"It's like your days are empty and yet there's life all around": A mixed methods, multi-site study exploring boredom during and following homelessness.

PURPOSE: To identify experiences of boredom and associations with psychosocial well-being during and following homelessness. METHODS: Using a convergent, mixed-methods explanatory design, we conducted quantitative interviews with 164 participants) (n = 102 unhoused; n = 62 housed following homelessness) using a 92-item protocol involving demographic components and seven standardized measures of psychosocial well-being. A sub-sample (n = 32) was approached to participate in qualitative interviews. Data were analyzed by group (unhoused; housed). Quantitative data were analyzed using descriptive statistics designed to generate insights into boredom, meaningful activity engagement, and their associations with psychosocial well-being during and following homelessness. Qualitative data were analyzed using thematic analysis. Quantitative and qualitative findings were integrated at the stage of discussion. RESULTS: Quantitative analyses revealed small to moderate correlations between boredom and increased hopelessness (rs = .376, p < .01), increased drug use (rs = .194, p < .05), and lowered mental well-being (rs = -.366, p < .01). There were no statistically significant differences between unhoused and housed participants on any standardized measures. Hierarchical regression analyses revealed that housing status was not a significant predictor of boredom or meaningful activity engagement (p>.05). Qualitative interviews revealed profound boredom during and following homelessness imposing negative influences on mental well-being and driving substance use. CONCLUSIONS: Boredom and meaningful activity are important outcomes that require focused attention in services designed to support individuals during and following homelessness. Attention to this construct in future research, practice, and policy has the potential to support the well-being of individuals who experience homelessness, and to contribute to efforts aimed at homelessness prevention.

Exploring Canadian Career Firefighters' Understanding of the Return-to-Work Process After Musculoskeletal Injuries.

PURPOSE: Firefighters perform dangerous and physically demanding work, increasing their risk of musculoskeletal injuries that can lead to work absences. Return-to-work procedures can help firefighters return-to-work sooner and safely. The purpose of this study was to explore what firefighters understand about return-to-work procedures in their workplaces, and what firefighters believe the facilitators and barriers to return-to-work are. METHODS: Thirty-eight Canadian career firefighters were recruited for semi-structured interviews. Qualitative descriptive methods were used to analyze the transcripts. Two researchers performed the inductive coding and thematic analysis. RESULTS: Five themes were identified: 1. Variation in the return-to-work process knowledge among firefighters based on their experiences; 2. Accessible medical resources and treatments to support injury recovery; 3. Light duties must be meaningful and suitable; 4. Pressures to return-to-work too soon may lead to negative consequences; and 5. Heavy physical demands of firefighting may become a barrier for return-to-work. 'Factors affecting RTW depended on personal experiences and context' was the overarching theme identified, as many reported facilitators for return-to-work were also reported as barriers in different contexts. There was a variation in the experiences and understanding of return-to-work. CONCLUSION: There is a lack of knowledge of the return-to-work processes. Firefighters require access to clear return-to-work policies and procedures and treatments that are targeted to firefighting duties to support recovery from injuries and regain physical abilities after an injury. Firefighters must be able to perform all essential duties before returning to firefighting work, as returning to work too soon can lead to further injury.

Meaningful Activity, Psychosocial Wellbeing, and Poverty During COVID-19: A Longitudinal Study.

Background: Only a few studies have explored experiences of meaningful activity and associations with psychosocial wellbeing during COVID-19. None reflect a Canadian context or focus on persons living in poverty. Purpose: To identify experiences and associations between meaningful activity and psychosocial wellbeing for persons living in poverty during the first year of COVID-19. Method: We delivered a quantitative survey at three time points during the first year of the pandemic supplemented by qualitative interviews at Time(T) 1 and 1 year later at T3. Findings: One hundred and eight participants completed T1 surveys, and 27 participated in qualitative interviews. Several statistically significant correlations between indices of meaningful activity engagement and psychosocial wellbeing were identified across T1-T3. Meaningful activity decreased from T1-T3 [X2 (2, n = 49) = 9.110, p < .05], with a significant decline from T2-T3 (z = -3.375, p < .001). In T1 qualitative interviews, participants indicated that physical distancing exacerbated exclusion from meaningful activities early in the pandemic. At T3 (1 year later), they described how classist and ableist physical distancing policies layered additional burdens on daily life. Implications: Meaningful activity engagement and psychosocial wellbeing are closely associated and need to be accounted for in the development of pandemic policies that affect persons living in low income. Occupational therapists have a key role in pandemic recovery.

