June 29, 2006
The Honourable George Smitherman
Minister of Health and Long-Term Care
th
10 Floor, Hepburn Block
80 Grosvenor Street
Toronto, ON M7A 2C4
Dear Minister Smitherman:
RE:
The Health Professions Regulatory Advisory Council’s (HPRAC)
Recommendation to Regulate Psychotherapy
The College of Occupational Therapists of Ontario (“the College”) is pleased to have an opportunity to
respond to the Health Professions Regulatory Advisory Council Report – Regulated Health Professions in
Ontario – New Directions. The College appreciates the difficult task that HPRAC was charged with, in a
short period of time, and commends the Council for addressing the Minister’s questions as thoroughly as
they have.
Overall, the College supports HPRAC’s recommendation to regulate both psychotherapy and
psychotherapists, due to the potential risk of harm to the public in the absence of regulation for
unregulated practitioners. While the approach proposed is different from the College’s initial vision for
regulation of this intervention, the decision to regulate psychotherapy under the Regulated Health
Professions Act, (RHPA) appears to be generally workable, with a few exceptions that the College would
like to bring to your attention. Of primary concern is the fact that the regulatory model HPRAC has
proposed does not recognize the scope of practice of occupational therapists. If adopted as is, the
regulation of psychotherapy will severely limit access to psychotherapy and occupational therapy services
by members of the public who need and currently use these services. We have provided information on
the attached response form to demonstrate that occupational therapists commonly use “psychological
interventions, delivered through a therapeutic relationship, for the treatment of cognitive, emotional or
behavioural disturbances”. These interventions are used by therapists to promote change and
engagement in meaningful occupations for their clients.
The College also questions the introduction of a protected scope of practice. This approach is not
consistent with the current regulatory model, which as HPRAC has indicated, is highly regarded by other
jurisdictions. We appreciate the challenge of using the RHPA with one group of professionals legislated
under a different act, however believe there is benefit in exploring how to apply the controlled act scheme
for psychotherapy, rather than returning to a former approach that mirrors licensing.
/…2
46948
The Honourable George Smitherman
June 29, 2006
Page 2
In the interest of public access to qualified health professionals, consistency of health care and the
reduction of redundant or overlapping services, we urge you to consider the attached information and
make the necessary changes to the proposed model to regulate psychotherapy, that allows occupational
therapists the opportunity to continue to practice within the full scope of their profession and continue to
offer the services that the public needs. To accomplish this objective, the College of Occupational
Therapists of Ontario needs to be added as one of the regulatory organizations, whose practitioners are
trained and qualified to engage in the practice of psychotherapy, as defined in the HPRAC report. (These
changes are necessary in chapter 7 of the report, recommendation numbers 3(2), 5, 8, 9, 11, 15 and 18.)
We look forward to continuing to work with your Ministry and our colleagues in health regulation to make
the necessary changes proposed by HPRAC to ensure the Ontario public receives quality health care
services they can rely on. If you have any questions, or need further information about these issues we
will be pleased to assist you further.
Sincerely,
Barbara J. Worth, B.Sc. (O.T.), OT Reg (Ont.)
Registrar
cc:
Barbara Sullivan, HPRAC
Marilyn Wang, MOHLTC
College of Occupational Therapists of Ontario
June 29, 2006
Page 3 of 28
Feedback Form
Health Professions Regulatory Advisory
Council (HPRAC) Recommendations
o Please download this template (Microsoft Word) and save on your computer.
o Please complete one template per recommendation and save a copy for your
records.
o Do not write in shaded areas.
o Feedback may be submitted anonymously, however, anonymous submissions
do not provide ministry staff with any opportunity to seek clarification of
comments or concerns.
o The text boxes will expand as necessary.
Please e-mail completed forms by June 30, 2006 to: RegulatoryProjects@moh.gov.on.ca
(preferred), or
Send by mail to: RHPA Review Project, 80 Grosvenor Street, 8th Floor, Toronto ON M7A 1R3,
or
Send by Fax to: 416-327-8879. Thank you.
Organization
(if any)
College of Occupational Therapists of Ontario
Barb Worth
Contact Person
Address
(do not complete)
Feedback/
Concern
bworth@coto.org
Phone #
20 Bay Street, Suite 900, Toronto, ON M5J 2N8
HPRAC Recommendation
RHPA
Reference
E-mail
416-214-1177 ext. 225
Chapter 7, Recommendation #3, 5, 8, 9, 11, 15,
18 – Regulation of Psychotherapy
A
Act
Section _____
Sub clause ____
New Profession
B
Code
Section _____
Sub clause ____
Profession-Specific
C
Please describe briefly your (organization’s) concern or feedback regarding an
identified recommendation from HPRAC.
The College of Occupational Therapists has two main concerns about the proposed
model for regulation of psychotherapy and psychotherapists.
Issue 1: The College is concerned that the regulatory model HPRAC has proposed
does not recognize the scope of practice of occupational therapists who are qualified
and regularly use psychological interventions, delivered through a therapeutic
relationship, for the treatment of cognitive, emotional or behavioural disturbances.
They use these interventions in order to promote change and engagement in
meaningful occupations for their clients. The College has recently become aware that
HPRAC did not have the needed information to determine if the scope of
College of Occupational Therapists of Ontario
June 29, 2006
Page 4 of 28
occupational therapy overlapped with psychotherapy. The College response to the
initial consultation indicated that we felt the definition was too broad and did overlap
significantly with the practice of occupational therapy. We noted that while the
practice of occupational therapy more frequently involves counseling, the
interventions described fell along a continuum and it was not easy to distinguish
when counseling stops and psychotherapy begins. At that time we recommended
HPRAC reconsider the definition, but also indicated that if regulation was to proceed
based on the proposed definition the College would expect to participate in further
discussion about the overlap in scope between psychotherapy and occupational
therapy.
Based on the definitions of psychotherapy and counseling in the report, which are
very similar to those proposed in the consultation, it is clear that psychotherapy
overlaps with the scope of occupational therapy to a greater extent than we had
anticipated. We therefore appreciate the need to provide further information about
the scope of occupational therapy to demonstrate this point. We have chosen to
provide this information in a format that reflects the type of legal analysis used to
determine if a professional has acted within the scope of practice of their profession.
The College has considered four elements (core curriculum, current practice,
literature of the profession and standards) that provide evidence of the overlap in
scope of occupational therapy practice and psychotherapy, as defined in the HPRAC
report. Review of these four elements confirms that occupational therapists have the
knowledge and skill necessary to engage in the provision of psychotherapy and are
currently providing these services to their clients.
