Client-centred practice in occupational therapy: Critical reflections

In Canada, the guidelines for the practice of occupational therapy are named and framed as client-centred. Two in-depth interviews were conducted with clients of mental health services about their experiences with a hospital-based occupational therapy service. These occupational therapy clients described their experiences as prescriptive, and as less than client-centred. With the publication of Enabling occupation: A Canadian occupational therapy perspective (Canadian Association of Occupational Therapists [CAOT], 1997) and an increasingly refined focus on being client-centred, these interviews highlight the challenges of a client-centred practice within the current health care environment. These occupational therapy clients raise issues of importance for occupational therapy. The participants stated that the prescription of 'activity', a lack of choice, and a focus upon the illness as opposed to the individual, served to diminish any collaborative partnership with the client and eliminate the client from any decision-making process. This distancing from the client, in their opinion, served to greatly diminish any therapeutic value of occupation. The participants recommended a greater focus upon occupational choice, consideration of the individual within the client, providing accepting, supportive environments, and using professional expertise on occupation to guide the client towards participation in meaningful occupation. These recommendations are strikingly similar to the most recent guidelines for the client-centred practice of occupational therapy in Canada. A discussion of the implications of these findings for the client-centred practice of occupational therapy is offered.

Background: Since the beginning of the occupational therapy profession, engagement in occupation has been valued as the primary therapeutic agent as well as the goal of intervention. While there are few today who would not support this idea, occupational therapists continue to struggle with implementing their beliefs through “what we do” and “how we do it”. Contributing to this problem is their failure to use terminology in a manner that clearly defines what and how occupational therapists do what they do in occupational therapy research, education, and practice. Methods: The author will, therefore, first discuss some key occupational therapy terms and propose that they represent an occupation-related taxonomy that can be used to more clearly define and describe for occupational therapists and others what they do and how they do what they do as occupational therapists. Then, with a goal of fostering critical self-reflection among occupational scientists and occupational therapy researchers, educators, and practitioners, the author will go through the stages of the occupational therapy process outlined in the Occupational Therapy Intervention Process Model (OTIPM) and demonstrate how a more precise use of this occupation-related taxonomy can facilitate maximizing the power of occupation in practice.

Upon completion of this chapter, the reader will be able to describe the history and importance of client-centred practice in occupational therapy and define client-centred practice and the key features of this way of working with people. The chapter will also consider the range of factors that occupational therapists need to consider in optimising the client-centred nature of their practice.

