An Occupational Perspective on Psychedelic Therapy: A Scoping Review.

Background. Interest in the use of psychedelics for mental health therapy is burgeoning. Qualitative research methods are increasingly used to understand patient's experiences; however, there is a lack of literature that explores psychedelic use from an occupational perspective. Purpose. To conduct a scoping review of qualitative literature on the experiences of psychedelic use for the purpose of mental health therapy, through an occupational lens. Key Issues. Wilcock's occupational perspective of health was employed to analyze the use of psychedelics in mental health from an occupational perspective. Despite heterogeneous therapy contexts and substances used, patients reported comparable benefits regarding occupational engagement, such as increased mindfulness and autonomy in doing, a renewed sense of being, greater motivation to grow and become, and an improved sense of connection and belonging. Implications. This review demonstrates how psychedelic use in the context of mental health support can be experienced as a meaningful occupation and may contribute to overall health. In turn, this review highlights the utility of an occupational perspective for "non-sanctioned" or stigmatized occupations like psychedelic use, as well as the need for more research on psychedelic use from an occupational perspective. Using an occupational perspective of health can help to de-stigmatize psychedelic use as a meaningful occupation, rather than a deviant one, and shed light on how psychedelics may also positively impact one's participation in everyday life and overall health.

Navigating Ethical Tensions When Working to Address Social Inequities.

IMPORTANCE: When providing services, occupational therapists encounter social inequities that affect the health and well-being of their clients and create ethical tensions. OBJECTIVE: To develop an understanding of the ethical tensions encountered by occupational therapists working with clients experiencing social inequity and how such tensions are navigated. DESIGN: This qualitative study used an interpretive description methodology. SETTING: Community and tertiary health settings. PARTICIPANTS: Fifteen occupational therapists who identified as working with clients experiencing social inequity. OUTCOMES AND MEASURES: Semistructured interviews were used to explore participants' practice experiences. Data were analyzed using thematic analysis. RESULTS: Two themes were identified in relation to participants' experiences of ethical tensions: (a) perpetuating inequities and (b) experiencing conflicting values. A further three themes were identified in relation to how participants identified and navigated these tensions: (a) taking action, (b) seeking support, and (c) ensuring integrity and accountability. CONCLUSIONS AND RELEVANCE: Ethical tensions frequently emerged when systemic health contexts were not responsive to social inequities or created barriers to health care access. Occupational therapists felt a sense of responsibility to take action to address inequity, which led them to stretch boundaries and roles. Having informal and formal supports, and confidence in the scope of their practice, helped the occupational therapists to navigate ethical tensions with integrity and accountability. Increased avenues for support that incorporate reflexivity offer an opportunity for occupational therapists to engage in dialogue about social inequities and ethical practice. What This Article Adds: This article explores the types of ethical tensions occupational therapists experience when addressing social inequities and provides insights into how such tensions are managed.

Occupational multi-level responsiveness: Describing the skills used by occupational therapists working with children seeking asylum in Australia.

BACKGROUND: Children seeking asylum face occupational deprivation and human rights violations. No research has investigated how occupational therapists work with child asylum seekers. The World Federation of Occupational Therapists promotes the Canadian Model of Client-Centred Enablement (CMCE) for occupational therapists working to promote human rights. AIMS/OBJECTIVES: This research investigates use of CMCE skills to investigate skills occupational therapists use when working with child asylum seekers in Australian immigration detention. MATERIAL AND METHODS: Interpretive description guided this investigation and purposive sampling was used to recruit 10 occupational therapists. Semi-structured interviews were conducted and thematically analysed. RESULTS: Occupational multi-level responsiveness, an overarching practice skill, involved keying into individual, family and socio-political levels to respond to occupational injustices. A wide array of practice skills extending beyond the CMCE framework were used in a nuanced and interwoven manner spanning multiple levels. CONCLUSIONS: Occupational multi-level responsiveness described occupational therapists working across macro-, meso- and micro-levels. SIGNIFICANCE: Understanding and enacting occupational multi-level responsiveness may support occupational therapists to plan and implement effective strategies when tackling occupational injustices. The skills identified may be applicable to other complex socio-political fields of practice. More research is needed. Further research should also investigate the occupational experiences of children seeking asylum. KEY POINTSOccupational therapists working with child asylum seekers in Australia take a multi-level approach, responding to individuals, families and socio-political structures.A three pronged approach to implementation of the occupational therapy practice process could support multi-level responsiveness to enhance practice that addresses occupational injustices.CMCE skills are not exhaustive and therapists discussed using other skills beyond those listed in the CMCE. Additional skills reflected humility and efforts towards more equal relationships between therapists and clients.