Competencies for occupational therapy practice in homelessness: A Delphi study.

BACKGROUND: Homelessness is growing internationally, and resources to guide occupational therapy practice in this area are needed. OBJECTIVES: To identify competencies needed for occupational therapists to support individuals during and following homelessness. MATERIAL AND METHODS: We conducted a three-round Delphi study with occupational therapy practitioners and researchers with expertise in homelessness. RESULTS: Of 35 potential participants, n = 16 participated in Round I, n = 20 participated in Round II, and n = 18 participated in Round III. Participants included occupational therapists and researchers in Canada, United States, Brazil, UK, Ireland and New Zealand. Consensus was achieved on a total of 93 competencies in 10 categories after 15 were eliminated in Rounds II and III. The categories with the greatest number of competencies included occupational knowledge (n = 18), followed by psychosocial competencies (n = 16). CONCLUSIONS AND SIGNIFICANCE: This study represents the first to identify the competencies needed for occupational therapists working in the area of homelessness. Practitioners and educators are encouraged to view the identified competencies as a guide for the professional development of occupational therapists in this context. Stakeholders consulted for this study were able to communicate in English and situated in middle to high-income countries. As such, the competencies identified in this study only apply to these sociocultural contexts.

Bridging the transition from homelessness: Developing an occupational therapy framework.

BACKGROUND: Occupational therapists support individuals experiencing homelessness in traditional roles, and occupational therapy positions focussed specifically on homelessness appear to be growing. OBJECTIVES: To develop and refine a framework to guide occupational therapy practice and research in homelessness. METHOD: We developed a framework and refined it through a stakeholder consultation process conducted with 17 international occupational therapy experts using an online survey. In this survey, we presented an initial framework and requested qualitative feedback. We analyzed this qualitative data using content analysis. RESULTS: Stakeholder feedback was categorized into eight recommendations: (1) Revision to the 'four processes'; (2) Emphasizing social justice and systems-level advocacy; (3) Reflecting intersectionality; (4) Emphasizing meaningful activity; (5) Emphasizing peer support; (6) Incorporating a focus on independent living skills; (7) Increasing a focus on an activity for addressing substance misuse; and (8) Acknowledging cognitive and physical health. Each of these recommendations was incorporated into a refined version of this framework. These recommendations and a refined version of the framework are presented in this paper. CONCLUSIONS: We have developed and refined a framework aimed at guiding practice and research in occupational therapy in homelessness that will be evaluated in future research. SIGNIFICANCE: Though a range of frameworks exists for guiding the practice of occupational therapists more generally, this framework represents the first that is focussed specifically on guiding occupational therapy practice and research with individuals who experience homelessness. Research and practice implications are discussed.

Financial incentives to promote employment of persons with disabilities: a scoping review of when and how they work best.

PURPOSE: To assess the state of evidence on the use of financial incentives to employ, retain, and promote persons with disabilities. MATERIALS AND METHODS: We completed a scoping review of the peer-reviewed literature published from 1990 to 31 March 2022. Inclusion criteria were - populations with a disability; employment, retention, or promotion; and use of financial incentives targeted at employers. Articles were excluded if incentive was targeted solely at persons with disabilities. RESULTS: Seventeen articles met the inclusion criterion and were collated based on their study designs, type of incentive investigated, employment sector, and jurisdiction. We identified seven common themes that are relevant contextual and situational factors associated with the use of financial incentives to employ, retain, and promote persons with disabilities. CONCLUSIONS: While the literature identified the fact that financial incentives are widely used, the current state of the literature is modest and insufficient to make strong statements about the evidence on how and when financial incentives work well or do not work well. The themes identified allude to a subset of contextual factors requiring consideration for incentive use; however, evaluative research is still required to substantiate best practices for their use.Implications for rehabilitationFinancial incentives for the recruitment, retention, and promotion of workers with disabilities take many different forms and can incent different behaviours based on their form and context.Workers with disabilities are as diverse as workers without disabilities, consequently the supports required will differ from situation to situation.In some cases, a worker with a disability may require several types of supports, at a point in time, or over their employment journey.Employer knowledge and experience are important considerations in the use of financial incentives, as are employer skills in recruitment, retention, and promotion of workers with disabilities.