Evidence in Curriculum:
Occupational therapists acquire the knowledge and skill needed to perform the
common elements of formal psychotherapy training (as defined in the HPRAC
report) within the core academic curriculum for the profession. The minimum
academic requirement to become registered with the College is a Bachelor of Science
degree in Occupational Therapy, obtained in Ontario, or equivalent. This is a four
year degree and requires a minimum of 1000 hours of supervised clinical practice. Of
note, the accreditation standards for the academic programs require that at least one
block of supervised clinical practice be in the area of mental health. It may also be
noted that while a bachelor degree is the minimum requirement for registration with
the College, the academic programs for occupational therapy have been in transition
for the last 5 – 7 years and currently in Canada, the entry level education for
accredited occupational therapy programs is at the masters level (4 of the 5 Ontario
OT programs are at the graduate level). We note that the overall academic
preparation for occupational therapy is certainly consistent with the profession of
nursing which has only recently moved from a College degree to an undergraduate
degree, and recent OT graduates have a similar degree of academic preparation as
social work.
With respect to the specific academic preparation, HPRAC described the common
skills of a psychotherapist as the ability to listen to and understand clients and
College of Occupational Therapists of Ontario
June 29, 2006
Page 5 of 28
patients and attend to non-verbal communication, develop and maintain a therapeutic
alliance with patients and clients, understand the impact of the therapist’s own
feelings and behaviour so they do not interfere with treatment, and recognize and
maintain appropriate therapeutic boundaries. These skills are all taught in the early
stages of the occupational therapy curriculum. For example, a summary from
McMaster University (Appendix 1) confirms that in term one of their program,
students have several classes related to self-awareness and awareness of others: a
growing understanding around knowledge of self and the impact on “other”, then
bridging to OT practice. They report that this includes addressing the intimacy of
relationships given the vulnerability of the client population and the need to help
clients understand their ‘self’ in the context of their life circumstances and in their
search for essential meaning in their lives. The curriculum builds on these initial
concepts in later terms and teaches students how to apply the learning to different
client populations and/or needs and age groups.
Further, a course outline from the Toronto University Program (Appendix 2)
demonstrates occupational therapy student learning of theoretical perspectives and
approaches in mental health including behavioural theory, social learning,
psychodynamic theory and psychosocial rehabilitation principles.
Current practice:
The College currently regulates about 4000 practitioners under the Regulated Health
Professions Act and the Occupational Therapy Act. Recent registration data reveals
that just over 10% of practitioners (461) have primary employment in mental health
in Ontario. This number does not capture therapists with a secondary practice in
mental health or primary employment in areas that include mental health, such as
community rehabilitation or general hospitals. Occupational therapy has long been
recognized as a profession that plays a primary role within an integrated mental
health system and has been identified as a key stakeholder within the provinces
human health resource strategy for mental health. Occupational therapists are core
team members throughout the mental health system (e.g. acute care treatment teams,
psychiatric facilities, rehabilitation programs, Assertive Community Treatment
Teams). For the purposes of determining an overlap in scope of practice however, it
is not simply a matter of determining how many OT’s work in the area of mental
health. While most OT’s in this area of practice routinely engage in the type of
interventions defined as psychotherapy (group therapy programs, assertiveness
training, cognitive behavioural interventions) there may be some who limit their
practice to the activities defined as counseling (instruction, support and advice).
Likewise though, there are therapists who do not work in mental health who also use
interventions described as psychotherapy. In order to confirm that current
practitioners identify themselves as providing psychotherapy services, the College
conducted a quick e-mail poll of registrants, asking them to indicate if their practice
included psychotherapy as defined in the HPRAC report. Within a very short
timeframe (2-3 days) well over 300 therapists responded that they do use
interventions defined as psychotherapy. Based on the responses, it was also clear that
respondents did not only work in mental health but other areas of practice as well
College of Occupational Therapists of Ontario
June 29, 2006
Page 6 of 28
(e.g. stroke rehabilitation, work hardening, paediatrics, neurological rehabilitation).
The following comments by respondents demonstrate this. For example, one
therapist reported “[I] use a cognitive behavioural frame of reference and treatment
approach in my practice for chronic pain management and work hardening programs.
Restrictions from OT’s using this approach would greatly impact on my practise and
the provision of the multi-disciplinary chronic pain management program.” Another
therapist states: “I draw on cognitive-behavioural principles, motivational
interviewing or cognitive re-framing to help my clients adjust and implement
adaptive coping strategies following a stroke. One might argue that these approaches
would constitute ‘ psychological intervention or interventions delivered through a
therapeutic relationship for treatment of cognitive emotional or behavioural
disturbances’. They are not however what purists might consider formal or
traditional psychotherapy interventions. At the same time, they go beyond simply
‘providing information, encouragement, advice or instruction about emotional,
social, educational or spiritual matters’.” While it is difficult to determine the actual
percentage of practitioners who engage in psychotherapy in their regular practice, it’s
fair to say that it is a significant percentage.
Professional literature:
Review of the common texts used in the OT academic programs reveals the fact that
occupational therapists develop and rely on literature that addresses a knowledge
base that overlaps with psychotherapy. For example, some of the core textbooks in
the entry to practice programs address use of therapeutic relationships and clientcentered practice. For example: Cara, E., & MacRae, A. (2005) Psychosocial
Occupational Therapy. A clinical practice (2nd Ed.) Clifton Park, NY: Thomson
Delmar Learning; Sumsion, T. (1999) Client-centered practice in Occupational
Therapy: A guide to implementation. Edinburgh: Churchill Livingston; and, Fearing
V., & Clark, J. (2000) Individuals in context: A practical guide to client-centered
practice. Thorofare, NJ: Slack Incorporated. (Further examples are attached in
Appendix 1). In addition, many occupational therapists have published works in
referred journals both nationally and internationally. For example, Kirsh, B. &
Welch, A. (2003). Opening the door to spiritual exploration: The power of narrative
in occupational therapy. In M. McColl (Ed.), Spirituality and Occupational Therapy.
(pp 161-179). Ottawa: CAOT Publishers and Kirsh, B. (1996). A narrative approach
to addressing spirituality in occupational therapy: Exploring personal meaning and
purpose. Canadian Journal of Occupational Therapy, 63, 55-61. Further examples are
provided in Appendix 3 although they only represent a small sampling from a couple
of authors, of a much larger pool of OT literature.
Professional Standards:
Like the other regulated professions whose practitioners engage in psychotherapy,
there are few formal regulatory standards in occupational therapy specific to this
activity. The wealth of literature in the area does serve as a type of professional
standard however and is relied on by practitioners. The College also has standards
that describe the broad scope of occupational therapy practice. These are published
as essential competencies for entry to practice. Many of the elements described as
College of Occupational Therapists of Ontario
June 29, 2006
Page 7 of 28
constituting psychotherapy, are addressed within the Essential Competencies of
Practice for Occupational Therapists in Canada, 2nd Edition.
