Working With Marginalized Populations.

This Eleanor Clarke Slagle lecture describes the author's work with marginalized populations, including homeless adults with mental illness, premature aging conditions, and poor literacy; women who became homeless as a result of domestic violence; children in impoverished, urban school systems reading below grade level; and adults with severe and chronic mental illness that impeded their ability to secure employment, housing, and independent community living. The author illustrates how and why occupational therapy practitioners should become part of the primary care team that evaluates the impact of multiple disorders on marginalized populations' daily life activities, provides services to optimize community participation, and provides environmental modifications to enhance safety and function.

A Comparison of Activity Participation between Children with and without Asthma.

BACKGROUND: Asthma affects approximately 6 million children in the United States and can greatly impact quality of life and occupational engagement. Although occupational therapists are well-equipped to address participation limitations, insufficient evidence exists to support the role of occupational therapists in asthma treatment. METHOD: The purpose of this study was to further understand the occupational limitations experienced by children with asthma. We also explored a dual diagnosis of asthma and obesity. The participants included children with (n = 84) and without (n = 63) asthma living in New York City. The Child Behavior Checklist, Youth Self Report, Brief Respiratory Questionnaire, and accelerometer data were used to examine occupational participation. RESULTS: Although accelerometry data demonstrated that children with asthma were equally as active as their non-asthmatic peers, the participants with asthma perceived themselves as participating more in sedentary occupations and were less likely to be members of sports teams. They also had more missed school days and nights of troubled sleep. The children with both asthma and obesity reported the highest level of activity limitations. CONCLUSION: This study illustrates specific limitations experienced by children with asthma and supports the need for occupational therapy intervention. Future studies are needed to design and assess interventions that will support the addition of occupational therapists to multidisciplinary asthma treatment teams.

Promoting Occupational Therapy Mental Health Research: Proceedings From the 2017 AOTF Mental Health Planning Grant Collective.

Although occupational therapists were once integrally involved in mental health practice, the percentage of therapists presently working in this clinical area is low. In 2017, the American Occupational Therapy Foundation convened a planning grant collective (PGC) to generate research to support populations with serious mental health challenges. The PGC's primary mission was to identify key research areas in which occupational therapists and colleagues could work collaboratively to demonstrate evidence for occupational therapy services supporting mental health community participation. Participants included 21 members from six professions and three program officers from federal funding establishments. The PGC identified seven overarching research concepts, three broad areas of research inquiry, and eight possible studies addressing occupational therapy's contribution to research promoting community participation and health outcomes for people with mental illness. This article provides a summary of the PGC proceedings so that researchers can collaboratively implement identified research topics.

The Association between LGBTQIA+ Self-Identification and Factors Facilitating Homelessness: A Scoping Review of the Occupational Therapy Peer-Reviewed Literature.

The purpose of this paper was to perform a scoping review examining the occupational therapy peer-reviewed literature regarding the LGBTQIA+ community to (a) determine what types of scholarship have been generated and (b) whether the association between LGBTQIA+ self-identification and homelessness has been identified and addressed in occupational therapy practice. A database search of seven peer-reviewed, health care publication indexes, with 19 key search terms was performed. The database search targeted articles published prior to January 2020. Fifty-three articles were identified within the occupational therapy literature and addressing the LGBTQIA+ community. The majority of this literature (n = 40) was exploratory studies through which researchers sought to better understand the unique needs of subgroups within the LGBTQIA+ community. Only three articles addressed the link between LGBTQIA+ self-identification and homelessness with no articles that addressed evaluation and intervention of the factors predisposing this population to homelessness. As occupational therapists have a unique skill set that could be used to help LGBTQIA+ community members transition from and remain free from homelessness, occupational therapy researchers must develop and assess interventions that target these factors. Occupational therapy educators should develop and assess curricular programming to heighten student comfort and preparedness in service delivery to this community.

A systematic review of occupational therapy interventions in the transition from homelessness.

