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This qualitative study aimed to explore the experiences of nine fathers with neurodevelopmental disabilities with children in foster care, including their fathering role, visits and formal and informal support. Systematic text condensation was the analysis method used. The respondents’ experience of fatherhood revealed two categories: I accept my situation and I am frustrated. Though self-confident, the fathers expressed ambivalence between acceptance and frustration with their role. The study shows that more should be done to provide adapted support for these vulnerable fathers with children in foster care, although they seldom demand such support. Social workers and professionals from the rehabilitation team within the healthcare service should be aware of gendered settings, specifically norms of masculinity. Increased efforts from the social workers may reduce the risks of detachment in parenthood because engaged and informed fathers are in the children’s best interests.

Mothers with cognitive limitations who have children in placement need to be listened to and to receive help in understanding and dealing with their situation. A support programme for this group was developed in Australia and then adapted for use in a Swedish context and named 'Mamma Trots Allt' (MTA). The aim was to examine the experiences of these mothers regarding their mothering role after participation in MTA. An explorative and qualitative design was used. Inclusion criteria were mothers with cognitive limitations, a child in placement and participation in MTA. Nine mothers, eight of them from a previous study, gave their informed consent to participate. A study-specific interview guide was adapted to people with cognitive limitations. The interviews took place after the final MTA session. The qualitative analyses resulted in a description of the mothers' experiences and how they changed after MTA, resulting in an overall theme, two subthemes, four categories and 11 subcategories. MTA facilitated the mothers' maturation and broadened their earlier, stereotypic life expectations. Offering a support programme benefits not only the mother but most likely the child as well.

In Sweden, when needed, children of mothers with cognitive limitations are placed infoster homes. There is a lack of knowledge about the mothers with cognitive limitations,their experiences of their maternal role, whether they get the support neededto maintain the relationship with their children, and whether the support system isadapted to mothers with cognitive limitations. The aim was to describe the experiencesof the maternal role and support given in mothers with cognitive limitationswho have children in placement. An explorative and qualitative design was used.Eleven respondents were interviewed with support from a study‐specific guide. Amodel representing the respondents' experiences revealed one theme “Struggling,dependent and frustrated mothers,” and three categories: I am a mother, I am dependenton an incomprehensible system, and I reluctantly accept my situation. Motherswith children in placement experience a threat to their identity and experience a needto alter their maternal role. They need adapted support to understand the decisionsmade and facilitate the cooperation with child protection services and the fosterhome. Offering service adapted to their cognitive limitations could be helpful forthe struggling, dependent, and frustrated mothers.

Experiences of fathering role in fathers with intellectual disability with children in foster care It is known that some mothers with intellectual disability (ID) with children in placement are in need of individual and adapted support concerning their mothering role. Knowledge if the fathers with ID need support concerning their fathering role is however lacking. The aim was to explore and describe experiences of fathering role and given support in fathers with ID who have children in foster care. Method An explorative and qualitative design was used. Men with ID (n=7) who had a child in placement were interviewed with help from an interview guide developed by the researchers. A systematic text condensation was used to analyse the material. Results The preliminary results reveal that the fathers accept their situation and are satisfied with their fathering role. The fathers experience that they have opportunities to be employed and time to practice their own interests since the child is taken care of. Conclusions The fathers seem to be satisfied and do not demand adapted support as the mothers do. Given that the fathers described satisfaction in their parenting role and relationship with their child, the need for support was not identified. This research has implications for service provision, as services to fathers might look different than services to mothers with ID. However, given that it is an exploratory study with a small sample size, we need to be careful not to state that results are generalizable but can explore possible gender-specific perspectives.

Meeting Abstract: 5603

Meeting Abstract: 5669

BACKGROUND: Adults with cognitive disabilities often have difficulties in dealing with the complexity of everyday life. With cognitive assistive technology (e.g. electronic planning devices [EPDs] and individual support), they can bring order to their often chaotic life. Assumptions are that environmental factors influence with non-use of EPDs. OBJECTIVE: To explore how adults with cognitive disabilities perceive the influence of environmental factors in the use of EPDs. METHODS: A reference group with experience of use of EPDs assisted the researchers. Twelve adults with cognitive disabilities and experience of using EPDs participated. An interview guide was implemented covering environmental factors according to the International Classification of Functioning, Disability and Health. Qualitative content analysis was applied in the analyses. RESULTS: Five categories and two themes emerged, which were integrated into a model of facilitating factors influencing the use of EPDs. Measures to prevent or eliminate negative influences of the device use are important to be taken. CONCLUSIONS: Professionals need more knowledge about EPDs, while users need individual adaption of the EPDs. EPDs need to be user-friendly, manageable and work in any seasons. Implications for Rehabilitation The users should have access to specially trained prescribers. There is a need for development of user-friendly and manageable products to function in any climate. Knowledge is lacking on how to implement the users in all stages of the prescribing process. Prescribers should increase knowledge in the use of EPDs to influence the attitudes of the social environment.

