Costs of Forced Retirement: Measuring the Effect of Lost Work Opportunity on Health.

OBJECTIVE: Unemployment is a known health stressor that also increases early retirements. This study addresses mixed literature on retiree health and underreporting of forced retirement to better identify potential health impacts of lost work opportunity. METHODS: A Lost-work Opportunity Score (LOS) was created using variables from the Health and Retirement Study assessing unemployment, forced retirement, and earlier-than-planned retirement for 2576 respondents. Reliability and unidimensionality of the score with multivariate regression analyses examined health impacts controlling for demographics and prior health status. RESULTS: The LOS possessed unidimensionality with a Cronbach's alpha of a = 0.76 while predicting self-reported health declines (LOS = 2; ß = 0.381, OR = 1.464, P < 0.05) and depression increase (LOS = 2; ß = 0.417, OR = 1.517, P < 0.05). CONCLUSIONS: LOS predicts 46% increased odds of negative self-reported health change after retirement associated with two LOS events, with implications to support aging workers.

A Mixed-Methods Examination of Lost Occupational Choice in Retirement.

Lost work opportunity and forced retirement demonstrate negative health impacts related to occupational deprivation. Measuring occupational loss during the retirement transition can be problematic. The objective of the study is to clarify measurement of involuntary retirement in its relationship to occupational loss and deprivation. Using an explanatory sequential mixed-methods design, survey data on unemployment, forced retirement, and earlier-than-planned retirement from 195 screened retirees yielded 102 reporting at least one lost work opportunity event, with 18 interviewed about occupational loss within the analytic timeframe. Planned retirement age was similar for full-employment and lost work opportunity groups. Actual retirement age was earlier in the lost work opportunity sample (age 57.5 compared with 61.2). Interviews identified a 22% discrepancy between forced retirement reported in survey versus interview data. Themes emerging from the interviews indicated financial and identity challenges from lost work opportunity, a dialectical trade-off between lost opportunity and daily freedom, and overall resilience.

Job Loss at Retirement Age is UnderreportedRetirement timing can be affected by several factors outside an individual's control, which we can label as forced retirement. Choice in timing is important as forced retirement can negatively impact health. Forced retirement fits an occupational deprivation model which describes how lost occupational opportunity or participation can have a negative impact. The present study found that from a pool of 195 surveyed and 18 interviewed retirees, one fifth of retirees underreported forced retirement. Retirees with lost work opportunities reported financial and identity challenges balanced by the trade-off between lost work and daily freedom. A theme of overall resilience in managing the challenges was notable. The mismeasurement of forced retirement in light of its negative health impact highlights a public health need to better measure lost work opportunity of aging workers to inform policy.

Qualitative study identifies life shifts and stress coping strategies in people with multiple sclerosis.

Multiple sclerosis (MS) is an auto-immune disease in which the body's immune system attacks the central nervous system. The demyelination of the nerve fibers can lead to physical, emotional, and cognitive impairments. We wanted to learn about challenges of living with the illness and how people deal with stress. 128 individuals with MS from Austria and the US participated in the qualitative interviews. We interviewed participants and coded their answers using inductive grounded theory. We asked three open-ended questions to inquire about life since being diagnosed with MS as well as about dealing with stress. Life shifts since diagnosis involved 'experiencing limitations' and could be categorized in 'emotional changes', 'changes with work', 'changes in social interaction', 'physical changes', 'changes in the medical context'. For dealing with stress active (strategies and activities) and passive coping strategies (avoid/ignore) were employed. General stress reactions were expressed in areas of emotional, physical and /or lifestyle. We recommend developing interventions in three core areas for the MS population: (1) dealing with life changes and significant experiences with MS, (2) focusing on the areas where life shifts took place, (3) focusing on active coping with stress and discussing consequences of passive coping strategies.

Toward Robust Assessments of Student Knowledge of Occupation.

