INVITED EDITORIAL

The idea for this special issue of the Scandinavian Journal of Occupational Therapy began during an International Symposium on Measuring, Planning, and Implementing Occupation-based Programs, held in July 2008 at Dalhousie University in Halifax, Nova Scotia, Canada. The Symposium was attended by more than 70 occupational therapists representing 18 countries from around the world (every continent except Antarctica). This theme encompasses complex topics that have challenged occupational therapists in all areas of practice. As researchers we have sought to develop assessments that are grounded in occupation, so that they can be applied to a broad range of practice areas. As managers we have endeavored to lead teams that are occupation-based and person-focused, and consequently lead to a better way of practicing occupational therapy. As evidence-based practitioners we have aspired to translate knowledge gained from our research colleagues into our daily practice in a way that benefits the clients with whom we work.

In the planning of the symposium the scientific committee had called for papers that demonstrated innovation or advances in four areas of research or practice: planning, implementing, documenting, and measuring occupation-based programs; envisioning and implementing client-centered care; occupational justice: bridging theory and practice; and critical reflections on school-based occupational therapy. This resulted in papers that varied in breadth, depth, and scope of practice. Such forward thinking by the scientific committee was a bold move, as practicing in a way that is occupation-based and person-centered can be challenging in today's healthcare environment where the focus is often on economic efficiency, quick turnover, and remediation of impairments. Occupational therapy is about facilitating individuals, regardless of impairments, to regain occupations and roles of their choice as long as they wish to do so. Key to this goal is using evaluations and interventions that are occupation-focused and person-centered [1].

This common interest in measuring, planning, and implementing occupation-focused interventions drew abstracts from occupational therapists from a broad spectrum of research and practice. Many delegates had an interest in instrument development and evaluation tools such as the Assessment of Motor and Process Skills (AMPS), the School AMPS, and/or the Evaluation of Social Interaction (ESI). This group of standardized assessments comprises criterion-referenced evaluations that use observation of performance in a natural context and have demonstrated very good reliability and validity when used to measure outcomes of occupational therapy. These evaluations are unique for three reasons: first, each uses occupation as the focus to measure performance (occupation-focused) in the context of activities of daily living (the AMPS), or classroom tasks (the School AMPS), or during a social exchange or conversation (ESI). Second, in each of these evaluations tasks are chosen by the client (client-focused) because there is a need or an expectation for these tasks to be carried out: cooking, laundry, or chores in the home; reading or writing in the classroom; or a social interaction such as a conversation or telephone call. Third, each uses a measurement model (Rasch analysis) that converts raw scores to interval or hierarchical data providing true measures, so that changes in performance can be measured before and after interventions.

Critical reflection on practice was also a key aspect of the symposium, and many papers acted as a springboard, triggering debate and discussion that focused delegates' thinking towards different ways of delivering occupational therapy services. Such innovation resulted in three areas of practice that are worthy of further discussion: novel use of occupations providing choices in lifestyles; occupational transitions where the use of occupations were liberating, enabling persons to move forward after occupational disruptions; and environmental transitions where environments or environmental factors supported existing occupations or facilitated change towards new ways of being.

This special issue of the Scandinavian Journal of Occupational Therapy contains seven peer-reviewed articles that were developed from papers or posters originally presented at the symposium. All of the papers in this special issue explore developments in practice that were shaped by occupational therapists who, dissatisfied with the current state of some aspect of occupational therapy assessment, intervention planning, or outcome measurement, have envisioned and explored solutions via alternative ways of practice.

Some of these papers focus on instrument development and propose ideas that may shape future practice in using standardized assessments. For example, Patomella and her colleagues report on the validity of a new version of a driving assessment, P-Drive, to assess the quality of driving performance by persons with neurological disorders. The original version of the test was developed using Rasch analysis and designed to be administered in a simulated driving situation. The revised assessment, P-Drive On Road, is designed to be used in a contextually natural, on-road test. Merritt et al. describe dissatisfaction with the current state of common vocational assessment methods that emphasize physical capacities over competence of performing actual work-related tasks and propose one possible solution to this concern.

Other papers in this special issue explore processes of incorporating new assessments into existing occupational therapy practice. This can enable clinicians to directly link client goals and interventions in a way that enables the person to achieve what he/she needs and wants to do in the natural context. Erickson, for example, uses critical reflection to describe the process change that she underwent while attempting to change practice in a large, school-based occupational therapy service. She wanted to move school-based occupational therapy practice towards assessing students in the natural classroom context, performing typical schoolwork tasks, with an assessment methodology that requires collaboration with teachers.

In another example, Simmons and Griswold demonstrate how the Occupational Therapy Intervention Process Model can be used as a framework along with the ESI to plan targeted and client-centered interventions around social interaction skills with clients who have acquired brain injury. This is an important area of concern to clients, but one that sometimes takes a back seat to activities of daily living during the early days of rehabilitation. Use of the ESI allowed assessment of the quality of the clients' social interactions in natural community contexts. Additionally, Simmons and Griswold demonstrated that social interaction difficulties identified from the results of the assessment can be used to plan and implement person-centered and occupation-focused intervention strategies.

Two other articles included in this special issue examine the implications of using the AMPS as an assessment tool in order to (a) establish diagnostic skill-item profiling of persons with schizophrenia, bipolar disorder in a manic episode, and bipolar disorder in a depressed episode (Moore et al.); and (b) predict the amount of assistance a person requires to live in the community (Merritt). Both of these papers demonstrate the importance of a valid and reliable measurement model (Rasch analysis). This enabled the researchers to use an evaluation tool that was sensitive enough to measure the small amounts of change necessary when making comparisons of the quality of occupational performance of different people in different contexts.

Lastly, Nilsson and Townsend challenge occupational therapists to consider an emerging perspective on practice: occupational justice. Arguing that occupational justice is aligned with core values of occupational therapy, their applications of this perspective to a group of older Swedish adults who experienced leisure participation restrictions demonstrate, in a practical way, that concerns regarding occupational injustice can be addressed in daily occupational therapy practice.

We wish to thank the many persons whose dedication and vision made this special issue possible: the Organizing Committee of this special 2008 International Symposium, the international group of keynote speakers and researchers whose work appears in the issue, and the reviewers who gave generously of their time and expertise. Finally, our thanks go also to delegates who attended the paper and poster sessions and contributed to the rich debate and challenging discussions that accompanied all of these sessions.