sequencing and timing, required actions, required body functions and required body structures. Evaluating activity demands allows the OT practitioner to match appropriate activities to the client’s needs and to determine how to modify, adapt or delete aspects of activity so the client can be successful. Context(s): Types of contexts: → Cultural, physical, social, personal, spiritual, temporal and virtual. The activity demands change as a result of the context or setting in which the occupation occurs. Context changes the requirements and performance skills, patterns and demands of the activity. Case application: An OT working at a home health agency evaluates 2-year-old David, who has developmental delays, and finds out the following: The parents are concerned because David does not ‘play like other children’. David does not sleep through the night, does not eat a variety of foods, and is small for his age. David drools and is difficult to understand. He talks using one-word sentences. He still sucks his thumb. David reaches with and uses a palmar grasp to hold objects. He walks with a wide-based gait. David smiles on approach and makes brief eye contact. David lives at home with three siblings (ages 7yrs, 5 yrs. and a new-born) Occupational therapy process OT practitioners are involved in the evaluation, intervention and outcome of services. The OT is primarily responsible for the evaluation and interpretation of assessments → However, the OTA may assist the OT. Stage 1: Evaluation Includes an occupational profile template (SUNLearn) and analysis of occupational performance. An occupational profile provides background information on the client’s goals, habits, occupations and history. Generally, an occupational profile is obtained through an interview. The OT may also administer assessments to obtain the information. 14 Client-centred Approach: The evaluation process involves a client-centred approach. The OT practitioner is interested in the client’s viewpoint, narrative and desires. Because the aim of therapy is to help the client – re-engage in occupations, the practitioner determines from the client, if possible, the occupations of interest. A client-centred approach involves working collaboratively with clients and is considered a foundational component of occupational therapy practice. During the evaluation, the OT analyses the client’s performance skills and client factors to determine strengths and limitations for the client. The OT may choose to use formal assessments, including standardized tests or protocols when evaluating clients. The OTA may assist in the process; however, the OT is responsible for the interpretation of the data. Stage 2: Intervention Plan An intervention plan is developed once the evaluation is completed and the OT has determined the client’s strengths and weaknesses and has analysed the areas of performance and contexts in which the occupation is performed. The intervention plan is developed with the client to address those areas important to him or her. The intervention plan includes a description of the goals and objectives of the intervention. → Although the OT develops the plan, the OTA may contribute ▪ Upon establishment of service competency Goals are designed to be meaningful, relevant to the client, measurable and occupation-based. Once the goals and objectives have been established, the intervention plan is developed. The OTPF identifies five general approaches to intervention: → Create/promote (health promotions) → Establish/restore (remediate) → Maintain → Modify (compensate, adaptation) → Prevent Create/promote (health promotion): This approach provides opportunities for people with and without disabilities. Name one example of health promotion programme. Establish/restore (remediate): The OT practitioner uses strategies and techniques to change client factors to establish skills that have not been developed or to restore those that have been lost. 15 Maintain: This intervention approach provides support to allow the client to continue to perform in the manner to which he or she is accustomed. The OT practitioners using this approach help clients keep the same level of performance and, therefore, not decline in functioning Modify (compensate, adaptation): Sometimes activities are changed so that clients may continue to perform them despite poor skill levels. Compensation refers to changing the demands of the activity or the way the client performs. This is useful when client factors are not changeable in a practical amount of time and the client wishes to engage in the activity. Prevent: OT practitioners are interested in keeping clients well, and as such, they may help clients engage in activities to prevent or slow down the disease, trauma, or poor health. So… The above-mentioned intervention approaches show the range of possibilities for servicing clients. The OT practitioner considers the context(s), client factors, performance skills, performance patterns and activity demand when determining the intervention approach. Once the approach is identified, the practitioner develops the intervention plan for the therapeutic use of occupation. Types of Occupational Therapy Interventions and Outcomes: Therapeutic use of self Therapeutic use of occupations and activities Preparatory methods Consultation Education 16  Occupational Narrative Outcomes: At the end of the 6 periods, the student will understand and be able to convey and/or apply the following: The definition of occupational narrative/storytelling; The purpose of occupational narrative/storytelling; How to plan for occupational narrative/storytelling; The stages of occupational narrative/storytelling; Confidentiality of information obtained through occupational narrative/storytelling; Posing questions using narrative reasoning; General guidelines used when doing occupational narrative/storytelling; Techniques used by the occupational therapists during occupational narrative/storytelling; Recording information obtained by means of occupational narrative/storytelling; Evaluation of information obtained through occupational narrative/storytelling and the process used to elicit the information. What is a narrative? “Clients’ occupational narratives reveal the overall meaning of life events, signifying their place in a plot that integrates past, present and future. Occupational narratives have also been demonstrated to predict how clients respond to therapy”. Narrative is both ‘the meaning we assign to occupational life and the medium through which we enact it’ It should not stand alone It can be interpreted differently by different people. → For example, if Kenny told his story to another person, he might well have given a different account. → It is necessary, therefore, to be reflexive and to probe how, why and with whom the narrative has been created. Also called storytelling “Symbolic account of the actions of human beings” Beginning, middle and end Held together by plots – problem/predicament and resolution A way to make sense of your life, give coherence to experiences “the self comes into being in the process of telling one’s story” Used in many disciplines, notably psychology “narrative psychologists” 17  You try to understand the occupations that a person participates in, why they choose to participate, what motivated them and what demotivates them what drives them and what gives them purpose I might interpret someone’s story differently from others – it depends on who is interviewing the person and what kind of questions are being asked. It could be an age-related difference that causes the person to keep some information from you You need to make the person feel comfortable and gain their trust Share a little