From: Carr, W. & Kemmis, S. (1986). Becoming critical: Education, knowledge, and action research. (Ch. 7 - pp.179-213). Philadelphia: The Falmer Press.

1. The objects of action research are one's own educational practices, our understandings of these practices, and the situations in which we practice.

A Work in Progress : Unpacking the Research Proposal Process

Joyce Tryssenaar

The Abstract

Exploring the Nature of the Mental Illness Component of an Occupational Therapy Curriculum Using A Critical Action Research Methodology

Curriculum is a living, breathing process,  multi-faceted in nature and includes, but is not limited to, the following influences which act and react to each other: the teachers of the curriculum, the institution where the curriculum is taught, the profession for which the students are being prepared, the students themselves, and the political environment. In September 2000 the School of Rehabilitation Science at McMaster University implemented a Masters entry level curriculum in occupational therapy which integrates the teaching of all practice areas.  This curriculum is significantly different than the previous baccalaureate entry level degree in which each specialty area was taught as a discrete unit. The prior curriculum was developmental across the lifespan and included all speciality areas of practice (child health, adult health-physical disability, adult health-mental disability, older adults).  The new curriculum follows the process of care and the theoretical underpinnings of the profession and integrates each specialty area across terms.

There are significant stigma and negative cultural biases towards persons with serious mental illness and there has been a gradual decline in the number of occupational therapists working in this practice area.  This societal stigma continues to be reflected by student occupational therapists  in their choice of practice areas and, therefore, practice with persons with serious mental illness may be further marginalized by the lack of dedicated attention  in the curriculum.   The purpose of the study is to explore, understand, and improve the nature of teaching and learning about mental illness in the new curriculum using a critical action research methodolology. The presentation will focus on the challenges of developing a critical action research design in a complex curriculum.

Setting The Question

2. Brainstorming my question:

Inherent in the naming is being able to Aset@ the research question often considered the most challenging part of the research. If it is too big we will never finish our PhD=s in 100 years. If it is too small our research becomes too narrow and minuscule to have meaning.  Marshall and Rossman (1989) suggest a number of specific steps in setting the research question:

1. The potential research moves from a troubling and/or intriguing real world observation [in the new curriculum the mental illness component is fragmented and/or integrated]

2. to personal theory [have we thrown the baby out with the bath water? Can there be some relationship between societal stigma in this practice area and the lack of dedicated teaching and learning time?]

3. to formal theory [ how do we or can we educate for both substantive knowledge and praxical knowledge?]

4. to frame a research question. [I am only at the brainstorming stage right now]

3. Framing the Question: What do I hope to accomplish?

I want to explore the philosophic and structural shift in the curriculum, namely the role of substantive (content) knowledge versus praxis knowledge related to the content area of mental illness. I want to explore the nature of the knowledge that students have coming out of the program and the extent to which this new approach favours or stigmatizes certain aspects of knowledge and what needs to change.  I want to uncover the assumptions underlying the values explicated in the curriculum. What are the significant curricular changes? To what extent can we have a praxically based program for professional neophytes (novices)? How do the cases chosen delimit the teaching and learning? How do they reinforce or dismantle stereotypical views of mental illness practice?

The Layers

-the breadth and depth of substantive and praxical knowledge in this practice area

-theoretical understanding of the nature of curriculum (political, sociocultural, theological, etc.)

-Classroom and clinical experiences

-translation into effective practice, what are the implications for mental illness practice?

The process follows an iterative loop based on deconstruction, reflection, re-presentation and improvement...through reconstruction of the whole.

underst

Smaller - What are the implications especially in this program with these characteristics?  What are the criteria by which you gauge its success?

Smallest - What is the impact on practice and mental illness, breaking down the stereotypes?

How do you think my question could be written? What do you understand my question to be?

Choosing The Methodology

4. What do I think I am going to do?

A. Gather factual information:

-classes and number of hours dedicated to teaching and learning about mental illness

 -# of learning problems in the handbooks about mental illness

 -# of learning problems used by tutorial groups about mental illness

  -# of triple jumps (type of assignment) available about mental illness

 -# of triple jumps used about mental illness

 -# of tutors whose specialty area is mental illness

 -percentage of paid faculty whose specialty area is mental illness

 -content of classes about mental illness in detail

 -content of assignments (available and used) about mental illness in detail

 -# of fieldwork placements available and used in mental illness

 -students marks on the mental illness components of the qualifying exam

All these quantifiable components of the curriculum can be compared to the "old"  curriculum.  I need to think about why I might want or not want to compare them.

B. Explore students'  learning about mental illness:

 -interview up to half of the graduating class following graduation about their experiences learning about mental illness in the curriculum using a critical incident approach eg. 3 particular learning experiences about mental illness that made a significant impact on you and why.

-I also want them to consider the nature of their learning - was it logical, coherent, in depth, sufficient - and what they would have liked to learn differently or more about.

