Multiskilling: a survey of occupational therapy practitioners' attitudes

OBJECTIVE: Multiskilling has been identified as one means of reducing she cost of health care. This study examined occupational therapy practitioners' knowledge of multiskilling, how it is affecting service delivery and quality of care, and how therapists believe the addition of skills should occur. METHOD: A questionnaire was constructed for the survey and mailed to a random sample of 200 occupational therapists and occupational therapy assistants, all of whom were members of the American Occupational Therapy Association. RESULTS: The 117 respondents had a moderate understanding of multiskilling. They responded that multiskilling is beneficial to both the occupational therapy profession and the clients it serves, but they were also aware of its potential risks or disadvantages. According to respondents, multiskilling occurs formally through defined protocol and; more commonly, informally, driven by necessity and the desire to treat the client most effectively. CONCLUSION: The results indicate a need for the occupational therapy profession to define multiskilling and cross training; develop ways of serving clients that respond to administrative needs and constraints while preserving the uniqueness of occupational therapy; and monitor treatment outcomes of all service delivery methods to provide information regarding efficiency, effectiveness, and client satisfaction.     

The national occupational therapy practice analysis: findings and implications for competence

OBJECTIVE: This article reports some of the findings from a national study of occupational therapy practice conducted by the National Board for Certification in Occupational Therapy (NBCOT) as part of its fiduciary responsibility to ensure that its entry-level certification examination is formulated on the basis of current practice. METHOD: The NBCOT developed a survey with input from approximately 200 occupational therapy leaders and then used it to solicit information about current practice from 4,000 occupational therapists and 3,000 occupational therapy assistants. The sample included geographical location, experience level, and practice area distributions. RESULTS: Approximately 50% of the sample responded to the survey. Data indicate similarities and differences in occupational therapist and occupational therapy assistant practice (e.g., occupational therapists spend more time conducting evaluations, planning interventions, and supervising, whereas occupational therapy assistants spend more time providing interventions), an increased emphasis on population-based services (e.g., serving a business or industry rather than an individual worker), and an emphasis on occupation as a core knowledge base for practice. From a continuing competency perspective, the data can be useful to the profession; we can plan continuing education to address topics that practitioners have indicated are critical to their practice. CONCLUSION: The findings will be useful for revising the entry-level certification examination and may guide thinking about the parameters of continuing competence because the responses represent a cross-section of the profession.     

The X-chromosomal human biglycan gene BGN is subject to X inactivation but is transcribed like an X-Y homologous gene

This article employs a metaphor of weaving in order to analyze, both historically and critically, the art and science of occupational therapy. To spark reflection about where occupational therapy has been, is now, and would like to progress as the new century approaches, the article is thematically organized around the profession's two most fundamental convictions. These convictions are termed the warp and weft of occupational therapy. The warp of occupational therapy is defined as our philosophical belief that engagement in occupation can favorably influence health. The weft of occupational therapy is defined as our humanistic value of respect for the person. Occupational therapy is, in turn, regarded as a powerful tapestry of human potential that unfolds when this belief and value are therapeutically applied. By analyzing selective clinical, educational, and research initiatives throughout this century, the article is dedicated to the continued adherence to, and development of, occupational therapy's core principles.     

Quantitative immunohistochemistry of androgen receptors in a microsphere model system and in prostate tissue sections

The idea of occupation is proposed as the basis for constructing a curricular renaissance for occupational therapy in preparation for a new millennium. Implementing an occupation-centered curriculum could create a more integrated profession in which practice, ideas, scholarship, and education nurture and support one another, increasing the autonomy of both the occupational therapy profession and recipients of its services. A practice-oriented rationale for curricular design includes explication of the idea of occupation, a view of the person as an occupational being embedded in that concept, and the thought process of occupational therapy. Recommendations are provided to create an integrated curriculum that will contribute to future-oriented practice and a self-defined profession.     