bit about yourself Engage in an activity to break the ice Reassure them that confidentiality will be kept → You need to delete the recorded document after the assignment is done → Password-protected document on your computer Have the interview in a safe space in a time that will make them feel more comfortable Body language is important – not just your own body language but you need to keep an eye on the client’s body language Verbally indicate and non-verbally indicate that you are listening Normal conversation and not interrogative → Open-ended questions – the question should not have a direct answer → E.g., instead of asking do you bathe and go to school every day? Ask: Tell me about what you do in a day… Illness narrative How a person’s illness, impairment or disability affects a person’s occupational performance, and what does it mean to them How do people adapt to illness and disability? Ability to cope is shaped by people’s subjective realities Illness and disability can change people’s underlying assumptions about themselves and their worlds “Biographical disruption” Chronic illness or disability can change someone’s perception of themselves – loss of self, loss of self-esteem Need for the reconstruction of self? Mental health – fighting against one’s own mind 18 Why do we use narratives? To understand occupational behaviour To understand the meaning and motives → Why? To understand what drives and motivates a person and what is important to consider in planning intervention. For OTs and for clients – both can gain insight. The Value of Narratives: The opportunity to understand one’s own life A way to integrate the past, present and imagined future Telling the story from within, rather than from the outside Hearing the voices of the people we serve, rather than the healthcare workers who serve them Seeing the person at a deeper level Understanding the person’s life, struggles and relationships rather than just their symptoms and problems Understanding coping strategies A means to address spirituality → Beliefs and who we are and how we engage with others Occupational Narratives: A narrative with a focus on the person’s occupations Understanding what motivates a person’s doing, being and becoming Helping people find meaning and relevance in their life story Making sense of our work with clients → The past experiences and symptoms → The possible futures (therapeutic goal-setting) Helping people tell their stories to find their occupational identities Understanding what is important to the person – values, interests, needs Listen to what they are saying or not saying. Planning for the Occupational Narrative: Find a person that has an impairment, disability, had COVID or a chronic illness and make an appointment with them Venue: Online / Face-to-face Relaxed, comfortable Private Familiar to the person if possible 19 Time: Decide on a length of time beforehand Information: Obtain background information if possible before the interview (referral) Determine the purpose of the interview/narrative Set appropriate questions in line with the purpose Requisites: Consent forms, questionnaires, and tests as required (B OT II) Stages in the Occupational Narrative: Beginning phase: Introduction Greet and be friendly and courteous. Make sure the person is comfortable Set expectations re: confidentiality, consent, time, purpose Middle phase: Exploration Focus on achieving the purpose Ask open ended, exploratory questions End phase: Termination Summarise information in line with the purpose Allow for questions Thank the person Posing Questions Using Narrative Reasoning: Questions are based on the purpose of the interview Common questions to be answered through the narrative interview: → What does the change in occupational performance mean to this person? → How is this change positioned within the person’s life story? ▪ Look at life stage, who they are, what occupational roles they have, etc. Guidelines when asking questions: → Only use questions, when necessary, to guide the discussion → Time your questions appropriately Open ended vs closed ended questions 20 Techniques Used During the Narrative Interview: Minimum verbal response – Yes, mmm, nod → Show the person that you are listening Paraphrasing – Reflecting back on what the person has said, in your own words → Show that you understood what they said Reflection – Reflecting back on unexpressed feelings or ideas Probing – Open-ended questions to find out more Clarifying – Checking if you understood correctly Informative – NOT Advice. Factual, objective information. → Question or a statement to provide information → Not advice because we are trying to make the person feel understood and heard ▪ Advice can be seen as judgement Evaluation of the Occupational Narrative: Evaluate your own conduct during the interview Did I achieve the purpose of the session? Did the person feel free and comfortable to share? Did I listen without judgement, and make the person feel heard and understood? Did I use the best techniques during the interview? Was my language appropriate? Was my non-verbal behaviour appropriate? 21  S killed Observations What ARE SKILLED OBSERVATIONS? Observations are a method of data gathering for the purpose of establishing what the occupational performance problem is (assessment), for ongoing evaluations during the intervention (for measuring improvement or change) and/or for collecting data when conducting research. Law et al (2005, p 73) state that ‘Observation is a vital part of the therapeutic process. Deciding what, when, and how to observe must be driven by the CLINICAL question asked’. Concepts: Observer: → Someone who sees or notices something Observation: → The act of recognizing and noting phenomena as they occur Observation skill: → A skill whereby information is obtained through the use of senses and reactions. Observation entails that a person observes and describes what he sees, hears, smells, tastes, feels or experiences in structured or unstructured settings. Skilled observation: → “Involves using professional knowledge and expertise to watch the performance in the actual contexts of interest and to make hypotheses about the meaning of those observations for meeting needs” (Christiansen & Baum, p346). Criteria for Observation: To qualify as an observation, the observation should be: Factual Measurable Made in the actual context of interest to the person The Steps of Skilled Observation: 1. Receiving stimuli e.g., hearing music 2. Focusing the attention on the stimulus (listening to it) 3. Perceiving what is observed/heard (classical music, pop or music that is far away) 4. Attaching meaning to the perception (using cognition and recalling information – e.g., it is a composition by Billie Eilish) OR Assess, Analyse, Articulate, Act 22 Why are Skilled Observations necessary in OT? Gathering assessment information Contributing to problem-identification with the team Planning the most effective intervention Monitoring treatment by observing the person’s reaction to treatment and for making adaptations to treatment Giving feedback to the team about the change in occupational performance Evaluating readiness for discharge to the natural context The OT Approach: Uses own senses optimally → E.g., vision, touch, hearing Kielhofner (2006, p533) says that “Observations are (is) most straightforward when there is tangible physical evidence, outcomes, or products that can be seen or heard”. Listens optimally using listening techniques Observes own feelings and reactions towards situations and people. → It is important that the occupational therapist has sufficient self-knowledge in order to understand his/her own feelings and reactions to be able to relate