Research for Occupational Therapist Coaches

This post is a stimulus piece for occupational therapist (OT) coaches who plan to attend the next International OT Coach Special Interest Group meeting, which will be held by teleconference on September 8th /9th , 5.00pm, Thursday for New York; 9.00pm, Thursday for UK; 7.00am Friday Australian Eastern Standard Time. Find city time and date

My colleague, Jeanette Isaacs-Young, has asked me to speak at the meeting about research … well this topic is quite broad, so following are just a few ideas that might be relevant!

 

Think first about purpose

In my view, all research is driven by the research question or hypothesis. Before you do anything you need to think about “what do I want to know?” Your research question will determine what kind of research activities you do, such as reviewing others’ studies, using a particular study to inform your practice, or perhaps conducting a research project.

So, when you think about your practice as an OT coach what do you want to know? Some possible questions might be:

  • Is my practice effective?
  • What do my clients think of my OT coaching?
  • Is OT coaching the best type of approach for my clients?
  • What types of clients would benefit from OT coaching?
  • Are there any clients for whom OT coaching is not effective?
  • What kinds of benefits do clients achieve from participating in OT coaching?

 

There is a continuum of research activities

Practitioners may use research in a variety of ways to inform their practice. For example, you may be a research consumer, that is, you read and appraise others’ research and determine whether and how others’ work may be relevant to your practice. Or, you might produce research, for example, you may engage in a research project with others to find out more about a gap in practice knowledge.

There are different levels of formality of research. For example, you may engage in a systematic review of your own practice to determine trends and patterns in your clients and to develop your own practice-based evidence or you may enrol in a higher research degree or you may opt to engage in a funded research study.

 

Research for practice development

When people think “research” they typically think about studies conducted by academics or students, however there is a kind of “everyday research” that might be more useful to practitioners. This type of research could be used to assist practitioners to develop their practices. This research is about systematically collecting information about the activities practitioners do every day and then reflecting on the data. So, for example, you might collect information about the kinds of clients you work with, such as demographic data, data about the problems and issues the clients are facing, and data about the kinds of actions you and your clients take and the outcomes of these actions.  When reviewing this data you might notice patterns among the clients, your activities, and/or the outcomes for clients. You can then use this information in planning services, targeting specific client groups, identifying areas for further professional development, or identifying issues for further, more formal, research.

 

Hints about engaging in research

Be systematic

In my view, being systematic is what makes something “research”. Having a system or a clearly defined process for identifying, thinking about, and using data is paramount. Being systematic means that you are less influenced by your own personal biases and others’ biases and therefore you are more likely to discover something which is useful for you.

Partner with others

Research that is conducted with others is more likely to be more rigourous, more useful, and more fun! Collaboration with others means that you have access to a greater pool of skills and knowledge than just relying on yourself. Working with others fosters creativity. It can increase access to resources and to wider networks when it comes time to sharing your findings.

Schedule time for research

Regardless of the type of research activity you engage in, it will take time. Time is needed to read, think, reflect, write, and discuss. Time is needed to integrate research knowledge into your future thinking, saying, and doing. Allow yourself this time.

 

Working with research higher degree students

Students who are completing an honours, a masters, a professional doctorate, or a PhD degree will usually need to complete research as part of their studies. Supporting research higher degree students to conduct research in your practice setting can be a very effective way of engaging with research. For example, you could suggest a research topic/question that is of interest to you and then encourage students to work with you to answer the research question. Students will complete much of the leg work and you will gain the knowledge that is relevant to your practice setting.

A partnership between a practitioner and a research higher degree student is mutually beneficial. You can enable access to your practice and/or your clients, which is desired (and needed) by students and universities. In return, students will help you answer your research question by reviewing existing literature about the topic and then engaging in original research to extend understanding about the topic. In addition, research higher degree students are supervised by experienced researchers (academics), which means that the project will be methodologically sound and conducted ethically. There may even be research grant monies available from the university to support the research project.