BACKGROUND: People with cognitive disabilities have difficulties in accomplishing everyday tasks. Electronic planning devices (EPDs) may compensate for the gap between a person’s capacity and everyday challenges. However, the devices are not always used as intended. Despite that, cognitive assistive technology has been investigated in several studies, knowledge regarding when and what makes adults decide to use EPDs is incomplete. People with cognitive disabilities have difficulties in accomplishing everyday tasks. Electronic planning devices (EPDs) may compensate for the gap between a person’s capacity and everyday challenges. However, the devices are not always used as intended. Despite that, cognitive assistive technology has been investigated in several studies, knowledge regarding when and what makes adults decide to use EPDs is incomplete. OBJECTIVE: The aim was to explore the subjective experiences of people with cognitive disabilities in relation to the use of EPDs. The aim was to explore the subjective experiences of people with cognitive disabilities in relation to the use of EPDs. METHODS: A qualitative approach was applied with a qualitative content analysis. Twelve respondents were interviewed with support from a study specific guide. A qualitative approach was applied with a qualitative content analysis. Twelve respondents were interviewed with support from a study specific guide. RESULTS: A model representing the respondents’ experiences in the use of EPDs, comprising one theme, Possibility to master my daily life , four categories, Degree of fit to my needs, I am aware of my cognitive disability, I get help to structure my everyday life and The EPD improves my volition and ten subcategories, was developed. A model representing the respondents’ experiences in the use of EPDs, comprising one theme, Possibility to master my daily life , four categories, Degree of fit to my needs, I am aware of my cognitive disability, I get help to structure my everyday

Purpose: To describe daily time management in adults with and without mental disability and to examine differences in the level of their daily time management; to describe the possessions and use of electronic planning devices (EPDs) in activities and how environmental factors influence the use of EPDs in adults with mental disability. Methods: In a descriptive and cross-sectional design 32 participants using EPDs and a matched comparison group of 32 healthy adults was recruited. Time-Self rating scale measuring daily time management was adapted for adults. A study specific questionnaire was applied to collect data on five ICF environmental factors. Rasch modelling, descriptive and non-parametric statistics were applied. Results: Time-S has acceptable psychometric properties for use on adults with mental disability. People with mental disability and low level of daily time management who use advanced EPDs are more influenced by environmental factors. The study group perceived that encouragement and support from professionals as well as services influence their use of EPDs. Conclusions: Time-S can safely be used for people with mental disability. EPDs do not fully compensate the needs of the target-group. Prescribers need to give considerations to this and therefore they should be provided with more knowledge about this matter.

Objectives To study health, health care, and legal requirements as reflected in predefined headings that were applied by users in a Swedish multi-professional electronic health record (EHR). Methods Predefined headings (n = 3 596) applied to 20 398 104 occasions by health care professionals in a module for care documentation in an EHR were analysed. A conventional qualitative content analysis was used to explore health and health care as reflected in the predefined headings. Furthermore, a comparison was made between the health and health care aspects and the Swedish Patient Data Act (PDA) to examine whether the aspects corresponded to legal requirements. Results The analysis yielded a meaningful structure that included five categories and 23 subcategories. The categories were Description of the patient, Health care process, Resources employed, Administrative documentation, and Development and research. Of the 23 subcategories, 15 corresponded to four of the seven legal requirements in the PDA. No corresponding subcategories were observed for three of the legal requirements. Conclusions The predefined headings of the multi-professional EHR were possible to analyse and categorise. The analysis showed that the headings reflected a wide range of health and health care and that synonyms or similar terms occurred as headings. The majority of the subcategories corresponded to the legal requirements of the PDA. The legal requirements that referred to patient rights did not have any corresponding subcategory. Subcategories that were found and that concerned goals to be attained and intervention outcomes were not explicitly expressed as legal requirements in the PDA

