Rallying Optimism & Resilience Becoming a Practice Scholar in Daily Practice Patricia Crist, PhD, OTR/L, FAOTA Patricia Crist, PhD, OTR/L, FAOTA Founding Chairperson & Professor Department of Occupational Therapy Duquesne University Pittsburgh, PA Keynote Address NMOTA Annual Conference Friday, September 12, 2009 Occupational Therapy Association
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Rallying Optimism & Resilience Becoming a Practice Scholar in Daily Practice Patricia Crist, PhD, OTR/L, FAOTA Founding Chairperson & Professor Department.
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Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice
Patricia Crist, PhD, OTR/L, FAOTAPatricia Crist, PhD, OTR/L, FAOTAFounding Chairperson & ProfessorDepartment of Occupational TherapyDuquesne UniversityPittsburgh, PA
Keynote AddressNMOTA Annual ConferenceFriday, September 12, 2009
Occupational Therapy Association
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice
Patricia Crist, PhD, OTR/L, FAOTAPatricia Crist, PhD, OTR/L, FAOTAFounding Chairperson & ProfessorDepartment of Occupational TherapyDuquesne UniversityPittsburgh, PA
Keynote AddressNMOTA Annual ConferenceFriday, September 12, 2009
Occupational Therapy Association
Crist’s Christmas 2008
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice
AOTA’S CENTENNIAL VISIONAOTA’S CENTENNIAL VISION
2017: A Century of Occupational Therapy2017: A Century of Occupational Therapy
“We envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs.”
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice
AOTA’S CENTENNIAL VISIONAOTA’S CENTENNIAL VISION
2017: A Century of Occupational Therapy2017: A Century of Occupational Therapy
P O E Person Occupation Environment
What are the characteristics within the person that leads one to become a Practice-Scholar?
From Vision Practice:From Practitioner Practice-Scholar
The Professional Path:
Practice-ScholarPractice-Scholar
Scholarship of Practice
Evidence-based Practice
Optimism
ResilienceWhat OT path are you on?
From Vision Practice:From Practitioner Practice-Scholar
The Professional Path:
Practice-ScholarPractice-Scholar Excellence is never an accident.Excellence is never an accident. It is always the result of…It is always the result of…
high intention,high intention, sincere effort,sincere effort, intelligent direction &intelligent direction & skilled executionskilled execution
It represents the wise choice of many alternatives.It represents the wise choice of many alternatives.
From Vision Practice:From Practitioner Practice-Scholar
The Professional Path:
Practice-ScholarPractice-Scholar
Scholarship of Practice
Evidence-based Practice
Optimism
ResilienceResilience
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily PracticeResiliency
the ability to bounce-back from or successfully adapt
to adverse conditions or challenges
not a fixed personal attribute but a process of interaction between person &
environment
If circumstance s change, the response & outcomes may also
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily PracticeResilience - The Strength Perspective
o Mobilize values competencies, talents, capacities
o Build self-confidence & possibility-thinking
o Stimulate vision & hope
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice The Resilient Person:*
Personal Interpersonal self-efficacy positive, caring relationships realistic appraisal of environment positive family, intimate social problem-solving skills environment
sense of direction or mission ‘high enough’ expectations empathy humor adaptive distancing
androgynous sex role behavior
*Norman, 2000. Resiliency Enhancement
From Vision Practice:From Practitioner Practice-Scholar
The Professional Path:
Practice-ScholarPractice-Scholar
Scholarship of Practice
Evidence-based Practice
Optimism
Resilience
By Martin E.P. Seligman, 1998
Optimism – reacting to setbacks from a presumption of personal power, strengths and authentic, positive beliefs
Learned Optimism: How to Change Your Mind & Your Life
Bad events are temporary setbacks • Isolated to particular circumstances • Can be overcome by my effort and abilities • Pessimism - reacting to setbacks from a
presumption of personal helplessness• Bad events will last a long time •Will undermine everything I do •Are my fault
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily PracticeLearned Optimism
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily PracticeLearned Optimism
"The explanatory-style theory of success says that in order to choose people for success in a challenging job, you need to select for three characteristics:
