OCCUPAT IONAL THERAPY NOW

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Table of Contents3 Knowledge exchange and translation: An essential competency in the twenty-first century

Law,M., Missiuna, C., Pollock, N.

6 Online communities of practice: Enhancing scholarly practice using web-based technologyWhite, C.M., Basiletti, M.C., Carswell, A., Head, B.J., Ju Lin, L.

8 Moving evidence into work practice: A collaborative approach to promoting and sustainingknowledge exchangeMcDonald, K., Shaw, L., Brenchley, C., Lysaght, R., Rappolt, S., Larney, E., Reardon, R.

10 Sense of DoingCapturing occupational knowledge: Enabling powerful outcomes for our clientsPolatajko, H.J., Davies, J.A.

13 Facilitating knowledge transfer through theMcMaster PLUS REHAB Project:Linking rehabilitation practitioners to new and relevant research findingsLaw,M., MacDermid, J., Vrkljan, B., Telford, J.

15 Implementing knowledge translation strategies: Integrating the Assessment of Motor andProcess Skills into practiceMoore, K., Lewis, N.

17 Workplace mental health: Developing an employer resource through partnerships in knowledgetranslationMoll, S., Pond Clements, E.

20 Data and information for advancing occupational therapy practiceLennox, L.

22 Innovative occupational therapy service delivery for children with Developmental CoordinationDisorderDeLaat, D., Missiuna, C., Egan,M., Gaines, R., McLean, J., Chiasson, V.

25 Up and running: Clinical Competency Program facilitates learningArsenault, S., Cobb, J., Lee, D.

28 Using knowledge from online education to tackle practice problemsClark, M., Thornton, D., Burton, K., Sisson, A., Stanton, S.V., Trysennaar, J.

30 Celebrating COTF's 25th AnniversaryGoldenberg, K.

THERAPY NOWOCCUPATIONAL

september/october 2008 • VOLUME 10 • 5

ISSN: 1481-5532 CANADA POST AGREEMENT #40034418

Occupational Therapy Now is published 6 timesa year (bimonthly beginningwith January) by the

Canadian Association of OccupationalTherapists (CAOT).

MANAGING EDITORBrendaMcGibbon Lammi,MSc, BHSc, OT Reg(Ont),

Tel. (613) 587-4124, Fax (613) 587-4121, email: [email protected]

TRANSLATIONDe Shakespeare à Molière, Services de traduction

DESIGN & LAYOUTJAR Creative

ON-LINE KEYWORD EDITORKathleen Raum

CAOT EDITORIAL BOARDChair: Anita Unruh

Members: Emily Etcheverry,Mary Forham, April Furlong,Stephanie Koegler & Catherine Vallée

Ex-officio:Marcia Finlayson & BrendaMcGibbon Lammi

COLUMN EDITORSCritically Appraised Papers

Lori Letts, PhD

International ConnectionsSandra Bressler,MA

In Touch with Assistive TechnologyRoselle Adler, BScOT & Josée Séguin,MSc

OT ThenSue Baptiste,MHSc

Private Practice InsightsJonathan Rivero, BScOT, OT(c)

Christel Seeberger, BSc OT, OT Reg (NB), OTR

Sense of DoingHelene J. Polatajko, PhD & Jane A. Davis,MSc

Tele-occupational TherapyLili Liu, PhD &Masako Miyazaki, PhD

Theory Meets PracticeHeidi Cramm,MSc

Watch Your PracticeSandra Hobson,MAEd

occupational therapy now volume 10.52

Statements made in contributions toOccupational Therapy Now (OT Now)are made solely on the responsibility ofthe author and unless so stated do notreflect the official position of CAOT, andCAOT assumes no responsibility forsuch statements.OT Now encouragesdialogue on issues affecting occupa-tional therapists and welcomes yourparticipation.

EDITORIAL RIGHTS RESERVEDAcceptance of advertisements does notimply endorsement by OT Now nor bythe CAOT.

CAOT PATRONHer Excellency the Right HonourableMichaëlle Jean C.C., C.M.M., C.O.M., C.D.Governor General of Canada

CAOT PRESIDENTSusan Forwell, PhD

CAOT EXECUTIVE DIRECTORClaudia von Zweck, PhD

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COPYRIGHTCopyright of OT Now is held by theCAOT. Permission must be obtained inwriting from CAOT to photocopy, repro-duce or reprint any material publishedin the magazine unless otherwisenoted. There is a per page, per table orfigure charge for commercial use.Individual members of CAOT or ACOTUPhave permission to photocopy up to 100copies of an article if such copies are dis-tributed without charge for educationalor consumer information purposes.

Copyright requests may be sent to:Lisa SheehanE-mail: [email protected]

PRESIDENTS MESSAGEExciting paper, poster and education sessions at the annualCAOT Conference inWhitehorse demonstrated the growingimpact that occupational therapists are having on the healthand wellness of all Canadians. However it was also apparentthat although we practice in diverse areas, many clients stillcannot access service. Nor can they access much of the infor-mation available to the public or the decision makers thatcontrol the distribution of services.

There is a critical shortage of occupational therapistsin many leadership areas who would facilitate the requiredtransfer of knowledge, particularly in practice areas in mentalhealth, primary health care, home care, school based practice,and even traditional areas of rehabilitation. The recent cover-age in the Globe and Mail on issues of mental health andwellness bring to the forefront the importance of knowledge,its translation and its potential impact for the profession ofoccupational therapy.

This special issue addresses the topic of knowledgeand will demonstrate how it can be used in diverse areas toensure a healthier Canadian public.

Elizabeth TaylorPresident of CAOT


In every client encounter, an occupational therapisthas the responsibility to obtain informed consent forall assessment and intervention. The informed con-sent process involves an exchange of informationwith the client that reflects the therapist’s evidence-based knowledge about the type of assessment andtreatment, expected benefits or risks, alternativetreatments and what is likely to happen withouttreatment (Health Care Consent Act, 1996). Theprocess of obtaining consent involves an explicitexchange of knowledge between therapist and client.The ability of competent practitioners to acquireknowledge, to synthesize it and to present it in a waythat will be meaningful to each client, therefore, isnot just an academic exercise. Knowledge translation(KT) is essential to every clinical encounter conductedby an occupational therapist.

What is knowledge translation?Knowledge translation (KT) takes place on a dailybasis in our interactions with clients, families, teammembers, administrators, policymakers and the gen-eral public. The “exchange” part happens when thera-pists share what they know from the evidence andtheir experience but also when they openly receiveinformation from clients and other stakeholders whomay view a situation from diverse perspectives. Theprocess of “translating” knowledge, however, embod-ies much more than summarizing concepts andresearch findings into user-friendly language. The KTprocess is complementary, and may even seem simi-lar, to evidence-based practice, which is an approachto clinical decision-making based upon the integra-tion of the research evidence with clinical expertiseand the client’s values and situation (Straus,Richardson, Glasziou & Haynes, 2005). KT is more ofan overarching construct that can involve any or all ofthe steps involved with responding to clinical dilem-mas including: synthesizing what is already known,defining a research question, conducting theresearch, making research findings accessible to oth-ers, interpreting research in the context of otherknowledge, acting on the basis of that knowledge,reviewing its impact and influencing subsequentdevelopment of new research questions (Canadian

Institutes of Health Research, 2007). KT can and doesoccur at each of these stages.

KT as a field of studyKT has been defined by the Canadian Institutes forHealth Research (Schryer-Roy, 2005) as:

"the exchange, synthesis, and ethically-sound applicationof knowledge - within a complex set of interactionsamong researchers and users - to accelerate the captureof the benefits of research for Canadians throughimproved health, more effective services and products,and a strengthened health care system."

This definition highlights the role of KT in ensuringthat what is learned through research is shared rap-idly in a focused and accessible manner so that prac-titioners are evidence-informed and clients benefit.

Studying the process of KT is actually quite chal-lenging because it is complex and may involve manydifferent types of individuals and/or organizations. Itcan be helpful to think about key groups within thehealth care system who possess different types ofvaluable information and who must work together asa system to exchange knowledge. Ho, Lauscher et al.(2004) describe these groups as:

• knowledge producers (the community ofresearchers)

• knowledge consumers (the community of prac-tice – clinicians)

• knowledge beneficiaries (the community ofclients)

In addition to these groups, the process of KT involvesthe decision-makers and policymakers who influencethe system and who may have different priorities andexpectations regarding service delivery, use of evi-dence, and outcomes.

KTmethods -What works, and what doesn’t?In health care, most of the KT research that has beenconducted has evaluated methods for improvinguptake and use of evidence by clinicians; most often,physicians. It is clear that the more traditional, pas-sive methods of disseminating information such asjournal articles or large group educational sessionsare generally ineffective in changing practitionerbehaviours (Grimshaw et al., 2001). However system-

Knowledge exchange and translation:An essential competency in the twenty-first century

Mary Law, Cheryl Missiuna, Nancy Pollock

atic reviews of studies examining many other KTinterventions suggest that there is no one optimalway to translate knowledge to practitioners (see sum-mary by Sudsawad, 2007). Approaches such as web-sites, newsletters and short information bulletins areuseful to increase awareness and general knowledge,but are not likely to lead to changes in practice. The

KT interventions that have beenshown most consistently to bemoderately effective are bothinterpersonal and multifaceted(Grimshaw et al, 2001). Someexamples of strategies that havebeen investigated include edu-cational outreach, reminder sys-tems, audit and feedback, inter-active continuing education ses-sions, and problem-based learn-ing groups. Since studies thatare reviewed often include acombination of interventions, ithas been difficult to identifywhich components led to suc-cess (Sudsawad, 2007). We doknow that KT is most effectivewhen the source of the knowl-edge is perceived to be credibleand competent, the informationis relevant and suitable to thelearning context of the practi-tioner, is easily accessed and ispresented in an understandablemanner (Lavis, Robertson,Woodside, Mcleod & Abelson,2003).

While increased uptake ofevidence by practitioners is

undoubtedly beneficial to clients, far less research inrehabilitation has focused directly on the transfer ofknowledge from clinician to client or vice versa. Onemight think that requests by clients based on infor-mation they have gathered would lead to changes inpractice but the evidence to support this type ofuptake is modest (Sudsawad, 2007). Research in adultlearning methods and the lessons learned from KTstudies in public health can inform knowledgeexchange within the field of rehabilitation. In thenext decade, this will become an important area ofstudy.

Innovative KT practices in occupationaltherapyThe articles selected for this special issue showcase awide array of KT methods that have been appliedacross different practice settings. A number of thearticles describe strategies for building and maintain-ing communities of practice that facilitate KT.Whiteet al. (pp. 6) developed three online communities ofpractice in Atlantic Canada to support the sharing ofknowledge and evidence. McDonald et al. (pp. 8)describe a collaborative approach among threeorganizations to build a sustainable provincial knowl-edge exchange and translation strategy in workhealth through a network of therapists selected aseducational influentials. The article by Moll and PondClements (pp. 17) highlights the work that can bedone in partnership with employers to develop evi-dence-based materials for employers about attendingto issues of mental illness in the workplace. Mooreand Lewis (pp 15) illustrate how a group of therapistscan work together to effectively implement use of anoutcome measure into their practice.

KT is facilitated by the availability of easy-to-understand knowledge summaries. Arsenault andcolleagues (pp 25) provide information about thedevelopment and implementation of a modular, evi-dence-based, education program to enable therapiststo be oriented to a particular service orupdate/consolidate their skills. The importance andvalue of therapist and client experiences and reflec-tions are highlighted in the analysis and summary ofcontents of the Occupational Therapy Now ‘Sense ofDoing’ column (Polatajko & Davis, pp. 10).

The use of technology as a vehicle to supportknowledge exchange will likely increase over the nextfew years as it is being shown to improve access anduptake of information and speed up the knowledgetransfer process among communities of practitioners(Ho, Lauscher et al., 2004). White and colleagues useweb-based technology to bring together a communi-ty of practitioners online. Clark et al. (pp. 28) describehow engagement in an online Masters program hasassisted one organization in speeding up the processand increasing therapists skills in translatingresearch information into their practice. Another new


About the authors –Mary Law , PhD,FCAOT,FCAHS, is a Professor andAssociate Dean (HealthSciences) in the school ofRehabilitation Science andCo-Founder,CanChildCentre for ChildhoodDisability Research atMcMaster University inHamilton,Ontario,Canada.Nancy Pollock,M.Sc.,OTReg (Ont) is an AssociateClinical Professor in theSchool of RehabilitationScience and an AssociateMemberwith the CanChildCentre for ChildhoodDisability Research both atMcMaster University.Nancyis also a practicing occupa-tional therapist with REACHTherapy Services.CherylMissiuna , PhD,OTReg(Ont) is an AssociateProfessor in the School ofRehabilitation Science andDirector of CanChild,Centrefor ChildhoodDisabilityResearch,atMcMasterUniversity.

“While the importance of moving knowledge into practicehas been acknowledged by researchers, practitioners, con-sumers and policy makers, the most effective methods ofdoing this remain uncertain.”


technology that is able to “push”well-synthesized evi-dence out to potential users is illustrated in Law etal.’s description of the new McMaster PLUS REHABproject on pp. 13. Lennox shares ideas about how thedata that is summarized by the Canadian Institutesfor Health Information can provide information toadvance occupational therapy practice (pp. 20).