IMPORTANCE: Occupational therapy students must master knowledge of occupation, yet how educators assess such knowledge has not been explored. In this study, we elucidate robust assessment practices that can help students master knowledge of occupation. OBJECTIVE: To examine practices that educators use to assess knowledge of occupation. DESIGN: Basic qualitative research. Using inductive and constant comparative methods, we coded 25 interviews and 82 educational artifacts for assessment practices, categorized practices as direct or indirect, and analyzed their alignments with features of robust assessments. SETTING: Twenty-five randomly selected occupational therapy and occupational therapy assistant academic programs in the United States, stratified by geographic region and institution type. PARTICIPANTS: Twenty-nine educators who represented selected programs. RESULTS: We found occupation at instruction and program levels primarily in relation to practice using indirect more than direct practices. Assignments were often highly creative and experiential, yet varied in their alignments with established criteria of robust assessments. CONCLUSIONS AND RELEVANCE: Knowledge of occupation was often intertwined with practice-oriented learning experiences and skills; hence, it was not assessed as a distinctly indispensable learning outcome. Educators can build on current practices to design robust assessments that require students to demonstrate knowledge of occupation in practice contexts and everyday life. WHAT THIS ARTICLE ADDS: In this study, we elucidate a continuum of prevalent educational practices used to assess knowledge of occupation; we also review best practices for robust assessments of such knowledge not only related to practice but also as a dynamic instrument of individual and societal well-being more broadly.

Assignment Artifacts and What They Reveal About How Occupation Is Addressed in U.S. Occupational Therapy Curricula.

IMPORTANCE: Artifacts convey essential skills, tools, and concepts to students. Studies of artifacts can therefore illumine priorities for learning. OBJECTIVE: To describe the skills, tools, and concepts that assignment artifacts required students to learn, especially in relation to occupation. DESIGN: Educators submitted 243 artifacts that illustrated how their programs addressed occupation. Artifacts included syllabi, lectures, assignments, rubrics, study guides, texts, and learning objectives. A sociocultural research paradigm informed a secondary analysis of all assignment artifacts. Assignments were coded for the skills, tools, and underlying concepts students were to use, particularly related to occupation. SETTING: U.S. occupational therapist and occupational therapy assistant academic programs. PARTICIPANTS: Twenty-five U.S academic programs selected through stratified random sampling that targeted representation by geographic region and the Carnegie Classification of Institutions of Higher Education. Fifteen occupational therapy and 10 occupational therapy assistant programs consented. RESULTS: Assignment artifacts required students to interview, observe, analyze, and teach (skills); artifacts emphasized learning the Occupational Therapy Practice Framework: Domain and Process (tool). Few artifacts required students to relate skills and tools to broader concepts, including occupation. Those that did used prompts that were ancillary to the assignment. Grading rubrics seldom measured students' ability to connect skills and tools to occupation. CONCLUSIONS AND RELEVANCE: By emphasizing skills and tools detached from the concepts supporting their relevance to occupation, the artifacts reflected black box learning. Creating artifacts that reflect glass box learning can improve education. In glass box learning, artifacts are transparent and clearly delineate the skills, tools, and conceptual understandings to be gained. WHAT THIS STUDY ADDS: For researchers, the study highlights the importance of including artifacts in studies of occupational therapy education. For educators, the study gives guidance for creating assignments that clearly delineate skills, tools, and concepts.

A National Survey of Learning Activities and Instructional Strategies Used to Teach Occupation: Implications for Signature Pedagogies.