1. aptitude
2. motivation
3. optimism
All three determine success." p. 101
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily PracticeLearned Optimism Positive Psychology Authentic Happiness (individual & institutional)
Ways To Use AOTA’s CATs and CAPs in Your Practice To guide clinical decision making To support or to reconsider practice decisions To share with clients to participate in clinical decision making To discuss the value of occupational therapy interventions with
external audiences, such as regulatory agencies, third-party payers,
referral sources, or institution-based program managers To stimulate continuing education programs, in-service programs, or journal clubs
prepares, maintains and disseminates systematic reviews in education, crime and justice, and social welfare
CEBM - Center for Evidence Based Medicine
UK based site provides information, resources, and workshops on evidence-based medicine
Cochrane Collaboration
full text of the regularly updated systematic reviews of the effects of healthcare
Evidence Based Mental Health Journal
summaries and commentaries on mental health articles that meet rigorous
EBP criteria - partial full text available
PEDro - the Physiotherapy Evidence Database
PICO - Instructional University of Illinois at Chicago site offers guidance on forming patient centered questions for searching relevant evidence using the PICO model
Evidence-based PracticeConditions that Promote Change to Evidence-based Practice
1. Readiness for change
2. Personal & Organizational Expectations
3. Presence of Deadlines
4. Availability of Support
The Scholarship of PracticeThe Scholarship of Practice
The Scholarship of Practice GAPThe Scholarship of Practice GAP
lack of relevance between lack of relevance between academic academic
research &research & practicepractice Kielhofner, 2005, Kielhofner, 2005, pp. 8-9pp. 8-9
From Vision Practice:From Practitioner Practice-Scholar
The Professional Path:
Practice-ScholarPractice-Scholar
Scholarship of Practice
Evidence-based Practice
Optimism
Resilience
The Scholarship of PracticeThe Scholarship of Practice
Research challenges the status quoResearch challenges the status quo
Ways of Knowing:intuition/ personal aspiration tradition/ experiencetenacity/ authoritycritical reason & logic/science
CreativeCreative
MotivatingMotivating
SystematicSystematic
The Scholarship of PracticeThe Scholarship of Practice
The purpose of researchThe purpose of research
justification of practicejustification of practiceleads to weak evidence aboutleads to weak evidence aboutwhat currently doingwhat currently doing
Needed to determine which of the many things Needed to determine which of the many things we do as [OTs] can be justified.we do as [OTs] can be justified.
Search for strong evidence that helps us Search for strong evidence that helps us change and improve our practices change and improve our practices
Dumholdt, 2005, pp. ixDumholdt, 2005, pp. ix
NIH Roadmap for Medical Research: translational research
The Scholarship of PracticeThe Scholarship of Practice
Research challenges the status quoResearch challenges the status quoReasons For Research in Rehabilitation: Develop body of knowledge Determine whether interventions
work Improve patient or client care Ethical concerns Overcoming barriers
The Scholarship of PracticeThe Scholarship of Practice
AOTA Agenda Assessment/ Measurement Interventions to promote function Translational Research Basic Research: (1) The experience of disability and/or chronic health problems for
individuals and their families across the life span
(2) Examination of body structures and functions supporting performance in daily life.
Health Services Research Research Training
The Scholarship of PracticeThe Scholarship of Practice
Outcomes measurement ‘comprehensive & integrated system of assessments to measure the efficiency and effectiveness of health care services and intervention (Barr, et. al. 2003)
Outcomes
site specific, practice-focused, observable evidence demonstrating that occupational therapy produces tangible results (Crist, 2008)
The Scholarship of PracticeThe Scholarship of Practice
OT Practice Framework
Outcomes are defined as important dimensions of health attributed to interventions include the ability to function,
health perceptions, and satisfaction with care
(adapted from Request for Planning Ideas, 2001). Outcomes are
1. the end-result of the occupational therapy process
2. describe what occupational therapy intervention can achieve with clients.