The benefit of using multifaceted and interper-sonal KT interventions is illustrated by DeLaat andcolleagues who shared specialized knowledge with pri-mary care physicians through educational outreach,individualized feedback and an online teaching casereport that showed videoclips of children (pp. 22).

As Rogers and Holm (1994) outlined more than adecade ago, clients have the right to expect that com-petent practitioners will provide a service that isbased on science, is effective and is appropriate totheir needs and preferences. Today, that competencerequires that occupational therapists acquire andsynthesize evidence from the literature, integrate itwith knowledge gleaned from prior experience andexchange this knowledge transparently with theirclients to deliver the best possible service. This specialissue inspires us to be forward thinking and innova-tive in KT with our clients, our colleagues, our employ-ers and our funders.

ReferencesBero, L. A.,Grilli, R., Grimshaw, J.M.,Harvey, E.,Oxman,A.D.,&

Thomson,M.A. (1998). Closing the gap between researchand practice: An overview of systematic reviews of inter-ventions to promote the implementation of research find-ings. BritishMedical Journal, 317, 465-468.

Canadian Institutes of Health Research (2007). Knowledge transla-tion (KT) within the research cycle. Ottawa,ON:Author.

Government of Ontario. (1996).Health Care Consent Act (HCCA).Toronto,ON:Author.

Grimshaw, J.M., Shirran, L.,Thomas, R.,Mowatt,G., Fraser, C., Bero, L.A., et al. (2001). Changing provider behavior: An overview ofsystematic reviews of interventions. Medical Care, 39(8,Suppl. 2), 11-2-11-25.

Ho K., Lauscher H.N., Best A., et al. (2004). Dissecting technology-enabled knowledge translation: Essential challenges,unprecedented opportunities.Clinical & InvestigativeMedicine, 27,70-78.

Lavis, J. N., Robertson,D.,Woodside, J.M.,Mcleod,C. B.,& Abelson, J.(2003).How can research organizationsmore effectivelytransfer research knowledge to decisionmakers?MilbankQuarterly, 81(2), 221—248.

Rogers, J.,& Holm,M. (1994). Accepting the challenge of outcomeresearch: Examining the effectiveness of occupational ther-apy practice.American Journal of Occupational Therapy, 48,871-876.

Schryer-Roy,A.M. (2005). Knowledge translation: Basic theories,approaches and applications. Ottawa,ON:CanadianInstitutes of Health Research. Available at:http://www.idrc.ca/uploads/user-S/11473620631Knowledge_Translation_Basic_Theories,_Approaches_and_Applications_-_May_2006.pdf

Straus, S. E., Richards,W. S.,Glasziou, P.,& Haynes, R. B. (2005).Evidence basedmedicine: How to practice and teach EBM(3rd ed.). Philadelphia: Elsevier.

Sudsawad, P. (2007) Knowledge translation: Introduction tomodels,strategies andmeasures. Austin,TX:National Center for theDissemination of Disability Research. Available at:http://www.ncddr.org/kt/products/ktintro/

Additional Resources in Knowledge Translation• Sudsawad’s (2007) review of the major concepts

and conceptual frameworks in knowledge trans-lation is user-friendly and applicable to rehabili-tation practitioners in Canada. Available at:http://www.ncddr.org/kt/products/ktintro/allinone.html

• Canadian Health Services Research Foundationhas produced an excellent summary to supportclinicians who wish to establish a community ofpractice around knowledge exchange. Availableat: http://www.chsrf.ca/other_documents/insight_action/insight_and_action_e.php?intIssueID=30

• CanChild’s Keeping Current on KnowledgeTransfer in Health Care provides ideas abouthow to develop a plan for knowledge translationand links to other selected KT resources on avariety of topics. Available athttp://www.canchild.ca/Default.aspx?tabid=124

As the practice of occupational therapy increasinglybecomes a knowledge-based activity, creating, apply-ing, and sharing relevant knowledge become keychallenges to continuing competency. It can, however,be challenging to find time to search for evidence, orgain access to other therapists in similar practiceareas who share our questions and concerns.

In Atlantic Canada, as a result of a project initi-ated by the School of Occupational Therapy atDalhousie University, the need for individual “commu-nities of practice” emerged as a possible solution tothis challenge (Manojlovich, 2006). Communities ofpractice are most valued for their ability to build rela-tionships, create a sense of belonging, a spirit ofenquiry, and a professional confidence and identityfrom which professional knowledge can flow(Wenger, McDermott & Snyder, 2002).

Communities of practice are defined as,“…groups of people who share a passion for some-thing that they know how to do, and who interactregularly in order to learn how to do it better”(Wenger, 2004, p. 2). This definition aligns with themandate of the Canadian Association ofOccupational Therapists (CAOT) Code of Ethics, whichrequires occupational therapists to apply new knowl-edge and skills to their professional work based onbest available evidence, and to contribute to thedevelopment and/or dissemination of professionalknowledge (www.caot.ca).

Communities of practice represent an excitingopportunity for occupational therapists.We want tomove in the direction of evidence-informed practice,but there are barriers.We are geographically separat-ed.We don’t have a lot of time, and many of us don’tknow where to start doing our own research.Weneed support. By using available technology, onlinecommunities of practice have the potential to bringpeople together virtually, to share expertise, identifygaps within an environment of mutual support andto advance scholarly practice.

In Atlantic Canada, we have taken steps to inte-grate the use of online communities of practice to‘test the waters’. Based on interest identified whenAtlantic Canadian therapists were surveyed(Manojlovich, 2006), three online communities haveemerged: Research and Aging; Occupational Therapy

and Pressure Management; and Occupation, Recoveryand Mental Health. These communities provide prac-tice guidelines, available evidence, and an opportuni-ty for discussion. As they evolve, common clinicalquestions may emerge, leading the way toward fur-ther enquiry, building scholarly practice and enhanc-ing research capacity.

The Research and Aging community of practiceprovides a forum for sharing information about evi-dence-based practice, clinical resources and the latestresearch in the area of occupational therapy practiceas it relates to the unique challenges faced by olderadults. Resources are posted, and there is a discussionboard where members can address common issues inthis ever-growing area of practice with the aging pop-ulation.

The Occupational Therapy and PressureManagement community emerged from a group ofoccupational therapists who realized that pressuremanagement was critical to enabling clients to par-ticipate in their occupations of choice. Therapists inthis community can access evidence and practiceguidelines, and are currently discussing specific caseexamples. By integrating available evidence withexperience, gaps can be identified, practice can beshaped, and clients stand to benefit.

The Occupation, Recovery and Mental Healthcommunity is currently focusing on the challenge ofintegrating the recovery model of mental health careinto occupational therapy practice, given the chal-lenge that most human resources are allocated toacute care settings. The recovery model shares avision with occupational therapy in promotingincreased community participation in valued roles forclients with persistent mental illness.

These communities of practice, currentlyrestricted to occupational therapists in AtlanticCanada, utilize Dalhousie University’s IntegratedLearning Online (ILO) services, which include theBlackboard Learning System (BLS). The BLS allowsfor the posting of articles and resources, a forumfor ongoing discussion among members and theopportunity for presentations and discussions to

Online communities of practice: Enhancing scholarlypractice using web-based technology

Cathy M. White, Mari C. Basiletti, Anne Carswell, Brenda J. Head and Lilli Ju Lin


“In Atlantic Canada, we have taken steps to integrate theuse of online communities of practice to ‘test the waters’. ”

can be valued and recognized. By clarifying goals,creating a user-friendly structure, and developingcredibility, communities of practice can provide aplatform to develop such a reputation (Garcia &Dorohovich, 2005). As we take a leadership role inAtlantic Canada, we can be actively involved in theevolution of occupational therapy practice throughthe use of online communities of practice.

ReferencesGarcia, J. & Dorohovich, M. (2005). The Truth About Building

and Maintaining Successful Communities of Practice.Defense Acquisition Review Journal, 10, 18-33.

Head, B. J., Ju Lin, L., Manojlovich, M., &White, C. M. (2007).Online Communities of Practice: An InnovativeWay toNetwork. CAOT national conference poster.

Head, B.J.,White, C.M., Ju, L., &Manojlovich, M. (2006). NewWaysto Network: Online Communities of Practice. OT AtlanticConference presentation.

Manojlovich, M. (2006). Building Occupational Therapy ResearchCapacity in Atlantic Canada. Unpublished documentprepared for Dalhousie University School ofOccupational Therapy.

Wenger, E.C. (2004). Knowledge Management as a Doughnut:Shaping your Knowledge Strategy ThroughCommunities of Practice. Ivey Business Journal,January/February, 1-8.

Wenger, E.C., McDermott, R., & Snyder,W.M. (2002). CultivatingCommunities of Practice: A Guide to ManagingKnowledge. Boston: Harvard Business School Press.


occur in real time (Head, Ju Lin, Manojlovich, &White, 2007: www. occupational therapy.dal.ca).

In order for communities of practice to be suc-cessful, for knowledge to actually be applied to prac-tice, frontline practitioners who use the knowledgeand see how it impacts their work must be involved.They are most valuable and generate the most enthu-siasm when they respond to the character and energyof the community members in an informal manner,but have a shared interest in benefiting the practiceand the organization. As such, they are guided by

both a top-down and bottom-up approach (Wenger, 2004),and because of this, they canenhance performance on bothan individual and organization-al level (Garcia & Dorohovich,2005).

Communities of practicehold great promise for occupa-tional therapists, but their usein Atlantic Canada is in itsinfancy. Feedback has beenobtained through conferencepresentations (Head,White, Ju&Manojlovich, 2006; Head, JuLin,Manojlovich, &White,2007), which has generatedinterest and helped to evolvethe process. However there arechallenges in finding and usingsuitable technology. The com-munities do not run them-selves. They can be challengingto set up, and require signifi-cant commitment from a facili-tator (Garcia & Dorohovich,2005). The facilitator need notbe an expert in the field, butmust bring enthusiasm andorganization to the communityif it is to thrive. The activities ofthe community must generateinterest and excitement, andmust be relevant to practice tokeep members engaged(Wenger et al., 2002).

Wenger (2004) highlightsthat knowledge is power, butthat hoarding knowledge is notbeneficial. Peers and theorganization must use knowl-edge to build a reputation that

About the authors –Weare a group of clinical,supervisory and academicoccupational therapistsrepresenting all fourprovinces in AtlanticCanada,who share aninterest in the developmentof online networking.Weare affiliatedwithDalhousie University, andare in the early stages ofdeveloping“OnlineCommunities of Practice”.CathyWhite ,MEd,MSc(OT-Post Professional) OTReg (NB)Occupationaltherapist,Acute CareMental Health,ChalmersRegional Hospital,Fredericton,[email protected] Basiletti,MSc, (OT-Post Professional),OT Reg(PE) Supervisor,Rehabilitation Services,HillsboroughHospital,Charlottetown,PEAnne Carswell, Ph.D.,FCAOT,OT Reg (NS)Associate Professor, Schoolof OccupationalTherapy,Dalhousie University,Halifax,NSBrendaHead,MSc, (OT-PostProfessional),OT Reg (NL)OccupationalTherapyFieldwork Coordinator,Memorial UniversitySt. John's,NLLilli Ju Lin , BScOTOTReg(NB) Occupational therapistin-patient geriatric assess-ment unit, St. Joseph'sHospital, Saint John,NB

This paper outlines the collaborative efforts and actionsof three organizations to create, promote, evaluate andsustain a system for knowledge transfer and exchange(KTE) in the work practice sector.The steps used in get-ting started and building capacity for KTE are sharedhere to encourage others to design unique communi-ties of practice to support KTE in other sectors of occu-pational therapy practice.

Processes that increase the likelihood of evi-dence being used in practice:

Moving research findings into clinical decision-making involvesmaking research findings understand-able, practice relevant and useful in the field. Strategiesare needed to support the review, reflection and criticalappraisal of information needed for therapists to inte-grate research knowledge in practice (Craik & Rappolt,2003). According to Lavis (2003a, b) the disseminationand use of research findings is most effective when itinvolves what have been coined ‘push’, ‘pull’ and ‘dissem-ination’ strategies and when it involves the users ofinformation as early as possible in the research andknowledge transfer process. Push strategies focus ondissemination, and increasing awareness of and accessto information. Pull strategies involve responding touser’s needs and suggestions, and dissemination strate-gies involve creating opportunities for dialoguebetween the researchers and knowledge users. Our planto develop a sustainable KTE process for the work prac-tice sector builds on these strategies.

Creating the partnership around shared goalsThree organizations interested in research-informedpractice and practice-informed research embarked onthe development of a partnership to support the trans-fer of occupational health and safety research into thepractice of occupational therapists working in the work-place through the creation of an unique occupationaltherapy network.

Each of the participating organizations had dis-tinct but complimentary goals:

• The Ontario Society of Occupational Therapists(OSOT) was interested in supporting opportuni-

ties for ongoing networking and knowledge shar-ing amongmembers to inform best practice inthe work practice arena. OSOTmembers identifiedthe need to promote and develop the profession'sroles in work practice as a critical priority for theprofession's future success.The commitment toaddress these needs is a strategic priority of theSociety.

