Meaningful activity as a health promoting factor: Occupational

Transcrição

fh gesundheit – university of applied health sciences tyrol
Meaningful activity
as a health promoting factor:
Occupational therapy’s potential
for clients and their families
Ursula M. Costa, MA (OT), PhD (PH)
University of Applied Sciences Tyrol (fhg), Austria
ENOTHE meeting - HAN/Nijmegen, October 24th, 2014
My work for and with families related to
meaningful occupation
My background
Practice
Professional association
Education
Curriculum development
Policies, legal
foundations
Research
•
•
•
•
•
•
•
•
•
•
occupation-based
systemic
transactive
salutogenetic
ecological
participatory
inclusive
integrative
client-centred
family-oriented
Thematic Overview
• The context of the European Year 2014
• Meaningful activity as a health promoting factor –
KRAH®-based intervention
• Education, practice and research in transaction
and dialogue
European Year 2014
Reconciling work and family life
“Good work-life balance promotes the well-being of
workers. It can also contribute to achieving major EU policy
goals: stimulating employment (especially among
women and older workers); promoting child and youth
development; and encouraging gender equality.”
Library of the European Parliament, 05/2013
http://ey2014.eu/
Coface: Confederation of Family Organisations in the European Union
European Year 2014
Year of the Brain
“(…) the national wealth is the brain health.
We want to encourage the youth, who are our future, to
develop their brains, nurture their brains and above all
protect their brains. (…)
We would like to see childhood brain diseases receive
more attention than that received at the moment.
(…) neuropediatric illnesses benefit from very little
research and funding. “
Baker, 2013 - European Brain Council
Public Health Context
http://www.europeanbraincouncil.org/
• need of effective care and therapies
• providing a standard of health care that enables people
to lead a good life
“Brain diseases (…) cause terrible distress if poorly
managed, and can represent a considerable and
expensive burden for the health care systems.“ (Baker, 2013)
Reconsidering OT‘s potential
„Is occupational therapy a sufficiently vital and
unique service for medicine to support and society
to reward?“
„A critical appraisal of the essential worth of
occupational therapy“
Mary Reilly,1961
Practice
growing in an interdisciplinary, academic context,
Occupation
„(…) includes all the things that people do, the
relationship of what they do with who they
are as humans and that through occupation
they are in constant state of becoming
different“
Wilcock, 1998
Transformative Model
belonging
doing
becoming
being
Wilcock, 1998
Agency/Self-Efficacy/Identity/Volition
Future
Present
Past
Agency, Self-efficacy, Identity in Time
Future
Present
Past
Costa, 2013
Agency/Self-Efficacy/Identity/Volition
Future
Past
Present
Costa, 2013
Engagement in occupation as a
resource for health and well-being
•
•
•
•
Occupational history
Occupational identity
Occupational role
Positive experiences of self-efficacy
…linked to a salutogenetic approach…
(picture: boy playing a music instrument in an unfamiliar context, with a flue)
Inspiration & Questions
• What is meaningful?
• What „happens“ during a treatment/ assessment/
consultation/evaluation session?
• What is really helpful for the people we work with?
• (Who defines this?)
• (Why) is it worth that they/we make all the efforts to come to
get/offer OT?
Research
Occupational Science – Occupational
Therapy Research
• Human occupation & health: concepts from occupational
science, occupational therapy and other disciplines
• Freedom and Occupation (Costa, 2013)
• OT and the Capability Approach (A. Sen) (Costa, 2013)
• Resilience and Unemployment (Costa, 2011b)
• Current best practice in OT – KRAH® (Costa, 2011a)
• Effects of meaningful occupation as therapeutic means and
aim on health and well-being in daily life as perceived by
clients and professionals
Aim of the Study
To explore the effects of meaningful occupation
as provided through client-centred, resource-,
occupation- and day-to-day-oriented/ -relevant
occupational therapy (KRAH®) on children’s
health (ICF-CY*)) as perceived by children,
parents, teachers and occupational therapists.
Costa, U. (2014). Meaningful activity as health-promoting factor. Outcomes of
KRAH®-based intervention. (Sinnvolle Handlung als gesundheitsfördernder
Wirkfaktor.) ergoscience, 9 (2), 46-56.
