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Purpose This paper aims to explore the use of lived experience research in peer work. Design/methodology/approach A suite of user-friendly and engaging lived experience research resources was introduced to consumers by peer workers. In-depth interviews were conducted with 33 consumer participants and five peer workers about their experiences. The data were analysed using qualitative content analysis. Findings The role of the peer workers appeared critical in ensuring that participants, despite their varied needs, preferences and backgrounds, derived optimum benefit from each resource. Features in resource delivery that promoted a positive experience included presenting the resources in the context of an existing relationship, providing clear explanations, going through resources together, encouraging reflection, taking enough time; and flexible delivery. Peer workers viewed the resources as potentially useful in their everyday peer work and as a valuable addition to their peer work toolkit. Practical implications The benefit of lived experience research to consumers is likely to be optimised by supportive and thoughtful delivery of the resources. Peer workers have the skills and are in an ideal position to do this. Bringing lived experience research to consumers provides peer workers with a potentially unique and helpful approach for supporting and promoting recovery and is congruent with their overall practice. Originality/value Lived experience research has the potential to benefit consumers directly but is rarely brought to their attention. This paper is the first to examine the potential role of peer workers in introducing learnings from lived experience research to consumers.

Importance: Occupational therapists require valid cognitive fitness-to-drive tools to advise drivers in this high-stakes area. Objective: To examine the psychometric properties and predictive validity of data gathered with the touchscreen DriveSafe DriveAware (DSDA). Design: Prospective study that compared a screening tool with a criterion standard. Setting: Ten community- and hospital-based driver assessment clinics in Australia and New Zealand. Participants: Older and cognitively impaired drivers (N = 134) ages 18 to 91 years (Mage= 68) who were referred for an assessment to determine the impact of a medical condition on driving. The inclusion criteria were a valid driver’s license, vision within license authority guidelines, completion of at least 1 year of high school, and English as a first language. Outcomes and Measures: The results of the touchscreen DSDA, a standardized assessment of awareness of the driving environment and one’s own driving abilities, were compared with those of a standardized occupational therapist–administered on-road assessment. Results: Rasch analysis provided evidence for the construct validity and internal reliability of data gathered with the touchscreen DSDA. Optimal upper and lower cutoff scores were set to trichotomize drivers into three categories: likely to pass an on-road assessment, likely to fail an on-road assessment, and further testing required. Specificity of the touchscreen DSDA was 86%, and sensitivity was 91%; positive predictive value was 83%, negative predictive value was 92%, and overall accuracy of classification was 88%. Conclusions and Relevance: Evidence supports the utility of the touchscreen DSDA for accurately predicting which participants require on-road assessment. What This Article Adds: The touchscreen DSDA is a promising screen for occupational therapists and other health professionals to use in conjunction with other clinical indicators to determine whether drivers require further assessment.

Learning from individuals with lived experience is considered an important element of developing recovery-oriented practice capabilities in mental health contexts. Additionally, service user involvement in the education of occupational therapy students is a requirement in accreditation standards. Despite this, many barriers to meaningful inclusion of Lived Experience Educators have previously been identified.This study evaluated the outcomes achieved by students who were involved in a unit of study that incorporated four recovery-oriented practice workshops that were co-designed and co-delivered by Lived Experience Educators and an occupational therapy academic. Change over time was measured using the Recovery Knowledge Inventory (RKI) and the Capabilities for Recovery Oriented Practice Questionnaire (CROP-Q). Change over time was evaluated using paired t-tests. Students also provided qualitative feedback at the conclusion of the workshops. These comments were analysed using interpretive content analysis.Students' scores on the RKI and CROP-Q both demonstrated statistically significant improvements from the beginning of the semester to the end of semester (RKI: 53.6-57.7, t = 6.3, P 0.001; CROP-Q: 75.6-77.0, t = 2.4, P = 0.019). The most common categories included in the qualitative comments were: "Learning from real experiences"; "Learning about how to be a better clinician"; "See the strength and resilience of the educators, reduce stigma"; "Learning about the negative aspects of the mental health system"; and "More effective than other types of learning".This study has demonstrated that students who engaged with the co-designed and co-delivered workshops improved their recovery knowledge and recovery-oriented capabilities over the course of the semester. Qualitative feedback also suggests that students' attitudes and skills for future practice were also influenced in positive ways by engaging with Lived Experience Educators.

Background: This study examined how occupational therapists, nurses, and their managers within different organizational contexts in the Australian health and aged care system prepare for implementation. The program being implemented was the Care of People with dementia in their Environment (COPE) program, a community reablement program for people with dementia and their carers. Methods: Qualitative data from 29 in-depth interviews were collected from occupational therapists, nurses, and their managers. Recruitment ensured a variety of organizational contexts were included. Thematic analysis was used to capture key themes. Results: Themes include innovation in a time of instability and uncertainty, values that align with the innovation, shifting the day-to-day practice, and confidence in new specialized skills. Conclusion: Organizations need to carefully consider internal and external contexts when planning implementation efforts. Study findings have informed plans for embedding delivery of the program within the health and aged care sector.