• The Institute forWork & Health (IWH) is an inde-pendent, not-for-profit research organization witha focus on research that will promote, protect andimprove the health of working people. In additionto generating and synthesizing research knowl-edge, the Institute has committed resources toKTE. This function exists to ensure that researchknowledge reaches those audiences whomightuse the knowledge in day-to-day decision-makingand to ensure there is ongoing exchange of ideas,information and experience.

• The College of Occupational Therapists ofOntario’s (COTO)mission is “to protect the publicinterest and well-being by registering, regulatingand supporting the ongoing competency of occu-pational therapists.”The College participated inthe network project in recognition that its focuson promoting evidence-based practice was consis-tent with the Collegemission.Drawing upon shared goals these three organiza-

tions developed the following network structures tosupport KTE in the occupational therapy community.

Moving evidence into work practice: A collaborativeapproach to promoting and sustaining knowledgeexchange

Kathy MacDonald, Lynn Shaw, Christie Brenchley, Rosemary Lysaght,Susan Rappolt, Elinor Larney and Rhoda Reardon


OTs in Work Practice

OT EI Network

Steering Committee

Knowledge Tr

ansfe

r

Associa

te

Sta�

WP

Task

Team

OSOTIWH COTO

TaskGroups

Figure 1: Partnerships and Structures supporting OT EI Networkand KTE

Developing a Steering GroupA Steering Group was established and led by theKnowledge Transfer Associate at IWH.Membersincluded representation from theWork Practice TaskTeam of OSOT, OSOT representatives (ExecutiveDirector and Professional Practice Director) and aca-demics from three Universities with expertise in evi-dence-based practice and work practice. COTO contin-ued to support the network but was not directlyinvolved in the events planning or tool developmentactivities. The Steering Group worked to establish thefirst Occupational Therapy Educationally Influential(OT EI) Network. OT EI’s are a group of occupationaltherapists considered to be informal opinion leadersby their peers. The process of selection of OT EI’s isoutlined below.

The Steering Group is responsible for regularcontact with the OT EIs, planning ongoing events,development of task groups, evaluation of the KTEprocesses and managing the confidentiality of thedatabase of the OT EIs.

Establishing the OT EI networkThe OT EI network was created using a well-estab-lished survey method developed by educator RolandHiss (1978). The Hiss methodology was used to identi-fy the “educationally influential”members of theoccupational therapy community that were work-place focused. Hiss demonstrated that health-careprofessionals (in his work, physicians) achieve muchof their on-going learning from peers who they self-select as mentors and teachers. Hiss showed thatthese individuals share common characteristics andthat it was possible to systematically identify them bysurveying a group of health-care professionals withina ‘practice community’.

The Steering Group identified occupationaltherapists active in workplaces and distributed theHiss survey that could be returned by email or fax.After the EI group was identified using establishedselection criteria, they were invited to join the net-work to assist in knowledge transfer activities. TheSteering Group surveyed 643 occupational therapistswith a work practice focus, obtained a response rateof 41% and identified 66 EIs.

An example of the KTE process in actionFollowing the identification of the OT EIs, the SteeringGroup planned an event to bring this new grouptogether to better understand the challenges and pri-orities for research exchange and transfer. The steps

related to the initial OT EI event are offered here todemonstrate the dynamic evolution of the networkthat emerged to mobilize evi-dence in this area of practice. TheOT EI inaugural event involved apresentation of the IWH systemat-ic review on effective workplace-based return-to-work (RTW) inter-ventions (Franche et al., 2005,MacEachen et al., 2006) and thesubsequent Seven Principles forSuccessful Return toWork (IWH,2005). Through dialogue andreflection the occupational thera-pists decided that the seven prin-ciples were relevant and useful totheir work in workplaces. Theyidentified the need to create a toolthat would help them engageemployers about implementingthe principles.

From here a number ofefforts began in parallel including:the transfer of evidence to anoccupational therapy specificpractice tool, the evaluation ofoutcomes and the feedback ofoccupational therapy research pri-orities. A subgroup of OT EIsworked with a member of theSteering Group and IWH to devel-op an evidence-informed practiceresource tool. The teammetthroughout 2007 and thenlaunched the booklet titled“Working Together” to the entireOT EI network. Information on thistool will be located on the OSOTwebsite and the IWH website.

The OSOTWork PracticeTeam developed an educationalresource support guide toenhance the usefulness and movement ofWorkingTogether to clinicians in the field. This occupationaltherapy specific guide will be available on the OSOTwebsite. It is composed of the “Working Together”booklet with embedded links to relevant occupationaltherapy resources.

The second parallel effort lead by the OT EISteering Group was the development of a frameworkfor evaluation of the network efforts and outcomes.


About the authors –KathyMacDonaldMT, BSc,MLIS Formerly KnowledgeTransfer Associate; InstituteforWork&Health.Currently OptometryLiaison Librarian,UniversityofWaterloo.Lynn Shaw, PhD.OT Reg(Ont) Assistant Professor,School of OccupationalTherapy, Faculty of HealthSciences,University ofWesternOntario, London,ON. [email protected] Brenchley, B.Sc.OT,OT Reg (Ont), ExecutiveDirector,Ontario Society ofOccupationalTherapistsRosemaryM. Lysaght,Assistant Professor, Schoolof RehabilitationTherapy,Queen's University,Kingston,ONSusan Rappolt, PhD,OT Reg(Ont),Associate Professor,Department ofOccupational Science andOccupationalTherapy,University ofToronto,Toronto,ONElinor Larney,MHSc,OTReg (Ont),Deputy Registrar,COTO,Toronto,ONRhoda Reardon, EducationCoordinator, ActingManager,Research andEvaluation,QualityManagement Division,College of Physicians andSurgeons of Ontario


Information gleaned through the evaluation of thenetwork will be used to establish the benefits of thisprocess. The evaluation of the KTE process is essentialto work practice, but will also be of interest to otherareas of practice. It is our goal that the lessonslearned through evaluating our outcomes will serveto generate innovations in KTE in other areas ofCanadian occupational therapy practice.

In the future, other opportunities to move newknowledge into practice will be the ongoing responsi-bility of the Steering Group. Regular communicationand planning of events for the OT EI network develop-ment are ongoing. For example, the Steering Group isconsidering using the provincial conference as a timeto hold events for OT EIs.Webinars are also beingused to include those OT EIs for whom distance ortime restrictions impedes participation.

References:Craik, J., & Rappolt, S. (2003). Theory of research utilization

enhancement: A model for occupational therapy.Canadian Journal of Occupational Therapy, 70, 266-275.

Franche R-L, Cullen K, Clarke J, Irvin E, Sinclair S, Frank J. et al.(2005).Workplace-based return-to-work interventions: Asystematic review of the quantitative literature. Journalof Occupational Rehabilitation, 15, 607-631.

MacEachen E, Clarke J, Franche R-L, Irvin E. (2006). The process ofreturn to work after injury: findings of a systematicreview of qualitative studies. Scandinavian Journal ofWork, Environmental & Health, 32, 257-269.

Hiss, RG., Macdonald, R., & Davis,WR.; (1978) Identification ofPhysician Educational Influentials in Small CommunityHospitals, Research in Medical Education:Proceedings of the 1978 annual Conference. Conferenceon Research in Medical Education. 17, 283-288.

Institute forWork & Health. Seven ‘principles’ for successfulreturn to work. Institute forWork & Health [online doc-ument] 2005 – updated 2007 March [cited 2007 May2]: [8 screens]. Available from: URL:http://www.iwh.on.ca/assets/pdf/rtw_7_principles_rev.pdf.

Lavis, JN.,Ross, SE., McLeod, C., & Gildiner, A. (2003). Measuringthe impact of health research. Journal of Health Services& Research Policy, 8,165-170.

Lavis, J., Robertson, D.,Woodside, JM., McLeod, CB., & Abelson, J.(2003). How can research organizations more effectivelytransfer research knowledge on decision making?Milbank Quarterly, 80,179-358.

Capturing occupational knowledge:Enabling powerful outcomes for ourclients

Jane A. Davis and Helene J. Polatajko

As the editors of the Sense of Doing columnwe areparticularly pleased that this issue of OccupationalTherapy Now is focused on knowledge: its exchangeand its translation, as that is the raison d’être of thiscolumn. Focused on people’s daily ‘doings’ from theoutset this column has offered occupational therapistsa place to exchange knowledge about human occupa-tion and practices which translate that knowledge intobetter outcomes for clients.We take this opportunity topresent an overview of four major knowledge perspec-tives that the 26 articles published in this column overthe past five years have afforded you. First, by sharingthe personal stories of colleagues,we highlight the per-spective that reflection on our own occupational expe-riences can offer an important source for understand-ing occupation. Second, by sharing the occupational

stories of clients,we highlight the perspective that ourclients too are, first and foremost, occupational beings.Third, by sharing colleagues’ reflections on the occupa-tional nature of their clients,we highlight how such aperspective can result in important shifts to occupa-tion-based practice. Finally, by sharing examples ofoccupation-based practice,we highlight the perspec-tive that an occupational focus can produce signifi-cantly better outcomes for our clients.

I Personal reflection as sources for under-standing occupationOne focus of the Sense of Doing column has been toillustrate the occupational stories of occupational ther-apists. In these stories colleagues have described theiroccupational challenges and shared their reflections

SENSE OF DOING

Column Editors: Helene J. Polatajko andJane A. Davis


on meeting and overcoming these challenges. LindaDel Fabro Smith (2005) wrote about her motherhoodexperiences and how she struggled with defining herrole as mother. She made sense of her doing by invok-ing the metaphor of conductor with the family asorchestra; her role was to decide which orchestral sec-tions were important at which time. She challenged allmothers,with and without disabilities, to come topeace with the nature of their occupational lives,allowing their lives to change as needed, just as musi-cal pieces require orchestras to change. Heather Moyse(2006) conveyed a different occupational challenge:not one that was imposed upon her, but one she choseherself, by setting an Olympic medal as a personal goal.She wrote about the constant challenge of having toperform better and better with each successive race, asher bobsleigh teammoved closer and closer to theOlympic medal. She shared how she was able to con-stantly refocus on this ever-increasing challenge.Colleen McCain (2004) found herself challenged byhealthcare system barriers making it difficult for her tobe the client-centred, occupation-based therapist shewanted to be. She spoke of how she rediscoveredmeaning in her choice to be an occupational therapistby speaking with others who had faced challenges intheir practice. She realized that regardless of the occu-pational challenges she will face, she would have suc-cesses and opportunities to enable her clients to strivetowards their occupational potential.

Together these stories highlight that everyone,not only our clients, faces occupational challenges. Allmanner of life situations present occupational chal-lenges and there are numerous ways of coping!

II Our clients’ occupational storiesSimilar to our colleagues, our clients have occupationalstories. As therapists we need to know how to ‘hear’our clients’ stories to understand how to enable them.Bice Amoroso and her students (2004) shared with ushow observation can be a key to understanding theoccupational interests of clients with significant cogni-tive andmental health challenges. Noticing a client’slove of books Bice and her students engaged Tom inassembling a book of his interests, thereby expressinghis occupational interests to others.When Tom pre-sented his book at a teammeeting, the attendees, forthe first time, saw him as having accomplishments andpotential. Katie Lee and Anne Fourt (2005) engagedtheir client, Claire, in a discussion about her occupa-tional life history to explore the meaning she attachedto her previous employment. Through a process of

occupational reflection, Claire came to realize themeanings she attributed to mothering,maintaining afunctional home, and engaging in creative occupa-tions. This enabled Claire to reconstruct her occupa-tional life and attain a steadier occupational trajectoryby balancing the occupations which held the mostmeaning and purpose for her.Marie Gage (2003) toldthe story of Jennifer andWilburand highlighted the interdepend-ence of their occupational lives.Following amassive stroke,Jennifer, 72, required a lot of sup-port to meet her daily occupationalneeds andWilbur, 75, insisted onproviding the support. They had avery close and caring relationship;Wilbur needed to care for Jenniferand the therapist needed to enableWilbur to do so to ensure both hiswell-being and that of his wife.

Together these stories pointto the importance of being open tothe rich occupational lives of ourclients. Observation and conversa-tion can be valuable tools in uncov-ering knowledge about occupation,the purpose andmeaning of which is unique to eachof our clients.

III Understanding the occupational natureof our clients as a source for a shift to occu-pation-based practiceMarie Gage (2003) changed her approach to Jenniferbecause she wanted to accommodate the occupationalinterdependency of her client and spouse. She realizedthat “being independent in self-care is not always thegoal ... Enabling people to engage in occupations thatare personally meaningful is the true focus of the workof occupational therapy” (p. 37). By sharing this storyMarie showed us how an occupational focus canchange our practice. Jill Stier (2004) had a similar mes-sage. She described how considering the occupationalneeds of Dr. Ames, a dentist, and enabling her to per-form the tasks required in her dental practice and inmothering her infant, changed her approach to splint-ing. Instead of constructing a typical wrist thumbsplint for a painful joint, Jill designed two differentfunctional splints to enable performance. If the focushad only been on relieving pain and stabilizing theinjury, the splint would have become a barrier to Dr.Ames occupation.

