Priscilla Harries

Generic and Specialist Occupational Therapy Casework in Community Mental Health Teams

The aim of this research was to conduct a cluster analysis on data from 40 community mental health occupational therapists to determine if subgroups of therapists had differing referral prioritisation policies. A Wards cluster analysis showed four clusters to be present. These four subgroups of occupational therapists were found to differ according to several factors: the percentage of role dedicated to specialist occupational therapy or generic work, satisfaction with the balance in these roles, the number of hours worked, the number of professionally trained team members and the presence of referral prioritisation policies. The subgroups were named the aspiring specialists, the satisfied specialists, the satisfied genericists and the chameleons (those not set in applying a consistent or specific policy). The policies that led to mainly generic working gave greatest importance to clients who were potentially violent or at risk of suicide. The policies that led to more of an occupational therapy role gave particular importance to the reason for referral and the clients diagnosis. The College of Occupational Therapists has recommended that the majority of casework should be focused on specialist occupational therapy interventions (Craik et al 1998): most of the participants in this study were not meeting this recommendation. Although some aspired to being more specialist, the pressures to work generically may have been affecting referral policies.

Factors used in the detection of elder financial abuse: A judgement and decision-making study of social workers and their managers

Factors social workers use in practice to detect elder financial abuse are currently unknown. A critical incident technique was applied within a judgement analysis approach to elicit cue use. Only three factors were key to decision-making: who raises concern, the elder’s mental capacity and the nature of the financial anomaly occurring.

Studying Clinical Reasoning, Part 1: Have We been Taking the Wrong ' Track' ?

This is the first of two papers that examine clinical reasoning research in occupational therapy. It discusses the reasoning studies of the 1980s and 1990s, focusing on ethnographic and process-tracing approaches. From this critique, a need for an approach that acknowledges the experienced thinkers intuitive reasoning is identified. The second paper will present such an approach, based on social judgement theory, and demonstrate the first application of such a method in the field of occupational therapy.

A systematic review of predictions of survival in palliative care: How accurate are clinicians and who are the experts?

Background Prognostic accuracy in palliative care is valued by patients, carers, and healthcare professionals. Previous reviews suggest clinicians are inaccurate at survival estimates, but have only reported the accuracy of estimates on patients with a cancer diagnosis. Objectives To examine the accuracy of clinicians’ estimates of survival and to determine if any clinical profession is better at doing so than another. Data Sources MEDLINE, Embase, CINAHL, and the Cochrane Database of Systematic Reviews and Trials. All databases were searched from the start of the database up to June 2015. Reference lists of eligible articles were also checked. Eligibility Criteria Inclusion criteria: patients over 18, palliative population and setting, quantifiable estimate based on real patients, full publication written in English. Exclusion criteria: if the estimate was following an intervention, such as surgery, or the patient was artificially ventilated or in intensive care. Study Appraisal and Synthesis Methods A quality assessment was completed with the QUIPS tool. Data on the reported accuracy of estimates and information about the clinicians were extracted. Studies were grouped by type of estimate: categorical (the clinician had a predetermined list of outcomes to choose from), continuous (open-ended estimate), or probabilistic (likelihood of surviving a particular time frame). Results 4,642 records were identified; 42 studies fully met the review criteria. Wide variation was shown with categorical estimates (range 23% to 78%) and continuous estimates ranged between an underestimate of 86 days to an overestimate of 93 days. The four papers which used probabilistic estimates tended to show greater accuracy (c-statistics of 0.74–0.78). Information available about the clinicians providing the estimates was limited. Overall, there was no clear “expert” subgroup of clinicians identified. Limitations High heterogeneity limited the analyses possible and prevented an overall accuracy being reported. Data were extracted using a standardised tool, by one reviewer, which could have introduced bias. Devising search terms for prognostic studies is challenging. Every attempt was made to devise search terms that were sufficiently sensitive to detect all prognostic studies; however, it remains possible that some studies were not identified. Conclusion Studies of prognostic accuracy in palliative care are heterogeneous, but the evidence suggests that clinicians’ predictions are frequently inaccurate. No sub-group of clinicians was consistently shown to be more accurate than any other. Implications of Key Findings Further research is needed to understand how clinical predictions are formulated and how their accuracy can be improved.

Boredom proneness in a psychiatric inpatient population

Background: Boredom has been reported as a common experience for service users of acute psychiatric wards. It has been associated with negative mental and physical health. Research has yet to show what factors are associated with boredom proneness within the acute psychiatric population. Aims: (1) To investigate the distribution of boredom proneness in a population of mentally ill inpatients according to age, gender, diagnosis, Mental Health Act status and length of stay in hospital. (2) To test the hypothesis that boredom proneness is negatively correlated with autonomous activity levels. Method: Two self-report questionnaires were used with 55 inpatients of acute psychiatric wards: the Boredom Proneness Scale (Farmer & Sundberg, 1986) and the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983). Questions were also asked about individuals’ activity engagement during their current admission. Data on age, gender, diagnosis, ethnicity, Mental Health Act status and length of stay were collected from case notes. Results and conclusions: The highest incidence of boredom proneness was in participants with depression. Those detained under the Mental Health Act appeared less boredom prone than those admitted voluntarily. Boredom proneness was not associated with age, gender or length of stay. There was an association between engagement in more autonomous activities and lower boredom proneness.

