New opportunities for occupational therapy through the occupation of contemporary pilgrimage

Twenty-first century pilgrimage is a journey of great personal significance not limited to traditional religiosity. The transformative potential of this diverse and evolving occupation is increasingly evidence based. This opinion piece explores the definition of contemporary pilgrimage and underlines the relevance of this occupation to occupational therapists and their clients. The exceptional accessibility of contemporary pilgrimage is described, suggesting limitless opportunities for the use of pilgrimage as a therapeutic tool. Interdisciplinary examples of promoting wellbeing through contemporary pilgrimage are then presented. This opinion piece seeks to inspire a local response to this global phenomenon.

Dynamic and diverse ways of knowing in mental health occupational therapy

This study focused on evidence based practice in mental health occupational therapy. It investigated the theoretical, evidentiary and practical knowledge that occupational therapists use to support consumers and understand the relationship between occupation and health.

Evidence for mental health occupational therapy: trends in the first decade of the new millenium (200-2013)

This article reports on the evidence for mental health occupational therapy in peer-reviewed journals from 2000 to 2013. Descriptive and inductive methods were used to address this question, with evidence from CINAHL, OTDBase, PSYCInfo, SCOPUS, and Google Scholar® included. Many articles (n = 1,747) were found that met the inclusion and exclusion criteria. A total of 47 different methods were used to develop evidence for mental health occupational therapy, and evidence appeared in 300 separate peer-reviewed journals. It takes on average 7 months for an article to progress from submission to acceptance, and a further 7 months to progress from acceptance to publication. More than 95% of articles published between 2000 and 2002 were cited at least once in the following decade, and around 70% of these citations were recorded in non-occupational therapy journals. The current evidence base for mental health occupational therapy is both substantial and diverse.

Occupational therapy with people with depression: using nominal group technique to collate clinician opinion

AIMS: This aim of this study was to obtain a consensus from clinicians regarding occupational therapy for people with depression, for the assessments and practices they use that are not currently supported by research evidence directly related to functional performance. The study also aimed to discover how many of these assessments and practices were currently supported by research evidence.

METHODS: Following a previously reported systematic review of assessments and practices used in occupational therapy for people with depression, a modified nominal group technique was used to discover which assessments and practices occupational therapists currently utilize. Three online surveys gathered initial data on therapeutic options (survey 1), which were then ranked (survey 2) and re-ranked (survey 3) to gain the final consensus. Twelve therapists completed the first survey, whilst 10 clinicians completed both the second and third surveys.

MAJOR FINDINGS: Only 30% of the assessments and practices identified by the clinicians were supported by research evidence. A consensus was obtained on a total of 35 other assessments and interventions. These included both occupational-therapy-specific and generic assessments and interventions. Principle conclusion. Very few of the assessments and interventions identified were supported by research evidence directly related to functional performance. While a large number of options were generated, the majority of these were not occupational therapy specific.

Identifying educational priorities for occupational therapy students to prepare for mental health practice in Australia and New Zealand: opinions of practising occupational therapists

BACKGROUND: The effective preparation of occupational therapy students for mental health practice is critical to facilitate positive consumer outcomes, underpin optimal practice and support new graduates' professional identity. This project was established to determine a set of 'educational priorities' for occupational therapy students to prepare them for current (and future) entry-level practice in mental health, from the perspective of mental health occupational therapists in Australia and New Zealand. METHODS: The study included two phases. In Phase One, participants identified what they considered to be important educational priorities for occupational therapy students to prepare them for practice in mental health. For Phase Two, an 'expert panel' was assembled to review and rank these using a Policy Delphi approach. RESULTS: Eighty-five participants provided educational priorities in Phase One. These were grouped into a total of 149 educational themes. In Phase Two, the expert panel (consisting of 37 occupational therapists from diverse locations and practice settings) prioritised these themes across three Delphi rounds. A final priority list was generated dividing educational themes into three prioritised categories: 29 'Essential', 25 'Important' and 44 'Optional' priorities. Highest-ranked priorities were: clinical reasoning, client-centred practice, therapeutic use of self, functional implications of mental illness, therapeutic use of occupation and mental health fieldwork experience. CONCLUSION: The priority list developed as part of this project provides additional information to support the review of occupational therapy curricula across Australia and New Zealand to ensure that new graduates are optimally prepared for mental health practice.