Official documents and professional policies are approved by the AOTA Representative Assembly and undergo scheduled review and approval by the Representative Assembly Coordinating Committee (RACC). These documents are used by the Association and its membership to guide education, practice, advocacy, and policy on behalf of the profession. The documents are a valuable resource for occupational therapy practitioners and provide a solid grounding in the profession for students, consumers, and external stakeholders.Items in bold are new for 2022 and are available in this supplement to the American Journal of Occupational Therapy. Official documents are periodically reviewed, and documents may be superseded by newer versions or rescinded. A complete list of the most current documents is available at https://www.aota.org/practice/practice-essentials/aota-official-documents.Guidance documents provide comprehensive perspective and guidance on topics that shape advancement of the profession and its future direction. ▪ Guidelines for Documentation of Occupational Therapy (2018)▪ Guidelines for Occupational Therapy Services in Early Intervention and Schools (2017)▪ Guidelines for Reentry Into the Field of Occupational Therapy (2020)▪ Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (2020)▪ Occupational Therapy Practice Framework: Domain and Process, 4th Edition (2020)▪ The Practice of Occupational Therapy in Feeding, Eating, and Swallowing (2017)▪ A Descriptive Review of Occupational Therapy Education (2016)▪ Scholarship in Occupational Therapy (2022)Position statements present an official stance on the provision of services, practice of occupational therapy, or role of occupational therapy. They are developed in response to a professional issue, concern, or need. ▪ COE Academic Terminal Degree (2022)▪ Assistive Technology and Occupational Performance (2016)▪ Autism Spectrum Disorders Across the Life Course and Occupational Therapy Services (2022)▪ Cognition, Cognitive Rehabilitation, and Occupational Performance (2019)▪ Continuing Professional Development in Occupational Therapy (2016)▪ Driving and Community Mobility (2016)▪ Fieldwork Level II and Occupational Therapy Students (2018)▪ Importance of Collaborative Occupational Therapist-Occupational Therapy Assistant Intraprofessional Education in Occupational Therapy Curricula (2017)▪ Importance of Interprofessional Education for Occupational Therapy (2022)▪ Importance of Primary Care Education in Occupational Therapy Curricula (2017)▪ Inclusive Environments: Home, Work, Public Spaces, Technology, and Specialty Environments (2022)▪ Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice (2017)▪ Occupational Therapy and Complementary Health Approaches and Integrative Health (2016)▪ Occupational Therapy Doctoral Capstone: Purpose and Value (2022)▪ Occupational Therapy Fieldwork Education: Value and Purpose (2022)▪ Occupational Therapy for Children and Youth Using Sensory Integration Theory and Methods in School-Based Practice (2015)▪ Occupational Therapy in the Promotion of Health and Well-Being (2019)▪ Occupational Therapy Scope of Practice (2021)▪ Occupational Therapy Services for Individuals Who Have Experienced Domestic Violence (2017)▪ Occupational Therapy Services in Facilitating Work Participation and Performance (2017)▪ Occupational Therapy Services in the Promotion of Mental Health and Well-Being (2016)▪ Occupational Therapy’s Commitment to Diversity, Equity, and Inclusion (2020)▪ Occupational Therapy’s Perspective on the Use of Environments and Contexts to Facilitate Health, Well-Being, and Participation in Occupations (2015)▪ Occupational Therapy’s Role in Case Management (2018)▪ Occupational Therapy’s Role in Medication Management (2017)▪ Occupational Therapy’s Role in the Neonatal Intensive Care Unit (2018)▪ Occupational Therapy’s Role With Chronic Conditions (2022)▪ Philosophical Base of Occupational Therapy (2017)▪ Philosophy of Occupational Therapy Education (2018)▪ Role of Occupational Therapy in End-of-Life Care (2016)▪ Role of Occupational Therapy in Pain Management (2021)▪ Physical Agents and Mechanical Modalities (2018)▪ Role of Occupational Therapy in Primary Care (2020)▪ Role of Occupational Therapy in Wound Management (2018)▪ Telehealth in Occupational Therapy (2018)▪ Value of Occupational Therapy Assistant Education to the Profession (2019)▪ Vestibular Impairment, Vestibular Rehabilitation, and Occupational Performance (2017)Professional standards describe and define minimal standards for practice, continued competence, and other professional behaviors. ▪ AOTA 2020 Code of Ethics▪ Standards for Continuing Competence (2021)▪ Standards of Practice for Occupational Therapy (2021)Societal statements are written in the form of public announcements and identify a societal issue of concern; state how the issue affects the participation of individuals, families, groups, or communities in society; and may offer action to be taken by individuals, families, groups, or communities. ▪ AOTA’s Societal Statement Denouncing Conversion “Therapy” (2022)▪ AOTA’s Societal Statement on Disaster Response and Risk Reduction (2017)▪ AOTA’s Societal Statement on Community Violence (2022)▪ AOTA’s Societal Statement on Gun Violence (2022)▪ AOTA’s Societal Statement on Health Disparities (2013)▪ AOTA’s Societal Statement on Health Literacy (2016)▪ AOTA’s Societal Statement on Livable Communities (2016)▪ AOTA’s Societal Statement on Stress, Trauma, and Posttraumatic Stress Disorder (2017)▪ AOTA’s Societal Statement on Youth Violence (2016)▪ Specialized Knowledge and Skills of Occupational Therapy Educators of the Future (2009)

Although there is a focus in occupational science (OS) and occupational therapy (OT) research on social, policy, and physical issues that limit participation, there needs to be continued emphasis on populations and global worldviews. I propose the identification and use of the concept of social and environmental determinants of occupation (SEDO) to examine the complex issues that influence people’s experience through an intersectional lens and affect their access to participate in culturally meaningful occupations. SEDO are defined as broad (and intersecting) social and environmental factors that increase or limit an individual, community, or population’s participation in culturally meaningful occupations of their choice. Unique to SEDO and supported by OS and OT research and practice is the consideration of intersectionality, or how these global factors intersect in a multiplicative manner to influence participation. The discussion highlights health and non-health related examples of the ways intersecting SEDO identify disparities and occupational injustices that affect access to occupations for populations who experience these injustices. The need for continued research and consideration of proposed SEDO is imperative to further OS research, OT practice, and education supporting occupational justice through program and policy development and advocacy. In addition to the effect on research and practice, these considerations provide a strategy for occupational scientists and occupational therapists to monitor and evaluate the impact of policies and programs developed to address these issues and increase participation in culturally meaningful occupations for marginalized populations.