Occupational therapists' application of the Do-Live-Well framework: A Canadian health promotion approach.

Background. The Do-Live-Well (DLW) framework is an occupation-focused health promotion approach. Online and in-person DLW educational workshops were offered to encourage occupational therapists to apply the DLW concepts. Purpose. The purpose of this study was to understand workshop participants' experiences of and perspectives on using the DLW framework to support its application in the future. Method. Interpretative description was used to understand workshop participants' perspectives on benefits, facilitators, and challenges of using DLW. Semi-structured interviews were conducted and analysed using a thematic analysis. Findings. Eight themes were identified as follows: (a) environmental factors of practice settings, (b) co-workers' support, (c) DLW enhanced occupational therapy practice, (d) confidence in using DLW, (e) nature of the DLW framework, (f) DLW promoted healthy occupational engagement, (g) DLW was not suitable for everyone, and (h) pandemic effects. Implications. The DLW framework supports occupationally focused practices, and continuous learning support will be needed.

Rasch analysis of the brief Michigan Hand Questionnaire in patients with thumb osteoarthritis.

BACKGROUND: The brief Michigan Hand Questionnaire (brief MHQ) is a 12-item self-reported measure of hand function for patients with hand disorders which has been validated using Classical Test Theory. Rasch analysis can provide more detailed psychometric information. The purpose of this Rasch analysis is to assess the psychometric properties of the brief MHQ for patients with thumb osteoarthritis, and to make recommendations for improvements to the questionnaire if needed.  METHODS: The Michigan Hand Questionnaire and demographic data were collected from 923 thumb osteoarthritis patients treated in specialized clinics for hand surgery and therapy in the Netherlands. Rasch analysis was performed on the 12 items of the brief MHQ using RUMM 2030 to assess the fit of the brief MHQ to the Rasch model. To determine fit, analysis of fit summary statistics, individual person fit and individual item fit were assessed. Threshold distributions were assessed to identify if any items required rescoring. The Person Separation Index was calculated to measure reliability of the questionnaire. Differential item functioning was assessed to identify item bias, and Principal Component Analysis was performed to identify unidimensionality and local dependence. RESULTS: The brief MHQ showed misfit (χ2 = 1312.5, p < 0.0001) with 6 items having disordered thresholds and 9 items requiring rescoring. After deleting 3 of the rescored items due to significant item fit residuals, the brief MHQ had an acceptable reliability (Cronbach's alpha = 0.79). Misfit to the model (χ2 = 49.6, p = 0.0001), multidimensionality (10.2% of t-tests were significant), and item bias from non-uniform differential item functioning for 7 items across many person variables were still found. CONCLUSION: Although no satisfactory solutions were found to correct the misfit to the Rasch model, it is recommended that the response options of the brief MHQ be rescored, and that items 6, 9 and 10 be removed. The lack of unidimensionality indicates that the items do not represent the singular construct of hand disability and that totalling the scores of the brief MHQ does not provide a valid measure of hand disability for people with thumb osteoarthritis. The 37-item Michigan Hand Questionnaire may provide a better assessment of hand disability for patients with thumb osteoarthritis.

Effectiveness of employment-based interventions for persons experiencing homelessness: A systematic review.