Enhanced clarity and holism: The outcome of implementing the ICF with an acute stroke multidisciplinary team in England

Abstract Purpose: Although it is recommended that the ICF (International Classification of Functioning, Disability and Health) should be implemented to aid communication within multidisciplinary stroke services, there is no empirical evidence to demonstrate the outcomes of such implementation. Working with one stroke service, this project aimed to address this gap and sought to evaluate the outcomes of implementing an ICF-based clinical tool into practice. Method: Using an action research framework with mixed methods, data were collected from individual interviews, a focus group, questionnaires, email communications, minutes from relevant meetings and field notes. Thematic analysis was undertaken, using immersion and crystallisation, to define overall themes. Descriptive statistics were used to analyse quantitative data. Data from both sources were combined to create key findings. Results: Three findings were determined from the data analysis. The ICF (1) fosters communication within and beyond the multidisciplinary stroke team; (2) promotes holistic thinking; and (3) helps to clarify team roles. Conclusions: The ICF enhanced clarity of communication and team roles within the acute stroke multidisciplinary team as well as with other clinicians, patients and their relatives. In addition, the ICF challenged stroke clinicians to think holistically, thereby appropriately extending their domain of concern beyond their traditional remit. Implications for Rehabilitation The ICF is a globally accepted framework to describe functioning and is in use in a variety of clinical settings. Yet, the outcomes of using it in clinical practice have yet to be fully explored. This study found that the ICF enhanced clarity of communication and team roles within an acute stroke multidisciplinary team and to others beyond the team, including clinicians, patients and their relatives. Using the ICF also challenged clinicians to think holistically about patient needs following a stroke.

To adopt is to adapt: the process of implementing the ICF with an acute stroke multidisciplinary team in England

Purpose: The success of the International Classification of Functioning, Disability and Health (ICF) depends on its uptake in clinical practice. This project aimed to explore ways the ICF could be used with an acute stroke multidisciplinary team and identify key learning from the implementation process. Method: Using an action research approach, iterative cycles of observe, plan, act and evaluate were used within three phases: exploratory; innovatory and reflective. Thematic analysis was undertaken, using a model of immersion and crystallisation, on data collected via interview and focus groups, e-mail communications, minutes from relevant meetings, field notes and a reflective diary. Results: Two overall themes were determined from the data analysis which enabled implementation. There is a need to: (1) adopt the ICF in ways that meet local service needs; and (2) adapt the ICF language and format. Conclusions: The empirical findings demonstrate how to make the ICF classification a clinical reality. First, we need to adopt the ICF as a vehicle to implement local service priorities e.g. to structure a multidisciplinary team report, thus enabling ownership of the implementation process. Second, we need to adapt the ICF terminology and format to make it acceptable for use by clinicians. Implications for Rehabilitation The International Classification of Functioning, Disability and Health (ICF) is a globally accepted framework to describe functioning and is in use in a variety of clinical settings. Yet, the actions necessary to aid the implementation process, with clinicians, have not been explored. This study found that an acute stroke multidisciplinary team needed to adapt the ICF and own the way it was introduced within their team, to adopt it into practice.

Framing the detection of financial elder abuse as bystander intervention: decision cues, pathways to detection and barriers to action

Purpose – The purpose of this paper is to explore the detection and prevention of elder financial abuse through the lens of a “professional bystander intervention model”. The authors were interested in the decision cues that raise suspicions of financial abuse, how such abuse comes to the attention of professionals who do not have a statutory responsibility for safeguarding older adults, and the barriers to intervention.Design/methodology/approach – In‐depth interviews were conducted using the critical incident technique. Thematic analysis was carried out on transcribed interviews. In total, 20 banking and 20 health professionals were recruited. Participants were asked to discuss real cases which they had dealt with personally.Findings – The cases described indicated that a variety of cues were used in coming to a decision that financial abuse was very likely taking place. Common to these cases was a discrepancy between what is normal and expected and what is abnormal or unexpected. There was a marked dif...

A comparison of two-coloured filter systems for treating visual reading difficulties

Abstract Purpose: Visual disturbances that make it difficult to read text are often termed “visual stress”. Coloured filters in spectacles may help some children overcome reading problems that are often caused by visual stress. It has been suggested that for optimal effect each child requires an individually prescribed colour for each eye, as determined in systems such as the “Harris Foundation” coloured filters. Alternatively, it has been argued that only blue or yellow filters, as used in the “Dyslexia Research Trust” (DRT) filter system, are necessary to affect the underlying physiology. Method: A randomised, double blind trial with 73 delayed readers, was undertaken to compare changes in reading and spelling as well as irregular and non-word reading skills after 3 months of wearing either the Harris or the DRT filters. Results: Reading improved significantly after wearing either type of filter (t = −8.4, p < 0.01), with 40% of the children improving their reading age by 6 months or more during the 3 month trial. However, spelling ability (t = 2.1, p = 0.05) and non-word reading (f = 4.7, p < 0.05) improved significantly more with the DRT than with the Harris filters. Conclusion: Education and rehabilitation professionals should therefore, consider coloured filters as an effective intervention for delayed readers experiencing visual stress. Implications for Rehabilitation Any disability that impacts on a child’s capacity to read has serious implications for academic development as well as the ability to participate independently in activities of daily living. One reading disability, generally termed “visual stress”, is related to visual disturbances that make it difficult to read text. This research demonstrates the beneficial use of coloured filters for promoting visual reading capacity for children with visual stress. Professionals who are involved in the needs of children with reading delay, may like to consider the benefits that coloured filters can afford children with visual reading problems.

Facilitating Change in Anorexia Nervosa: The Role of Occupational Therapy:

Patients with anorexia nervosa benefit from a multidisciplinary approach. This article gives a brief description of, first, the illness and its treatment and, secondly, the occupational therapy techniques used at the Maudsley Unit. It then demonstrates the progress of patients through examples of projective art.