them objectively to the situation in which they are observed. → If not, it may lead to subjectivity which could result in bias and incorrect conclusions. Observations are made from: → General to specific → Sum total to detail → Superficial to in-depth → Gross to fine Make observations AFTER deciding what information is needed and therefore, what should be observed Information from observations should be conveyed objectively and accurately → I.e., be aware of the impact of personal expectations, prejudices, experiences and thoughts about the observed situation. Information from observations should be reported accurately and without interpreting them → I.e., don’t draw conclusions Observations should be reliable. To achieve this, practice: → Occupational therapists observing the same situation, compare observations. → Make a list of aspects that need to be observed and do this over a regular time period. → After the specific time period, add up the observations to obtain their frequency. Observations are made in the contexts/environments that are important to the client. → Specify in your report, in which context the observations were made. Sometimes the occupational therapist may need to set up and structure a situation in which the observations have to be done. 23  Observations of one person’s occupational performance should be made in multiple contexts to obtain accuracy and reliability for observation results. Observations can be used to support data that has been collected through other assessment methods → E.g., interviews or self-report measures. Observations can be used when clients/research participants lack insight or self-evaluation skills or are not able to participate in an interview or provide an accurate self-report → E.g., infants or persons with severe cognitive limitations or use other languages. The observer watches or listens to clients/participants, recording information about: Affective states Communication (verbal and non-verbal) Behaviour Environmental situations Methods for recording observations Observation guides: Structured form with area for marking quantitative or qualitative information Structured checklists: Paper and pencil forms to indicate the presence of absence or frequency of certain states, behaviours or communication Quantitative Rating scales: Likert scale (ordinal data) which differentiates positions along a continuum E.g., Comprehensive Occupational Therapy Evaluation (COTE) and the Prevocational assessment of Rehabilitation Potential (PARP). Semi-structured or unstructured note-taking: Take notes on broad topics or spontaneous observations and can be used to support anecdotal data 24 Context in which skilled observations take place Natural Context: This refers to the context in which a person lives and functions such as home, workplace, neighbourhood and general community environment. Advantages: Disadvantages: Gather data that is real and ecologically Introduces individual differences valid Is time-consuming and expensive unless Useful in evaluating the outcome of the therapist is working in a community- treatment based setting → E.g. can the client apply the skill at home Semi-structures or Clinical Context: This refers to inpatient or outpatient clinical settings where the following structures are present: Time – length of therapy session Space – size and configuration of the therapy space Objects – therapeutic equipment, assessment tools, assistive technologies, arts and crafts. Sensory variation – different lighting, sounds, smells People – therapists, support staff, administrators and others that are artificial to a person’s natural environment Advantages: Disadvantages: Can simulate natural context very closely Introduces extraneous variables that are (created environment) not present in a natural context and this Semi-structured settings can be applied introduces risks for confounding variables uniformly across persons/clients/participants 25 Standardized or Laboratory Context: Offers a high degree of control over confounding variables. In occupational therapy, a structured context can be created or a highly structured treatment or assessment room in a clinical setting. Advantages: Disadvantages: Standardization allows the Limited generalizability to the client’s researcher/therapist to control the natural environment environmental context across clients/participants Listening Skills Listening can be improved by developing a commitment to listening, avoiding distractions, waiting before responding and suspending judgements. There are various levels of listening and it is proposed that a therapist has difficulty when he fails to match his level of listening to that required in the situation. 1. Analytical Listening for specific kinds of information and arranging them into categories. 2. Directed Listening in order to get answers to specific questions. 3. Attentive Listening for general information in order to get the overall picture. 4. Exploratory Listening because of one's own interest in the subject being discussed. 5. Appreciative Listening for easthetic pleasure, such as listening to music. 6. Courteous Listening because one feels obliged to listen. 7. Passive Listening as in overhearing something; not attentive to the matter being discussed. 26  O c c u p a t i o n a l Th e r a p y Ro l e s Outcomes: Describe three levels of role fulfilment List the 6 roles fulfilled by an OT Describe the main functions attached to each role Explore and identify the OT roles in the clinical setting Motivate the fulfilment of the various roles List the values and attitudes that may affect role fulfilment Discuss the way in which values and attitudes are applied in OT practice OTs Different Fields of Practice: Health care Education Academic Government Social Corporate Industrial settings An individual’s employment setting, method of service delivery, performance competence and career goals are interdependent and result in an individualised composite of roles during actual job performance. Roles are not exclusive and are valued equally because jobs performed by OTs may include aspects of more than one role. What is a Role? A role may be defined as follows: “A socially prescribed pattern of behaviour corresponding to an individual’s status in a particular society” A role can be described in terms of: Level of role fulfilment, Focus of the role and Level of supervision required 27 Three levels of role fulfilment: Entry level – skills are developed and continuous supervision is usually offered Intermediate level – more independent mastering of role functions, draws on previous experience to deal with situations Advanced level – the refinement of specialist skills, more understanding of complex situations, contribute to and develops profession, regarded as an expert. Minimal supervision is required. Progression within a role through the three levels of professional development is based on an accumulation of higher-level skills through experience, education, guided self-development and professional socialisation. Progression is not simply the amount of time in a role. An individual may function in more than one role simultaneously. → When this occurs, it is possible to function at different levels within each role. Levels of Supervision: Close – daily, direct contact at the site of work Routine – direct contact at least every 2 weeks at the site of work, with interim supervision occurring by other methods such as telephone or written communication General – at least monthly direct contact, with supervision available as needed by other methods Minimal – provided only on a need basis, and may be less than monthly Level of Role Fulfilment Level of Supervision Entry Close Intermediate