Combination insulin and sulfonylurea therapy in insulin-requiring type 2 diabetes mellitus

OBJECTIVES: To identify ethical dilemmas experienced by occupational and physical therapists working in the UK National Health Service (NHS). To compare ethical contexts, themes and principles across the two groups. DESIGN: A structured questionnaire was circulated to the managers of occupational and physical therapy services in England and Wales. SUBJECTS: The questionnaires were given to 238 occupational and 249 physical therapists who conformed to set criteria. RESULTS: Ethical dilemmas experienced during the previous six months were reported by 118 occupational and 107 physical therapists. The two groups were similar in age, grade, and years of experience. Fifty of the occupational therapy dilemmas occurred in mental health settings but no equivalent setting emerged for physical therapy. Different ethical themes emerged between the two groups, with the most common in occupational therapy being difficult/dangerous behaviour in patients and unprofessional staff behaviour, and for physical therapists resource limitations and treatment effectiveness. No differences were found in the ethical principles used. CONCLUSION: The ethical dilemmas reported by the therapists were primarily concerned with health care ethics, rather than the more dramatic ethics reported in much of the biomedical ethics literature. Differences were found between the two professional groups when ethical contexts and themes were compared but not when ethical principles were compared. This suggests that educators and researchers need to be aware of work settings and the interdisciplinary nature of employment as well as ethical principles held by individual therapists.     

Including the family perspective in sensory integration outcomes research

Occupational therapy, along with other health and rehabilitation professions, is experiencing an increased emphasis on measurement of intervention outcomes. The results of outcomes research are being used to develop practice guidelines, set standards for reimbursement, and justify health care policy. The outcome assessments used by therapists reflect our belief systems and the assumptions about behaviors we expect to influence. Using a sensory integration perspective to illustrate key points, we present a conceptual framework that is based on the disablement framework and Coster's occupational functioning for children model. We highlight the need to examine each of the multiple levels at which intervention may influence child and family function and the links among levels. Sensory integration theory and efficacy studies are reviewed to identify assumptions relative to how sensory integration affects the everyday occupations of children in the context of their families. Potential research methods and assessments are suggested to include the family perspective in outcome studies.     

Contrast-sensitivity testing with scanning-laser ophthalmoscope stimulation in normal, ocular hypertensive, and glaucomatous patients

This article reviews the history, growth, and evolution of managed care in mental health and substance abuse treatment. Specific issues described are stigma, the important social dimensions and chronicity of some types of mental illness and chemical dependency, and reliance on the public sector for care. Opportunities and challenges for occupational therapists in the rapidly changing mental health system are discussed, including the use of interdisciplinary teams, the importance of measuring functional outcomes of interventions, the need to develop clinical guidelines, the importance of the community setting and a continuum of services, ethical dilemmas, and the importance of assertive occupational therapy advocacy and involvement in health care reform.     

Academic occupational safety and health training programs

Occupational safety and health encompasses four core disciplines: industrial hygiene, occupational safety, occupational medicine, and occupational health nursing. This chapter traces the growth of these specialties throughout the 20th century in response to growing demands of the workplace. Graduate and certification programs are described for each of these four areas.     

An overview of professional liability in occupational therapy

Occupational therapists occasionally are sued for professional malpractice; thus, they need to be aware of the law of malpractice, those areas of practice that present the greatest legal challenges, and strategies to reduce client injury and liability risks. This article provides an overview of the law of professional malpractice, explains the impact of various employment relationships on liability risks, reviews specific malpractice actions against occupational therapists, and provides suggestions on how to reduce the risk of injuring a client in therapy. By increasing one's awareness of the legalities of professional malpractice and implementing certain strategies, therapists can improve quality of care and reduce their exposure to malpractice liability.     

Review of Occupational health psychology.

Reviews the book, Occupational health psychology edited by Stavroula Leka and Jonathon Houdmont (see record 2010-10988-000). Leka and Houdmont describe their book as the first textbook devoted to occupational health psychology intended for undergraduate instruction in the field. Leka and Houdmont have chosen an interesting strategy in creating an edited textbook with individual chapters written by established experts in the field. In doing so, they have in many cases gotten “the best” people in a particular area to write chapters in their area of expertise. Despite their reliance on multiple authors, the editors have maintained a consistent style throughout the volume—each chapter begins with a chapter outline and ends with a chapter summary. Textboxes throughout are used to highlight individuals prominent in the field (e.g., Tom Cox) or to highlight applications and research issues and to provide definitions of key terms. I would expect that students will appreciate such pedagogical features in addition to the depth of expertise that underlies each chapter. Although not divided into sections, one can intuit a structure to the book that begins with a broad perspective on occupational health psychology and then progressively adopts a narrower focus. When I first heard of this book, I was pleased at the prospect of being able to assign a single textbook that would offer a survey of occupational health psychology. Although the authors met their explicit goal of covering the core education curriculum defined by the European Academy of Occupational Health Psychology, I am not convinced that they have produced a “stand-alone” text that provides an adequate coverage of the field. In particular, issues of workplace safety are strikingly absent from the text. Personally, I would feel the need to supplement this text with specific readings on issues of occupational safety and occupational disease in order to cover the major topics that comprise the field of occupational health psychology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Fatal and non-fatal childhood injuries in Metropolitan Toronto, 1986-1991

