Showing papers in "Canadian Journal of Occupational Therapy in 1990"

The Canadian Occupational Performance Measure: An Outcome Measure for Occupational Therapy:

Abstract: The Canadian Association of Occupational Therapists, in collaboration with Health and Welfare Canada have developed and published a conceptual model for occupational therapy, the Occupational Performance model. This paper describes the development of an outcome measure, The Canadian Occupational Performance Measure (COPM), which is designed to be used with these guidelines for client-centred clinical practice. The COPM is an outcome measure designed for use by occupational therapists to assess client outcomes in the areas of self-care, productivity and leisure. Using a semi-structured interview, the COPM is a five step process which measures individual, client-identified problem areas in daily function. Two scores, for performance and satisfaction with performance are obtained. This paper describes the rationale and development of the COPM as wellas information about its use for therapists.

The Reliability and Validity of Self-Report Activities of Daily Living Scales

Abstract: A measurement evaluation study was conducted to examine the reliability and validity of the Physical Self-Maintenance Scale and Instrumental Activities of Daily Living Scale (Lawton & Brody, 1969) as a discriminative measure to assess the independent living status of elderly hospitalized patients. A sample of thirty patients from two geriatric specialty units was used for the study. Inter-observer reliability was shown to be excellent (ADL r=.96, IADL r=.99) and test-retest reliability was considered to be good (ADL r=.59, IADL r=.93). The results comparing patient self-report of ability and ratings based on direct observation of performance indicated that patients consistently over-rated their ability in both ADL and IADL tasks. This provides support for the use of direct observation of performance to obtain valid data on an individual's ability. There was a significant difference in scores between those patients able to be discharged home compared to those requiring institutionalization; however, a scor...

A New Definition of Disability: Implications for Rehabilitation Practice and Social Policy

Abstract: Until the 1970s, individual physical, be-haviourial and vocational limitations were seen as the main difficulties preventing people with disabilities from participating fully in society. Rehabilitation professionals concentrated on improving functional abilities of disabled clients and the main policy approaches were income maintenance and vocational rehabilitation. In the 1970s, the individualistic conception of disability was challenged by a socio-political definition. The socio-political model implies that improvement in the status of persons with disabilities requires alterations in the social environment as well as changes in individual functional abilities. This paper examines the extent to which disability policies and rehabilitation practice have changed to embrace this new definition. There has been some progress in policies related to shelter and transportation but little progress in the areas of employment and income maintenance. Rehabilitation professionals still have a largely clinical or ind...

Developing guidelines for client-centred occupational therapy practice.

Abstract: The Canadian Guidelines for the client-centred practice of occupational therapy are national, generic, consensus guidelines developed to address growing concerns inside and outside the profession for assuring the quality of health services. From 1979 to 1987, successive Task Forces, sponsored by the Department of National Health and Welfare and the Canadian Association of Occupational Therapists, developed three volumes of guidelines. A pivotal guideline in Volume I is a conceptual framework of occupational therapy's central concern: occupational performance within an individual's physical, cultural and social environment. Volume I also outlines stages in the process of client-centred occupational therapy practice, and specific assessment and program planning guidelines. Volume II covers issues, concepts and fundamental elements of intervention, as well as specific guidelines for intervention, discharge, follow-up and evaluation. Volume III reviews issues in outcome measurement given occupational therapy's primary concern for occupational performance. The authors, members of the Task Forces, provide an overview of the development of and their hopes for the Guidelines. Uses and influences of the Guidelines have not been formally documented. However, projects are arising from the Guidelines and a new CAOT Client-Centred Practice Committee is proposing an updating process for the three volumes.

Occupational Performance Measures: A Review Based on the Guidelines for the Client-centred Practice of Occupational Therapy:

Abstract: In 1987, Health and Welfare Canada and the Canadian Association of Occupational Therapists Task Force recommended that work go forward to develop an outcome measure for occupational therapy which reflects the Occupational Performance Model. The first step in this process was to review critically those outcome measures which assess occupational performance and that are currently available in the literature. This paper will present the review process, describe in more detail eight assessments that fulfilled many of the review criteria, discuss the limitations of these measures using the "Guidelines for the Client-centred Practice of Occupational Therapy as the framework, and make recommendations for the development of a new outcome measure for use in occupational therapy.