About the authors –Jane Davis,MSc,OT Reg.(Ont) is a lecturer in theDepartment ofOccupational Science andOccupationalTherapy attheUniversity ofToronto.Jane can be reached [email protected] Polatajko, Phd,OTReg. (Ont), FCAOT is aProfessor in theDepartment ofOccupational Science andOccupationalTherapy attheUniversity ofToronto.Helene can be reached [email protected]

Through exploring the occupational story of hermother during her final years of life, Cynthia Perlman(2004) discovered that engagement in occupations,even the simplest ones, can lead to self-actualizationand the development of one’s capacity for life and liv-ing, as well as for illness and life completion. Cynthiawrote about the power of choice making and control ineveryday activities as a way of promoting health. Byreflecting on the occupational nature of a nativewoman in her early 20s, Kathy Hatchard (2005) wasable to discover the importance of ‘sense of place’ tooccupational performance (p. 7). Knowledge of herclient’s occupational life allowed Kathy to realize whenher client had achieved a fit between her occupationalneeds and environmental resources, enabling her clientto find her way and proceed on her own.

Together these clinical stories show us how anoccupational perspective can produce practicechanges. Some stories highlighted small shifts in theway therapists did things while others offered insightsinto how changes are made in overall practice to fitwith the new knowledge gained from our clients.

IV Occupation-based practice as a source ofsuccessAnn Zilberbrant and Angela Mandich (2005) showed ushow occupation-based practice enabled Roger, 10, notonly to reach his goal of learning to ride his bike butalso yielded numerous secondary gains such as newsocial opportunities. Similarly, Susan Yee (2007) illus-trated the power of occupation through her work withDaphne, a backyard gardener,who gradually lost herability to garden due to both physical andmentalhealth issues.Working with Susan, Daphne found away to re-engage in gardening by planning her gardendesign and directing others to do the heavier work. Byaccepting this occupational interdependence, Daphneregained a sense of control over her garden and home,and restored some of the occupational identity thatshe had lost due to her health issues.

On a student placement at St. George House, ahome for individuals with mental health issues andintellectual disabilities,Melissa Heidebrecht andMelissa Monardo (2007) also experienced the power ofan occupational approach.Through the formation ofgroups focused on active participation the residentsdeveloped a sense of purpose, enjoyment and structurefor each day, established relationships with each otherand appeared to form a sense of community andbelonging.Through engaging in a group occupation,Maggie,who had previously remained isolated in her

room, began to integrate better into the home, con-struct an occupational routine and establish relation-ships around a commonly enjoyed leisure occupation.

An occupation-based practice can have far reach-ing effects. As Marie Gage (2003) described, coordinat-ing the occupational re-engagement of Jeffrey Pinney, a55-year-old artist with a neurologically degenerativedisease helped to alleviate his depression. Jill Stier andher father, Harold Smordin, (2008) wrote about howengaging in a group exercise program at a local gymled its members to achieve unexpected positive healthoutcomes that went well beyond the physical benefitsof exercise.

Together these four perspectives show thatknowledge about occupation can be gleaned from our-selves and our clients and that the translation of thisoccupational knowledge into our practice can trans-form it and enable powerful outcomes for our clients.To quote Marie Gage “When we enable our clients todo the occupations that bring meaning and purpose totheir lives, … we are ‘giving them back their life’ andbringingmeaning to our own occupation” (Gage, 2003,p. 37).

ReferencesAmoroso, B., Dharamshi, R., & Lee, K. (2004).What our clients

teach us: Uncovering meaningful occupation.OT Now,6(1), 10-12.

Del Fabro Smith, L. (2005). Mothering with a disability: Listeningand learning. OT Now, 7(3), 19-21.

Gage,M. (2003). Sense of doing – The impact of occupationalrestoration in the home.OT Now, 5(5), 35-37.

Hatchard, K. (2005). A sense of place.OT Now, 7(4), 6-8.Heidebrecht,M., &Monardo,M. (2007). Redefining occupations

for individuals living with a mental illness.OT Now, 9(2),15-17.

Lee, K., & Fourt, A., (2005). Deriving occupational meaning andbalance:The story of Claire.OT Now, 7(6), 8-10.

McCain, C. (2004). A student occupational therapist’s journey:Discovering meaning in my chosen occupation.OT Now,6(2), 7-9.

Moyse, H. (2006). Pushing the boundaries: Occupational chal-lenges and the drive to reach potential.OT Now, 8(3), 5-6.

Perlman, C. (2004). An achievement of doing, being and becom-ing: Lessons frommymother.OT Now, 6(6), 13-14.

Stier, J. (2004). Occupation-based splinting.OT Now, 6(4), 19-21.Stier, J. & Smordin, H. (2008). Sid’s group:The power and signifi-

cance of occupation in the lives of older adults.OT Now,10(2), 23-25.

Yee, S. (2007). Re-capturing an important piece of self throughleisure occupations.OT Now, 9(1), 11-13.

Zilberbrant, A., & Mandich, A. (2005). Enabling a sense of doing inchildren.OT Now, 7(2), 19-21.



Evidence-based practice (EBP) can enhance health andis valued by clinicians. Rehabilitation practitioners inCanada have consistently reported that finding andevaluating relevant research information is one of thelargest barriers to practicing EBP (McClusky, 2003).Novel push-out electronic knowledge translation (KT)strategies that deliver high quality information direct-ly to the practice community have the potential toreduce this barrier and make EBP more accessible tothe practicing clinician (Ho, Chockalingam, Best, &Walsh, 2003).

KT is a rapidly evolving field yet high-quality evi-dence on the most effective KT is lacking. In particu-lar, Technology Enabled Knowledge Translation (TEKT),information and communication technology, is at thecutting edge of innovation in KT and requires morerigorous evaluation. Using technology as “a vehicle forKT may be extremely useful because it can:

• assist practitioners with access and uptake ofinformation

• improve the uptake of research in policy makingsince it speeds up the knowledge transferprocess

• facilitate the transfer of public data (e.g. nation-al health surveys) to policy makers more quickly

• support communities of practice where groupsshare knowledge and information regarding aspecific topic(s) of interest” (Law & Telford, 2007,p. 303).There is no doubt that TEKT will be embedded in

the future of clinical practice and it is therefore imper-ative that TEKT strategies be evaluated using a multi-dimensional evaluation framework.

A technology-enabled system for movingresearch knowledge into rehabilitation prac-tice:The McMaster PLUS Rehabilitation service (MacPLUSREHAB) is a customized, personalized, evidence-based,alerting and look-up service that is designed to maxi-mize uptake of new knowledge. It is based on thephysician version, called MacPLUS, implemented byMcMaster’s Health Information Research Unit (HIRU).Over the past decade, the HIRU has pioneered and

perfected the development of resources for evidence-based clinical practice. These activities have includedtechniques for finding, assessing (for quality and con-tent), organizing, summarizing, and disseminatingbest evidence as it is published in the medical litera-ture (Haynes &Wilczynski, 2005). Using innovations in“push-out” and user-interface technology MacPLUSREHAB will deliver new and relevant research findingsto rehabilitation practitioners.

The purpose of this project is to evaluatewhether the availability of MacPLUS REHAB will resultin more effective KT within rehabilitation practiceacross Canada and identify the barriers,mediatorsand facilitators that modulate this KT process.

How the MacPLUS REHAB project will work:Practitioners will receive an online tutorial aboutusing MacPLUS REHAB and will have access for aperiod of one year. The service will be offered free ofcharge to 1,000 practicing occupational therapists andphysiotherapists in Canada.MacPLUS REHAB will pro-vide the following services:

• a cumulative searchable database of quality-andrelevance-rated rehabilitation publications and aweb site that is continuously updated

• a customized user interface allowing identifica-tion of the rehabilitation interests of each userand matching those interests to the appropriate“virtual” subset of the accumulating database

• e-mail alerts about new evidence, tailored to theuser’s interest profile

• web links to product and client information forintervention

• stored search strategies for MEDLINE to supple-ment searches in the cumulated MacPLUSREHAB database when needed

• assistance for users to develop effective localinformation systems that match their needsprecisely with the supply of current bestevidence for clinical practice.Through an individually linked interface, clini-

cians can log on to MacPLUS REHAB to register theirpractice profile. This profile would serve as a filter tothe rehabilitation literature within MacPLUS REHAB.

Facilitating knowledge transfer through theMcMaster PLUS REHAB Project: Linking rehabilitationpractitioners to new and relevant research findings

Mary Law, Joy MacDermid, Brenda Vrkljan and Jessica Telford

The enhanced system would identify key, high qualityarticles of relevance.

MacPLUS REHAB differs from other informationdelivery services by specifically addressing the barriersthat prevent the timely translation of research find-ings into patient benefit as it:

1) separates high quality information from litera-ture less relevant to practice,

2) provides practitioner specific information,3) integrates the delivery of health information,

and includes appropriate linkswhich highlight the cumulativenature of evidence, and,4) addresses rehab practition-ers’ concerns that they lack skillsand expertise to appraise newscientific papers.

Work to date and how youcan get involved:The MacPLUS REHAB system hasnow been fully developed and theresearchers are seeking funds toevaluate the design and its use byrehabilitation practitioners.

In the meantime, we haveteamed up with McMasterUniversity’s HIRU to expandBMJupdates+ to include ratingsof both relevance and interest byclinical occupational therapists,physical therapists and clinicalpractice leaders. BMJupdates+ is“a searchable database of thebest evidence from the literature,pre-rated for methodologicalquality, and then rated for clinicalrelevance and interest by at least3 members of a worldwide panelof practicing physicians, thatsends the user e-mail alerts andsearching access to literaturematched to your clinical inter-

ests” (www.bmjupdates.com).We are recruiting occupational therapists and

physiotherapists as raters to assess the clinical rele-vance of high quality, hot-off-the-press studies in theirown primary practice area. Feedback from rehabilita-tion raters has been very positive. If you would like tojoin us as a rater or just receive more information,please contact us at [email protected].

Conclusions:This project will develop and evaluate the effect ofMacPLUS REHAB, a push-out technology in improvingthe uptake and use of evidence-based knowledge inrehabilitation. The project builds on the innovationsof MacPLUS to create a rehabilitation version to pro-vide evidence tightly tailored to the interests of indi-vidual rehabilitation practitioners.

This project will also provide novel informationon the barriers,mediators, and facilitators of TEKT thatcan be generalized across rehabilitation serviceproviders. In addition, this project will contribute toour understanding of how rehabilitation practitionersmanage and adapt to change in the professional envi-ronment to keep up with the innovations in their area.

The MacPLUS REHAB service will make EBP acces-sible to practitioners by individualizing search andalerts, providing a credibly rated and trustworthy sys-tem of relevant articles and saving many valuablesearch and evaluation hours.

References:Bowen, S., Martens, P., & Crockett, S. (2005). Demystifying knowl-

edge translation: Learning from the community. Journalof Health Services & Research Policy, 10(4), 203-211.

Haynes, R. B., Holland, J., Cotoi, C., McKinlay, R. J.,Wilczynski, N. L.,Walters, L. A., et al. (2006). McMaster PLUS: A cluster ran-domized clinical trial of an intervention to accelerateclinical use of evidence-based information from digitallibraries. Journal of the American Medical InformaticsAssociation, 13(6), 593-600.

Haynes, R. B., &Wilczynski, N. (2005). Finding the gold in MED-LINE: Clinical queries. ACP Journal Club, 142(1), A8-9.

Ho, K., Chockalingam, A., Best, A., &Walsh, G. (2003). Technology-enabled knowledge translation: Building a frameworkfor collaboration. CMAJ: Canadian Medical AssociationJournal, 168(6), 710-711.

Law,M. & Telford, J. (2007). Knowledge Transfer and Exchange. InM. Law and J. MacDermid (Eds). Evidence-basedRehabilitation: A Guide to Practice (2nd Edition).Thorafore, NJ: Slack Inc.

Maher, C.G., Sherrington, C., Elkins,M. Herbert, R.D., & MoselyA.M. (2004). Challenges for evidence-based physicaltherapy: Accessing and interpreting high-quality evi-dence on therapy. Physical Therapy, 84, 644-654.

McCluskey, A. (2003). Occupational therapists report a low levelof knowledge, skill and involvement in evidence-basedpractice. Australian Occupational Therapy Journal, 50(1),3-12.

McCluskey, A., & Lovarini,M. (2005). Providing education on evi-dence-based practice improved knowledge but did notchange behaviour: A before and after study. BMCMedicalEducation, 5, 40.

14 occupational therapy now volume 10.5

About the authors –Mary Law, PhD,OT Reg(Ont), FCAT, FCAHS isProfessor and AssociateDean (Health Sciences)Rehabilitation Science andCo-Founder of CanChildCentre for ChildhoodDisability Research atMcMaster University.JoyMacDermid, PT, PhD,Associate Professor inRehabilitation Science atMcMaster University andCo-Director of ClinicalResearch at theHand andUpper LimbCentre inLondon,ON.BrendaVrkljan, PhD,OT Reg(Ont) is a junior facultymember atMcMasterwithexperience in technologyuse in rehabilitation andmember of theOntarioSociety of OccupationalTherapists Evidence-BaseTask Force.JessicaTelford, BA, is aResearch Assistant/CoordinatorwithinCanChild Centre forChildhoodDisabilityResearch and the School ofRehabilitation Science atMcMaster University.