BACKGROUND With the introduction of consumer-directed care in the Australian community aged care sector, there are more opportunities for occupational therapists to provide evidence-based services that meet consumer needs. There is also an increasing requirement for health professionals to promote their interventions to consumers. Particularly for the implementation of new programs within organisations. However, occupational therapists have historically neglected widely promoting the role of occupational therapy services for older people. This study examines the perceptions of occupational therapists and their managers in promoting their service; the Care of People in their Environment (COPE) Program. METHODS This study utilised a qualitative interpretative description; including 28 in-depth interviews. Purposeful sampling ensured a variety of occupational therapists from different health contexts. Thematic analysis captured key emergent themes related to promoting occupational therapy interventions and implementation. RESULTS Many occupational therapists were apprehensive about promoting or selling their services and interventions. Greater levels of confidence in promoting the program were present when the program aligned with traditional models of service delivery and organisational processes. Occupational therapists described having limited opportunity to directly promote the program to consumers as community case managers were mostly the main contact at the organisation. There was limited consideration of promotion strategies and therefore limited enactment of strategies by organisations. Not-for-profit and non-government organisations recognise that the changed community aged care market provided new business opportunities. CONCLUSION With changes in the Australian aged care system, occupational therapy has great opportunity to provide diverse, evidence-based interventions driven by the needs of consumers. Reframing the notion of 'selling', to empowering consumers to be more informed about their options, will allow occupational therapists to build confidence in their promotional skills. Promoting evidence-based programs will have positive outcomes for the visibility, professional identity and recognition of occupational therapy.

Parents are a critical resource in supporting young people who live with mental health problems. Qualitative research has identified that parents use a wide range of strategies to provide support. However, parents report being unsure which strategies are likely to be helpful, so often struggle in this role. Presently, little empirical evidence exists to assist parents to decide which strategies are likely to be most helpful. This study aimed to explore the parent-perceived helpfulness of parental strategies to support young people living with mental health problems. Data were collected from February to July of 2018, using a cross-sectional, online, anonymous, self-report survey of participants who identified as parenting a young person (15-24 years) diagnosed with a mental health problem (n = 70). Overall, the strategies perceived as most helpful were practical assistance and personal interactions aimed at promoting positive thoughts and feelings and obtaining appropriate treatment. Least helpful strategies tended to be control-type strategies, aimed at behaviour change. Overall, there was good alignment between strategies' helpfulness and frequency of use, however, there were exceptions. These exceptions are likely reflections of the specific context of particular situations as well as parental uncertainty regarding alternative strategies. Generally, perceptions of strategies' helpfulness were unrelated to parent or child characteristics. However, helpfulness of strategies was associated with parents' satisfaction with their relationship with the young person. Parents' collective experience-based perceptions about the helpfulness of strategies used to support young people experiencing mental health problems can be harnessed to inform mental health practitioners' advice to parents and contribute to better mental health outcomes for young people.

Aims:Implementation of novel interventions occurs within broad organisational contexts, which contain many relationships and moving parts. Efforts need to be made to understand these relationships as they are an important predictor of successful implementation. This study examines the relationships between health professionals involved in the implementation of an evidence-based community program for people with dementia and their carers in Australia, The Care of People with dementia in their Environments program.Methods:This study utilised mixed methods including in-depth interviews and organisational diagrams. Qualitative data from 28 interviews were collected from occupational therapists, nurses and their managers. Recruitment ensured a variety of different organisational contexts were represented. Thematic analysis was used to capture key emergent themes.Findings:The strongest relationships were usually between the occupational therapist and their manager. Strong trusting relationships with managers were instrumental in advocating for the need for reablement programs and the occupational therapy professional role in dementia care. Large teams of occupational therapists were seen to be beneficial in supporting each other in case complexities. Relationships between occupational therapists and nurses were often missing or perceived as weak relationships. A conducive physical environment contributed to stronger more collaborative relationships, where individuals were visible and therefore felt to be more approachable.Conclusion:Our study highlights the additional preparation work that is required of organisations to consider relationships in their strategies for implementation.

The study objective was to identify the types of experiences that consumers identify as igniting and maintaining hope, and those most frequently reported. Data were collected through an anonymous online survey. Two open-ended questions elicited reflective personal accounts regarding hope-promoting experiences. Using an interpretive content analysis design, data were coded inductively using constant comparative analysis. Numbers of participants reporting each type of experience were calculated to identify patterns of hopeful experiences. Findings from 72 participants highlighted a diversity of hope-promoting experiences and sources. Fifteen experiences were identified, forming two broad categories: interactions and experiences involving others, and personal or internal experiences, insights and actions. Findings suggest that consumers play an active role in igniting and maintaining their own hope. Peer workers and health workers can support this by being cognizant of the quality of their interactions with consumers and by facilitating connections with others, particularly families, friends and peers.

Young adults who experience psychosis want to work but are less likely to be employed than their peers. Sixty two studies relating to young adults with psychosis and employment were reviewed following a systematic search of five databases: CINAHL, PsycINFO, MEDLINE, SCOPUS and EMBASE. Publication date ranged from 1973 to 2019 with > 70% between 2010 and 2019. Intervention was considered in 29 papers; critical appraisal revealed 90% of these had moderate to good methodological quality with only three RCTs. Of 11 intervention types “Early Intervention” and “Individual Placement and Support” were most common; both demonstrating positive impact on obtaining employment. The review identified minimal participant perspectives and great variability in: terminology used; the reporting of participant attributes; intervention characteristics and ways employment outcomes were measured. Employment processes identified were preparing for, seeking, obtaining, keeping and re-obtaining employment, with current research efforts focused on obtaining work. More focus is required on keeping and re-obtaining employment.