Employment is frequently desired by persons who experience homelessness yet is often elusive. Little is known about the range and effectiveness of employment-based interventions evaluated in existing literature on key psychosocial outcomes including employment participation, mental well-being, housing tenure, community integration and substance use. To identify and synthesise existing studies, we conducted a systematic review of effectiveness using the methodology proposed by the Joanna Briggs Institute (JBI) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Following the removal of duplicates, we screened 13,398 titles and abstracts, and reviewed 79 studies at the full-text review stage using two independent raters. A total of 16 studies met criteria for inclusion in a narrative synthesis and were subjected to critical appraisal. The majority of studies were conducted in the US (n = 14; 87.5%) with other studies published in Canada (n = 1; 6.3%) and Australia (n = 1; 6.3%). Interventions evaluated in existing studies included combined substance use and vocational skills interventions (n = 7; 43.8%), supported employment (n = 6; 37.5%), and integrated supports including an employment component (n = 3; 18.8%). The effectiveness of these interventions on employment, mental well-being, housing tenure, community integration, and substance use is presented. Findings suggest that research evaluating employment interventions for persons who experience homelessness is in an early stage of development. Researchers and practitioners may consider collaborating with persons with lived experiences of homelessness and practitioners in co-designing and modifying existing approaches to target key outcomes more effectively. Policymakers may consider allocating resources to such initiatives to further the development of practice and research aimed at supporting persons who experience homelessness to secure and sustain employment during and following homelessness.

Demand-side Employment Interventions for Individuals with Common Mental Disorders: a Scoping Review.

PURPOSE: Traditional approaches to vocational rehabilitation tend to focus on improving worker skills and competencies rather than addressing barriers and inequities in existing workplace structures. The purpose of this scoping review is to provide an overview of current demand-side employment interventions that are aimed at building inclusive hiring and retention practices for persons living with common mental disorders (CMD). Methods Using the method advanced by Arksey and O'Malley (2005), and furthered by Levac et al., (2010), we carried out a scoping review to identify the range and breadth of literature exploring demand-side employment interventions for individuals with CMD. One rater screened titles and abstracts and two independent raters evaluated full-text articles against a set of inclusion/exclusion criteria. A descriptive analysis was conducted to highlight the state of the literature in this area. Results A total of 10 articles were retrieved, including six empirical papers and four theoretical papers. Three broad themes were extracted from the literature: (1) Workplaces as a determinant of worker health; (2) Unique interventions are needed for different work sectors; and (3) Individualistic perspectives embedded in demand-side interventions. Conclusions Demand-side employment interventions hold promise for building employer capacity to hire and retain people with CMD. There is a need for innovative approaches to engage workplace stakeholders in developing and evaluating innovative solutions to build inclusive workplaces.

Comparing Web-Based and In-Person Educational Workshops for Canadian Occupational Therapists and Understanding Their Learning Experiences: Mixed Methods Study.

BACKGROUND: The Do-Live-Well (DLW) framework is an occupation-focused health promotion approach. Occupational therapists (OTs) have been interested in training opportunities regarding this framework. Traditionally, in-person continuing educational interventions are the main way that OTs obtain knowledge, but web-based learning has become popular among health care professionals. However, its effectiveness and learners' experience in web-based learning have not been well-studied in occupational therapy education. OBJECTIVE: This study aims to evaluate the effectiveness of the web-based and in-person educational DLW workshops for Canadian OTs and to understand their experiences in both workshop types. METHODS: An explanatory sequential mixed methods study design was used, where quantitative data were collected first, then qualitative data were used to explain the quantitative findings. A quasi-experimental design and interpretative description methodology were used in the quantitative and qualitative phases, respectively. RESULTS: Quantitative results were as follows: a total of 43 OTs completed pre-, post-, and follow-up evaluations (in-person group: 21/43, 49%; web-based group: 22/43, 51%). Practice settings of the participants varied, including geriatric, hospital, long-term, mental health, pediatric, and primary settings. The primary outcome was as follows: there were no statistically significant differences in knowledge changes at the 3 time points (P=.57 to P=.99) between the groups. In the web-based group, the knowledge scores at follow-up were lower compared with the posttest results, meaning that knowledge gain was reduced over time (P=.001). The secondary outcomes were as follows: there were statistically significant differences between the groups in factors influencing DLW adoption at posttest (P=.001) and in satisfaction with the workshop (P<.001) at posttest in favor of the in-person group. Qualitative results were as follows: a total of 18 OTs (9/18, 50% from each group) participated in an individual interview. Five themes were identified regarding learners' workshop experiences: relevance to their practices and interests may improve learning, a familiar learning environment may facilitate learning, synchronous in-person interaction is valuable in the learning process, ease of access to learning should be considered, and flexibility in web-based learning can be both beneficial and challenging. CONCLUSIONS: The quantitative results of this study reported no difference in knowledge acquisition between the in-person and web-based groups, indicating that web-based education is as effective as in-person workshops. However, participants' satisfaction with the workshop was statistically significantly higher for the in-person workshop. The qualitative findings described the participants' perceived benefits and challenges of each educational format. The participants in both the web-based and in-person workshop groups valued in-person interactions in learning, but the participants in the web-based workshop group expressed web-based learning lacked in-person-like interactions. Thus, adding synchronous in-person interactions to web-based learning may improve learners' educational experiences in web-based occupational therapy and continuing education.

