Lynn Cockburn

Understanding the stigma of mental illness in employment

BACKGROUND Stigma has been identified as an important barrier to the full community participation of people with mental illness. This study focuses on how stigma operates specifically within the domain of employment. OBJECTIVES The purpose was to advance the development of theory related to the stigma of mental illness in employment to serve as a guiding framework for intervention approaches. METHOD The study used a constructivist grounded theory methodology to analyze over 500 Canadian documents from a diverse range of sources and stakeholders, and interviews with 19 key informants. FINDINGS The paper develops several key components central to the processes of stigma in the work context. These include the consequences of stigma, the assumptions underlying the expressions of stigma, and the salience of these assumptions, both to the people holding them and to the specific employment situation. Assumptions are represented as varying in intensity. Finally specific influences that perpetuate these assumptions are presented. IMPLICATIONS The model suggests specific areas of focus to be considered in developing intervention strategies to reduce the negative effects of stigma at work.

An Interfaculty Pain Curriculum: Lessons learned from six years experience

Abstract Minimal pain content has been documented in pre‐licensure curricula and students lack important pain knowledge at graduation. To address this problem, we have implemented and evaluated a mandatory Interfaculty Pain Curriculum (IPC) yearly since 2002 for students (N = 817 in 2007) from six Health Science Faculties/Departments. The 20‐h pain curriculum continues to involve students from Dentistry, Medicine, Nursing, Pharmacy, Physical Therapy, and Occupational Therapy as part of their 2nd or 3rd year program. Evaluation methods based on Kirkpatrick’s model now include evaluation of a Comprehensive Pain Management Plan along with the previously used Pain Knowledge and Beliefs Questionnaire (PKPQ) and Daily Content and Process Questionnaires (DCPQ). Important lessons have been learned and subsequent changes made in this iterative curriculum design based on extensive evaluation over the 6‐year period. Modifications have included case development more relevant to the diverse student groups, learning contexts that are uni‐, inter‐, and multi‐professional, and facilitator development in working with interprofessional student groups. PKBQ scores have improved in all years with a statistically significant average change on correct responses from 14% to 17%. The DCPQ responses have also indicated consistently that most students (85–95%) rated highly the patient panel, expert‐lead clinically focused sessions, and small interprofessional groups. Relevancy and organization of the information presented have been generally rated highly from 80.3% to 91.2%. This curriculum continues to be a unique and valuable learning opportunity as we utilize lessons learned from extensive evaluation to move the pain agenda forward with pre‐licensure health science students.

Participatory action research: integrating community occupational therapy practice and research.

Participatory action research (PAR) is a form of collaborative research particularly concerned with power inequities of marginalized communities. With this approach, occupational therapists can work with clients and communities to address issues of access, inclusion, equity and collaboration in practice and research. This paper begins with a summary of key concepts and controversies related to participatory action research. Two examples from occupational therapy experience are used to demonstrate the initial steps and key principles of PAR projects and to highlight the conceptual links between PAR and community-based, client-centred occupational therapy. One project involved a group of mental health consumers, the other a community group of older adults. Several challenges and potential outcomes in PAR projects are highlighted in this examination of the complexity of PAR processes. The paper concludes by identifying possibilities and obstacles to the further use of PAR in occupational therapy.

Disability in low-income countries: Issues and implications

This article reports on a study conducted for the CANADIAN INTERNATIONAL DEVELOPMENT AGENCY by THE INTERNATIONAL CENTRE FOR DISABILITY AND REHABILITATION at the University of Toronto. We critically examined the broad literature in the area of disability and development and in this article we identify the key issues which emerged. Most of the data were collected from existing literature in the academic and practice settings and from the publications of key NGOs and governments. We first, examine disability in the context of low-income countries, and then discuss key critical issues: disability and poverty, disability and health, disability and education, disability and gender, disability and children/youth, disability and conflict/natural disasters and disability and human rights. In all these areas we find reports of discrimination, stigmatisation and marginalisation. We conclude that, as we address issues of multi-cultural disability services in developed countries, it is important to bear in mind the various issues that many people with disabilities and their families bring with them as the result of immigrating from a developing country. Although we address these issues within our own countries, we must bear in mind the changes that are occurring due to globalisation.

