EVALUATING PSYCHIATRIC TREATMENT METHODS THROUGH CLINICAL TRIALS RESEARCH

The author presents a design for single subject/clinical trial research that is applicable for occupational therapists working in a psychiatric treatment facility. The potential factors that can affect outcome are analyzed in terms of the treatment framework, patient characteristics, environmental factors, and therapist skills. Experimental control of external factors affecting behavioral change are analyzed and a protocol for designing a study in psychiatric occupational therapy is presented as a method of generating research.     

Concept and Use of The Social Skills Game to Facilitate Group Interaction

A primary goal of occupational therapy is to improve psychiatric patients' social interaction skills. The role of the therapist, in this effort, is to provide opportunities for patients to practice and learn more effective ways of relating with others. Theorists in the profession have encouraged occupational therapists to consider the use of group games to accomplish this objective. Although the use of games has been reported by occupational therapists who work with menlally retarded children and adults, the use of games with psychiatric populations has received little attention in the literature. This article describes the use of The Social Skills Game to facilitate social interaction and the devcloprnenl of social skills in a psychiatric population.     

Psychiatric Hospital Treatment of Suicidal Children

ABSTRACT: Three phases of psychiatric hospital treatment of children, ages 6 to 12 years, admitted to the hospital because of suicidal threats or suicidal attempts are described. Suicidal behavior in young children must always be taken seriously. Although suicidal behavior usually ceases upon hospitalization, suicidal ideas may continue to be expressed in play and fantasy. In addition to individual and milieu therapy, treatment must also include concomitant assistance of the parents. The treatment procedures are illustrated by suicidal case examples of a depressed girl, an acting-out boy, and a psychotic boy.     

Responsive Changes in Mental Health Practice in Wisconsin

SUMMARY

Delivery of mental health care is changing dramatically at the state and county levels in Wisconsin. These new trends are affecting psychiatric institutions and rehabilitation personnel in reference to staffing patterns, the roles of occupational therapists, certified occupational therapy assistants, patient population and level of acute care and the type and site of intervention. Therapists are moving to more community-based and innovative programming and are leading state and local advocacy initiatives.

Many occupational therapists in Wisconsin have become pioneers pursuing nontraditional occupational therapy roles in response to changes in philosophy, funding, population demographics and evolving needs.     

Uncovering the Value and Meaning of a Horticulture Therapy Program for Clients at a Long-Term Adult Inpatient Psychiatric Facility

This qualitative study investigated the value and meaning of the Greenhouse Program and its impact on recovery goals of residents with severe and persistent mental illness at an adult, long-term psychiatric facility. Eight participants and two occupational therapists were interviewed. Findings revealed two main themes, relating to the essence of the program and personal growth of the participants, supplemented by six sub-themes. The findings suggest that initiatives, such as the Greenhouse Program, are an appropriate intervention that occupational therapy professionals can use in adult inpatient psychiatric facilities.     

The Role of Occupational Therapy within the Federal Strategic Action Plan on Services for Victims of Human Trafficking in the United States

The occupational injustices experienced by human trafficking survivors lead to immediate occupational performance deficits and promote long-term instability. Experience and previous patterns of behavior contribute to the deficits and instability. The occupational manifestations of complex trauma are reflected in the inability to participate in meaningful and necessary occupations. Occupational therapy intervention can be a means of empowering victims of human trafficking by using the occupational therapy process, occupational therapy theories, and models of practice. Occupational therapy practitioners can enable survivors to address the intrinsic and extrinsic barriers to achieving increased overall well-being and occupational performance.     

Mind-Body Patterns of Symptom Generation

Effective ways for joining family therapy with other treatment modalities are becoming increasingly important as the efficacy of family therapy gains acceptance in the medical and mental health community. When one interfaces family therapy with medical and psychopharmacological treatments, which find the sources of symptoms within individuals, rather than interpersonal systems, careful attention must be paid to the mind and body relationships that guide interactions between family behavior and the somatic physiology of each family member. We present six mind-body patterns of symptom generation found to be particularly useful for designing multimodality treatments and for communicating the treatment rationale to medical and psychiatric clinicians or to family members. Case examples illustrate their clinical use.     

Personalized Occupational Transformations: Narratives from Two Occupational Therapists’ Experiences with Complex Therapeutic Processes

Recovery and occupation-centered practices with persons with severe psychiatric disabilities involve many dynamic issues and processes. This study aimed to develop an understanding of how the therapeutic process unfolds in occupational therapy among persons with severe psychiatric disabilities living in sheltered or supported housing. Repeated interviews were conducted with two occupational therapists working in sheltered and supported housing facilities. Narrative analysis was used to analyze their stories. The findings reveal “personalized occupational transformations” describing significant events of interaction establishing therapeutic processes to promote personal agency and social recovery while targeting meaningful activities based on each resident’s wishes.     

Teaching Approaches and Occupational Therapy Psychoeducation

Abstract

Patient education has become an important feature of any treatment program. Psychoeducational procedures dominate the treatment used by occupational therapy practitioners in psychiatric rehabilitation. Occupational therapy literature frequently describes the content of psychoeducational programs but rarely examines the teaching approach therapists use in them. It is necessary, therefore, to begin carefully questioning how we are approaching psychoeducation and justifying it as a method compatible with our basic philosophical principles and our growing understanding of occupation. Three approaches to teaching are examined and contrasted with occupational therapy values: the executive approach, the therapist approach, and the liberationist approach. Each of these approaches points to dramatically different outcomes of the therapeutic process. Ultimately, they bring into question the way in which we build a relationship with our clients. The liberationist approach is proposed as the best guide of how and why to use psychoeducation in the quest for providing authentic occupational therapy.     

