Occupational Science & Occupational Therapy - Masters by Research Theses
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Item How do children and young people with intellectual and/or developmental disabilities experience the therapy process when engaging with occupational therapists, speech and language therapists, and physiotherapists?(University College Cork, 2022-03-26) Hynes, Patrick Joseph; Lynch, Helen; Robinson, KatieBackground: The UN Convention on the Rights of Persons with Disabilities (CRDP) was adopted by the United Nations General assembly in 2006 to protect, promote and ensure full equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities. The right of all children to be heard and taken seriously constitutes one of the fundamental values of the United Nations Convention on the Rights of the Child (UNCRC). For children with disabilities the UNCRC applies, confirming the child’s right to have a voice in all matters that affect them. Children with disabilities face barriers to participation and threats to enactment of their rights, including in healthcare settings such as those provided by the disciplines of occupational therapy, speech and language therapy, and physiotherapy. Children with disabilities frequently access these services. These disciplines purport to deliver client centred services in line with human rights. However, little is known about children’s experiences of these therapies as voiced by children themselves. Aim/Objectives: Through the completion of a systematic review of qualitative evidence, this study aimed to explore how children with intellectual and/or developmental disabilities experience the therapy process when engaging with occupational therapists, speech and language therapists, and physiotherapists. Methods: A systematic search of seven databases was undertaken, and included studies were synthesised following the stages of meta-ethnography described by Noblit and Hare (1988). Databases searched were Academic Search Complete, AMED, CINAHL complete, MEDLINE, APA PsycINFO, APA PsycARTICLES, and Social Sciences Full Text (H.W. Wilson). The Preferred Reporting Items for Systemic Reviews and Meta-Analysis Protocols (PRISMA-P) checklist was used to illustrate the research strategy procedures. Searches were limited to English language publications. No limits were applied to date of publication. The Critical Skills Appraisal Skills Programme (CASP) Qualitative Studies Checklist was used to critically appraise the quality of the included papers. Findings: Sixteen studies were included in the synthesis. Four interrelated themes were identified; “Interpersonal experience of therapy”, “Who is in the driving seat? – Children’s experiences of power in therapy”, “The nuts and bolts of therapy: experiencing therapy in the here and now”, and “Making sense of therapy”. Conclusions: The value of qualitative research can be seen in this review due to the rich data that was extracted from a range of qualitative papers. Children with intellectual and/or developmental disabilities described how they experienced therapy sessions. Common experiences included having fun (and a desire for therapy to be more fun) and conversely boredom, discomfort and pain were also commonly experienced. Children described their interpersonal experiences and relationship with the therapist during therapy including their experiences of engagement, communication and trust and their experiences of therapist attunement. Children described how they understood therapy and its purpose, including their experiences of making progress in therapy or achieving outcomes and how therapy related to their view of themselves and their views of ability and disability. Children reported on their experiences of power in therapy, with finding suggesting that therapists often hold power over decisions and goals for therapy, and less frequently children hold power, often regarding smaller decisions. Findings point to the need for occupational therapists, speech and language therapists, and physiotherapists who work with children with intellectual and/or developmental disabilities to further create opportunities for children to be part of the decision-making process and goal setting process. Through interrogation and reflection on their practice, therapists have the potential to be poised for action to utilise a model such as Lundy’s model of participation (Lundy, 2007) to ensure that children experience the full participation in therapy of having their voice heard in all matters that affect them.Item Occupation, identity and belonging within community: experiences of mental health disability(University College Cork, 2020-04-18) Cassidy, Caoileann; Jackson, Jeanne; Lynch, HelenBackground: This is a qualitative research study exploring the perspectives of Irish people with self-reported mental health disability in participating in occupation within their community environments. The relatedness of occupation to health and the concept of belonging requires further research and understanding within the discipline of Occupational Science and within the practice of Occupational Therapy. Methodology: Purposive sampling was employed to recruit three participants, from one national mental health support organisation. A phenomenological and narrative framework was adopted in this research. This informed the use of narrative interviews and observation methods to gather data about occupations enacted by participants within their community environments. Open ended narrative interviews were adopted to encourage storied accounts of participants’ experiences, with each participant engaging in two interviews. Following the first interview, each participant collaborated with the researcher in planning an observation session, with the researcher as complete participant, in a chosen occupation within their local, familiar environment. Following this each participant engaged in a second interview with the researcher. Data Collection and Analysis: Digital audio recordings were transcribed anonymously and verbatim from interviews, coupled with field notes from observations, using thematic analysis. This analysis upheld the integrity of each story while illuminating shared meaning of participants’ chosen occupations. Findings: In answer to the research questions, two primary themes were identified, with each theme encompassing two subthemes. The first theme “Experiencing Normality and Promoting Health” explores how participants in this study experienced feeling or anticipated feeling normal through their participation in occupation. Additionally, they chose occupations to promote their physical and mental health when navigating changes to their identities as a result of their mental health distress or disability. The second theme was “Meaning Making and Experiences of Inclusion and Exclusion within Community” exploring participants meaning making through occupation in their local environments, within places and amongst others. The first subtheme captures how participants participated in meaning making with others. The second focuses on their experiences of inclusion and exclusion with stigma emerging from their surrounding environments, impacting feelings of belonging. Discussion: The findings of this study inform understanding of occupation and expand knowledge of its relationship to health, specifically mental health. It contributes to existing research concerning the impact of the social world on a person’s occupational choices, possibilities and resultant identities. Further these findings have elicited greater understanding about the meaning of these occupations to participants and how this enabled their participation through “being” and “belonging” in their communities. Conclusion: The results of this study contribute to theory generation of occupation within the discipline of occupational science and to the clinical practice of occupational therapy. The findings of the current research indicate that stigma and experiences of exclusion prevail for people with mental health disabilities. Results also find that participation in occupation, within affirming environments can create experiences of normality and promote health. Further, participation in occupation fosters experiences of inclusion and belonging.