Self-Determination Skills of Adolescents Enrolled in Special Education: An Analysis of Four Cases

This study provides information about four adolescent students participating in an occupation-based self-determination program drawn from the Model of Self-Determination and the Model of Human Occupation. Students were selected from a Career Lab based on their ability to participate. The analysis of the cases demonstrate that psycho-educational strategies incorporated into a special education curriculum can instill in the students the knowledge, attitudes, and behaviors necessary for personal goal setting and attainment.     

Innovating With the Model of Human Occupation in Mental Health

This article describes a new approach in a group of National Health Service trusts in the United Kingdom. The assessment and intervention were focused on using the Model of Human Occupation in Mental Health services. An occupation focused assessment and intervention protocol were developed based on the Model of Human Occupation Screening Tool Single-Observation Form (MOHOST-SOF). The aim was to develop a guide to treatment and monitoring to support efficient practice while maintaining an occupation and client-centered focus. Implementation has been successful to date.     

The Use of Play in Child Psychiatry

The Model of Human Occupation is used as a theoretical framework to evaluate a preschool child on an inpatient psychiatry unit, and as a guide for designing treatment. The therapeutic environment is reframed through the use of play to facilitate competent functioning. Literature on play and play environments is reviewed to highlight the success of this approach.     

Occupational Therapy Treatment Goals,Objectives, and Activities for Improving Low Self-Esteem in Adolescents with Behavioral Disorders

This paper examines the concept of self-esteem: its definitions and the association between low self-esteem and adolescents with behavioral disorders. It also provides goals and objectives for OT intervention based upon the taxonomy in the affective domain (Krathwohl, Bloom, & Masia, 1964) and suggests activities integrated into the Model of Human Occupation (Kielhofner, 1985). Finally, a scheme organizing the goals, objectives, and activities is offered to occupational therapists which can be used in the treatment planning process.     

The Model of Human Occupation

The Model of Human Occupation is used as a theoretical framework to review literature on the diagnosis of conduct disorder in adolescence. Specific occupational dysfunctions typical of this population are highlighted. A Newspaper Treatment Group based on this model is described focusing on three levels of treatmcnt: exploratory, competence and achievement. The purpose of this group is to facilitate healthy adaptation in this population.     

Perinatal Posttraumatic Stress Disorder: Implications for Occupational Therapy in Early Intervention Practice

The purpose of this article is to present literature regarding perinatal posttraumatic stress disorder and to describe the implications of research findings for occupational therapy screening and treatment in early intervention practice. Changes in legislation regarding early intervention practice and family centered care are presented as a rationale for including maternal mental health screening as a standard practice in the field of early intervention. A case study illustrates symptoms of perinatal posttraumatic stress disorder and the effect on maternal-infant co-occupational engagement. The Model of Human Occupation is used to guide clinical reasoning about potential occupational therapy interventions.     

Occupational Therapy's Role with Victims of Domestic Violence

ABSTRACT

Occupational therapists encounter individuals who are victims of domestic violence in many different settings. The role of the occupational therapist with each client depends on that client's specific needs, the treatment setting, and the skills and beliefs of the therapist. This article presents a theoretical argument for why the occupational therapist should choose to be involved in the treatment of domestic violence. The Model of Human Occupation provides a framework for understanding functional issues related to domestic violence. Methods of assessment and treatment are presented using this model. A continuum of levels of involvement including referrals for resources or treatment, direct and indirect treatment and program consultation is offered. Each level is illustrated with case vignettes demonstrating the therapist's role. Issues related to the challenge of working in domestic violence and reasons that women may refuse intervention are also discussed.     

