CLとTHの認識のズレ

ADOCを開発した理由でも書いたが，CL中心実践（CCP）の，特に目標設定の認識においてCLとTHの間にズレがある．

つまりほとんどのTHは，自分は治療目標についてClと相談しながらやっているし，CLは目標設定過程に参加しているし，CLが目標設定に関与することが重要であると考えている．しかし，CLの約半数は目標設定をほとんど手伝っていないと答え，1/4のCLは目標設定に参加することは重要ではないと答えた．またCCPのプロセスには施設によって差があるとのこと．

まあ，ズレが有るのは仕方ないと思う．CL30名とTH11名という数がとても少ないし，その人たちを選んだ基準が不明確なので，この結果をそのまま受け入れるよりは，もう少しその辺を再検討してからズレについて判断する必要があるだろう．ただ臨床的な印象や，先行研究を概観する限りでは，このズレはもっとありそうな気がするが・・・．特に我が国ではその検証はされていないと思うので，やる価値は十分にある．

あなたの作業療法での目標は何ですか？
あなたは作業療法での目標設定に参加しましたか？
あなたにとって作業療法の目標設定に参加することは重要ですか？

などなど，CLとTHにインタビューをして確認してみる必要があると思われる．
ADOCによってCCPプロセスに関するCLの認識が変化するかどうか検証してみたい．
そのためのツールだから．


Kinsuk K. Maitra, Frances Erway
Perception of Client-Centered Practicein Occupational Therapists and Their Clients
AJOT. 2006(60) 298-310.

OBJECTIVE. The purpose of this study was to comparatively analyze the perceptions of clients and occupational therapists regarding their involvement in the process of client-centered practice. METHOD. Participants (11 occupational therapists, 30 clients) in adult/geriatric health care facilities were each engaged in a semistructured interview to determine their perceptions of client-centered practice, specifically in the goal-setting process. Descriptive statistics were used to analyze the item data. In addition, one-way analysis of variance was computed to identify the differences of opinions in clients and occupational therapists on the process of client-centered practice in four facilities: long-term-care or rehabilitation, hospital outpatient, hospital inpatient, and nursing homes. RESULTS. The occupational therapists in this study indicated use of the principles of client-centered practice in their delivery of occupational therapy services. Their clients, however, displayed mixed perceptions about their role as active participants in client-centered practice and all responded in the negative when asked if they were aware of the approach. Perceptual differences existed between the occupational therapists and their clients in relation to the use of client-centered practice, because their responses to similar questions varied. Last, type of facility significantly influenced clients’ knowledge of certain aspects of their treatment processes in the following four areas: (a) treatment goal selection, (b) encouragement provided in setting clients’ goals, (c) clients’ perception of the importance in the goal-setting process, and (d) education of clients about their participatory role in the goal-setting process. CONCLUSION. Results suggest that a perceptual gap exists between occupational therapists and their clients in relation to their stated use of and participation in client-centered practice. In light of the results, development of a systematic strategy by occupational therapists to elicit the roles that their clients desire to play in the therapeutic process may be an effective intervention to ensure that occupational therapists and their clients are able to fulfill their roles in client-centered practice.