Best Practice in Occupational Therapy: Program Characteristics that Influence Vocational Outcomes for People with Serious Mental Illnesses

Background. Despite the known benefits of work for people with mental illnesses, vocational outcomes of this group remain poor. Attempts at comparing the efficacy of various models of service delivery have met with limited success due to variations across studies. Purpose. The purpose of this paper is to provide information about key characteristics related to outcomes in the field of vocational rehabilitation for people with serious mental illnesses. Method. A comprehensive review of literature published between 1990 and 2003 was conducted, resulting in 39 articles for analysis. Results. A set of twelve characteristics was identified that appear to influence vocational outcomes across models. These characteristics relate to the types of services offered, the manner in which services are delivered, and the work environment. Practice Implications. The authors suggest these characteristics can be incorporated across models and practice settings. The findings are discussed in terms of implications for best practice in occupational therapy.

Occupational Therapy Intervention with Children Survivors of War

A preventive occupational therapy program with children surviving the Kosovo conflict is examined. The objective of the program was to facilitate the emotional expression of traumatic experiences in order to prevent the development of future psychological problems. The intervention was based on a community-centred approach with spirituality as a central focus of the intervention. The Model of Human Occupation and the Occupational Performance Process Model were utilized to guide the identification and intervention of occupational performance issues. The childrens return from a land of war to a land of children demonstrates the potential of occupational therapy intervention in this field. With increasing awareness of populations facing social and political challenges, there is a growing importance of the concept of occupational justice and the need to work against occupational apartheid.

Reproductive health experiences among women with physical disabilities in the Northwest Region of Cameroon

To investigate the reproductive health experiences among women with physical disabilities in the Northwest Region of Cameroon.

A Canadian model of work integration for persons with mental illnesses

Purpose. The many programmes, services and policy initiatives that focus on work integration for persons with mental illnesses and psychiatric disabilities reflect a multitude of beliefs and practices that lead the field to work in divergent, sometimes conflicting directions. This article presents a framework of the central constructs that dominate the field of work integration and mental illness. Method. Using the principles of constructivist grounded theory, an analysis of Canadian documents was conducted; the sample was comprised of 100 academic publications, 76 government documents, 138 popular press, 5 legal papers and 107 documents from work initiatives across Canada. In addition, semi-structured interviews were conducted with 19 key informants from across Canada. Results. Five central perspectives were identified, around which the field of work integration currently operates: a competency perspective; a citizenship perspective; a workplace health perspective; a perspective focussing on potential, growth and self-construction; a community economic development perspective. Conclusions. Uncovering the varied discourses around work integration enables an understanding of the different ways in which the problem of work integration has come to be seen in todays context; how it is understood, spoken about, dealt with and internalised by individuals and groups. The framework sheds light on the rationale for the range of solutions that have been developed to address the problem of work integration, and it is useful in the analysis of how policy, practice and research initiatives are shaped and promoted.

Global partnerships for international fieldwork in occupational therapy: reflection and innovation.

International fieldwork placements (IFPs) have become very popular among healthcare students including those in occupational therapy programmes. There are many potential benefits that can accrue to the students; however, there are critiques of international placements especially for students going to underserviced areas. The purpose of this paper is to provide a case study/model programme description that critically reflects on six partnerships in three underserviced countries that provide IFPs to students from one Canadian university. The personal opinions of each partner were collected verbally, by email and by a qualitative review of the past 10 years of partnership interaction. Some of the benefits reported by partners include the development of an increased number of sustainable long-term quality placements, orientation materials, student supports and the involvement of university faculty in research and capacity building projects in partner countries. A number of challenges were identified including the need for an expanded formal agreement, more bilateral feedback and examination of supervision models. This paper examines a limited number of partnerships with only one Canadian partner. Direct input of students is not utilized, although feedback given to co-authors by students is reflected. More research is needed on perspectives of partners in IFPs, impact of IFPs on clinical practice in students home countries, impact of IFPS on underserviced areas and effective strategies for debriefing.

Employment Outcomes Associated with ACT: A Review of ACT Literature

While the efficacy of the Assertive Community Treatment (ACT) model has been well researched in the areas of hospitalization rates, there is significantly less research on outcomes affecting quality of life, community living, and, in particular, employment. This article examines vocational outcomes associated with ACT through a comprehensive examination of the literature published between 1990 and 2003. Results show that employment outcomes are variable across studies but that ACT generally shows superior rates of employment than standard care. The presence of a vocational specialist may account for some of these variations.