(http://www.coto.org/media/documents/Essent_Comp_04.pdf). One example of this
is Competency number 1.6: Acts with Professional Integrity. The performance
indicators address establishing and maintaining professional boundaries; identifying
and managing behaviours and circumstances that could lead the therapist to go
beyond the limits of the professional relationship; and, understanding issues relating
to personal benefit and positions of power. The College’s publication, Principled
Occupational Therapy Practice
(http://www.coto.org/media/documents/Principled_OT_pratice.pdf) also provides
further guidance about practice and clarifies expectations related to professional
boundaries, effective communication, and professional accountability and
transparency issues in practice. While the College has not published specific
standards related to the practice, minimum qualifications and quality assurance
programs for psychotherapy, this is similar for the Colleges of the other regulated
professions of social work, nursing, medicine and psychology. The College of
Occupational Therapists, like the others would need to develop these specifically for
psychotherapy, consistent with the standards of the College of Psychotherapists.
Issue 2:
Not withstanding the need to recognize that psychotherapy is within the scope of
occupational therapy practice, the College questions HPRAC’s decision to
recommend a legally enforceable scope of practice for psychotherapy. As HPRAC
note in their report, the RHPA regulatory model serves as model legislation in
Canada and is considered an “unrealized dream” in the United States compared to the
state licensing models. The problems associated with overlapping scope in the
licensing model, was abandoned in the RHPA in recognition of the benefits of
allowing for overlap in scope among professions. HPRAC has endorsed the
controlled act model elsewhere in their report and therefore it is not clear why they
would propose to return to a model of protected scope. The rationale provided relates
to the challenge of defining psychotherapy as a process, which is different from other
controlled acts that describe an activity. The College did not originally suggest a
controlled act model but rather suggested HPRAC consider a form or regulation
outside of the RHPA. Given the intent to regulate under the RHPA, the College
believes the approach should be consistent with the current regulatory model. An
enforced scope of practice will not avoid the challenge of having to define the
process of psychotherapy more specifically. Clearly, establishing an enforceable
scope of practice introduces further inconsistencies into the framework of the
legislation and may open the door for future arguments to return to a more traditional
licensing model.
HPRAC also notes in their legislative review that the profession specific scope
statements should be reviewed to ensure they reflect current practice, which
continues to evolve. One of the benefits of the controlled act model is that it can
allow for changes in scope of practice in a profession. This benefit would seem to
apply in this situation. HPRAC also provides a means to strengthen the controlled
College of Occupational Therapists of Ontario
June 29, 2006
Level of
Concern to
Your
Organization
Proposed
Solution/
Alternative
Page 8 of 28
act model by expanding the harm clause to include ‘serious bodily harm” which by
definition will capture harm resulting from activities consistent with psychotherapy.
This also supports using a controlled act model for psychotherapy.
On a scale of 1 -10, please indicate the relative importance of the matter where 10
represents a recommendation/issue that is a high degree of concern to yourself or
your organization and 1 is a matter of lower concern.
10
Please provide a description of an alternative solution that may address the concern
noted above.
Issue 1: HPRAC has proposed that psychotherapy be regulated with a model that
ensures members of all regulatory colleges who practice psychotherapy have the
benefit of broad standards that can be applied to the unique circumstances of their
professions. Occupational therapists are members of such a profession and should be
granted the same benefit as their colleagues in social work, nursing, psychology and
medicine.
Occupational therapy therefore needs to be identified as one of the regulated
professions, whose practitioners are trained and qualified to engage in the practice of
psychotherapy, as defined in the HPRAC report. The College of Occupational
Therapists needs to be added to the list of existing regulatory Colleges identified in
recommendation #3(2), 5, 8, 9, 11 and 15. In addition the Occupational Therapy Act
needs to be added to the list of complementary legislative amendments that are
necessary in recommendation #18.
How does
your solution
favour the
public
interest?
Issue 2: The College believes HPRAC should reconsider the controlled act model for
psychotherapy and look at finding a mechanism to allow Social Work to have access
to the controlled act; perhaps through an exemption.
Please explain how the proposed solution will favour the public interest.
Issue 1 and 2: One of the tenets of the RHPA and the Ontario health care system is
to provide the public with access to quality healthcare that is both integrated and
efficient. Allowing occupational therapists to practice within the full scope of their
practice will allow members of the public, who need and currently use psychotherapy
and occupational therapy services, continued access to qualified practitioners. The
government has already identified the need for a health human resource strategy in
this practice area and allowing occupational therapists to continue to work to the full
potential of their scope of practice will support this initiative. To exclude
occupational therapy from the provision of psychotherapy interventions will serve to
limit access to services that are already scarce for a population of vulnerable
individuals. Furthermore, if occupational therapists are not permitted to provide the
services they currently offer, there will be need for these individuals to terminate
current therapeutic relationships and begin again with a different practitioner. Future
clients who require occupational therapy services and psychotherapy interventions
will not have the benefit of one health care provider, but will be required to receive
College of Occupational Therapists of Ontario
June 29, 2006
Page 9 of 28
services from at least two individuals. The more healthcare providers, the greater the
potential for overlap in service, increased costs and inconsistencies in care.
The public interest is also served by allowing occupational therapists to focus on the
provision of quality care rather than becoming distracted by concerns of providing
services they are no longer entitled to offer. Where a profession’s own scope
overlaps with the protected scope of another profession it is reasonable to expect that
practitioners’ behaviour may be affected. For example, if occupational therapists are
excluded from practicing psychotherapy, yet they recognize their practice overlaps
with the protected scope, they may feel compelled to avoid doing some activities that
are necessary to provide appropriate occupational therapy practice. For example, an
occupational therapist who does not attend to the cognitive, emotional or behavioural
disturbances of an individual, may not fully address the needs of their client, which
may result in a poor treatment outcome or actually place the client at risk (e.g.
recommending premature return to work). It is also possible that in the event of a
subsequent complaint, a therapist may use the protected scope of practice as a
defense for their behaviour. The College is concerned that this type of argument may
be considered reasonable and in such a case the College would not be able to rectify
the behaviour or eliminate the potential for future harm.
The College believes the controlled act model has the potential to serve the public
interest better than a protected scope approach. The flexibility of the controlled act
model provides a mechanism, through delegation, for other qualified and regulated
professionals, who may have an expanded scope of practice beyond the usual scope
of their profession, to provide services to their clients. While these cases may be rare,
the public benefits when one health care professional is able to offer the full range of
services they are qualified to provide. The primary health care model embraces this
principle.
