Patty Rigby

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.

Conceptualizing participation in context for children and youth with disabilities: an activity setting perspective

Abstract This article considers the conceptualization, operationalization and implications of “activity settings” for research on the recreation and leisure participation of children and youth with disabilities. Activity settings are contextualized settings that situate child and youth activities and their participation experiences. We discuss activity settings as an important construct for considering environmental qualities that provide opportunities for beneficial participation experiences for children and youth with disabilities. The article considers existing research using the concept of activity settings, the conceptualization of environment and contemporary issues in the measurement of participation and environment, indicating how these are addressed by an activity settings approach. We then describe the development of two quantitative measures of recreation and leisure activity settings – one assessing environmental qualities and the other assessing youth experiences – that have the potential to inform researchers, managers and clinicians about relationships between environmental qualities and participation experiences. Finally, we consider the implications of an activity settings approach for research, theory building and clinical practice. Implications for Rehabilitation An activity setting perspective can enhance understanding of the recreation and leisure participation of children and youth with disabilities. The Measure of Environmental Qualities of Activity Settings (MEQAS) and Self-reported Experiences of Activity Settings (SEAS) provide unique assessments of environmental qualities and experiences from an activity setting perspective. Clinicians might use the SEAS alone to understand particular youth experiences in certain types of settings, which may be limiting or facilitating development. The combined use of the SEAS and MEQAS can provide experiential profiles linked to activity setting qualities such as structure, type of activity and social partners, providing a valuable source of information about youth programs.

Development of a Measure to Assess Youth Self-Reported Experiences of Activity Settings (SEAS).

There is a need for psychometrically sound measures of youth experiences of community/home leisure activity settings. The 22-item Self-Reported Experiences of Activity Settings (SEAS) captures the following experiences of youth with a Grade 3 level of language comprehension or more: Personal Growth, Psychological Engagement, Social Belonging, Meaningful Interactions, and Choice & Control. Forty-five youth aged 14–23 years (10 with severe disabilities) completed the SEAS in 160 leisure activity settings. The SEAS has good to excellent internal consistency (Cronbach’s alpha from 0.71 to 0.88) and moderate test–retest reliability (mean scale intra-class correlation coefficient  =  0.68), as expected due to changes in activity settings over time. The SEAS was able to differentiate various types of activity settings and participation partners. The SEAS can be used to gain greater understanding of situation-specific experiences of youth participating in various types of recreation and leisure activity settings, including youth with different types of disabilities and those without disabilities.

The leisure activity settings and experiences of youth with severe disabilities

Abstract Objective: The objective was to describe the leisure activity settings of youth with severe disabilities, the environmental qualities of these settings, and youths’ experiences. Methods: Fifteen youth using augmentative and alternative communication and 11 with complex continuing care needs took part in 54 leisure activity settings of their own choosing. Following their participation, they completed the Self-Reported Experiences of Activity Settings questionnaire and trained observers completed the Measure of Environmental Qualities of Activity Settings. Results: Youths’ selected activity settings provided relatively high opportunities for choice, interaction with adults, and social activities, and youth experienced relatively high levels of psychological engagement, social belonging, and control and choice. Youth primarily took part in activity settings that provided opportunities for competency/relatedness and involved others. Conclusion: Implications for future research and clinical practice include the importance of valuing passive recreational activities for the opportunities for challenge, choice, and social interaction they provide.

Development of a direct observation Measure of Environmental Qualities of Activity Settings

The aim of this study was to develop an observer‐rated measure of aesthetic, physical, social, and opportunity‐related qualities of leisure activity settings for young people (with or without disabilities).

Optimizing engagement in goal pursuit with youth with physical disabilities attending life skills and transition programs: an exploratory study

Abstract Purpose: Identify strategies youth perceive will optimize their engagement in goal pursuit in life skills and transition programs using an engagement framework involving affective, cognitive, and behavioral components. Methods: A qualitative descriptive design was used. Two semi-structured interviews were conducted with seven youth. The first was informed by a prior observation session, and the second occurred after the program ended and explored youths’ perceptions of whether and how their engagement changed. Data were analyzed using thematic analysis. Results: The analysis generated eight strategies youth considered effective. These were categorized under the three components of engagement. Affective strategies: (1) building a relationship on familiarity and reciprocity; and (2) guiding the program using youths’ preferences and strengths. Cognitive strategies: (3) assisting youth to envision meaningful change; (4) utilizing youths’ learning styles; and (5) promoting awareness of goal progress. Behavioral strategies: (6) ensuring youth access to a resource network; (7) providing youth multiple decision opportunities; and (8) enabling youth to showcase capabilities. Conclusions: Service providers together with youth are encouraged to consider the role of context and self-determination needs in order to optimize youth engagement in goal pursuit. Systematic approaches to studying engagement are necessary to learn how to maximize rehabilitation potential. Implications for Rehabilitation Service providers are encouraged to be aware of the nature of engagement strategies identified by youth. Comprehensive frameworks of engagement are essential to generate knowledge on the range of strategies service providers can use to engage clients in rehabilitation services. Strategies perceived by youth to optimize their engagement in goal pursuit in life skills and transition programs have subtle yet significant differences with strategies used in other rehabilitation settings like mental health and adult healthcare services. Self-determination theory shows potential in guiding further research on exploring the role of engagement in maximizing rehabilitation outcomes.

