Reliability of the instrument DOA: dialogue about ability related to work

The aim of this study was to examine the reliability of the new instrument "DOA--a dialogue about ability related to work" [6]. DOA was developed using the Model of Human of Occupation as a theoretical base [12,13]. The instrument is divided into two sections; client self-assessment and professional assessment focusing on the individual's ability to perform work-related activities. Assessments are followed by a dialogue to distinguish goals for the return-to-work process based on the client's own preferences [6,14]. 34 outpatients' clients and 14 professionals from four clinics within psychiatric work rehabilitation in Sweden participated in the study. The Spearman Rank Correlation test generally showed acceptable significant correlations in test-retest (n=34). A greater part of items correlated "moderate to good" (r=0.51-0.75). In the raters' test (n=14) Percentage of agreement (PA) was good ranging between 93.1%-96.5%, which is above the acceptable criteria of 80%. There were no significance differences between the raters. The study has indicated that items in DOA work with generally good reliability to measure ability related to work. The instrument was demonstrated to be a reliable therapeutic tool in goal setting for return-to-work in a position outside of the clients' preferences.     

Case report: a work simulation program for a manual worker with a fracture injury

Work rehabilitation programs targeting different client groups are available in nearly all major hospital occupational therapy departments in Hong Kong. Clients receiving work rehabilitation are referred from various out-patient clinics and other occupational therapists. Those clients experience limitation in work after their injuries or diseases and plan to return to work after rehabilitation. Program objectives are 1) to assist clients to reach maximum work capacity as rapidly as possible 2) to ensure clients return to work safely 3) to improve clients' work readiness. This case report describes an individualized work simulation program at a general hospital in Hong Kong provided for a typical client who is preparing to return to his worker role. Specific job analysis, goals and program rationale for the client are discussed.     

The power of outcomes: FOTO Industrial Outcomes Tool -- Initial assessment

OBJECTIVE: To demonstrate how outcomes assessment can assist in describing clients receiving rehabilitation in occupational health rehabilitation clinics and to describe the preliminary assessment of internal consistency reliability and construct validity of the FOTO Industrial Outcomes Tool. METHODS: 266 adults referred for acute work rehabilitation (AWR), work conditioning/hardening (WC/WH) or a Functional Capacity Evaluation (FCE) comprised the data set. Clients were treated between July 1998 and January 1999 in 15 clinics from 6 states by 46 clinicians participating in the Focus on Therapeutic Outcomes (FOTO) national rehabilitation database beta test. For AWR and WC/WH, clients completed a health status questionnaire on intake and discharge, and health status was assessed prior to the FCE. Comprehensive demographic data were collected describing the clinics, clinicians, clients and work status collected 2 weeks following discharge. RESULTS: Internal consistency reliability coefficients for the health status scores ranged from 0.57 to 0.89. Construct validity was supported. CONCLUSION: Results demonstrate the power of collecting outcomes from a variety of constructs for clients receiving industrial rehabilitation services. Initial reliability and construct validity findings were adequate and support continuing data analyses.     

Examining new ways of office work between the Netherlands and the USA

There are many definitions of new ways of work, but working with a computer at another location than at the office or at the clients' location with Information Communication Technology as a support is becoming more prevalent. A new office having shared desks and facilitating informal meetings along with a changed leadership style is yet another way. Examining the experiences of alternative work styles, telework, between the Netherlands and the USA are especially apparent in the design of office environments as is the emergence of new leadership behaviors to promote safe and healthy work.     

How can cooperation between rehabilitation professionals in rehabilitation planning be improved? A qualitative study from the employer's perspective

Research shows that there are often problems with cooperation between rehabilitation professionals within vocational rehabilitation. The aim of this study was to describe employers' experiences of how cooperation between different rehabilitation professionals can be improved in a vocational rehabilitation planning process. Ten employers who had sent their employees to vocational rehabilitation at a rehabilitation centre in the north of Sweden during 2000 and 2001 participated in the study. Qualitative interviews were performed and analysed by thematic content analysis. The employers' cooperation with clients could be improved by a focus on clients' needs and participation in the rehabilitation process. The employers cooperation with Social Insurance companies could be improved by, 1) early prevention and intervention, 2) knowledge of each other's roles, responsibilities and opportunities and 3) priority making. The employers' cooperation with rehabilitation professionals could be improved by, 1) early identification of rehabilitation needs and goals and early rehabilitation and, 2) increased focus on own responsibilities from each part in the process.     

A twice-told tale: a phenomenological inquiry into clients' perceptions of therapy

Typically, what we understand about therapy and the families we work with comes from the therapist's observations. This inquiry evolved out of the empirical data that indicate the dramatic importance of the client's perceptions to achieving a successful outcome. The research was guided by the understanding that it is vitally important for therapists and therapy researchers to listen to clients and to examine our practices and theoretical approaches in the light of the client's experience of them. This study is a phenomenological inquiry into the client's experience of therapy.     