College of Occupational Therapists of Ontario
June 29, 2006
Page 10 of 28
APPENDIX 1
McMaster University Occupational Therapy Program
Mental Health Curriculum Sessions/Assignments
RE: COTO’s Response to HPRAC Recommendations on Regulation of
Psychotherapy
Term 1
Term 2
Term 3
Term 4
Term 5
- the communication skills sessions in PREP are critical to the development of
foundational skills and knowledge about psychosocial issues, mental
health/illness and psychotherapy etc.
- several sessions related to self-awareness and awareness of others: the growth of
understanding around knowledge of self, knowledge of self and the impact on
'other', then the bridging to OT practice. This includes addressing the intimacy of
relationships that we develop since we are present with clients at their most
vulnerable times and circumstances. While we rarely declare ourselves engaged
in psychotherapy per se in the classic interpretation of it, we are indeed engaged
in psychotherapy almost continually if one defines it as working with clients
towards a deeper understanding of their 'self', in context of their life circumstances
and in their search for essential meaning for their lives
- several PBT scenarios where we focus on the longer term psychiatric illness
issues around transition to the community from long-term care and the need for
support, clarity of interpretation for clients of feelings and responses
- the chronic pain scenario also touches on the beginning understanding of whole
body and life "suffering"; more of the existential side of managing a chronic pain
situation
- 3 of 9 PBT scenarios are in the area of mental health
(schizophrenia, bipolar disorder, and depression/suicide)
- in Inquiry seminars, 2 sessions deal with psychological-emotional and cognitive
theories
- in PREP course, 3 sessions focus on mental health assessment
and interviewing. Evidence-based appraisals of assessment (EBAA) assignment
includes standardized measures used in mental health field.
-in PREP, sessions on psychosocial rehabilitation and life skills specifically
address mental health and mental illness. There are many other sessions that
incorporate interventions with people with mental illness: planning and running
groups, enabling productive roles (including a focus on supported employment,
and cognitive behavioural interventions).
- Inquiry sessions- Adolescent mental health issues; Recovery; and Transition to
adulthood with a mental illness.
- PBT Problems: 12 year old with Conduct disorder; Native youth –suicide; and
Substance abuse.
- PREP - Eating disorder interventions, Suicide assessment and intervention,
Cognitive behavioral interventions.
- One session in PREP on OT’s working with people who have
experienced psychological trauma.
College of Occupational Therapists of Ontario
June 29, 2006
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- Several PBT problems address specific mental health issues and illness
Term 6
- Interdisciplinary OT/PT sessions are physical issues primarily, with reference to
mental health issues
- One workshop on pain and one problem scenario- no specific lecture or
emphasis though.
- OT Students develop own workshops and problem scenarios, which may be
related to mental health or mental illness
College of Occupational Therapists of Ontario
June 29, 2006
Page 12 of 28
Texts:
Canadian Association of Occupational Therapists. (2002). Enabling occupation: An
occupational therapy perspective (Rev. ed.). Ottawa, ON: CAOT Publications.
Cara, E., & MacRae, A. (2005). Psychosocial occupational therapy. A clinical practice (2nd
ed.). Clifton Park, NY: Thomson Delmar Learning.
CaseCase-Smith, J. (2004). Occupational Therapy for children (5th ed.). Toronto: Slsevier
Mosby.
Christiansen, C., & Baum, C., (Eds.). (2004). Occupational therapy: Performance,
participation, and well-being. Thorofare, NJ: Slack.
Crepeau, E.B., Cohn, E.S., & Schell, B.A. (2003). Willard & Spackman’s Occupational
Therapy (10th ed.). Baltimore, MD: Lippincott, Williams & Wilkins.
Law, M., Baum, C., & Dunn, W. (Eds.). (2005). Measuring occupational performance: A
guide to best practice (2nd ed.). Thorofare, NJ: Slack Incorporated.
McColl, M., Doubt, L., Krupa, T., Law, M., Pollock, N., & Stewart, D. (Eds.). (2003).
Theoretical basis of occupational therapy (2nd ed.). Thorofare, NJ: Slack Inc.
Whiteford, G. & Wright-St.Clair, V. (2005). Occupation & practice in context. NSW: Elsevier.
Stei
Stein, F., & Cutler, S. (Eds.). (2002). Psychosocial occupational therapy: A holistic approach
(2nd ed.). Albany, NY: Delmar Thomson Learning.
Velde, B., & Fidler. G. (2002). Lifestyle performance: A model for engaging the power of
occupation. Thorofare, NJ: Slack Incorporated.
Letts, L., Rigby, P., Stewart, D., (Eds). (2003). Using environments to enable occupational
performance. Thorofare, NJ: Slack Incorporated.
Law, M., (Ed.). (1998). Client-centred occupational therapy. Thorofare, NJ: Slack
Incorporated.
Christiansen, C., & Townsend, E. (Eds.). (2004). Introduction to occupation. The art and
science of living. Upper Saddle River, NJ: Prentice Hall.
Fearing, V., & Clark, J. (2000). Individuals in context: A practical guide to client centered
practice. Thorofare, NJ: Slack Incorporated.
College of Occupational Therapists of Ontario
June 29, 2006
Page 13 of 28
APPENDIX 2
University of Toronto
OCT 1162Y: Psychosocial Perspectives in Occupational Therapy
Course Outline
2005-2006
Course Instructor: Bonnie Kirsh, PhD
Email: bonnie.kirsh@utoronto.ca
Teaching Assistants (TAs): Rebecca Gewurtz, Lisa Detwiler
This course provides students with core theories and tenets of psychosocial occupational
therapy and their applications. The course will examine theories from occupational
science and other disciplines as well as psychosocial issues central to occupational
therapy philosophy and practice that affect or enhance occupational performance.
Concepts studied will span the continuum from mental health promotion to intervention
in the area of mental health and mental illness.
Course Objectives:
By the end of this course the student will:
1. Understand the broad scope of variations in understanding mental health and
mental illness
2. Understand how OT models, constructs and values relate to the field of mental
health and mental illness
3. Appreciate the relationship between occupational engagement and mental health
4. Be familiar with contextual factors affecting occupational therapy and mental
health (social, political, historical)
5. Understand occupational performance and mental health through a number of
theoretical perspectives and approaches including:
• anti-oppression perspectives
• behavioural theory
• social learning theory
• psychodynamic theory
• neurobiological approaches
• psychosocial rehabilitation principles
• recovery framework
• group dynamics theory
6. Develop an understanding of a health promotion framework as it relates to
occupational performance and mental health
Format:
The Psychosocial Perspectives course meets twice weekly: Mondays 12 – 2 and
Wednesdays 9-12. The course begins by examining numerous broad-based perspectives
and contexts within which mental health and mental illness are situated. It then examines
specific psychosocial theoretical frameworks from an occupational perspective. The
course also addresses key issues and constructs which impact on mental health and
College of Occupational Therapists of Ontario
June 29, 2006
Page 14 of 28
mental illness. The course utilizes interactive lectures, learning in the field, and divergent
case method (DCM).