Revised Measure of Environmental Qualities of Activity Settings (MEQAS) for youth leisure and life skills activity settings

Abstract Purpose: The aim was to create an expanded version of a published observer-rated Measure of Environmental Qualities of Activity Settings (MEQAS-32). Method: Testing was conducted using a diverse sample of activity settings. Raters completed the original MEQAS questionnaire (MEQAS-66) for 76 youth leisure and life skills activity settings. Scales for the revised measure (MEQAS-48) were determined using a two-step approach: (a) developing a theoretically-based model based on item-to-item linkages, and (b) confirmatory factor analysis. Results: The analysis revealed a good fitting 9-factor model (CFI= 0.965, RMSEA= 0.049). Five of the six MEQAS-32 scales remained and were validated in an independent dataset. Four additional scales were identified in the MEQAS-48: Comfortable Place-related Qualities, Opportunities for Privacy/Relaxation, Opportunities to Interact with Peers, and Opportunities for Cooperative Group Activity. Opportunities for Choice and Opportunities for Personal Growth were significantly correlated with corresponding youth experiences. Construct validity was demonstrated through predictions for various types of activities. Conclusions: The MEQAS-48 more completely reflects the original conceptualization of the measure’s content than does the MEQAS-32. Findings suggest the increased utility of the measure due to broader coverage of environmental qualities. The MEQAS-48 can be used to assess environmental qualities for research, program design, and clinical practice. Implications for Rehabilitation The MEQAS is the first observer-completed measure of environmental qualities of activity settings. Compared to the MEQAS-32, the MEQAS-48 captures a broader range of important environmental qualities, including comfortable place-related qualities, and opportunities for privacy/relaxation, peer interaction, and cooperative group activity. The MEQAS-48 has clinical utility for use in program design and development, and research utility for understanding environmental qualities.

Conceptual clarification of the playful engagement in social interaction of preschool-aged children with autism spectrum disorder (ASD)

ABSTRACT Children with autism spectrum disorder (ASD) demonstrate limited playfulness. Their difficulty engaging in meaningful interaction with others renders playful engagement in social interactions a challenge. Although little direct evidence exists regarding the promotion of these children’s playful engagement, links can be established with many traits cited in play and social interaction studies. This paper presents the results of a conceptual clarification exercise regarding the key behaviours associated with the construct of playful engagement in preschool-aged children with ASD. Behaviours were identified based on hallmark deficits in early social interactions and play of children with ASD. The analysis revealed the following behaviours: positive affect, engagement, imitation, joint attention, initiation of social interaction, social responsiveness, flexibility, child’s laughter in funny situations and giving and reading non-verbal cues. In conclusion, a conceptually coherent stage has been set for exploring the literature regarding interventions to promote the playful engagement of preschool-aged children with ASD.

Autism inside out: lessons from the memoirs of three minimally verbal youths

Abstract Background: To date, research exploring experiences and perspectives of people who have severe autism and are minimally verbal, has been sparse. Objectives: To build new understanding based on insider perspectives of people who have severe autism and are minimally verbal. We took interest in how these perspectives support, challenge, or augment current depictions of autism in academic literature. Method: Adopting a descriptive qualitative approach, three memoirs written by youths who have severe autism and are minimally verbal were examined using inductive thematic analysis. Analytic methods followed a recursive process of coding, collating, mapping, reviewing, creating clear themes, and then reporting using compelling extracts. Results: Analysis generated an over-arching theme regarding the youths’ concern that the way they are perceived from the outside does not match the people they are on the inside. In explaining this mismatch, the youths identify differences in the way their brains work, as well as difficulty controlling their bodies. Conclusions: These youths emphasize concepts of embodiment and physical control as central to their experiences of autism. Findings highlight the need for research exploring insider perspective and the development of innovative methods to gain insight into the understanding and interests of people who are minimally verbal. Implications for rehabilitation The development of a communication system (hi-tech or low tech) should be a top priority for intervention when serving clients who have severe autism and are minimally verbal. When working with clients who have severe autism and are minimally verbal, clinicians should be cautious in applying and interpreting assessments of intelligence and understanding, since difficulties with verbal output and movement control can obscure results. To improve information gathering and therapeutic outcomes, clinicians and educators should use varied assessment and intervention techniques, administered across multiple sessions, and environments. Consideration should be given to difficulties with movement initiation and movement inhibition when guiding and interpreting behaviors.

Interventions to promote the playful engagement in social interaction of preschool-aged children with autism spectrum disorder (ASD): a scoping study

ABSTRACT Children with autism spectrum disorder (ASD) experience significant difficulties engaging in meaningful play. Although enabling their playful engagement in social interactions is an important objective, little is known about which interventions effectively promote it. The aim of this was study to conduct a scoping study to map the breadth and summarize the research evidence regarding interventions that promote the playful engagement of preschool-aged children with ASD with adult play partners. Arksey and O’Malley’s (2005) methodological framework for scoping studies was used. Literature from January 2000–December 2015 was included. The results of this study revealed a considerable number and variety of strategies as well as intervention approaches that are coherent with the promotion of playful engagement. The conceptually based approach used allowed the integration of the literature from different perspectives. The results provide specific guidance to therapists and parents on strategies that may be embedded in their daily interactions with these children.