BACKGROUND: Although systematic and scoping reviews have identified a range of interventions for persons experiencing homelessness, no known reviews have captured the range and quality of intervention studies aimed at supporting a transition from homelessness. OBJECTIVES: To capture the range and quality of occupational therapy intervention studies aimed at supporting a transition to housing following homelessness. METHOD: Using Joanna Briggs Institute (JBI) guidelines, we conducted a systematic review including a critical appraisal and narrative synthesis of experimental studies. RESULTS: Eleven studies were included. Critical appraisal scores ranged from 33.3 to 88.9 of a possible score of 100 (Mdn = 62.5; IQR = 33.4). The majority of studies evaluated interventions for the development of life skills (n = 9; 81.8%), and all were conducted in the USA. Several of the included studies were exploratory evaluation and feasibility studies, and all were quasi-experimental in design. Only three studies (27.2%) incorporated a control group. Intervention strategies included (1) integrated group and individual life skills interventions (n = 6); (2) group-based life skills interventions (n = 3); and (3) psychosocial and consultative interventions (n = 2). CONCLUSIONS: Research evaluating occupational therapy interventions aimed at supporting homeless individuals as they transition to housing is in an early stage of development. SIGNIFICANCE: Implications for research and practice are discussed.

Effectiveness of a Tailored Intervention for Women With Attention Deficit Hyperactivity Disorder (ADHD) and ADHD Symptoms: A Randomized Controlled Study.

IMPORTANCE: Women with attention deficit hyperactivity disorder (ADHD) and ADHD symptoms may experience difficulty carrying out desired life roles and activities. OBJECTIVE: To determine whether a 7-wk tailored occupation-based intervention can reduce perceived stress and ADHD symptoms and enhance perceived performance of and satisfaction with daily roles and activities among women with ADHD. DESIGN: Randomization to intervention (n = 11) and control (n = 12) groups. SETTING: Home and community. PARTICIPANTS: Twenty-three participants ages 20-55 yr, English speaking, and with a self-reported diagnosis of ADHD. INTERVENTION: The intervention was administered for 7 wk in individual 1-hr sessions and addressed routine establishment, organization, time management, stress management, and sensory regulation in the home and community. OUTCOMES AND MEASURES: Adult Attention Deficit Hyperactivity Disorder Self-Report Scale, Perceived Stress Scale, and Canadian Occupational Performance Measure. RESULTS: At 1-wk postintervention, statistically significant differences were found between intervention and control groups in perceived stress (Z = -3.838, p < .000, d = -2.66), ADHD symptoms (Z = -3.605, p < .000, d = -2.17), and COPM Performance (Z = -4.074, p < .000, d = 3.04) and Satisfaction change scores (Z = -3.759, p < .000, d = 2.82). CONCLUSION AND RELEVANCE: A 7-wk tailored intervention reduced perceived stress and ADHD symptoms and enhanced perceived performance of and satisfaction with desired occupational roles and activities in a sample of women with ADHD. Further research is warranted to determine whether the intervention can be useful to women with ADHD beyond the present sample. WHAT THIS ARTICLE ADDS: This intervention may offer an effective nonpharmacological option for women with ADHD symptoms.

Effectiveness of a Functional Literacy Program for Sheltered Homeless Adults.

This study aims to determine whether a functional literacy program using principles from the Cognitive Orientation to daily Occupational Performance approach and Occupational Adaptation theory, and embedded in community-based daily activities, could enhance occupational participation in a sample of sheltered homeless adults. This study used a two-group, controlled design with pre- and post-intervention measures. Intervention was carried out in a group setting in 1.5 hr, twice-weekly sessions over 8 weeks. Intervention addressed literacy skills needed to complete participant identified, desired daily activities. Statistically significant differences were found between intervention and control groups' perceived functional literacy skills with regard to occupational performance (Z = -4.075, p < .0001, d = 1.02) and satisfaction (Z = -4.113, p < .0001, d = 1.40); reading frequency (Z = -3.594, p < .0001, d = 0.48), reading effectiveness (Z = -10.673, p < .0001, d = 0.68), level of support (Z = -10.410, p < .0001, d = 1.81), and reading efficiency (Z = -10.297, p < .0001, d = 1.83). The intervention enhanced perceived reading and occupational participation in the study's sample. Further research is needed to replicate and translate results in daily practice.

A Rasch Analysis Study Determining the Internal Validity and Separation Reliability of the Inventory of Reading Occupations - Adult: A Measure of Functional Literacy Participation.

