A father nevertheless: Self-confident but resigned fathers with children in foster care.

This qualitative study aimed to explore the experiences of nine fathers with neurodevelopmental disabilities with children in foster care, including their fathering role, visits and formal and informal support. Systematic text condensation was the analysis method used. The respondents' experience of fatherhood revealed two categories: I accept my situation and I am frustrated. Though self-confident, the fathers expressed ambivalence between acceptance and frustration with their role. The study shows that more should be done to provide adapted support for these vulnerable fathers with children in foster care, although they seldom demand such support. Social workers and professionals from the rehabilitation team within the healthcare service should be aware of gendered settings, specifically norms of masculinity. Increased efforts from the social workers may reduce the risks of detachment in parenthood because engaged and informed fathers are in the children's best interests.

Perception of the influence of environmental factors in the use of electronic planning devices in adults with cognitive disabilities.

BACKGROUND: Adults with cognitive disabilities often have difficulties in dealing with the complexity of everyday life. With cognitive assistive technology (e.g. electronic planning devices [EPDs] and individual support), they can bring order to their often chaotic life. Assumptions are that environmental factors influence with non-use of EPDs. OBJECTIVE: To explore how adults with cognitive disabilities perceive the influence of environmental factors in the use of EPDs. METHODS: A reference group with experience of use of EPDs assisted the researchers. Twelve adults with cognitive disabilities and experience of using EPDs participated. An interview guide was implemented covering environmental factors according to the International Classification of Functioning, Disability and Health. Qualitative content analysis was applied in the analyses. RESULTS: Five categories and two themes emerged, which were integrated into a model of facilitating factors influencing the use of EPDs. Measures to prevent or eliminate negative influences of the device use are important to be taken. CONCLUSIONS: Professionals need more knowledge about EPDs, while users need individual adaption of the EPDs. EPDs need to be user-friendly, manageable and work in any seasons. Implications for Rehabilitation The users should have access to specially trained prescribers. There is a need for development of user-friendly and manageable products to function in any climate. Knowledge is lacking on how to implement the users in all stages of the prescribing process. Prescribers should increase knowledge in the use of EPDs to influence the attitudes of the social environment.

How people with cognitive disabilities experience electronic planning devices.

BACKGROUND: People with cognitive disabilities have difficulties in accomplishing everyday tasks. Electronic planning devices (EPDs) may compensate for the gap between a person's capacity and everyday challenges. However, the devices are not always used as intended. Despite that, cognitive assistive technology has been investigated in several studies, knowledge regarding when and what makes adults decide to use EPDs is incomplete. OBJECTIVE: The aim was to explore the subjective experiences of people with cognitive disabilities in relation to the use of EPDs. METHODS: A qualitative approach was applied with a qualitative content analysis. Twelve respondents were interviewed with support from a study specific guide. RESULTS: A model representing the respondents' experiences in the use of EPDs, comprising one theme, Possibility to master my daily life, four categories, Degree of fit to my needs, I am aware of my cognitive disability, I get help to structure my everyday life and The EPD improves my volition and ten subcategories, was developed. CONCLUSIONS: EPDs allow people with cognitive disabilities the possibility to deal with daily challenges; those who find EPDs beneficial tend to use them. EPDs can help people with cognitive disabilities in organisation, managing time and improve volition.

Daily time management and influence of environmental factors on use of electronic planning devices in adults with mental disability.

PURPOSE: To describe daily time management in adults with and without mental disability and to examine differences in the level of their daily time management; to describe the possessions and use of electronic planning devices (EPDs) in activities and how environmental factors influence the use of EPDs in adults with mental disability. METHODS: In a descriptive and cross-sectional design, 32 participants using EPDs and a matched comparison group of 32 healthy adults was recruited. Time-Self rating scale measuring daily time management was adapted for adults. A study specific questionnaire was applied to collect data on five ICF environmental factors. Rasch modelling, descriptive and non-parametric statistics were applied. RESULTS: Time-S has acceptable psychometric properties for use on adults with mental disability. People with mental disability and low level of daily time management who use advanced EPDs are more influenced by environmental factors. The study group perceived that encouragement and support from professionals as well as services influence their use of EPDs. CONCLUSIONS: Time-S can safely be used for people with mental disability. EPDs do not fully compensate the needs of the target-group. Prescribers need to give considerations to this and therefore they should be provided with more knowledge about this matter. Implications for Rehabilitation The Time-S can be applied for measuring daily time management in adults. Adults with mental disability provided with EPDs are not fully compensated in daily time management. Professional support and encouragement as well as backing from the services are important factors for the use of EPDs. Because the smart phones are not prescribed as assistive technology, the need for help from professionals to facilitate daily life is stressed. Therefore, the professionals should be provided with more knowledge about the use of EPDs.

