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Influencing Policy Special Issue
Volume 76, Special issue
Table of Contents
From the Guest Editor
Influencing policy to advance practice in ways that improve health
Diane Watson PhD, MBA, BScOT
Bridges to Practice
Commentary on child health and well-being … the policy-research interface
Children and youth, Child health policy, Evidence-based practice
A critical examination of school-based occupational therapy collaborative consultation
Background. Although collaborative consultation has been widely adopted in school-based occupational therapy practice, there is limited conceptual understanding of how collaboration contributes to educationally relevant outcomes for students with disabilities. Even without a clear understanding of the evidence related to school-based occupational therapy services, there continue to be decisions about funding and delivery of services. Purpose. This paper synthesizes and critically appraises the research literature on collaborative consultation services in school-based occupational therapy in order to provide program administrators with direction for critically examining decision making for service delivery in their districts. Key Issues. Advancing occupational therapy practice in education settings requires a sound theoretical understanding of collaborative consultation. Distributed cognition offers a more robust understanding of the relationship between educator-therapist collaboration and outcomes of school-based occupational therapy services. Implications. This review concludes with two fundamental conditions necessary for collaboration between educators and occupational therapists to flourish.
Collaboration, Consultation, School health services, Occupational therapy
Addressing pediatric wait times using the model of human performance technology
Gillian Hoyt-Hallett, Kim Beckers, Michael Enman, Conny Betuzzi
Background. When traditional approaches to waitlist management are unsuccessful, service managers and providers must consider alternatives. Purpose. To describe how the model of human performance technology was used to address an extensive pediatric waitlist. Methods. Data were obtained from in-depth interviews with clinicians, educators, and parents and analyzed according to the model. Findings. The need for a paradigm shift from a linear model of service delivery to a continuum of service was identified which could meet the unique needs of each child and family. Services include information, education, and supports, and all are grounded in principles of family-centred care. Implications. The model of human performance technology provided a systematic approach with which to reveal the reason for extensive wait times for pediatric occupational therapy service. The model suggested a paradigm shift from a linear model of care to a continuum of care grounded in family-centred care. Implementation and evaluation of this new care model are ongoing.
Occupational therapy, Child, Waitlist management, Service delivery models , Family-centred care
Bridging research and policy in aging: Issues of structure, process and communication
Older adults, Health care policy, Aging policy
Client-centred home modifications improve daily activity performance of older adults
Susan Stark, Amanda Landsbaum, Janice Palmer, Emily K. Somerville, John C. Morris
Background. Remaining at home is a high priority for many older adults, but the capacity to “age in place” often is threatened by environmental barriers. Purpose. To describe a client-centred occupational therapy home modification intervention program and examine the impact of the intervention on daily activity performance over time. Methods. Using a competence-environmental press framework, a client-centred home modification program for older adults was implemented. In this quasi-experimental, single group prospective study, participants’ subjective ratings of daily activity performance were evaluated before and after the intervention (baseline/post/post). Findings. After home modification, participants’ perception of their daily activity performance at home improved significantly and was maintained 2 years post-modification. Implications. Home modification may benefit older adults attempting to age in place.
Aging, Home environment, Environmental modifications, Competence-environmental press framework
Criterion validity of a home health aides’ algorithm for recommending bathroom equipment
Manon Guay, Johanne Desrosiers, Marie-France Dubois
Background. Occupational therapists are experts at adapting bathroom environments. However, to increase access to services, the algorithm “Préalables aux soins d’hygiène” (French for “Prerequisites for bathing care”) has been developed to be used by trained home health aides to recommend bathroom equipment. Purpose. The purpose of this study was to assess the criterion validity of the algorithm by measuring the level of agreement between an occupational therapist's recommendations (gold standard) and those made by four home health aides using the algorithm. Methods. Community-living adults with bathing difficulties (n = 96) were visited by both types of evaluators. Findings. Home health aides correctly identified clinical situations in which they should feel confident about their ability (sensitivity: 96%, specificity: 69%) and, apart from type of bathing seat (κw = 0.63 [0.52; 0.75]), agreement between recommendations varied from substantial to almost perfect (∆ ≥ 0.72). Implications. Results increase confidence in the algorithm, but other studies are needed to ensure population safety and fulfil the occupational therapist’s obligations.
Community health services, Needs assessment, Home health aides, Hygiene Criterion validity, Assistive devices