The art and science of teamwork: enacting a transdisciplinary approach in work rehabilitation

Teamwork, collaboration and interprofessional care are becoming the new standard in health care, and service delivery in work practice is no exception. Most rehabilitation professionals believe that they intuitively know how to work collaboratively with others such as workers, employers, insurers and other professionals. However, little information is available that can assist rehabilitation professionals in enacting authentic transdisciplinary approaches in work practice contexts. A qualitative study was designed using a grounded theory approach, comprised of observations and interviews, to understand the social processes among team members in enacting a transdisciplinary approach in a work rehabilitation clinic. Findings suggest that team members consciously attended to a team approach through nurturing consensus, nurturing professional synergy, and nurturing a learning culture. These processes enabled this team to work in concert with clients who had chronic disabilities in achieving solution focused goals for returning to work and improving functioning. Implications for achieving greater collaborative synergies among stakeholders in return to work settings and in the training of new rehabilitation professionals are explored.     

The Worker Role Interview: a powerful tool in Icelandic work rehabilitation

A pilot-study using the Worker Role Interview (WRI) was conducted to gather information from clients attending a work- rehabilitation program in an Icelandic psychiatric center. The work rehabilitation program traditionally used a performance-capacity-oriented assessment (PCA) to evaluate work readiness. Clients scoring 90% or higher on the PCA were considered able to re-enter the job market. However, scoring over 90% did not result in automatic return to work for the majority of clients. As a result, many questions were proposed about the effectiveness of the PCA to predict client ability to re-enter the work force. A pilot study using the Worker Role Interview was conducted with an aim to gain insight into what barriers prevented clients from entering the work force. Ten clients scoring 90% or over on the PCA were interviewed using the WRI. Qualitative methods were used to analyze the data. Results from the WRI indicated that clients failed to join the work force due to a number of psychosocial factors, such as lack of personal causation and self-efficacy combined with environmental factors. The WRI provided clients with an opportunity to express their attitudes and opinions towards work. Information gained through the WRI also gave new direction in goal setting for the work rehabilitation program and validated the need to expand occupational therapy services.     

"Our babies shall not die": a community's response to medical neglect

The free neighborhood health center in a Midwest U.S. town was developed in response to a report that indicated that infant mortality rates were higher for the Black community than for the community-at-large. The health center soon took on the full range of health problems brought by clients regardless of client's race, ethnicity, or income. The processes for managing health care problems in an environment where racism was the rule rather than the exception are considered in this study.     

Queues and care: how medical residents organize their work in a busy clinic

How do medical residents organize their work in settings where queue demands are heavy and resources are limited? Under such conditions, a queue theory would predict the delivery of care that is indifferent to clients' needs or that gets rid of clients as quickly as possible. In an exploratory case study of medical residents in a Veterans Administration outpatient clinic, we found instead that the medical residents' work was characterized by a high level of professional commitment: they provided thorough medical examinations and attempted to expedite patient care in other ways. We attribute the residents' professional ethos to opportunities provided in the VA hospital to learn the craft of routine medicine and to be directly responsible for patient care; such opportunities were not available in other settings.     

Physical health problems of the psychiatric client

The psychiatric nurse can make significant contributions to the client's overall state of health by attending to the physical health care needs of clients in psychiatric settings. Psychiatric clients die at a younger age than the general population and their incidence of physical health problems tends to be higher. As major providers of psychiatric care, especially to the chronically mentally ill, nursing skills are crucial to the physical and mental health of vulnerable clients. The case reports provide examples of how the interaction between physical and psychological states influence care.     

"WE DON'T PAY FOR BUS TICKETS, BUT WE CAN HELP YOU FIND WORK":

Guided by the concept of social problems work and the micropolitics of trouble perspective, we examine the discursive strategies used by social workers to conduct intake interviews with homeless clients. Trouble was a pervasive feature of these encounters: clients often requested services that diverged from the service preferences expressed by social workers. Social workers used elicitation strategies to solicit information about clients' biographies and their service needs and seminarrative raps to construct service plans with clients. Conceptualized as rhetorical devices, these strategies appear to have managed trouble in ways that articulated closely with material and nonmaterial aspects of the organizational context. We illustrate how these strategies articulated with an agency preference for consensus-style service planning and a focus on clients' recent biographies and immediate problems. Further, we show how these strategies managed the provision of scarce resources in ways that focused on remedies that could be tied to long-term client stability. We conclude by offering the outlines of a general model of the micropolitics of trouble in human service encounters.     