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Translating knowledge from workshops and confer-ences into practice can be challenging, with barriersat the individual and systems levels. The purpose ofthis article is to share some strategies that we haveused to incorporate the Assessment of Motor andProcess Skills (AMPS) (www.ampsintl.com) into ourclinical practices.

The AMPS is an occupational therapy specific,standardized observational evaluation tool used toevaluate the quality of clients motor and processskills when performing activities of daily living (ADL).The quality of clients’ performance is rated by trainedand calibrated occupational therapists according tothe effort, efficiency, safety, and independencedemonstrated when the clients perform 16 motor and20 process skills. The AMPS can be used to assess theADL abilities of clients over the developmental age ofthree years, regardless of gender, diagnosis or culturalbackground, as long as there is a concern about ADLperformance.

Nine years ago,many of the occupational thera-pists in the Mental Health Division of Capital DistrictHealth Authority in Halifax, Nova Scotia completedthe AMPS training and calibration process.We decid-ed to become trained and calibrated AMPS raters in

order to upgrade and have access to a valid and reli-able evaluation tool. By incorporating the AMPS, ourpractices changed from focusing on clients’ perform-ance impairments to examining the strengths andlimitations of clients’ occupational performance.Webelieve this focus reflects the expertise of occupation-al therapists and more accurately reflects the ‘reallife’ concerns of clients. As we began to ‘own’ this newidentity, our ability to clearly articulate to teammem-bers the role that we can play in assessing and inter-vening with our clients improved greatly. However,

before we reached this level of confidence we had totranslate what we had learned during the AMPStraining course into our practices.

We did this by using a number of strategiesincluding: (a) developing a support network; (b) beingpersistent; (c) using support mechanisms of the AMPSProject International; (d) educating teammembers onthe value of what we learn about clients when wecomplete an AMPS evaluation; and (e) taking advan-tage of continuing education opportunities.Whatfollows is a discussion of each strategy in more detail.

The advantage of having a number of us withinthe same workplace complete our AMPS training at thesame timemeant that we could more easily establish apeer support network.We shared our challenges, suc-cesses, and howwe overcame obstacles as we shiftedthe focus of our assessments and ultimately, our prac-tices.We reviewed and critiqued each other’s assess-ment reports to learn how to clearly document andinterpret our clients’ performance using the AMPS. Peersupport meetings were organized where we had theopportunity to discuss our experiences in using theAMPS and learn from each others’ experiences in agroup format. The success of these peer support meet-ings lies in having one person assume responsibility forarranging the meetings, sending out reminder noticesand chairing the meetings.

We highly value the AMPS as it enables us togenerate valid and reliable estimates of clients’ ADLperformances that can be used to predict clients’needs for support and plan intervention. This value ofthe AMPS helped us to maintain our motivation andability to persevere even when we encountered chal-lenges, particularly when we first began to use theAMPS.We found the more routinely we used theAMPS and the more time we took to reflect on thefindings, the more proficient we became in adminis-tering and interpreting the findings.

Another strategy that we have adopted hasbeen to use available resources. During the AMPStraining courses, occupational therapists becomefamiliar with their AMPS manuals as sections of themanual are studied in detail. Our ongoing success inincorporating the AMPS into our practices is reflected

Implementing knowledge translation strategies: Integratingthe Assessment of Motor and Process Skills into practice

Karla Moore and Norma Lewis

“The advantage of having a number of us within thesame workplace complete our AMPS training at the sametime meant that we could more easily establish a peersupport network. We shared our challenges, successes, andhow we overcame obstacles as we shifted the focus of ourassessments and ultimately, our practices.“

disciplinary staff of the Mental Health Division toeducate teammembers and managers on the valueof the AMPS and thus earning their support for us touse the AMPS. For example, during a workshop thatincluded presentations on Position EmissionTomography (PET) scans and neuropsychological tests,two occupational therapists presented a case study inwhich the AMPS was used to measure occupationalperformance. They were able to highlight that theAMPS can generate valid and reliable measures ofoccupational performance.

Taking advantage of continuing education oppor-tunities at local and national conferences where prac-tice implications and research related to the AMPS areshared has also been beneficial.We benefited greatlyfrom attending the 2008 International AMPSSymposium: Measuring, Planning and ImplementingOccupation-based Programs and as well as the pre-conference workshop Knowledge Translation whichwas held in Halifax this summer. The symposiumincluded presentations related to new evidence thatsupports the validity, reliability, and utility of the AMPSand the School AMPS, as well as the development ofother assessments such as the Evaluation of SocialInteraction Skills.

While we have shared our perspectives as occu-pational therapists working in a mental health set-ting, we believe the strategies that we have used tointegrate the AMPS into our practices are applicableto integrating it into other practice settings, and tointegrating other evaluation tools or interventiontechniques into practice.

in the fact that we continue to refer to our ‘dog-eared’ AMPS administration manual for guidancedespite using the AMPS for several years. The AMPS

manuals have undergone sever-al revisions and these revisions,in large measure, have beenmade to address the ‘real life’challenges occupational thera-pists have described whenusing the AMPS. In our experi-ence, reading the administra-tion manual not only savestime, but reduces frustration.

Contact with the AMPSfaculty and AMPS ProjectInternational staff has also beena valuable strategy that hasenabled us to integrate thisnew tool into practice. At most

AMPS training workshops, faculty members provideparticipants with their contact information. Some ofour colleagues have contacted faculty who were ableto answer questions about administering, scoring orinterpreting AMPS evaluations. The website main-tained by the AMPS Project International is also asource of useful information.The website includes aforumwhere occupational therapists can post ques-tions that will be answered by the AMPS ProjectInternational and a reference list of AMPS articles thatis regularly updated.

Over the years, we and other occupationaltherapists have given presentations to the multi-

About the authors –KarlaMoore,OT Reg (NS)is an occupational therapistat Bedford/SackvilleMentalServices in Lower Sackville,N.S. She canbe contacted at:[email protected] Lewis,OT Reg (NS)is an occupational therapistat Connections ClubhouseinHalifax,N.S. She can becontacted at:[email protected]


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In the fall of 2006, the authors were hired by theCanadian Psychiatric Research Foundation (CPRF) tocoordinate their knowledge translation (KT) project;"When Something'sWrong -Strategies for theWorkplace". The goal of the project was to producean evidence-based handbook for employers on howto address mental illness in the workplace. At thetime we were hired for the project, Sandra was a doc-toral candidate studying mental illness in the work-place, and Erika ran her own private practice with anemphasis on occupational mental health. As occupa-tional therapists, we felt that we had the knowledgeand skills regarding workplace mental health andpartnership development that would be a goodmatch for the project. Thus began our year-longadventure in KT! The purpose of this paper is to illus-trate the ways in which we engaged in an activeprocess of KT to produce an evidence-based hand-book that is being utilized by employers across thecountry.

CPRF is a national charitable organization whichraises and distributes funds for psychiatric researchand awareness in Canada. In order to facilitate effec-tive KT and to create more awareness of the organiza-tion’s work, CPRF has created a series of handbooksfor the general public on how to identify, cope, andfind help for those who may be experiencing a men-tal disorder. The first book in the series was designedfor families/parents, the second for teachers, and theplan was to develop a third handbook for employers.

The purpose of the third handbook was to pro-vide employers with evidence-based tools for learningabout and managing employees who may be dealingwith mental health problems in the workplace. Thehandbook would then be augmented through train-ing workshops for employers. A workplace project

committee, formed to oversee the project, was com-prised of over 25 stakeholders including serviceproviders, employers, and mental health consumers.

One of the fundamental principles guiding theproject was a commitment to an interactive processof KT. According to the Canadian Institutes of HealthResearch (2004), KT refers to “the exchange, synthesisand ethically-sound application of knowledge - with-in a complex system of interactions amongresearchers and users - to accelerate the capture ofbenefits of research for Canadians…” Rather than atraditional approach whereby researchers transmitinformation to passive recipients, we incorporatedemployers and other potential stakeholders as activepartners in all stages of issue identification, knowl-edge production and evaluation. Interactive strategiessuch as early stakeholder involvement increases therelevance of the information and likelihood that itwill be adopted (Davis et al., 2003). Figure 1 illustratesthe key stakeholders that were involved as partners inKT throughout the project.

Workplace mental health: Developing anemployer resource through partnerships inknowledge translation

Sandra Moll and Erika Pond Clements

"This is a fine piece of work. … It will make a very signifi-cant contribution to the growth and development of aknowledge base in the field.”Bill Wilkerson, Co-Founder and CEO, Global Business andEconomic Roundtable on Addiction and Mental Health

Employees withmental health issues

EXCHANGE

Occ health & disabilitymanagement providers

Managers

Unions Human Resourcepersonnel

Researchers andeducators

HealthcareProfessionals

Insurers

APPLICATION DEVELOPMENT

Figure 1 - Stakeholder Involvement

roles/responsibilities of employers versus employees,difficulty accessing and coordinating services, chal-lenges with accommodation and return to work, andunsupportive, stressful work environments. Chaptersin the handbook were therefore designed to reflect

each of the identified knowledge gaps:Making thebusiness case; Recognizing and addressing mentalhealth problems; Accessing services; Managing dis-ability leave and return to work; Providing workplaceaccommodations; Creating healthy workplaces; and,Signs, symptoms & interventions.

Steps two and three of handbook developmentinvolved searching for and appraising evidence toaddress each of the identified issues. Sources of evi-dence included research (published studies), practice(expert opinion and experience), and policy (legisla-tion and legal guidelines). Since research in the fieldis only starting to emerge, it was difficult to find highquality evidence regarding workers with mentalhealth issues. Research conducted with other popula-tions (e.g. workers with pain or musculoskeletal con-ditions) was therefore reviewed and appraised interms of its relevance. In addition, input was soughtfrom experts in the field who have addressed theseissues in practice (e.g. disability managers, occupa-tional psychiatrists, employees), and with researcherswhose findings had not yet been published. Policyissues were also important to consider, particularlywith respect to providing workplace accommodation.Labour lawyers were involved in development of theaccommodation and return to work sections of thehandbook, with references to feder-al/provincial/territorial human rights commissionsand legislation. "Valid" knowledge therefore emergedfrom a variety of sources.

Steps four and five of the handbook develop-ment included understanding stakeholder expecta-tions and integrating their perspective with researchevidence. Initial drafts of each chapter were sent toat least one representative from each of the eightstakeholder groups for feedback. Revised drafts werethen reviewed by members of the steering commit-tee. Since committee members represented a rangeof stakeholders, meetings were often lively debatesabout the content of the handbook. When disagree-

The process of developing the handbook unfold-ed in stages. Two student occupational therapistswho participated in the project adapted theIntegrated Model of Evidence Based Practice©(Dematteo & Law, 2005) as a way of conceptualizingthe different stages in handbook development (seeFigure 2).

Step one involved identifying key issues or ques-tions that needed to be addressed in the handbook.In the fall of 2006, a focus group meeting was heldwith over 70 stakeholders who had an interest inworkplace mental health. Participants included a mix

of representatives from humanresource departments, occupa-tional health, disability man-agers/EAP providers, managersor supervisors and consumersof mental health services.Businesses represented includ-ed municipal service providers(e.g. police, transit commission),health care providers (large &mid-sized hospitals as well ascommunity based programs),the educational system (schoolboards and post-secondaryinstitutions), and large andmid-sized retail and manufac-turing businesses. Key issues orchallenges identified by focusgroup participants included;

stigma and skepticism regarding the legitimacy ofmental health problems, lack of clarity regarding


About the authors –SandraMoll is anAssistant Professor in theSchool of RehabilitationScience atMcMasterUniversity and a PhDCandidate in Public HealthSciences at theUniversity ofToronto. She can be [email protected] Pond Clements is aRegisteredOT and CertifiedDisabilityManagementProfessional in private prac-tice (www.workmatters.ca)in Kitchener,Ontario. Shecan be reached [email protected]

"I got the handbook in the mail last night. It looks fantas-tic. It’s very comprehensive and user friendly. Let's hopethat companies pick it up and begin to use it. Well done!!"Jocelyn Cowls, an occupational therapist from Ontario

Figure 2 -Model of Handbook Development*


Acknowledgements:We would like to acknowledge the support of the primary fun-ders of this project: the Frank Cowan Foundation and CanadaPost Corporation. Thanks also to Lisa Cosentino and Julia Harris,the student occupational therapists who contributed to hand-book development as part of their Evidence-Based Practiceproject.

Funding from sale of the handbook will be usedto support psychiatric research in Canada. To order acopy of the handbook, "When Something'sWrong -Strategies for theWorkplace", see www.cprf.ca.

ReferencesArmstrong, R.,Waters, E., Roberts, H., Oliver, S., & Popay, J. (2006).

