Occupational therapist and client experiences of a mental health group

The purpose of this qualitative study was to understand the client and occupational therapist experiences of a mental health group. A secondary aim was to explore the extent to which this group seemed to have reflected a client-centred approach. The topic emerged from personal and professional issues related to the therapist as teacher and to inconsistencies in practice with the profession's client-centred philosophy. This philosophy, the study's frame of reference, was established in terms of themes related to the client-therapist relationship and to client values. Typical practice was illustrated through an extensive literature review. Structured didacticexperiential methods aiming toward skill development were predominant. The interpretive sciences and, to a lesser extent, the critical sciences directed the methodology. An ongoing support group at a community mental health clinic was selected as the focus of the study; the occupational therapist leader and three members became the key participants. A series of conversational interviews, the . core method of data collection, was supplemented by observation, document review, further interviews, and fieldnotes. Transcriptions of conversations were returned to participants for verification and for further reflection. Analysis primarily consisted of coding and organizing data according to emerging themes. The participants' experiences of group, presented as narrative stories within a group session vignette, were also returned to participants. There was a common understanding of the group's structure and the importance of having "air time" within the group; however, differences in perceptions of such things as the importance of the group in members' lives were noted. All members valued the therapeutic aspects of group, the role of group as weekly activity and, to a lesser extent, the learning that came from group. The researcher's perspective provided a critique of the group experience from a client-centred perspective. Some areas of consistency with client-centred practice were noted (e.g., therapist attitudes); however the group seemed to function far from a client-centred ideal. Members held little authority in a relationship dominated by the leaders, and leader agendas rather than member values controlled the session. Possible reasons for this discrepancy ranging from past health care encounters through to co-leader discord emerged. The actual and potential significance of this study was discussed according to many areas of implications: to OT practice, especially client-centred group practice, to theory development, to further areas of research and methodology considerations, to people involved in the group and to my personal growth and development.

A Foucaultian analysis of power relations in child protection case work with youth and families

This thesis takes some steps in examining the child protection system from a position that is rarely discussed. Specifically, I explore how Foucault's concept of disciplinary power can be used to demonstrate how power operates within the client/worker relationship. This relationship is shown to be quite complex with power flowing bidirectionally, rather than hierarchically. Instead of viewing power imbalances as a function of state control, I show how the client/worker relationship is constituted by the worker, the client, the organization and the social body. A postmodern auto ethnography is used to document my journey as I expose the disciplinary practices and instruments that I was subject to and used with my clients. 2 Given that the child protection system is constantly shifting and changing in order to improve its ability to safeguard children a greater emphasis is required to examine how workers operate within this complex, overwhelming and multi-dimensional world. This thesis has shown that by engaging in a reflexive examination of my position of power different approaches to making intervention beneficial to all involved become available. This is important if child protection work aims to work with clients rather than on clients.

The relationship between working alliance and treatment outcomes in remedial instruction for older dyslexic children

Research in psychotherapy has demonstrated that a positive working alliance between therapist and client leads to positive treatment outcomes. Though its focus is in the area of psychotherapy, the concept of working alliance holds significant value to the area of education. Current applications of the theory in educational settings have looked at relationships between teacher and students in the broad context of classroom interaction and found significant promise. The present study investigates the application of the theory of working alliance in a sample of older reading disabled children. The study examined the psychometric properties of the Reading Alliance Scale for Children (RASC) and for Teachers (RAST) in relation to student reading ability and motivation. A sample of 254 (66.1 % male, 33.9% female) grade 6-8 students (mean age 12.7 years) were enrolled in a remedial reading program for reading disabled children. The average standard score across multiple reading measures was more than 1 SD below age-level expectations. Students responded to measures of reading achievement and motivation at pretest, after 70 hours (post 70) of remediation and at the end of the program (post 125). All participants completed measures on the working alliance relationship at post 70 and post 125. Results showed that teacher reports were most predictive of outcome compared to student reports of the working alliance relationship. Working alliance was correlated with posttest reading ability and motivation. Male students and Black students obtained the weakest working alliance reports from their teacher. Overall, findings support the view that students' relationships with teachers provide an important component of success in the classroom.