 

Example of research in OT coaching

A good starting point for thinking about research in OT coaching is to read Dorothy Kessler and Fiona Graham’s article in the Australian Occupational Therapy Journal, “The use of coaching in occupational therapy: An integrative review”. In this review of 24 articles published between 1995 and 2014, Kessler and Graham (2015) found that the effectiveness of coaching in occupational therapy was “promising” (p. 175) however more research was needed. In particular, Kessler and Graham recommend that in any study of coaching in occupational therapy, the definition of coaching ought to first be defined, and the theories upon which the practice was based ought to be described. This is because there is variation in how coaching is practiced in occupational therapy. Kessler and Graham further recommend that at a minimum, occupational therapists could use coaching in their practice and carefully monitor the outcomes achieved.

 

There is a research activity for you

No matter what stage of your career, you can always learn something new; indeed, I think that learning is what keeps practice fresh, interesting, and up-to-date. There is a range of ways that you can engage in research in your practice: as a research consumer, a scholarly thinker, a research sharer, a supporter of research higher degree student research, or a research producer.

Helping adults with disability through changes

The experience of transition, or change, is a common experience for all people. We have all experienced life changes such as going from school to work, moving house, starting and stopping significant relationships, and so on. But what about people who experience disability? What is their experience of change? We all appreciate practical and emotional support during changes but do people with disability have access to these forms of support? It was these questions that lay of the heart of research that I conducted with colleagues, Terri Mears, formerly of Northcott, and Michael Curtin, at Charles Sturt University.

There is research about changes faced by young people with disability as they transition from school to young adult life. However, there is much less research about the changes that adults with disability face. Therefore, Ageing, Disability and Home Care (ADHC) in the Department of Family and Community Services, New South Wales (NSW) Government, commissioned our research to find out what changes adults with disability experienced and what kind of support they needed to help them to move through these changes.

To find out about the experiences of change for middle-aged adults (aged 40 – 65 years) we conducted interviews and surveys. Any middle-aged adult who was living in NSW in Australia and who was born with a disability or acquired a disability before 18 years of age was eligible to participate in our study. We offered adults with longstanding disability the option to be interviewed or to complete a survey about their experiences of change.

 

 What were the causes of transition?

The people in our study experienced life changes for 5 main reasons:

  • Their health decreased
  • The health of a person or people helping to care for them decreased. Sometimes carers, who were often the parents of the adult with a disability, died
  • They moved house and/or lived with different people than they had been living with
  • They experienced changes to their daily activities such as retiring from work
  • They sought out change, for example, they took on study or made changes to their work or leisure activities

Health changes

As some people with disability got older their health reduced and this meant they were less able to do their usual activities. Sometimes they needed extra assistance. The parents of the participants were often moving into the older adult age bracket and therefore they were at increased risk of illness and death.  Parents had often provided much of the care and the greatest length of time of care to the participants. When parents passed away there was not only the emotional transition of grief and loss, but the people with disability also faced further changes to care arrangements, living arrangements, daily routine, and work, leisure, and social activities.

Change to living situation

Sometimes people with disability had to move to a new type of accommodation because of the death or illness of a carer or because of their own loss of health. For example, a person might move to a group home or a boarding house.

Change to daily activities

Some changes to daily activities such as work and leisure activities were expected, such as retirement. Becoming close to retirement age can create the desire and opportunity for people to take up new leisure, social, and community activities.

Multiple and complex changes

The participants often experienced multiple transitions at the same time.  For example, changes to their health often resulted in further change to their daily activities, where they lived and who cared for them. The complexity of these changes was challenging. For example one participant with a longstanding physical disability wrote:

“There were all sorts of transitions involved and it continues. Going from being healthy to being ill, going from full-time employment to full-time student. It really was not easy to do this. A lot of this involved grieving … I grieve my health. I grieve my old job. I grieve my old salary. I grieve my old friends … But I am thankful for the new opportunity at the same time. I think if I didn’t have something else to try (like this new course) it would have been even more difficult to adjust.”

 

Helpers and hindrances during change

There were 5 factors that influenced the outcome of transitions: (1) knowledge and understanding, (2) time, (3) attitudes, (4) environments, and (5) support and services. Depending on the amount or type, these factors could be either helpful or harmful to success in moving through a transition.

Knowledge and understanding

For some people, fear of the unknown caused paralysis and negatively impacted on decision-making. People with disability and their families and carers wanted to know about challenges they were likely to face and the services that were available to help them.

Time

Having sufficient time to move through, and accept, a transition seemed to help with coping with change. Sometimes a long period of adjustment was needed.

