Rallying Optimism & Resilience Becoming a Practice Scholar in Daily Practice

1. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice 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

2. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice 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

5. Crist’s Christmas 2008

6. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice AOTA’S CENTENNIAL VISION 2017: 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.”

7. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice AOTA’S CENTENNIAL VISION 2017: A Century of Occupational Therapy P O E PersonOccupation Environment What are the characteristics within the person that leads one to become a Practice-Scholar?

8. From Vision  Practice: From Practitioner  Practice-Scholar The Professional Path: Practice-Scholar Scholarship of Practice Evidence-based Practice Optimism Resilience What OT path are you on?

9. From Vision  Practice: From Practitioner  Practice-Scholar The Professional Path: Practice-Scholar Excellence is never an accident. It is always the result of… high intention, sincere effort, intelligent direction & skilled execution It represents the wise choice of many alternatives.

10. From Vision  Practice: From Practitioner  Practice-Scholar The Professional Path: Practice-Scholar Scholarship of Practice Evidence-based Practice Optimism Resilience

11. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice Resiliency 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

12. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice Resilience - The Strength Perspective • Mobilize values competencies, talents, capacities • Build self-confidence & possibility-thinking • Stimulate vision & hope

13. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice The Resilient Person:* PersonalInterpersonal 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

14. From Vision  Practice: From Practitioner  Practice-Scholar The Professional Path: Practice-Scholar Scholarship of Practice Evidence-based Practice Optimism Resilience

15. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice Learned Optimism: How to Change Your Mind & Your Life By Martin E.P. Seligman, 1998 Optimism – reacting to setbacks from a presumption of personal power, strengths and authentic, positive beliefs • 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

16. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice Learned Optimism • Optimism psychology is in the field of cognitive science.  It is not magic.  But, the event-explanations of optimism can be practiced and learned, even by those who have not consistently used them previously.    • Optimism: • Inoculates against depression • Improves health • Combines with talent and desire to enable achievement

17. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice Learned 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

18. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice Learned Optimism Positive Psychology Authentic Happiness (individual & institutional) “ABCDE” A = Adverse event or situation B = Beliefs about that event C = Consequences of those beliefs D = Disputation and Distraction E = Energization Learned Optimism Self-Assessment http://www.stanford.edu/class/msande271/onlinetools/LearnedOpt.html

19. From Vision  Practice: From Practitioner  Practice-Scholar The Professional Path: Practice-Scholar Scholarship of Practice Evidence-based Practice Optimism Resilience

20. Evidence-based Practice Practice that integrates the results of sound scientific research with clinical experience and patient values Dumholdt, 2005 pp 550 Changing from “experienced–based To evidence-based practice McCluskey in Kielhofner 2006, pp 685 To collect & critically appraise literature related to your everyday practice

21. Evidence-based Practice Conditions that promote change to evidence-based practice: • Readiness for change • Personal & Organizational Expectations • Presence of Deadlines • Availability of Support

22. OT Specific EBP AOTA CATS and CAPS Critically Appraised Topics and Critically Appraised Papers (requires login based on AOTA membership) AOTA EBP Resources OT-specific EBP resources (requires login based on AOTA membership) Evidence-Based Occupational Therapy Web portal for international information on evidence-based practice in OT OTCATS - Occupational Therapy Critically Appraised Topics Site contains Critically Appraised Topics, which are shorter versions of systematic reviews, on OT subjects OT Seeker Database contains abstracts of systematic reviews and randomized controlled trials related to EBM in occupational therapy

23. OT Specific EBP Example: AOTA CATS and CAPS Critically Appraised Topic/Critically Appraised Paper Alzheimer's Disease Autism Spectrum DisorderMental HealthTraumatic Brain Injury Workers' CompensationSensory Processing Disorders/Sensory Integrative Dysfunction Driving & Community Mobility for Older Adults 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 OTCATS - Occupational Therapy Critically Appraised Topics OT Seeker

24. General EBP Campbell Collaboration 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 - InstructionalUniversity of Illinois at Chicago site offers guidance on forming patient centered questions for searching relevant evidence using the PICO model

25. Evidence-based Practice Conditions that Promote Change to Evidence-based Practice • Readiness for change • Personal & Organizational Expectations • Presence of Deadlines • Availability of Support

26. The Scholarship of Practice The Scholarship of Practice GAP lack of relevance between academic research & practice Kielhofner, 2005, pp. 8-9

27. From Vision  Practice: From Practitioner  Practice-Scholar The Professional Path: Practice-Scholar Scholarship of Practice Evidence-based Practice Optimism Resilience

28. The Scholarship of Practice Research challenges the status quo Ways of Knowing: intuition/ personal aspiration tradition/ experience tenacity/ authority critical reason & logic/science Creative Motivating Systematic

29. The Scholarship of Practice The purpose of research justification of practice leads to weak evidence about what currently doing • Needed to determine which of the many things we do as [OTs] can be justified. • Search for strong evidence that helps us change and improve our practices Dumholdt, 2005, pp. ix

30. NIH Roadmap for Medical Research: translational research

31. The Scholarship of Practice Research challenges the status quo Reasons For Research in Rehabilitation: • Develop body of knowledge • Determine whether interventions work • Improve patient or client care • Ethical concerns • Overcoming barriers

32. The 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

33. The 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)

34. The 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 • the end-result of the occupational therapy process • describe what occupational therapy intervention can achieve with clients.

35. 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

36. The 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

37. The 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

38. From Vision  Practice: From Practitioner  Practice-Scholar The Professional Path: Practice-Scholar Scholarship of Practice Evidence-based Practice Optimism Resilience My Secret Garden

39. Practitioners Practice Scholar who engages the scholarship of OT Practice Students Faculty Jaime Muñoz Jeryl Benson Diana Reichenbach Clients Citizens Ingrid Provident Anne Marie Witchger Hansen Patricia Crist

40. 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! 1 Crist, P., Muñoz, J.P., Witchger Hansen, A.M., Benson, J, & Provident, I. (2005). The practice-scholar program: An academic-practice partnership to promote the scholarship of “best practices.” Occupational Therapy in Health Care, 19 (1/2), 71-93.

41. Practice-Scholars … • leads practice through the roles they assume. • disseminates acquired knowledge regarding “best practices.” • models behaviors for others to emulate through fieldwork education, mentoring and other leadership activities. • creates exemplary partnerships with key entities to provide contemporary quality, evidence –based practice. www.healthsciences.duq.edu/ot/practicescholar.html

42. Practice-Scholars … • facilitates the translation of all levels of evidence for use in everyday practice • creates as well as uses relevant evidence

43. Practice-Scholars … • demonstrates competency in an evidence-based practice specialty. • establishes the requisite habits to create occupation-based evidence. • engages as leaderfacilitating change and/or knowledge-sharing. • embeds the scholarship of practice into their everyday activities. http://www.healthsciences.duq.edu/ot/practicescholar.html

44. Becoming 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

45. Rallying Optimism & ResilienceBecoming a Practice Scholar in Daily Practice 20 Ways to Nurture the Scholar Within

46. Occupation:Ecology of Human Performance Dunn, et al (1994) Performance range is the configuration of tasks that a person executes.

47. Occupation:Ecology of Human Performance Intervention Establish/ improve skills & abilities Restore 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)

48. Occupation:Ecology of Human Performance Arrows = Variables affected by each intervention Dunn, et al (1994)

49. Occupation:Occupational Adaptation Develop individual’s capacity for adaptation Encourages innovative choice of meaningful occupations for intervention

50. “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.” Transformation Into a Practice Scholar