To add knowledge on how occupations contribute to health and wellbeing and to explicit describe thetherapeutic potential in occupations deeper knowledge is needed. One way is to ground the knowledgeon narratives from people’s experiences. In consequence a questionnaire was constructed based onnarratives from persons with mental disorders who have taken part in occupational therapy. A new version of the questionnaire was developed and as the items have been reformed a new underlying structure was expected. The aim of the present study was to investigate the construct validity and the internal consistency of the questionnarie in a new sample of individuals with severe mental disorders. Persons (n=106) with mental disorders participated in the study by answering the questionnarie after performing an occupation in therapy. The correlation between each of the 35 items was analyzed and items with high correlation were excluded from further analysis. Twenty-five items were left to explorethe underlying factor structure of the questionnarie. A principal component analysis with varimaxrotation resulted in the five factors, “Ability to perform occupation”, “Feeling of belongingness”, “Engaging in occupation”, “Influencing on occupation” and “Insight into ability”. A second order factoranalysis resulted in a three component structure explaining 79 % of the variance. In summery, a pattern of occupation as a therapeutic medium was found and gave a ground for the construction of the questionnaire Self Assessment of Occupational Ability (SAO). The pattern found is constructed by the three components, “Sense of competence, “Feeling of belongingness” and “Insight into ability”including the five factors and 25 items. The SAO will be presented the first time in the WFOT 2014, a tool to bee used by occupational therapist in their cooperation with persons with mental disability to find out how occupation can be of help in their recovery.

Purpose An evaluation of a model of intervention in everyday settings, consisting of cognitive assistive technology (CAT) and support provided by occupational therapists to adults with attention deficit hyperactivity disorder (ADHD). The purpose was to study how professional support and CAT facilitate everyday life and promote community participation of adults with ADHD. Method The intervention was implemented in five steps and evaluated in a 15-month study (March 2006 = T1 to June 2007 = T2). One questionnaire and one protocol describe the CATs and provided support. Two questionnaires were employed at T1 and T2 for evaluation of the intervention in everyday settings. Results The participants tried 74 CATs, with weekly schedules, watches and weighted blankets being most highly valued. Carrying out a daily routine was the most frequent support. More participants were working at T2 than at T1. Frequency of performing and satisfaction with daily occupations as well as life satisfaction were stable over the one-year period. Conclusions The results indicate a higher frequency of participating in work but only a tendency of increased subjectively experienced life satisfaction. However, to be of optimal usability, CAT requires individually tailored, systematic and structured support by specially trained professionals., KogniTeck

Boken är en översättning och bearbetning till svenska av originalutgåvan:Goal Attainment Scaling for people with learning disabilities av Jane Tobbell & Jan Burns

Background Applying multiprofessional electronic health records (EHRs) is expected to improve the quality of patient care and patient safety. Both EHR systems and system users depend on semantic interoperability to function efficiently. A shared clinical terminology comprising unambiguous terms is required for semantic interoperability. Empirical studies of clinical terminology, such as predefined headings, in EHR systems are scarce and limited to one profession or one clinical specialty. Objective To study predefined headings applied by users in a Swedish multiprofessional EHR system. Materials and methods This was a descriptive study of predefined headings (n=3596) applied by 5509 users in a Swedish multiprofessional EHR system. The predefined headings were classified into four term and word categories. Results Less than half of the predefined headings were shared by two or more professional groups. All eight professionals groups shared 1.7% of the predefined headings. The distribution of predefined headings across categories yielded two-thirds “terms for special purposes” and “specialist terms” and one-third “common words” and “unclassified headings”. Discussion The indicated presence of profession-specific predefined headings and the conflict between ambiguity and comprehension of terms and words used as headings are discussed. Conclusions The predefined headings in the multiprofessional EHR system studied did not constitute a joint language for specific purposes. The improvement of the quality and usability of multiprofessional EHR systems requires attention.