Family Climate of Adolescents with and Without Type 1 Diabetes: Longitudinal Associations with Psychosocial Adaptation

Family climate is theorized to influence psychosocial functioning of adolescents both with and without type 1 diabetes. Family system theory considers adolescent behavior as a function of the dynamic interactions between family members. In the present multi-informant longitudinal study, we used two-step cluster analysis to empirically derive family climates based on four family dimensions (i.e., cohesion, conflict, organization, and control) at baseline and we related these climates to longitudinal assessments of adolescent psychosocial functioning. Analyses were conducted on a total of 220 adolescents (102 with diabetes, 118 healthy controls), 217 mothers, and 168 fathers. Cluster analysis on the four FES subscales revealed the following four family climates: a cohesive (moderately high on cohesion and moderately low to low on the other dimensions), balanced (high on cohesion and organization, low on conflict), conflictual (high on conflict, low on organization and cohesion), and controlling (high on control, moderately high on conflict and organization, moderately low on cohesion) climate. Adolescents with diabetes were somewhat overrepresented in the balanced climate, and underrepresented in the cohesive and conflictual climate as compared to their healthy peers. Consistent with hypotheses, we found that adolescents raised in cohesive or balanced climates fared better in terms of internalizing symptoms, externalizing symptoms, and self-concept as compared to adolescents raised in conflictual or controlling climates. Additionally, family climate was not associated with differential changes in outcome variables over time. These finding were consistent across informants and across time. Finally, these associations were not moderated by having type 1 diabetes. Suggestions for future research and practical implications are discussed.     

Use and Results of MOHO Global Assessments in Community Mental Health: A Practice Analysis

This practice analysis reports an evaluation of occupational therapists' utilization of assessments derived from the Model of Human Occupation (MOHO) within adult community mental health settings. An audit of all documented assessments recorded details of (1) the number of assessments completed by each of the occupational therapists, and (2) the specific occupational difficulties identified across all assessments. Thirty-eight assessments had been completed, with a total of 35 service users. Results show variation in practice among occupational therapists in their application of MOHO assessments and, further, that the range of occupational difficulties identified for the client cohort is diverse.     

The Role of Parental and Adolescent Attributions in Adjustment of Adolescents with Chronic Illness

Previous literature has demonstrated the separate contributions of parental attributions and adolescent attributions to psychosocial adjustment of adolescents with chronic illness. However, it is unknown whether parental attributions affect adolescents' mental health directly or indirectly by influencing the youths' attributional style. This study evaluated the direct and indirect (through adolescent attributions) effects of parental attributions on internalizing and externalizing problems of adolescents with chronic illness. Adolescents (N?=?128; M?=?14.7?years) diagnosed with cystic fibrosis or diabetes and their caregivers completed measures of attributional style and adolescent adjustment. Parents' optimistic attributions were associated with fewer adolescent internalizing and externalizing problems. These effects were partly mediated by adolescent attributions. These results suggest that targeting both adolescent and parent attributions may be important for improving adolescents' adjustment to a chronic illness.     

Applying the Transactional Stress and Coping Model to Sickle Cell Disorder and Insulin-Dependent Diabetes Mellitus: Identifying Psychosocial Variables Related to Adjustment and Intervention

This review paper examines the literature on psychosocial factors associated with adjustment to sickle cell disease and insulin-dependent diabetes mellitus in children through the framework of the transactional stress and coping (TSC) model. The transactional stress and coping model views adaptation to a childhood chronic illness as mediated by several psychosocial factors. This review examines the utility of the model in explaining adjustment in two different childhood diseases, identifies needed research and intervention targets, as well as highlights potential changes to the model. The major conclusions of this review suggest that, in addition to child-specific factors, family functioning is an area that interventions should address in sickle cell disease and insulin-dependent diabetes mellitus.     

Detrimental psychological outcomes associated with pubertal timing in adolescent boys

Though often discussed as a discrete event, puberty comprises one segment of a larger developmental continuum and is notable for rapid transformation across a multitude of domains. While an earlier timing of puberty relative to peers stands as one of the most well-replicated antecedents of adolescent difficulties for girls, findings have been less consistent for boys’ development. The current review synthesizes the research on pubertal timing and psychosocial development in adolescent boys. Results are evaluated in the context of three theoretical perspectives by which precocious development is believed to affect the emergence of adverse outcomes: biological, psychosocial and selection.     

Understanding Appalachian Values

This paper, which is based on the Model of Human Occupation, examined Southern Appalachian subcultural values through a review of the literature and two case studies. The subjects for this study were one male and one female both over the age of fifty and of the working class, who had lived in the Southern Appalachian region from birth to the time of the study. Values were assessed through interviews which consisted of a series of questions written by the investigator and based on the literature review, the Values Orientation Interview Schedule and an Activity Configuration. Results supported the literature which discusses the values of persons of the Southern Appalachian region which differ from those of the typical middle class American. The study reinforced the importance of occupational therapists integrating information on values and culture into the treatment planning process.     