The perceptions of commune health workers about an education strategy received for counselling fathers about infant and breastfeeding involvement

Objective To evaluate the perceptions of healthcare workers in Vietnam about the efficacy of a continuing education strategy about father involvement and breastfeeding counselling. Design One group, post-test only, quasi-experimental design Method A questionnaire based on Social Cognitive Theory (SCT; Bandura, 2004) was disseminated to participants (N=28). This questionnaire measured self-efficacy, outcome expectations, socio-structural factors, goal setting and behaviour. Multiple regressions were analyzed predicting participants’ practice of client focused father involvement consulting. Results Bivariate correlations demonstrated the anticipated patterns of association between SCT-based constructs. Multiple regression analysis indicated that outcome expectations and barriers were significant predictors of client focused father involvement consulting. Conclusions Participants reported that the education increased their self-efficacy, outcome expectations and client focused father involvement consulting behaviour. Future education should be accessible, increase counselling confidence and address beliefs about the outcomes and challenges of father involvement consulting.

The evaluation of a predialysis class on client knowledge and attitude toward compliant behaviours

In this quasi-experimental study, the theory of reasoned action was used as a conceptual framework to assess the outcome effect of a predialysis class. A pretest, posttest design was used to determine changes in client knowledge about their condition and its treatment, and their intention, attitudes and social norm towards compliant behaviours. The related compliant behaviours were following a low-salt diet and taking medications as proscribed. Thirty-eight End Stage Renal Diseases (ESRD) clients were self-selected into the treatment or control groups. Both groups received the standard predialysis education from members of the multidisciplinary renal team. In addition, the treatment group also attended the predialysis class. Subjects' health locus of control, anxiety and demographic variables were measured as possible extraneous variables. Study subjects from both groups demonstrated a high internal and powerful others health locus of control and a normal range of anxiety. Although not statistically significant ill = .64), the experimental group demonstrated higher knowledge level and greater intention to follow a low salt diet UL= .73). They developed more significantly positive attitudes towards following a low salt diet and increased subjective norm influence after attending the predialysis class. Attending the predialysis class did not have an effect on subjects' intentions, attitudes or subjective norm towards taking medications as prescribed. Conclusion: The predialysis class was only marginally effective in increasing client knowledge, but influenced clients' attitudes towards following a low-salt diet. Based on the results, recommendations for improvements to the class have been suggested.

Preoperative education and its influence on perception of recovery for clients awaiting total hip and total knee replacement surgery /

The puqjose of this study was to examine the manner in which an inviting approach to a preoperative teaching and learning educational experience influenced the perception and subsequent recovery of clients who were awaiting total hip and total knee replacement surgery. An in-depth review of the internal and external factors that shape client perceptions was undertaken in this study. In addition, this study also explored whether or not the Prehab Program was preparing clients physically, socially, and psychologically for surgery. Data for this qualitative case study research were collected through preoperative interviews with 4 participants awaiting total hip replacement surgery and 1 participant awaiting total knee replacement surgery. Four postoperative interviews were conducted with the participants who had received total hip replacement surgery. The occupational therapist and physical therapist who were the coleaders of the Prehab Program at the time of this study were also interviewed. The results of this study suggest that while individuals may receive similar educational experiences, their perceptions of the manner in which they benefited from these experiences varied. This is illustrated in the research findings, which concluded that while clients benefited physically from the inviting approach used during the practical teaching session, not all clients perceived the psychological benefits of this practice session, especially clients with preexisting high levels of anxiety. In addition to increasing the understanding of the internal as well as external factors that influence the perceptions of clients, this study has also served as an opportunity for reflection on practice for the Prehab therapists and other healthcare educators.

The efficacy of cognitive retraining of attentional deficits for a client who has schizophrenia

The purpose of this study was to assess the efficacy of the Process Specific Approach to cognitive rehabilitation for a client with schizophrenia who has attentional deficits. The study was a single case experimental design which followed a variation of the multiple baseline approach. Prior to training of the attentional deficit, multiple baseline assessments were completed. These included an ov:erview of the sUbject's information processing ability, random measures of attention and a genera.l level of functioning in living, learning and working environments. During the re-training, attention tests were administered at the completion of each attention component. A general functional evaluation through interviews and a measure of information processing ability were. completed after the re-training was concluded. The results of the study demonstrate a significant i'mprovement in attention and memory measures. Qualitative data indicate si·gni.ficant others observed improvements in performance in r livi'ng, learning and working environments. The results suggest this approach to cognitive rehabilitation was effective with this subject and further research to establish generalizability is recommended.