*)ICF-CY
– International Classification of Functioning, Disability, and Health –
Child/Youth Version (WHO, 2007)
What mattered for this study
• participation of children, caregivers, and fieldwork
educators in therapeutic and research process
• perspectives of clients / participants (Wright, 2010)
• to give children a voice (UN, 1998)
• to understand reasons for clients‘ goals
• to explore effects of meaningful occupation on health as
perceived by clients and their proxies
Meaningful Occupation
what makes sense and matters to me
exciting
enjoyable
interesting
relevant & important for everyday life
adequate for the current developmental themes
in line with the set of values of the child‘s family and the
sociocultural context
promoting healthy child development
potentially fulfilling
Children‘s views & focus group discussions (Costa, 2009; 2014)
KRAH®
• client-centredness (Klientenzentrierung)
• recource-orientation (Ressourcenorientierung)
• orientation and relevance to daily life
(Alltagsorientierung und Alltagsrelevanz)
• orientation to meaningful occupation / occupation& participation-based (Handlungsorientierung)
occupation-based * systemic * transactive * salutogenetic *
ecological * participatory * integrative * client-centred *
family-oriented
(Costa, 2009; 2011)
KRAH® Clientcentredness
•
•
•
•
clients are active participants/partners
telling their stories
sharing their perception of competences
hopes, dreams, priorities,…
• client, relatives, others involved.
• communities
• stakeholders
• WHO is the client? „Clarifying who wants what“
KRAH® Resource Orientation
•
•
•
•
•
Person, occupation & environment
Look at the possible!
enablement & empowerment
Name what is working well!
Creating a ground for healthy growth and
development
Costa, 2009; 2011
KRAH® Daily Life-Orientation & -Relevance
Daily life – daily context – daily concerns throughout
the therapeutic process
assessment
• goal setting
• intervention
• transfer to and from treatment session
• documentation
• evaluation
•
Costa, 2009; 2011
KRAH® : Occupation-based
• throughout the therapeutic process
(Creek, 2010)
• positive experiences of agency (Gergely, 2004) and
self-efficacy (Bandura, 1997; Gage & Polatajko, 1994)
• Meaning-dimension (Hammell, 2004; Persson et al.; 2001)
• Top-down AND bottom-up
Costa, 2009; 2011
Study
Exploratory, mixed-method study, pre-post design (10
times of KRAH®-based intervention, 10-12 weeks),
triangulation
Austria, Italy, [South Germany]
Participants:
children (n = 42) with occupational performance difficulties,
developmental cognitive age of at least five years, referred
to OT because of occupational performance difficulties
their parents (n= 33), educators (n= 17) and occupational
therapists (n=16)
Children‘s age: 5;1 – 9;2 yrs.
Assessment
Perceived competence
Searching for understanding
clients in/and their context
Costa, U. (2014). Translation and cross-cultural adaptation of the Perceived Efficacy
and Goal Setting System (PEGS): Results from the first Austrian-German PEGS
version exploring meaningful activities for children. OTJR: Occupation,
Participation, and Health. doi:10.3928/15394492-20140325-02 .
Assessment
Assessment
Perceived Competence
Collaborative Goal setting with and for Children as
part of therapeutic Intervention
Costa & Brauchle, 2014
Costa, U. & Lindenthal, M. (submitted). Perceived competences in everyday
activities: Children’s self-report and parents’ and teachers’ report using the first
Austrian-German PEGS (Perceived Efficacy and Goal Setting System) version.
Perceived Competence
Costa, U. & Lindenthal, M.
(submitted). Perceived
competences in everyday
activities: Children’s self-report
and parents’ and teachers’ report
using the first Austrian-German
PEGS (Perceived Efficacy and
Goal Setting System) version.
