Rosemary Lysaght

From margins to mainstream: what do we know about work integration for persons with brain injury, mental illness and intellectual disability?

Employment is a right of citizenship and a social determinant of health, but employment rates remain low for persons with disabilities. The purpose of this paper is to examine the principles and practices guiding work integration within the fields of intellectual disability (ID), brain injury, and mental illness and to identify best practices to support transitions to employment across these three groups. This integrative review drew upon an occupational perspective to analyze the current literature. Findings reveal that the need and benefits of working are recognized across disability groups but that philosophical perspectives guiding work integration differ. In the area of mental illness, recovery is seen as a process within which work plays an important role, in ID work is viewed as a planned outcome that is part of the developmental process, and in the field of brain injury, outcomes of employability and employment are emphasized. A common theme across the three disability groups is that in order to facilitate work integration, the person, the job and the work environment are important factors in need of examination. Evidence pointing to the effectiveness of the supported employment model is increasing across these three populations. A framework for guiding the development of further research and for promoting changes to support work integration is presented.

Experiences of Burnout and Coping Strategies Utilized by Occupational Therapists

Background. Work-related stress and burnout have been found to lead to job dissatisfaction, low-organizational commitment, absenteeism, and high turnover. Purpose. The purpose of this study was to examine the burnout experiences of occupational therapists practicing in Ontario and to describe the practice implications and coping strategies employed. Methods. Data for this mixed methods study were collected using the Maslach Burnout Inventory-General Survey, Areas of Worklife Survey, focus groups, and interviews in the hermeneutics tradition. Findings. High levels of emotional exhaustion were reported by 34.8% of participants, high levels of cynicism by 43.5%, and low professional efficacy by 24.6%. Practice issues included excessive demands on time, conflict, and lack of autonomy and respect. Coping strategies included spending time with family and maintaining professional/personal balance, control of work responsibilities, maintaining a sense of humor, and self-awareness/self-monitoring. Implications. This study contributes to understanding the practice challenges for occupational therapists, factors that contribute to therapist burnout, and strategies employed to maintain competent practice.

Care of self – care by other – care of other: the meaning of self‐care from research, practice, policy and industry perspectives

BACKGROUND Currently, no single definition of self-care is broadly accepted in the literature. Definitions vary as to (i) who engages in self-care behaviour; (ii) what motivates self-care behaviours; and (iii) the extent to which healthcare professionals are involved. Perspectives of self-care differ between healthcare professionals and the general public, and between healthcare professionals in different disciplines and different roles. As different professions view self-care within their own domain of practice, we are left with a multitude of explanations and descriptions. This variety of conceptualisations does impact and complicate research on self-care. As part of a larger enquiry focused on the clarification of this complex concept, this study provides a content analysis of documented definitions of self-care, and a summary of the evolution of the definition of self-care over time. OBJECTIVES To examine the diversity of definitions of self-care from the perspectives of research, practice, policy and industry, and to identify themes or trends in the evolution of the definition of self-care over time. SEARCH STRATEGY The search strategy was designed in consultation with a library scientist to find both published and unpublished papers. A three-step search strategy was used to locate the literature. The databases searched included CINAHL, Medline, EMBASE, PsycINFO, AMED, Cochrane Library, Scirus and Mednar. DATA COLLECTION AND ANALYSIS The definition of self-care was extracted from each paper included in the study. Using an inductive process, a content analysis was performed identifying common terms and phrases from the definitions. The definitions were then divided into four decades, 1970s, 1980s, 1990s and 2000s, and the evolution of the definition of self-care was examined. RESULTS AND CONCLUSIONS In this study we sought to clarify the concept of self-care by examining in detail the definition of self-care. Content analysis of 139 definitions identified seven components of the definition and a range of terms that were applicable to each component. Evolution of the definition over time showed a more expansive definition by the end of the 2000s. Current and evolving definitions of self-care would benefit by being comprehensive and encompassing as many facets of the concept as possible. IMPLICATIONS FOR PRACTICE Healthcare professionals assess, guide, instruct and support individuals as they initiate or engage in self-care. Using a comprehensive definition of self-care would provide an anchor linking each discipline as they interact not only with the individual but also among themselves. IMPLICATIONS FOR RESEARCH The concept of self-care is a many-layered one. Identifying the components in the definition of the term delineates the different areas for potential research in this area. When planning a research project, the definition of the key concept guides the research and shapes the approach to the investigation. For researchers in this area, this study illustrates the wealth and diversity of the definitions of self-care.

The Development of Recovery Competencies for In-patient Mental Health Providers Working with People with Serious Mental Illness

Delivering recovery-oriented services is particularly challenging in in-patient settings. The purpose of this study was to identify the most salient recovery competencies required of in-patient providers. Established methods for the development of competencies were used. Data collection included interviews with multiple stakeholders and a literature review. Data analysis focused on understanding how characteristics of the in-patient context influence recovery-enabling service delivery and the competencies associated with addressing these issues. Eight core competencies with four to ten sub-competencies were identified based on a tension–practice–consequence model. The competency framework can serve as a tool for tailoring workforce education.