Attitudes

The attitudes of others, including those of the general public, could have a large impact on participants’ lives. Welcoming and helpful attitudes enabled happiness and well-being; but on the other hand, threatening or hostile attitudes created misery and poor health.

Support and services

The participants often relied upon family members to help them during transitions. Families offered practical assistance such as helping to move house, as well as emotional support, for example during bereavement.

Participants sought and received professional help from medical and health workers, disability support workers, attendant carers, home care helpers, and as part of planned activities programs. Although much of this support was reported to be very helpful, in some areas, especially rural areas, there was, at times, a lack of available services. Services could be missing due to a funding shortfall or because of difficulty with attracting or retaining staff. A lack of health and disability workers in rural areas meant that there was a lack of choice because there was frequently only one (if any) worker who was able to provide the needed services.

Sometimes services and professionals were difficult to access because there were problems with lengthy waiting lists, lack of accessible offices/rooms, excessive travel time to reach services, and lack of extended hours. Some participants noted that many types of paid assistance were provided during traditional working hours of Monday to Friday 9 a.m. to 5 p.m. but that services were very difficult to organise in under-serviced hours at night-time, early morning, and on public holidays or weekends.

 

Conclusions

As middle-aged adults with disability grow older they are likely to face a range of transition situations. These changes may be challenging and therefore they may need support from others, including therapy, rehabilitation, and disability service providers. It would be valuable to ensure middle-aged adults with longstanding disability have knowledge and understanding of available support services. Planning for transition and allowing plenty of time to adjust to the change may be useful. Services must ensure they offer choice and are accessible.

 

An article  about this study was recently published:

Wilding, C., Mears, T. & Curtin, M. (2016). Understanding and facilitating transition for middle-aged adults with longstanding disabilities. International Journal of Therapy and Rehabilitation, 23(4):164-172. DOI: 10.12968/ijtr.2016.23.4.164

A summary report is located on the research publications page of the Northcott website.

Helping people to make behaviour change

In my experience one of the most challenging aspects of trying to improve health is to support others to make behaviour change. Implementing changes, even when they result in positive outcomes, can be very challenging for all of us! So, I was interested to read a study by Greene, Hibbard, Alvarez and Overton (2016) Supporting patient behaviour change: approaches used by primary care clinicians who patients have an increase in activation levels.

Greene et al.’s mixed method study interviewed practitioners whose patients had high patient activation scores. They compared these effective practitioners’ methods of working with patients with practitioners whose patients had low patient activation scores. Patient activation was defined as “having the knowledge, confidence, and skills to take care of one’s health and health care [and] has been shown to be associated with a broad range of health-related outcomes, including better self-management and clinical indicators, fewer hospitalizations, and lower health care costs” (Greene et al., 2016, p. 148).

The 5 strategies identified as being most effective for supporting patients to make behaviour change were:

  1. Emphasing patient ownership (acting as a coach for patients and providing messages that patients were in control of their own health rather than health workers)
  2. Partnering with patients (including talking less and listening more and asking patients how they could work with them to help patients achieve their health goals)
  3. Identifying small steps (making big changes is achieved in small increments. Practitioners helped patients to identify at least one small positive action that could be taken)
  4. Scheduling frequent follow-up visits to cheer successes and problem solve (This strategy meant that practitioners stayed in contact with patients; they knew about achievements and celebrated them and they heard about problems along the road and helped patients to find ways to overcome these problems)
  5. Showing care and concern for patients (This was about being interested in helping patients to achieve their goals and believing that they could achieve them)

I think the findings of this study provide helpful advice for health care workers – I hope that you do too!

Full citation: Greene, J., Hibbard, J., Alvarez, C. & Overton, V. (March/April 2016). Supporting patient behaviour change: approaches used by primary care clinicians whose patients have an increase in activation levels. Annals of Family Medicine, Vol. 14, No. 2, pp. 148-154.

Tips for networking at conferences

I’m excited! – next week the Occupational Therapy Australia 26th National Conference and Exhibition is being held in Melbourne, Australia.  I have just been chatting with a colleague about how to make the most out of the networking opportunity that a conference like this can provide and thought that I would share a few ideas about this.