The Relationship Between Volition and Independent Occupational Performance in People with Mental Disorders

Mental disorders and psychiatric institutionalization reduce the volition and limit the occupational performance of those affected. This article investigates the relationship between volition and occupational performance of people with mental disorders and analyzes the influence of sociodemographic variables on their volition. The results show that high levels of volition and regular participation in occupational therapy programs improve independence in daily occupational performance but also show that psychiatric pathology and the length of institutionalization reduce this volition.     

Vocational Transition in Acute Care Psychiatry

The history of vocational rehabilitation in mental health occupational therapy is a sporadic one. Today, vocational integration is an essential part of holistic practice. The Vocational Transition group protocol identifies vocational services in acute care settings for psychiatric inpatients who are planning to return to work after discharge.     

Application of the Modelof Human Occupation

The model of human occupation is proposed to be an effective basis for occupational therapy assessment in child and adolescent psychiatry. The theoretical tenets of this model are reviewed with emphasis on the development of human occupation during childhood and adolescence. Application of themodel is demonstrated through the presentation of human occupation assessment batteries currently in use on short-term, diagnostic and research units for child and adolescent psychiatric inpatients. In addition, two case studies demonstrate the model's effectiveness in conceptualizing the occupational functioning of this population.     

Tell Us What Your Drawings Say

A projective evaluation tool is used in occupational therapy to evaluate short-term inpatient psychiatric clientele to gather information for treatment planning is described. Areas of assessment covered in the evaluation include: (1) cognitive performance, (2) affect and mood, (3) insight, (4) motivation, and (5) situational components. A case illustration showing results of the use of the tool is presented, and the value of information gathered for occupational therapy treatment planning is discussed.     

Evaluating Occupational Therapy Psychiatric Care Through Medical Documentation

Recent JCAH survey results have reported serious deficiencies in quality assurance efforts of support departments, especially Rehabilitation Services. Because occupational therapy is grouped under Rehabilitation Services, occupational therapists should closely monitor quality assurance efforts. Quality assurance activity becomes somewhat more complex when dealing with psychiatric patients where treatment modalities lack unanimity. However, those quality assurance efforts can be more productive through better medical documentation. Medical documentation essentials are reviewed and described with an emphasis on problem oriented methods. It is proposed that adhering to these essentials will enhance professional performance as well as improve the outcome of quality assurance activities.     

Applying the Group Process to Psychiatric Occupational Therapy Part 1

The authors trace the current use of group activities in occupational therapy from an historical perspective. A pilot study of thirty-four psychiatric treatment programs located in Wisconsin, Quebec, and Alberta are described. The five most frequent groups used in these facilities include: social skills training, independent living skills, leisure time activities, stress management and exercise. The results are compared to a previous study by Duncornbe and Howe, 1985.     

An Aggregate Fieldwork Model: Cooperative Learning,Research, and Clinical Project Publication Components

An occupational therapy psychosocial level-two fieldwork model, which consists of cooperative learning, clinical project or research publication, and interdisciplinary collaboration and intervention, is herein outlined. An example of the model is presented using an acute inpatient psychiatric setting with a multidisciplinary staff and 50 occupational therapy interns. Data on the aggregate fieldwork model collected over a two-and-a-half-year period from: 1) logs; 2) supervision; 3) peer reviewed publications; 4) conference presentations; 5) verbal feedback from the occupational therapy educational institutes; and 6) the supervisor's comparisons with other fieldwork models is presented. The outcome of the aggregate fieldwork model is that students do well, seem to learn more than in 1:1 supervisory models, and manage to publish while on fieldwork. It is hoped that more academic programs will consider working with clinical educators to develop programs based on this model.     

Creative Occupational Therapist: It's About the Client Using Focus Groups to Explore Creativity in Occupational Therapy

Although creativity is an important aspect of occupational therapy theory and practice, there have been few studies that would explore this concept in the context of the occupational therapy process. This was the first qualitative study of creativity in occupational therapy in Slovenia. It was conducted as part of a larger mixed-methods study and included 22 experienced occupational therapists who participated in four focus groups. The focus of the study was on the exploration of different factors that could contribute to creativity and creative strategies in occupational therapy, in either a positive or a negative way. Since occupational therapy promotes a client-centered therapy approach, the role of the client as the motivating factor was of particular interest to our study. Six factors that can influence the creativity of occupational therapists emerged from the qualitative analysis (Strauss & Corbin, 1990). While the client was identified as the key factor, the potential of other factors was also recognized. This qualitative study increased the understanding of the concept of creativity and creative behavior in occupational therapy, and also provided empirical material that formed the basis for the development of a questionnaire on creativity in occupational therapy.     

History of the Hospital Real y General de Nuestra Señora de Gracia in Saragossa: Occupational Therapy Pioneer in Neurology and Psychiatry in Spain

In this article the authors describe the program of the Hospital Real y General de Nuestra Señora de Gracia in Saragossa (Spain) and its importance in the history of occupational therapy. It is believed to be the first hospital in the world to use occupations as therapy for psychiatric patients. Pinel knew about this new trend through a report by Iberti and wrote about it in his book Medico-Philosophical Treatise on Mental Alienation.     

Project ABLE

This paper describes a proposed model for the management of Army soldiers rendered ineffective due to inadequate skills in coping with life stress. The history of Army mental health programs is reviewed to establish the rationale for program development. The proposed treatment methods and staffing are discussed. The application of this peacetime treaetment model in the management of combat psychiatric casualties is presented. Emphasis is placed on the role of the Army occupational therapist as a professional skilled in the use of task-directed behavior to enhance daily living skills.     

An Empirical Examination of Symptom Substitution Associated With Behavior Therapy for Tourette's Disorder

Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette’s disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette’s disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette’s disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette's disorder.