Heidi Cramm

Executive functioning: A scoping review of the occupational therapy literature: Les fonctions exécutives : une analyse de la portée de la littérature en ergothérapie

Background. Increasingly recognized as an important factor in the performance of complex, goal-directed tasks, executive functioning is understood in different ways across disciplines. Purpose. The aim was to explore the ways in which executive functioning is conceptualized, discussed, described, and implied in the occupational therapy literature. Method. A scoping review of the occupational therapy literature was conducted following Levac, Colquhoun, and O’Brien’s (2010) recommended methodology. Results. Executive functioning is described both as a set of performance component skills or processes and as the executive occupational performance inherent in complex occupations. Executive functioning is implicit in occupational performance and engagement, and some health conditions seem to be commonly associated with impaired executive functioning. Assessing executive functioning requires dynamic occupation- and performance-based assessment. Interventions targeting executive functioning are grounded in metacognitive approaches. Conclusion. Executive functioning is a complex construct that is conceptualized with considerable variance within the occupational therapy literature, creating barriers to effective service delivery. Description. Bien qu’elles soient reconnues comme un facteur déterminant du rendement lors de la réalisation de tâches complexes et dirigées vers un but, les fonctions exécutives sont définies de différentes façons d’une discipline à l’autre. But. Examiner comment les fonctions exécutives sont conceptualisées, discutées, décrites et sous-entendues dans la littérature en ergothérapie. Méthodologie. Une analyse de la portée de la littérature en ergothérapie a été réalisée, selon la méthodologie recommandée par Levac, Colquhoun et O’Brien’s (2010). Résultats. Les fonctions exécutives sont décrites à la fois comme un ensemble de compétences ou de processus liés à la composante du rendement, et comme le rendement occupationnel exécutif inhérent aux occupations complexes. Les fonctions exécutives sont contenues implicitement dans le rendement occupationnel et la participation occupationnelle et certains problèmes de santé semblent être associés couramment à un trouble des fonctions exécutives. L’évaluation des fonctions exécutives fait appel à une évaluation dynamique du rendement occupationnel. Les interventions ciblant les fonctions exécutives sont fondées sur des approches métacognitives. Conclusion. Les fonctions exécutives sont un construit complexe et l’on observe une variance considérable face à la conceptualisation de ce construit dans la littérature en ergothérapie, ce qui constitue un obstacle à la prestation de services efficaces.

Mental Disorder Symptoms among Public Safety Personnel in Canada

Background: Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP. Methods: An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures. Results: There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure. Interpretation: The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.

Distance-delivered interventions for PTSD: A systematic review and meta-analysis

This systematic review and meta-analysis evaluated the efficacy of distance-delivered, guided approaches to treatment (e.g., delivered via telephone, Internet, mail, videoconferencing) for clinical and subclinical posttraumatic stress disorder (PTSD). A comprehensive search yielded 19 randomized controlled trials (1491 participants) to be included. Meta-analyses revealed that distance-delivered interventions led to significant within-group improvements in PTSD symptoms at post-treatment (g=0.81, 95% CI 0.65 to 0.97) and 3-6 month follow-up (g=0.78, 95% CI 0.59 to 0.97). Within-group depression and quality of life outcomes showed similar results, with medium post-treatment and follow-up effects. Compared to a waiting list, distance delivery (specifically, Internet treatments) led to superior PTSD outcomes (g=0.68, 95% CI 0.51 to 0.86). Compared to face-to-face interventions, distance delivery (specifically, videoconferencing treatments) did not result in significantly different PTSD outcomes at post-treatment (g=-0.05, 95% CI -0.31 to 0.20) but led to inferior outcomes at 3-6 month follow-up (g=-0.25, 95% CI -0.44 to -0.07). Distance delivery of PTSD treatment is promising, but research is needed to determine its optimal use.

Occupational disruption: A scoping review

ABSTRACT Introduction: The term occupational disruption is used increasingly throughout the occupational science and therapy literature. Despite frequent mentions, a clear understanding of the concept and its use is lacking. Aim: The purpose of this scoping review was to conceptualise occupational disruption by explaining how the term is described and understood. Methods: Levac, Colquhoun, and O’Brien’s (2010) refinements to Arksey and O’Malley’s (2005) scoping review methodology were used to map the research literature around occupational disruption. Results: Occupational disruption is present in the literature in a number of contexts, with discussions relating to impact on identity, management strategies, and engagement in social relationships and valued occupations. However, the term was used inconsistently throughout the literature. Conclusions: An enhanced conceptualization of occupational disruption will promote understanding of its effects and implications, allowing researchers to apply the concept to diverse populations.

Perspectives on the International Classification of Functioning, Disability, and Health: Child and Youth Version (ICF-CY) and Occupational Therapy Practice

ABSTRACT Classifying disability for children and youth has typically meant describing a diagnosis or developmental lag. The publication of the International Classification of Functioning, Disability and Health: Child & Youth version (ICF-CY) marks a global paradigm shift in the conceptualization and classification of childhood disability. Knowledge and awareness of the ICF-CY has been slow to diffuse within occupational therapy. Purpose. The purpose of this paper is to foster the integration of the ICF-CY into occupational therapy practice with children and youth. Key issues. Research describes positive trends in using the ICF-CY for cross-disciplinary communication; further clarity and development is warranted around activity and participation categories and functional profiles. Implications. Occupational therapy can contribute to the evolution of the ICF-CY, but must clarify its complementary perspective and knowledge base. If the ICF-CY can be further integrated into occupational therapy systems, it holds promise for shifting practice patterns and creating professional opportunities.