Upon completion of this chapter, the reader will be able to describe the contribution that research makes to underpin and justify occupational therapy education and practice in Australia, explain the purpose of different methodologies commonly used by occupational therapy researchers, and highlight the importance of becoming an informed and skilled research consumer as an occupational therapy student and professional.

Introduction: Occupational therapy has traditionally focused on child development but motherhood as an occupation is rarely analyzed. This study aimed to identify practices, theoretical perspectives, and concepts described or used in occupational therapy research concerning the early periods of motherhood and explore the literature to contribute to the advancement of practice. Method: A scoping review was conducted to map and synthesize multiple perspectives, provide current insights into motherhood as an occupation, and inform occupational therapists’ practice. Search across five databases and manual research in periodicals in the area were conducted up to mid-2024. Thematic analysis was used for data analysis. Findings: Eleven articles were included. The analysis revealed three themes: occupational therapy practitioner goals; occupational therapy practices; and theories and concepts supporting the relationship between motherhood, occupation and occupational therapy. The study underscores the limited number of studies available and highlights the need for clearer conceptual definitions and more explicit links between intervention strategies and underlying theoretical frameworks. Conclusion: There is a compelling need for more research to enhance our understanding of the significance of motherhood as an occupation. This understanding will serve as a foundation for refining the role of occupational therapy in supporting motherhood.

In her 2001 edited text, Qualitative Research in Occupational Therapy: Strategies and Experiences, Joanne Valiant Cook presents an approachable and informative introduction to qualitative research for occupational therapists. As the discipline of occupational therapy continues to develop its own base of knowledge, the need for research methods which capture the complexity of occupation has become evident. Through considering the similarity between the founding principles of occupational therapy and the world-view of qualitative research, Cook presents a theoretically-oriented research guide specific to the domain of concern of occupational therapy. Examples of qualitative studies and reflections of occupational therapy researchers will be helpful to occupational therapy practitioners and researchers embarking upon the journey of qualitative inquiry to contribute to the discipline’s body of knowledge.

Development, refinement, and testing of occupational therapy interventions require a systematic approach. The authors explain the four phases for clinical trials used in pharmaceutical research and apply them to the development and testing of occupational therapy interventions. The challenges faced by occupational therapy researchers in designing clinical trials include difficulties in specifying the intervention, blinding subjects, therapists, and evaluators, and identifying objective but client-centered measures of primary outcomes. Examples are provided of researchers who have developed and tested occupational therapy interventions in phases.

Occupational therapists use a range of types and sources of information when making clinical decisions. It is unclear how this information is integrated. This paper describes an exploratory qualitative case study that identified the types and sources of information accessed by one experienced paediatric therapist and how this information was combined and prioritised when making clinical decisions. . Data were collected using observations of therapy sessions, key informant interviews, and semi-structured interviews. Data were analysed thematically. To inform clinical decisions, the participant prioritised information about each child in his or her context when making decisions. Other types of information from text books and journals, professional development activities and professional and personal experience, expanded her unique body of knowledge over time. Re-conceptualisation of how information use supports clinical decision making and expands a therapist's unique body of knowledge over time can support client-centred practice in occupational therapy.

Objective: To obtain an insight into the present situation of Occupational Therapy as a profession in India. Considering the professional experiences, documentation, and availability of Occupational therapy resources. The online survey was conducted using a single-phase, cross-sectional design. Participants: Convenience sampling, Occupational Therapy Professionals, having a minimum of 6 months working experience. Approximately 1700+ potential respondents were approached via social media and E-mails. Only 60 responses were recorded, however, out of 60, three responses did not meet the inclusion criteria, and 1 response because of deliberately misleading details was excluded, therefore leaving only 56 responses for consideration. The primary outcome measure was to report about the present scenario in occupational therapy practices in India and to understand the current occupational therapy industry across India. After analyzing responses findings were that Occupational Therapy practices in the country were skewed to domains of pediatrics. SOAP notes were chosen as leading methods of documentation, and a large number of Occupational therapy professionals felt that there is scarcity and lacunae in the availability and provision of Occupational therapy equipment and prescription aid in their regions, in India, and also on online market palaces. Conclusion: In a country like India, the skewing of most of the Occupational therapy professionals to domains of ?pediatrics? and ?rehabilitation & disability may be a major cause in restriction of growth of profession on whole. Also, introducing Occupational Therapy assistants in the Indian Context should be considered for the growth of the profession and to concord with WFOT?s QI framework.

