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This qualitative study attempted to explore and describe the initial evaluation process in psychosocial occupational therapy. Observation of 19 therapists interviewing patients, detailed transcripts of those interviews, interviews with the therapists, and two questionnaires on therapists' beliefs and attitudes about psychosocial occupational therapy and mental illness were analyzed. Results suggested that the initial evaluation interview process varies in terms of content and format; links exist between interview formats and types of treatment programs; communication of therapist beliefs seems to be an important facet of the interview; as with other health professionals, much routinization seems to exist in clinical decision making; and the environment appears to be a more pervasive influence on clinical reasoning than personal beliefs and attitudes.
Key Words: clinical judgment * decision making * treatment planning
Clinical reasoning is a relatively elusive process; until recently, it had not been the subject of much research in either occupational therapy or other professions. It is elusive because it is an ongoing, interactive process of decision making, involving art, science, and ethics (Rogers, 1983), and because it is private- individuals rarely voice the steps they follow during decision making.
Yet, clinical reasoning (or clinical decision making) is an integral part of practice in fields where design or problem solving is involved. Schön (1983) referred to it as a process of reflecting-in-action and suggested that, ideally, it should not be approached as problem solving but as problem setting. In other words, every time a practitioner faces a new client or situation, he or she must find a frame that allows the client to be viewed as unique. Problem setting thus leads to a process of defining goals and means interactively with particular reference to each client or frame. The extent to which this is done, however, is questionable.
The purpose of this investigation was to explore the early stages of clinical reasoning- the initial interview or assessment- used by occupational therapists in psychosocial practice. The study proceeded from the formulation of four basic questions·. What happens during the initial occupational therapy psychosocial interview? Are there observable trends or patterns that characterize this stage of clinical reasoning? How does the clinical reasoning of psychosocial occupational therapists compare with that of other health practitioners? What factors, if...