Untapped potential: Perspectives on the employment of people with intellectual disability

OBJECTIVE While individuals with intellectual disabilities can make valuable contributions in community workplaces, they typically experience low rates of paid employment. The goal of this article is to explore the reasons for the limited involvement of this population in competitive employment, provide a rationale for including individuals with intellectual disabilities as employees, and propose policy, structural and attitudinal changes that would be necessary to include them more meaningfully in the workforce. METHODS The authors conducted a review of the literature relevant to the key theoretical concepts of disability, employment, organizational management and inclusion. RESULTS The analysis reveals a number of theoretical, philosophical, legal and business arguments for and against the inclusion of workers with intellectual disabilities as employees, and suggests system level changes needed to mitigate challenges to recruiting, hiring and retaining these workers. CONCLUSIONS Changes to the employment situation for workers with intellectual disabilities will require major shifts in government policy, workplace practices and vocational preparation of youth with intellectual disabilities. Continued research is necessary to identify best practices.

Inclusion as a focus of employment-related research in intellectual disability from 2000 to 2010: a scoping review

Purpose: This paper presents the results of a scoping review of the research literature on community-based employment for individuals with intellectual disabilities from 2000 to 2010. The review examined the variables studied in each paper, and considered the degree to which elements of social inclusion were addressed. Method: The search strategy identified a total of 245 articles, the total pool of which was reduced to 42 following abstract and text review. Two researchers reviewed the final set of articles and extracted information relevant to the study goals. Independent and dependent measures used in the studies were categorized relative to a conceptual model of social inclusion. The frequency with which each aspect of inclusion was addressed in the studies was totalled, and the resulting pattern analyzed qualitatively. Results: The analysis revealed that the majority of papers identified the work role achieved (i.e. employment and pay rates, job titles) as the primary construct of interest, while fewer than 5 articles focused on central aspects of inclusion, such as sense of belonging, reciprocity, and need fulfillment. Conclusions: This study profiles the evidence base relative to inclusive employment for people with intellectual disabilities. The lack of evidence on the degree to which social inclusion is being achieved through community-based employment highlights a critical area requiring attention. Implications for Rehabilitation Work is an important social and financial involvement for persons with disabilities, and provides a potentially rich venue for social inclusion. Supported employment has become an accepted best practice in employment of persons with intellectual and other disabilities. While past research has focused on outcomes related to social integration, studies that examine and promote central features of social inclusion are important to move practice forward.

Factors affecting measures of activities and participation in persons with mobility impairment

Purpose. This study examined important factors affecting activities and participation of persons with mobility impairments. Method. This mixed methods study employed grounded theory approaches and data conversion to quantify impact of environmental and personal factors on standard measures of activities and participation. Semi-structured interviews of participants with mobility impairments were conducted to identify key factors and the magnitude of their influence on activities of daily living and participation. Participants were individually scored on the Barthel index (BI) and the Participation scale (P-scale); BI scores that would have been obtained without associated factors were estimated. Average cumulative impact of factors on BI and P-scale scores were estimated to identify factors with the greatest numeric impact. Results. Twenty-four participants identified 258 factors that impacted activities. For the BI, adaptive equipment, gait aids, wheelchairs, scooters and home modifications were most influential. For the P-scale, personality, community and home accessibility, level of impairment, mobility aids and transportation were among the most influential. Conclusion. Convergent results through various methods suggest that reporting of contextual factors that may affect scores on standardised measures of activities and participation may assist in interpretation, and identification of interventional needs at the individual or system levels.

Meaning and Value of Productivity to Adults With Intellectual Disabilities

Involvement in productivity roles such as work, volunteerism, and personal projects plays a central role in the lives of most adults and is associated with enhanced physical and mental health. This study examined the meaning of productivity to adults with intellectual disabilities, their satisfaction with the roles they held, and contributors and barriers to achieving satisfying productivity outcomes. The results suggest a number of key areas to address in future research and practice, including systemic and social barriers to choice and meaningful participation.

Measuring Workplace Social Support for Workers with Disability

Introduction Social support in the workplace has been has been demonstrated to serve as a contributor to a worker’s ability to manage work demands and to manage stress. Research in the area of disability management indicates that interpersonal factors play an important role in the success of return-to-work interventions. The role of workplace support has received limited attention in rehabilitation, despite the salience of support to the disability management process. Prior to this study, there existed no validated quantitative measure of social support for workers who re-enter the workplace following injury or disability. Methods A support measure prototype, the Support for Workers with Disability Scale, was tested with 152 workers in accommodated work situations. Four validation tools were used to assess criterion validity. Factor analysis was used to validate the content structure and reduce the total number of response items. Additional analysis was conducted to determine the ability of the measure to discriminate between groups, and to provide insight into how social support operates in workplaces. Results Based on analysis, a reduced measure consisting of 41 items and measuring supervisor, co-worker, and non-work supports was created. Secondary analysis disclosed information concerning the nature of supports in the workplace. Higher levels of support were identified for workers with fewer work role limitations and for those with one versus multiple injury claims. Conclusions This tool provides a validated outcome measure for research examining the social aspects of workplace disability. It can also serve as a quality management tool for human resource professionals engaged in continuous improvement of disability management programs.

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.