The objective of this study was to determine the internal validity and separation reliability of the Inventory of Reading Occupations - Adult (IRO-Adult), an assessment of functional literacy participation for adults. Participants included 69 adults with typical reading abilities and difficulties with reading. The fit of the IRO-Adult items was analyzed with the Rasch model of unidimensionality using goodness-of-fit analysis and analysis of standardized residuals. Also analyzed was the tool's ability to reliably separate distinct levels of reading participation and the optimal functioning of its rating scales. The IRO-Adult items fit the Rasch model of unidimensionality. Three test items can be further refined to strengthen internal validity. Items are able to reliably detect multiple levels of reading participation and change in functional literacy participation over time. Several categories in the tool's rating scale can be combined for better clarity and to optimize rating scale functioning. The study provides preliminary evidence of validity and reliability of the IRO-Adult as a useful tool to assess functional literacy participation of adults. Further studies on other psychometric properties and clinical utility are warranted.

High Impact and Highly Cited Peer-Reviewed Journal Article Publications by Canadian Occupational Therapy Authors: A Bibliometric Analysis.

A bibliometric analysis of high impact and highly cited peer-reviewed literature published between 1992 and 2016 by Canadian occupational therapy authors that were included in the Science Citation Index-Expanded (SCI-E) or Social Sciences Citation Index (SSCI) was completed. To complete the analysis, journal article titles, abstracts, author details, and keywords were searched. A second-filter identified articles where the first or corresponding author had a Canadian affiliation and occupational therapy qualification. The total number of times an article was cited since its initial publication and during 2016 in Web of Science Core Collection was recorded. A total of 919 retrieved articles met the inclusion criteria with 18 articles having 5 or more citations during 2016 alone and another 34 articles having 50 or more citations since their initial publication date. The top three journals where high impact and highly-cited articles were published were Archives of Physical Medicine and Rehabilitation, Disability and Rehabilitation, and American Journal of Occupational Therapy. The three institutions that generated the largest number of high impact and highly cited articles were McGill University, University of Toronto, and University of British Columbia. Therefore, as of 2016, Canadian occupational therapy authors published 18 high impact and 34 highly cited articles.

A comparison of bibliometric indicators in occupational therapy journals published in English.

BACKGROUND.: The use of bibliometrics to evaluate the quality and impact of refereed journals has increased along with access to electronic databases and citation counts. PURPOSE.: This analysis compared and contrasted the range of publication metrics available for English-language occupational therapy journals. METHOD.: Bibliometric data were sourced for 23 English-language occupational therapy journals, including data from the Journal Citation Reports (JCR) 2- and 5-year impact factor, JCR Immediacy Index, Eigenfactor Score, Article Influence Score, Scopus Source Normalized Impact per Paper, SCImago Journal Rank (SJR) score, and ResearchGate journal impact score. H-indexes for journals were also sourced. FINDINGS.: The American Journal of Occupational Therapy had the highest publication metrics. SJR-based scores included a larger number of journals, whereas JCR-based metrics were more restrictive in the number of journals included. IMPLICATIONS.: Multiple metrics should be used to comprehensively understand occupational therapy journal performance.

Impact factor, eigenfactor, article influence, scopus SNIP, and SCImage journal rank of occupational therapy journals.

BACKGROUND: Journals are currently assessed and ranked using a number of different quantitative performance metrics. AIM: To compare and correlate the publication metrics of English-language occupational therapy journals published in 2015. METHOD: Bibliometric data was sourced for 14 English-language occupational therapy journals including the Journal Citations Report (JCR) 2-year impact factor (IF), Eigenfactor Score (EFS), Article Influence Score (AIS), Scopus Source Normalized Impact per Paper (SNIP), Scopus Citescore, and SCImago Journal Rank (SJR) score. The JCR, Scopus, and SJR 2015 bibliometric data were correlated. RESULTS: The top six English-language occupational therapy journals in relation to JCR IF, EFS, AIS, SNIP, Citescore, SJR score, and SJR IIF were AJOT, AOTJ, POPT, CJOT, SJOT, and BJOT. JCR IF, EFS, JCR AIS, SNIP, Citescore, SJR score and SJR IIF were all significantly correlated with coefficients ranging from 0.751 to 0.961 (p < 0.05; p < 0.01). The calculated SJR IIF was on average 0.335 larger than the JCR IFs reported. CONCLUSIONS: The findings indicate that the range of available bibliometric measures should be used collectively to yield a more comprehensive assessment of journal and article rankings rather than the singular use of IF scores that currently and frequently occurs in many jurisdictions.

Feasibility and Satisfaction of an Apartment Living Program for Homeless Adults With Mental Illness and Substance Use Disorder.

