Communicating With Intention: Therapist and Parent Perspectives on Family-Centered Care in Early Intervention.

IMPORTANCE: Responsive communication is critical to ensuring family-centered care in early intervention (EI). The Intentional Relationship Model (IRM) offers a framework for examining therapist-parent communication and offers strategies for supporting therapist responsiveness. OBJECTIVE: To explore family-centered care and therapists' communication in EI using the IRM. DESIGN: Prospective descriptive study. SETTING: Illinois EI program. PARTICIPANTS: Convenience sample of 101 therapists and 19 parents enrolled in an EI program. Therapist disciplines included developmental (n = 24), occupational (n = 32), physical (n = 17), and speech (n = 28) therapy. OUTCOMES AND MEASURES: Demographic questionnaire, Early Interventionist Self-Efficacy Scale, Early Intervention Parenting Self-Efficacy Scale, Measure of Processes of Care (MPOC)-Short Form, MPOC-Service Provider, Clinical Assessment of Modes (CAM), and Clinical Assessment of Suboptimal Interaction-Short Form (CASI-SF). RESULTS: Therapists used family-centered practices specific to relationship building more frequently than information sharing (especially sharing of general information). Therapists used the empathizing, encouraging, and instructing modes most frequently in their interactions with families. Participants' scores on the MPOC, CAM, and CASI-SF were significantly correlated. CONCLUSIONS AND RELEVANCE: Therapist-parent interactions were aligned with family-centered care. Opportunities for practitioners were identified in (1) sharing specific and general information and (2) expanding the use of collaborating, problem-solving, and advocating modes. What This Article Adds: In this study, we explored how the IRM can inform family-centered practices in EI through examination of therapists' interpersonal competency and therapeutic mode use.

Perceiving Therapeutic Communication: Client-Therapist Discrepancies.

IMPORTANCE: Few studies have examined differences in clients' and therapists' perspectives on therapeutic communication; this article contributes to the knowledge base. OBJECTIVE: To examine clients' and therapists' real-time perceptions of therapeutic communication. DESIGN: Observational, quantitative, cross-sectional study. SETTING: Inpatient and outpatient units of a large urban teaching hospital. PARTICIPANTS: Clients (n = 110) and rehabilitation therapists (n = 38; occupational, physical, and speech). OUTCOMES AND MEASURES: Demographic characteristics, Clinical Assessment of Modes (CAM). RESULTS: Clients perceived that therapists communicated by instructing more, and therapists reported empathizing more. CONCLUSIONS AND RELEVANCE: The findings suggest that clients and therapists may perceive therapeutic communication differently. What This Article Adds: This article supports therapists' use of the CAM to examine multiple perspectives on their communication mode use, as described in the Intentional Relationship Model.

Contemporary occupational priorities at the end of life mapped against Model of Human Occupation constructs: A scoping review.

INTRODUCTION: People with end-of-life care needs are seen in an increasingly diverse range of health and community settings. Opportunity for continued occupational participation is highly valued by people at the end of life. This scoping review sought to identify the priorities and preferences for participation at the end of life and to map findings using the model of human occupation. METHODS: A search strategy informed by the research question was developed in collaboration with a research librarian. Data sources used were Ovid Medline(R), CINAHL, Ovid Emcare, Scopus, Web of Science and PsychInfo. Studies that focused on clinician perspectives, clinical care, grief and loss, did not clearly identify end-stage diseases, <18 years and written in languages other than English were excluded. FINDINGS: Forty-four studies were included with a total of 1,070 study participants. Inductively developed themes were mapped against the model of human occupation constructs of volition (personal causation, values, interests), habituation (habits of occupational performance and routine), performance capacity and the lived body within the physical, social and occupational environment. The majority of findings sat within the construct of volition, particularly around sense of personal capacity, self-efficacy and values. At the end of life, people prioritise ongoing engagement in valued occupations even if participation is effortful. As disease progresses, opportunity to exert influence and control over this participation and engagement increases in importance. Personal causation plays an important role in the experience of occupational participation at this time. CONCLUSION: This review provides important insights into the occupational priorities of people at the end of life and the importance of supporting agency and volition at this time. The model of human occupation and its client-centred focus offer a framework for a more robust examination of ways to enhance volitional capacity and enable occupational participation for people at the end of life.

