British Journal of Occupational Therapy

A wide-ranging multiprofessional research project explored issues relating to the introduction of assistive technology into the existing homes of older people in order to provide them with the opportunity to remain at home. The financial relationship between assistive technology and packages of formal care was also explored. The costs of residential care and those of a number of packages containing differing quantities of assistive technology, formal care and informal care were compared. The analyses provide a strong financial case for substituting and/or supplementing formal care with assistive technology, even for individuals with quite disabling conditions. Although needs and hence the cost of provision rise with an increasing level of disability, the savings in care costs accrue quickly.

The consideration of a variety of users with different needs and informal care provision, and occupying a very wide range of housing, leads to the conclusion that in comparison with traditional care packages, at worst, incorporating significant amounts of assistive technology into care packages is cost neutral, but that with careful specification of assistive technology major savings are feasible.

A literature review was conducted to facilitate allied health professionals' implementation of the recommendations made by the Prevention of Falls Network Europe (ProFaNE) (Yardley et al 2007a) on promoting older people's engagement in activities to prevent falls. The falls prevention literature was searched for relevant papers to aid allied health professionals' choice of strategies and to inspire ideas about how to implement ProFaNE's recommendations in everyday practice. Suggestions for each of the six ProFaNE recommendations are made, which may in turn promote older people's adherence to falls prevention interventions.

This is the first in a series of three articles that explores occupational therapy's philosophical foundations in rationalism and Romanticism. The articles report the findings of a study that employed a history of ideas approach, which centres on the ideas people hold and how those change over time. The core idea in this study was that people's sense of themselves is expressed through the things that they have and use, a proposition that was explored in the context of occupational therapy as it was becoming established in the United Kingdom. The data comprised references to objects in occupational therapy texts and a precursor to the British journal published in England in the 25-year period between 1938 and 1962, which were analysed to identify the ways in which therapists thought about the things that they used in practice, along with those that they asked their patients to make.

This article focuses on occupational therapists' Romantic assumptions. It introduces the Romantics, together with their historical context and their ideas, and outlines how those ideas were transmitted to occupational therapy through the Arts and Crafts Movement. It then discusses occupational therapists' Romantic accounts of the tragedy of illness and disability, the dehumanising effects of industrial labour, the joy of crafting things by hand and the transformative potential of occupational therapy. Finally, the seeds of discontent with Romanticism that surfaced within the profession are identified.

Little is known about what influences the success of psychosocial interventions for first-episode psychosis. One possible explanation for the mixed results of clinical trials is the influence of confounders on outcome. Psychosocial functioning prior to the onset of psychosis (premorbid adjustment) is one possible confounder. In order to examine the importance of premorbid adjustment to occupational therapists providing and evaluating psychosocial interventions, this study compared the baseline characteristics and premorbid adjustment of the people with first-episode psychosis referred to psychosocial rehabilitation with those of the people not referred, and the outcomes of both groups.

All people with first-episode psychosis (n = 171) were assessed at baseline, including their premorbid adjustment. The participants were followed up 4 years later. A subgroup (n = 44) had been referred to psychosocial rehabilitation. The baseline presentation, premorbid adjustment and outcomes (symptoms and functioning) at 4 years of both groups were compared.

The results showed that the people referred to a psychosocial rehabilitation programme had a poorer premorbid adjustment and fewer years in education than those not referred. Unsurprisingly, those not referred had better outcomes 4 years after initial presentation. It was concluded that premorbid psychosocial functioning is influential in determining the likelihood of referral to psychosocial rehabilitation and can influence evaluations of psychosocial interventions.

The Newham Children's Services Occupational Therapy Department faced a number of major challenges, including an insufficient capacity to meet the growing demand for services, insufficient funding, an inability to fill posts consistently and an extremely long waiting list. It used business process redesign (BPR) techniques to address these problems. The redesign process involved a systematic and thorough approach to problem solving and the implementation of the solutions. Within 3 years, the team had decreased significantly both the rate of formal complaints and the length of the waiting list. It had also increased staff retention and morale. The team's success demonstrates that BPR can be a useful tool in improving the efficiency and effectiveness of occupational therapy services and stakeholder satisfaction.

An earlier opinion piece considered the professional issues surrounding the occupational therapist's dress code within the workplace (Davys et al 2006). This second paper considers the role of the occupational therapist when a client's choice of clothing may conflict with social expectations and have a negative impact upon social inclusion. Three hypothetical cases that reflect clinical realities are presented, which serve as prompts for reflection upon informed choice, professional responsibilities and the therapeutic relationship. It is concluded that there needs to be debate about the conflict between each of these areas and the concept of social inclusion.

International occupational therapy organisations spend time and energy on arranging conferences and meetings for occupational therapists in order to encourage the exchange of ideas and developments. This is essential for the profession and its members; however, the barriers in the form of language, money and time often prevent attendance at such events. All professionals should be looking more at the advantages and doing everything possible to try to attend these events. Evidence-based practice is required in Europe and some evidence may be found there. This opinion piece provides some information about the international occupational therapy organisations in order to motivate readers to find out more from the websites given, to consider sharing knowledge and experience and perhaps to attend the European congress mentioned.