This paper explores the challenges of implementing client-centred occupational therapy practice. While many occupational therapists believe in the principles of client-centred practice and espouse them, it seems much more difficult to implement these into everyday practice. Findings from three qualitative studies with three different populations (i.e., family-centred care for children and their families, community-based home care, facility-based care for older adults) are used to illustrate the challenges which are divided into three broad categories: challenges at the level of the system, at the level of the therapist and at the level of the client. Suggestions for change at each level are addressed. Organizations, therapists and clients must work together to facilitate these changes and ensure that each occupational therapy client receives respectful, supportive, coordinated, flexible and individualized service.

Implementing client-centred practice: why is it so difficult to do?

Purpose. Goal setting has been described as the core skill of rehabilitation professionals, but there is little information about patients understanding of goal setting. This study explored how in-patients with neurological impairments experienced two different types of goal setting and identified the issues that underpin individuals' experience of goal setting.Method. The study took place in a neurological rehabilitation unit in which two approaches to goal setting were being used that differed in the amount of patient involvement. A qualitative research design was adopted. Six focus groups were convened, three for participants experiencing usual participation and three for those with increased involvement in goal setting. A total of 28 participants (12 women, mean age 49 years) with a variety of deficits were recruited to the study over nine months. Thematic analysis was used to analyse the focus group transcripts.Findings. Four themes were identified which impact on the ways in which in-patients make s...

Goal setting in neurological rehabilitation: patients' perspectives.

"Someone's rooting for you": continuity, advocacy and street-level bureaucracy in UK maternal healthcare.

The need for an understanding of ‘ageing in place’ as a progressive process has emerged among researchers in the field of environmental gerontology. The aim of this study was to explore this process, in relation to home modification services. Four older adults who had applied for home modification services in one Swedish municipality were included. Data were collected by open interviews with the participants in their homes on subsequent occasions, from before the modification had been installed until recognised stability in the situation relating to the home modification. In the analysis, the concept of place integration was used as a tool to explore the active relations that connect people and context over time. The main findings show that the participants used creativity and initiative to direct future situations towards increased possibilities for action. This indicates that services aiming to support people ‘ageing in place’ should be directed towards increasing possibilities for action rather than only facilitating activity performance. Furthermore, it can be concluded that if the service-users' creativity and efforts are recognised as resources in design and provision of services, services that aim to support individuals who are ageing in place have the potential to be empowering. Language: en

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0144686X08007538

Creating possibilities for action in the presence of environmental barriers in the process of ‘ageing in place’

This article describes the development and implementation of a brief values assessment protocol to be used by case managers working in community-based long-term care (LTC) for the elderly and presents data on the values and preferences of 790 LTC clients at two locations. The importance that clients placed on selected issues related to their care (e.g., privacy, daily routines, activities, involvement of family in care, the trade-off between freedom and safety) varied as did the specific content of those issues. Associations were found between the content and strength of preferences. The work has implications for research and practice.

/pdf/care-related-preferences-and-values-of-elderly-community-2c1s00izh7.pdf

Care-Related Preferences and Values of Elderly Community-Based LTC Consumers: Can Case Managers Learn What's Important to Clients?

New long-term care legislation and managed care legitimate case management for gatekeeping and advocacy for frail elderly. Qualitative in-depth interviews with case managers who are social workers and nurses were used to address the question: To what extent is client-centered theory reflected in case management practice? Differences between reported client-centered theory and directive practice were identified by five themes: (a) client wishes versus system constraints; (b) the paradox of working to keep clients home versus the perceived inevitability of nursing home placement; (c) client centeredness versus the case manager's care plan; (d) client self-determination versus strategies of persuasion; (e) informing the client about case management versus the reality of practice. Ethical implications, competing demands, and environmental constraints are discussed. Suggestions are made to better integrate client-centered theory with directive practice.

Contradictions in case management: client-centered theory and directive practice with frail elderly.

Objective: To describe case managers' perceptions of the physician-case manager relationship.



Design: A qualitative field study using in-depth open-ended interviews was used to elicit case managers' experiences and practices. A muladisciplinary team analyzed transcripts using an adaptation of the “grounded theory” approach of Glaser and Strauss.



Participants/Setting: Case managers were selected for interview using a maximum variation sampling strategy within an established state-wide case management agency.



Main Outcome Measures: Transcript analysis allowed for the organization of observations into themes, which were merged across interviews to generate theses.



Results: Case managers report that: (1) The case manager role is poorly understood by physicians. (2) Physicians lack insight into the social and environmental aspects of home-bound elderly people. (3) Access to physician services is often difficult to obtain. (4) Power struggles occasionally surface in care planning. (5) Decisions by physicians and case managers regarding the care of frail elderly are often made from different agenda.



Conclusions: From the perspective of case managers, gaps in interprofessional communication may hinder the optimal care of frail elderly individuals. J Am Geriatr Soc 42:5–10, 1994

Michael Feltes

Papers

Contradictions in case management: client-centered theory and directive practice with frail elderly.

Case Managers and Physicians: Communication and Perceived Problems