An examination of the psychometric properties of the occupational identity questionnaire for community-living elderly who require care.

INTRODUCTION: Authors created an Occupational Identity Questionnaire Provisional version (OIQ-P) to assess occupational identity for elderly individuals. The purpose of this study was to examine the psychometric properties of the OIQ-P. METHODS: Participants included 135 (42 males) elderly who lived locally and required care or support. OIQ-P was evaluated in terms of structural validity, criterion validity and internal consistency. RESULTS: Based on the results of an exploratory factor analysis and confirmatory factor analysis, an OIQ with a factor structure of 3 factors and 14 items was created. Rasch rating scale model revealed that 14 participants and 1 item did not fit the goodness of fit, nevertheless, the overall result was good. Spearman's rank correlation coefficient indicates that there was a law correlation between OIQ and the occupational identity scale of the Occupational Performance History Interview Version 2. In terms of internal consistency, the person separation index and person separation reliability coefficient were 2.30 and 0.84, respectively. CONCLUSION: This study confirmed the structural validity, criterion validity and internal consistency for the OIQ. To enhance the clinical utility of the OIQ, it is necessary to examine the interpretability and conduct an intervention study using the OIQ.

Evaluating Students' Use of Therapeutic Communication in Entry-Level Education: The Observer Version of the Clinical Assessment of Modes (CAM-Observer).

IMPORTANCE: The Intentional Relationship Model (IRM) guides learning about therapeutic use of self. The observer version of the Clinical Assessment of Modes (CAM-Observer) may be used to evaluate students' therapeutic communication as the process is defined in the IRM. OBJECTIVE: To assess the structural validity of the CAM-Observer. DESIGN: Cross-sectional, psychometric study. SETTING: Master's in occupational therapy program. PARTICIPANTS: One hundred thirty-four entry-level students. OUTCOMES AND MEASURES: The overall CAM-Observer and the individual subscales (Advocating, Collaborating, Empathizing, Encouraging, Instructing, Problem-Solving) were used to assess students' communication from the instructor's perspective. RESULTS: The overall CAM-Observer and six subscales demonstrated appropriate rating scale functioning and dimensionality. The Advocating subscale demonstrated poor item fit, floor effects, and low person separation. One Collaborating item demonstrated poor fit to the overall CAM-Observer and the Collaborating subscale, requiring revision. Instructing and Encouraging items were most likely to be endorsed by the instructor-observers, resulting in a ceiling effect for the Instructing and Encouraging subscales. The Advocating and Problem-Solving items were least likely to be endorsed by the instructor-observers. Except for the Problem-Solving subscale, the overall CAM-Observer and the individual subscales could reliably separate items according to difficulty. Except for the Advocating subscale, the overall CAM-Observer and the individual subscales could reliably separate people into high- and low-performance groups. CONCLUSIONS AND RELEVANCE: The CAM-Observer offers a structurally valid and theoretically grounded assessment of students' therapeutic communication as the process is defined in the IRM. The CAM-Observer can be integrated into occupational therapy education to guide students' critical reflection on their interpersonal communication. WHAT THIS ARTICLE ADDS: The CAM-Observer offers a means of evaluating students' therapeutic use of self.

Validation of the Clinical Assessment of Modes-Therapist Version (CAM-T) in Acute Rehabilitation Settings.

