Rallying Optimism & Resilience Becoming a Practice Scholar in Daily Practice

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


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


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.”


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?



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.






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






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 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)

“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






Optimism

Resilience


Practice that integrates the results of sound scientific research with clinical experience and patient values Dumholdt, 2005 pp 550

Changing from “experienced–basedTo evidence-based practice McCluskey in Kielhofner 2006,

pp 685

To collect & critically appraise literaturerelated to your everyday practice


Conditions that promote change to evidence-based practice:

Readiness for change

Personal & Organizational Expectations

Presence of Deadlines

Availability of Support

OT Specific EBPAOTA 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

OT Specific EBPExample: AOTA CATS and CAPS

Critically Appraised Topic/Critically Appraised Paper

Alzheimer's Disease Autism Spectrum Disorder Mental Health Traumatic Brain Injury

Workers' Compensation Sensory 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

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 - 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






Optimism

Resilience


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 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


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


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


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)


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


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


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



Practice-ScholarPractice-Scholar Scholarship of 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.

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

Practice-Scholars …

facilitates the translation of all levels of evidence for use in everyday practice

creates as well as uses relevant evidence

Practice-Scholars … demonstrates competency in an evidence-

based practice specialty. establishes the requisite habits to create

occupation-based evidence. engages as leader facilitating change and/or

knowledge-sharing.

embeds the scholarship of practice into their everyday activities.

http://www.healthsciences.duq.edu/ot/practicescholar.html

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


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)


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)


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

• Knowledge• Critical Reasoning• Interpersonal• Performance • Ethical Reasoning

DEVELOP A PLAN FOR CONTINUING COMPETENCE

• Needs• Goals & Objectives• Resources

IMPLEMENTPLAN

EXAMINERESPONSIBILITIES

DOCUMENTCONTINUING COMPETENCE& CHANGE IN

PERFORMANCE

IMPLEMENT CHANGE

What do you need to

nurture the practice

scholar within?


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

PDUs/ verification of participation

waitlist for participation

The Practice-Scholar Transformation:

Recent learning from sharing our approach:

Look for institutional levers: mission, vision, strategic plan, accreditation, valued recognition, ‘irritations’

Practitioners stress at hearing word research. Call outcome studies or practice scholarship.

Consider collaborating with your Institutional Research Department (if no faculty readily available)

Lead into PS as staff development process

Support for role engagementUse technology to connect—bulletin boardsEngage volunteers so have time (Ex. data entry)Adapt fieldwork student activities






Optimism

Resilience


Purpose

The SCIENCE …………..………The ART

of Practice

Purpose


Which best describes your current daily practice path?

Busynessis a way of gaining

approval for your

self-worth

Rust-out Syndrome

FIND YOUR FLOW

Csikszentmihalyi (1997) Finding Flow

Optimal experience

Quality of Life1.Pick activity that moves you.

2.Challenge yourself to use your gifts

3.Set clear goals & seek constant feedback

4.Scan out distractions

5.Focus on what you are doing

6.Build in time for solace, reflection (& re-generation)

Practitioners

Practice Scholar

who engages the Scholarshipof OT Practice

Students Faculty

Clients Citizens

SO WHAT DO YOU THINK?

WHAT ARE YOU GOING TO DO?

ENTICEMENT.EXCITEMENT.TRANSFORM!

GO FOR IT!

BECOME A

PRACTICE-

SCHOLAR !!


[email protected]@duq.edu

````` copy of keynote:

pcrist.wordpress.com

Thank you NMOTA Thank you NMOTA for bringing me for bringing me back home back home

Practice Scholar &

the Scholarship of Practice

Academia

Community

Practitioners

Consumers

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Rallying Optimism & Resilience Becoming a Practice Scholar in Daily Practice