The role and theoretical evolution of knowledge transla-tion and exchange in public health. Journal of PublicHealth, 28(4) , 384-389.

Canadian Institute of Health Research. (2005). Knowledge trans-lation strategy 2004-2009: Innovation in action. Ottawa,ON: Author. Retrieved May 14, 2007 fromhttp://www.cihr-irsc.gc.ca/e/26574.html#defining

Davis, D., Evans, M., Jada, A., Perrier, L., Rath, D., Ryan, D., Sibbald,G., Straus, S., Rappolt, S.,Wowk,M. & Zwarenstein, M.(2003). The case for knowledge translation: shorteningthe journey from evidence to effect. British MedicalJournal, 327, 33-35.

Dematteo, C. & Law,M. (2005). An integrated model of EBP andOPPM. Hamilton:McMaster University.

ment arose, all perspectives were considered in mak-ing revisions. Feedback and discussion was helpful inidentifying how the information could be interpretedby others.

The sixth step in the process was handbook pro-duction. One of the key steps at this stage was tohave the handbook reviewed by professional editors.After reviewing submissions from several editors, weopted for an editing team who had experience withpublications aimed at our target market. Use ofquotes, text boxes, colour and bullet points signifi-cantly added to the impact and readability of thefinal product.

The seventh and eighth steps are now under-way. CPRF has posted a handbook evaluation on thewebsite and end-users are invited to provide feedbackon such areas as the quality, ease of use, and rele-vance of the information.Workshops that focus onintegrating evidence into practice are currently in theprocess of being developed.

Key learningOne of the greatest strengths and challenges of thisproject was the collaborative process of knowledgeexchange. We engaged in a dialogue with diversestakeholders who had different perspectives, agendas,and even language for discussing issues.Communication challenges that we experienced werenot unlike those in the field of workplace mentalhealth.

Identifying and addressing areas of controversyand misunderstanding was critical to the relevanceand acceptability of the final product. It should benoted, however, that handbooks are static end prod-ucts, whereas knowledge is a "changing set of under-standings shaped by those who both generate anduse research" (Amstrong et al., 2006, p.385). Thehandbook is only one element of an overall process ofKT; customized workshops are needed.

Overall, it was extremely exciting to walk into aproject with funding and infrastructure in place, aswell as a committed steering committee. We wereable to bring an occupational therapy approach(addressing worker, workplace and work) to the table.We wanted to ensure that employers did not focus ondiagnosis, but rather on collaborative problem solvingand enabling function.With the support of a strongcommittee and executive director, we were able topull together a product that has been well receivedby leaders across the country in workplace mentalhealth.

Benefits of CIHI information foroccupational therapistsClinical occupational therapists can benefit fromusing standardized assessment instruments for clini-cal decision-making. For example, in teammeetings,occupational therapists can discuss and compare thefunction scores of various clients and determinetreatment planning based on these discussions.Clinical instruments and tools provide a standard sys-tem and language to discuss the client’s function forthe entire rehabilitation team. Occupational thera-pists may be interested to know that CIHI is the licen-sor for the FIM™ instrument in Canada. Occupationaltherapists that do not have access to the FIM™ instru-ment within their facilities can access it by contact-ing CIHI.

Occupational therapists that are in roles ofmanagers and decision-makers can use CIHI organi-zational reports to evaluate and support rehabilita-tion program decision-making. CIHI organizationalreports contain detailed information about the pro-file of clients and their functional outcomes (basedon data collected using the FIM™ instrument) by hos-pital/rehabilitation unit. They also contain compari-son data and information regarding peer hospi-tals/rehabilitation units and national averages.Occupational therapy managers can look at thesereports to make decisions regarding the need formore rehabilitation beds, admission criteria, or evenwhether a pilot program has been improving clienttreatment. The Data in Action: Stroke Rehabilitation

Data and information for advancing occupationaltherapy practice

Lori Lennox


The Canadian Institute for Health Information (CIHI)helps facilitate and develop new health care andhealth system knowledge by collecting informationfrom various sources in Canada. Occupational thera-pists can use this knowledge in their practice as clini-cians, managers and researchers.

National health care and health systeminformationThere are several different ways that occupationaltherapists contribute to the collection of data thatare sent to CIHI.

Clinical occupational therapists working in hos-pitals, rehabilitation centres, mental health facilitiesand home and continuing care organizations, inselected jurisdictions, all complete clinical assess-ment instruments as part of their assessment andtreatment of clients. These data and information aresent to CIHI. CIHI uses the FIM™ instrument

1and the

Resident Assessment Instruments (RAI)2as part of

their data collection efforts. These data collectionefforts help provide information on the characteris-tics and demographics of clients along the continu-um of health care at hospital, regional and nationallevels.

Clinical occupational therapists also collectfinancial and statistical workload data on the day-to-day operations of health service organizations. Thisinformation facilitates reporting regarding resourceuse, budget development and more informed man-agement decisions. CIHI provides the standards forthe collection of these data.

Regulatory bodies send data to CIHI to captureinformation on workforce trends, such as migrationpatterns, educational profiles, practice patterns, andthe average age of occupational therapists.

There are also several occupational therapiststhat work at CIHI. They help with adding the clinicalrelevance and expertise to the collection of data, aswell as the analysis and interpretation released inCIHI reports and publications.

1The FIM™ instrument referenced herein is the property of Uniform Data System forMedical Rehabilitation, a division of UB Foundation Activities Inc.

2© Copyright interRAI, 1997, 1999. Modified with permission for Canadian use underlicence to the Canadian Institute for Health Information

Figure 1: Transforming Data from the Front Line into Knowledge


and data-collection tools for the2004 project, which was funded byOntario’s Ministry of Health andLong-Term Care. The resultsinspired the Community CareAccess Centre of SoutheasternOntario to consider continuing thenew type of care for similarclients. These results and those offive similar projects across Ontariowere also considered by a provin-cial panel led by the Heart andStroke Foundation and the OntarioStroke System in the developmentof a provincial set of standards forstroke rehabilitation services.

Advancing occupationaltherapy practiceIn an environment with a range oftreatment options, an aging population, consumerswith heightened expectations, constrained resourcesand increasing complexity of the delivery of healthcare, occupational therapists and all health careproviders are faced with the challenge of providingquality care. They are striving to provide ‘the rightcare, at the right time, for the right person, in theright way’. Data and information can help occupa-tional therapists in this process. The first steptowards achieving this goal is being aware of theinformation available that can be applied into occu-pational therapy practice.

story (below) provides a good example of CIHI datafrom organizational reports (combined with othersources) that has been used for improving client care.

Occupational therapists in other roles withinthe health care system, such as policy-makers andresearchers, can request and use CIHI data. Theymight be interested in answering questions aboutoccupational therapist migration patterns or work-force planning. Research-related questions that helpform best practices and promote quality improve-ment, such as how functional outcomes are affectedby enhanced or extended treatment, could also beanswered using CIHI data.

CIHI public reports of interest to occupa-tional therapists

• Inpatient Rehabilitation in Canada: providesinformation on the characteristics of clients ininpatient rehabilitation, including their averageage, how long they stay and their functionaloutcomes. Go to www.cihi.ca/nrs.

• Workforce Trends of Occupational Therapistsin Canada: provides information on the supplyand distribution of occupational therapistsworking in Canada, including education trends,migration patterns and employment trends. Goto www.cihi.ca, click on data collection, thenhealth human resources.

• Improving the Health of Canadians:Promoting HealthyWeights: features the envi-ronments in which we live, learn, work and playthat make it easier - or harder - for Canadians tomake choices that promote healthy weights. Goto www.cihi.ca/cphi.

Data in actionThe Stroke Rehabilitation Project of SoutheasternOntario used CIHI data to come up with recommen-dations on how to improve community-based reha-bilitation for stroke clients while using resourcesmore effectively. The project found that intense andtimely professional rehabilitation, including occupa-tional therapy, played a critical part in stroke recoveryafter clients were discharged from inpatient rehabili-tation. Clients recovered function faster in the firsttwo months when they had shorter waits and moreintense community rehabilitation, including occupa-tional therapy. Care costs also decreased, as clientswere 50% less likely to be readmitted to hospital andhad shorter stays than those receiving regular com-munity care. CIHI played a key part in providing data

About the author –Lori Lennox, B.Sc.OT Reg.(Ont.),MHALori Lennox startedworkingat CIHI after beginning hermaster’s degree in healthadministration. Followingseveral yearsworking inacute care and the commu-nity, shewas looking tomake a broader impact onthe health care system. Shewas drawn to CIHI becauseof its ability to provide valu-able information to alltypes of health stakeholderstomake decisions forimproving our health sys-tem. Lori currentlyworks inthe strategy,policy and gov-ernance unit at CIHI.

Canadian Institute for HealthInformation (CIHI)The Canadian Institute for Health Information (CIHI) isan independent, not-for-profit organization that pro-vides essential data and analysis on Canada’s healthsystem and the health of Canadians. CIHI tracks data inmany areas, thanks to information supplied by hospi-tals, regional health authorities, regulatory authorities,medical practitioners and governments. Other sourcesprovide further data to help inform CIHI’s in-depth ana-lytic reports.

CIHI is responsible for many databases and reg-istries that capture information across the continuumof health care services and on the health care system inCanada. This information supports research and analy-sis for planning and policy making purposes.

Visit our website at www.cihi.ca!

agement of this chronic condition in primary care.Occupational therapists are in an excellent positionto provide outreach education to primary care physi-cians to assist them in identifying these children

through the occupational therapists’ knowledge ofDCD and related research and their understanding ofthe relationship between motor abilities and func-tion.

A demonstration project was conducted by amultidisciplinary research team in Ottawa, Ontarioutilizing knowledge translation strategies and collab-oration within primary care settings. In this project,occupational therapists:

1) Increased physicians’ awareness and knowledgeof the condition of DCD through the provisionof both general and targeted personalized edu-cation;

2) Supported physicians in the identification anddiagnosis of DCD through outreach educationand collaboration in the assessment process;

3) Facilitated knowledge about appropriate com-munity resources through joint consultationwith parents following the diagnosis of DCD;

4) Provided evidence-based educational materialsthat supported families and increased the fami-lies’ ability to manage and advocate for theirchild;

5) Provided a liaison with other services (e.g., spe-cial education, other allied health professionals)to support the implementation of managementstrategies in the community.Education of primary care physicians began

with a broad-based, ‘grass roots’ approach.Presentations were provided, not only to the targetgroup of physicians, but also to other groups ofhealth and educational professionals including alliedhealth professionals and special educators. Physicians

Educational outreach and collaboration:An innovative role for occupational therapy

Denise De Laat, Cheryl Missiuna, Mary Egan, Robin Gaines, Jennifer McLean and Veronique Chiasson


With more emphasis being placed on primaryhealth care, occupational therapists are increasinglychallenged to demonstrate their valuable contribu-tions to Family Health Care Teams. The potential foroccupational therapy involvement in primary caresettings is considerable. Realization of this potentialrequires that occupational therapists educate othersabout how our skills in evaluating aspects of the per-son, environment, occupation and understanding ofoccupational performance throughout the lifespancan contribute to the management of primary healthissues.With this in mind, we describe a demonstra-tion project in which a community-based occupation-al therapist provided educational outreach and col-laboration to physicians in primary care, offeringthem the skills and knowledge of an occupationaltherapist that are necessary for early identificationand successful management of children withDevelopmental Coordination Disorder (DCD).

DCD is a pervasive childhood condition that isoften accompanied by other developmental disorderssuch as attention deficit/hyperactivity disorder orspeech/language difficulties. Children with DCD havedifficulty performing everyday motor tasks despitehaving at least average intellectual ability and noother diagnosable neurological disorder (AmericanPsychiatric Association, 2000). DCD may lead to long-term negative consequences including academic fail-ure, poor social relationships, emotional difficultiesand diminished physical fitness and health. Evidencesuggests that the motor skill difficulties associatedwith DCD often persist through adolescence and intoadulthood (Missiuna, Gaines, Soucie & McLean, 2006).

Primary care physicians are well placed to bothrecognize and manage children with DCD (Hamilton,2002). They have regular, ongoing contact with youngchildren, and parents trust them as their primaryresource for health care and referral to other profes-sionals. Physicians are able to collect a detailed histo-ry and conduct the physical and neurological exami-nations needed to rule out other causes of motorcoordination difficulties. However, many physiciansare unfamiliar with DCD (Hamilton, 2002) and thispresents a major barrier to identification and man-

While 18% of children in primary care practices havedevelopmental conditions, many go unrecognized.Developmental Coordination Disorder is one of theseconditions.


recruited to the project received personalized occupa-tional therapy office visits in which their learning pri-orities were clarified, and they were provided withselected educational materials (Missiuna, Gaines &Soucie, 2006). These materials, developed collabora-tively with local physicians and representatives of theCollege of Family Physicians of Ontario, included:

• Binder: a DCD Physician Allied healthCollaboration Kit (DCD PACK), providing succinctsummaries of evidence-based informationregarding DCD;

• Website: a website that included the sameinformation as the binder, for physicians whopreferred to access materials online(www.dcdpack.ca);

• DVD: a DVD that illustrated typically-develop-ing children and children with DCD performingtasks that could be observed in a primary careoffice setting (e.g., climbing up on an examina-tion table; catching and throwing a tennis ball;buttoning a shirt, tying shoelaces);

• Physician screening activities: laminated folderswhich outlined age-appropriate office screeningactivities for the physician; a tear-off pad with ashort questionnaire for parents to complete; alaminated sheet of referral services in Ottawa;

• Waiting room advertisement: a colourful flyer(“Does your child have DCD?”) was designed forparents outlining the key characteristics of chil-dren with DCD.