IMPORTANCE: Assessments that evaluate health care providers' communication in acute rehabilitation settings remain scarce; this article contributes to the knowledge base. OBJECTIVE: To assess the reliability and validity of the Clinical Assessment of Modes-Therapist version (CAM-T) from the provider's perspective. DESIGN: Cross-sectional, psychometric study. SETTING: Acute care and acute inpatient rehabilitation. PARTICIPANTS: Ninety-six clients and 32 providers (occupational therapy, physical therapy, and nursing). MEASURES: The CAM-T was psychometrically evaluated using classical test theory and Rasch analytic approaches. RESULTS: The findings offer strong evidence for the CAM-T's reliability and validity for evaluating overall communication and adequate evidence for evaluating individual communication modes. CONCLUSION AND RELEVANCE: The CAM-T may be used by providers as a self-assessment of communication in occupational therapy and in associated rehabilitation professions. WHAT THIS ARTICLE ADDS: This article offers evidence in support of the CAM-T's reliability and validity for evaluating health care providers' communication with clients in acute rehabilitation settings. The CAM-T may be used to evaluate providers' overall communication and individual mode use as described in the Intentional Relationship Model.

Development and Validation of the Occupational Self-Assessment-Short Form (OSA-SF).

IMPORTANCE: The Occupational Self-Assessment, Version 2.2 (OSA 2.2), is a client-centered measure of clients' perceived occupational competence and value. The OSA 2.2 has previously demonstrated good structural validity and internal consistency; however, the administration length could deter therapists from using this assessment in acute care and acute inpatient rehabilitation. OBJECTIVE: To evaluate reliability and validity of the OSA 2.2 in acute care and acute inpatient rehabilitation and to develop and validate the OSA-Short Form (OSA-SF). DESIGN: We performed a descriptive psychometric analysis using the Rasch analytic approach. SETTING: The data were collected in acute care and acute inpatient rehabilitation. PARTICIPANTS: Our convenience sample consisted of 86 patients in acute care and acute inpatient rehabilitation. OUTCOMES AND MEASURES: Participants rated their perceived occupational competence and value by completing the OSA 2.2. RESULTS: We examined psychometric properties of the OSA 2.2 and OSA-SF using a partial credit Rasch model. The 21-item OSA 2.2 was reduced to a 12-item OSA-SF through iterative removal of items on the basis of item-misfit statistics. The OSA-SF demonstrated adequate rating scale functioning, dimensionality, item and person goodness of fit, item targeting, item hierarchies, and item and person separation. CONCLUSIONS AND RELEVANCE: Findings indicate that the OSA-SF is a valid and reliable measure that can guide client-centered goal setting and intervention planning for adults receiving acute care and acute inpatient rehabilitation. WHAT THIS ARTICLE ADDS: The OSA 2.2 and the OSA-SF offer a client-centered approach to evaluating patients' self-reported ability and ratings of the importance of performing everyday occupations. These assessments can guide client-centered goal setting in acute care and acute inpatient rehabilitation.

Assessing Therapeutic Communication During Rehabilitation: The Clinical Assessment of Modes.

OBJECTIVE: This study applied Rasch analysis to test four versions of the Clinical Assessment of Modes (CAM), an assessment based on Taylor's Intentional Relationship Model: CAM-P, which assesses clients' pretreatment preferences; CAM-E, clients' treatment experience; CAM-T, therapists' self-reported perspective; and CAM-O, an observer rating scale. METHOD: The CAM-P was administered to 63 inpatients. The CAM-E was administered to 110 inpatients and outpatients. Trained raters rated therapists' modes with 59 inpatients and outpatients on the CAM-O. The CAM-T was administered to 38 therapists. Analyses of reliability and validity were conducted. RESULTS: The CAM demonstrated adequate construct validity. All versions showed acceptable internal consistency and unidimensionality within each of the subscales. Disorder between the 5 points on the ordinal rating scale was found for the client measures (CAM-P, CAM-E) and was resolved by modifying the ratings to encompass a 4-point scale. CONCLUSION: The four CAM versions are reliable and valid measures of therapeutic communication in rehabilitation.

Participating in diagnostic experience: adults with neuropsychiatric disorders.