C. Explore faculty experiences

 -what are the concerns in teaching this area for faculty?

 -what is it like for us to not teach in our specialty area?

D. Current changes

 -explore if and how changes in this teaching of this speciality area have occurred in the second cohort of students into the program based on the first cohort.

E. Translation into practice

 -How does the learning about mental illness become translated into practitioners who are interested and willing to practice in this area? How do we inspire students in this curriculum? What else might we need to do?

How closely does this relate to the critical action research paradigm?  Is it more like another approach?  What are the defining features of the approach [see concepts].

The Insider Perspective

4. Research as an Insider

My personal ground: I am a  faculty who is currently teaching in the curriculum.  I am the only full-time faculty member whose practice area is in mental illness. In the last decade there have been fewer numbers of dedicated occupational therapists working with persons with serious mental illnesses and I think that the integrated curriculum may perpetuate this loss.  I have a strong personal and professional bias that occupational therapists need to work with people with the greatest need. I want the students to be open to working with persons with serious mental illness as a viable career option based on an informed choice. I have included a poem I wrote about my perspective in the Sociocultural Theory and the Curriculum course in the fall.

On Influencing Practice

All these lovely young women (mostly)

want a career that is "rewarding"

want to work with cute babies

and little children

want to do good and be thanked

want to make a difference in someone's life

without getting their hands dirty.

I  want them to

at least consider working with a group

that is not sexy or cute

to work with the marginalized

the most stigmatized, the under served

the unserved

to work with people who are homeless

people who wear rags

(people who are someone's brother, someone's child, who were loved and loved someone once)

people with serious mental illness.

To work where they will receive little thanks

on a day to day basis

(there will be no chocolates at Christmas like on the rehab ward)

where one always sits right on the edge and in the midst

of hard pain, of shame, of sorrow

of grief, of not belonging in the world,

of suffering.

Because I believe we have a duty, an obligation, as skilled professionals

to work with those most in need,

first.

And I know that working here is, in the end,

a privilege, an honour

the gifts we receive are invaluable

are of the Spirit

and make us reach beyond ourselves toward all humanity.

The trend towards fewer occupational therapists working in this practice area is evident in the United States and Canada. There are well-documented  concerns regarding the decreasing numbers of occupational therapists practicing in the specialty area of mental health (Brintnell, 1989; Stein, 1996).   The opportunities for students to experience dynamic role models in mental health are limited by the sheer availability of therapists practicing in this area (Ezersky, Havazelet, Scott & Zettler, 1989).  Therefore, a secondary issue related to mental health practice is the importance of successful fieldwork experiences on future practice choices of student occupational therapists (Cusick, Demattia, & Doyle, 1993;  Scott, 1990).  Interestingly enough this reduction in service is not apparent in Europe and may be a reflection of the more socialized nature of health care in many European countries.

The reduction in numbers of occupational therapists working in the area of mental illness concerns me, grieves me, and worries me on behalf of the clients who do not get the service they so desperately need and on behalf of the profession because it is a loss to all of us. If the core of the profession is working with people who have occupational performance problems and the profession then disregards an entire client group who have significant occupational performance problems, than we are diminished.

What are the issues I need to keep in my foreground?  Can one be both insider (faculty member) and outsider (researcher)?  What am I mostly?  What about resistance from the other faculty members?  Is resistance a form of learning? How does one deal with that?  How do I pay attention to the importance of boundaries and naming the hat I am wearing when I am wearing it?  How do I capture the changing curriculum which would happen regardless of the research? What about the effect of research on that which is being researched ?

References

Brintnell, E. S. (1989).  Occupational therapy in mental health: A growth industry.  Canadian Journal of Occupational Therapy, 56, 7-8.

Carr, W. & Kemmis, S. (1986). Becoming critical: Education, knowledge, and action research. (Ch. 7 - pp.179-213). Philadelphia: The Falmer Press.

 Cusick, A., Demattia, T., & Doyle, S. (1993).  Occupational therapy in mental health: factors influencing student practice preference.  Occupational Therapy in Mental Health, 12(3), 33-53.         

Ezersky, S., Havazelet, L., Scott, A.H., & Zettler, C. L. B. (1989).  Specialty choice in occupational therapy.   American Journal of Occupational Therapy, 43, 227-233.

Marshall, C. & Rossman, G. B. (1989). Designing qualitative research. Newbury Park, CA: Sage Publications

Scott, A.H. (1990).  A review, reflections, and recommendations:  Specialty preference of mental health in occupational therapy.  Occupational Therapy and Mental Health, 10(1), 1-28.

 Stein, F. (1996, May).   Promoting mental health OT. [Letter to the editor].  OT Practice, p. 45.  

Tryssenaar, J. (2001). The gestalt of learning and teaching curriculum: A personal professional narrative. Unpublished manuscript.