Mindfulness in paediatric occupational therapy practice: a phenomenological inquiry.

PURPOSE: While research into mindfulness practices is on the rise across populations, there is evidence to suggest that clinical practice has outpaced the literature with regard to mindfulness in pediatric rehabilitation. The aim of this study was to explore the perceptions of occupational therapists who opt to incorporate mindfulness into their clinical practices with children and youth. METHODS: Hermeneutic phenomenology was the methodology of the study. The theoretical framework employed a Heideggerian-informed phenomenology of practice. Eight occupational therapists practicing in Canada and the United States participated in 90-120 min semi-structured interviews that elicited first-hand accounts of mindfulness in pediatric occupational therapy practice. Interviews were transcribed verbatim and analyzed using Finlay's four-step approach. RESULTS: Six salient themes were identified in the data: drawing from personal practice, enhancing participation, fostering healthy habits, adapting for children, keeping it playful, and doing with. CONCLUSION: The findings of this study offer insights for therapists who are considering incorporating mindfulness into their practices with children and youth. Further, this research highlights a number of research priorities that require further inquiry.IMPLICATIONS FOR REHABILITATIONMindfulness is growing in popularity and may support occupational engagement in children and youth receiving rehabilitation services.Mindfulness practices may support rehabilitation providers in approaching their work with children and youth from a critical perspective.Further development of the child- and youth-centred mindfulness approaches may be warranted to enhance engagement and appropriateness for a range of ages and conditions.

Mindfulness and therapeutic relationships: A phenomenological inquiry into paediatric occupational therapists' practices.

BACKGROUND: A growing body of literature points to the potential of mindfulness to support therapeutic relationships, and the importance of the therapeutic relationship when working with children and youth, yet little attention has been paid to this topic in occupational therapy. AIMS/OBJECTIVES: The aim of this study was to inquire into occupational therapists' experiences of mindfulness in the therapeutic relationship with children and youth. MATERIALS AND METHODS: Hermeneutic phenomenology was the methodological approach, with Heidegger's concepts of being-with and care as theoretical underpinnings of the study. Eight North American occupational therapists participated in semi-structured interviews that elicited first-hand accounts of mindfulness in the therapeutic relationship with children and youth. Interviews were transcribed verbatim and analysed using a phenomenological approach. RESULTS: Four key themes were identified: fostering a safe space, enhancing presence, being authentic, and cultivating acceptance. CONCLUSIONS AND SIGNIFICANCE: The findings offer insights regarding the potential affordances of mindfulness to support clinicians in the development of therapeutic relationships with children and youth. Further, this study highlights research priorities for future inquiry.

Capturing the voices of mothers: Delivery and content efficacy of a community attachment parenting program.

This qualitative case study sought to examine the delivery and content efficacy of a community attachment parenting program developed and hosted by an attachment and trauma-informed organization that services infants and their pre- or postnatal mothers in Ontario, Canada. A focus group and participant reflective journals were employed to amplify the voices of mothers who engaged in the 8-week program. Five overarching themes surfaced in the data which include (1) infant/mother attachment, (2) program delivery validations and recommendations, (3) program content validations and recommendations, (4) facilitator delivery, content and relational competencies and (5) connections with others. The findings of this study are intended to inform future offerings of this program, as well as incite further research to illuminate the voices of mothers and other participants who engage in attachment-postured community parenting programs across the globe.

Mindfulness and human occupation: A scoping review.

BACKGROUND: Mindfulness is an emergent construct with implications for our understanding of approaches to engagement in human occupation. Little is known about how mindfulness is being applied and what its possibilities are in the occupation-based disciplines. OBJECTIVE: The purpose of this scoping review was to summarize, describe, and identify gaps in the existing literature on mindfulness in relation to human occupation. MATERIAL AND METHOD: A scoping review, guided by Arksey and O'Malley's methodological framework was undertaken. The initial search yielded 929 articles; 20 articles met the criteria for inclusion. Articles included peer review and gray literature published in English between 2006-2016. Articles addressed mindfulness in OT or OS and included the terms 'human occupation', 'occupational therapy' and/or 'occupational therapist', and 'mindfulness' and/or 'meditation' or 'yoga'. FINDINGS: The qualitative thematic analysis identified an overarching theme of mindful occupation, with 5 sub-themes including occupational presence; occupational awareness; occupational engagement; occupational well-being; and occupational fulfillment. CONCLUSIONS AND SIGNIFICANCE: The findings have important implications for practice, education, theory and research. Future directions should focus on more depth and breadth of empirical research about mindful engagement in human occupation that can be used to implement and evaluate mindfulness in occupation-based theory and practice.

Ethical Tensions Related to Systemic Constraints: Occupational Alienation in Occupational Therapy Practice.

Ethical tensions arise daily in health care practice and are frequently related to health care system structures or policies. Collective case study methodology was adopted to examine ethical tensions reported by occupational therapists practicing in different settings in Southwestern Ontario, Canada. Inductive analysis involving multiple layers of coding was conducted. This article focuses on tensions related to systemic constraints. Participants reported ethical tensions related to balancing client priorities with those of health care services. Four themes related to systemic constraints were identified including imposed practices, ineffective processes, resource limitations, and lack of services. Therapists' aims could be seen to align with an "ethic of care" and were seen to be in tension in light of systemic constraints. The findings raise issues related to occupational justice, particularly related to occupational alienation in occupational therapy practice, and open conversations related to neoliberalist health care agendas.

Critical reflexivity in client-centred therapeutic relationships.

AIM/OBJECTIVES: This paper explores how a particular form of reflection--critical reflexivity--can support clinicians in developing a more nuanced understanding of therapeutic relationships, and work to advance the goal of client-centred practice. METHODS: A critical autobiographical narrative was written, and critical reflexivity adopted, as methods to critically examine the therapeutic relationship. FINDINGS: Critically reflexive stories have the potential to advance client-centred therapeutic relationships by inspiring the (re-)consideration of practices, and by interrogating interpretive systems. DISCUSSION: Understandings and practices that potentially limit the extent to which therapeutic relationships are client centred include (i) Dichotomous thinking, (ii) Objectification, (iii) The economic imperative, and (iv) Knowledge generation. CONCLUSION: The critical autobiographical account points to ways in which critical reflexivity on the therapeutic relationship has the potential to foster critical questioning, interrogate interpretive systems, attune to subjectivities, contribute to practice-based knowledge, resist violation, foster compassionate practice, and develop new understandings of relevance to client-centred practice. SIGNIFICANCE: This critical examination of the therapeutic relationship supports occupational therapists in more fully realizing the profession's core value of client-centred practice.