Father-absent adolescents with insulin-dependent diabetes mellitus: A population at risk?

This study evaluated whether family structure is associated with the psychosocial functioning and physical health of adolescents with insulin-dependent diabetes mellitus (IDDM). Subjects were 30 intact families and 30 father-absent families. Adolescents and their mothers completed several self-report and observational instruments that assessed adolescent adherence to treatment, adolescents' and mothers' perceptions of maternal support and nonsupport of treatment, mothers' parental competence, and adolescent social competence. Metabolic control was determined by averaging the adolescent's hemoglobin A1c levels during the previous year. A 2 × 2 (Family Structure × Gender) analysis of variance was conducted on each dependent measure. The results showed that father-absent adolescents had better adherence to the IDDM treatment regimen, despite the fact that adolescents from intact families reported significantly more maternal support for treatment. In addition, single mothers reported relatively high parental competence; and statistical interaction effects indicated that single mothers of girls were more involved in the daily treatment of IDDM, consisting of both positive and negative interactions, than single mothers of boys. There were no between-groups differences for adolescents' metabolic control or social competence. Together, these findings suggested that the father-absent adolescents have adjusted very well to living with one parent and a chronic illness.     

Anger Management

Many occupational therapy techniques and theories addressing anger have been incluenced by general misconceptions about anger within the field of psychology and the general public. Until occupational therapists develop a unique perspective for defining anger and understanding how anger affects one's ability to function in one's occupational roles, they will continue to depend upon other professions to provide information on addressing anger problems. Part one of this two-part series on anger management formulates a construct of normal anger pertinent to occupational therapy practice and identifies complexities and misconceptions which have obscured the nature of anger. The second article presents basic concepts of anger management and mismanagement, provides clinical applications of these concepts, and delineates how anger affects human occupation. To accomplish this purpose, the Model of Human Occupation was used as a framework for integrating information on anger from the social sciences into a perspective of anger useful for the occupational therapist.     

An Exploration of Family Problem-Solving and Affective Involvement as Moderators Between Disease Severity and Depressive Symptoms in Adolescents with Inflammatory Bowel Disease

Little is known about how family functioning relates to psychosocial functioning of youth with inflammatory bowel disease (IBD). The study aim was to examine family problem solving and affective involvement as moderators between adolescent disease severity and depressive symptoms. Participants were 122 adolescents with IBD and their parents. Measures included self-reported and parent-reported adolescent depressive symptoms, parent-reported family functioning, and physician-completed measures of disease severity. Disease severity was a significant predictor of adolescent-reported depressive symptoms, but not parent-reported adolescent depressive symptoms. Family affective involvement significantly predicted parent-reported adolescent depressive symptoms, while family problem-solving significantly predicted adolescent self-report of depressive symptoms. Neither affective involvement nor problem-solving served as moderators. Family affective involvement may play an important role in adolescent emotional functioning but may not moderate the effect of disease severity on depressive symptoms. Research should continue to examine effects of family functioning on youth emotional functioning and include a sample with a wider range of disease severity to determine if interventions aimed to enhance family functioning are warranted.     

Maternal adjustment and infant outcome in medically defined high-risk pregnancy.

Biological and psychosocial risk factors in high-risk pregnancy and their relation to infant developmental outcomes were explored in a sample of 153 pregnant Israeli women who had pregestational diabetes mellitus, gestational diabetes mellitus, or were nondiabetic. Questionnaires on coping and resources as well as well-being and distress during the 2nd trimester were administered. Estimates of maternal fuels (HbAlc and fructosamine) were obtained throughout pregnancy. At 1 year, offspring were administered the Bayley Scales of Infant Development and mother-infant interactions were observed. Infants of mothers in the diabetic groups scored lower on the Bayley Scales and revealed fewer positive and more negative behaviors than did infants of mothers in the nondiabetic group. Infant outcomes in the maternal diabetic groups were associated with maternal metabolism. Maternal coping and resources differed in the 3 groups and differentially predicted infant development.