Goal Setting
Family-oriented, client-centred, effective service provision:
Collaborative goal setting with and for children as
part of therapeutic intervention
(Costa, Brauchle & Kennedy-Behr, under review)
Children‘s reasons for their goals
• Social motives
“I want to belong to the others”
“I don’t want to be laughed at”
“so that I can play with the other kids”
“to be a good child”
“so that they [adults] don’t scold at me so often”
“so that there is more peace at home”
“then the teacher draws stars in my exercise book”
“that mum and dad are happy”
• Independence (autonomy): self-care & mobility
„I want to do it myself“
“so that mum does not have to do it for me”
• Ease, competence & joy through occupation
“because I want to be able to do this”
“because I like doing this”
“because it feels good to do nice things”
“because I cannot yet do it [tie my shoes] by myself”
“because it feels great being able to do things by myself!”
…for realizing a longtime wish or dream…
“being good at it is more enjoyable”
“so that I am as good [in running] as the others”
“because it feels good to be good at it – I like it better to be good
at doing things than not”.
“to be faster in doing the homework so that I have more leisure
time”.
•
•
•
•
autonomy,
relatedness,
competence (self-efficacy)
meaningful personal orientation
(Deci & Ryan, 2000; Mende, 2006)
• growing, belonging, performing (Hüther, 2009)
• independence, participation, occupational performance
(OT & OS literature)
Evaluation - overview
(ICF-CY)
Body functions: ↑ strength, ↑ coordination, ↑ spatial perception
Activities: ↑ spectrum, ↑ performance
Participation: ↑ engagement in leisure-, kindergarten- and
school related activities (alone and with others)
Personal context factors: ↑ self-confidence; ↑ volition
Environmental context factors: ↑ understanding and support for
children and parents
Evaluation after 10-12 weeks of intervention for 19 children
Evaluation - Children
ICF-CY – WHO, 2007
Health Condition
(Disorder or Disease)
Body Structure
& Functions
Activity
Environmental
Factors
Participation
Personal
Factors
Evaluation by 19 children: 11 boys, 8 girls; age: 5;1 – 9;2
Evaluation - Children
„I just enjoy now so many things…“
„I feel more confident trying out new things“
„I feel less anxious“
„I dare going to the woods and play there – by
myself and with the others“
„I now get my tasks done in time“
„yes, it helps“
Evaluation - Parents
Health Condition
(Disorder or Disease)
Body Structure
& Functions
Activity
Environmental
Factors
Participation
Personal
Factors
ICF-CY – WHO, 2007
Parents‘ Evaluation: Personal Factors
„happier“ „more satisfied“ „more balanced“
„searches and finds solutions to problems“
„more ambitious“ „enjoys to learn new things“
„better strategies and ideas how to start and perform an
occupation“
„finishes/completes what he has started“
„is more creative“ „open to new things“
„more self-confidence and self-esteem“
Parents‘ Evaluation:
Environmental Factors
better understanding for the child and his/her behaviour,
difficulties & competencies
(parents & teachers)
more ideas how to support the child in his/her development
coping strategies for daily life
ideas how to prepare and shape the physical and
occupational environment for the child
Volition
Volition
Child‘s joy about performance
Parents
Teachers
Occupational Therapists
Child shows joy when engaging in
occupations
Parents
Teachers
Child explores new things
Parents
Teachers
More interests in occupations
Parents
Teachers
Achieved
Mostly
achieved
Partly
Not
achieved achieved
46,7%
45,5%
44,4%
46,7%
45,5%
55,6%
0%
9%
0%
6,7%
0%
0%
33,3%
45,5%
38,9%
60,6%
36,4%
55,6%
0%
18,2%
0%
6,7%
0%
5,6%
26,7%
27,3%
50%
53,3%
18,2%
33,3%
13,3%
27,3%
11,1%
6,7%
27,3%
5,6%
93,3%
81,8%
50%
0%
0%
44,4%
0%
0%
0%
6,7%*)
18,2%*)
5,6%*)
Note. *) showed interest for engagement in occupations from the very beginning.