A trial of the AASPIRE healthcare toolkit with Australian adults on the autism spectrum.

BACKGROUND: Autistic adults experience barriers to accessing health care, such as service provider communication not meeting their needs, healthcare facilities causing sensory discomfort and feeling fear or anxiety regarding their healthcare visit. The Academic Autism Spectrum Partnership in Research and Education (AASPIRE) developed and trialled an online healthcare toolkit to reduce such barriers and improve healthcare interactions between autistic adults and their primary care providers in the United States. This preliminary study aimed to explore experiences of autistic adults using the AASPIRE Healthcare Toolkit in Australia. METHODS: Semi-structured interviews were conducted with six autistic adults about their experiences and perceptions of utilising the toolkit in an Australian healthcare setting. RESULTS: Participants identified that the toolkit facilitated their interactions with health professionals by providing structure to appointments, supplementing new knowledge and increasing individual confidence. They also offered suggestions to tailor the toolkit for use in Australia. CONCLUSIONS: Future research should seek to explore the experiences of autistic adults using a version of the toolkit adapted for Australian use, as well as exploring the views of health professionals utilising it.

Afflexivity in post-qualitative inquiry: prioritising affect and reflexivity in the evaluation of a health information website.

Increasingly, people turn to online sources for health information, creating human-non-human relationalities. Health websites are considered accessible in scope and convenience but can have limited capacity to accommodate complexities. There are concerns about who gets to 'assemble' with these resources, and who is excluded. Guided by Ahmed's socio-political theories of emotions, we questioned our feelings as we intra-acted with a consumer information website about back pain (MyBackPain). This encouraged us to approach resource evaluation in a way that alters conventional rational/cognitive judgement processes. Our inquiry was 'supra-disciplinary' involving public health, sociology, allied health and consumer collaborators. Specifically, we considered relationality - the feelings circulating between bodies/objects and implicated in MyBackPain's affective practices; impressions - the marks, images or beliefs MyBackPain makes on bodies/objects; and directionality - how these intra-actions pushed in some directions and away from others. Although Ahmed would likely not consider herself 'post-humanist', we argue that her socio-political theories of how objects and emotions entangle are of great interest to furthering critical post-human understandings of health. Rather than threatening decision-making, we suggest that feelings (and their affects) are central to it. The article demonstrates the productive potential of critical post-human inquiry in identifying/countering 'othering' possibilities, and catalysing a 'nomadic shift' towards new human-non-human formations.

Destabilising social inclusion and recovery, and pursuing 'lines of flight' in the mental health sector.

People who have been diagnosed with serious mental illness have a long history of confinement, social stigma and marginalisation that has constrained their participation in society. Drawing upon the work of Gilles Deleuze and Felix Guattari, we have used the concepts of: assemblages, major and minor and deterritorialisation to critically analyse two pervasive and 'taken-for-granted' assemblages in mental health: recovery (including clinical recovery, social recovery and recovery-oriented practice) and social inclusion. Our analysis explores how dominant and oppressive forces have been entangled with liberating and transformative forces throughout both of these assemblages - with dominant forces engaging in ongoing processes of capture and control, and transformative forces resisting and avoiding capture. In pursuit of social transformation for people categorised with serious mental illness, deterritorialisation is posited as a potential way forward. To have transformation in the lives of mental health service users, we present the possibility that ongoing, disruptive movements of deterritorialisation can unsettle majoritarian practices of capture and control - producing liberating lines of flight.