Exploring patient perspectives of barriers and facilitators to participating in hospital-based stroke rehabilitation.

BACKGROUND: Patient participation is recognized as an important element of rehabilitation. However, few studies have used a qualitative lens to specifically examine factors influencing patient participation in stroke rehabilitation. AIM: The purpose of this study was to investigate patient perspectives of barriers and facilitators to participating in hospital-based stroke rehabilitation. METHODS: Semi-structured interviews were conducted with 11 patients, with confirmed diagnoses of stroke, recruited from three separate rehabilitation settings. Analysis of the interviews was guided by a process of interpretive description to identify key barriers and facilitators to participation in stroke rehabilitation. RESULTS: Four main themes and corresponding sub-themes were constructed concerning participation in rehabilitation: (i) Environmental Factors, (ii) Components of Therapy, (iii) Physical and Emotional Well-Being, and (iv) Personal Motivators. An exploratory model of personalized rehabilitation emerged, integrating the themes emerging from the data. DISCUSSION: Personalized rehabilitation can be considered in comparison to person-centred care principles. The barriers and enablers experienced by patients in this study contribute to the existing knowledge of the patient experience of stroke rehabilitation and may be used to inform clinical practices and future research.Implications for RehabilitationThe surrounding environments can facilitate participation in rehabilitation using strategies to reduce noise and disruption and also by encouraging social interactions among patients.Increasing the frequency and consistency of communication with patients about rehabilitation goals and progress could enhance participation.Designing interventions to include activities that are meaningful and focused on the resumption of valued life roles is key to participation.Therapy intensity, time spent sedentary, and the emotional impact of stroke are aspects of rehabilitation patient's feel are neglected.

Identifying predictors of return to work and the duration of time off work in first responders affected with musculoskeletal injuries or mental health issues.

PURPOSE: To identify predictors of return to work, duration of time off work, and claim closure for first responders experiencing injuries or illnesses, and summarize the claim data. METHODS: First responder claims collected between January 2012 and July 2017 were obtained from a disability management company. Known predictors of return to work were extracted from the data including age, sex, diagnosis, years of service, claim lag, medical report lag, and the return-to-work duties. Survival analyses were performed to identify predictors of return to work and claim closure using the Cox proportional regression analysis. Log-rank tests were performed to identify predictors that affected the rate of return to work and claim closure. Summary statistics were performed for the injury and return-to-work data. RESULTS: 60 of the 67 (89.6%) identified first responders returned to work within the data collection period. Musculoskeletal injuries predicted an increased likelihood of returning to work (hazard ratio = 2.0, 95%CI = 1.14-3.60) and a shorter duration of time off work (37 days on average) compared to mental health issues. Everyday of claim lag and medical report lag predicted a 2% decrease in likelihood of return to work. Returning to work was the only predictor of claim closure. 45 (67.2%) first responders returned to their pre-absence duties. 22 (32.8%) mental health claims and 45 (67.2%) injury claims were identified. CONCLUSIONS: 89.6% of first responders returned to work, although only 67.2% returned to their pre-absence duties. Predictors of return to work included injury type, as first responders with musculoskeletal injuries returned to work sooner, and claim and medical lag delayed the return to work.

Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to investigate the effectiveness of occupational therapist-/physiotherapist-guided fatigue self-management for individuals with chronic conditions. METHODS: Eight databases, including MEDLINE and EMBASE, were searched until September 2019 to identify relevant studies. Randomised controlled trials and quasi-experimental studies of self-management interventions specifically developed or delivered by occupational therapists/physiotherapists to improve fatigue symptoms of individuals with chronic conditions were included. A narrative synthesis and meta-analysis were conducted to determine the effectiveness of fatigue self-management. RESULTS: Thirty-eight studies were included, and fatigue self-management approaches led by occupational therapists/physiotherapists were divided into six categories based on the intervention focus: exercise, energy conservation, multimodal programmes, activity pacing, cognitive-behavioural therapy, and comprehensive fatigue management. While all exercise programmes reported significant improvement in fatigue, other categories showed both significant improvement and no improvement in fatigue. Meta-analysis yielded a standardised mean difference of the overall 13 studies: 0.42 (95% confidence interval:-0.62 to - 0.21); standardised mean difference of the seven exercise studies was -0.55 (95% confidence interval: -0.78 to -0.31). DISCUSSION: Physical exercises inspired by the self-management principles may have positive impacts on fatigue symptoms, quality of life, and other functional abilities.

The interactive process of negotiating workplace accommodations for employees with mental health conditions.

BACKGROUND: Implementing workplace accommodations is an effective means of retaining employees with mental health conditions. However, the process is poorly understood and poorly documented. OBJECTIVE: The purpose of this research is to explore the interactive process of negotiating workplace accommodations from the perspective of employees with mental health conditions and workplace stakeholders. METHODS: We interviewed employees across Canada who self-identified as having a mental health condition requiring accommodations, and six stakeholders at various workplaces across Canada who are involved in providing accommodations. Data were analyzed using a qualitative descriptive approach to identify key themes. RESULTS: The findings highlight that the process of negotiating accommodations is non-linear, interactive, and political. The process is shaped by organizational and political factors and collaboration between stakeholders. CONCLUSIONS: The negotiation process is a combination of social, relational and political factors. Clear and accessible accommodation policies, workplace awareness and specific workplace training on how to implement accommodations are needed to optimize the accommodation process for all involved.

Meaningful Activity and Boredom in the Transition from Homelessness: Two Narratives.

BACKGROUND.: Few studies have examined boredom and meaningful activity during the transition from homeless to housed, and those that exist are retrospective. PURPOSE.: To prospectively examine how meaningful activities and boredom are experienced during the process of leaving homelessness. METHOD.: Using a mixed-methods case study design, we interviewed 13 homeless participants at baseline using a 92-item quantitative interview, followed by a semi-structured qualitative interview. Two participants were located six months later and were interviewed again using the same protocol. Quantitative data are presented descriptively. Qualitative data were analyzed using narrative analysis. FINDINGS.: Qualitative data revealed two unique narratives of boredom and meaningful activity engagement in the transition from homeless to housed, with opportunities for engagement in meaningful activity limited largely by the social and housing environments in which both participants were situated. Quantitative data indicates that boredom and meaningful activity changed little before and after homelessness. At both baseline and follow-up, boredom scores for both participants were comparable to a sample of participants who were exposed to a "boredom" condition in an experimental study (Hunter, Dyer, Cribbie, & Eastwood, 2016). IMPLICATIONS.: Formerly homeless persons may struggle to engage in meaningful activity, and boredom may negatively affect mental well-being. Research with larger samples is needed.

Occupational experiences of homelessness: A systematic review and meta-aggregation.

Background: Studies exploring the occupational experiences of homeless persons have grown in the past twenty years, and there is a need to identify, evaluate, and aggregate existing studies to direct future research.Objectives: To capture the scope and quality of literature exploring the occupational experiences of homeless persons in high-income countries, and to aggregate the findings of these studies to inform future research efforts.Method: Using Joanna Briggs Institute (JBI) guidelines, we conducted a systematic review including a critical appraisal, and meta-aggregation of themes in existing qualitative literature.Results: Fifteen studies were included and were of high quality (Mdn = 8/10; IQR = 2). Meta-aggregation resulted in four themes (n = 335 participants) describing the occupational experiences of homeless persons: 1) Restrictions on time use and activity engagement; 2) Activity as a means of belonging; 3) Institutional processes as determining time use; and 4) Transcending the self through doing.Conclusions: Homeless persons in high-income countries face multiple challenges to engaging in meaningful activity, which we argue is a disabling experience. Simultaneously, homeless persons demonstrate resilience by finding ways to engage in activities of meaning, and opportunities to connect with others in the face of multiple barriers.Significance: Implications for research and practice are discussed.