Occupational Performance
Parents
Eltern
Teachers
Pädagogen
Ergotherapeuten
Kind führt
bis zum Ende
ChildHandlung
finishes tasks
durch
Kind
versucht
in dersolve
Aufgabe
Child
tries
to problem
auftretende Probleme zu lösen
Aufmerksamkeit
und Bezogenheit
des
Child‘s attention
improved
Kindes auf Tätigkeit
Child
brings
up ideas
Kind
bringt
vermehrt
Ideen ein
ImprovedGrobmotorik
gross motorverbessert
skills
Improved fine-motricity
Handgeschicklichkeit
verbessert
Percentage of participating children
0%
50%
100%
Participation & Self-confidence
Participation / Self-confidence
Child plays/works more with other
children
Parents
Teachers
Child demonstrates positive
behavioural changes
Parents
Teachers
Child shows more self-confidence
Parents
Teachers
Achieved
Mostly
achieved
Partly
achieved
Not
achieved
13,3%
9,0%
38,9%
46,7%
36,4%
5,6%
26,7%
18,2%
22,2%
6,7%
27,3%
33,3%
13,3%
45,5%
38,9%
46,7%
36,4%
50%
26,7%
18,2%
5,6%
6,7%
0%
5,6%*)
40,0%
45,5%
50,0%
46,7%
36,4%
44,4%
6,7%
18,2%
0%
6,7%
0%
5,6%*)
Note. *) showed positive behaviour and self-confidence from the very beginning.
Education
KRAH®-based intervention
• Importance of defining and operationalizing
what we are offering along an intervention
process
• Clinical reasoning- KRAH®-approach
• Intervention protocols (fieldwork)
• Example: Obstacles to goal achievement
Teaching how to intervene
• offering and supporting a social environment:
encouragement, recognition, appreciation, valuing
perspectives and experiences, understanding, attention,
supporting as a professional in a respectful partnership
• opening achievable perspectives which are „worth to
engage for“ / have or bring meaning (daily life & life
course)
• pacing and adapting activities (activity analysis)
• listening to „what they really want“
• taking and investing time to gather different and shared
perspectives, concerns, goals & clarify what matters
(„needs assessment“)
• Working with clients in and with their context
Meaningful activities
•
•
•
•
•
•
•
Who is considered being part of „the family“?
Who is a „significant other“?
Who is involved in which way in caring?
Who should be included? For what reasons?
Who is to decide whom to include?
Matters of migration and cultural background
Multitude of context and shaping daily life
Meaningful activities
Family-oriented services need
adequate time and financial resources
for efficacy, efficiency, and sustainabilitiy of
intervention.
(see WHO, 2013)
"European Year 2014“
• understanding occupational roles
• working with clients‘ and their proxies‘ occupational
profiles
• collaborative assessment and goal setting
time invested in clarifying goals and counselling (stakeholders,
insurances) as part of professional intervention
• transfer of intervention to daily life
• searching for and strengthening resources for supporting
clients/families
• reconsidering our role and our main tasks (coaching,
designing, enabling,…)
Health through meaningful occupation
OTs‘ substantial contribution to society
creating opportunities
strengthening capabilities
contributing to a meaning-dimension
to health
to quality in life
Reconsidering OT‘s potential
„Is occupational therapy a sufficiently vital and
unique service for medicine to support and society
to reward?“
„A critical appraisal of the essential worth of
occupational therapy“
Mary Reilly, 1961
What we do matters!
Contact
[email protected]
References
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Verhaltenstherapie.
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Costa, U. (2014). Meaningful activity as health-promoting factor. Outcomes of KRAH®-based intervention.
[Sinnvolle Handlung als gesundheitsfördernder Wirkfaktor. Ergebnisse KRAH®-basierter Therapie.]. ergoscience, 9(2), 46-56.
Costa, U., Brauchle, G., & Kennedy-Behr, A. (under review). Collaborative goal setting with and for children as
part of therapeutic intervention.
Costa, U., & Lindenthal, M. (under review). Perceived competences in everyday activities: Children’s self-report
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Meaningful activity
„That man, through the use if his hands as they are
energized by mind and will, can influence the state of
his own health.“
Reilly, p. 81, 1961
„…engagement in meaningful occupation as the primary
goal for achieving better health and regaining active
participation in life“
Law et al.,1996
„(…) focus on value and meaning as perceived by the
unique person“
Persson et al., 2001

Meaningful activity as a health promoting factor: Occupational

Transcrição

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