Factors Influencing Leisure Activities following a Stroke: An Exploratory Study:

Abstract: This exploratory study identified factors that influence social and leisure activities following a stroke. Thirty subjects who had suffered a stroke within the previous 15 months and had returned home, were interviewed regarding the effect of the stroke on their activities, roles and relationships. Factors which influenced leisure activities were extracted from documentation of interviews and observations. Kielhofner's Model of Human Occupation was used to organize the findings. Age affects the type of activities a person finds meaningful; younger subjects are more likely than older subjects to be motivated by work-related activities. Age also influences the maintenance of friendships; older people are more accepting of disabilities in their friends than are younger individuals. Personal standards, range of interests and access to transportation also affect involvement in social and leisure activities. Some activity changes are attributable to the loss of physical and mental function. However, the interac...

Factors affecting a clinician's decision to provide fieldwork education to students.

Abstract: Fieldwork represents an important component of the education of an occupational therapist. In this study thirteen occupational therapists in small Saskatchewan occupational therapy facilities were interviewed to determine the factors and the relationships among these factors that affected their involvement in the fieldwork process. The directors of the two large occupational therapy departments in Saskatchewan, together with eight Canadian university fieldwork coordinators were interviewed for comparison purposes. The findings of the study have shown that there were four major influences affecting Saskatchewan therapists' involvement in the fieldwork program of occupational therapy students. They were: workload; feelings of isolation; the parameters of a placement; and professionalism. This study is important because it has identified significant factors for university fieldwork coordinators to consider in their contact with therapists. It has also provided a model for other similar studies.

Using the World Health Organization's International Classification of Impairments, Disabilities, and Handicaps in Occupational Therapy

Abstract: Health status, although commonly defined in terms of the presence or absence of disease, can also be defined in terms of performance or functional status. Loss of performance results in disablement...

Collaborative Research: Campus and Clinic Working Together

Abstract: Collaborative research has been heralded as one means to increase research productivity within the field of occupational therapy. Drawing on the literature and an example of collaborative research of the authors, several benefits of faculty/clinician collaboration will be identified, including: the sharing of theoretical and practical knowledge, gaining access to resources, and enhancing the credibility of the research, ingredients that increase the probability of success in such an endeavour will also be outlined to suggest how research can be made more manageable in overcoming some of the deterrents to research.

A Comparative Study of Visual Perceptual Skills in Normal Children and Children with Diplegic Cerebral Palsy

Abstract: The conceptual notion that children's visual perceptual skills may develop independently of their motor skills was addressed in this study. Visual perceptual abilities were evaluated in a group of children with spastic diplegia cerebral palsy and a group of normal children using the Motor-Free Visual Perceptual Test (MVPT) (Colarusso & Hammill, 1972) and the Test of Visual-Perceptual Skills (TVPS) (Gardner, 1982). The results indicated that the disabled children attained significantly lower mean perceptual quotient and perceptual age scores on both tests than a group of normal children matched for age and sex. In addition, the performance of the disabled children showed significantly lower mean percentile ranks on the TVPS than the normal group. Finally, high correlations (based on the perceptual quotient and perceptual age scores) of the TVPS and the MVPT scores were computed for both groups. The results are discussed with implications for future research.

Interview Scores and Academic Grades as Selection Criteria for Admission to an Occupational Therapy Program

Abstract: This paper investigates the relationship of previous academic performance and selection interview results to the academic and fieldwork performance of students during four years of study in Occupational Therapy. Only students who met the basic academic requirements of the occupational therapy department were included. Half of the students who were admitted were selected on the basis of highest academic grades and half were selected on the basis of highest interview scores. At the end of the academic program evaluations indicated no significant difference beween the two groups in terms of academic performance. Over the four years those students who were selected by high interview scores showed more improvement in fieldwork performance than students admitted only on the basis of previous academic grades. Students who had some previous university experience exhibited significantly greater improvement in fieldwork performance than those admitted directly from high school.

A survey of Canadian occupational therapy private practice.

Abstract: This descriptive study provides an overview of the business structure and function of occupational therapy private practitioners in Canada. Aspects covered include basic demographic information, practice issues defining operational aspects of the business, financial issues including initial investment and fee structures, and other miscellaneous business issues. Some implications for the national and provincial professional organizations arose from the results and are presented in the discussion.