A sequential analysis of therapist scaffolding and child concept formation in narrative therapy

Narrative therapy is a postmodern therapy that takes the position that people create self-narratives to make sense of their experiences. To date, narrative therapy has compiled virtually no quantitative and very little qualitative research, leaving gaps in almost all areas of process and outcome. White (2006a), one of the therapy's founders, has recently utilized Vygotsky's (1934/1987) theories of the zone of proximal development (ZPD) and concept formation to describe the process of change in narrative therapy with children. In collaboration with the child client, the narrative therapist formalizes therapeutic concepts and submits them to increasing levels of generalization to create a ZPD. This study sought to determine whether the child's development proceeds through the stages of concept formation over the course of a session, and whether therapists' utterances scaffold this movement. A sequential analysis was used due to its unique ability to measure dynamic processes in social interactions. Stages of concept formation and scaffolding were coded over time. A hierarchical log-linear analysis was performed on the sequential data to develop a model of therapist scaffolding and child concept development. This was intended to determine what patterns occur and whether the stated intent of narrative therapy matches its actual process. In accordance with narrative therapy theory, the log-linear analysis produced a final model with interactions between therapist and child utterances, and between both therapist and child utterances and time. Specifically, the child and youth participants in therapy tended to respond to therapist scaffolding at the corresponding level of concept formation. Both children and youth and therapists also tended to move away from earlier and toward later stages of White's scaffolding conversations map as the therapy session advanced. These findings provide support for White's contention that narrative therapists promote child development by scaffolding child concept formation in therapy.

The development, assessment, and implementation of an evaluation of the EMPOWER Program at shelters for abused women /

The development, assessment, and implementation of a program evaluation instrument was carried out to evaluate the impact and efficacy of the EMPOWER Program. This intervention was created to educate residents at a shelter for abused women with an anticipated outcome of prevention. Participants included the staff and residents at 2 shelters in Southern Ontario. Client pre, post and follow-up measures were obtained and analyzed statistically and using keyword content analysis. A single staff measure was obtained and summarized using keyword content analysis. Qualitative results were suggestive of important change in participants. All women in the post and follow-up measures believed their participation in the EMPOWER Program provided them with the knowledge, skills, and confidence to avoid abusive relationships in the fliture. This transformational impact was repeatedly expressed in both resident and staff feedback. Limitations of this research, as well as suggestions for future study were discussed.

Reading Instruction and Instructors’ Perceptions of Learners’ Needs in LINC Level 1-3 Classes

This study investigates instructors’ perceptions of reading instruction and difficulties among Language Instruction for Newcomers to Canada (LINC) Level 1-3 learners. Statistics Canada reports that 60% of immigrants possess inadequate literacy skills. Newcomers are placed in classes using the Canadian Language Benchmarks but large, mixed-level classes create little opportunity for individualized instruction, leading some clients to demonstrate little change in their reading benchmarks. Data were collected (via demographic questionnaires, semi-structured interviews, teaching plans, and field study notes) to create a case study of five LINC instructors’ perceptions of why some clients do not progress through the LINC reading levels as expected and how their previous experiences relate to those within the LINC program. Qualitative analyses of the data revealed three primary themes: client/instructor background and classroom needs, reading, strategies, methods and challenges, and assessment expectations and progress, each containing a number of subthemes. A comparison between the themes and literature demonstrated six areas for discussion: (a) some clients, specifically refugees, require more time to progress to higher benchmarks; (b) clients’ level of prior education can be indicative of their literacy skills; (c) clients with literacy needs should be separated and placed into literacy-specific classes; (d) evidence-based approaches to reading instruction were not always evident in participants’ responses, demonstrating a lack of knowledge about these approaches; (e) first language literacy influences second language reading acquisition through a transfer of skills; and (f) collaboration in the classroom supports learning by extending clients’ capabilities. These points form the basis of recommendations about how reading instruction might be improved for such clients.