Routine or General Advanced Minimal Roles Mostly Fulfilled by OTs: Therapist Team member Consultant Educator Researcher Manager 28 OT as a therapist Four Main Functions Performed by a Therapist: 1. Treatment of disease and injuries 2. Rehabilitation within limits of illness and/or health 3. Prevention of diseases and injuries 4. Promotion of health OT as clinician and educator Family/caregivers Educate and advise family members, referral. OT Students Clinical supervision, demonstrate and evalutae skills to students Professional Act as team member or consultant, raising awerness of role and scope of OT Colleagues Continuing CPD as clinician, offer CPD activities to colleagues, other professionals and Education students. Advocate and motivate for OT posts, raise awareness of rights of persons Public Education with disabilities, training of family members and community members. Induction of junior occupational therapy, profession specific mentorship. Orientation Orientate students to the field of practice during service learning. Management in OT Outcomes: Identify and briefly describe the four functions of managers List supportive management functions Explain the difference between supervision and management Roles and Functions of Managers: Supervise the work of others Requisite managerial authority Four functions 29 Requisite managerial control: The level of control and discretion that a manager must have to be fairly held responsible for the outcomes of work groups The authority to hire and fire employees Managers: Solve problems with long-range implications Future planning Management is the art of getting things done through other people Supervision is interaction with employees Four functions of management: Planning: 1. Strategic planning: → The process of determining the long-term goals of an organization as a means of formulating strategies to accomplish these goals 2. Policies and procedures: → This is the responsibility of the departmental manager, includes management of supplies, materials and facilities and guidance of staff 3. Financial planning: → Development and oversight of budget, projection and calculation of volume of work, revenue and expenses 4. Facility planning: → The process of determining if needed resources are available by asking for preferences and mistakes Example of Calculation of Expenses: Category of expenses Total Cost Category of expenses Total Cost Direct expenses Indirect Expenses Salaries R 2 352 000 Phones R 12 600 Medical supplies R 134 456 Storage R 28 000 Office supplies R 3 900,20 Equipment R 30 000 Food supplies R 5 600 CPD R 15 000 Total Expenses R 2 581 556,20 30 Planning continues: Deciding what to do Setting measurable performance objectives Setting short- and long-term goals Determining human resource needs, materials, supplies, facilities, equipment Identifying activities needed to accomplish objectives Distribution of finances Guidelines on effective planning: Make specific and measurable plans Should not be too idealistic/ too practical Recognize potential challenges/roadblocks Develop contingency plans Allow flexibility Consistent, effective and clear communication is key Trouble shoot plans Organising and staffing: Designing workable units Defining lines of authority and communication Developing and managing patterns of coordination Designing or maintaining human resource structure, including resources → Lines of authority and communication Development of organisational chart and job descriptions Developing and managing patterns of coordination Should provide identification of responsibility, authority, expected levels of performance and separation of work activities Recruitment and hiring Orientation → General, organisation, job-specific Training, education and development → Performance assessment, succession planning, quality of service provision Discipline and separation → Overseeing performance, providing feedback, providing opportunities for improving quality and quantity of performance Directing: Provide guidance and leadership so that work performed is goal oriented. Mentoring or coaching 31 Controlling: Involves information management Establishing performance standards and measuring, evaluating and correcting performance against expectations Eliminating obstacles to achieving organisational goals Three phases of controlling: Establish standards Measuring performance Correcting deviations Managers VS Leaders: Emphasise the contribution of management and supervisors Goals of management and supervision OT consultation for case managers The OT Consultant has the Potential to: Address client concerns Enhance daily living skills Provide both direct intervention and consultation services to address client needs and program development Consultation can be a cost-effective means for an OT to provide evaluation and treatment planning services in collaboration with the client and case manager. How do we Know When to Consult? Needs assessment with case managers: Difficulty in determining client levels of cognitive functioning Needed assistance with home safety evaluations Desired to provide activity programming as requested by clients Lacked time or expertise to do the above High caseloads and staff turnover Interest in receiving additional resources to help them be more effective in their work Little formal case management education Hence: A consultation model of intervention was developed and tailored to meet these identified needs. 32 Design and Procedure of the Consultation Process: Year 1: the OT consultant focused on: Establishing collaborative working relationships with case managers Completed initial evaluations consisting of functional cognition and client perception of occupational performance problems → The OT used this to establish goals. Designed and implemented life skills, diabetes education, structured crafts, health and wellness, money management, horticulture and therapeutic horseback riding – groups. Presented evaluation findings and client progress at weekly case management meetings Was available for informal consultation and on an as-needed basis. Throughout the process the OT consultant: Received referrals for assistance with client home maintenance and self-care needs. → In these cases, the OT consultant either temporarily assumed case management duties with a client with special needs OR → Joined the case manager’s in-home visits Was assigned a small caseload of clients with multiple psychological, physical and cognitive issues A modified consultation approach was used: Provided direct intervention as well as Providing assessments and treatment recommendations to case managers. Result: Consultation Requests Throughout the study, the OT consultant: Recorded the number of referrals received from case managers Result after 18 months the percentage of case managers requesting referrals had increased to 63% Result: Job Satisfaction and Self-efficacy Statistical significant decline in job satisfaction between baseline and 12 months In contrast – significant increase in job satisfaction from 12-month – 18-month assessment (another steady decline afterwards A possible explanation for the significant increase at 18 months: Case managers’ job satisfaction and self-efficacy improved when case managers were more actively seeking and utilizing occupational therapy consultation services. 