Mealtimes of the Institutionalized Elderly: A Literature Review:

Abstract: The absence of social interaction at mealtimes and lack of independence in feeding and eating among residents have been identified as problems requiring investigation in Vancouver General Hospital's Extended Care Unit. An extensive literature review was undertaken, to examine various factors that influence the nutritional intake of the elderly and to learn about intervention programmes which have been aimed at improving mealtime behaviour. The literature review identified growing concern about feeding and eating problems of the institutionalized elderly. The major factors influencing the nutritional intake of the elderly appear to be physical and perceptual disability, social support systems and the opportunity to socialize, and cultural influences. Intervention programmes aimed at improving mealtime behaviours have mainly fallen within the following categories: rehabilitative approach, alteration of physical environment, and behaviour modification using operant conditions. This literature review is preli...

Muriel Driver Memorial Lecture. Occupational therapy--our time has come.

Abstract: Anne Carswell-Opzoomer Ph.D.,O.T.(C) is an assistant professor in the Occupational Therapy Program at the University of Ottawa. She is a member of the Premier's Council on Health Strategy and is engaged in clinical research related to Alzheimer's Disease. C'est un honneur et un privilège d'être ici aujourd'hui et de partager avec vous mes idées personnelles. It is also an honour and a privilege to follow in the foot steps of some unique and extraordinary Canadian occupational therapists. There were two purposes in instigating the Muriel Driver Memorial Lecture in 1975, the first was to honour the memory of Muriel Driver, an outstanding occupational therapist who with innovation and enthusiasm made a significant cont ribution to occupational therapy in Canada. The second was to provide an opportunity to stimulate an interest in improving the practice of occupational therapy by promoting the need for research, graduate education and marketing in occupational therapy. As well to provide an opportunity to honour other occupational therapists who have contributed the profession in C anada. The title of this paper is \"Occupational therapy Our time has come\". My thesis is that in Canada we are on the brink of a health care revolution, and occupational therapists have the knowledge and skills to be in the forefront of that revolution. The ideas in this paper should awaken interest, stimulate thought and challenge each occupational therapist. Je vais présenter une revue rapide du courant de la pensée des dernières années, de la situation politique, économique et démographique actuelle. Je vais aussi tenter de faire une prédiction du future des soins en santé où y inclure nos responsabilités en tant que professionnels en ergothérapie.

Quality assurance: the current challenge.

Abstract: Occupational therapists are being challenged to measure and evaluate the care provided to their patients. This paper discusses the various stages of development of a quality assurance program withi...

The Application of the Client-Centred Approach to School-Based Occupational Therapy Practice

Abstract: The Guidelines for the Client-Centred Practice of Occupational Therapy (Department of National Health and Welfare and Canadian Association of Occupational Therapists, 1983) have been successfully applied to various institutional and community settings. However one of the most challenging appears to be the application to school-based practice. In this article the conceptual frame of reference and the practice stages in the occupational therapy process are directly applied to school settings. Philosophical differences are apparent and these are likely influencing the development of occupational therapy services in schools. A case study is used to illustrate some of the issues andthe preparation of guidelines for school-based occupational therapy services is recommended.

Physical Disability and Depression a Methodological Consideration

Abstract: Evidence that the physically disabled are at substantially elevated risk for depressive symtomatology has been widely reported. This paper considers the meaning of these reports with respect to the...

Psychosocial Issues for People with Cancer Their Families

Abstract: The diagnosis of cancer has a devastating impact not only for the person diagnosed but for family members as well. A number of psychosocial problems become evident as the individual and family attempt to come to terms with the diagnosis and what it means. Occupational therapy intervention can contribute to the psychosocial adjustment of the person with cancer and their family.

Application of the guidelines for client-centred practice to paediatric occupational therapy.

Abstract: This paper outlines the process of incorporating the "Guidelines For the Client-Centred Practice of Occupational Therapy" into the practice of occupational therapy in an out-patient rehabilitation facility serving young people with physical disabilities. Specifically, the areas of practice addressed are screening and assessment. The process started in 1987 with an identification of the need to find a holistic framework that meets the complex needs of clients with chronic physical disabilities. The conceptual model of occupational performance, as outlined in the Guidelines, provided such a framework. The process of incorporating the Guidelines into the screening and assessment practices of occupational therapists at Erinoak Serving Young People With Physical Disabilities is described, with examples of documents developed by the department. Suggestions are given to integrate the conceptual model of occupational performance into the practice of occupational therapists working with children and adolescents with physical disabilities.