IMPORTANCE: Occupational therapy practitioners' professional identities and distinctive contributions to health care connect essentially to their knowledge of occupation. Thus, the strategies educators use to convey occupation to students and the perspectives embedded in those strategies are critical topics for researchers. OBJECTIVE: To generalize findings from a previous qualitative study of how educators in 25 U.S. occupational therapy assistant and occupational therapy programs addressed occupation to a national sample of educators. DESIGN: As part of an exploratory sequential design, a national survey of U.S. occupational therapy and occupational therapy assistant educators explored activities and strategies used to teach occupation. Data were analyzed using descriptive statistics. SETTING: An online survey about educators' practices in the academic education setting. PARTICIPANTS: Occupational therapy and occupational therapy assistant educators (N = 1,590) from all programs in the United States. Of these, 634 returned surveys, 315 of which were complete and included in the analysis, for an overall response rate of 19.8%. RESULTS: Respondents identified similar learning activities and instructional strategies as those identified in the qualitative phase of the design. Most instruction was active and experiential, requiring students to integrate various skills and content areas. Definitions of occupation, as a basis for teaching, varied. CONCLUSIONS AND RELEVANCE: The combined survey and qualitative results offered initial empirical support for occupational therapy's proposed signature pedagogies and the importance of attending to the deep and implicit structures within those pedagogies. Such structures are believed to support students' formation of a professional identity and an occupational perspective. WHAT THIS ARTICLE ADDS: This study provides evidence for the instructional strategies that educators use to convey knowledge of occupation to students. The predominant strategies support proposed signature pedagogies in occupational therapy: relational learning, affective learning, and highly contextualized active learning.

Curriculum-Level Strategies That U.S. Occupational Therapy Programs Use to Address Occupation: A Qualitative Study.

OBJECTIVE: This study's objective was to describe curriculum-level strategies used to convey occupation to occupational therapy students. METHOD: The study used a descriptive qualitative research design. Fifteen occupational therapy and 10 occupational therapy assistant programs participated in interviews, submitted curriculum artifacts such as syllabi and assignments, and recorded teaching sessions. Data were coded both inductively and deductively and then categorized into themes. RESULTS: Occupational therapy programs designed strategies on two levels of the curriculum, infrastructure and implementation, to convey knowledge of occupation to students. The degree to which strategies explicitly highlighted occupation and steered instruction fluctuated depending on how differentiated occupation was from other concepts and skills. CONCLUSION: Two arguments are presented about the degree to which occupation needs to be infused in all curricular elements. To guide curriculum design, it is critical for educators to discuss beliefs about how ubiquitous occupation is in a curriculum and whether curricular elements portray occupation to the extent preferred.

A Way of Seeing: How Occupation Is Portrayed to Students When Taught as a Concept Beyond Its Use in Therapy.

OBJECTIVE: The concept of occupation is core to learning occupational therapy, yet how occupation is taught has not been widely studied. We explored how occupation is addressed in 25 U.S. occupational therapist and occupational therapy assistant programs. METHOD: We used a basic qualitative research design, collecting data through interviews, artifacts, and video recordings of teaching. We secondarily analyzed 8 programs in which occupation was taught beyond its application in practice. RESULTS: Educators portrayed occupation as (1) a way of seeing self (students learn about themselves as occupational beings), (2) a way of seeing others (students learn about others as occupational beings), and (3) a way of seeing the profession (students learn occupation as the central focus of occupational therapy). Varied learning experiences promoted these perspectives. CONCLUSION: Three concepts-subject-centered learning, threshold concepts, and transformative learning-formed the theoretical foundation for teaching occupation as a way of seeing.

Explicit or Hidden? Exploring How Occupation Is Taught in Occupational Therapy Curricula in the United States.

OBJECTIVE: Occupation is considered core and threshold knowledge for occupational therapy, yet how it is conveyed through education is not well understood. This study examined how the concept of occupation was taught in occupational therapy and occupational therapy assistant curricula in the United States. METHOD: Using a qualitative descriptive research design, in-depth interviews, video recordings, and artifacts of teaching occupation were collected from 25 programs, chosen using stratified random sampling. Interview data were analyzed using an inductive, constant comparative approach; video and artifact data were analyzed deductively using findings from the interviews. RESULTS: Instructional methods were innovative and ranged from didactic to experiential. The degree to which occupation was present in instruction ranged from explicit to implicit to absent. CONCLUSION: Although educators valued teaching occupation, the concept was still elusive in some instructional methods and materials. Occupation knowledge and pedagogical content knowledge may have influenced how explicitly occupation was taught.