Required text:
Bruce, M. & Borg, B. (2001) Psychosocial Frames of Reference: Core for OccupationBased Practice, Third Edition. NJ: Slack.
Course Assignments and Evaluation:
An average mark of 70% must be attained in order to pass the course.
During the course, remedial work will only be allowed for exceptional and serious health
problems or other personal circumstances which may adversely affect the student's
performance in the course. Students should refer to the departmental Policies and
Regulations for information on the procedure which must be followed in these cases. If
remedial work is allowed, the student will receive the actual mark earned on the remedial
work.
Proportion of marks for the course are assigned as follows:
Assignment
Due Date
DCM #1
Two of the following three DCMs:
Cognitive- Behavioural:
Psychodynamic:
Recovery:
Cognitive-Behavioural,
Psychodynamic, Recovery
(20% each)
Group protocol (in pairs; 20%) and
reflection (individual; 10%)
Participation mark (5% self assigned
and 5% prof assigned)
Total
Feb 15
March 22
March 29
April 12
20%
40%
April 29
30%
ongoing
10%
100%
Assignments #1,2,3: DCM Write-ups
DCM #1 will be completed by all students. You will then choose an additional two out of
three DCMs provided. You will be required to do both an initial and final DCM analysis
for each DCM. The final analysis will be handed in and marked. Maximum: 5 (five)
pages. Procedures for writing up DCMs will be discussed in class.
Assignment #4:Group protocol assignment
All students will work in pairs to develop a group protocol (see Cole, p.294). The
protocol must include objectives, rationale, theoretical approach, and set of activities.
Pairs of students will then facilitate experiential groups which will be comprised of
student classmates. Each student will then write up a reflection analyzing group process
in the group in which they participated. This will be handed in with the group protocol.
Weekly Outline
College of Occupational Therapists of Ontario
June 29, 2006
Page 15 of 28
Week 1: Jan 4
Review of course outline and objectives.
Week 2:
January 9
The Occupational Paradigm and Alternative Paradigms in Mental Health
Explores how occupational engagement and the context within which it occurs relates to
mental health. Examines relationship of the occupational paradigm to other paradigms
and discusses applications. Traces the history of occupation as (mental) health promoting
and healing in occupational therapy and identifies key points in the history of OT practice
in mental health and psychiatry.
January 11
Mental Status Assessment and DSM
Addresses mental status assessment and its relevance in understanding and evaluating
occupational performance. Examines the DSM and its implications for persons with
mental illnesses.
Required Readings:
Bruce & Borg: Chapter 1: Evolution of Psychosocial Practice – Specialty and Core
Occupational Therapy Contexts
Hatchard, K. & Missiuna, C. (2003). An occupational therapist’s journey through bipolar
affective disorder. Occupational Therapy in Mental Health. 10, 1-17. **to be discussed
in class
Rebeiro, K. (1998). Occupation-as-means to mental health: A review of the literature, and
a call for research. Canadian Journal of Occupational Therapy. 65, 12- 19.
Recommended Readings:
Bonder, B. (1995). Psychopathology and function. Chapter 2:DSM-IV and Occupational
Therapy. NJ: Slack.
College of Occupational Therapists of Ontario
June 29, 2006
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Kirsh, B. & Welch, A. (2003).Opening the door to spiritual expression: the power of
narrative in occupational therapy. In M. McColl (Ed.) Spirituality and Occupational
Therapy. (pp.161- 179). Ottawa: CAOT.
Legault, E. & Rebeiro, K. L. (2001). Occupation as means to mental health: a single-case
study. American Journal of Occupational Therapy, 55, 90-96.
Cara, E. & MacRae, A. (Eds.) (1998). Psychosocial occupational therapy. A clinical
practice. Chapter 5: Psychopathology and the Diagnostic Process, p. 140-159. Toronto,
ON: Delmar
Week 3:
Jan 16
Understanding Occupational Performance through a Neurobiological Framework
Examines key neuroanatomical and neurophysiological concepts related to mental illness
and promotes understanding of occupational performance through a neurobiological
framework.
Jan 18
Mental Health: Individuals in Context: The Mental Health System
Examines how the mental health system affects occupational performance and quality of
life for persons with mental health problems. Specific attention is given to stigma, its
effects and potential strategies to combat it. The Dream Team will be our guests for the
final part of the class.
Required Readings:
Bruce & Borg: Chapter 2: Person-Activity/Occupation-Environment/Context –
Occupational Therapy Practice Variables.
Ontario Ministry of Health. (1999). Making it happen: Operational framework for the
delivery of mental health services and support. Queen’s Printer for Ontario. (Available online: http://www.gov.on.ca/health/english/pub/pub_links/pub_mental.html)
College of Occupational Therapists of Ontario
June 29, 2006
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Link, B. and Phelan, J.C. (2001). Conceptualizing stigma. Annual Review of Sociology.
27.363-385.
Recommended Readings:
Brown, R. & Mann, J. (1993). A clinical perspective on the role of neurotransmitters in
mental disorders. In R. Cottrell (Ed.). Psychosocial Occupational Therapy. MD:AOTA.
Pearlson GD. (2000). Neurobiology of schizophrenia. Annals of Neurology. 48(4), 55666.
Ontario Ministry of Health.(2001) Rights and Responsibilities: Mental Health and the
Law. Queen’s Printer for Ontario.
(http://www.gov.on.ca/health/english/pub/pub_links/pub_mental.html)
Prowse, A. & Carpenter, L. (2003). A brief history of mental health reform in Ontario. In
Psychiatric Patient Advocate Office (Ed.) Mental Health and Patients’ Rights in Ontario:
Yesterday, Today and Tomorrow. Queens Printer for Ontario.
Week 4: January 23 and 25
The Therapeutic Relationship: A workshop in two parts
Explores the importance of the therapeutic relationship between the occupational
therapist and the client/consumer when working in a mental health setting (however these
principles apply in any OT setting). Integrates both occupational therapy literature and
gestalt therapy concepts on the therapeutic relationship. Provides opportunities for
discussion and experiential exercises to highlight the importance of factors such as
transference, countertransference and issues related to maintaining boundaries with
clients. Students will have an opportunity to gain insight into their own awareness and
beliefs about working with people with a mental illness, dealing with resistance, issues of
support, and the therapeutic relationship with clients.
Lisa Detwiler, OT and postgraduate of the Gestalt Institute of Toronto;
Betty Yu, OT and student of the Gestalt Institute of Toronto.