Occupational Therapy in Schools: Identifying Items for a Referral Instrument

Abstract: As the first step in developing an instrument for referring students to occupational therapy in schools, a survey of Canadian pediatric occupational therapists was conducted. Sixtysix behavioural items which covered daily living skills, psychosocial functioning, sensorimotor skills, cognition, and therapeutic adaptation were selected. Therapists rated each item on a four point scale which reflected the extent to which an item indicated a need for occupational therapy in a school setting. Useable responses were obtained from 192 therapists (response rate of 61.5%) who had an average of 6.5 years experience in pediatric occupational therapy, 39 of whom worked in integrated school settings. Over 70% of the therapists identified 31 items as often or always indicating a need for referral, none of which were in the psychosocial domain. Comparisons between therapists in different work settings revealed few significant differences. Implications for practice and future projects are discussed.

Health Promotion — An Opportunity for Occupational Therapy:

Abstract: Effective health care se rv ices must do more than respond to illness: they must also focus on prevention and health promotion" (Manitoba Health, 1989). Economically, as Canadians experience escalating health costs, society is placing greater emphasis on the individual responsibility for health. Recent repo rts and policy papers, such as Partners for Health A New Direction for the Promotion of Health in Manitoba (Manitoba Health, 1989) and Achieving Health for All (Epp, 1986), suppo rt this trend. The practice of occupational therapy "remains a blend of art and science" (Peloquin, 1988). The enormous developments in technology and scientific research in the health care arena however, have placed an increased emphasis on the scientific components of all health professions. This in turn, has "compromised the relationship" (Peloquin, 1988) between the patient and the care providers of health se rv ices. Despite modem technological advances, occupational therapists must retain the 'a rt ' of practice which restores the emphasis on human relationships, the impo rtance of quality of life, and the meaning of 'occupation' in life. Jeanette Edwards, B.O.T., O.T.M., is the Executive Director of the Health Action Centre, Health Sciences Centre, 425 Elgin Avenue, Winnipeg, Man. R3A 1P2 This consideration of the 'art' of occupational therapy inherently leads to the critical and potentially increased role of our profession in health promotion activities. Health promotion is the process of enabling people to increase control over, and improve their own health. Today, more so than ever before, health is portrayed "as a pa rt of everyday living, and an essential dimension of the quality of our lives. Quality of life in this context implies the opportunity to make choices and gain satisfaction from living" (Epp, 1986). Quality of life also implies equal opportunity, access to resources, and the capacity to function independently. This holistic concept of health is not new to occupational therapists, however, we have traditionally worked in a medical system aimed at the eradication of disease rather than one that is based on the concepts of health and health promotion. Although individualized patient assessments, patient pa rticipation and thus, self empowerment, have been the fundamental principles of occupational therapy since its inception, they have often been overshadowed by the need to respond to systems demands.

Occupational Therapy in Schools

Abstract: Occupational Therapy is the a rt and science which utilizes the analysis and application of activities specifically related to occupational performance in the areas of selfcare, productivity and leisure." (Department of National Health and Welfare & Canadian Association of Occupational Therapists (DNHW & CAOT), 1983). Self-care activities are routine activities of daily living, such as dressing, feeding and toiletting, which are directed towards the preservation of an individual's health and wellbeing in the environment. Leisure or play activities include games and crafts, playground, community and recreational activities. The behaviours and skills acquired through play and leisure serve as the bridge to an adult productive role (Reilly, 1974). Productivity focuses on activities which are done to provide meaning and support to the self, family and society. (DNHW & CAOT, 1986). It includes the pe rformance of educational and prevocational tasks at school, in preparation for the work and home management activities of the adult. Through assessment and intervention in school settings, occupational therapists address problems affecting functional or adaptive behaviour of students in each of the areas of occupational performance, influenced by social, cultural and physical elements of the environment. (DNHW & CAOT, 1983). Occupational therapists have traditionally worked in segregated school settings, however this has expanded within the last two decades to include the regular school system

The Miller Assessment for Preschoolers: Analysis of Score Patterns for Children with Developmental Delays

Abstract: This paper describes data trends of the Miller Assessment for Preschoolers (MAP) (Miller, 1982) in a clinical sample of children with suspected or confirmed developmental delay. A retrospective cha...