Examination of students' ability to observe domains of client behaviour in therapeutic recreation

When observing client behaviours, a therapeutic recreation specialist must have a base understanding of typical client behaviours to provide an informed analysis (burlingame & Blaschko, 2010). Providing students with the necessary tools for client observation is significant to the success of this process. The purpose of this study was to assess the relationships amongst the TR student demographic characteristics on acquiring the observation competency necessary to conduct a TR assessment. One hundred seventy-two TR college and university students, enrolled in post-secondary undergraduate TR programs across Ontario, observed a client assessment via video, and recorded their observations using the Tracking Behavioural Assessment (TBA) (Passmore, 2002). Independent samples t-tests and analysis of variance were calculated for the different student characteristics on the domains of the TBA. Significant findings indicated that university students scored more accurately than college students, and advanced students more accurately than novice students, on the emotional and socialization domains.

Using Network Analysis to Understand and Advance Falls Prevention Services and Programs

The purpose of this study was to understand referral linkages that exist among falls prevention agencies in a southern Ontario region using network analysis theory. This was a single case study which included fifteen individual interviews. The data was analyzed through the constant comparative approach. Ten themes emerged and are classified into internal and external factors. Themes associated with internal factors are: 1) health professionals initiating services; 2) communication strategies; 3) formal partnerships; 4) trust; 5) program awareness; and 6) referral policies. Themes associated with external factors are: 1) client characteristics; 2) primary and community care collaboration; 3) networking; and 4) funding. Recommendations to improve the referral pathway are: 1) electronic database; 2) electronic referral forms; 3) educating office staff; and 4) education days. This study outlined the benefit of using network analysis to understand referral pathways and the importance of implementing strategies that will improve falls prevention referral pathways.

The Hidden Truths of Self-Presentation, Self-Disclosure, and Deception on Online Dating Profiles: A Call for Change

The way in which individuals seek romantic partners has changed considerably in the past decades, most notably through online dating sites (ODSs). Despite the possibility of misrepresentation amongst client users, such sites continue to grow in popularity because ODSs provide a large pool from which individuals can select and attract potential partners. While much research has been undertaken on ODSs, little empirical research has examined postsecondary students’ use of ODSs. Therefore, this study sought to investigate why postsecondary students have become involved with and how they present themselves on ODSs. The researcher surveyed 20 postsecondary students and conducted in-depth interviews with 2 participants who use ODSs. Although the limited sample prevented results from being generalized, quantitative and qualitative analyses suggest that participants became involved with ODSs for various purposes, such as seeking long-term relationships and/or marriage partners, or simply exploring or visiting ODSs out of curiosity. Findings indicate that ODS users’ physical appearance and/or “attractiveness” is considered the strongest predictor of relationship success. The study discusses how participants’ self-presentation affects outcomes of ODS usage, particularly when negative self-identification and presentation corresponding to factors such as individuals’ weight and age are taken into account.

Social competence following mild head injury and moderate traumatic brain injury: Investigating the neuropsychological relationships between arousal, social decision-making and depression

Client-directed long-term rehabilitative goals and life satisfaction following head injury emphasize the importance of social inclusion, rather than cognitive or physical, outcomes. However, very little research has explored the socio-emotional factors that pose as barriers to social reintegration following injury. This study investigates social barriers following head injury (i.e., decision-making - Iowa Gambling Task [IGT] and mood – depression) and possible amelioration of those challenges (through treatment) in both highly functioning university students with and without mild head injury (MHI) and in individuals with moderate traumatic brain injury (TBI). An arousal manipulation using emotionally evocative stimuli was introduced to manipulate the subject’s physiological arousal state. Seventy-five university students (37.6% reporting a MHI) and 11 patients with documented moderate TBI were recruited to participate in this quasi-experimental study. Those with head injury were found to be physiologically underaroused (on measures of electrodermal activation [EDA] and pulse) and were less sensitive to the negative effects of punishment (i.e., losses) in the gambling task than those without head injury, with greater impairment being observed for the moderate TBI group. The arousal manipulation, while effective, was not able to maintain a higher state of arousal in the injury groups across trials (i.e., their arousal state returned to pre-manipulation levels more quickly than their non-injured cohort), and, subsequently, a performance improvement was not observed on the IGT. Lastly, head injury was found to contribute to the relationship between IGT performance and depressive symptom acknowledgment and mood status in persons with head injury. This study indicates the possible important role of physiological arousal on socio- emotional behaviours (decision-making, mood) in persons with even mild, non-complicated head injuries and across the injury severity continuum.