33 Case Managers: Felt that they had become more aware of what their roles could and should consist of They had experienced treatment successes with the addition of OT consultation. Factors that Positively Impacted OT Consultation as Reported by Case Managers: Increased independence of clients/less work for case managers Assistance in problem-solving The pro-active approach used by the OT consultant instead of the ‘case managers put out fires’ Working with a professional skilled in developing objective and realistic treatment plan goals Having a fresh, outside perspective The OT consultant’s ability to break down tasks and information to the ‘nitty gritty’ Home safety evaluation A skilled group leader who introduced a variety of activity-based groups A spontaneous colleague who ‘jumps in and helps as needed’ Ability of occupational therapy to become accepted by the group over time. Factors that Negatively Impacted OT Consultation as Reported by Case Managers: Management concerns Resistance to consultation Occupational dissatisfaction OT As a Team Member The Success of Teamwork my Require: 1. Proper communication 2. Shared collaboration 3. An understanding of the roles of each discipline within the health care team 4. Understanding the specific roles that each profession can contribute to the whole team Factors Reducing the Quality of Patient Care: Limited knowledge about the roles of team members. Ineffective communication, Poor interprofessional relationships, Underestimation of the roles of other health professionals, Diminished appreciation of the unique contributions of each discipline 34 Effective Collaboration and Improved Health Outcomes: Two or more different professional backgrounds provide opportunities to learn about, from and with each other. An Occupational Therapist is a vital member of an interdisciplinary team and can bring a unique perspective to patient care. Main Tenet of OT as a Health Care Profession: People are occupational beings who need to participate in everyday activities to promote health, maximize function, and achieve self-actualization However: Factors that have been found to limit effective interdisciplinary teamwork: A lack of awareness of the OT knowledge base among other team members, As well as a lack of understanding about the nature of the occupation and its effect on health and well-being are factors that have been found to limit effective interdisciplinary teamwork. Limited knowledge of practice areas and OT domains based on the type of services delivered within a certain setting. Functional Teams Need to Aspire to: Effectively communicate at all times Collaboration, Coordination, Conflict resolution, Leadership, Decision-making, and Participation. Factors contributing to the functionality of health care teams: Task design, Team processes, Organisational context, and The social and policy context. 35 Multidisciplinary Teams: Each member "has a clearly defined role with specific areas of responsibility; team members understand each other’s professional scope of practice and rely on each team member to address their area of concern" The assessment, goal setting, and intervention process for each profession take place separately and usually clients meet with each team member individually. → Team members communicate with each other either through formal meetings, informal conversations, or via written or electronic documentation in clients' medical charts Interdisciplinary Teams: Professional staff share responsibility for providing services Frequently provide support for the objectives of the other team members Team members conduct their own individual assessments, but will share their findings with other team members when formulating a coordinated intervention plan. Interdisciplinary team members have a broad knowledge of the other professions and work collaboratively with them to provide synchronised services to clients Frequently found in rehabilitation centres Often involve a number of health care staff including physiotherapists, occupational therapists, speech-language pathologists, dieticians, psychologists, social workers, nurses, respiratory therapists, rehabilitation medicine specialists, recreation therapists, audiologists, and others Well-functioning interdisciplinary teams: Communicate to resolve disagreements Promote shared, collegial decision making Traits of a strong, functional team: Egalitarianism, Consensus, Fairness, Commitment, Honesty, Relevancy, Ethical behaviour, Expediency, and Loyalty, Efficiency 36 Transdisciplinary Teams: “Team members commit to teaching, learning, and working across disciplinary boundaries to plan and provide integrated services… traditional role boundaries are crossed and the skills of other disciplines are integrated into the total care plan” Found in early intervention centres and community-based rehabilitation teams. The transdisciplinary team approach is intended to → Reduce the duplication of services, → Provide one port of call for service recipients, and → Reduce the fracturing of service provision ▪ E.g., the client goes to see the occupational therapist, physiotherapist, speech- language pathologist, and psychologist all separately OT as a Researcher What is Research? Structure or plan for investigating or exploring an issue or phenomenon Detailed proposal outlining methods to be used and ethical approval Certain academic requirements Flexibility and Responsiveness: Assumes that the researcher has the power to determine what will be done to achieve the goal of the research. Occupational therapists work collaboratively with individuals and communities to determine goals and objectives and identify strategies to achieve those goals. Being flexible and collaborative ensures ethically responsible and responsive action. Values in Research: African values: → Wholeness, community and harmony, collective sense of responsibility – a ‘collective ethic’, interdependence and interconnectedness, relationship, wholeness; people-centred; equal and respectful mutual exchange; participatory; oneness. Aboriginal and Torres Strait Islander values: → Spirit and integrity; reciprocity; respect; equality; survival and protection; responsibility. Supervision and Mentoring: Bring their knowledge and experience as members of indigenous communities Provide introductions and links 37 Involving Cultural Advisors: Cultural mentors may challenge and support the OT non-indigenous researchers and may provide valuable feedback in relation to the research process. Relationship with Indigenous People and Effective Professionals: Observations through many hours of fieldwork; engagement in a range of contexts; In-depth interviews may provide the basis of knowledge in the context of real relationships Conclusion: Occupational therapists should be prepared to question their own expectations in relation to the indigenous research community → Specifically, persons with disabilities, and determine the most effective and accessible service delivery process to ensure outcomes are achieved Non-indigenous occupational therapists may be unaware of attitudes or actions that are ethnocentric and/or inappropriate for their Indigenous clients. Consider avenues for knowledge translated. Sound research = professional practice Having sufficient mentoring to check out ideas when working at the cultural interface is essential to developing culturally competent and safe professional practice. 