ABSTRACTThe purpose of this study was to explore the assessments used in occupational therapy practice through identifying most commonly used assessments and the rationale for their use in different occupational therapy practice areas. The study utilized a nonprobability convenience sample of 260 occupational therapy practitioners attending the American Occupational Therapy Association's annual conference. A descriptive survey research design was used for conducting this study. The survey instrument addressed three major questions related to (a) the area of practice, (b) the specific assessments used, and (c) reasons for using the specific assessments. Descriptive statistics were utilized to analyze the results. Results indicated most of the assessments used in occupational therapy clinics target body structure and function. Assessments were used due to their convenient availability in clinics, clinical utility and standardization, client-centeredness, development by occupational therapists, being taught in school/fieldwork, and being satisfying to insurance companies. Implications for occupational therapy education, practice, and research are presented.

BackgroundAssessing self-efficacy in evidence-based practice (EBP) is crucial for identifying training needs, evaluating the effectiveness of educational programs, and assessing the overall application confidence of EBP in healthcare professions, including occupational therapy (OT). Thus, the objectives of this study were to cross-culturally adapt the Evidence-Based Practice Confidence Scale (EPIC) for Spanish-speaking OT students and professionals and to evaluate its internal consistency, test–retest reliability, and construct validity.MethodsA professional translation and cross-cultural adaptation of the EPIC was developed, including a pilot study that resulted in the EPIC Spanish version. A total of 260 OT students and 202 professionals completed the Spanish EPIC at baseline, with 177 (68.1%) students and 129 (63.9%) professionals participating in the test–retest reliability assessment two weeks later. The EPIC’s internal consistency was evaluated using Cronbach’s alpha. Test–retest reliability was assessed using Spearman’s correlations and intra-class correlations (ICC). Known-groups validity hypothesis based on participants' roles (students, diploma/bachelor’s, master’s, and doctorate) was explored using ANOVA. Finally, an exploratory factor analysis with oblique Promax rotation was conducted to examine the EPIC factor structure.ResultsCronbach’s alpha for the total EPIC score was excellent in both OT professionals (α = 0.91) and students (α = 0.90). For OT students, Spearman’s correlation was 0.67 (p < 0.001) for the total score, and the ICC was 0.66 (95%CI 0.57–0.73). Conversely, for OT professionals, test–retest reliability showed a Spearman’s correlation of 0.87 (p < 0.001) for the total score, and the ICC was 0.87 (95%CI 0.81–0.90). The highest scores were observed in professionals with a doctorate followed by those with a master’s degree (p < 0.001). The exploratory factor analysis yielded a 3-factor solution that explained 71% of the observed variance, with item-level loadings ≥ 0.35.ConclusionsThe EPIC scale showed excellent internal consistency, strong test–retest reliability, and adequate construct validity for evaluating EBP self-efficacy among Spanish-speaking OT professionals using the total score. However, test–retest reliability was moderate among Spanish-speaking OT students, indicating that changes in EBP confidence assessed with the EPIC scale in this group should be interpreted with caution.

Development of a Unique Screening Tool for Acute Care Occupational Therapy Services in Patients Following Total Joint Replacement Surgery

Within professional and practice knowledge there are many assumptions about disability that underpin occupational therapy philosophy. The objectives of this paper are to (a) critically examine how disability has been constructed in mainstream society by introducing perspectives from contemporary disability studies theories, and (b) apply a critically reflexive lens informed by disability studies perspectives to occupational therapy practice. Drawing upon critical disability perspectives, notions of "nondisabled" versus "disabled"; metanarratives of disability; built environments and social structures; and social and attitudinal constructions of disability and identity are examined. Key issues pertaining to rehabilitation, norms, client-centred practice, language, and education within occupational therapy are discussed. This critically reflexive examination has revealed the ways in which occupational therapy and society at large are embedded in discourses that may reinforce negative connotations around disability. A renewed understanding of disability may challenge current practices.