Background: Transitioning from psychiatric hospitalisation back to community presents a period of heightened suicide, homelessness, relapse, and rehospitalisation risk. The Australian state of New South Wales established a state-wide Peer Supported Transfer of Care (Peer-STOC) initiative to enhance recovery-focused supports available during this transition period. Aims: To understand the impacts and outcomes of the Peer-STOC program on service users from three stakeholder perspectives: service users themselves, peer worker service providers, and other mental health workers and clinicians interfacing with the program. Methods: Qualitative data from 82 questionnaires and 58 individual in-depth interviews were analysed thematically using constant comparative methods and an iterative and inductive process. Results: All stakeholders described positive impacts and outcomes of the program for service users. These included: (a) a better, less traumatic inpatient experience; (b) felt understood, cared about and less alone; (c) easier to leave hospital; (d) easier to get back into life and daily routines; (e) built and re-established community connections; (f) gained new knowledge, strategies, and skills; and (g) felt more hopeful about my recovery. Conclusions: The Peer-STOC program had a positive impact. It enhanced people’s experience in hospital, eased their transition from hospital and assisted with people recovering community-based relationships, activities, and routines.

Cognitive impairment is common amongst people experiencing homelessness, yet cognitive screening and the collection of history of brain injury rarely features in homelessness service delivery practice. The purpose of this research was to scope and map strategies for screening for the potential presence of cognitive impairment or brain injury amongst people experiencing homelessness and identify instruments that could be administered by homelessness service staff to facilitate referral for formal diagnosis and appropriate support. A search was conducted across five databases, followed by a hand search from relevant systematic reviews. A total of 108 publications were included for analysis. Described in the literature were 151 instruments for measuring cognitive function and 8 instruments screening for history of brain injury. Tools that were described in more than two publications, screening for the potential presence of cognitive impairment or history of brain injury, were included for analysis. Of those regularly described, only three instruments measuring cognitive function and three measuring history of brain injury (all of which focused on traumatic brain injury (TBI)) may be administered by non-specialist assessors. The Trail Making Test (TMT) and the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) are both potentially viable tools for supporting the identification of a likely cognitive impairment or TBI history in the homelessness service context. Further population-specific research and implementation science research is required to maximise the potential for practice application success.

Mental health lived-experience research illuminates the perspectives and experiences of people who live with mental illness. However, little is known about how useful people with lived experience of mental illness/distress might find lived-experience research, nor what the best formats are to bring it to their attention. This paper describes the STELLER study (Supporting the Translation into Everyday Life of Lived-Experience Research), which explores the translation of lived-experience research in the lives of people living with mental illness. Our aim was to use a design thinking approach to develop a range of user-friendly formats to disseminate lived-experience research. A staged design thinking approach was used to develop a translation strategy for lived-experience research. We explored empathy via consumer consultation to understand their perspectives on lived-experience research, refined the design aim, research questions and generated ideas with consumers and mental health professionals, identified the evidence based on lived experience-authored journal articles, worked with design students and peer workers to create a suite of resources and developed prototypes tailored to individual settings and clients. Participatory design thinking strategies are essential to identify the best ways to translate evidence-based lived-experience research via accessible, lay-friendly resources targeted to individuals impacted by mental illness. This study is the first to investigate the feasibility and usefulness of bringing the findings of lived-experience research to individuals impacted by mental illness/distress. It provides evidence about a potentially important source of information that can be used to facilitate their recovery.

Introduction Occupational therapists are an integral part of Australian mental health services. Recent changes in the mental health sector mean that increasing numbers of occupational therapists now work in generic, non-profession-specific roles in non-government organisations. Previous research has identified a range of challenges faced by occupational therapists in generic roles, including reduced satisfaction and loss of professional identity. An exploration of potentially positive aspects and strategies that assist occupational therapists to succeed and flourish within generic roles is lacking. The aim of this study was to explore what assists occupational therapists to thrive within generic roles in Australia's non-government mental health sector. Methods Semi-structured, in-depth interviews were conducted with 12 occupational therapists working in generic mental health roles across three non-government organisations spanning three Australian states. Data were analysed thematically using constant comparative analysis. Results Thriving was supported in three domains. First, occupational therapists facilitated their own thriving by keeping their occupational therapy lens, and managing ambiguity. Second, workplaces were supportive when their values aligned with occupational therapy core values, they recognised and valued the occupational therapy contribution, and their roles allowed opportunities for therapists to use their profession-specific skills. Third, the broader occupational therapy profession assisted thriving through preparation, validation and ongoing inclusion. Conclusion Despite some challenges, occupational therapists can and do thrive in generic non-government mental health roles. The preliminary framework of thriving provides valuable insights for those developing university curricula, those providing continuing professional development opportunities and for individual occupational therapists entering this expanding area of practice. Findings also provide insights into how individuals, academic curricula and the profession can respond and adapt to systemic transformations occurring in mental health service delivery.

IntroductionConsumer-led and collaborative research is consistent with occupational therapy principles of inclusion and client-centredness, and is increasingly valued in mental health. Our research...