Prise de position sur l'ergothérapie et les soins à domicile

Abstract: Borg, N. (1985). Home care occupational therapy: A vital link to independence. Occupational Therapy in Health Care, 2(1), 51-62. Brown, D. (1983). A community mode! for arthritis rehabilitation. Canadian Journal of Occupational Therapy, 50, 115-118. Department of National Health and Welfare & Canadian Association of Occupational Therapists. (1983). Guidelines for the client-centred practice of occupational therapy(H39-33/1983E). Ottawa, ON: Department of National Health and Welfare. Department of National Health and Welfare & Canadian Association of Occupational Therapists. (1986). intervention guidelines for the client-centred practice of occupational therapy (H39-100/1986E). Ottawa, ON: Department of National Health and Welfare. Department of National Health and Welfare. (1986). Achieving Health for All: A framework for health promotion (H39-102/ 1986E). O ttawa, ON: Minister of Supply & Services Canada. Etcheverry, E. (1979). Curriculum planning for community occupational therapy. Canadian Journal of Occupational Therapy, 46, 201-205. Goldenberg, K., & Quinn, B. (1985). Community Occupational Therapy Associates: A model of private practice. Occupational Therapy in Health Care, 2(2), 15-23. Howell, J. (1988). Coordinated home care in Canada: A preventive approach. Paper presented at the International Conference on Caring for the Elderly: Prevention, Therapy, and Rehabilitation, Rome, Italy. Howland, G. (1986). Occupational therapy across Canada. Canadian Journal of Occupational Therapy, 53 (Commemorative Issue), 18-26. (Reprinted from Canadian Geographical Journal, 1944, 28(1), 32-40). MacBain, P. (1970). O.T.'s on wheels. Canadian Journal of Occupational Therapy, 37, 63-68. McKinnon, A., & Madill, H. (1987). Occupational therapy: A growing profession in community health. Canadian Public Health Association Health Digest, 11(1), 3-4. Robinson, I. (1981). The mists of time. Canadian Journal of Occupational Therapy, 48, 145-152. Townsend, E. (1986). Undergraduate Education for Community Occupational Therapy Practice. Paper presented at the Symposium on Issues in Community Occupational Therapy Practice held in conjunction with the 1986 Conference of the Canadian Association of Occupational Therapists, Calgary, Alberta. Townsend, E. (1987). Directory of Community Occupational Therapy Services in Canada. Toronto, ON: CAOT Publications. Townsend, E. (1988). Developing community occupational therapy services in Canada. Canadian Journal of Occupational Therapy, 55, 69-74. Zgola, J. (1988). Therapeutic companionship: The occupational therapist's role in a home-based program for clients with Alzheimer's disease. Canadian Journal of Occupational Therapy, 55, 26-30.

Proximal & Distal Upper Limb Motor Development in 24 Week Old Infants

Abstract: The developmental concept that the maturation of motor skills proceeds in a proximal to distal direction, and thatdistal movements emerge only after proximal movements have been established has come into question. Neurophysiological and developmental research has suggested that proximal and distal development occur simultaneously, under the influence of two independent neural systems. In order to clarify the questions raised by such opposing viewpoints, twenty-nine normal infants (15 girls, 14 boys), 24 weeks of age, were videotaped reachingfor and grasping a cube deposited in a form-board. The degree of proximal (reach) and distal (grasp) maturity was rated by two independent scorers usinga scale specifically designed for this purpose. Correlation between each rater's proximal and distal scores for each child, evidenced a positive linear relationship (r1 = 0.58, p > 0.001; r2 = 0.79, p > 0.001). It is hypothesised that these results may be indicative of the speed in which the neural centres responsible for proximal and distal function, myelinate and develop functional synapses. Thus, although proximal and distal motor skills mature sequentially, they may nonetheless be contingent upon the controlling influence of two separate neural systems. These findings have implications for occupational therapy treatment approaches.

