Danielle Hitch

In the Footsteps of Wilcock, Part One: The Evolution of Doing, Being, Becoming, and Belonging

ABSTRACT This article will present a critical analysis of the four dimensions of occupation, doing, being, becoming and belonging, and propose clearer understandings of the terms. The concepts have developed and evolved since Wilcock first introduced them as main constructs of Occupational Perspective of Health (OPH), with doing and being receiving the most comprehensive development. However, the concepts of becoming and belonging remain underdeveloped. Given the complex nature of occupation, this comprehensive analysis of each dimension adds greater depth to our understanding, and provisional definitions of each term are provided to guide their ongoing development.

Strategies and effectiveness of teaching universal design in a cross-faculty setting

Universal design of built environments is an area of professional interest for both architects and occupational therapists, yet is not always specifically included in undergraduate curricula. This paper reports on the student experience of introducing universal design education into architecture and occupational therapy curricula. Online and face-to-face teaching methods were employed, including virtual and real-life simulation activities designed to provide students with a personal experience of impairment. Virtual simulation activities used the medium of Second Life™. Results showed improvement in self-reported learning outcomes related to universal design and, overall, students found the learning activities and resources useful. Real-life simulations were reported to be more useful than virtual simulations. Project outcomes support the introduction of universal design education into architecture and occupational therapy curricula, and offer insight into student perceptions and future directions for related teaching and learning resources.

Experiences of engagement in occupations and assertive outreach services

Aim: The purpose of this study was to describe the experience and meaning of engagement for staff and clients of assertive outreach teams. Method: Interpretative phenomenological analysis was selected for its flexibility and transparency. Data were collected by semi-structured interviews from a sample of five client and five staff participants (n = 10). The interviews were analysed idiographically, inductively and interrogatively. Findings: Four themes identified by both staff and client participants emerged: engagement as an interpersonal relationship, engagement in and through time, enabling and disabling factors and engagement in occupation. In addition, clients developed a theme around engagement as a means to self-actualisation. Staff also raised a specific theme around the role of engagement in mental health services. Conclusion: Staff and clients experienced engagement in broadly similar ways, but with differing emphases. Although all participants described it as both an invisible ‘means’ and a visible ‘end’, the staff related engagement only to mental health services whereas the clients experienced it in the context of both mental health services and occupations. Relevance: This study is relevant to all occupational therapists who work with people experiencing mental health problems.

In the Footsteps of Wilcock, Part Two: The Interdependent Nature of Doing, Being, Becoming, and Belonging

ABSTRACT The four dimensions of occupation developed by Wilcock in the Occupational Perspective on Health—doing, being, becoming, and belonging—have evolved. Although the inter-relationships between the dimensions have been explored by clinicians and researchers to some degree, the reciprocal and multidimensional nature of these relationships are rarely explicitly addressed. This article will present a critical analysis of the relationships and interaction between doing, being, becoming, and belonging, initially in dyads and then in a multidimensional way. The article proposes provisional understandings of how they combine and influence each other in occupational engagement. Six observations are made on the dimensions of occupation, along with a discussion of the impact of their interrelationships on research and practice.

Better Access to Mental Health program: Influence of mental health occupational therapy

BACKGROUND/AIM The Better Access to Mental Health program has enabled eligible occupational therapists to provide services to people with a mental health condition. No studies have yet reported the influence of occupational therapy under this scheme. The aim of this study was to investigate whether attending an occupational therapist under this initiative influences change in psychological distress of clients as measured by the Kessler Psychological Distress Scale (K10). METHOD A quasi-experimental pretest-posttest design, using pre-existing data collected in the process of regular treatment was used. Data from a total of 31 clients (mean = 17.13 years, SD = 3.603) were accessed for this study. Pre- and post-intervention scores on the K10 were used to determine if psychological distress had changed over the course of intervention. RESULTS Highly significant improvements (P < 0.001) were found between the K10 pre-intervention score (mean = 25.68, SD = 9.944) and the K10 post-intervention score (mean = 21.00, SD = 9.212). Male K10 post-intervention scores (mean = 17.64, SD = 5.3) significantly improved (P = 0.05), whereas results for females were not statistically significant. Medication use, diagnosis, age, number of sessions and prior contact with health services did not influence the results. Results from specific evidence-based interventions were not able to be considered in this study. CONCLUSION The results of this study demonstrate effectiveness of occupational therapy services for adolescents and provide support for the ongoing participation of occupational therapists in this scheme.