BACKGROUND DriveSafe measures awareness of the driving environment. It is one subtest of DriveSafe DriveAware, a cognitive fitness-to-drive screening instrument. We converted DriveSafe to a touchscreen format for ease of administration; this necessitated the development of an automatic data collection and scoring system to reflect the decision that would otherwise have been made by an expert rater. We applied a structured process to determine what constituted 'correct' scores. We then examined the resulting scoring parameters to determine if these discriminated at-risk drivers from a comparison sample. METHODS Thirty at-risk older drivers and 30 younger drivers took touchscreen DriveSafe. Following presentation of images containing between one and four objects/hazards for 4 seconds, participants indicated their recall of object/hazard characteristics (type, location and direction of movement) by touching the screen. We analysed responses via descriptive statistics to compare spread, accuracy and consistency; and via a Fisher's exact test to determine whether the set scoring parameters could discriminate between at-risk and comparison drivers. RESULTS Fisher's exact test results indicated 24 of 28 location zones and 18 of 28 direction ranges discriminated at-risk drivers from the comparison group (P < 0.05). Frequency of missed or incorrectly identified hazards was much higher for the at-risk group for all variables. At-risk drivers missed or misidentified significantly (P < 0.00) more object types (34%), directions (47%), and locations (36%) than the comparison group (≤4% for each variable). At-risk drivers entered 31 additional responses for objects/hazards not displayed; the comparison group entered no additional responses. CONCLUSION The automatic variable data collection and scoring system reflected decisions that would have been made by an expert rater. This systematic process provided automated scoring decisions that enabled us to discriminate at-risk drivers from a comparison group. Psychometric evaluation of data gathered with touchscreen DriveSafe is required prior to use in clinical practice.

Background Burnout and employee turnover in mental health services are costly and can have a negative impact on service user outcomes. Using the Job Demands-Resources model as a foundation, the aim of this study was to explore the relationships between burnout, turnover intention and job satisfaction in relation to specific job demands and job resources present in the workplace in the context of one Australian mental health service with approximately 1100 clinical staff. Methods The study took a cross-sectional survey approach. The survey included demographic questions, measures of burnout, turnover intention, job satisfaction, job demands and job resources. Results A total of 277 mental health personnel participated. Job satisfaction, turnover intention and burnout were all strongly inter-correlated. The job resources of rewards and recognition, job control, feedback and participation were associated with burnout, turnover intention and job satisfaction. Additionally, the job demands of emotional demands, shiftwork and work-home interference were associated with the exhaustion component of burnout. Conclusion This study is the largest of its kind to be completed with Australian mental health personnel. Results can be used as a foundation for the development of strategies designed to reduce burnout and turnover intention and enhance job satisfaction. Electronic supplementary material The online version of this article (10.1186/s12913-018-3841-z) contains supplementary material, which is available to authorized users.

Reliable and valid assessment of sports nutrition knowledge can inform athlete nutrition education to address knowledge gaps. This study aimed to test the reliability and validity of an electronically administered sports nutrition knowledge tool – Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaire (PEAKS-NQ). A 94-item PEAKS-NQ was piloted to 149 developmental athletes (DA) in New Zealand, with a subset invited to complete the PEAKS-NQ again to assess reliability. Reliability was evaluated using sign test, intraclass correlation and Cronbach’s α. Accredited sports dietitians (ASD; n 255) completed the PEAKS-NQ to establish construct validity via known-groups methodology and provided relevance scores to determine the scale content validity index (S-CVI). Rasch analysis was conducted to identify potentially problematic items and test reliability. Score differences between DA and ASD were analysed using independent t or non-parametric tests. DA (n 88) were 17·8 (sd 1·4) years, 61·4 % female and mostly in high school (94·3 %). ASD (n 45) were 37·8 (sd 7·6) years, 82·2 % female, with >5 years of dietetic experience (59·1 %). ASD scored higher than DA in all sections and overall (91·5 (sd 3·4) v. 67·1 (sd 10·5) %) (P < 0·001). There were no differences between retests (n 18; P = 0·14). Cronbach’s α was 0·86. S-CVI indicated good content validity (0·88). Rasch analysis resulted in a fifty-item PEAKS-NQ with high item (0·91) and person (0·92) reliability. The PEAKS-NQ is reliable and valid for assessing sports nutrition knowledge which could assist practitioners effectively tailor and evaluate nutrition education.

Objectives: The aim of this scoping review was to map and synthesise peer-reviewed literature reporting on the Australian National Disability Insurance Scheme and psychosocial disability. Method: The review followed the rigorous and systematic protocol of Arksey and O’Malley. Five databases were searched and, using strict inclusion and exclusion criteria, publications were identified for inclusion. Data were extracted from publications, tabulated and graphically presented. A qualitative analysis was also completed. Results: Twenty-eight publications were included. While a wide range of issues were covered across this literature, only eight publications specifically focused on the National Disability Insurance Scheme. Almost half of publications were only author commentary without analysis of external data. There were no evaluations and a paucity of publications documenting the lived experiences of people with psychosocial disability or their families. Qualitative analysis identified 59 separate themes. These were grouped using a modified strengths, weakness, opportunities and threats framework. While it was acknowledged that the Scheme has the capacity to enrich people’s lives and enhance service integration, themes relating to weakness and threats dominated within this literature. These included a variety of existing or predicted problems such as poor integration of a recovery philosophy into the National Disability Insurance Scheme, complex application processes creating barriers to access, concern for those ineligible or not accessing the National Disability Insurance Scheme, the need to ensure National Disability Insurance Scheme plans address specific, changing participant needs and that services will be available to provide required supports. Conclusion: Given the significant impact of the National Disability Insurance Scheme on the lives of individuals and the wider mental health service system, there continues to be surprisingly limited peer-reviewed literature reporting on experiences and outcomes of the Scheme for people living with psychosocial disability. Future research examining outcomes and shedding light on National Disability Insurance Scheme experiences of people with psychosocial disability and their families are particularly important for ongoing development and evaluation of the Scheme.