OBJECTIVE: To estimate the prevalence of human immunodeficiency virus (HIV) infection among health care workers who donate blood. DESIGN: Point prevalence survey of blood donors. SETTING: 20 U.S. blood centers that participate in an ongoing interview study of HIV-seropositive blood donors. MEASUREMENTS: Prevalence rates for HIV in persons who reported being health care workers were measured directly for 6 of the 20 blood centers. For the other 14 centers, we derived the numerator from the interview study in the same manner used for the 6 centers; we estimated the denominator using blood collection logs at those centers and extrapolations from the survey completed at the 6 blood centers. RESULTS: Between March 1990 and August 1991, 8519 health care workers donated blood at 6 hospitals and other medical facilities. Three persons were HIV seropositive: Two reported being health care workers and having nonoccupational risk factors for HIV infection; the occupation and other possible risk factors of the third seropositive donor could not be determined. Therefore, the highest overall prevalence of HIV infection among health care worker donors at these 6 centers was 0.04% (3 of 8519; upper limit of 95% CI, 0.1%). We estimated that during the same period, approximately 36,329 health care workers were tested for HIV at all 20 centers. Twenty-seven persons infected with HIV who donated at hospitals were identified; 7 did not return for interviews, so their health care occupations could not be verified. Thus, the highest estimated overall prevalence of HIV infection among health care worker donors at the 20 centers was 0.07% (27 of 36,329; upper limit of CI, 0.1%). Of the 20 known health care worker donors, 11 reported nonoccupational risks for HIV infection; 3 of the remaining 9 health care workers described occupational blood exposures that could have resulted in transmission of HIV. CONCLUSIONS: Blood donors can serve as a sentinel cohort when evaluating the risk for occupationally acquired HIV infection. These findings suggest that among the many health care worker donors in this study, HIV infection attributable to occupational exposure was uncommon.     

Physical abuse of preschoolers: identification and intervention through occupational therapy

Child abuse is a major public health concern in the United States, one that has negative consequences on abused persons' productivity and mental health throughout their lives. Occupational therapists who work with preschool-aged children are in a strategic position to screen for physical abuse and aid in the rehabilitation of children and families engaged in abuse. This article provides a review of the literature and accounts of clinical experience with children and families in a variety of settings. It offers an overview of behavioral risk factors that have been shown to correlate with physical abuse, including how these factors can be observed within the context of an occupational therapy evaluation. Guidelines for interacting with child protective services via reporting suspected cases of child abuse and working collaboratively with such agencies are provided. Strategies for occupational therapy intervention with abused children and their parents are described. These strategies include using activities to facilitate positive parent-child interaction, educating parents regarding child development and management techniques, and facilitating children's psychosocial development.     

HIV-associated brain pathology: a comparative international study

OBJECTIVES: This study examined the use of aides in occupational therapy practice, the supervision and training of aides, and practitioners' attitudes toward the use of aides. METHOD: A questionnaire was mailed to a systematically selected sample of 510 occupational therapists and occupational therapy assistants. The response rate was 74%. RESULTS: The use of occupational therapy aides is prevalent in a variety of settings. Forty percent of respondents reported that they currently work with aides, whereas 23% reported that they have never worked with aides. Occupational therapy aides perform a variety of tasks and receive various levels and amounts of supervision and training. Of those respondents who delegated specific skilled tasks to aides, 76% reported daily contact for purposes of supervision and training. Nineteen percent who currently work or have worked with aides reported being in a situation where an ethical issue arose related to aide use. CONCLUSION: On the basis of the data, it is suggested that occupational therapy practitioners would benefit from taking a proactive role in determining how aides can be used to maximize service delivery while maintaining quality services. There also appear to be ethical concerns related to appropriate delegation of tasks to aides and to their supervision and training.     