38  Occupational Science Previous Knowledge: What is an Occupation? Why do people engage in Occupations? So, what is Occupational Science? What is occupational science? An established and rapidly growing international discipline that concerns itself with “the relationship between occupation and other phenomena such as health, quality of life, identity, social structures and policies” (Hocking, 2000:60). Occupational science is a “basic science devoted to the study of the human as an occupational being. As a basic science it is free to pursue the widest and deepest questions concerning human beings as actors who adapt to the challenges of their environments via the use of skill and capacities organised or categorised as occupation” (Yerxa, 1993:5). Occupational scientists study people’s activities, tasks and roles across a broad spectrum of concerns such as “politics, spirituality, education, social structures, science and technology, the media, work, growth, development and creativity, and health from an occupational perspective” (Wilcock, 2001:416). Occupational scientists investigate the influences of the environment and context on the occupational behaviour of people and populations by describing risk factors such as occupational deprivation, - imbalance and -alienation (Wilcock 1998). Occupational Science through a new lens… By ‘discovering and synthesizing ideas from other relevant fields of study into a fresh configuration […] a new pair of glasses through which we may view the human as an occupational being. These lenses will enable us to see the people we serve with new clarity, enabling us to do a better job’ (Yerxa, 2000). What is occupational justice? Focuses on the meaningful and purposeful occupations that people want to do, need to do and can do considering their personal and social circumstances. Can be seen as a justice of difference. It is focussed on creating environments in which opportunities for participation are equalised, it recognises difference. → It focuses on opportunity rather than possession. Enables different access to resources and opportunities because it recognizes individual and group differences. 39 Occupational rights: Right to experience occupations as meaningful and enriching. Right to develop through participation in occupations for health and social inclusion. Right to exert individual or population autonomy through choice in occupations. Right to benefit from fair privileges for diverse participation in occupations. “People have the right to participate in a range of occupations that enable them to flourish, fulfil their potential and experience satisfaction in a way consistent with their culture and beliefs.” “People have the right to be supported to participate in occupation and, through engaging in occupation, to be included and valued as members of their family, community and society.” “People have the right to choose for themselves: to be free of pressure, force, or coercion; in participating in occupations that may threaten safety, survival or health and those occupations that are dehumanizing, degrading or illegal.” “The right to occupation encompasses civic, educative, productive, social, creative, spiritual and restorative occupations. The expression of the human right to occupation will take different forms in different places, because occupations are shaped by their cultural, societal and geographic context.” Factors Contributing to Occupational INJUSTICE? Occupational Deprivation Occupational Marginalisation Occupational Imbalance Occupational Alienation Domains of Occupational Therapy: Play Leisure Learning and Teaching (Education) Work Personal and Community Living Social Interaction 40 Dimensions of meaning in the occupations of daily life "Spirituality is a universal concern, growing where people feel alienated, isolated, lonely, oppressed, marginalized, demoralized, or trapped in bureaucracy, abuse or meaningless occupation" The belief that occupation is a primary source of life's meaning. The concept of occupation that relates to the experiences and expressions of meaning in people's lives. “The source of meaning found in occupation and the contributions that occupation makes to meaning in our lives. The Concept of Occupation in Occupational Therapy Theory: Occupation "is everything people do to occupy themselves, including looking after themselves (self- care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (productivity)” Due to age, culture, socioeconomic status or lifestyle, an occupation may be labelled by as leisure and by others as productive. Individuals may define an occupation differently at different times, dependent upon mood, goals, context and the presence of other people "Occupations are meaningful to people when they fulfil a goal or purpose that is personally or culturally important.” Meaningful is a positive term, yet all occupations are meaningful → They all have some meaning for the individual engaged in them. Occupations meet the person's "intrinsic needs for self-maintenance, expression and fulfilment"; → Suggesting that occupations might usefully be explored, not in terms of categories, but in terms of how they meet intrinsic needs. Biographical Disruption: Consequences and Significance Accident and one damaged the spinal cord. → Challenges and gradual change → Now one think of growing up, your career, happiness → There is now a sense of disruption to expectations, life-plans and "the seductive predictability" of everyday life Biographical disruption has been described as comprising three dimensions: → Body, conceptions of self, and time. ▪ Injuries you loss certain aspects of the self, such as perceptions of competence, self- worth and identity The meaning of an impairment will lie in its consequences and will impact everyday life activities and relationships. → Meaning of impairment lies in its significance, that is, in terms of its social connotations. → Aspects such as (blame), stigma, competence and social worth. 41  Just think about an unexpected event such as the death of a life partner, a life-threatening illness, a marital breakdown or the loss of a valued job, can be seen as a biographical disruption. Changing the Meaning of Consequences: One of the primary consequences of an illness or injury is the cessation of doing: → The ability to engage in personally meaningful occupations It requires several responses: → Attention to the body → Fundamental re-thinking of biography → Mobilization of social and material resources There is growing evidence that many people who have physical impairments undergo a conceptual transformation, such that they change the way they think about disability → Indeed, many no longer view themselves as disabled. As a young man with high tetraplegia observed: "I don't look at you as able-bodied and me as disabled...We're [all] doing the best we can with what we have" Changing the Meaning of Significance: Post-war need to rebuild one's life, the freedom to re-make oneself and the denial of the determinism of circumstances. Transformation is a way of looking at things differently. Transformation, research suggests that people who make a good adjustment to the sudden onset of impairment are those who are able to redefine their values, broaden the range of things that are cherished and decrease the emphasis on physique as a measure of the self Basic Needs: Purpose The importance of creating meaning through purposeful occupations has not been lost on writers: → "Working restored his equilibrium and gave him back that sense of purpose that even living with a fatal disease requires if one is to live at all" Meaning: Doing something purposeful is directly associated with the meaning of one’s day and that engagement in occupations that are personally meaningful contributes to a sense of purpose. Choice of Control: People whose live have been disrupted by illness or injury make a conscious decision to take control of their lives (or “get back on track”), notably through re-engagement in occupations they find personally meaningful. 