Construct validity of the instrument DOA: a dialogue about ability related to work

This study examined the construct validity of the newly developed instrument A Dialogue About Ability Related To Work (DOA). DOA [18] was developed using concepts from the Model of Human Occupation [20] as theoretical framework. The instrument assumes the assessment of work ability by both the client and the occupational therapist, and is followed by a dialogue which is expected to distinguish possible goal-setting for further rehabilitation [18,19]. Twenty-one professionals and 126 clients from three clinics in Sweden participated in the study. All clients were involved as outpatients in psychiatric work rehabilitation in county councils or community services. Results of a Rasch analysis test indicated that items are well separated and generally work together in five unidimensional continuums to measure work ability. Twenty-nine of 34 items showed goodness-of-fit statistics, which means acceptable infit MnSq values from > or = 0.6 to < or = 1.4 in association with Z values from -2 to 2. The five misfit items have to be revised. The study has indicated that DOA is a valid instrument in psychiatric work rehabilitation and ought to be useful in the dialogue between occupational therapists and clients about goalsetting and treatment planning.     

The healing power of dogs: Cocoa's story

Animals bring a sense of "at homeness" and even normalcy to people who are hospitalized or live in health care facilities. Illnesses, separation from family, fear, loneliness, and even depression may be lessened for those who receive a therapy dog visit by providing a welcome change in routine and something to look forward to. Individuals are often more active and responsive during and after a visit. Just stroking and petting a dog requires the use of hands and arms, as well as the motions of stretching and turning. Dogs are also unconcerned with age or physical ability; they accept people as they are. This alone causes many to reach out and interact with dogs. Animals provide a focus for conversation and a common interest. As Cocoa's human partner can attest, a pet also makes it easier for strangers to talk. Cocoa is known by so many people at the facilities she visits that residents' family members often stop to talk with "Cocoa's mom" when they meet her in the community, asking questions about how Cocoa is doing. When Cocoa is no longer able to perform her services, many in her community will mourn. Cocoa's story, as well as the limited research literature, supports the positive physical and psychological effects of animals, but continued research on the effect of therapy animals on health outcomes is needed. As advocates for clients, nurses are in key positions to facilitate the inclusion of animals in clients' care. Although not for everyone, including those who react negatively to animals or who are allergic, pet therapy offers important possibilities for providing holistic care that extends not only to clients, but also to family members and staff, and to the pets themselves.     

Clients' unconscious communications as the basis for establishing the framework of treatment: A response to articles by Schamess and Saari

Robert Langs' conclusions regarding clients' needs for a specific type of framework are based on listening to unconscious communication. His critics argue that certain severely disturbed clients need modifications in this frame. But these critics are arguing from a different set of data—data derived primarily from manifest content listening. Clients' unconscious communications reveal that—in spite of apparent need or conscious demand for modifications in the framework—clients actually need the therapist to maintain the frame. Langs' concept of unconscious communication is explained. A clinical vignette demonstrates how a client communicates an unconscious need for a therapist to maintain an aspect of the frame.     

Clinical management of "entitled" clients

As this process occurs, the painful affects become toned down for the clients. By exploring the source of clients' painful affects, wounded self-esteem, fearful projections, and dysfunctional defenses, misguided entitlement can be undermined. Much of this work will occur in a formal psychotherapy process, but nurses can create healthy object relatedness. To do so, they must see beyond the provocative and offensive behaviors to the vulnerable individual within who desperately needs compassionate and intelligent nursing care.     

A GENOGRAM WITH AN ATTITUDE

The approach described in this paper is predicated on the fundamental belief that in order to become competent and ethical practitioners, students must understand themselves and how they see others. They must be given tools and skills that facilitate examinations of their own assumptions and beliefs about themselves, other, and how the world works. It is also essential that students examine how these assumptions and beliefs will influence the way they choose to conduct therapy. Once they are aware of their biases, they must learn to choose to consciously influence themselves in a way that permits their clients the largest room for change within the clients' own contexts of belief, understanding, experience, and possibility. In this paper I describe the use of the genogram as a tool to facilitate the process of gaining self knowledge. This tool has been used in a multicultural counseling course, as well as in professional development workshops for psychologists, mental health counselors, and marriage and family therapists.     

Existential social work and the quest for existential meaning and well-being: A conceptual framework

ABSTRACT

The aim of this article is to conceptualize “existential social work.” A greater understanding of what existential social work means may enable social workers and those studying social work to see how its practice can reveal “the truth” about human existence and how they, as professionals, can enhance existential meaning and existential well-being among their clients. In such work, existential social workers have at their disposal tools such as the Frankl therapeutic approach to existential analysis (i.e., logotherapy) as well as spiritual-sensitive modalities (prayer and mindfulness). To interpret and understand apparent phenomena in the therapy is the ultimate goal with existential social work practices, thus providing clients with the opportunity to discover the meaning that exists in themselves. In addition, these practices pave the way for existential well-being.