Translating Knowledge to Optimize Value-Based Occupational Therapy: Strategies for Educators, Practitioners, and Researchers

With the continued evolution of health care reform and payment models, it is imperative that the occupational therapy profession consistently and clearly articulate its distinct value. As payment models shift from paying for the volume of services provided to paying for the value of services, the field of occupational therapy must be sure to implement high-quality care by translating evidence into practice and facilitating improvements in client outcomes. Yet the process of translating evidence-based interventions and programs to real-world settings can be quite complex, and successful implementation often requires active collaboration across occupational therapy stakeholders. In this Health Policy Perspectives article, we provide occupational therapy educators, practitioners, and researchers with key recommendations for how the profession can translate evidence into practice, ultimately leading to the improvement of client outcomes and the provision of value-based care.

Probation Officers, Discretion, and Participatory Management

Probation officers (POs) are perhaps the correctional workers with the greatest reach, since more people are under probation supervision relative to every other correctional branch (i.e., jail, prison, and parole). The individuals under probation supervision and the community-at-large depend on POs to do their job well. However, POs have a job that requires them to make numerous decisions within an organization with conflicting goals and ambiguous roles, often with great discretionary power and little oversight. This relatively autonomous discretionary power often produces racial disparities in probation outcomes, the misuse of evidence-based tools such as risk and needs assessments, and ultimately the inability of probation organizations to effectuate change. These effects have negative consequences for probation organizations, probationers, and POs themselves. Participatory management produces an organizing framework that calls for hierarchical organizations to take a balanced approach to decision-making by increasing information sharing throughout the organizational hierarchy. This organizational structure carries the potential to remedy these aforementioned problems. By increasing oversight and accountability for POs via participatory management, POs’ discretionary power may be managed without limiting decision-making. Participatory management may create additional benefits such as increasing the efficiency of probation organizations, improving client outcomes for probationers, and increasing occupational satisfaction for POs. There are numerous potential threats to participatory management and several solutions for overcoming them. The main solution calls on probation agencies to make participatory management as effective as possible by constructing an equal balance between a loosely and tightly coupled organizational implementation of policies and practices.

Rehabilitation Evidence-Based Decision-Making: The READ Model

Evidence-based practice is the foundation of rehabilitation for maximizing client outcomes. However, an unacceptably high number of ineffective or outdated interventions are still implemented, leading to sub-optimal outcomes for clients. This paper proposes the Rehabilitation Evidence bAsed Decision-Making (READ) Model, a decision-making algorithm for evidence-based decision-making in rehabilitation settings. The READ Model outlines a step-by-step layered process for healthcare professionals to collaboratively set goals, and to select appropriate interventions. The READ Model acknowledges the important multi-layered contributions of client's preferences and values, family supports available, and external environmental factors such as funding, availability of services and access. Healthcare professionals can apply the READ Model to choose interventions that are evidence-based, with an appropriate mode, dose, and with regular review, in order to achieve client's goals. Two case studies are used to demonstrate application of the READ Model: cerebral palsy and autism spectrum disorder. The READ Model applies the four central principles of evidence-based practice and can be applied across multiple rehabilitation settings.

Therapeutic alliance in vocational rehabilitation counseling: assessing client factors and functioning

BACKGROUND: The therapeutic relationship is often acknowledged as one of the most significant factors in clinical process that influences client outcomes. OBJECTIVE: While considerable research has been conducted on the therapeutic relationship in psychotherapy, there is a paucity of research on the impact of the therapeutic relationship in vocational rehabilitation counseling settings. METHODS: This study explored the relationship between areas of client functioning (individual, interpersonal, social, and overall) and the therapeutic alliance among clients who receive services from the State vocational rehabilitation agency. RESULTS: In this study, younger clients (ages between 16 to 29) reported stronger therapeutic alliance. CONCLUSION: The findings of this study suggest that clients’ perceived individual, interpersonal and overall functioning have a significant positive relationship with the task and bond components of therapeutic relationship.

Using the Five Core Components of Competency-Based Medical Education to Support Implementation of CBVE

In recent years, veterinary education has begun the transition to competency-based models, recognizing that, like medical education, our goals include improved patient and client outcomes and the importance of learner-centered methods in education. Given that implementation of competency-based veterinary education (CBVE) is still in its relative infancy across many veterinary programs, we stand to gain from a unified approach to its implementation. As a guideline, the five core components of competency-based medical education (CBME) should serve to ensure and maintain fidelity of the original design of outcomes-based education during implementation of CBVE. Identified the essential and indispensable elements of CBME which include 1) clearly articulated outcome competencies required for practice, 2) sequenced progression of competencies and their developmental markers, 3) tailored learning experiences that facilitate the acquisition of competencies, 4) competency-focused instruction that promotes the acquisition of competencies, and 5) programmatic assessment. This review advocates the adoption of the principles contained in the five core components of CBME, outlines the approach to implementation of CBVE based upon the five core components, and addresses the key differences between veterinary and medical education which may serve as challenges to ensuring fidelity of CBVE during implementation.

The effectiveness of knowledge translation interventions for promoting evidence-informed decision-making among nurses in tertiary care: a systematic review and meta-analysis

Nurses are increasingly expected to engage in evidence-informed decision-making (EIDM) to improve client and system outcomes. Despite an improved awareness about EIDM, there is a lack of use of research evidence and understanding about the effectiveness of interventions to promote EIDM. This project aimed to discover if knowledge translation (KT) interventions directed to nurses in tertiary care are effective for improving EIDM knowledge, skills, behaviours, and, as a result, client outcomes. It also sought to understand contextual factors that affect the impact of such interventions. Methods A systematic review funded by the Canadian Institutes of Health Research (PROSPERO registration: CRD42013003319) was conducted. Included studies examined the implementation of any KT intervention involving nurses in tertiary care to promote EIDM knowledge, skills, behaviours, and client outcomes or studies that examined contextual factors. Study designs included systematic reviews, quantitative, qualitative, and mixed method studies. The search included electronic databases and manual searching of published and unpublished literature to November 2012; key databases included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica (EMBASE). Two reviewers independently performed study selection, risk of bias assessment, and data extraction. Studies with quantitative data determined to be clinically homogeneous were synthesized using meta-analytic methods. Studies with quantitative data not appropriate for meta-analysis were synthesized narratively by outcome. Studies with qualitative data were synthesized by theme. Results Of the 44,648 citations screened, 30 citations met the inclusion criteria (18 quantitative, 10 qualitative, and 2 mixed methods studies). The quality of studies with quantitative data ranged from very low to high, and quality criteria was generally met for studies with qualitative data. No studies evaluated the impact on knowledge and skills; they primarily investigated the effectiveness of multifaceted KT strategies for promoting EIDM behaviours and improving client outcomes. Almost all studies included an educational component. A meta-analysis of two studies determined that a multifaceted intervention (educational meetings and use of a mentor) did not increase engagement in a range of EIDM behaviours [mean difference 2.7, 95 % CI (−1.7 to 7.1), I 2 = 0 %]. Among the remaining studies, no definitive conclusions could be made about the relative effectiveness of the KT interventions due to variation of interventions and outcomes, as well as study limitations. Findings from studies with qualitative data identified the organizational, individual, and interpersonal factors, as well as characteristics of the innovation, that influence the success of implementation. Conclusions KT interventions are being implemented and evaluated on nurses’ behaviour and client outcomes. This systematic review may inform the selection of KT interventions and outcomes among nurses in tertiary care and decisions about further research.