Vuxna personer med psykisk funktionsnedsättning har ofta problem med sin kognitiva förmåga, vilket leder till problem med att hantera vardagslivets komplexitet. Med behovsanpassade kognitiva hjälpmedel och individuellt stöd från kunnig personal finns möjlighet för personen att få ordning på sitt ofta kaotiska vardagsliv. Dock finns studier och klinisk erfarenhet som påvisar att hjälpmedel inte används i den utsträckning som förväntats. Antaganden finns om att komplexa faktorer i omgivningen interagerar med hjälpmedelsanvändning. Syftet med studien var att dokumentera erfarenheter av underlättande och hindrande omgivningsfaktorer som personer med psykisk funktionsnedsättning har av användningen av elektroniska planeringshjälpmedel. Metod: tolv personer med psykisk funktionsnedsättning och med erfarenhet av elektroniska planeringshjälpmedel rekryterades efter informerat samtycke via förskrivare och besök vid dagliga verksamheter. En studiespecifik frågeguide med öppna frågor med ett innehåll som täcker omgivningsfaktorer enligt Klassifikation av funktionstillstånd, funktionshinder och hälsa (ICF) användes i de inspelade intervjuerna. Materialet bearbetades med kvalitativ, induktiv innehållsanalys. Resultatet utmynnade i sex kategorier och två teman formade till en modell med underlättande eller hindrande faktorer som inverkar på användning av elektroniska planeringshjälpmedel enligt deltagarna. Kategorierna benämndes: Insikt om funktionsnedsättning/behov; Medveten social omgivning; Egen kontroll och hanterbarhet av hjälpmedel; Nytta av och brister i hjälpmedlets funktion; stöd av kunnig personal; och Tydligt och lättbegripligt myndighetsutövande. Teman benämndes: Tydlig önskan om delaktighet och Nödvändig individuell anpassning. Åtgärder för att förebygga eller förhindra omgivningens negativa inverkan på hjälpmedelsanvändning är angelägen., Adults with mental disabilities often have problems with their cognitive ability, leading to problems in dealing with everydaylife's hindrancecomplexity. With the needs-based cognitive assistive technology and individual support from knowledgeable staff it is possible for the person to bring order to their often chaotic daily life. However, there are studies and clinical experience which indicate that assistive technology is not used to the extent expected. Assumptions are that complex environmental factors interact with use of the assistive technology. The purpose of this study was to document the experiences of facilitating or hindrance environmental factors that people with mental disabilities have of using electronic planning devices. Method: Using prescribers and at visits to community activity centres twelve adult persons with mental disabilities and own experience of useing electronic planning devices were, after informed consent, recruited. A study-specific interview guide with open questions, with a content that covers environmental factors according to International Classification of Functioning, Disability and Health (ICF) was used in the recorded interviews. The material was analysed by using qualitative inductive content analysis. Result: From the interviews six categories and two themes emerged, wich were molded to a model of facilitating or impeding factors affecting the use of electronic planning devices. The categories were named: Insight of disability/needs; Cognisant social environment; Self control and manageability of the device; Benefits and shortcomings of using the device; Assistance of skilled personnel and Clear and simple exercise of authority. The themes are named: A clear desire for participation and Necessity of individual adaption of the device. Measures to prevent or eliminate ambient negative impact of the device use is keen.

Quality of life (QoL) is seldom described in terms of the essence of what it is.Also, an essential task for the research community is to create space for the voicesof people with intellectual disabilities. The aim of the present study was tounderstand the lived meaning and the essence of QoL in adults with thisdisability. Using a phenomenological approach, 21 informants living in a Swedishcounty were interviewed. The interviews were audio taped and analyzed with theempirical phenomenological psychological method. The results indicate that thegeneral essence of QoL consists of well-being and five themes: social adult status,control of life, personal safety, social belonging and self-chosen solitude. Theresults challenge the stereotype of the informants as passive receivers of supportfrom others. The interrelatedness between the five themes of QoL should befurther studied., First published on: 17 November 2010 (iFirst)

Persons detained as mentally disordered offenders need support for transition from care to community life. Few systematic studies have been completed on the outcomes of standard forensic care. The aim was to investigate the target group's life conditions and daily occupations one year after care. In a follow-up design occupational performance (OP) and social participation (SP) were investigated at two time points. After informed consent 36 consecutively recruited participants reported OP using the Capability to Perform Daily Occupations, Self-Efficacy Scale, Importance scale, and Allen Cognitive Level Screen. SP was measured with the Manchester Short Assessment of Quality of Life, and Interview Schedule for Social Interaction. After one year 24 participants were still incarcerated, 11 were conditionally released, and one participant was discharged. The group were generally more satisfied and engaged in daily occupations than at admission. The study's attrition rate, 51%, is discussed. The conclusion and the clinical implications indicate that the target group need early, goal directed interventions in OP and SP for alterations in daily occupations. Furthermore, to increase the knowledge base concerning mentally disordered offenders, studies with research designs that have the potential to uncover changes in daily occupation and other measures for this target group are necessary.