Energizing Occupation as the Center of Teaching and Learning.

The concept of occupation has experienced a renewal in the past 3 decades and is widely accepted as the core subject in occupational therapy. Professional education has a critical stewardship role in continually enhancing how occupation is taught and understood to enrich new occupational therapy practitioners' ability to grasp the purpose of the profession and reason clinically in complex practice environments. The authors discuss three questions that frame approaches educators can use to effectively centralize occupation in teaching and learning environments: (1) To what degree is a curriculum and its courses and class sessions subject centered? (2) To what degree do instructional processes create links to occupation? and (3) To what degree do instructional processes expose and promote complex ways of knowing needed for learning occupation? Keeping occupation in the foreground is important to facilitate new research, teaching methods, and curricular relevance to practice.

"Still there is beauty": one man's resilient adaptation to stroke.

The study was designed to generate understanding of the phenomenon of resiliency following stroke, its role in supporting continuity of identity and ways in which occupational therapists might foster resiliency. The authors used a qualitative case study design to collect data during two face-to-face interviews. These were transcribed verbatim and analyzed using thematic analysis, narrative analysis, narrative smoothing, and content analysis using resiliency theory. The participant's narrative revealed resilient characteristics throughout his adaptive process including drawing upon positive social support, accessing spirituality, having an internal locus of control, building on past successes and a commitment to succeed, and having an action-oriented approach and positive personal goals for the future. Occupational therapists frequently interact with people following disability and have the opportunity to promote adaptation by identifying and fostering clients' resilient characteristics through narrative reconfiguration and other intervention approaches. Further research is needed to study facilitation of resiliency as a part of intervention to promote occupational engagement.

Case study on effect of household task participation on home, community, and work opportunities for a youth with multiple disabilities.

OBJECTIVE: This case study explored how household task engagement influenced participation in the home, community and work for a youth with multiple disabilities. PARTICIPANTS: Participants were the first author's single father and her brother, who has spina bifida and intellectual disability. METHODS: Researchers used a case study design with mixed methods. Quantitative repeated measures included the Canadian Occupational Performance Measure (COPM), the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES), and the Arc's Self-determination Scale (SDS). Qualitative data was collected from interviews and observations and was analyzed using a constant comparison method. RESULTS: Visual analysis revealed gains in self-determination and in performance and satisfaction on the COPM. At follow-up, the father reported his son did more self-care household tasks and was more independent with these tasks. Family-care household task performance declined and father reported relatively no change in assistance. Qualitative findings illuminated the strategies and the processes that evolved through collaboration amongst the youth, the therapist, and the father. CONCLUSIONS: The son's competence with a daily household task increased positive perceptions of his capabilities that led to increased participation and independence in home, community, and work activities. Interventions addressing adaptations, development of self-determination skills, and parental education promoted these changes.

Occupation emerges in the process of therapy.

OBJECTIVE: The current literature offers no cohesive definition of occupation-based practice. Current definitions emphasize intervention forms and contexts, which do not reflect the complexity of practice. This article demonstrates that the therapeutic relationship and the meanings that are created in the therapy process are central aspects of occupation-based practice. Occupation, as an idea that emerges in the therapeutic process, has aspects of both doing and becoming. METHOD: The authors conducted observation sessions and interviews with an occupational therapist, Nancy, who used multiple therapeutic strategies with one child, Hannah, as they worked toward Hannah's goals of going to preschool and becoming a friend. RESULTS: Strategies include changing therapeutic conditions, using cognitive strategies, bridging the person-task-social context, pushing participation, and engaging in narrative micronegotiations. CONCLUSION: Occupation emerged in the therapeutic processes as the occupational therapist and client co-created meaning about the client moving toward or away from who she wanted to become.