Connectedness and ICT: Opening the door to possibilities for people with intellectual disabilities.

This study aimed to investigate the experiences of people with intellectual disability (ID) using information and communication technologies (ICTs) and the ways these technologies foster social connectedness. In partnership with a community mental health organization, this qualitative descriptive study explored the experiences of 10 people with ID using ICTs. Participants described how ICTs Opened the Door to Possibilities in their life - ICTs provided an avenue for connecting with other people, a means to pursue personal interests and a tool for organizing everyday life. Opening the door to possibilities was further understood as movement towards digital inclusion for people with ID, conceptualized as the fit between social opportunity and personal skills. We have identified the prominent role social supports play in creating (and constraining) opportunities for digital inclusion, and that digital inclusion has the potential to enable social connectedness and the development of agency. Consideration of the complex interaction between social opportunity and personal skills, and the mediating influence of supports, will enhance the inclusion of people with ID.

Safety and Feasibility of Intermittent Electrical Stimulation for the Prevention of Deep Tissue Injury.

Objective: To investigate the safety, feasibility, and acceptability of a novel treatment, intermittent electrical stimulation (IES), for preventing deep tissue injury (DTI) in different healthcare settings. Approach: Testing was conducted in an acute rehabilitation unit of a general hospital, a tertiary rehabilitation hospital, a long-term care facility, and homecare (HC). IES was delivered through surface electrodes placed either directly on the gluteal muscles or through mesh panels inside a specialized garment. Study participants at risk for DTI used the system for an average of 4 weeks. Outcome measures included skin reaction to long-term stimulation, demands on the caregiver, stability of induced muscle contraction, and acceptability as part of the users' daily routine. Results: A total of 48 study participants used the IES system. The system proved to be safe and feasible in all four clinical settings. No pressure ulcers were observed in any of the participants. There was no difference between the clinical settings in patient positioning, ease of finding optimal stimulation site, and patient acceptance. Although donning and doffing time was longer in the long-term care and HC settings than the acute rehabilitation unit and tertiary rehabilitation facility, time required to apply the IES system was <18 min (including data collection). The patients and caregivers did not find the application disruptive and indicated that the stimulation was acceptable as part of their daily routine in over 97% of the time. Innovation and Conclusion: We demonstrated the safety, feasibility, and acceptability of a novel method of IES to prevent DTI in a continuum of healthcare settings.

Using SMS as a tool to reduce exclusions experienced by caregivers of people with disabilities in a resource-limited Colombian community.

PURPOSE: The community of El Codito, located in the mountainside on the perimeter of Bogota, Colombia, is considered one of the most vulnerable and resource-limited communities in the region. This community-based research (CBR) project used short message service (SMS) messaging as a tool for information access and social interaction with caregivers of people with disabilities (PWD). METHOD: Using a focused ethnographic method, this research evaluated the experience of caregivers participating in the project. In addition to primarily qualitative methods, supplementary quantitative message data was also collected. This project utilized free and open source software for SMS message distribution. RESULTS: Caregivers experienced the project as a window to possibility; the possibility of a social support network, the possibility of community participation and the possibility of change. During the three-month implementation, a total of 56 information messages were sent to caregivers, 20 question messages were received from caregivers and 30 social interaction messages were sent by caregivers to the group. CONCLUSIONS: The proliferation of mobile phones in this resource-limited setting provided a feasible method for reducing the exclusion of PWD and caregivers. SMS was a useful tool for sharing information and reducing the isolation experienced by this socially excluded population. Implications for Rehabilitation Mobile phones are a prevalent technology in many resource-limited settings; short message service (SMS) is a feasible tool for sharing information and reducing isolation experienced by people with disabilities (PWD) and their families. When developing technology-based projects in resource-limited settings, the field of rehabilitation could apply principles from the field of Information and Communication Technology for Development (ICT4D). Projects in resource-limited settings could consider using a community-based research (CBR) approach. This collaborative approach can enhance the contextual relevance of the project. Caregivers of PWD found the project to be both useful and meaningful, and as a result of the project became more involved in their community.