Abstract Knowledge regarding neuropsychiatric disabilities has increased in recent years, resulting in an increasing number of adults requesting neuropsychiatric evaluation. The aim of this qualitative study was to describe adult clients' experiences of participating actively in a supportive assessment process in which they received a diagnosis of either autism spectrum disorder (ASD) and/or attention-deficit hyperactivity disorder (ADHD) and then received follow-up counselling, guidance, and compensatory resources that were immediate and directly integrated into the diagnostic experience. The Occupational Performance History Interview - Second Version (OPHI-II) was selected because it is client-centred. It measures how a significant life event affects a person's occupational identity, occupational competence, and interaction with the environment. The OPHI-II was administered to capture 15 participants' experiences of being diagnosed with ASD and/or ADHD as the significant life event of focus. Three categories were formed by using qualitative content analysis: (i) strengthened occupational identity; (ii) compensatory support enhances occupational competence, and (iii) effects of the social environment on relationships. Findings indicated that the diagnostic experience had transformative effects on participants' occupational identities, occupational competence, and ability to self-advocate for increased understanding and resources within their environments. The implications of these findings and future research are discussed.

Evaluating the Psychometric Properties of a Clinical Vocational Rehabilitation Outcome Measurement: The Assessment of Work Performance (AWP).

This study examined the validity and reliability of the Assessment of Work Performance (AWP) using Rasch analysis. The AWP was administered to 365 clients with a variety of work-related problems. Rasch analysis and principal component analysis were used to examine the appropriateness of the rating scales and unidimensionality of AWP items. The person-response validity, internal consistency, targeting appropriateness, and differential item function were also analyzed. The Rasch analysis confirmed the 4-point rating scale, and the item set met the criteria of unidimensionality. The AWP exhibited satisfactory person-response validity and internal consistency. Among the three subdomains, the targeting of item-difficulty was sufficient in the motor skills and process skills subdomains. Differential item functioning was found across gender and diagnoses. This study presented evidence to support that the AWP functioned as a reliable and valid assessment in assessing work performance. [OTJR: Occupation, Participation and Health 2013;33(3):125-133.].

Impact of using the Model of Human Occupation: a survey of occupational therapy mental health practitioners' perceptions.

AIM: While little is known about how occupational therapists perceive the use of occupation-focused theory in their practice, evidence indicates that it has been called for in the profession. To date, the Model of Human Occupation (MOHO) is the most widely used model internationally. The aim of this study is to document practitioners' perceptions of how using MOHO impacted on their practice. METHODS: A descriptive study using an Internet-based survey study design was conducted with 429 therapists in six National Health Service (NHS) trusts in the UK. RESULTS: Of the 429 therapists, 262 completed the survey, for a response rate of 61.07%. Most were female (85.5%) with a varying range of years of experience. Most worked in community and/or inpatient mental health settings; 92.1% responded that they use MOHO as their primary model. Therapists reported using MOHO moderately to greatly improve their assessment, goal setting, and conduct of relevant interventions as well as professional identity as an OT in their mental health occupational therapy practice. CONCLUSION/IMPLICATIONS: This study examined therapists' perceived impact of using an occupation-focused model in mental health practice. The findings of this study provided promising results. Findings suggest that the utilization of MOHO increases service for clients and professional stature and identity for therapists.

The myth of participation in occupational therapy: reconceptualizing a client-centred approach.

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.

The occupational and quality of life consequences of chronic fatigue syndrome/myalgic encephalomyelitis in young people.

INTRODUCTION: Chronic fatigue syndrome, termed myalgic encephalomyelitis in the United Kingdom (CFS/ME), is a debilitating condition involving severe exhaustion, cognitive difficulties, educational and vocational losses, and disruption of social activities and relationships. CFS/ME may affect volition (that is, value, interest and sense of competence). PURPOSE: To test Model of Human Occupation (MOHO) concepts by comparing young people with and without CFS/ME in terms of occupational participation, volition and health-related quality of life during infection and over time. METHOD: Three hundred and one people (12-18 years old) diagnosed with glandular fever were evaluated at the time of acute infection (baseline). Six months following diagnosis, 39 of them met the criteria for CFS/ME. A further 39 who recovered were randomly selected and matched to CFS/ME participants. Both groups were re-evaluated at 12 months and 24 months. The Occupational Self Assessment and the Child General Health Questionnaire were used to compare occupational participation. RESULTS: Those with CFS/ME reported lower levels of perceived competency, more difficulties with physical functioning and poorer general health status than those who recovered. CONCLUSION: Those with CFS/ME report lower perceived competency, and compromises in physical functioning, school performance, social activities, emotional functioning and general health. This supports the MOHO assertion that impairments affect volition and quality of life.

