Debra Stewart

The Person-Environment-Occupation Model: A Transactive Approach to Occupational Performance.

Occupational therapy theory, practice and research has increasingly emphasized the transactional relationship between person, environment and occupation. Occupational performance results from the dynamic relationship between people, their occupations and roles, and the environments in which they live, work and play. There have, however, been few models of practice in the occupational therapy literature which discuss the theoretical and clinical applications of person-environment interaction. This paper proposes a Person-Environment-Occupation Model of occupational performance which builds on concepts from the Occupational Therapy Guidelines for Client Centered Practice and from environment-behaviour theories. The model describes interactions between person, occupation and environment, outlines major concepts and assumptions, and is applied to a practice situation.

Environmental factors affecting the occupations of children with physical disabilities

Abstract Children with physical disabilities encounter environmental constraints that limit their participation in daily occupations. The purpose of this qualitative research study was to work together with parents to discover environmental situations which presented substantial challenges to their children. The study took place in a city of 92,000 people in southern Ontario, Canada. Twenty‐two families who had a child with a disability between the ages of 3 to 12 years participated. Through focus groups and individual interviews, participants identified environmental factors which supported or hindered the daily occupations of their children. Social and institutional barriers were identified as the most significant environmental barriers. Although many physical barriers were identified, participants believed that attitudes or lack of knowledge prevented these barriers from being changed. The primary themes for change emerging from this study include parents’ desire for more control, increased use of incl...

A qualitative study of the transition to adulthood for youth with physical disabilities.

The purpose of this qualitative study was to explore the experiences, perceptions, and needs of youth with physical disabilities in transition from adolescence to adulthood. Purposeful sampling strategies were used to select 34 study participants who lived in three regions of south-central Ontario, Canada. Data collection methods were individual and focus group interviews, and were guided by a set of open-ended questions. An editing style of analysis sorted the text into codes for description and interpretation. Themes emerged about context, the transition process, needs, and services. Participants identified a poor fit between young persons with disabilities and the adult world they were entering. They recommended that services be focused on environmental supports to enable them to “build their own bridges” to the adult world. Community-based transition services need to be planned in collaboration with youth with disabilities and their parents. Concepts of person-environment fit and health promotion can be incorporated into services to enable young persons with disabilities to experience a

Application of the Person-Environment-Occupation Model: A practical Tool

Occupational therapy focuses on complex dynamic relationships between people, occupations and environments. Therapists must clearly communicate their practices and how their practice influences outcomes. This paper explores applications of the Person-Environment-Occupation Model (Law et al., 1996) in occupational therapy practice, and delineates how this particular model helps therapists to conceptualize, plan, communicate and evaluate occupational performance interventions. Three case studies illustrate how the model can be used by occupational therapists to systematically approach analysis of occupational performance issues while considering the complexities of human functioning and experience. The ways in which the model facilitates communication within and outside occupational therapy are explained. The Person-Environment-Occupation Model is offered as a tool for therapists to use in client(s)-therapist alliances to enable clients to successfully engage in meaningful occupations in chosen environments.

A Critical Appraisal of Literature Reviews About the Transition to Adulthood for Youth with Disabilities

A critical appraisal of five review articles on the transition to adulthood for youth with disabilities was conducted to identify evidence about (1) the factors that help or hinder the transition process, and (2) “whats working” in transition services. The appraisal identified a number of important “success” factors and elements of service delivery that are worthy of consideration by service providers and researchers. These include the need for skill development of youth with disabilities, environmental supports, and an individualized approach to service delivery. All of the reviews identified the need for more evidence to support the implementation and evaluation of best practice models/approaches that address the complex issue of the transition from paediatric to adult services for youth with disabilities.

Transition to adult services for young people with disabilities: current evidence to guide future research.