BackgroundLived experience research is conducted by people who have experience of mental health issues and is therefore better placed than more traditional research to illuminate participants’ experiences. Findings that focus on identifying enablers of recovery from a lived experience perspective have the potential to assist people in their recovery process. However, this lived experience research is often difficult to find, access and interpret. We co-produced user-friendly and engaging resources to disseminate findings from six lived experience research studies. This paper seeks to answer the research questions: a) Did exposure to lived experience research increase hopefulness for participants?; and b) How else did interacting with lived experience research resources influence participants’ lives?MethodsThirty-eight participants were introduced to four resources of their choosing by peer workers over a four-week period. The helpfulness of resources was evaluated using mixed methods, including a quasi-experimental analysis of change in hope, an anonymous survey and in-depth interviews.ResultsFindings indicated that the resources promoted hope, but that increases in hopefulness may not be seen immediately. Other impacts include that the resources: encouraged helpful activities; provided a positive experience; increased valued knowledge; encouraged people to reflect on their journey and think constructively about mental health issues; helped people to feel less alone; and assisted people to explain their situation to others.ConclusionsThe research suggests the potential usefulness of lived experience research resources, presented in user-friendly formats, in the lives of people who experience mental health issues and implies a need to nurture this type of research.

Clinical reasoning in occupational therapy is a complex process. Researchers investigating clinical reasoning in occupational therapy have often described it as a tacit process: one that is understood, but is difficult to describe. Procedural reasoning is arguably the most concrete aspect of clinical reasoning. Specifically, clinical reasoning in occupational therapy requires the consideration of clients’ current and future occupational functioning, and how they engage and relate to others and the environment. Occupational therapists use clinical reasoning in all aspects of their work, but in general this process can be broken into three stages: impression, information gathering and planning, and monitoring. Clinical reasoning is an important skill that therapists develop as they gain experience in practice settings. It provides the basis for professional decision-making and day-today problem solving. Different types of clinical reasoning are used, depending on the contextual requirements and practice requirements of the client and family.

Background Consumer peer workers are individuals with lived experience of mental health issues and recovery who are employed to use their lived experience to support others. The consumer peer workforce has expanded substantially in recent years. While some research has explored the workplace experiences of peer workers, no previous studies have explored job satisfaction, burnout or turnover intention for this workforce. Methods Consumer peer workers in New South Wales, Australia were invited to complete a survey designed to explore their workplace experiences. The survey included measures of job satisfaction, burnout, turnover intention, job demands and job resources, and satisfaction with supervision, professional development and opportunities for career progression. Questions also explored positive and negative aspects of positions. Analyses included exploration of the relationships between of job satisfaction, burnout, turnover intention, job demands and job resources as well as tabulation of common positive and negative aspects of positions. Results were also compared with findings from a previous study exploring workplace experiences of other mental health workers. Results A total of 67 peer workers participated in the study. Overall job satisfaction, burnout (disengagement and exhaustion) and turnover intention for peer workers was not significantly different to other mental health workers. Job satisfaction, disengagement, exhaustion and turnover intention were all significantly inter-related. Job resources of social support, job control, feedback, and rewards and recognition were associated with positive workplace experiences and the job demand of “physical environment” was most substantially associated with poorer workplace experiences. The most common positive aspect of positions was “connecting with consumers” and the most common negative aspect of positions was “attitudes of clinicians / workplace culture”. Access to supervision from a senior peer worker was associated with more positive workplace experiences. Conclusions This research demonstrates that while consumer peer workers do not appear to experience poorer job satisfaction or higher levels of burnout or turnover intention than other mental health workers, a range of challenges do exist. Efforts to further expand the peer workforce (especially senior peer worker roles) and to promote more positive attitudes and workplace cultures are likely to promote better workplace experiences for peer workers.

Background and Objectives The translation of reablement programs into practice is lagging despite strong evidence for interventions that maintain function for the person living with dementia as well as improve carer well-being. The aim was to evaluate the implementation of an evidence-based program, Care of People with Dementia in Their Environments (COPE), into health services. Research Design and Methods An implementation-effectiveness hybrid design was used to evaluate implementation outcomes while simultaneously involving a pragmatic pre–post evaluation of outcomes for people with dementia. We report uptake, fidelity to intervention, outcomes for people living with dementia and carers, and beliefs and behaviors of interventionists contributing to successful implementation. Results Seventeen organizations in Australia across 3 health contexts, 38 occupational therapists, and 17 nurses participated in training and implementation. While there were challenges and delays in implementation, most organizations were able to offer the program and utilized different models of funding. Overall, we found there was moderate fidelity to components of the program. Pre–post outcomes for carer well-being and coping (Perceived Change Index, p < .001) and activity engagement of the person living with dementia (p = .002) were significantly increased, replicating previous trial results. What contributed most to therapists implementing the program (Determinants of Implementation Behaviour Questionnaire) was a stronger intent to deliver (p < .001), higher confidence (p < .001), a sense of control in delivery (p = .004), and a belief the program was very useful to their clients (p = .002). Discussion and Implications This study demonstrated that implementation is possible in multiple health systems and beneficial to individuals and their families.