Following outreach education by the occupa-tional therapist, physicians had the opportunity toapply their knowledge by reflecting on patients intheir practice and identifying children whom theybelieved might have DCD. Physicians screened thesechildren using their newly developed skills andresources and completed a brief interview with the

family (Missiuna, Gaines & Soucie, 2006). If appropri-ate, physicians then referred children to the occupa-tional therapist for assessment of motor skills. The

occupational therapist completed standardizedmotor and functional assessments and a structuredinterview with the parents in order to gather infor-mation that would enable the physician to confirm orrefute the potential diagnosis of DCD (Missiuna,Pollock, et al., 2008). The occupational therapist com-municated these results back to the physician in away that met his/her needs (e.g., brief, focused report;review of clinical observations; discussion of impacton function).

The physician and the occupational therapistmet with the family to communicate the assessmentresults, and, if warranted, the physician provided thediagnosis of DCD. The physician and occupationaltherapist provided educational materials to the fami-ly to help them understand and improve manage-ment of the daily challenges. Educational materialsincluded a parent booklet explaining DCD, flyersdeveloped for health promotion and prevention ofsecondary disability and flyers for members of thecommunity such as teachers and sports coaches(available at www.canchild.ca). Finally, where neces-sary, the occupational therapist assisted the family toadvocate for accommodations and resources atschool and assisted the parents to obtain furtherservices.

The specific results of this study are reportedelsewhere (Gaines, Missiuna, Egan and McLean,2008). The occupational therapist’s role as outreacheducator and consultant within primary health caresettings was a successful innovation in a number ofways:

• Quality care was provided for children with DCDin a timely and cost effective manner;

• Occupational therapy involvement facilitatedself-management of this chronic condition byfamilies and potentially prevented the develop-ment of secondary problems;

• Coordinated access was provided to appropriatecommunity services;

• Ripple effects were evident in the education sys-tem and the community at large.An occupational therapist functioning within

“It seems that all of these kids are in my practice, I justdidn’t identify them before”

Physician participant

this type of innovative role must bring several skills tothe position to ensure the successful knowledgetransfer to physicians and other primary careproviders. Access to physicians was difficult but sever-al strategies secured the collaborative partnershipssuch as:

• Repecting the physician’s limitations throughquestions like “what do you need to know?” and“howmuch time do you have?”

• Responding quickly to physician needs, whetherthat meant prompt scheduling of education ses-sions or meeting with families who hadconcerns.

• Being available for further consultation, uponphysician request.

• Being aware of communities of practice in whichphysicians network and offering to meet theneeds identified by these groups (e.g., breakfastdiscussions, evening journal clubs).

The information that was beingshared in this project about chil-dren with DCD and about thebody of knowledge that occupa-tional therapists bring to pri-mary care settings was alsoenhanced by:• Educating frontline office,nursing and administrative staffabout the characteristics ofthese children. As gatekeepersof the practice, they are able tocue physicans about observa-tions they have made in thewaiting room when childrenstruggle to get their coat off orlose their balance stepping ontothe weighing scale.• Displaying confidence in thecontribution that can be madethrough our expertise in knowl-edge of occupation and its rolein disease prevention and pro-motion of wellbeing in children.

Challenges encountered inthis project included the consid-erable variation amongphyscians and their willingnessto embrace the transfer of

knowledge: some demonstrated minimal interest,while others were keen to embrace the evidence.Similar to practice in homecare, the community out-

reach occupational therapist was required to travel tomultiple settings. Finally, while it was clear from thestudy results that occupational therapists have abreadth of knowledge to impart to primary careproviders, the process of policy change regarding reha-bilitation providers in primary care is moving slowly.

The role of the occupational therapist as an out-reach educator and consultant within primary careworked extremely well for children with a commondevelopmental health condition such as DCD. Thistype of model may be applicable to primary care withother individuals (O’Brien et al., 2007), particularlythose who have chronic conditions that affect occupa-tion and occupational development.

ReferencesAmerican Psychiatric Association (2000).Diagnostic and

Statistical Manual of Mental Disorders (4th edition textrevision).Washington, DC: American PsychiatricAssociation.

Gaines, R.,Missiuna, C., Egan,M., &McLean, J. (2008). Educationaloutreach and collaborative care enhances physician's per-ceived knowledge about developmental coordination dis-order. BioMedCentral Health Services Research, Jan 24, 8, 21.PMID: 18218082

Hamilton, S. (2002). Evaluation of clumsiness in children.American Family Physician, 66, 1435-1440.

Missiuna, C., Gaines, R., Soucie, H.,McLean, J. (2006). Parentalquestions about developmental coordination disorder: Asynopsis of current evidence. Paediatrics and ChildHealth, 11, 507-512.

Missiuna, C., Gaines, R., Soucie, H. (2006). Why every office needsa tennis ball: A new approach to assessing the clumsychild. Canadian Medical Association Journal, 175, 471-473.

Missiuna, C., Pollock, N., Egan,M., De Laat, D., Gaines, R., & Soucie,H. (2008). Enabling occupation through facilitating thediagnosis of developmental coordination disorder.Canadian Journal of Occupational Therapy, 75, 26-34.

O'Brien, M.A., Rogers, S., Jamtvedt, G., Oxman, A.D., Odgaard-Jensen, J., Kristoffersen, D.T., Forsetlund, L., Bainbridge, D.,Freemantle, N., Davis, D.A., Haynes, R.B., Harvery, E.L.(2007). Educational outreach visits: effects on profes-sional practice and health care outcomes. CochraneDatabase of Systematic Reviews, Issue 4. Art. No.:CD000409. DOI: 10.1002/14651858.CD000409.pub2.

Polatajko, H.J., Cantin, N. (2006). Developmental coordinationdisorder (dyspraxia): An overview of the state of the art.Seminars in Pediatric Neurology, 12, 250-258.

Wilson, P.H. (2005). Practitioner review: Approaches to assess-ment and treatment of children with DCD: An evalua-tive review. Journal of Child Psychology and Psychiatry,46, 806-823.


About the authors –Denise De Laat,MEd.OT Reg(Ont),Children’s Hospital ofEasternOntario,Ottawa,ONCherylMissiuna,PhD,OTReg (Ont) School ofRehabilitation Science,McMaster University andCanChild Centre forChildhoodDisabilityResearch.Mary Egan, PhD,OT Reg(Ont), School ofRehabilitation Sciences attheUniversity of Ottawa,Ottawa,ONRobinGaines,PhD,SLP(C),CASLPO,CCC-SLP,Children’sHospital of EasternOntarioand School ofRehabilitation Sciences,University of Ottawa,ONJenniferMcLean, M.D.,FRCP(C), IWKHealth Centre,Halifax,Nova Scotia.Veronique Chiasson ,OTReg (Ont), Private Practice,Ottawa,ON

Acknowledgements:The Ontario Ministry of Health and Long Term Care PrimaryHealth Care Transition Fund funded this demonstration project.


included. Amodular format was chosen so therapistsmay quickly “pick and choose” the clinical informationneeded. Also, this format facilitates the addition orremoval of clinical content tomatch expansion of occu-pational therapy services, changes in best practices, andtrends in service provision.

Format and content criteria were determined toguidemodule development. Eachmodule is: accessible,quickly and effortlessly available; flexible,meeting theneeds of both new and experienced therapists; ordered,simple and direct in organization and navigation; con-sistent, easily recognized and understood in terms offormat; dynamic, easily updated with new information;sustainable,maintained without undue burden. Inaddition, the clinical content is: focused, including only“key information”and not an exhaustive listing of allpossible types and approaches to intervention; inclu-sive, contains information specific to the patient popu-lation and to core occupational therapy practice; valid,based on best occupational therapy practice, consistentwithVGH Patient Care Guidelines (2008) and reflectingthe COTBC Essential Competencies of Practice forOccupational Therapists in Canada.

Eachmodule follows a four-part organizationalformat: 1) title page,which includes themodule nameand a brief description of the focus, content, and area ofapplicability, 2) clinical practice guideline,whichincludes a description, Site & Unit applicability, delegat-ed task, background information, standard of care,Priority Intervention Criteria ranking, documentationstandards, Preparation (independent and collaborativelearning activities), associated guide-lines/forms/educationmaterials, references to addition-al resources,Unit & date of origin, 3) clinical content,which includes general background information, specif-ic guidelines or treatment protocols, patient health edu-cational materials, standard assessment forms, and 4)case study,which includes information to permit reflec-tion and identification of additional learning needs.

Human resourcesSupport from administrators was requested and onefull-time position was approved to provide supernu-merary coverage for threemonths.To ensure ongoingsupport, administrators receivedmonthly progress

Up and running: Clinical Competency Programfacilitates learning

Sacha Arsenault, John Cobb and Deirdre Lee

Today’s overburdened health care system requires ther-apists to be up-and-running quickly, independently andsafely. However, scant resources of time and current,easy-to-access informationmakesmeeting the dynamicand varied learning needs of occupational therapists achallenge. Adding to this, the College of OccupationalTherapists of BC (COTBC) has brought into clear focusthe responsibility to demonstrate the provision of “safe,competent and ethical care”as outlined in their Code ofEthics (2006, p. 3). To facilitate orientation of new staffand skills-consolidation of senior staff, the occupationaltherapists of the Acute Neuroscience and SpinePrograms conceived and developed an innovative sys-tematic approach to competency based learning atVancouver General Hospital (VGH) - the ClinicalCompetency Program (CCP).

This achievement is noteworthy for several rea-sons. It was developed by a team of occupational thera-pists to resolve a collective, clinical dilemma. Its univer-sal designmakes it suitable for other clinical settingsand to other professional groups. It has the potential toreduce time intensive, one-to-one teaching. Importantly,because the content can be used repeatedly, the cost ofdevelopment compares favourably to the high cost oftraditional methods such as one-to-one teaching.

Concept developmentThree senior occupational therapists, based on priorexperience in creating educationmaterials, developedthe concept and format of the CCP; amodular, easy-to-access, user-friendly education program based on acombination of self-directed and collaborative learningactivities set on a foundation of best practices. As Miller(1987) states,“the use of self-instructionmaterials instaff development settings is gaining increased accept-ance as educators look for viable, cost-effective optionsfor their staff to improve clinical competence” (p. 73).

Intervention provided in each clinical area (i.e.Neurology/Neurosciences, Intensive Care, Spinal Injury,and Stroke) has an associatedmodule. Eachmoduleincludes the information necessary to begin workingquickly, independently and safely. Additionally, refer-ences to additional resources (e.g. Power Point presenta-tions, on-line resources, CDs & DVDs, texts, etc.) are


reports including expected timelines, completion rates,and successes as well as unexpected challenges.Withcontinued interested and encouragement of adminis-trators, the timeline was increased from three to sixmonths and the scope of the project, discovered to bemuch greater than first anticipated,was limited to theorientation needs of new staff.

Module developmentConsultation with all occupational therapists of theAcute Neuroscience and Spine Programs began thenext development phase.Two activities were undertak-en: investigation of the therapists’ learning styles andevaluation of the care needs of the patient populations.First, using group discussion, the teammembersexplored their individual learning styles as well as theireducation paths. Based on their own experiences,mem-bers recognized that a combination of self-directed (i.e.independent learning via case studies, online learning,etc.) and collaborative learning (i.e. clinical timewith amentor) is a practical method to achievemilestones inclinical competencies. Such approaches to learning andcompetency development are supported by other find-ings (Morris et al., 2007). Second, the examination ofcurrent Occupational Therapy Plans of Care yielded avalidated list of patient interventions for each clinicalarea.These findings further enhanced CCP evolutionwhereupon the team established 21 CCPmodules (seeTable One).

Table One: CCPmodules1. Activities of Daily Living - Spine2. Activities of Daily Living - Neuro/Stroke3. Arm and Hand Rehabilitation - Spine/ICU4. Background Information - Spine5. Background Information - Neuro/Stroke/ICU6. Casting - Neuro/Stroke/ICU7. Cognition - Spine/Neuro/Stroke/ICU8. Discharge Planning - Spine9. Discharge Planning - Neuro/Stroke10. Dysphagia - Spine/Neuro/Stroke/ICU11. Education (Patient and Family) - Spine/ICU12. Education (Patient and Family) - Neuro/Stroke13. Environmental Access - Spine/Neuro/ICU14. Mobility - Spine15. Orthosis Management - Spine/Neuro/Stroke/ICU16. Perception - Spine/Neuro/Stroke/ICU17. Physical Neurorehabilitation - Neuro/Stroke18. Seating - Spine/ICU19. Seating - Neuro/Stroke20. Supportive or Functional Splinting - Spine/Neuro/Stroke/ICU21.Vision - Neuro/Stroke

Existing educationmaterials wereevaluated to determine whether ornot they reflected current, bestpractice. Expert consultation, litera-ture review (including library andon-line searches), and comparisonto other standards of practice (i.e.COTBC,VGH, other health care cen-tres within theVancouver CoastalHealth Authority) were utilized andchanges weremade as indicated.Certain information wasmain-tained or revised,while other infor-mation was newly created to fill themodules with content. Contentdevelopment is complete for certainmodules and ongoing for others.