Cognitive assistive technology and professional support in everyday life for adults with ADHD.

PURPOSE: An evaluation of a model of intervention in everyday settings, consisting of cognitive assistive technology (CAT) and support provided by occupational therapists to adults with attention deficit hyperactivity disorder (ADHD). The purpose was to study how professional support and CAT facilitate everyday life and promote community participation of adults with ADHD. METHOD: The intervention was implemented in five steps and evaluated in a 15-month study (March 200 = T1 to June 2007 = T2). One questionnaire and one protocol describe the CATs and provided support. Two questionnaires were employed at T1 and T2 for evaluation of the intervention in everyday settings. RESULTS: The participants tried 74 CATs, with weekly schedules, watches and weighted blankets being most highly valued. Carrying out a daily routine was the most frequent support. More participants were working at T2 than at T1. Frequency of performing and satisfaction with daily occupations as well as life satisfaction were stable over the one-year period. CONCLUSIONS: The results indicate a higher frequency of participating in work but only a tendency of increased subjectively experienced life satisfaction. However, to be of optimal usability, CAT requires individually tailored, systematic and structured support by specially trained professionals. Implications for Rehabilitation Adults with ADHD report an overall satisfaction with the cognitive assistive technology, particularly with low-technological products such as weekly schedules and weighted blankets. Using cognitive assistive technology in everyday settings indicate a higher frequency of participating in work, but only a tendency of increased subjectively experienced life satisfaction for adults with ADHD. Prescription of cognitive assistive technology to adults with ADHD in everyday settings requires individually tailored, systematic and structured support by specially trained professionals.

Predefined headings in a multiprofessional electronic health record system.

BACKGROUND: Applying multiprofessional electronic health records (EHRs) is expected to improve the quality of patient care and patient safety. Both EHR systems and system users depend on semantic interoperability to function efficiently. A shared clinical terminology comprising unambiguous terms is required for semantic interoperability. Empirical studies of clinical terminology, such as predefined headings, in EHR systems are scarce and limited to one profession or one clinical specialty. OBJECTIVE: To study predefined headings applied by users in a Swedish multiprofessional EHR system. MATERIALS AND METHODS: This was a descriptive study of predefined headings (n=3596) applied by 5509 users in a Swedish multiprofessional EHR system. The predefined headings were classified into four term and word categories. RESULTS: Less than half of the predefined headings were shared by two or more professional groups. All eight professionals groups shared 1.7% of the predefined headings. The distribution of predefined headings across categories yielded two-thirds "terms for special purposes" and "specialist terms" and one-third "common words" and "unclassified headings". DISCUSSION: The indicated presence of profession-specific predefined headings and the conflict between ambiguity and comprehension of terms and words used as headings are discussed. CONCLUSIONS: The predefined headings in the multiprofessional EHR system studied did not constitute a joint language for specific purposes. The improvement of the quality and usability of multiprofessional EHR systems requires attention.

Mentally disordered offenders' daily occupations after one year of forensic care.

Persons detained as mentally disordered offenders need support for transition from care to community life. Few systematic studies have been completed on the outcomes of standard forensic care. The aim was to investigate the target group's life conditions and daily occupations one year after care. In a follow-up design occupational performance (OP) and social participation (SP) were investigated at two time points. After informed consent 36 consecutively recruited participants reported OP using the Capability to Perform Daily Occupations, Self-Efficacy Scale, Importance scale, and Allen Cognitive Level Screen. SP was measured with the Manchester Short Assessment of Quality of Life, and Interview Schedule for Social Interaction. After one year 24 participants were still incarcerated, 11 were conditionally released, and one participant was discharged. The group were generally more satisfied and engaged in daily occupations than at admission. The study's attrition rate, 51%, is discussed. The conclusion and the clinical implications indicate that the target group need early, goal directed interventions in OP and SP for alterations in daily occupations. Furthermore, to increase the knowledge base concerning mentally disordered offenders, studies with research designs that have the potential to uncover changes in daily occupation and other measures for this target group are necessary.