OBJECTIVE: We assessed the feasibility and satisfaction of an apartment living program for formerly homeless adults with mental health and substance use disorders. METHOD: A one-group pretest-posttest design was used with 22 participants who attended a six-week apartment living program. RESULTS: Sixteen participants completed the study and demonstrated improvement in the performance of and satisfaction with needed daily life skills (performance: Z = -3.56, p ≤ 0.000, d = -1.86; satisfaction: Z = -2.84, p ≤ 0.004, d = -1.85), interpersonal skills (Z = -3.52, p ≤ 0.000, d = -2.98) and quality-of-life scores (Z = -3.52, p ≤ 0.000, d = -1.34). Participants reported high levels of satisfaction with the program. CONCLUSION: This study demonstrates the feasibility and satisfaction of an apartment living program and warrants further research.

Home Safety Fall and Accident Risk Among Prematurely Aging, Formerly Homeless Adults.

OBJECTIVE: Homelessness prematurely ages people. A large subgroup of formerly homeless adults between ages 40 and 64 yr have health conditions similar to or worse than people categorized as elderly. Little is known about the impact of this group's chronic health conditions on their ability to safely function in supportive housing. METHOD: Home safety visits were carried out with 25 formerly homeless adults, ages 40-64 yr, now residing in supportive housing. RESULTS: Participants had physical, cognitive, and mental health problems that significantly interfered with their ability to perform daily life skills, safely function in an apartment, and manage chronic health conditions. Home safety hazards included cluttered walking paths, the presence of steps, and the lack of grab bars and nonskid flooring. CONCLUSION: The homeless population would benefit from aging specialists, such as occupational therapists, who could help people to maintain and function more safely in their homes. Without such services, this population may be at risk for home safety events leading to hospitalization and mortality.

Occupational therapy publications by Australian authors: A bibliometric analysis.

BACKGROUND: Bibliometrics refers to the collection and measurement of publishing and citation data configurations with the goal of quantifying the influence of scholarly activities. Advantages of bibliometrics include the generation of quantitative indicators of impact, productivity, quality and collaboration. Those parties who benefit from the results of bibliometric analysis include researchers, educators, journal publishers, employers and research funding bodies. METHODS: A bibliometric analysis was completed of peer-reviewed literature from 1991 to 2015, written by Australian occupational therapists (who were able to be identified as such), and indexed in the Science Citation Index-Expanded (SCI-Expanded) or the Social Sciences Citation Index (SSCI) databases. "Occupational therapy" and "occupational therapist(s)" were used as keywords to search journal articles' publication title, abstract, author details, keywords and KeyWord Plus. RESULTS: Between 1991 and 2015, 752 peer-reviewed journal articles were published by Australian occupational therapy authors. On average, those articles had 3.7 authors, 35 references, and were nine pages in length. The top four journals in which Australian occupational therapists published were Australian Occupational Therapy Journal, British Journal of Occupational Therapy, American Journal of Occupational Therapy, and Physical and Occupational Therapy in Paediatrics. The four Australian institutions that generated the largest number of occupational therapy articles were the University of Queensland, University of Sydney, La Trobe University, and Monash University. The top four countries with whom Australian authors collaborated in manuscript writing were the United Kingdom, United States, Canada and Sweden. CONCLUSION: The volume of occupational therapy peer-reviewed literature has grown over the last two decades. Australian authors have and continue to make significant contributions to the occupational therapy body of knowledge nationally and internationally.

A bibliometric analysis of occupational therapy publications.

BACKGROUND: Bibliometrics involves the statistical analysis of the publications in a specific discipline or subject area. A bibliometric analysis of the occupational therapy refereed literature is needed. AIM: A bibliometric analysis was completed of the occupational therapy literature from 1991-2014, indexed in the Science Citation Index-Expanded or the Social Sciences Citation Index. METHOD: Publications were searched by title, abstract, keywords, and KeyWords Plus. Total number of article citations, citations per journal, and contributions per country, individual authors, and institution were calculated. RESULTS: 5,315 occupational therapy articles were published in 821 journals. It appears that there is a citation window of an approximate 10-year period between the time of publication and the peak number of citations an article receives. The top three most highly cited articles were published in Developmental Medicine and Child Neurology, JAMA, and Lancet. AJOT, BJOT and AOTJ published the largest number of occupational therapy articles with the United States, Australia, and Canada producing the highest number of publications. McMaster University, the University of Queensland, and the University of Toronto were the institutions that published the largest number of occupational therapy journal articles. CONCLUSION: The occupational therapy literature is growing and the frequency of article citation is increasing.