Looking aheadContent development related toexperienced therapist skills-consoli-dation is pending. Currently,mod-ules are a combination of paper-based resources and electronic files;a fully on-line version of the CCP isunder consideration. As identified byWalsh and Farrow(2007),“online learning is one way in which clinicianscan learn new knowledge and problem-solving skills intoday’s changing healthcare environment” (p. 71). Aprocess tomeasure CCP effectiveness will be developed.A poster presentation will be created to present the CCPto clinical teams and at local and national conferences.

SuccessesThe CCP represents a team success in which all AcuteNeuroscience and Spine Program occupational thera-pists contributed. Undertaking this project presentedseveral challenges although twomajor benefits havebeen realised: (1) an updated and validated approach toclinical practice is realised via systematic review and (2)there exists ameans of delivering the information tostaff.The CCP is regularly used by junior and senior clini-cians and by students with extremely positive feedback.Interest to learnmore about the CCP, and possibly adoptit in part or in whole, has been expressed by occupa-tional therapists in other provinces as well as by otherdisciplines. A workshop was developed and presented tooccupational therapists and physiotherapists in anotherBC hospital based on the Casting - Neuro/Stroke/ICUmodule.

About the authors –Sacha Arsenault, BScPhys,BScOT,OT Reg. -(BC) is a sen-ior occupational therapistin theNeurosciences pro-gramatVancouver GeneralHospital. She can bereached [email protected] Cobb,BScOT,OT Reg.-(BC) is the senior occupa-tional therapist of theAcute Spinal InjuryProgramatVancouverGeneral Hospital.He can bereached [email protected] Lee,BScOT,OT Reg.-(BC) is theOccupationalTherapy PracticeCoordinator of theNeuroscience and Spineprograms atVancouverGeneral Hospital. She canbe reached [email protected]


ConclusionsTo facilitate orientation of new staff and skills-consoli-dation of senior staff,we conceived and created a seriesof educationmodules based on a validated list ofoccupational therapy interventions. Flexible in terms ofcontent, but constant in terms of overall design, eachmodule reflects best practices. Learning activities asso-ciated with eachmodule include a combination ofself-directed and collaborative learning. Developing for-mat, content, and organisation criteria, and consideringlearning needs and styles was invaluable to guidingdevelopment.Team participation, includingmanage-ment support,was integral to project completion andsuccess.The CCP has proved relevant to our team and toothers; the notion of a Clinical Competency Program isgainingmomentum.

References:COTBC (2006). Code of Ethics. Retrieved April 11, 2008 from

http://www.cotbc.org/documents/Code_of_Ethics.pdfCOTBC (2003). Essential Competencies of Practice for

Occupational Therapists in Canada, 2nd Ed. RetrievedApril 11, 2008 fromhttp://www.cotbc.org/documents/EssentialCompetencies_2ndEd_mar04_english.pdf

Miller, P. (1989). Developing Self-Learning Packages. Journal ofStaff Development, March/April, 73-77.

Morris, L., Pfeifer, P., Catalano, R., Fortney, R., Hilton, E.,McLaughlin, J., Nelson, G., Palamone, J., Rabito, R.,Wetzel,R., Goldstein, L. (2007). Designing a ComprehensiveModel for Critical Care Orientation. Critical Care Nurse,27(6), 37-60.

Vancouver Coastal Health (2008). Policy Net-Vancouver Acute.Retrieved April 11, 2008 fromhttp://policynet.vch.ca/index.cfm

Walsh, K., Farrow, S. (2007). Development of educational tools toimprove the knowledge and problem-solving skills ofprimary care professionals in rheumatology.Work BasedLearning in Primary Care (5), 71-79.

ment, and the critical review, selection, interpretation,and integration of measures into practice. “Therapistshave chosen to study measurements we use at SunnyHill, and they share their results at staff meetings.Wemake our decisions on the evidence they present.”

Through the use of online technologies, learnerscan access and discuss theory and evidence, experi-ment with its application to practice, and return todiscuss challenges, successes, and next steps. Theircolleagues and instructors came from all parts ofCanada and around the world and from a variety ofhealth disciplines, which allows for an expansive net-work and exchange of interprofessional ideas previ-ously only possible through attending conferences orcorrespondence.

Alison Sisson, an occupational therapist in theYukon, describes how online learning is incorporatedinto her daily life:

“Initially I was concerned that I would missclassroom discussions, especially since discussionshave been such an important and beneficial part ofmy learning in the past… what I’ve found is thatonline postings mean that the classroom is alwaysthere… I can take my time in responding to variousideas in the postings. I find I’ve gotten into the habitof coming home from work and reading the postingsfrom the day. Over the course of dinner I might mullover the ideas, then log on later in the evening torespond. I think this process has really helped me tointegrate my learning, which I hope in turn will makeme a better clinician.”

Evaluating Sources of Evidence is the firstcourse taken by most learners. The skills and knowl-edge gained from this course enable learners toengage in further discovery in the areas of outcomemeasures, clinical reasoning, program development,and education for themselves, their clients, and theircommunities. After completing their core courses,learners embark on a major paper or action researchproject that addresses a current work problem, oftenwith the endorsement of their employers. How theytake their new knowledge back to the workplacevaries dramatically.

For example, Deirdre Thornton, who had a babypart way through her MRSc studies, wondered: “Howcan I balance a demanding home life, continue to

Using knowledge from online education to tacklepractice problems


Mary Clark, Deirdre Thornton, Kathy Burton, Alison Sisson, Sue Stanton and Joyce Tryssenaar

Requiring a master's degree for a promotion, feelingisolated, or needing new perspectives to re-igniteinterest are just a few of the reasons why occupation-al therapists are pursuing master’s degrees. Barriersof time and financial resources that previously pre-vented many from continuing their studies have nowbeen overcome with programs designed for workingoccupational therapists. In 2002, the University ofBritish Columbia (UBC) and McMaster Universitydeveloped five online courses that could be usedtoward a Graduate Certificate in Rehabilitation or aMasters in Science (MSc) at McMaster or Master ofRehabilitation Science (MRSc) at UBC. Through thesecourses, learners share and build on each other’sexisting knowledge and transform new informationinto knowledge to solve today’s practice problems.

“It’s a commitment. You need to spend timeeveryday but with the assignments related to mywork, it makes it easier to stay motivated,” describedRoslyn Livingstone, who graduated in May 2008 fromthe McMaster MSc program. Roslyn is one of five ther-apists at Children’s Hospital/Sunny Hill Health Centrefor Children in Vancouver who have participated ineither the McMaster or UBC programs. These thera-pists have found working on their master’s togetherhas many benefits and attribute their success to theirmanager Lori’s encouragement and support.

Lori Roxborough, Associate Director of theTherapy Department needed to find a way to increaseher department’s capacity to create and translateresearch. She felt it was imperative that the environ-ment supported learning.

“Some staff feel ill-equipped to rapidly evaluateresearch and most effectively apply it to practice. Thecourses in these online programs allow them to buildthese skills,” explained Lori.

Lori recognized that the program courses are veryrelevant to the workplace. She sees immediate resultsfrom the courses,which she believes are very ‘in sync’with the therapists’ clinical and leadership goals.

“We try to synchronize the course goalswithdepartment goals – project-based assignmentsmake thiseasy to do,”explained Lori.“Often therapists are able tocomplete their assignments as part of their paidwork.”

An example of this is the Measurement inPractice course, which covers the theory of measure-


art program, and actively involved people with mentalhealth difficulties in the development of the project.Initially she was concerned about raising false hopes,but the end result was a stronger proposal that wasaccepted and funded.

As Kathy explained, “My workplace experiencedsignificant benefits from the application of theknowledge I gained from the MRSc program. The indi-viduals with mental health difficulties developed newskills, increased their self-esteem and connected withother people, all of which contribute to their recovery.Sharing their unique perspective increased the likeli-hood that the program would be effective in meetingthe needs of the target audience. It was exciting andan honour to share the experiences with these indi-viduals as they successfully developed a program andrealized that they were able to make meaningful con-tributions to program development.”

Just as everyone decides to pursue a master’sdegree for different reasons, we have also found thatlearners take their new knowledge and translate it inmany different ways to improve their individual prac-tices, their workplaces, and the lives of their clients.Sharing their successes online with colleagues broad-ens the transfer of knowledge across the country andaround the world and has the potential to create life-long connections for the learners.

impact the occupational therapy community, andadvance my personal professional development?”

She found her solution dur-ing the data collection for hermajor project.While exploringprofessional development prac-tices of clinicians in her work-place, a perceived shortage ofadvanced learning opportunitiesbecame evident.“Now equippedwith a comprehensive array ofclinical reasoning, program devel-opment, and education strate-gies, I am anticipating creatingand pursuing a unique privatepractice opportunity that willenable and support occupationaltherapists to confidently transfernew learning into practice anddeliver therapeutic services in atruly evidence-basedmanner.”

BC-based occupationaltherapist Kathy Burton,who grad-uated this past May, took anotherapproach. She obtained endorse-ment from her employer for hermajor project, a proposal for an

About the authors –At the time ofwritingDeirdreThorntonwas anoccupational therapist inthe Recovery inMotion pro-gramat the SunnybrookHealth Sciences Centre andis nowpatiently awaitingher second child.KathyBurton is a school occupa-tional therapist with theCentre of ChildDevelopment,andAlisonSisson is a Policy&Standards Analyst inContinuing Care for theGovernment of Yukon.SueStanton and JoyceTryssenaar are respectiveprogram coordinators attheUBC andMcMasteronlinemaster programs,aswell as instructors, alongwithMary Clarkwho is alsothe special projects coordi-nator for theUBC onlinegraduate programs.

It is with great pride that I am given the honour of reflecting on the creation of COTF as we celebrate 25 years ofachievement.

In 1982, I was working with our beloved professors Isabel Robinson and Thelma Cardwell on CAOT businessand we discussed the need for a Foundation, a need we perceived to be critical to our development as a profes-sion. We worked assiduously to apply for charitable status and in May 1983, we received our letters patent andthe COTF was born.

It was an exciting and bold initiative and we were passionate about the need to raise funds for scientificand educational activities.

As I reflected on this time I came across an article I wrote in 1984 for the CAOT journal – OccupationalTherapy Today: A Changing Profile. The following are excerpts.

“A history of diffidence and low confidence has marked the development of occupational therapy to date.A poor understanding of our role in health care by other professionals and the public has led to reticence andunder valuation as a health resource. The greatest challenge to occupational therapists lies in our ability tocommunicate what we do and how our services will benefit people, their families and society.

Occupational therapists must take up positions of leadership. By being involved in the process of design-ing and implementing models of service delivery, we will be taking greater responsibility for defining our servicepotential in order to compete and survive in times of shrinking health dollars. Waiting for other health profes-sionals to prescribe the needs for our service will leave us in a subordinate position where many of the roles weshould perform will be assigned to others or not done at all.

In order to strengthen the profession, high-quality graduate programs are crucial. Scientific validation ofour work is the only way to raise our professional image. Improved education in research, health care policy for-mulation and administration will help improve the inadequacies confronting us today.”

With funds from CAOT for start up and support from individuals, agencies and all provincial OT organiza-tions, COTF was launched. Originally driven by volunteers alone we hired our first part time executive coordina-tor, Helen Goldlist, in 1984. In that year COTF offered the first awards to Canadian occupational therapists forgraduate education and research. Today we can look back and boast about a rich research program and a highlyprofessional staff – a story of success.

I was the Executive Director of COTA at the time, and I could feel the potential of our great profession andthe untapped contribution we could make. I knew that unless we raised the bar, we would continue to be mar-ginalized. We were passive and politically unsophisticated for too long. We had been remiss in using politicalstrategies for our professional purposes and it was essential that we make our abilities known to other profes-sionals, business and politicians.

Well, here we are today, a strong force in the health and social service system and respected professionalsin high demand. We did it!

As I look back, I am continuously grateful for my education as an occupational therapist and the doors ithas opened. Regardless of my position in the community, I am first and foremost an occupational therapist, adesignation I wear with much pride.

Please join me as we salute the first 25 years of COTF and the tremendous success we have achieved. Wehave come a long way.

Karen Goldenberg

On May 17, 1983, the Canadian Occupational Therapy Foundation became a reality. The first Board of Governorsconsisted of three prominent occupational therapists: Karen Goldenberg, President; Dr. Thelma Cardwell,Vice-President; and Dr. Isobel Robinson, Secretary/Treasurer.

Karen Goldenberg continues to be a great supporter of COTF. An award called the Karen GoldenbergVolunteer Award was also created in her name to recognize the tremendous dedication that Karen hasexhibited towards the Foundation.


Celebrating COTF's 25thAnniversary

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