usc Refereed/Peer-reviewed Introduction: Recovery-oriented practice policies and occupational therapy education accreditation standards require that consumers are engaged in the design, delivery and evaluation of curricula. This consumer involvement (sometimes referred to as service-user involvement or patient involvement in other contexts) should go beyond consumers simply ‘telling their stories’ to more meaningful collaboration in curricula. This study was designed to map the current patterns of consumer involvement in occupational therapy programs across Australia and Aotearoa New Zealand. Method: A survey was distributed to all occupational therapy programs across Australia and Aotearoa New Zealand. The survey included questions related to: (a) perceived enablers and barriers to consumer involvement in education; (b) organisational structures and support; (c) ways in which consumer are involved in the design, delivery and evaluation of curricula; (d) access to remuneration for consumers; (e) overall ratings of the level of consumer involvement in curricula; and (f) academic confidence in working with consumers. Results: Usable responses were received for 23 programs from 19 universities (83% response rate). Every program reported some consumer involvement in the curriculum. Consumer participation tended to be mainly focussed on curriculum delivery with less frequent involvement in curriculum design or evaluation. The most common barrier to consumer involvement in curricula was ‘funding/remuneration for consumers’ and the most common enabler of consumer involvement was ‘positive attitudes of teaching staff’. Conclusion: In comparison to previous reports, consumer involvement in occupational therapy curricula has increased over the past decade. However, ongoing effort is required to support true collaboration in all aspects of curriculum design, delivery and evaluation. While this will require attention and effort from academic teams, changes at a university level to establish systems to engage and effectively remunerate consumers for their involvement (especially in design and evaluation elements) are also required.

Background Occupational therapists employed within eating disorder services provide unique and valuable interventions. However, existing literature suggests that occupational therapists in this area may be at substantial risk of experiencing poor work-related wellbeing (e.g., high levels of burnout and low levels of job satisfaction). Despite these risks, no previous studies have explored the work-related experiences of occupational therapists in this specialist area of practice. Objectives To explore challenges faced by occupational therapists working in eating disorders, their sense of professional identity, burnout and job satisfaction. Method A mixed methods sequential design was adopted. Australian occupational therapists working in eating disorder services were invited to complete a survey exploring job challenges, burnout, professional identity and job satisfaction. Follow-up interviews were conducted and analysed using Braun and Clarke's method of thematic analysis. Results Ten occupational therapists (representing approximately 50% of the workforce in this specialist area in Australia) participated. There were strong correlations between challenges from the client group and exhaustion (a component of burnout), and moderate correlations between stronger professional identity, pressure to adopt generalist approaches and exhaustion. Qualitative analysis suggested job challenges arose from structural, personal and client-related sources, especially underutilisation of occupational therapy and pressure to adopt non-occupation-based practices. Participants reported using strategies such as maintaining an occupation focus, supervision, professional interactions and maintaining work-life balance to mitigate job stress. Conclusion Occupational therapists working in eating disorders do face challenges. These are particularly related to the lack of evidence base for occupational therapy in this area. Future research should focus on developing further evidence for occupational therapy in eating disorders and designing outcome measures that capture improvements in daily functioning. These efforts would strengthen the role of occupational therapy and may reduce the risk of burnout and improve job satisfaction and sense of professional identity.

Background/aim It has been suggested that occupational therapy practitioners with a poor sense of professional identity experience more difficulties in the workplace and may be less likely to implement evidence-based, occupation-focused interventions. Poor sense of professional identity has also been linked to increased risk of burnout. Although professional identity is considered important, few measures are available and none have been rigorously evaluated. The project was established to evaluate the construct and internal validity of one such measure, the Professional Identity Questionnaire (PIQ). Methods The PIQ includes 10 questions, each rated on a 5-point Likert scale. Rasch analysis was used to evaluate several aspects of construct and internal validity of the PIQ. These included rating scale validity, unidimensionality, statistical validity, differential item functioning, overall construct validity and person response validity. Correlations were also calculated to explore the relationship between the Professional Identity Questionnaire and a commonly used measure of burnout, the Oldenburg Burnout Inventory (OLBI). Results A total of 118 occupational therapists working in mental health completed the PIQ and OLBI. Initial analyses suggested that the rating scale validity and targeting of item difficulties to person abilities were not optimal. Revision of the rating scale structure improved the overall rating scale validity and item targeting. Analyses using the revised scale structure showed generally good alignment with quality control criteria established for this study. Fit statistics for one item were less than optimal and some differential item functioning was present. Correlations between PIQ and OLBI total scores were -0.53 for the original PIQ rating scale structure and -0.46 for the revised rating scale structure. Conclusions Results from this study provide preliminary evidence for the construct and internal validity of the PIQ, especially when using the revised scale structure. However, further research is required before the PIQ can be recommended for widespread use.

There are effective non-pharmacological treatment programs that reduce functional disability and changed behaviours in people with dementia. However, these programs (such as the Care of People with dementia in their Environments (COPE) program) are not widely available. The primary aim of this study is to determine the strategies and processes that enable the COPE program to be implemented into existing dementia care services in Australia. This study uses a mixed methods approach to test an implementation strategy. The COPE intervention (up to ten consultations with an occupational therapist and up to two consultations with a nurse) will be implemented using a number of strategies including planning (such as developing and building relationships with dementia care community service providers), educating (training nurses and occupational therapists in how to apply the intervention), restructuring (organisations establishing referral systems; therapist commitment to provide COPE to five clients following training) and quality management (coaching, support, reminders and fidelity checks). Qualitative and quantitative data will contribute to understanding how COPE is adopted and implemented. Feasibility, fidelity, acceptability, uptake and service delivery contexts will be explored and a cost/benefit evaluation conducted. Client outcomes of activity engagement and caregiver wellbeing will be assessed in a pragmatic pre-post evaluation. While interventions that promote independence and wellbeing are effective and highly valued by people with dementia and their carers, access to such programs is limited. Barriers to translation that have been previously identified are addressed in this study, including limited training opportunities and a lack of confidence in clinicians working with complex symptoms of dementia. A strength of the study is that it involves implementation within different types of existing services, such as government and private providers, so the study will provide useful guidance for further future rollout. 16 February 2017; ACTRN12617000238370 .