Take plenty of business cards

When meeting someone you haven’t met before or even when reacquainting yourself with colleagues you had lost track of over time, it’s useful to exchange business cards. An additional hint is to write on the back of the card what you talked about with the person – this will help you remember “who was who” when you return home with your stack of cards.

Be friendly: say “hello” to people you don’t know

People go to conferences to learn new things and to meet new people. Although you may not naturally be inclined to strike up a conversation with a stranger, at a conference you’re all there already sharing a common interest (in this case, the wonderful profession that is occupational therapy) – so you know that you will have something in common to speak about. Introduce yourself and say what part of the occupational therapy world you fit into. Be interested to hear about the other person’s occupational therapy story.

Ask questions

Asking questions is reassuring for presenters and it also helps you to be more visible to others who may be interested in the same topics and issues that you are interested in. When you ask a question, stand up so that you can be seen and heard more easily. Say your name and the organisation you work for or represent – this is useful to provide some context for the presenter and it also helps other audience members to know who you are so they can find you later if they want to talk to you more about the issue you raised.

Join in the Twitter chat

You can “meet” and get to know people better before, during, and after a conference by using the conference hashtag: #ota2015 and following @otaust  

Make a list of people you want to meet

During  the conference take note of names of people who you would like to meet – perhaps these are people whose work you know about, or they work in an organisation that is interesting to you, or they presented an interesting paper or poster, or perhaps they were at all the same sessions you went to. Look the people up on the “attendee” list in the conference App. (To download the App search OTA 2015 on the App Store for iPhone/iPad or Occupational Therapy Australia in the Play Store for Android devices.) Drop them a line to say “hello” and let them know what your common interests are.

Ask for an introduction

Networks “work” by connecting you to people who you don’t know through people who you do know. (Linked In does this well and shows you people you could be connected to through your existing connections.)

So, there you go, I’m heading off now to pack my business cards in my suitcase … if you see me at the conference, please say “hello” and ask for one 🙂

Refreshing our knowledge

Last week I blogged about the need for occupational therapists to be occupation-focused rather than medicalised. It seems that lack of clear professional self-knowledge and representation has been a long-standing challenge for our profession, since in 1977, well-known occupational therapy scholar, Mary Reilly said this:

“From our very beginning, it has been up for grabs as to whether the improbable venture of occupational therapy would survive, never mind succeed. Our danger, and it is especially critical now, is that we may at last and finally fail as a known discipline because we cannot comprehend the great institution that we are. And it is this failure of will and the need to refresh it and the need to re-organise and refresh our body of knowledge that I feel strongly is the next order of business for our State Associations.” (Mary Reilly on Occupational Behavior – 1977 posted by the University of Southern California Mrs T.H. Chan Division of Occupational Science and Occupational Therapy)

What can be done to change this problematic situation?

I think that this is an issue to be addressed not only by our Associations, but by every occupational therapist – and especially by experienced occupational therapists, who are the carriers of professional identity. One argument for creating professional culture change has been to look to new graduate therapists; they have recent and up-to-date knowledge. However, I believe that it is too difficult for them to lead a turn toward occupation-focused practice. Inexperienced therapists have less power and influence than experienced therapists. And, rather than changing the views and practice of experienced therapists, it is the inexperienced therapists who are changed to become more like the status quo, more like the existing practice.

I think that one way that we can refocus and refresh our knowledge of what is most important to us as occupation-al therapists is to create opportunities in which we can have open, in-depth, occupation-focused discussions about day-to-day occupation-al therapy. At least initially, these discussions are likely to be most effective if they remain profession-specific to occupational therapy. I think we need to have case-based discussions with each other, which focus on occupational issues and which draw on occupational theory and evidence. Concomitantly, through this process, we will be expanding our knowledge of occupation-al therapy and inspiring and creating practice-based evidence.

Resisting medicalisation of occupational therapy in all its many guises

During 2004 – 2008 I collaborated with a group of occupational therapists who were working in a large acute hospital in metropolitan Melbourne, in Australia. The purpose of the study was to better understand why it was so difficult for occupational therapists to explain occupational therapy to others and what we could do to make describing occupational therapy easier.   One of the major findings of the study was that occupational therapists need to become “re-enchanted” with occupation-focused occupational therapy; that is, they needed to remember and practice being occupation-al therapists.