Practice Patterns of School-based Occupational Therapists Targeting Handwriting: A Knowledge-to-Practice Gap

Poor handwriting is a common reason for referral to school-based occupational therapy. A survey was used to explore the extent to which current practice patterns in Ontario, Canada, align with evidence on effective intervention for handwriting. Knowledge-to-practice gaps were identified related to focus on performance components versus occupational performance. Therapists identified three learning needs: integrating technology, promoting handwriting practice, and addressing complex areas of difficulty in learning, attention, and language. Therapist and system barriers to best practice were identified. Support for challenging system barriers and access to relevant continuing education opportunities is indicated.

Can Interventions Have Negative Impacts? The Importance of Seeing the Bigger Picture

When children and youth are referred to rehabilitative services, they, along with their families and teachers, often engage in the rehabilitation process with the belief that, with enough effort, the deficits will decrease or even disappear (Carlsson, 2009). What happens, though, when the deficit issue is not—or cannot be—resolved, regardless of what the client or the therapist does, and the child remains unable to engage in daily life tasks in a typical form? In an ethnographic research study with school-based therapists, Carlsson conveyed one therapist’s observation: “I think that [fixing] has some covert messages in it to the child, and I think those messages are about ‘you need fixing’ and ‘you are not quite right”’ (Carlsson, 2009, p. 7). When it comes to working with children, we need to remember that Raising children ... is vastly more than fixing what is wrong with them. It is about identifying and nurturing their strongest qualities, what they own and are best at, and helping them find niches in which they can best live out these strengths (Seligman & Csikszentmihalyi, 2000, p. 6). It is critical that we consider the messages we communicate to the children, youth, families, and communities in which we work. If we don’t, we may run the risk that the outcome of therapy is experienced as “unhelpful at best and harmful at worst” (Kielhofner, 2005, p. 487), with our clients interpreting our drive to fix as a statement of their lesser value, worth, and potential contribution to their communities. With this “fix-it factor” comes the view that there is something that is broken and correctable (Carlsson, 2009, p. 7), a perspective at odds with the World Health Organization’s (WHO) emphasis on participation for children and youth (WHO, 2007). Priestley has labeled the tendency to focus on fixing rather than participation as the “tyranny of ‘normal’ child development” (Priestley, 2003, p. 64), recognizing the trend flowing from stage-based development theories to compare children’s abilities to some physical, cognitive, and social standard of what it means

Mental Health Services Use Trends in Canadian Veterans: A Population-Based Retrospective Cohort Study in Ontario:

Objective: A substantial evidence base in the peer-reviewed literature exists investigating mental illness in the military, but relatively less is documented about mental illness in veterans. This study uses provincial, administrative data to study the use of mental health services by Canadian veterans in Ontario. Method: This was a retrospective cohort study of Canadian Armed Forces and Royal Canadian Mounted Police veterans who were released between 1990 and 2013 and resided in Ontario. Mental health–related primary care physician, psychiatrist, emergency department (ED) visits, and psychiatric hospitalisations were counted. Repeated measures were presented in 5-year intervals, stratified by age at release. Results: The cohort included 23,818 veterans. In the first 5 years following entry into the health care system, 28.9% of veterans had ≥1 mental health–related primary care physician visit, 5.8% visited a psychiatrist at least once, and 2.4% received acute mental health services at an ED. The use of mental health services was consistent over time. Almost 8% of veterans aged 30 to 39 years saw a psychiatrist in the first 5 years after release, compared to 3.5% of veterans aged ≥50 years at release. The youngest veterans at release (<30 years) were the most frequent users of ED services for a mental health–related reason (5.1% had at least 1 ED visit). Conclusion: Understanding how veterans use the health care system for mental health problems is an important step to ensuring needs are met during the transition to civilian life.

School participation and children in military families: A scoping review

ABSTRACT Children from military families experience high mobility, stressors due to parental separation and increased risk of parental injury and death. This study aimed to identify and describe school-related occupational disruption for students from military families. Arskey and O’Malley’s structured approach to scoping reviews was used. Students in military families experience occupational challenges in managing transitions across schools, maintaining academics, developing social relationships, and engaging in extracurricular activities. The environment can also enable school-related occupations. Occupational therapists are encouraged to consider military-connected students as a vulnerable population and use school-based services to address mental health issues.

“Playing the system”: Structural factors potentiating mental health stigma, challenging awareness, and creating barriers to care for Canadian public safety personnel

There are growing concerns about the impact of public safety work on the mental health of public safety personnel; as such, we explored systemic and individual factors that might dissuade public safety personnel from seeking care. Public safety personnel barriers to care-seeking include the stigma associated with mental disorders and frequent reports of insufficient access to care. To better understand barriers to care-seeking, we thematically analyzed the optional open-ended final comments provided by over 828 Canadian public safety personnel as part of a larger online survey designed to assess the prevalence of mental disorders among public safety personnel. Our results indicated that systematic processes may have (1) shaped public safety personnel decisions for care-seeking, (2) influenced how care-seekers were viewed by their colleagues, and (3) encouraged under-awareness of personal mental health needs. We described how public safety personnel who do seek care may be viewed by others; in particular, we identified widespread participant suspicion that coworkers who took the time to address their mental health needs were “abusing the system.” We explored what constitutes “abusing the system” and how organizational structures—systematic processes within different public safety organizations—might facilitate such notions of abuse. We found that understaffing may increase scrutiny of injured public safety personnel by those left to manage the additional burden; in addition, cynicism and unacknowledged structural stigma may emerge, preventing the other public safety personnel from identifying their mental health needs and seeking help. Finally, we discuss how system-level stigma can be potentiated by fiscal constraints when public safety personnel take any leave of absence, inadvertently contributing to an organizational culture wherein help-seeking for employment-related mental health concerns becomes unacceptable. Implications for public safety personnel training and future research needs are discussed.