Aggression and psychopathology in persons with severe or profound mental retardation

In order to determine key competences required of occupational medicine specialists, common throughout Europe, a questionnaire has been developed and distributed among several European countries. The questionnaire contained 115 subjects related to 8 fields of activities carried out by occupational medicine physicians (occupational hazards to health, assessment of disability and fitness for work, communications, research methods, management, environmental medicine, occupational health law and ethics, and health promotion). In each of these fields, competences were classified into three following categories: knowledge, experience and skills. Respondents were asked to allocate a score from 0 to 5 for each subject, where 0 = not necessary; 1 = of minimum importance, and 5 = most important or essential. In Poland the questionnaire was distributed among two groups of specialists: group I--experienced specialists in occupational medicine (leading representatives of occupational health care management), and group II--relatively younger and less experienced occupational medicine physicians, participating in the specialist training, organised by The Nofer Institute of Occupational Medicine. A comprehensive analysis of the completed questionnaires was carried out in two dimensions: substantive (the importance of individual competences as perceived by Polish specialists in occupational medicine), and comparative (evaluation and interpretation of similarities and differences between two groups of respondents). A hierarchy of requirements, occupational medicine training in Poland is to satisfy, was reconstructed with two sets of competences, one recognised by respondents as needless and the other recognised as useful with different grades of importance. Some characteristic differences in opinions between two groups studies were highlighted.     

Relationship of behavior therapists' characteristics, activities, and clients to reported practices in therapy.

Investigated the relationship of behavior therapists' characteristics, activities, and treatment conditions to their reported practices in therapy using 69 practicing therapists from the Association for Advancement of Behavior Therapy, who completed a questionnaire assessing their personal and professional characteristics and their use of 99 varied therapeutic techniques and skills. 13 scales were constructed via principal component analysis and analyzed for effects due to each of the independent variables. Results suggest that, even for a homogeneous sample of behavior therapists, reported frequency of use of particular therapeutic techniques varies as a function of the setting of therapy and type of clients. Behavior therapists appeared to selectively employ interventions based on, and generally appropriate to, the particular clinical setting and problem encountered. Behavior therapists' personal characteristics as well as their professional activities also appeared to influence professed clinical practices. The importance of an adaptable therapeutic armamentarium and the need for flexible clinical training are discussed. (60 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of standardized assessment in occupational therapy: the BaFPE-R as an example

Before 1970, most assessments administered by occupational therapists were informal and nonstandardized. Since the 1970s, the use of scientifically sound instruments has increased. One such standardized assessment, the Bay Area Functional Performance Evaluation (BaFPE), was developed to measure the functional performance of psychiatric clients. This study was designed to explore the use of a revised version of BaFPE as an example of standardized assessment in occupational therapy. The BaFPE was selected as an example of an assessment extensively used in psychiatric occupational therapy practice. A qualitative study that used in-depth semistructured interviews was conducted with a convenience sample of occupational therapists. The occupational therapists who were interviewed described and explained making several adaptations and modifications to the recommended administration and scoring of the BaFPE. An analysis of the interview data suggested that standardized assessments are valued as indicators of professional status. However, the interview responses also suggested that the demands of test standardization were incongruent with the values that guide occupational therapy practice. The findings of this study suggest that the future development and use of standardized instruments should be consistent with the values of the profession. In particular, assessments that recognize the diverse nature and needs of individual clients are required.     

An educational strategy for occupational therapy community service

In response to the increasing trend toward community health care, a model of training that prepares students for community practice was incorporated into the occupational therapy curriculum at the University of Southern California. During academic training students are placed in a part-time community assignment where no occupational therapy services are offered. Training students for the role of community health specialist produces a dilemma for curriculum design. A balance must be achieved between providing traditional clinical content and providing the knowledge and expertise necessary for community practice. However, this training is considered necessary for maintaining the viability of the profession in a changing health system. Significantly, during the four-year period using this model, many graduates have sought employment in "nontraditional" community roles.     

Helicobacter pylori: from bench to bedside

Within occupational therapy education, there has been increased attention to curricula and courses that emphasize problem solving, clinical reasoning, and synthesis of information across traditional discipline-specific boundaries. This article describes the development, implementation, and outcomes of a problem-based learning course entitled Selected Cases in Occupational Therapy. The course was designed to help students to integrate the various elements of a specific occupational therapy curriculum and to enhance their abilities to respond to an ever-changing health care environment. An evaluation of the course by the first 11 students who completed it revealed both strengths and weaknesses. Students responded that the course enhanced their professional behavior, including interpersonal communication skills, team work, and follow-through with professional responsibilities; helped them to integrate the various elements of the total occupational therapy academic program; enhanced their clinical reasoning skills by providing a structure for thinking through clinical issues; and provided personal gain or benefit (i.e., students perceived the course to be a valuable, realistic, and motivating experience). The students also identified several specific course elements that contributed to its integrating function, including content, class session format, and students' role. Identified course weaknesses included the methods of evaluating student performance and the format and content of specific cases.