This article outlines the evidence upon which best practice guidelines for transition to adulthood for young people with physical and developmental disabilities were developed in Ontario, Canada, through consensus activities. Evidence was gathered from published and unpublished literature and focus groups with young people, parents, community members, service providers and policy makers across the province. The evidence was then synthesized and analyzed by an expert panel. Guidelines were developed in the areas of collaboration, capacity‐building, information, education, and research. This article focuses on the findings of this project as they relate to transition services and care. These best practice guidelines for the transition to adulthood for young people with disabilities offer a starting point to encourage service providers to work collaboratively with young people, parents, communities, governments, and researchers. The evidence from this project supports a move away from purely service‐driven models of transition to holistic, lifecourse/lifespan approaches. Recommendations for future study and collaborative knowledge dissemination are provided.

The Meaning of Play for Young People with Physical Disabilities

As a primary area of occupation, play is central to the lives of children. Emerging views of play reflect the complexity of the area, and focus on the relationship between the person and the environment during play. This paper reports the results of a qualitative study of twenty adolescents with and without physical disabilities. The participants were interviewed about their perceptions and personal experiences of play. Through a textual analysis of the data, significant themes related to the nature of play, environmental barriers and supports, and personal influences on play were identified. Clinical implications are discussed in relation to these themes.

Organizational Characteristics and Issues Affecting the Longevity of Self-Help Groups for Parents of Children with Special Needs

In this article, the organizational characteristics and issues affecting the maintenance of nine self-help groups for parents of children with special needs are discussed. Qualitative data were collected through interviews with 20 parents and observation of six group meetings. For continued existence, groups must deal with the challenges of encouraging new leaders, attracting new members, obtaining funds or assistance to support their activities, and meeting the changing needs of members. Important organizational characteristics associated with longevity are committed and effective leadership, community connections that help provide needed funds or practical assistance, and the willingness of group members to change activities to meet changing needs. This information can be used by parents and service providers to plan new groups, recruit group members, and ensure the effective functioning of groups as they change over time.

Mobility experiences of adolescents with cerebral palsy.

The purpose of this study was to describe how youth with cerebral palsy experience mobility in their daily lives using a phenomenological approach. The participants were 10 youth with cerebral palsy, 17 to 20 years of age, selected using purposeful sampling with maximum variation strategies. A total of 14 interviews were completed. Transcripts were analyzed for key concepts and themes. Credibility was established through triangulation of researchers and member checking. Participants viewed mobility as important for self-sufficiency. Youth who walked and also used wheeled mobility spoke of making choices. Safety and efficiency were important considerations when making choices. Some participants had mobility preferences at home that may not be safe, practical, or socially appropriate at school or in the community. Youth spoke of constantly adapting to situations that often reflected a lack of control over the environment. Youth indicated the need for constantly planning ahead to go places and do things. Most participants were dependent on others for transportation and expressed dissatisfaction with public transportation. Safe and efficient mobility to enable participation in daily activities appears to be the primary concern of youth with cerebral palsy.

Exploring Issues of Participation Among Adolescents with Cerebral Palsy: What's Important to Them?

ABSTRACT The purpose of this cross-sectional study was to determine what participation issues are important to adolescents with cerebral palsy (CP). Two hundred and three adolescents with CP (mean age 16.0 ± 1.8 years) were assessed using the Canadian Occupational Performance Measure (COPM). This was done through semistructured interviews by trained physical and occupational therapists. Adolescents responded either directly (n = 144) or through a parent or a caregiver (n = 59) if they were unable to communicate. Issues were extracted from completed questionnaires and coded under three COPM categories (self-care, productivity, and leisure) and 16 subcategories. There was no association between the total number of issues identified and gender (p = .99), age (p = .88), type of respondent (adolescents versus parent) (p = .27), Gross Motor Function Classification System (GMFCS) level (p = .93), or 66-item Gross Motor Function Measure (GMFM-66) score (p = .45). The issues identified most frequently were related to active leisure (identified by 57% of participants), mobility (55%), school (48%), and socialization (44%). Interventions aimed at improving participation among adolescents with physical disabilities, such as CP, should be directed towards these four key areas. Health care professionals should also recognize and consider the interaction of person and environment when addressing issues related to participation.