OT Practice Framework
OT Outcomes:
adaptation role competence
health & wellness self-advocacy
participation occupational justice
prevention
quality of life
occupational performance
OTPF, AJOT (2008)pg 662-663
The Scholarship of PracticeThe Scholarship of Practice
AM-PAC: towards the Centennial Vision!AOTA has endorsed the AM-PAC™ as an
outcomes measurement tool that identifies
many of the critical areas of outcome for OT
This tool will become part of AOTA’s long-term efforts to develop health information technology tools and resources that are sensitive to the unique needs of occupational therapy.
www.crecare.com
The Scholarship of PracticeThe Scholarship of Practice
AM-PAC: functional assessment in adults with a
wide range of conditions & functional abilities national database to benchmark
Ideal for tracking outcomes as a client progresses across an
episode of care. completing by clients, clinicians or family members comparing treatment outcomes across facilities & against
national averages. tracking outcomes of their services for quality improvement &
for marketing impacting health care policy
From Vision Practice:From Practitioner Practice-Scholar
The Professional Path:
Practice-ScholarPractice-Scholar Scholarship of Practice
Evidence-based Practice
Optimism
Resilience
My Secret Garden
Jaime Muñoz
Ingrid Provident
Anne MarieWitchger Hansen
Jeryl Benson
Diana Reichenbach
Patricia Crist
Practitioners
Practice Scholar
who engages the scholarship of
OT Practice
Students Faculty
Clients Citizens
What is a Practice-Scholar?Practice-scholars in occupational
therapy are practitioners with advanced knowledge and skills in the practice and delivery of occupational therapy services…..
But it’s more than this!
Practice-Scholars … leads practice through the roles they assume.
Becoming a Practice ScholarBecoming a Practice Scholar "I think my constant questioning of why I am doing what I am doing and
why other clinicians do what they do really drives my occupations as a practice-scholar. I look to the research and question if there is sufficient evidence available. This has driven me to start several research projects.”
Capt. Lynsay R. Whelan, United States Army, Assistant Chief of Occupational Therapy Services, Baghdad, Iraq
“Participating in research has stressed the importance of following best practices. It has increased my confidence in my knowledge and my ability to share this information. The most influencing aspect of the practice-scholar role is that I consider almost daily how my interventions could be challenged or confirmed by research.”
Debbie Smitsky, OTR/L Watson Institute
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice
20 Ways to Nurture the Scholar Within
Practice Scholarship
Reflect on my development as a scholar
Attend local association mtgs
Improve skills for appraising evidence
Join a journal club
Identify clinical questions to study
Develop a journal club
Take outcomes measurement course
Participate as subject in a research study
Improve skills for searching evidence
Seek supervised research position
Read about how researchers become researchers
Collaborate - collect data
Discuss my role as a scholar with mentor
Attend state or national conferences
Secure release time for an outcomes project
Advocate for research in my work setting
Supervise a FW student doing a scholarly project
Produce - generate a study
Secure funding for outcomes project
Collaborate - provide clinical expertise
Occupation:Ecology of Human Performance
Performance range is the configuration of tasks that a person
executes.
Dunn, et al (1994)
Occupation:Ecology of Human Performance
Intervention
Establish/ improve skills & abilitiesRestore
Alter modify the context for performance
Adapt modify contextual or task features
Prevent preclude the development of barriers to performance
Create creates new contexts & options Dunn, et al (1994)
Occupation:Ecology of Human Performance
Arrows =Variables affected by each intervention
Dunn, et al (1994)
Occupation:Occupational Adaptation
Develop individual’s capacity for adaptation
Encourages innovative choice of meaningful occupations for intervention
Transformation Into a Practice Scholar
“To realize PS you need ‘energy, enthusiasm and experience’
“I am stale; I feel isolated. I need to organize, prioritize.”
“Connect to create”
“I am the ‘Queen of the Uncomfortable’; PS is way to challenge the process.
“It’s a way to positively direct my energy.”
“This is “practice scholars without borders”• “Everyone dances differently.”
The Practice-Scholar Transformation:From Concept to Professional Engagement
SELF-REFLECTION:
How can I initiate the practice-scholar processwithin myself?
What What passions…passions…desires…desires…do I already have?do I already have?
Practitioners
PERFORM SELF
ASSESSMENT
IDENTIFY NEEDS IN LIGHT OF CONTINUING COMPETENCY STANDARDS
Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice
Practitioner Outcomes/Evidence of Success: narrative reports; retrospective data not analyzed yet
desire for more not less involvement in process increased motivation for the ‘just right’ evidence increased confidence to do own research ability to connect with university &
prior learning (re-newed) passion to contribute to profession employer gave release time