Gail Fisher

Worker Role Interview: Toward Validation of a Psychosocial Work-Related Measure

Three studies were conducted to examine the validity of the Worker Role Interview (WRI), a semi-structured interview and rating scale designed to assess psychosocial capacity for return to work in injured workers. The first Rasch analysis study of 119 work-hardening clients with low back pain showed that scale items worked together to measure unidimensional construct, except for two work-environment items (work setting and boss); and the items were logically ordered representing the least to most psychosocial capacity for return to work. The second Rasch analysis study involved a refined scale (including redefinition of environment items to reflect the workers perception of the environment) applied to 55 work-hardening clients with diverse injuries. All items except perception of boss defined a unidimensional construct. The ordering of items was similar to that in the first study and similar across two different diagnostic groups (low back and upper extremity injuries), indicating the scale was sample invariant. The third study of 42 work-hardening clients examined the predictive validity of the WRI. A logistic regression, which included demographic variables (chronicity, diagnosis, number-of-surgeries, attorney involvement and age), showed that none of the variables predicted return to work (odds ratio ranged from 0.3–1.0). This initial series of studies present a theoretically based instrument, which shows promising psychometric qualities. While the predictive study indicated that the WRI was not useful in predicting return to work, this finding may have been a function of the small n-size in the study or that the WRI may mediate its effect through other variables.

Implications of the Affordable Care Act for occupational therapy practitioners providing services to Medicare recipients.

The passage of the Patient Protection and Affordable Care Act of 2010 (ACA; Pub. L. 111-148) represents the largest expansion in government funding of health care since Medicare and Medicaid were established in 1965 (Curfman, Abel, & Landers, 2012). Although the health insurance mandate and Medicaid expansion have received the most attention as a result of legal challenges and the July 2012 Supreme Court ruling on the legality of the ACA (Henry J. Kaiser Family Foundation, 2012), other ACA initiatives may have even greater implications for occupational therapy. The ACA includes sections on improving quality and health systems performance for Medicare recipients, with some sections also applying to Medicaid recipients. Insurance companies commonly follow Medicare rules; therefore, the Medicare reforms are likely to spread across all payers, health care settings, and care recipients.

Developing and Maintaining Community Partnerships Within “A Scholarship of Practice”

SUMMARY This article describes the application of a model developed and adopted by the occupational therapy faculty at the University of Illinois at Chicago to utilize partnerships with community-based organizations to meet a tripartite mission of education, research, and service delivery. The model (A Scholarship of Practice) was developed and adopted in response to contextual influences occurring at multiple levels. These influences are identified and the actions taken by the faculty are described. “A Scholarship of Practice” is briefly described and the principles that have guided development and maintenance of successful partnerships with community-based organizations are discussed. Finally, the outcomes and benefits of partnering with community-based organizations are identified.

Synthesizing Research, Education, and Practice According to the Scholarship of Practice Model: Two Faculty Examples

SUMMARY The Scholarship of Practice involves an ongoing, reflective discourse among the theoretical concepts of occupational therapy, the empirical verification of those concepts through research, and the application of those concepts in real-world clinical practice. This article illustrates how the Scholarship of Practice framework is applied by occupational therapy faculty members as a key aspect of their scholarly and teaching roles. Two distinct perspectives are provided-one describes the scholarship and teaching of a clinical-track faculty member and the other describes that of a research-track faculty member. Both examples illustrate how each faculty members work involves an integration of teaching and advising, scholarship (i.e., developing occupational therapy theory and conducting research), and practice. In both cases, the faculty member uses the Scholarship of Practice approach to better understand the kinds of problems and needs of clients and the ways in which practitioners can use knowledge generated by theory and research to most effectively address them. In turn, each faculty member relies heavily on the feedback from students and practitioners regarding the outcomes of the practical application of the concepts offered by theory and research. This feedback is then utilized to revise and refine existing theory, generate new research questions, and ultimately inform best occupational therapy practice. Finally the process serves as an ideal context for teaching and advising.

Comparing and Using Occupation-Focused Models.

ABSTRACT As health care moves toward understanding the importance of function, participation and occupation, occupational therapists would be well served to use occupation-focused theories to guide intervention. Most therapists understand that applying occupation-focused models supports best practice, but many do not routinely use these models. Barriers to application of theory include lack of understanding of the models and limited strategies to select and apply them for maximum client benefit. The aim of this article is to compare occupation-focused models and provide recommendations on how to choose and combine these models in practice; and to provide a systematic approach for integrating occupation-focused models with frames of reference to guide assessment and intervention.

Developing the Residential Environment Impact Survey Instruments Through Faculty–Practitioner Collaboration

ABSTRACT The Residential Environment Impact Survey (REIS) and the REIS-Short Form (REIS-SF), based on the Model of Human Occupation, are non-standardized, semi-structured assessments aimed at evaluating how a home influences the quality of life of the resident(s). Occupational therapy practitioners have used these instruments as consulting tools to formulate and implement recommendations to improve residents’ occupational functioning. Using a faculty–practitioner collaboration framework, international REIS and REIS-SF users were surveyed to elicit feedback regarding how these tools are being used, and how they can be improved. Survey results were analyzed and will be used to further develop these instruments to better meet the needs of practitioners.

Primary Care: A New Context for the Scholarship of Practice Model

ABSTRACT Interest in the emerging role for occupational therapy in the primary care practice setting has increased due to implementation of the Patient Protection and Affordable Care Act (ACA), which intends to expand health care coverage to uninsured Americans while improving coordination of care, health outcomes, and cost savings. Expanding occupational therapy to encompass promotion of wellness and prevention in a primary care context provides an opportunity for occupational therapy. The purpose of this article is to describe the role of occupational therapy in primary care and how the Scholarship of Practice model can guide the development of occupation-based and evidence-based best practice in primary care.

Managed care: Survival skills for the future

The last two decades have been a time of dramatic and consistent change in the way health care is delivered. The use of managed care strategies by health care providers impacts occupational therapy practitioners directly, yet they are often ill-prepared to respond to changes constructively. With adequate preparation, occupational therapy practitioners may not only respond to organizational change, but play a major role in helping to shape their organizations future. This article presents and defines the major managed care strategies being utilized by health care providers and their impacts on occupational therapy practitioners. The skills and strategies occupational therapy practitioners can use to effectively respond are presented and discussed. Suggested methods for gaining these skills are included. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworth.com].