42 Self-worth: When people lose their ability to do those occupations that are important to them this erases their perceptions of themselves as capable and competent, such that they describe feeling useless and valueless. Occupation: Occupational engagement has been found to contribute to the experience of a life worth living. Occupation is a source of meaning, purpose and choice and control It can be used to construct meaning and self-identity can reveal ways in which people find fulfilment and invoke agency through their activities. Doing: The concept of doing includes purposeful, goal-orientated activities Being: Being has been defined as time taken to reflect, be introspective or meditative, (re)discover the self, savour the moment, appreciate nature, art or music in a contemplative manner and to enjoy being with special people. Belonging: The necessary contribution of social interaction, mutual support and friendship, and the sense of being included, to occupational performance and life satisfaction. Becoming: People living with AIDS had an "opportunity to reassess their life priorities and to refocus their purpose on what was really important Becoming’ describes the idea that people can envision future selves and possible lives, explore new opportunities and harbour ideas about who or what they wish to become over the course of their biographies and how their lives might be experienced as worthwhile. Conclusion: Engagement in personally meaningful occupations contributes, not solely to perceptions of competence, capability and value, but to the quality of life. 43 Time use What is Time Use? How people use their time and why. How people spend their day/week/ month, etc. What they do with their time. Einstein proposed that time is relative to the observer; therefore, it is experienced differently by all of us and is not the abstract phenomenon encapsulated by the universal clock. Time use is not static: Culture Personal choice → Clock time use vs Event time use Current situation: e.g., employed or → Christmas time, Ramadan, Sabbat unemployed. etc. Health issues Society…changes in society Gender Developmental age Etc. Often, clients describe their lives in relation to significant events that have happened to them; using the concept of social time would support the occupational therapist in focusing on the sequence and order between life events, rather than the calendar point at which they occurred Time use in OT: 1. Occupations as a consumer of time: → Occupation is a natural time user → Insight in socio-cultural issues/ beliefs/ values → Insight into factors impacting health. → Western vs Southern/ African notions of time → Increasing demand for work (industrialisation) ▪ Less time for leisure → Definition of constructive time use ▪ Time should be used and not wasted → OTs do not just need to know how people are using their time, but also why they use their time in that way. ▪ By having an understanding of how and why people use their time we gain insight into socio-cultural issues and determinants of health (factors impacting health) → If changes happened in time use is this the choice of the person or not? 44  2. Time as a context for occupation: → The time to do occupations and activities. → Internal clocks (biological) vs external clocks. → Social expectations vs personal expectations Why is it important for an Occupational Therapist to understand how people use their time? Understand how a person’s pattern of time use influences their health and wellbeing Link to health and well being → Too much = stress → Too little = Boredom → Too restricted / fixed = Lower mental well-being Shift work – higher rates of stress, cardiovascular disease, suicide Prison and Nursing Care – severe restrictions on what people are allowed to do and when. Improve the quality of time use Need to support a person to establish meaningful patterns of time use Ways of assessing time use: Activity clock Time use diary → Time slots → Each hour of a day → Weekday and weekend → 24 hours Bar chart showing the amount of time used in different categories Random time allocation Tactical Activity Planning (TAP) Reasons to use visual methods: Data visualization allows you to better understand and ”get to know” a person’s time use Spot visual patterns much better than looking at a detailed time-use diary Visualization allows you to see large amounts of time use information summarized and simplified Occupational Trajectory: The path a person follows → Includes the past, the present, and the future → Includes both positive and negative experiences Every person’s occupational trajectory is different, even if they are working towards the same goal Occupational trajectories include activities that are purposeful and meaningful to the person 45 Occupational Balance Read the article and go through the questions done in class. Occupational Identity Read the article provided. Occupational Risk Factors Occupational Risk Factors or Cases of Occupational Injustice: Occupational Alienation Occupational Deprivation Occupational Marginalisation Occupational Imbalance Occupational Alienation: Occupational alienation is experienced when the individual or population is unable to experience meaningful and enriching occupations and instead has a sense of emptiness, isolation and lack of identity. Occupational Deprivation: A “state of prolonged preclusion from engagement in occupations of necessity and/or meaning due to factors that stand outside of the individual’s control i.e., geographic isolation, unsatisfactory work conditions” Occupational Marginalisation: When an unseen force dictates how, when and where people ‘should’ participate in occupations and implies a lack of autonomy for the individual in the making of daily decisions. Occupational Imbalance: Is used as a population-based term to identify populations that do not share in the labour and benefits of economic production. Occupational Rights: “Occupational justice requires rights for all to: Participate in a range of occupations that support survival, health and well-being so that populations, communities, families and individuals can flourish and realise their potential, consistent with the Ottawa Charter1 Choose occupations without pressure, force, coercion, or threats but with the acknowledgement that with choice comes responsibility for other people, lifeforms and the planet. Freely engage in necessary and chosen occupations without risk to safety, human dignity or equity.” 46  Activity Analysis How do Activity and Occupation fit together? Several activities make up a task. Several tasks make up a role. → When activities fit under a role in this matter, we refer to it as an occupation. Example of Occupation: Role – Student Tasks of a Student Role: Roles Attend lectures Complete assignments Write Examinations Tasks Study (etc.) Activities of ‘Study’ Task: Activities Review work done Make summaries Answer question from previous paper (etc.) Example of Activity: Role - ??? In this case the activities are not connected to a role. Tasks of exercise: Drive to the gym Get dressed in gym gear Exercise Shower Travel home Activities of Task “Exercise”: Warm up Cycle for 20 minutes Rowing for 20 minutes Cool down and stretch 47 Activities Comprise Steps: Roles Steps of an activity: “Cycling for 20 minutes” Get onto the exercise bike. Tasks Set the timer. Set resistance. Exercise for 20 min. Activities Steps of the IMPORTANT NOTE: Activity When you do an activity analysis – it is important to do it on an ACTIVITY. Not on a task → Tasks first have to be divided into activities before analysing each of the activities separately. Not one of the steps of the activity. How do I determine whether it is an activity I am planning to analyse? Activities are the smallest, discrete components into which doing can be divided Two questions have to be satisfied: → Did I break the doing up into the smallest possible discrete component? → Can this component be named logically and does it have a goal? Differentiating activity from steps in an activity: Ask