Required Readings:
Bruce and Borg. Establishing and maintaining a therapeutic relationship and context.
Pages 56-66.
College of Occupational Therapists of Ontario
June 29, 2006
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Kleinke, C. (1994). Common principles of psychotherapy. Pacific Grove, CA:
Brooks/Cole. Chapter 4: The therapeutic relationship.
Peloquin, S. (1990). The patient-therapist relationship in occupational therapy:
Understanding visions and images. American Journal of Occupational Therapy, 44, 1321.
Walker, R.& Clark, J. (1999). Heading off boundary problems: Clinical supervision as
risk management. Psychiatric Services, 50(11), 1435-1439.
Recommended Readings:
Robinson, J. (1991). Towards a state of being able to play. Integrating Gestalt concepts
and methods into a psychodynamic approach to counselling. British Journal of Guidance
and Counselling, 19(1), 44-65.
Rosa, S & Hasselkus, B. (1996). Connecting with patients: The personal experience of
professional helping. Occupational Therapy Journal of Research, 16(40): 245-260.
Week 5: Jan 30 and Feb 1
Depression and Suicide
Examines depression as a pervasive and potential factor relevant to a variety of situations
and conditions in OT practice. Explores variety of theoretical understandings of suicide,
research on risk factors and demographics associated with suicide and culture as it relates
to suicide. Examines assessment and intervention practices related to suicide and applies
these principles to a case.
February 1 – DCM to be assigned
Required Readings:
Bruce and Borg Chapter 11: Suicidal Behavior – Critical Information for Clinical
Reasoning.
Gutman, S. & Hayes, J.L. (2002). Unipolar depression: A literature review or the most
current epidemiological theories. OT in Mental Health,18(2), 45- 79.
Whitney, D. Kusznir, A., & Dixie, A. (2002). Women with depression: The importance
of social, psychological and occupational factors in illness and recovery. Journal of
Occupational Science, 9, 23-31.
College of Occupational Therapists of Ontario
June 29, 2006
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Website: “What Occupational therapists need to consider: Mental Illness Awareness
Week, October 6-12, 2002. Reach out to prevent suicide” Originally posted on
www.caot.ca Hard copy provided in reading package.
Week 6: Feb 6 & 8
Mental Health Promotion
Develops an understanding of a health promotion framework as applied to OT and
examines strategies to promote health for adults with mental illness. Addresses the
relationship between occupational performance and application of principles of health
promotion.
Required Readings:
Review articles previously discussed in Term 1 (Foundations of Occupational Science).
World Health Organization (1986). The Ottawa Charter. Report from the International
Conference on Health Promotion. Ottawa, Canada
Hamilton, N. and Bhatti T. (1996). Population health promotion: An integrated model of
population health and health promotion. Report by the Health Promotion Development
Division, Ministry of Health, Ottawa, Canada.
Raeburn, J. (2001). Community approaches to mental health promotion. International
Journal of Mental Health Promotion, 3 (1), 13-19.
Recommended Readings:
Raeburn, J. and Rootman, I. (1998). People centred health promotion: What is it? In
People centred health promotion. (pp 3 –15). Toronto: John Wiley & Sons.
Week 7: Feb.13 and 15
Anti-oppression perspectives on mental health and mental illness
Examines and critiques accepted ideas within mental health, mental illness and health
care practices from anti-oppression perspectives including concepts around institutional
racism, sexism and homophobia. Promotes understanding of how anti oppression
principles and practices can be embodied by occupational therapy.
Feb 15 – DCM due
College of Occupational Therapists of Ontario
June 29, 2006
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Required Readings:
McIntosh, P. (1990). White privilege: Unpacking the invisible knapsack. Independent
School, Winter, 31-36.
Jackson, J. (2000). Understanding the experience of noninclusive occupational therapy
clinics: Lesbians' perspectives. American Journal of Occupational Therapy, 54, 26-35.
Worell, J. & Johnson, D. (2001). Therapy with women: Feminist frameworks (pp. 317329). In R. Unger (Ed.), Handbook of the Psychology of Women and Gender. NY: John
Wiley & Sons.
Recommended Reading:
Malone, J. (2000). Working with Aboriginal women: Applying feminist therapy in a
multicultural counseling context. Canadian Journal of Counseling, 34, 33-42.
Wyche, K.F. (2001). Sociocultural issues in counseling for women of color. (pp. 329340). In R. Unger (Ed.), Handbook of the psychology of women and gender. NY: John
Wiley & Sons.
Week 8: February 20 : Reading Week
Week 9: Feb 27 and March1
Understanding Occupational Performance through a Behavioural Framework
Reviews major theorists and principles underlying behavioural approaches and promotes
understanding of occupational performance through a behavioural framework across the
lifespan.
Required Reading:
Bruce and Borg, Chapter 5: Behavioral Frame of Reference – Objective Perspective
Week 10: March 6 and 8
Understanding Occupational Performance through a Cognitive-Behavioural Framework
Reviews major theorists and principles underlying cognitive-behavioural approaches and
promotes understanding of occupational performance through a cognitive framework
across the lifespan.
March 8 – DCM to be assigned
Required Readings:
College of Occupational Therapists of Ontario
June 29, 2006
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Bruce and Borg, Chapter 6: Cognitive-Behavioral Frame of Reference – Thought and
Knowledge Influence Performance
Yakobina, S. Yakobina, S. and Tallant, B. (1997). I came, I thought, I conquered:
Cognitive behaviour approach applied in occupational therapy for the treatment of
depressed (dysthymic) females. Occupational Therapy in Mental Health, 13, 59-73.
Recommended Reading:
Rector, N.A. & Beck, A.T.(2001). Cognitive behavioural therapy for schizophrenia: An
empirical review. The Journal of Nervous and Mental Disease, 189 (5), 278-287.
Week 11: March 13 and 15
Understanding Occupational Performance through a Psychodynamic Framework
Reviews major tenets of psychodynamic theory and examines contributions of OT
psychodynamic theorists. Promotes understanding of occupational performance through a
psychodynamic framework across the lifespan.
March 15- DCM to be assigned
Required Readings:
Bruce & Borg, Chapter 4: Psychodynamic Frame of Reference – Person, Perspective and
Meaning.
Fidler, G. and Fidler, S. (1978). Doing and becoming: Purposeful action and selfactualization. American Journal of Occupational Therapy, 32, 305-310.
Eklund, M. (2000). Applying object relations theory to psychosocial OT: Empirical and
theoretical considerations. OT in Mental Health, 15, 1-26.
Recommended Readings:
Atkinson, K. &Wells, C. (2000). Creative therapies: A psychodynamic approach within
occupational therapy. Cheltenham: Stanley Thornes.