Engagement in activities and occupations by people who have experienced psychosis: a metasynthesis of lived experience

Purpose: The purpose of this study was to answer the question ‘How do people who have experienced psychosis describe their engagement in activities of daily living and occupations?’ Procedures: A qualitative metasynthesis was undertaken on nine studies (encompassing 73 participants) published in occupational therapy literature. Only studies that had used individual qualitative interviews were included to highlight lived experience on a personal level. The quality of the evidence was assessed across all studies and found to be generally high. Findings: Four overarching themes across the nine studies were identified: my emotions and identity; my own health and wellbeing; my relationships with family, friends and community; and my activities and occupations. The overarching themes are not intended to be considered categorically, as they all influence and interact with each other. Conclusion and relevance: There is considerable synchronicity between the experiences of people who have experienced psychosis and the values of the profession. A clients meaningful engagement in activities and occupation is evidence towards how therapists provide authentic, respectful and effective support to these clients, in a manner that meets their needs as individuals.

The Integrating Theory, Evidence and Action (ITEA) Method: A Procedure for Helping Practitioners Translate Theory and Research into Action

Introduction The aim of this article is to describe and explain a new method for integrating theory and evidence that enables practitioners to translate evidence into action applied in their practice. Method A new multiple methods procedure called the Integrating Theory, Evidence and Action method is described. It is a mixed method that progresses through seven distinct steps: clinical question, framework, identification, deconstruction, analysis, reconstruction, and transfer/utilization. An example of using this method to review evidence around occupational therapy with people recovering from alcohol misuse and/or abuse is provided. Findings This method highlights the importance of theory, tests the empirical strength of theories, includes diverse forms of evidence, and encourages the integration of knowledge within clinical practice. Conclusion The Integrating Theory, Evidence and Action method is accessible and useful to practitioners and will support their efforts to make their practice evidence based. Current methods of evidence-based practice focus mostly on research evidence (particularly quantitative evidence); however, research is only one of the ways of knowing that practitioners draw upon to guide their practice. This method enables occupational therapists to integrate theory, evidence, and practice in a coherent and translatable way.

Evidence for Mental Health Occupational Therapy

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.

Readiness for interprofessional learning: a cross-faculty comparison between architecture and occupational therapy students

Abstract Health and wellbeing includes a need for built environments to accommodate and be inclusive of the broadest range of people and a corresponding need to ensure graduates are ready to engage in this field of interprofessional and inter-industry practise. All too often, interprofessional education in higher education is neglected with a tendency towards educational silos, particularly at a cross-faculty level. This paper reports on an initiative that embedded universal design practice education into the curricula of first year architecture and third year occupational therapy students and evaluated the impact on students’ readiness for interprofessional learning. The Readiness for Interprofessional Learning Scale (RIPLS) was given to students at the beginning and end of the semester during which students participated in a variety of online and face-to-face curriculum initiatives. Results showed that at the beginning of semester, occupational therapy students were significantly more positive about interprofessional learning than their architecture counterparts. Post-results showed that this trend continued but that occupational therapy students became less positive on some items after the interprofessional learning experience. This study provides insights into the interprofessional learning experiences of a group of students who have not previously been studied within the available literature.

The pan occupational paradigm: development and key concepts

Abstract Background/Aim: Wilcock’s Occupational Perspective of Health (OPH) aligns with the profession’s re-discovery of its holistic, occupationally focused roots. Its dimensions of occupation–doing, being, becoming and belonging – resonate strongly with therapists on an intuitive, implicit level. However, its documented use in practice to date has been sparse, and several barriers to its implementation have been identified. The aim of this article is to present a renewal of the OPH - the Pan Occupational Paradigm (POP). Method of development: POP was developed using critical analysis, reflection and a comprehensive literature review. Each stage of development is described in detail, including the POPs inherent assumptions. Key concepts: POP retains the four dimensions of occupation, and shows their interdependent role within occupational entities (e.g. individuals, groups or communities). An entity can be approached by occupational therapy at any point and all the dimensions (either directly or indirectly) can be engaged. Occupational entities move along a continuum of wellbeing, and this movement can be in both positive and negative directions over a lifespan. Conclusion and significance: POP is a distillation of occupational therapy’s unique way of knowing about occupation and the promotion of wellbeing. It is put forward as an updated paradigm for occupational therapy in the 21st century.