Construct Validation of an Acute Care Occupational Therapy Cerebral Vascular Accident Assessment Tool

Abstract: This study was the last in a series of six investigations of the construct validity of the St. Marys CVA evaluation, a clinician constructed test composed of items designed to evaluate sensory, perceptual, motor, and self care performance in cerebral vascular accident patients. Data for the present study were obtained from 250 new patients referred for occupational therapy services from 1983 to 1988. Factor analysis with varimax orthogonal rotation was performed on 22 items of the evaluation including perception, recovery stages, measures of grasp and pinch strength and other functional variables. Three factors emerged - Right Function, Recovery Stage, and Left Hand Strength. The results of the study, combined with results of previous research, indicate that this CVA Evaluation has reasonable construct validity as an occupational therapy assessment tool in an acute care setting.

Crisis in Psychosocial Occupational Therapy: A Closer Look

Abstract: To date, there are no existing data concerning similarities and differences in occupational therapist shortages among the broad areas of clinical practice. Accordingly, this study sought to develop a profile of therapist shortages in Metropolitan Toronto within three broad foci of intervention, namely, physical dysfunction (PD), psychosocial dysfunction (PS), or a combination of both (C). Seventy-seven questionnaires were mailed to occupational therapy managers in Metropolitan Toronto. The 74% response rate from managers supervising a total of 516 therapists provided information which included numbers of existing positions (full- and part-time), numbers of vacancies and vacancy periods, as well as perceptions concerning reasons for vacancies and need for additional positions. Although no significant differences were found among vacancy rates in the three areas there was a perception that the greatest shortage was within the PS area of practice. Implications of these results are discussed in light of the perceived crisis in psychosocial therapy. Recommendations for future research are delineated. Recently, there has been concern about a perceived crisis in occupational therapy in mental health. A repo rt of the American Occupational TherapyAssociation (ROTA) on Manpower (1985) stated that, while overall employment of occupational therapists had increased by more than 75% between 1977 and 1982, the number working in community mental health centres had been cut in half. Bonder (1987) noted that occupational therapy in mental health had not kept pace with other areas of practice and suggested thatAOTA's findings (1985) might be indicative of a change of crisis propo rtions. In C anada, MacKinnon (1985) described a lack of growth and development in occupational therapy manpower both in mental health centres and psychiatric facilities. She also pointed out that recruitment into psychiatric areas was sluggish, staffing was down, morale was low, and sala ries were not competitive. Some therapists with whom MacKinnon communicated believed that the demise of psychiatric occupational therapy was under way. Although Brintnell (1989) has described the current situation as one of challenge, she too has noted the apparent decrease in the numbers of occupational therapists who identify mental dysfunction as their area of specialty. Although occupational therapy in mental health would appear to be experiencing a decline in manpower, the profession as a

Adapted Clothing for Patients in Halo Traction

Abstract: Astri Prugger is a Fashion Designer, currently residing in Montreal. A halo-brace is a traction device worn by patients who have undergone spinal injury and/or neurosurgery, and who require immobilization of the cervical spine. The purpose of this paper is to describe a simple technique for adapting comfortable, neat, and well-finished garments for halo wearers. Once the few basic steps described here have been mastered, a little creativity can go a long way in the design of unique and functional halo-clothing. While only minimal sewing experience is required to follow these basic steps, this paper is also intended to make a more general contribution to the Occupational Therapy profession by providing some challenging ideas for the creation of innovative clothing. Moratz (1979) has previously described a method of adapting a practical dress shirt for patients in halo traction. However, the adaption technique outlined here has more general use with garments of any style or fabric. In addition, because of the basic design of the back of the garments described here, halo wearers will find it easier to dress themselves, and will therefore enjoy greater independence. Finally, in the case of a halo patient who has undergone posterior surgery of the cervical spine (Edmonds & Tator, 1982), the off-centre openings and closures of this back structure tend to be less abrasive in the area of the healing incision. The clothing required by a halo wearer depends on the season, but any clothing from light-weight T-shirts to heavy winter coats (see Figures 1 & 2) can be designed following the same basic principles. Since the sheepskin lining of the

Operational review: beyond the numbers game.

Abstract: The first response to operational review is, traditionally, an examination of productivity indicators and a rationale for their defense. This paper describes the creative approach chosen by one hospital setting with specific reference to the occupational therapy department. The focus was placed on outcome for the child and productivity measurement. Results of the review for the occupational therapy department were positive and established a precedent for parts of the presentation when the review continued throughout the hospital. Occupational therapy managers are encouraged to become more innovative in the effective management of their departments, continuing to develop and build leadership skills for the future.