Benetton, M. (1995) A case study applying a psychodynamic approach to OT. OT
International 2, 220-228.
Graham, SF. (2002). Dance: A transformative occupation. Journal of Occupational
Science. 9(3) 128-134.
College of Occupational Therapists of Ontario
June 29, 2006
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Kupers, T. (1990). Using psychodynamic principles in public mental health. New
Directions for Mental Health Services. Number 46.
Lloyd, C. & Papas, V. (1999). Art as therapy within occupational therapy in mental
health settings: A review of the literature. British Journal of Occupational Therapy, 62,
31-34.
Week 12: March 20 and 22
Community Mental Health: Paradigm and Practice
Examines paradigm shifts within community mental health. Addresses principles of
psychosocial rehabilitation and recovery and their application to working with individuals
with severe mental illnesses.
March 22: DCM due
DCM to be assigned
Required Reading:
Cnaan, R. Blankertz, L. Messinger, K. and Gardner, J. (1988). Psychosocial
rehabilitation: Toward a definition. Psychiatric Rehabilitation Journal, 11, 61-77.
Rebeiro, K, (2005) Reflections on ... The recovery paradigm: Should occupational
therapists be interested? Canadian Journal of Occupational Therapy, 72, 96-102.
Jacobson, N. & Greenley, D. (2001). What is recovery? A conceptual model and
explication. Psychiatric Services, 52, 482-487
Recommended Readings:
Anthony,W. & Liberman, R. (1994). The practice of psychiatric rehabilitation: Historical,
conceptual and research base. In L. Spaniol et al.(Eds.), Psychiatric Rehabilitation,
MD:IAPSRS. Chapter 1, pp18-41.
Barris, R., Kielhofner,G. Hawkins- Watts, J (1988). Community mental health. In Bodies
of knowledge in psychosocial practice. Pp 147-160. Thorofare: Slack
Scaffa, M.E. (2001). Paradigm shift: From the medical model to the community model.
In Occupational therapy in community-based settings. (pp 19-34). Philadelphia: F.A.
Davis Co.
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June 29, 2006
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Week 13: March 27 and 29
Recovery-oriented systems and services
Examines recovery principles and applications to mental health services and systems.
March 29 – DCM due
Required Readings:
Anthony, W. (2000). A recovery-oriented service system: Setting some system level
standards. Psychiatric Rehabilitation Journal, 24, 159-168.
Mead, S.& Copeland, M. (2000). What recovery means to us: Consumers’ perspectives.
Community Mental Health Journal, 36(3),315-328.
Recommended Reading:
Frese, F., Stanley, J., Kress, K., Vogel-Scibilia, S. (2001). Integrating evidence-based
practices and the recovery model. Psychiatric Services, 52,11, 1462-1468.
Week 14: April 3 and 5
Examines best practice in community mental health. Addresses Assertive Community
Treatment as a model of service delivery.
April 3: Visits to Community Facilities ***
Required Readings
Kirsh, B., Cockburn, L. & Gewurtz, R. (2005). Best practice in occupational therapy:
Program characteristics that influence vocational outcomes for persons with serious
mental illnesses. Canadian Journal of Occupational Therapy, 72, 265-279.
Krupa, T., Radloff-Gabriel, D., Whippey, E., Kirsh, B. (2002) Occupational therapy and
Assertive Community Treatment. Canadian Journal of Occupational Therapy.69, 95-99.
Week 15: April 10 and 12
Group Dynamics
Examines group dynamics theory and provides opportunities to apply theory to observed
and experienced groups. Promotes understanding of occupational performance as a
function of group interaction.
Students work in pairs to plan a group protocol. Pairs of students facilitate experiential
groups with their peers and an OT. Reflections on group process to be documented and
handed in with group protocol.
College of Occupational Therapists of Ontario
June 29, 2006
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April 12 – DCM due
Required Readings:
Cole, M. (1998). Group Dynamics in Occupational Therapy. Second Edition. NJ: Slack.
Chapter Two – Understanding Group Dynamics.
Cole, M. (1998). Group Dynamics in Occupational Therapy. Chapter 10: Writing a group
treatment protocol. NJ:Slack.
Posthuma, B. (1999). Small groups in counseling and therapy. 3rd edition. Mass: Allyn
& Bacon. (Chapter 1: The Small Group in Counselling and Therapy; Chapter 3: Group
Dimensions; and Chapter 6: Leadership)
Recommended Readings:
Bruce & Borg Appendices L: Sample Cognitive-Behavior Group Descriptions; N:
Developmental Groups; and O: Group Assessment Examples – Dynamic Interactional
Model.
Week 16/17:
Course Summary and Student-Led Group Sessions (April 17 and April 24)
*Note no class on April 19
*Note session on April 24 runs 12-3.
April 29 – Group protocol and reflection due
College of Occupational Therapists of Ontario
June 29, 2006
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APPENDIX 3
Cognitive Orientation to Daily Occupational Performance
(CO-OP Publications)
Book:
Polatajko, H. J. & Mandich, A. (2004). Enabling occupation in children: The Cognitive
Orientation to daily Occupational Performance (CO-OP) approach. Ottawa, ON: CAOT
Publications ACE.
Available form the CAOT at http://www.caot.ca/
More specifically at
https://www.caot.ca/ebusiness/source/orders/index.cfm?section=unknown&task=3&CAT
EGORY=PUBS&PRODUCT_TYPE=SALES&SKU=PUB%2DML31&DESCRIPTION
=&FindSpec=&CFTOKEN=64322664&continue=1&SEARCH_TYPE=find&StartRow=
6&PageNum=2&FindIn=
Chapters:
1. Mandich, A., & Polatajko, H. J. (2005). A cognitive perspective on
intervention for children with developmental coordination disorder: The COOP experience. In D. Sugden & M. Chambers (Eds.), Children with
developmental coordination disorder. London, UK: Whurr.
2. Polatajko, H. J., & Cantin, N. (2005). La prise en charge des enfants atteints
d’un Trouble de l’Acquisition des Coordinations : approches thérapeutiques et
niveau de preuve. In Geuze, R. H. (Ed.). Le Trouble d'Acquisition de la Coordination.
Evaluation et rééducation de la maladresse chez l'enfant (Chapitre 5 pp 147-195).
Collection Psychomotricité. Marseille: Solal Éditeurs. [French] (invited) . (Two separate
editions, one in French and one in English). ISBN 2-914513-70-4
3. Polatajko, H. J., & Mandich, A. (2004). Cognitive Orientation to daily Occupational
Performance: (CO-OP) with children with Developmental Coordination Disorder. In
N. Katz (Ed.), Cognition and occupation in rehabilitation: Cognitive models for
intervention in occupational therapy (2nd ed.). Bethesda, MD: AOTA
4. Segal, R., Mandich, A., Polatajko, H., & Cook, J. V. (2003). Stigma and its management: A
pilot study of the experiences of children with development coordination disorder. In C. B.