Objective: The aim of this study was to identify aspects of the consumer-provider relationship that consumers saw as important in a care coordination service model.Method: Semi-structured interview...

Secure and appropriate housing is critical for the well-being of people living with mental illness (consumers). Yet it is often difficult to achieve. Housing assistance is available, but is often d...

Introduction The core tenet of occupational therapy is that engaging in meaningful occupations promotes health and wellbeing. Despite this, surprisingly little research has explored the meaningfulness of occupational therapists' own work. Occupational therapists in mental health have been identified as at risk of poor work-related wellbeing, therefore, it is important to explore potential 'protective factors' that may support wellbeing. Meaningfulness of work may be one such factor. This study was established to explore the relationships between job satisfaction, burnout, professional identity and meaningfulness of work activities for occupational therapists working in mental health. Method Participants (N = 118) completed a time use diary and measures of job satisfaction, burnout and professional identity. 'Meaningfulness of work activities' was constructed from respondents' ratings of each work activity according to client-relatedness, occupational therapy specificity and value of the activity to the individual, clients and families and colleagues. Relationships between meaningfulness of work activities, job satisfaction, burnout and professional identity were explored using bivariate correlations and stepwise regression. Analyses were also conducted to examine differences between individuals in working in 'generic' roles and those in 'occupational therapy specific' roles. Results Higher levels of meaningfulness of work activities were associated with higher job satisfaction, lower burnout and stronger sense of professional identity. The element of meaningfulness of work activities of 'value to self' was the most influential in terms of associations with each of the measures. There were no statistically significant differences in ratings of job satisfaction, burnout or professional identity between respondents in 'generic' and 'occupational therapy specific' positions. Conclusion Efforts to increase the meaningfulness of work activities for occupational therapists in mental health may enhance work-related wellbeing. Supporting staff to engage in work duties they find valuable through individualised work allocations across teams may be an innovative approach to improve staff satisfaction and wellbeing.

Introduction Engaging in employment enhances mental health recovery and is therefore of central focus for many occupational therapists working in mental health. Individual placement and support (IPS) is an evidence-based, supported employment model specifically designed for individuals with severe mental illness who have the desire to work. Despite strong support for IPS in Australia, implementation challenges have been encountered. This study evaluates outcomes achieved by participants engaged with WorkWell, an IPS programme delivered by a large Australian non-government organisation. In addition to following IPS principles, WorkWell was informed by principles of the collaborative recovery model (CRM). Method De-identified outcomes data for each participant were analysed by an independent research team. The proportion of individuals engaged with the programme who achieved a competitive employment placement was calculated. Average employment duration and weekly wages were calculated for individuals who achieved a competitive employment placement. Finally, the proportion of individuals who achieved some form of vocationally relevant outcome was calculated. Results Ninety-seven participants were engaged with the programme. Forty-eight participants (49.5%) gained a competitive employment position. Average employment duration was 151 days (21.6 weeks) and average weekly wage was $478. Overall, 62 participants (63.9%) were supported to achieve some kind of vocationally relevant outcome (e.g. competitive employment, education, work trial or voluntary work) as a result of their engagement with the programme. Conclusion While the addition of CRM principles appears to have supported positive outcomes for participants, especially in terms of employment duration, results for employment placement rates were lower than expected. While the employment placement rate compares favourably to results from the international literature and numerous programmes in Australia, more development is required to increase the proportion of individuals who are supported into competitive employment positions. Future research should focus on the specific elements of CRM that most contribute to enhancing IPS processes.

AIM The Recovery Assessment Scale-Domains and Stages (RAS-DS) is a self-rated measure of mental health recovery. While this instrument has demonstrated good measurement properties and acceptability to clinicians and consumers in adult mental health services, it has not been evaluated in the context of youth-focused mental health services. This study was established to evaluate the measurement properties, feasibility and acceptability of the RAS-DS in a youth mental health service context. METHODS Young people accessing a youth mental health service were invited to complete the RAS-DS and both young people and clinicians provided feedback about its usefulness. Analyses of the measurement properties of the RAS-DS were completed using Rasch analysis. Usability feedback was analysed using descriptive statistics and constant comparative analysis. RESULTS Fifty-eight consumer-clinician dyads participated. Analyses revealed that items on the RAS-DS generally demonstrated good fit with the expectations of the Rasch model and clinician and consumer feedback was generally positive. Ninety-one percent of young people completed the RAS-DS in less than 15 minutes. Thirty-four percent of young people had measure scores above the level of the "hardest" item on the RAS-DS, suggesting that measurement precision is lower for individuals at more advanced stages of recovery. CONCLUSIONS This study demonstrates that the RAS-DS has acceptable measurement properties and was acceptable to young people and clinicians. Future research should explore the use of the RAS-DS by young people in other contexts as well as explore whether additional items could be added to capture the later stages of recovery for young people.

Introduction The purpose of this article is to describe the outcomes of the enhanced intersectoral links (EIL) approach to supporting employment outcomes for individuals accessing a large mental health service. Method Based on individual placement and support (IPS) principles, features of EIL included: strong service-level relationships between mental health and local disability employment services; monthly joint meetings to share information; resources to assist mental health clinicians in supporting consumers to access employment services; and provision of training. Programme fidelity was evaluated against IPS principles. Outcome measures included: time from referral to commencement; time to first employment placement; employment placement rate; and duration of employment. Results Seventy-nine consumers were referred to the programme. At the close of data collection, 60 participants remained in the programme and 38 of these (63%) had gained at least one employment placement. Average duration of employment was 10.9 weeks. As expected, the EIL programme demonstrated ‘fair’ fidelity against IPS principles. The average time from referral to commencement was 47 days and from commencement to first placement was 81 days. Conclusion This project demonstrated how EIL can be implemented in a large mental health service. Further development is required to avoid delays in consumers’ commencement with employment services and support better job tenure.