yourself the question: If I am told by someone: I am going to [name of activity]. Will (s)he understand without having to ask further questions? → A ‘why’ question might imply you are talking about a step of an activity. Examples: Putting on my gym shoes – Step of activity ‘going to the gym’. Measuring ingredients – Step of activity ‘baking scones. Activity Analysis: Activity analysis is the identification of the component parts that make up an activity. It is a fundamental skill of Occupational Therapists. Different formats can be used for conducting activity analysis → We will use Stellenbosch University approach 48 When an individual is doing the activity: Inherent demands (of the activity) will elicit performance enablers (of the individual). AND/OR elicit Inherent effects (of the activity) will be experienced through doing. → Thus, the individual doing the activity will benefit when performance enablers (deemed in need of improvement, development or strengthening) are elicited and inherent effects are experienced. Through doing an activity analysis the occupational therapist will consider the best MATCHING of inherent demands and inherent effects (of the activity) WITH performance enablers and performance deficits (of the person) to achieve a specific therapeutic outcome. Inherent Effects Two parts of selecting an activity for intervention: Goals of 1. Assessment of the person Session 2. Analysis of an activity Inherrent Demands Assessment of the person Activity Analysis Determine performance enablers and performance Identify the inherent demands and inherent effects deficits of the person. of the activity. Synthesis information to choose an activity that will facilitate the person’s doing in such a way as to enable performance deficits and/or enhance performance enablers through the inherent demands and –effects of the activity. Purpose: Activity Analysis 1. Activity Analysis is undertaken to describe the unusual manner in which an activity is performed. 2. Activity Analysis is applied in selecting an activity for treatment. 3. Activity analysis is applied when an activity must be adapted to meet prerequisites for treatment. → By referring to the characteristics of the activity in terms of the prerequisites, the variable inherent properties inherent might be adapted to bring about closer alignment. → Adaptation occurs prior to and during treatment to ensure that the activity matches the changes in the patient's condition. 4. Activity analysis can be applied during treatment as a means for recording the way in which the patient performs an activity to ensure that; → The inherent demands of treatment are being fulfilled or → For ongoing assessment purposes. 49 Analysis for Purpose if Selecting Activity for Treatment: To establish whether an activity has the necessary characteristics for successful treatment. → To identify the characteristics of an activity, which is provisionally regarded as most suitable for treatment. → The characteristics of the activity are considered against the goals of the treatment session in order to confirm that the intended outcome will be achieved. Analysis of Occupational Patterns: What can we learn from the analysis of Occupational Patterns? Patterns of occupations over time inform us about what people value or what society/environment demands from them. Time use patterns tell us something about the structure of people’s lives. The combined meaning/purpose of occupations we engage in shape health/wellness The structure and routine of people’s lives are often habitual. Habits stabilise (or destabilise, in the case of health-compromising habits) the capacity to cope with the demands of everyday life because they conserve emotional and physical energy. Occupational Balance: The highly individual combination of time uses patterns, habits and routines that enables optimal participation in life and promote a sense of wellbeing. Balance: Satisfaction in terms of: Occupational Areas. → Work → Leisure → Play → Learning → Social Interaction → Personal and Community Living The dimensions of activity. 50 Definitions: “Right amount of occupation and the right variation between occupations in the occupational pattern subjectively defined by the individual” “The individual’s subjective experience of having the “right mix” (i.e., amount and variation) of occupations in his/her occupational pattern”. This definition can be used from several perspectives: → Occupational areas → Occupations with different characteristics → Time use. A balanced lifestyle is one in which available opportunities for participation in occupations are utilised in order to promote self-maintenance, intrinsic gratification, social contribution and interpersonal relatedness. Occupational balance does NOT necessarily mean 8 hrs a work, 8 hrs sleeping, 4 hrs self-care and 4 hours leisure. OB is generally accepted to be subjective and individual in nature. Dimensions considered in OB: Occupational areas Occupations with different characteristics Challenges Occupational patterns Roles Rhythm of occupations Satisfaction with occupation Social environment A Focus on Time: Balance: Satisfaction in terms of: Time Use → Regardless of how they are named or classified, occupations constitute the use of time. Instruments used by Occupational Therapists to analyse Occupational Time Use Patterns: → Activity Clock → Idiosyncratic Activities Configuration ▪ Questionnaire 51 Activity Clock: Used to depict time over a 24-hour cycle as classified into Work, Leisure, PLS and Rest/Sleep Limitations: The measurement provides a global idea and lacks specificity. The issue is not that people are expected to fit into prescribed patterns; rather getting symmetry of habits and routines – highlighting highly personal use of time. Idiosyncratic Activities Configuration: (From Activities Health by Cynkin & Robinson) Mon Tue Wed Thu Fri Sat Sun 12h00 – 01h00 01h00 – 02h00 02h00 – 03h00 03h00 – 04h00 04h00 – 05h00 Instructions: Activity Configuration Record everything you do every day for one week, hour by hour. Make a list of all the activities that you have done during the entire week. Classify the activities and code them by colour → Sleep/ Work/ Chores/ Leisure/ Self-care. Answer the Questionnaire. Questionnaire: 1. Using Activities Schedule and Activities List: a. At which specific times is each activity done? (TIMING) b. For how long is each activity done? (DURATION). c. What activity comes before each activity? After each activity? (SEQUENCING). d. How often during the week do you do the same activity? (FREQUENCY). e. List the activities appearing in the completed schedule under the following headings; i. Number of times weekly ii. Number of times daily 52  2. Using the list of Activities only: a. For how long have you been doing each activity? (HISTORICAL DURATION). b. Where do you do each activity? (SPACIAL/ LOCATIONAL) c. With whom do you do each activity? (SOCIAL) d. From whom did you learn each activity? (PERSONAL EQUATION). e. How do you feel about each activity? (PERSONAL EQUATION). f. Which activities do you choose to do? (PERSONAL EQUATION). A Focus on Roles: Role Analysis: Role Past Present Future Value assigned to the role Student Worker Volunteer Care giver Home maintainer Friend Family member Religious participant Hobbyist Participant in organisations A Focus on Dimensions of Occupation: Personal Project Analysis: 1. List the projects in which you are currently engaged on a piece of paper. → You will probably have between 8 and 15. 2. Choose 10 of the projects that you are most likely to engage in during the coming weeks. Number the projects from 1 to 10. 3. Refer to the Core Dimensions listed on the next slide. Use the 10-point matr