Yvonne Thomas

The Impact of Exercise on the Mental Health and Quality of Life of People with Severe Mental Illness: A Critical Review

Introduction: Physical exercise has been proven to benefit the general population in terms of mental health and wellbeing. However, there is little research investigating the impact of exercise on mental health and quality of life for people who experience a severe and enduring mental illness. Method: This review aims to describe the effect of physical exercise intervention on the mental health and quality of life of people with severe mental illness. Quantitative and qualitative articles published between 1998–2009 were sourced using electronic databases. Articles were included if the study intervention involved exercise and the outcome measure included mental health or quality of life. Sixteen articles were analysed for common themes and appraised critically. Findings: The findings show that exercise can contribute to improvements in symptoms, including mood, alertness, concentration, sleep patterns and psychotic symptoms. Exercise can also contribute to improved quality of life through social interaction, meaningful use of time, purposeful activity and empowerment. Implications: Future research is warranted to describe the way exercise can meet the unique needs of this population. Studies with a focus on psychological outcome measures would provide greater evidence for its use in therapy.

Increasing the occupational therapy mental health workforce through innovative practice education: A pilot project

AIM This paper describes the evaluation of a pilot trial of two innovative placement models in the area of mental health, namely role emerging and collaborative supervision. The Queensland Occupational Therapy Fieldwork Collaborative conducted this trial in response to workforce shortages in mental health. METHOD Six occupational therapy students and eight practice educators were surveyed pre- and post-placements regarding implementation of these innovative models. RESULTS Students participating in these placements reported that they were highly likely to work in mental health upon graduation, and practice educators were positive about undertaking innovative placements in future. An overview of the placement sites, trials, outcomes and limitations of this pilot trial is provided. CONCLUSION Though limited by its small sample size, this pilot trial has demonstrated the potential of innovative placement models to provide valuable student learning experiences in mental health. The profession needs to develop expertise in the use of innovative placement models if students are to be adequately prepared to work with the mental health issues of the Australian community now and in the future.

A Systematic Review of Occupational Therapy Interventions With Homeless People

ABSTRACT A systematic review of the occupational therapy literature 1990–2008 was undertaken with the aim to assess the quality of evidence that supports the role of occupational therapy with homeless people. Forty articles were initially identified and critically appraised, including 16 research studies. Seven quantitative articles were included in this review and demonstrated the effectiveness of occupational therapy in providing interventions that increase employment and education prospects, money management, coping skills, and leisure activities. The literature suggests that occupational therapy has an appropriate role with people experiencing homelessness.

An Exploration of Subjective Wellbeing Among People Experiencing Homelessness: A Strengths-Based Approach

Negative perceptions of homelessness contribute to deficit models of practice, false notions of homogeneity, and marginalization. Wellbeing is a state of satisfaction with material, social, and human aspects of life and can be measured both objectively and subjectively. The study explored the meaning and experience of wellbeing in the everyday lives of 20 homeless participants through fieldwork and interviews. This study revealed that health contributed little to their overall perception of wellbeing. Keeping safe, being positive and feeling good, connecting with others, and the ability to participate in “normal” life were the key contributors of subjective wellbeing. The authors demonstrate that social exclusion experienced in homelessness has a negative effect on subjective wellbeing. Services that provide opportunities to experience social inclusion and develop community and cultural connections will improve the wellbeing of homeless persons.

Closing the gap: Supporting occupational therapists to partner effectively with First Australians

BACKGROUND/AIM Occupational therapists need to be able to work competently with all clients, including First Australians. Currently, there are no national standards for occupational therapists working with First Australian clients. This article presents current issues in practice and education with First Australians and makes recommendations for the future. METHODS A survey of 41 occupational therapists working with, or interested in First Australian health issues was conducted at a workshop held at the Australian National Occupational Therapy Conference in 2008. Results of the workshop group discussions were also collated. RESULTS Several themes emerged from both survey data and discussions. A substantial proportion of participants rated their confidence and competence to work with First Australians as low to moderate. Higher levels of perceived confidence and competence were associated with current experience in the field. Discussions centred around six major themes: building relationships, service provision and design, education and training of occupational therapists, increasing First Australian representation within occupational therapy, professional issues and political issues. These themes were further collapsed into areas of action, which could be taken by individuals, managers, researchers and professional bodies to improve practice with First Australians. CONCLUSIONS Occupational therapists will benefit from coordinated efforts, on individual and systemic levels, to work more effectively, and in partnership with, First Australians. Such developments should include guidelines for practice, education and research; professional development and networking opportunities; and improved collaboration, especially with First Australian partners, on a national level.

Homelessness and the right to occupation and inclusion: an Australian perspective

Abstract People experiencing homelessness are at risk of poor health and occupational injustice. Recent government initiatives have created an opportunity in Australia for occupational therapists to expand their role to meet the needs of the growing homeless population. The World Federation of Occupational Therapists position statement on human rights in relation to human occupation and participation provides a mandate for promoting health and wellbeing through occupation. A critical review of the literature was undertaken to identify the contribution of occupational therapy to homelessness. Secondary analysis of the findings of seventeen research studies on occupational therapy and homelessness demonstrates the occupational needs of people experiencing homelessness, the meaning of occupation to homeless people, and some evidence of the benefits of occupational therapy. It is proposed that future service provision should focus on both individual occupational engagement societal barriers that inhibit participation. Working in collaboration with people experiencing homelessness in partnerships will assist in addressing marginalisation of this group.

