This article concerning ethics and the therapeutic relationship when working in a pediatric setting sheds light on some interesting findings and how to best approach families from a therapist perspective on growing your relationship.

Delany, C., & Galvin, J. (2014). Ethics and shared decision-making in paediatric
occupational therapy practice. Developmental Neurorehabilitation, 17(5), 347-354.
doi:10.3109/17518423.2013.784816

This article aims to break apart three term often talked about interchangeably when talking, describing, or thinking about what we do as occupational therapists. The three terms are occupation-centered, occupation-based, and occupation-focused. The author defines occupation-centered is at the core of our profession and it is what we do. The occupational-centered perspective guides our reasoning and in turn guides our actions. The centering of occupation ables us to link everything we do to the occupational core of our profession. Everything we do is pulled inward toward occupation. Occupation-based on the other hand is to have occupation as the fundamental base or foundation of what we do. Occupation-based interventions are when an occupational therapist uses engagement in occupation as a therapeutic agent for change. A method of evaluation and intervention that involved engaging a person in occupation. Occupation-focused then is being focused, as in our attention on occupation. We use evaluations and interventions that focus on occupation and the uses these focused interventions as a means to an end.

Fisher, A. G. (2014). Occupation-centred, occupation-based, occupation-focused:
Same, same or different?. Scandinavian Journal Of Occupational Therapy,
2196-107. doi:10.3109/11038128.2014.952912

I chose this article because of the growing interest in the profession and why people decide to pursue occupational therapy as a career. Seventy percent of students in this research had direct contact with an occupational therapist that influenced their decision to go into the profession. Forty percent of students did not go into the profession straight out of college rather decided to pursue the degree after working directly or closely with a therapist. This statistic is noteworthy of mature-aged students like myself. This article talks about the importance of professionalism and the impact each and every one of us has in interacting with community members and how we uphold and outwardly portray the profession.

Byrne, N. (2015). Exposure to occupational therapy as a factor influencing recruitment
to the profession. Australian Occupational Therapy Journal, 62(4), 228-237.
doi:10.1111/1440-1630.12191

Evidence suggests that living close with nature and having easy access to the outdoors can have a positive impact on physical and mental well-being. This concept is being studied and implemented to enhance the lives of those living with dementia. It has been studied and shown that outdoors activities led to improvements in mood and self-esteem and just 5 minutes of outdoor physical activity is optimal for good mental health. This research is translatable to those living with dementia and continues to be studies with this population. Dementia Adventures is an organization set out to get those living with the disease to have regular and positive experiences outdoors. This organization is based in the UK, however the idea is expanding into other communities worldwide.

Clark, P. (2014). Nature and the outdoors: stimulating those with dementia. Nursing &
Residential Care, 16(6), 336-339.

I chose this article because of the implications this study may have on the psychosocial needs of patients particularly in a mental health setting with individuals suffering from mental illness. This quantitative study used the Tree Theme Method (TTM), an intervention based on creative activities and occupational storytelling. The intervention is made up of five sessions and the client is asked to draw and paint tress symbolising various periods in their life. The pictures are used as a starting point to their life story and enhance the health and management of their everyday lives. The aim of this study is to evaluation whether of not improvements in mental health were sustainable over time, three year period according to this study. It was found that results were stable over time compared to the improvements that were made at the end of the five sessions. However many variables were not accounted for over the three year period and it is not possible to determine whether the positive changes were due to the TTM or outside circumstances, such as living environment, therapy, lapse in time, etc. Overall, the TTM shows positive impact as an effective intervention with psychiatric patients, however longevity needs to be furthered studies..


Gunnarsson, A. B., & Björklund, A. (2013). Sustainable enhancement in clients who
perceive the Tree Theme Method® as a positive intervention in psychosocial
occupational therapy. Australian Occupational Therapy Journal, 60(3), 154-160.
doi:10.1111/1440-1630.12034

I chose this article because my second FW placement is in an outpatient setting. This study/audit was performed in England over a three-year period. Non-attendance of outpatient services cause many disruptions in a therapists and organizations day to day not to mention the digression its causes the patient in their condition. The majority of OT outpatient referrals request stress management and relaxation techniques for people with anxiety, chronic pain, headaches, epilepsy, non-epileptic attacks, anger, and a small number with memory problems 126 patients were referred during the study period. 87 patients completed their scheduled therapy through entirety. Non-attenders were evenly split between genders in the study but literature suggests males were higher among the non-attenders. The study found age to be a factor finding younger people (35 and younger) fail to attend more. The literature did not support this finding. Of those referred by letter, 11.24% did not attend, compared to only 2.7% of those referred by direct contact. This finding suggests that personal contact is a retention factor that should be considered. There was no difference reported as to whether the contact was in person or via telephone. Shorter waiting times between consultant apartment and occupational therapy appointment also supports patient retention to therapy. This study and literature review is relevant in making sure doctors and therapist are ensuring they are taking the necessary steps in maximize outpatient attendance.

