Directions for advancing the study of work transitions in the 21st century.

OBJECTIVES: The purpose of this article is to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. PARTICIPANTS: Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. METHODS: A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. FINDINGS: Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. CONCLUSIONS: Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

Client satisfaction of hand therapy intervention: An evaluation of the effectiveness of therapy for clients recovered from complex regional pain syndrome.

Complex regional pain syndrome (CRPS) is a neuropathic pain condition that may develop following trauma to an extremity. Clients treated for CRPS at St Joseph's Health Care London - Hand and Upper Limb Centre, London, Ontario, were asked to evaluate their level of satisfaction with the treatment they had received by comparing their pain, functional status and emotional status before and after receiving therapy. The results indicated a high level of satisfaction among clients, attributable to the unique nature of the therapy program in use at this facility, where the occupational therapist works in close collaboration with the surgeon and pain specialists, and the therapy regimen is designed for each client individually according to his or her needs. The unique contribution of the present study to the body of clinical literature on CRPS is that it introduces a focus on client functionality and on client satisfaction with therapy received.

A review of evidence on the conceptual elements informing client-centred practice.

BACKGROUND: Client-centred practice is a central concept in occupational therapy in Canada. Since 1980, Canadian occupational therapy publications have discussed the elements of a client-centred practice approach. PURPOSE: The purpose of this paper is to enhance the understanding of key elements of a client-centred approach and to highlight the implications for practice that arise from this discussion. METHOD: Literature about client-centred practice in health care from 1990 - 2005 was reviewed regarding thoughts and ideas about client-centred practice. The content was analyzed for thematic focus about client-centred practice conceptual ideas and their influence on practice. RESULTS: Thematic conceptual elements emerging from the review include an overarching theme of power, with important underpinning themes of listening and communicating, partnership, choice, and hope. Selected definitions of client-centred practice and the link to best practice provide the context for the presentation of the concepts and recommendations for the implementation of client-centred practice. PRACTICE IMPLICATIONS: The paper concludes with a discussion of practice implications through the presentation of questions for therapists to consider as a quick reference tool and suggestions for further research and dialogue concerning client-centred practice.

Critical elements of spirituality as identified by adolescent mental health clients.

BACKGROUND: Client spirituality has been recognized as a central component of Canadian occupational therapy, but little research has been conducted in this area. PURPOSE: This exploratory study attempted to gain insight into the relevant elements of spirituality and its importance to inpatient adolescent mental health clients. METHOD: An adolescent spirituality questionnaire was developed from definitions of spirituality in the literature, modified by a focus group consisting of members of the target population, and administered to 11 respondents. RESULTS: Elements related to the individual and lifelong pursuits of the individual were most closely associated with spirituality while those items traditionally connected with spirituality and with external pursuits, activities, and relationships are considered less relevant by this population. Results suggest that spirituality is important to a majority of inpatient adolescent mental health clients. PRACTICE IMPLICATIONS: It is suggested that more studies drawing information on spirituality directly from specific client populations are essential for the occupational therapy community to improve its comprehension of, and to better its ability to address in practice, the critical area of client spirituality.

Facilitating client-centred practice: insights from clients.

BACKGROUND: This paper adds to the established importance of client-centred practice in mental health programs by reporting on the outcome of client interviews in one community setting in England. PURPOSE: The purpose of these interviews was to determine the opportunities for, and barriers to, the application of a definition of client-centred practice. METHODS: Purposive sampling was used to obtain 9 clients who participated in structured interviews. A combination of methods, including template analysis and the editing approach, were employed to determine themes and sub themes that are presented within the context of the clients'reasons for attending these programs. RESULTS: These themes included initiating client-centred practice with the sub themes of providing information to enable choice, participate in negotiating goals, overcoming fear and the severity of illness. Other themes related to the therapist's response to the client's illness and the client's knowledge about client-centred practice. PRACTICE IMPLICATIONS: It was clear from these interviews that client-centred practice was important to this group of clients and there were both opportunities and barriers to be considered by therapists.

Consumer participation in the employment rehabilitation process: contextual factors and implications for practice.

Rehabilitation models of practice have emerged that offer persons' with disabilities opportunities to have an active role in the work entry or re(entry) process. Despite the growth and interest in empowering client involvement in practice, consumer views on the determinants of participation are not fully understood. Thus, consumer feedback on using a self-directed approach to employment rehabilitation was elicited to identify factors integral to their participation in the process. Focus groups were conducted with 35 adult consumers with developmental, mental health, physical and learning disabilities to gain insights into their involvement in a participatory approach to find employment. Content analysis of data revealed barriers and facilitators, which hindered or enabled consumer involvement in the vocational service process. This article discusses the importance of considering issues across the rehabilitation system, practice and lived contexts when implementing participatory approaches in vocational rehabilitation settings.