The occupational wellbeing of people experiencing homelessness

ABSTRACT This paper reports findings of a study that utilised an occupational perspective to explore how well-being was achieved and sustained by the occupations of people experiencing homelessness in Australia. Thirty three in-depth qualitative interviews were conducted with homeless individuals in a regional city in Australia. Data from the interviews were thematically analysed to understand the relationship between well-being, as defined by the individual, and the occupations engaged in by people experiencing homelessness. The findings are reported here as three collective narratives that illustrate the experiences of diverse groups within the homelessness population explored in this study. The study demonstrates how occupations go beyond individual experience and choice to explore the social and cultural value of occupations as a means to well-being. The findings are discussed in relation to three key themes that emerged from the study: survival, self-identity and social connectedness. These interconnected concepts complement the existing occupational science literature, and offer a preliminary framework for understanding and improving well-being for disadvantaged and marginalised people where occupations are restricted by societal forces. The findings support the urgent need to redirect services to support occupational opportunities that are socially and culturally valued and enhance survival, self-identity and connectedness of homeless people.

Evaluation of a Collaborative Project to Engage Occupational Therapy Clinicians in Promoting Practice Placement Education

The Queensland Occupational Therapy Fieldwork Collaborative (QOTFC), which was founded in 2004, includes representatives from universities, practising occupational therapists, professional registration bodies and key employers, and aims to promote a shared vision for the future of practice placement education (fieldwork) in Queensland, Australia. Strategic alliances between key occupational therapy stakeholders were fostered by the QOTFC to address a shortfall of occupational therapy practice placement education opportunities in Queensland. This paper describes a project that aimed to engage occupational therapy clinicians in localised ‘hubs’ across the state of Queensland, with a view to solving practice placement shortfalls. The project evaluation and outcomes are discussed. The outcomes indicated that ownership of practice placement education across the entire profession is critical, and can be achieved through a strategic and a collective focus of key stakeholders working collaboratively with local professionals.

Establishing a community of practice for Occupational Therapy curriculum development: The value of a two‐way process

INTRODUCTION A novel application of the concept of a community of practice was adopted in the development of a revised curriculum for undergraduate occupational therapy education in July 2012. University Academic staff and invited practice scholars met together, half yearly for day long meetings to develop and review a new curriculum. The formation of this community of practice allowed for open discourse and feedback to integrate theory and practice. METHOD A qualitative study utilised two focus groups, one for academic staff and one for practice scholars, at the end of the third meeting. The focus groups were facilitated by an external researcher, recorded and transcribed verbatim. Thematic analysis elicited five major themes. FINDINGS Participants reported a sense of community and commitment to the curriculum process. Five themes emerged from the focus groups: (i) a sense of community; (ii) a two-way process with mutual benefits; (iii) benefits to the curriculum and to student learning; (iv) future opportunities including resilience of graduates, and potential research collaborations; and (v) the structure and process of engaging in the community of practice. CONCLUSION The commitment of time, planning and resources required to establish and participate in collaborative curriculum development with practice scholars is shown to be a valuable investment for occupational therapy academics, expert practice scholars and ultimately for student learning. Further studies of student and graduate outcomes from the curriculum are warranted. Potential future outcomes of this process include resilience in graduates and collaborative research with practice scholars.

World Federation of Occupational Therapists (WFOT) Standard For 1000 Hours of Practice Placement: Informed by Tradition or Evidence?

The 2016 World Federation of Occupational Therapists (WFOT) Minimum Standards for the Education of Occupational Therapists (World Federation of Occupational Therapists, 2016) state that all students are expected to complete a minimum of 1000 practice education hours. Reference to a minimum of 1000 hours has been consistent since the original WFOT document Establishing a Programme for the Education of Occupational Therapists, published in 1958, with almost no variation to this requirement in subsequent revisions of the standards. The current minimum standards justify the tradition of retaining 1000 hours, stating ‘it has been consistent since practice-related experience was part of the occupational therapy educational process and appears comparable to other health professional preparation programmes’ (World Federation of Occupational Therapists, 2016: 49). Despite significant revision of the minimum standards in every other way, the original 1000 hours standard (based on 35 hours per week for 30 weeks) remains unchanged 60 years later, with almost no evidence to support or deny its relevance and validity in the current context. The 1000 hours minimum standard was established at a time when practice education usually took place in large mental health institutions and hospitals providing rehabilitation in a wide range of occupation-based interventions. Occupational therapy departments comprised large craft-based workshops and farms, where clients spent extended periods of time engaging in diversional or remedial activities. In this context, students were expected to observe and carry out assessment and interventions, while developing their medical knowledge, personalities, verbal and written reporting and gaining an appreciation of the administration of an occupational therapy service focused primarily on the medical model (World Federation of Occupational Therapists, 1958: 54–55). In line with educational theories of this time, an apprenticeship model of training with one-to-one supervision by a qualified occupational therapist was