Active labour market policies for people with disabilities in receipt of public income benefits: A scoping review.

BACKGROUND: Active labour market policies (ALMP) are used in advanced welfare states to support transitions to work for people who are unemployed or underemployed, including people with disabilities (PWD) in receipt of means-tested disability income support. OBJECTIVE: This study explores the nature, strength, and limitations of ALMP across advanced welfare states (ALMP) for people with disabilities (PWD) in receipt of income benefits from social assistance programs. METHODS: Following the eight steps of a scoping study, we identified 21 documents through a scan of eight databases and consultation with key informants. The majority of these documents are scholarly publications including seven literature reviews, two program evaluations, four social policy analyses, and two longitudinal studies. RESULTS: We extracted key findings related to delivery of labour (re)entry interventions for people with disabilities. Six themes are identified that discuss these ALMP features: 1) welfare ideology and the role of citizenship; 2) conditionality of benefits; 3) work capacity and the need for an appropriate definition of disability; 4) the politics of employment outcomes for PWD; 5) the missing elements of a successful ALMP; and 6) moving beyond ALMP. The findings indicate that while various approaches are used in reintegrating PWD into mainstream employment, there are significant limitations that curtail the impact of these policies. CONCLUSIONS: Regardless of welfare regime, no welfare state provides a policy mix that results in long-term employment success for PWD in receipt of means-tested income benefits.

Boredom and meaningful activity in adults experiencing homelessness: A mixed-methods study.

BACKGROUND.: Boredom has been reported as a frequent problem experienced by homeless persons, with implications for mental and social well-being. PURPOSE.: This study aimed to explore the nature and impact of boredom in the lives of homeless and formerly homeless persons. METHOD.: A mixed-methods design was used to engage 13 participants in a structured 92-item quantitative interview using six standardized measures, followed by a semistructured qualitative interview. Correlational analyses were performed with the data compiled from the quantitative interviews, and grounded theory strategies were used to analyze our qualitative data. The two analyses were integrated at the stage of interpretation. FINDINGS.: Boredom was described as a profound and pervasive experience for homeless persons, imposing deleterious impacts on mental well-being and driving substance use. A strong positive correlation between meaningful activity and mental well-being (r s = .767, p <. 01) and a strong negative correlation between boredom and belonging in one's community (r s = -.771, p < .01) were identified. IMPLICATIONS.: Boredom is a critical topic of study for occupational therapy in the area of homelessness. Future research is needed to design and test interventions to optimize the mental well-being, participation, and social connectedness of this population.

The experiences of workers who do not successfully return to work following a work-related injury.

BACKGROUND: A minority of workers with work-related injuries experience challenges returning to work. While factors that hinder return-to-work (RTW) are well-documented, the consequences of failing to successfully return to work on the lives of workers who have experienced a workplace injury remain poorly understood. OBJECTIVE: The purpose of this study is to explore the experiences of workers who do not successfully return to work following a work-related injury. METHODS: Using an interpretive approach to qualitative research and maximal variability sampling, 11 workers who have sustained work-related injuries without a successful RTW and four service providers were recruited through community organizations. Participants were interviewed using a semi-structured interview guide. A constant comparative approach was used to identify key themes across the worker and service provider experiences. RESULTS: The findings that emerged from the analysis capture the challenging RTW experiences of workers and describe wide ranging impacts on their lives when their workers' compensation claims are denied or discontinued, including ongoing financial strain, family tensions, subsequent health concerns, and negative employment experiences. The findings also highlight the negative consequences of existing cost-cutting frameworks that can restrict entitlement and benefits for many people with disabilities. CONCLUSIONS: The findings from this study highlight the experiences of workers who might need additional supports throughout the RTW process, and begin to shed light on the impact on their lives when RTW is not successful.