Therapeutic use of self: a nationwide survey of practitioners' attitudes and experiences.

Practitioners' preparation for, attitudes toward, and experience of the therapeutic relationship and use of self were explored using a survey study with a random sample of 1,000 American Occupational Therapy Association members. Participants reported a high value for the therapeutic relationship and use of self; most felt that they were inadequately trained and that the field lacks sufficient knowledge in these areas. Regardless of practitioners' age, gender, experience level, setting, treatment intensity, and client impairment, those who placed higher value on the use of self and had more training related to the therapeutic use of self were more likely to report interpersonal difficulties and feelings of positive regard for clients and were more likely to report concerns about clients. The findings suggest that more attention needs to be paid to the therapeutic relationship and to the therapeutic use of self in education and in research.

Long-term outcomes of an integrative rehabilitation program on quality of life: a follow-up study.

OBJECTIVE: To assess the long-term effects of an integrative rehabilitation program on the overall quality of life of individuals with chronic fatigue syndrome (CFS). METHODS: This study utilized a within-subjects, repeated measures cohort design. Twenty-three subjects diagnosed with CFS attended eight sessions of an illness-management group followed by 7 months of goal-oriented, individualized counseling that occurred once weekly for 30 min per session. Quality of life was assessed at five time points (baseline, following the group phase, following the one-on-one phase, and 4 and 12 months following program completion). RESULTS: A within-subjects repeated measures ANOVA revealed significant increases in overall quality of life for up to 1 year following program completion [F(4, 21)=23.5, P<.001]. CONCLUSIONS: Definitive conclusions about program efficacy are limited by design issues. However, findings suggest that the program may have led to improvement in quality of life for up to 1 year following program completion.

Linkages between goal attainment and quality of life for individuals with chronic fatigue syndrome.

Goal setting was the cornerstone of a rehabilitation program for people with chronic fatigue syndrome. This study examines the relationship between goal attainment and quality of life. Participants (N = 47) set goals over eight supportive and educational group sessions. Group members reported goal progress and confidence level for goal attainment. Using a forward, stepwise linear regression analysis, goal attainment emerged as the only significant predictor of quality of life improvement (B = 0.234, 95% CI for B: 0.050 to 0.419, SE = 0.091, ß = 0.372, p <. 05) independently of fatigue severity, symptom severity, and comorbid psychiatric diagnosis.

Can the social model explain all of disability experience? Perspectives of persons with chronic fatigue syndrome.

OBJECTIVE: The social model of disability has had a major influence on the academic field of disability studies and on contemporary understandings of the causes and experience of disability. The purpose of this study was to examine the adequacy of the social model for explaining the disability experience of persons with chronic fatigue syndrome (CFS). METHODS: This qualitative study examined the experiences of 47 adults with CFS participating in a research project that aimed to evaluate a participant-designed rehabilitation program. Data were aggregated from focus group interviews, open-ended questionnaires, progress notes, and from a program evaluation questionnaire. Data analysis was based on a grounded theory approach and used triangulation of multiple data sources and member checks to assure dependability of findings. RESULTS: Four themes emerged from the analysis: (1) minimization and mistrust of the disability; (2) negative experiences of impairment; (3) lack of identification with the disability community; and (4) the focus on advocacy as a quest for legitimacy. These themes varied in the extent to which they conformed to the principles set forth by the social model. CONCLUSIONS: Although the social model has important contributions to lend to occupational therapy practice, it is important to recognize that it may not capture the full reality of disability. In particular, the social model has serious limitations in describing the disability experience of individuals with disabilities who do not have visibly obvious disabilities and whose impairments do not conform to the traditional viewpoint of disability.