Highly Cited Occupational Therapy Articles in the Science Citation Index Expanded and Social Sciences Citation Index: A Bibliometric Analysis.

OBJECTIVE: A bibliometric analysis was completed of highly cited occupational therapy literature and authors published from 1991 to 2014 and accessible in the Science Citation Index Expanded (SCI-Expanded) and Social Sciences Citation Index (SSCI) databases. METHOD: Data were obtained from the SCI-Expanded and SSCI. Articles referenced >100 times were categorized as highly cited articles (HCA). RESULTS: Of 6,486 articles found, 31 were categorized as HCA. The American Journal of Occupational Therapy published the largest number of HCA (n = 8; 26%). The 31 HCA were distributed across seven countries: United States (20 articles), Canada (3), United Kingdom (3), Australia (2), the Netherlands (1), New Zealand (1), and Sweden (1). The three authors with the highest Y-index were S. J. Page, F. Clark, and W. Dunn. CONCLUSION: A latency period of 4 to 5 yr post-publication appears to be needed for a journal article to gain citations.

A Bibliometric Analysis of Highly Cited and High Impact Occupational Therapy Publications by American Authors.

A bibliometric analysis was completed of peer-reviewed literature from 1991-2015, written by American occupational therapists, to examine US high impact scholarship with "occupational therapy" and "occupational therapist(s)" used as keywords to search journal articles' publication title, abstract, author details, and keywords. Results included 1,889 journal articles from 1991-2015 published by American occupational therapists as first or corresponding author. Sixty-nine articles attained a TotalCitation2015 ≥ 50 and 151 attained a Citation2015 ≥ 5 indicating that they were the most highly cited literature produced in this period. Although the majority (58%) of this literature was published in occupational therapy-specific journals, 41% was published in interdisciplinary journals. Results illustrate that the volume of highly cited American occupational therapy peer-reviewed literature has grown over the last two decades. There is need for the profession to strategize methods to enhance the publication metrics of occupational therapy-specific journals to reduce the loss of high quality publications to external periodicals.

Comparative Effectiveness of Three Occupational Therapy Sleep Interventions: A Randomized Controlled Study.

Although sleep intervention is within the domain of occupational therapy, few studies exist supporting practice. Effectiveness of three sleep interventions was compared: Dreampad Pillow®, iRest® meditation, and sleep hygiene. Twenty-nine participants were randomly assigned to the Dreampad Pillow® ( n = 10), iRest® meditation ( n = 9), and sleep hygiene ( n = 10) groups. In Phase 1, all participants used a 7-day sleep hygiene regimen to reduce poor sleep habits. In Phase 2 (14 days), 10 participants used the Dreampad Pillow® and sleep hygiene, nine used the iRest meditation and sleep hygiene, and 10 continued sleep hygiene only. At intervention-end, the iRest meditation group experienced statistically greater time asleep than both the Dreampad Pillow® ( p < .006, d = 1.87) and sleep hygiene groups ( p < .03, d = 1.80). The Dreampad Pillow® group experienced statistically fewer nighttime awakenings than the iRest® meditation ( p < .04, d = -1.53) and sleep hygiene ( p < .004, d = -1.43) groups. No differences were found between groups in perceived sleep quality, length of time needed to fall asleep, and fatigue level next day. This study provides support for sleep interventions within occupational therapy's domain.

Feasibility and Acceptability of a Pilot Housing Transition Program for Homeless Adults with Mental Illness and Substance Use.

The purpose of this study was to determine if a housing transition program was feasible and acceptable to homeless clients with mental illness and substance use histories. Ten male residents of a homeless shelter participated in the 3-week housing intervention. The intervention used a DVD format with instructional videos, graphics, and opportunities for hands-on practice of functional skills in a simulated apartment environment. Outcome measures included goal attainment scale scores (GAS), satisfaction surveys, and case manager reports. Six of the 10 participants completed the program and achieved GAS scores at a greater level than expected at baseline (T > 50). Participants reported the intervention to be engaging and enhanced their knowledge of the housing transition process. The intervention appears to have assisted the participants in the attainment of housing skills and warrants further study.