IntroductionEngagement in occupation, including employment, is central to mental health recovery. However, evidence demonstrates that people living with mental illness struggle to maintain their employment. The aim of this qualitative study was to gain a rich understanding of the experiences of people living with mental illness who have managed to maintain their employment, and specifically, the strategies they actively choose and use to stay in work.MethodSemi-structured interviews explored the perspectives of 10 people living with mental illness who were successfully maintaining their employment. Data were analysed using constant comparative analysis.ResultsParticipants described maintaining employment through a conscious and active process of using individualised combinations of specific strategies within the broader categories of: identifying and connecting with helpful people; looking after all of me; having a job that fits with who I am; staying motivated; positive reflection and re-framing; and choosing and using strategies in the workplace.ConclusionOccupational therapists might better support long-term employment outcomes for people living with mental illness by adopting a more recovery-oriented approach, facilitating people to actively identify, choose and use their own strategies to maintain employment.

The research reported in this article seeks to explore how anxiety disorders, when accommodated, can assist to improve job performance. Online surveys were completed by 71 persons currently employed by Queensland government and who have been medically diagnosed with one or more anxiety disorders. The authors thematically analyzed the open-ended responses made by participants. Aligning with the Yerkes–Dodson law, this research suggests that accommodations can improve the work productivity of employees with anxiety disorders by keeping stress at a manageable level. This exploratory study also raises a potential variance to this law. A possibility exists that some people with anxiety disorders are able to maintain strong performance while experiencing an elevated level of anxiety. By revealing potential performance benefits of accommodating government employees with anxiety disorders, this research calls for managerial decision makers to think of such adjustments as investments in workplace productivity.

INTRODUCTION Men's Sheds are community spaces where socialisation occurs alongside participation in meaningful activities. Shed activities and socialisation make them useful for supporting transition to adulthood of 'at-risk' young people through meaningful occupations. Many sheds have implemented intergenerational mentoring programmes. However, many programmes are established on an ad-hoc basis without specific attention to factors that may support effective and sustainable outcomes. We aimed to inform future programmes by exploring different programmes to provide insight into the purpose, design and programme characteristics that are perceived as beneficial for young males. METHOD Four Sydney-based sheds providing intergenerational mentoring programmes were selected. We interviewed shed coordinators, mentors and mentees to explore their perceptions of programme characteristics that supported mentees' transition to adulthood. Thematic analysis techniques were used to first analyse and understand the unique context of each programme and these were then merged and integrated to identify the most helpful aspects of these mentoring programmes. RESULTS Mentor attitude towards the mentees, freedom to make independent choices and the nature and perceived usefulness of the project were considered the most significant characteristics of these programmes. CONCLUSION This was the first known examination of the different characteristics of Men's Sheds intergenerational mentoring programmes. On the basis of our findings, we have made recommendations to help guide the planning and implementation of future programmes. While our findings largely support previous research on mentoring programmes, findings from this study suggest that 'expert skills' may not be as important as mentor attitude to working with the mentees.

Background Electroconvulsive therapy (ECT) is one of the most controversial treatments in psychiatry. This controversy and diverse and often strongly held opinions can make decision making processes around ECT more complex. Method This consumer-led project explored the experiences of individuals who had received ECT in terms of the information they received, their experience of ECT and suggestions for ways that decision making processes and experiences of ECT can be improved. Interviews were conducted by consumer researchers who had also received ECT and transcripts were analysed using constant comparative techniques. Results Seventeen individuals participated. Four overarching categories were identified from participant interviews: Information matters; Preparation and decisions before ECT; Experience of ECT; and Suggestions for improvement. Most participants suggested that more information was required and that this information should be made available more regularly to support decision making. Additional suggestions included greater involvement of family and friends (including having a family member or friend present during the ECT procedure), opportunities to gain information from individuals who had received ECT and more support for managing memory and cognitive side effects. Conclusion This study provides valuable consumer-provided insights and recommendations for psychiatrists and mental health clinicians working within ECT clinics and with consumers considering or preparing for ECT. Electronic supplementary material The online version of this article (10.1186/s12888-018-1813-9) contains supplementary material, which is available to authorized users.

Background: DriveSafe DriveAware (DSDA) is a cognitive fitness-to-drive screen that can accurately predict on-road performance. However, administration is restricted to trained assessors. General practitioners are ultimately responsible for determining fitness to drive in many countries but lack suitable tools. We converted DSDA to touchscreen to provide general practitioners and other health professionals with a practical fitness-to-drive screen. This necessitated the development of an automatic data collection system. We took a user-centred design approach to test usability of the system with older adults, the group most likely to take the test. Method: Middle-aged and older adult volunteers were asked to try an iPad application to assist in the development of a fitness-to-drive screen. Seventeen males and 18 females (mean age 70 years) participated in four trials; each participant was tested only once. We tested all text and function changes until all older adults could successfully self-administer the screen. Results: Older adults found basic touchscreen functions easy to perform, even when unfamiliar with the technology. Conclusion: Usability testing allowed us to develop a user-friendly touchscreen data collection system and ensured that design errors were not missed. Psychometric evaluation of data gathered with touchscreen DSDA was conducted in a separate study prior to use in clinical practice.