A traditional area in which occupational therapy is practiced is in healthcare settings – and occupation-al therapists have much to offer these places. We can bring the perspective that people can influence their own health through their everyday doings; that is, as is stated in occupational therapy philosophy:

health and wellbeing can be created through engaging in occupations that we need and want to do


For any non-occupational therapists who may be reading this, the idea of “health through occupation” can be readily understood in your own life. Think about something you love to do. It may be dancing, swimming laps, making craft, reading, trawling the internet, playing chess, caring for kids, cooking, throwing parties  (These are all “occupations”: doings that occupy your time and your life) … There will be lots of reasons why you love doing these occupations. They are fun, they are engaging, they help you relax, they help you keep fit, they engage your creativity, they increase your self-esteem, they enhance the well-being of others, they give you a reason to get out of bed in the morning … hence health and well-being through occupation.

The value of doing is often most keenly felt when we cannot do, such as if we are sick, injured, impaired, or prevented from doing the things we love. Think about it … how would you feel if you couldn’t do the doings that you love to do? Hence the need for occupation-al therapists: people who help other people do the doings that they need or want to do.


Although occupational therapists learn about this occupation-al perspective of health at university, when they arrive at health care settings they start to doubt themselves.

Most of the staff in health care settings are nurses and doctors and these professionals have a different philosophical foundation: the “medical model”, which is that health is achieved when illness is cured and injury is healed. Both perspectives are correct. Health can be achieved through curing illness and it can also be created through doing valued and wanted occupations. However, problems arise when one pathway to health dominates and the other pathway is viewed as somehow “lesser”, “not quite legitimate”, or possibly even as something to be ridiculed or be derisive about. Unfortunately, this IS the situation that frequently occurs, and it is the “health through occupation” philosophy that is the minority view.

Occupational therapists start to doubt themselves, and in an effort to fit in, they can distort their practice so that it becomes more congruent with the medical model and less like enabling occupation. So for example, occupational therapists may spend lots of their time assessing cognitive function or physical function or emotional pain (rather than assessing occupational performance and engagement). Or, they may use treatment techniques like cone stacking or theraputty (rather than helping their clients practice occupations such as eating with utensils, or getting one’s self dressed, or cooking). Or, they may engage in treating pain using heat packs and massage (rather than coaching a person to learn how to self-manage the pain and use behavioural and environmental modification strategies and continue to walk the dog, go to the footy, or play with the kids).

I make this posting today because these were problems faced by occupational therapists in an acute care setting in 2008, but in 2015 occupational therapists continue to face similar challenges in a range of different settings: aged care, community health practice, mental health practice, hospital-based practice…

Sometimes occupational therapists try to address these problems by encouraging their colleagues to feel pride in occupational therapy. I think pride in one’s profession is important, but I wonder if what we really need to develop is courage.

I think we may need more courage to speak up about being an occupation-al therapist when everyone else is focusing on a different aspect of the solution.

Embracing client-centred research in occupational therapy

I was excited after reading a blog post by Marie Ennis O’Connor “The unknown unknowns: crowdsourcing research through social media” (May 8, 2015). O’Connor argued for the importance of making patients central to the process of health research.

As O’Connor contended, more usually it is researchers or health workers who decide what should be researched, and yet, it is clients who are the ultimate beneficiaries of the knowledge that is generated. If clients are not consulted about research during the initial scoping and design phase, there may be a mismatch between the questions that they want answers to and those that researchers are investigating (O’Connor, 2015).

As a researcher, the idea of conducting research with the people who will most benefit from it is very interesting and invigorating to me. Research is hard work and takes time; researchers want their work to be used by people. It is frustrating to think that after the days, weeks, and years of work invested, the findings may not be utilised. However, if the people who can most benefit from the research are included at the outset and throughout the research process, then it is clear that they will be much more likely to use the findings and share them with their friends, families, and communities.

One of the core values of occupational therapy is a commitment to client-centred practice, and now I can also see how this idea is also very relevant to research. I was already enamoured with the idea of crowdsourcing – which is when many people collaborate together to invest in and support a project (such as making a film, undertaking research, or advancing a cause) – and now I can see how it might be applied to creating client-centred research.