Heidi Cramm, Terry Krupa, Cheryl Missiuna, Rosemary M. Lysaght, Kevin C. H. Parker; Broadening the Occupational Therapy Toolkit: An Executive Functioning Lens for Occupational Therapy With Children and Youth. Am J Occup Ther 2013;67(6):e139–e147. https://doi.org/10.5014/ajot.2013.008607
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© 2020 American Occupational Therapy Association
OBJECTIVE. Attention to executive functioning (EF) and its effect on occupational performance is increasing in the occupational therapy literature. This study explored occupational therapists’ perceptions of how EF is recognized and addressed within occupational therapy for children and youth.
METHOD. Inductive qualitative content analysis was used to analyze the in-depth interview data from 13 occupational therapists with a range of practice contexts and experience.
RESULTS. EF should be explicitly considered during clinical reasoning. System and professional barriers create challenges to occupational therapists, constraining their ability to recognize, label, and address EF performance issues. Occupational therapists who have integrated EF into their practice perspective have acquired knowledge and skills through interprofessional collaborations, client interactions, and professional development opportunities.
CONCLUSION. Occupational therapists working with children and youth need an occupational EF framework and practice resources if they are to integrate an EF lens to more broadly enable occupational performance.
permission, like, this is an OT thing, but I think they get anxious or you know, you just feel like, ooh, this isn’t really my role, you know, why are you talking about this, but it is, it is the part of the whole, you are in the idea, you are in the job of improving occupational performance. (OT11–E)
There’s an understanding out there that the OT role is going to be this, and to step in with something new might be—it would take a while for people to get on board with it, or there might be some disappointment because a lot of people really like to hear that it’s a sensory issue. (OT12–B)
hard to practise as occupational therapists… . Sometimes these therapists enthusiastically defend what they are doing as being “real” occupational therapy, stressing the idea that assessing and remediating underlying impairments will ultimately result in enhanced occupational performance. More often than not, however, such persons readily acknowledge a troubled sense that what they are doing is not what they feel they should be doing, and that they struggle with how to make a change in their practice. At worst, they feel powerless to effect change. (Fisher, 2003, pp. 193–194)
Occupational performance issues associated with EF are poorly understood.
EF needs to be explicitly and systematically considered in the clinical reasoning process if negative secondary consequences are to be avoided.
Individual- and system-level barriers to acquiring the EF lens exist.
Learning to see EF issues is supported through interprofessional relationships, clients, and professional development opportunities.
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