Historical perspectives of occupational therapy and mental health

Occupational therapy emerged as a health profession in Australia at a time when thousands of people with mental illness lived behind high walls, devoid of normal routines and activities. Detailed analysis of texts of practice, images and stories are used in this study to illustrate the dynamic link between practice environments and the knowledge of occupational therapy that aimed to confront the problems of institutional living. Occupational therapists implemented craft-based practice within psychiatric institutions of the 1940s and 1950s. Through two decades, occupational therapists aligned their practice with medical paradigms before returning to occupation as a core of practice knowledge. Following closure of institutions during the 1990s, occupational therapists were challenged by relocation to community-based, multidisciplinary environments. Occupation again emerged as the central concept of community living. The study concludes that occupational therapy has a quiet, yet consistent role within the changing environment of mental health practice. Gender, social views and practice environments are significant influences on the evolution of occupation as a core of practice.

Perceptions of fieldwork in occupational therapy

Background There are few studies in occupational therapy that compare the perceptions of supervisors and students regarding quality clinical placement programmes, and those that exist indicate substantial differences in the perceptions held by each group. Methods This pilot study was conducted using a cross-sectional descriptive design, with a single questionnaire distributed to occupational therapy students and clinical supervisors. A total of 40 questionnaires were returned: 17 from students and 23 from clinical supervisors. Results Differences were found between the perceptions of occupational therapy students and clinical supervisors in response to four topics: preparation from the university for their placements; consistency across placement sites; instances of supervisors seeking feedback from students; and the burden associated with the placement-related workload for clinicians.

Occupational therapy in forensic psychiatry: Recent developments in our understandings (2007-2013)

Introduction: Occupational therapy in forensic settings has developed in recent decades, leading to an increasing amount of research being conducted in this field. There have been two previous attempts to provide overviews of this body of evidence and future directions for research; however, the rate of research has accelerated in recent years. This critical review addresses the following question: what evidence has been published about occupational therapy in forensic psychiatry over the past 7 years? Method: A mixed methods approach was adopted, with four databases and a search engine consulted (OTDBase, CINAHL, AMED, PSYCHInfo, Google Scholar). The inclusion criteria were: (a) articles published in peer reviewed journals since 2007 and (b) authored by at least one occupational therapist. Twenty-five studies were identified for review, and the four dimensions of occupation - doing, being, becoming and belonging - were used to provide a theoretical context for the subsequent discussion. Findings: The recent evidence base in forensic psychiatry focuses on doing and being, with fewer articles addressing becoming and belonging. Conclusion: This review has identified increasing numbers of studies about forensic occupational therapy, which may reflect growth in both interest and the worldwide workforce.

Occupational therapists and the use of constraint-induced movement therapy in neurological practice

There is adaquate evidence for supporting the use of constraint-induced movement therapy (CIMT) in post-stroke rehabilitation. However, the actual usage of CIMT in routine occupational therapy practice appears limited. Further research is required to study why this might be so.

A grounded theory of intuition among occupational therapists in mental health practice

Objectives: This study aimed to explore occupational therapists’ understanding and use of intuition in mental health practice.
Method: Using a grounded theory approach, a theoretical sample of nine occupational therapists practising in mental health settings participated in semi-structured interviews. Data were analysed using the constant comparative method.
Findings: Intuition was found to be embedded within clinical reasoning. From the data, intuition was defined as knowledge without conscious awareness of reasoning. The participants viewed intuition as elusive and underground, and suggested that professional experience led to a more comfortable use of intuition. Using intuition relied on therapists’ understanding of their own and others’ emotions, and intuition partnered analysis within their clinical reasoning. A grounded theory of the use of intuition in mental health settings is proposed.
Conclusion: Occupational therapists practising in mental health settings understand intuition to be an instinctive understanding of situations, resulting from their professional experience and the understanding of emotions.