Royeen (Ed.), Pediatric Issues in Occupational Therapy (Chap 45). Bethesda, MD, AOTA
Press (Reprint)
College of Occupational Therapists of Ontario
June 29, 2006
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5. Mandich, A., Polatajko, H. J., Macnab, J. J., & Miller, L.T. (2001). Treatment of children
with developmental coordination disorder: What is the evidence? In Missiuna, C. (Ed),
Developmental coordination disorder: Strategies for success (pp. 51-68). New York: The
Haworth Press Inc. (Co-published simultaneously)
6. Mandich, A., Polatajko, H.J., Missiuna, C., & Miller, L. (2001) Cognitive strategies and
motor performance in children with developmental coordination disorder. In Missiuna, C.
(Ed), Developmental coordination disorder: Strategies for success (pp. 125-143). New York:
The Haworth Press Inc. (Co-published simultaneously)
7. Missiuna, C., Mandich, A., Polatajko, H.J., & Malloy-Miller, T. (2001). Cognitive
orientation to daily occupational performance: Part I - Theoretical foundations. In Missiuna,
C. (Ed), Developmental coordination disorder: Strategies for success (pp. 69-81). New York:
The Haworth Press Inc. (Co-published simultaneously)
8. Polatajko, H.J., Mandich, A.D., Miller, L., & Macnab, J. (2001). Cognitive orientation to
daily occupational performance (CO-OP): Part II - The evidence. In Missiuna, C. (Ed),
Developmental coordination disorder: Strategies for success (pp. 83-106). New York: The
Haworth Press Inc. (Co-published simultaneously)
9. Polatajko, H.J., Mandich, A.D., Missiuna, C., Miller, L., Macnab, J., Malloy-Miller, T., &
Kinsella, E.A. (2001) Cognitive orientation to daily occupational performance (CO-OP): Part
III - The protocol in brief. In Missiuna, C. (Ed), Developmental coordination disorder:
Strategies for success (pp. 107-123). New York: The Haworth Press Inc. (Co-published
simultaneously)
Journal articles
1. Polatajko, H.J., Mandich, A.D., Missiuna, C., Miller, L., Macnab, J., Malloy-Miller,
T., & Kinsella, E.A. (in press). Cognitive orientation to daily occupational
performance (CO-OP): Part III - The protocol in brief. Ergoterapeuten (Norwegian).
REPRINT from Physical and Occupational Therapy in Pediatrics (2001), 20(2/3),
107-124.
2. Polatajko, H.J., Dennhardt, S., Mandich, A. (2006). Der CO-OP Ansatz (Cognitive
Orientation to daily Occupational Performance): Vorstellung eines
Behandlungsansatzes, um Kindern mit motorischen Schwierigkeiten die erfolgreiche
Ausführung von Betätigungen zu ermöglichen. Ergotherapie - Zeitschrift für angewandte
Wissenschaft (1), Heft Nr. 1/2006 • April/Mai 2006 http://www.verlag-moderneslernen.de/
3. Sangster, C.A., Beninger, C., Polatajko, H.J., & Mandich, A. (2005). Cognitive strategy
generation in children with developmental coordination disorder. Canadian Journal of
Occupational Therap, 72, 2, 67-77.
College of Occupational Therapists of Ontario
June 29, 2006
Page 27 of 28
4. Mandich, A., & Polatajko, H. (2003). Editorial: Developmental coordination
disorder: Mechanisms measurement management. Human Movement Science, 22,
406-411. INVITED
5. Mandich, A.D., Polatajko, H.J., Miller, L., & Missiuna, C. (2003). A cognitive perspective
on handwriting: Cognitive orientation to daily occupational performance (CO-OP).
Handwriting Today, Summer, No. 2, 41-47.
6. Mandich, A., Polatajko, H., & Rodger S. (2003). Rites of passage: Understanding
participation of children with developmental coordination disorder. Human Movement
Science, 22, 583-595.
7. Segal, R., Mandich, A., & Polatajko, H. (2002, November). Play Time. Rehab
Management: The Interdisciplinary Journal of Rehabilitation, Article 112002/8.
Retrieved December 4, 2002, from http://www.rehabpub.com/features/112002/8.asp
ADAPTED REPRINT
8. Segal, R., Mandich, A., & Polatajko, H. (2002). Stigma and its management: A
framework for understanding social isolation of children with developmental
coordination disorder. American Journal of Occupational Therapy,.56(4), 422-428.
9. Mandich, A., Polatajko, H.J., Macnab, J.J., & Miller, L.T. (2001).
Treatment of Children with developmental coordination disorder: What is the
evidence? Physical and Occupational Therapy in Pediatrics, 20(2/3), 51-68
10. .Mandich, A., Polatajko, H.J., Missiuna, C., & Miller, L. (2001).
Cognitive Strategies and Motor Performance in Children with Developmental
Coordination Disorder. Physical and Occupational Therapy in Pediatrics,
20(2/3), 125-144.
11. Miller, L.T., Polatajko, H.J., Missiuna, C., Mandich, A.D., & Macnab,
J.J. (2001). A pilot trial of a cognitive treatment for children with
developmental coordination disorder. Human Movement Science, 20(1/2),
183-210.
12. Missiuna, C., Mandich, A., Polatajko, H.J., & Malloy-Miller, T. (2001).
Cognitive Orientation to daily Occupational Performance: Part I Theoretical foundations. Physical and Occupational Therapy in Pediatrics,
20(2/3), 69-82.
13. Polatajko, H.J., Mandich, A.D., Miller, L., & Macnab, J. (2001).
Cognitive Orientation to daily Occupational Performance: Part II - The
evidence. Physical and Occupational Therapy in Paediatrics, 20(2/3), 83-106.
14. Polatajko, H.J., Mandich, A.D., Missiuna, C., Miller, L., Macnab, J.,
Malloy-Miller, T., & Kinsella, E.A. (2001). Cognitive Orientation to daily
College of Occupational Therapists of Ontario
June 29, 2006
Occupational Performance (CO-OP): Part III - The protocol in brief. Physical
and Occupational Therapy in Pediatrics, 20(2/3), 107-124.
15. Polatajko, H.J., Mandich, A.D., Martini, R. (2000). Dynamic performance
analysis: A framework for understanding occupational performance. American
Journal of Occupational Therapy, 54(1), 65-72.
16. Martini, R., & Polatajko, H.J. (1998). Verbal self-guidance as a
treatment approach for children with Developmental Coordination Disorder: A
systematic replication study. Occupational Therapy Journal of Research,
18(4), 157-181.
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