Construct and discriminant validity and dimensionality of the Interview Schedule for Social Interaction (ISSI) in three psychiatric samples.

This study was aimed at investigating the psychometric properties of the Interview Schedule for Social Interaction (ISSI), in terms of construct and discriminant validity and unidimensionality, in three psychiatric samples with varying prerequisites for social interaction: 1) an outpatient sample of working age with mixed diagnoses, 2) an outpatient sample with schizophrenia, and 3) an inpatient sample composed of mentally ill, male offenders. The target constructs were psychosocial functioning and satisfaction in different life domains. It was hypothesized that the ISSI would mainly be related to psychosocial functioning and life domains characterized by social interaction, such as friends and family. A second hypothesis was that the ISSI ratings would discriminate between the three samples. The first hypothesis was confirmed, but the pattern of relationships was somewhat different between the groups. Whereas family contacts were of great importance for social integration in Samples 1 and 2, friends seemed more important for the mentally ill offenders. The second hypothesis was partly confirmed: three ISSI sub-scales out of four discriminated between the samples. Moreover, the ISSI proved to be a unidimensional construct. The support for the four proposed sub-scales was not unanimous, however, and the sub-scales targeting attachment constituted less stable factors. This study demonstrated the construct and discriminant validity of the ISSI when applied to samples with various mental disorders. The fact that similar results were obtained in all three samples, despite varying prerequisites for social interaction, strongly supports the validity of the ISSI. Providing the sub-scales are used with caution, the ISSI seems to be a reliable tool for use with patients with severe mental disorders.

Background factors related to and/or influencing occupation in mentally disordered offenders.

OBJECTIVE: Knowledge of background and occupational related factors of mentally disordered offenders are missing. It is essential to understand these issues when planning discharge from forensic psychiatric hospital care to enable community dwelling. AIMS: One aim was to investigate mentally disordered offenders' background factors, confidence in and how they value occupations. Another aim was to investigate MDOs background factors' in relation to and the influences on Occupational Performance and Social Participation. METHOD: Data was collected with an explorative, correlative design after informed consent, from 74 mentally disordered offenders (mean age 34,2) cared for in forensic psychiatric hospitals. Assessments were Allen Cognitive Level Screen, Capability to Perform Daily Occupations, Interview Schedule of Social Interaction, Manchester Short Assessment of Quality of Life, Self-efficacy Scale and Importance scale. Eight background factors were assembled from the individual forensic psychiatric investigation. FINDINGS: Most of the investigated background factors relate to and half of them influence occupational performance, particular the cognitive aspect of occupational performance. The influences on occupation originate from adulthood, such as suffering from schizophrenia, psycho/social problems, and having performed violent crimes. These findings indicate that staff in forensic hospital care should initiate rehabilitation with knowledge about MDOs' complex daily occupations. For avoiding information bias, information gathering preceding treatment planning should be performed in collaboration between caring staff and mentally disordered offenders.

Personality traits as predictors of occupational performance and life satisfaction among mentally disordered offenders.

The study investigated to what extent personality traits, e.g. socialization, proneness for anxiety, aggression and hostility were associated with and predictive of self-reported and observed occupational performance and perceived life satisfaction among male mentally disordered offenders (MDOs). Also, subjects with psychopathic-related personality traits were compared with subjects without such traits regarding demographic data and dependent variables. The MDOs were included from the Swedish National Board of Forensic Medicine. A total of 55 subjects were visited at their hospital ward for data collection with the Karolinska Scales of Personality (KSP), Capability to Perform Daily Occupation (CPDO), Allen Cognitive Level Screen (ACLS) and the Manchester Quality of Life Scale (MANSA). Seven KSP scales and two KSP factors correlated significantly with the dependent variables. Regression analyses revealed that the KSP Socialization scale, the KSP Anxiety-proneness and Psychopathy factors were the most important predictors. Subjects with psychopathy differed from remaining groups by having more conduct disorders before 15 years, being more often brought up in outcasted families and less subjected to measures of pupil welfare activities. The life history was concluded to be important influencing occupational performance and life satisfaction. Subjects with high anxiety proneness should be given attention in treatment planning.