Goal Attainment Scaling (GAS) är en metodik för att beskriva behov och mål för personer med funktionshinder. Målen kan med denna metodik systematiskt utvärderas och följas upp över tid. Fördelen med GAS är dess anpassningsbarhet, vilket innebär att olika typer av mål kan skrivas och varierande former av dokumentation kan användas. Med GAS kan målrelaterade under- och överprestationer konkretiseras. I denna manual presenteras GAS-metodiken genom att beskriva hur mål formuleras, hur måluppfyllelse graderas, hur GAS dokumenteras och följs upp. Avsikten med manualen är att avsnitten skall studeras i den ordningsföljd som är beskriven i den detta för att ge en god introduktion till metodiken. För att underlätta inlärningen ges exempel samt möjligheter till att öva metodiken. Förhoppningen är att övningarna även skall uppmuntra till tankeväckande reflektion om hur det är att arbeta med GAS-metodiken. Denna manual vänder sig i första hand till personal inom psykiatrisk vård och rehabilitering., Individuell måluppfyllelse och långtidsuppföljning för personer med psykiska funktionshinder i samverkan mellan landsting och kommun.

I denna utvärdering av KogniTek i Uppsala diskuteras om individuellt utprovade kognitiva hjälpmedel och stödgärder underlättar ett självständigt liv.

This study was aimed at investigating the psychometric properties of the Interview Schedule for Social Interaction (ISSI), in terms of construct and discriminant validity and unidimensionality, in three psychiatric samples with varying prerequisites for social interaction: 1) an outpatient sample of working age with mixed diagnoses, 2) an outpatient sample with schizophrenia, and 3) an inpatient sample composed of mentally ill, male offenders. The target constructs were psychosocial functioning and satisfaction in different life domains. It was hypothesized that the ISSI would mainly be related to psychosocial functioning and life domains characterized by social interaction, such as friends and family. A second hypothesis was that the ISSI ratings would discriminate between the three samples. The first hypothesis was confirmed, but the pattern of relationships was somewhat different between the groups. Whereas family contacts were of great importance for social integration in Samples 1 and 2, friends seemed more important for the mentally ill offenders. The second hypothesis was partly confirmed: three ISSI sub-scales out of four discriminated between the samples. Moreover, the ISSI proved to be a unidimensional construct. The support for the four proposed sub-scales was not unanimous, however, and the sub-scales targeting attachment constituted less stable factors. This study demonstrated the construct and discriminant validity of the ISSI when applied to samples with various mental disorders. The fact that similar results were obtained in all three samples, despite varying prerequisites for social interaction, strongly supports the validity of the ISSI. Providing the sub-scales are used with caution, the ISSI seems to be a reliable tool for use with patients with severe mental disorders.

The study investigated to what extent personality traits, e.g. socialization, proneness for anxiety, aggression and hostility were associated with and predictive of self-reported and observed occupational performance and perceived life satisfaction among male mentally disordered offenders (MDOs). Also, subjects with psychopathic-related personality traits were compared with subjects without such traits regarding demographic data and dependent variables. The MDOs were included from the Swedish National Board of Forensic Medicine. A total of 55 subjects were visited at their hospital ward for data collection with the Karolinska Scales of Personality (KSP), Capability to Perform Daily Occupation (CPDO), Allen Cognitive Level Screen (ACLS) and the Manchester Quality of Life Scale (MANSA). Seven KSP scales and two KSP factors correlated significantly with the dependent variables. Regression analyses revealed that the KSP Socialization scale, the KSP Anxiety-proneness and Psychopathy factors were the most important predictors. Subjects with psychopathy differed from remaining groups by having more conduct disorders before 15 years, being more often brought up in outcasted families and less subjected to measures of pupil welfare activities. The life history was concluded to be important influencing occupational performance and life satisfaction. Subjects with high anxiety proneness should be given attention in treatment planning.

The major aim was to describe occupational performance (OP) and social participation (SP) of mentally disordered offenders (MDO), and to compare professionals’ and MDOs’ appraisals of these abilities. Also, diagnostic groups and groups with/without substance related disorders were compared with regard to OP and SP. Self-report instruments (Capability to Perform Daily Occupations, Self-Efficacy Scale, Importance scale, Interview Schedule for Social Interaction), observations (Allen Cognitive Level Screen), and register data (Psychosocial and Environment Problems—Axis IV; Global Assessment of Functioning Scale—Axis V; Assessment Concerning Support and Service for Persons with Certain Functional Impairments) were utilized. Demographic and register data were collected from the Swedish National Board of Forensic Medicine. Seventy-four out of 161 incarcerated subjects (46%), selected consecutively after informed consent during a period of 16 months, were interviewed on their hospital wards. The MDOs reported some disability in performing occupations and participating in community life. However, they were satisfied with their performance and participation, implying limited awareness of their disabilities. The professionals judged the MDOs as having problems with social participation, and major, longstanding disablements in several areas. Subjects with schizophrenia scored lower in some OP and SP variables than did subjects with personality disorders and other mental disorders. The results suggest that a large proportion of MDOs need support to enable their community living.