Green, A. (1997). An audit of occupational therapy outpatient attendance. The
British Journal Of Occupational Therapy, 60(9), 384-388.
doi:10.1177/030802269706000902

This research discusses why there is uncertainly among other health professional concerning the role of occupational therapy in mental health. The study looked at the live experiences of seven nurses and they they perceived occupational therapy in their workplace. Some of the reasons for uncertainly include the large range of approaches and interventions used, poor communication, lack of professional education of health professional at the undergraduate and workplace level, lack of promotion of the value of the profession by its practitioners, limited contributions to evidence base for OT in mental health, difficulties for ot to articulate aspects of their professional assessment, and lack of a uniform role definition amongst occupation therapists working in mental health. These factors have contributed to the lack of referrals for ot in the mental health arena. The seven nurse participants have between 4-32 years of nursing experience, and 2-10 years working with occupational therapists. Five themes were identified from 41 coding categories.
1) Guessing - most nurses did not have a broad understanding of the ot profession saying it was a bit "mysterious" and had to guess how to work with an ot.
2) Perceptions and stereotypes - ot was attempting to take over nursing role, ot paid more than nurses, more senior than nurses, did not understand the nursing role or have respect for nursing opinions, ot did not communication with nurses, ot had lack of knowledge and experience in inpatient mental health settings
3) Talking a different language - misunderstandings between ots and nurses
4) Anything is better than nothing - Nurses suggested that ot had value on the mental health team even though they could not identify exactly what their roles were.
5) Visibility and availability - Nurses felt ot had low visibility on the wards and were no perceived as an integral member of the team.

Overall, the nurses had a range of experiences and engagement with ot that effect the may have influenced relationships with ot staff. Overall, the results have raised some imports issues to address for the ot profession working in a similar setting.

Smith, E., & Mackenzie, L. (2011). How occupational therapists are perceived
within inpatient mental health settings: The perceptions of seven Australian
nurses. Australian Occupational Therapy Journal, 58(4), 251-260.
doi:10.1111/j.1440-1630.2011.00944.x

This article looks at whether or not retained primitive reflexes such as the Moro and the Galant have an impact on ADHD disorder. The current research shows that the retention of these primitive reflexes lead to neuropsychiatric disorders. Children with ADHD ages 8-11 were tested against a control group. The results of this research show ADHD is closely linked to persisting primitive Moro and Galant reflexes in school age children. Theses persisting developmental stages related to certain motor and cognitive functions may indicate that that ADHD is the residual effect of children compensating for being "stuck" in certain stages of development.

I chose this article because several kids on our caseload have these same persisting reflexes that have not integrated yet. You can almost always pick out the kids that experience these unfinished developmental stage. They are just "off", meaning uncoordinated physically and have difficultly completing tasks or are easily distracted. Moro should disappear around 2-3 months and Galant around 4-6 months of age. I see kids around 2-3 yrs of age with these reflexes still in tact.


Konicarova, J., & Bob, P. (2012). Retained primitive reflexes and ADHD in children.
Activitas Nervosa Superior, 54(3-4), 134-137.

This article posted in AJOT is still relevant today regarding professionalism within our profession. The big take away from this article is that a professional should be able to give and receive education as well as educate the next generation in clinical care. As we are all venturing out into our Fieldwork Experiences, we all take away the good, the bad, and the ugly side of OT (to put it bluntly). This is with anything in life and it is important to form our impressions and our professionalism around the positives while thinking critically about the changes we can all make to the future of the profession. We will all have the opportunity to become Clinical Instructors in our career. Taking our experiences and understanding from a student prospective what is most important, setting a great example, showing high levels of professionalism and ethical standards, and exemplifying passion is a great way to help the next generation succeed with confidence and optimism.