Genevieve Pepin

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.

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.

The lived experience of Australian retirees: 'I'm retired, what do i do now?'

Introduction: The purpose of this qualitative study was to explore the lived experience of retirement in a context where it is not compulsory, and to understand consequent changes in roles, identity and occupational adaptation from the perspective of Australian retirees. Method: Five people aged between 61 and 68 years, who had retired during the previous 18 months, were interviewed. Data analysis included transcription and coding of data, data aggregation and identification of themes. Findings: The themes that emerged from the data analysis were related to time structure and meaningful occupations, ageing and performance capacity, role changes, emotional adjustment to retirement and preparation for retirement. Conclusion: The findings suggest that engagement in meaningful occupations and valued roles, along with the emergence of grandparenting as a significant role, the development of new interests and engagement in retirement planning activities, and support in restructuring the use of time are essential to maintain a positive identity and to adapt successfully to retirement.

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.

Come Play With Me: An Argument to Link Autism Spectrum Disorders and Anorexia Nervosa Through Early Childhood Pretend Play

This article builds on the argument of a link between behaviours observed in persons with autism spectrum disorders and persons with anorexia nervosa. In describing these behaviours, a link is made between deficits in social cognition, lack of flexible and creative thinking, theory of mind, and deficits in early pretend play ability. Early pretend play ability is a strong avenue to the development and strengthening of social cognition, problem solving, language, logical sequential thought, and understanding social situations. Currently, there is no literature on the pretend play ability of persons who develop anorexia nervosa. This article argues for research into this area which may potentially contribute to developments in new intervention strategies for these persons.

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.

Processes of task performance as measured by the Assessment of Motor and Process Skills (AMPS): A predictor of work-related outcomes for adults with schizophrenia?

OBJECTIVE To determine whether the processes of task performance as measured by the Assessment of Motor and Process Skills (AMPS) would discriminate between the employment levels of adults with schizophrenia. PARTICIPANTS Twenty adults with schizophrenia who were engaged either in competitive employment, supported employment, prevocational training, or non-vocational activities, participated in this exploratory study. METHODS Each participant completed the AMPS, the Positive and Negative Syndrome Scale (PANSS), the Addiction Severity Index (ASI), and the Worker Role Interview (WRI) to gather data about their occupational performance, symptoms, drug / alcohol use, and psychosocial / environmental factors that might influence their work-related outcomes. RESULTS Analysis revealed a moderate correlation between the level of employment and the global scores of the process skills scale in the AMPS. CONCLUSIONS This should be seen as preliminary evidence that beyond the basic cognitive functions, processes of task performance may also be a predictor of work-related outcomes for this population. The results also highlighted the importance of considering personal causation and worker roles when assessing the work capacities of these clients. Finally, findings supported the four levels of employment used in this study, which appeared to form a continuum from non-vocational activities, prevocational training, supported employment, through to competitive employment.

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.

Collaborative care skill training workshop: how Australian carers support a loved one with an eating disorder

ABSTRACT This study examined the impact of participating in the Collaborative Care Skill Training Workshops on carers’ coping strategies, expressed emotion (EE), burden, distress, confidence in their loved ones capacity to change, as well as the previously unexplored dimension of accommodating and enabling of their loved ones eating disorder behaviour. A non-experimental research design was implemented and 77 carers from Victoria, Australia participated in the study and completed questionnaires at pre-and post-intervention and an 8-week follow-up. Significant reductions occurred in accommodation and enabling of some eating disorder behaviours, as well as in carers’ maladaptive coping, EE, eating-disorder-specific burden and psychological distress. Increased confidence that their loved one could change was also observed. These changes were maintained at a follow-up. Results suggest that the workshop can be effective in decreasing carer use of maladaptive coping, carer distress and burden. Notably, it targets and had contributed to reducing factors associated with maintaining eating disorders such as accommodation and enabling of certain eating behaviours and high levels of EE. Modification to the content of the workshop may be required to improve carers’ adaptive coping and reduce certain behaviours which accommodate and enable the eating disorder.