Employers' Perceptions of Occupational Therapy in Community Mental Health

ABSTRACT

This paper explores the nature of occupational therapy practice from the perspective of community mental health agency directors currently employing occupational therapists. Directors were interviewed using a semi-structured format. Retrospective content analysis produced a systematic detailed summary of six major and eight minor themes separating into process themes or how the occupational therapist practised, and content themes, or what the occupational therapist practised. The process themes included a holistic approach, client centredness, and a practical, outcome oriented focus. The content themes included the use of activity, focus on individual functioning, and specific vocational and living skill training. In addition, some directors identified inadequacies including insufficient medical background and the need for education in community practice. Themes were compared against two additional data sources; expert occupational therapists and current literature in occupational therapy in mental health. There was agreement on the major themes. Implications of these results are discussed.     

Occupational Therapy Shared Decision Making in Adolescent Mental Health

Shared decision making (SDM) shares values of client-centered practice; however, a few studies exist that explore experiences of occupational therapists (OTs) working in adolescent mental health. This study aims to better understand SDM in adolescent mental health using the Canadian Model of Client-Centered Enablement. A qualitative study included interviews (n = 6) and analysis using an inductive approach. The role of the OT, client factors, therapeutic relationship, and nature of the decision were identified as influencing the process and outcome of SDM. The study helps better understand SDM in practice, the need for specialized education for OTs and has identified future research areas.     

Principles of Occupational Therapy Group Outcome Assessment in Mental Health

In today's penurious health care climate, occupational therapists must scrutinize their practice and substantiate their interventions in order to remain viable service providers. This article proposes a method of occupational therapy outcomes assessment in mental health care that is rooted in client-centered functional outcomes. Since little consensus exists on which instruments are most effective, this article begins with an outline of broadly accepted principles for assessment of patient outcomes in mental health. Next, we describe a practical method for selecting outcomes measures in interdisciplinary settings. Finally, we offer pragmatic solutions to address barriers to outcome assessment.     

A Bibliometric Analysis of the Quantitative Mental Health Literature in Occupational Therapy

ABSTRACT

A bibliometric analysis was performed to examine the impact and use of the peer-reviewed occupational therapy intervention effectiveness literature addressing adults with mental illness, 2000–2016. Of 2,597 articles, 68 were quantitative studies assessing an intervention for adults with mental illness. These studies had a collective citation count of 1,455 and were published in 29 journals in 14 countries. The majority (n?=?36; 52.94%) were randomized controlled and two-group controlled studies. The most commonly assessed interventions were life skills and community reintegration (n?=?20, 29.41%) and supported employment (n?=?16, 23.52%). Sixty-five (95.58%) studies found statistically significant results on the primary or secondary outcomes.     

Occupational Therapy Student Experiences and Transformations During Fieldwork in Mental Health Settings

The purpose of this study is to better understand the transformative experiences of occupational therapy students during fieldwork. In occupational therapy education, fieldwork provides students with an in-depth experience in the field. Thirty-one students submitted narratives following completion of Level II fieldwork in a mental health setting. Concepts from transformative learning theory guided the analysis. The themes that emerged were: (1) understanding clients with mental illness; (2) understanding occupation and occupational therapy; (3) feeling like a professional; and (4) changing as a person. The results highlight the importance of understanding the transformative process and fieldwork in mental health settings.     

Occupational Therapy Interventions in Mental Health: A Literature Review in Search of Evidence

A growing body of literature sheds light on occupational therapy (OT) interventions and outcomes in adult mental health. Although this research has not developed to the point where a systematic review is warranted, a synthesis of these findings is needed. This article provides an overview of OT interventions in adult mental health and their documented outcomes. Fifty peer-reviewed intervention studies targeting adults with mental illness were reviewed. Seven categories of interventions emerged: employment/education; psychoeducation; creative occupations/activity; time use/occupational balance; skills/habit development; group/family approaches; and animal-assisted therapy. Further research involving rigorous designs is needed to establish a solid evidence base for OT interventions in adult mental health.     

The Evidence Base for Occupational Therapy in Mental Health: More Systematic Reviews Are Needed

To shape its work, the Research Centre for Occupation & Mental Health is interested in research priorities. Systematic reviews develop an overview of the research available about an intervention, which can provide evidence to underpin practice. They also however, identify gaps in the knowledge base and so are useful for research-prioritization exercises. A rigorous literature search identified only four systematic reviews about occupational therapy in mental health, which suggests that more are needed to underpin practice. This article also explains a six-stage process for conducting a systematic review that can be used by occupational therapists in mental health.     

Dialectical Behavior Therapy Group Skills Training in a Community Mental Health Setting: A Pilot Study

Abstract

Effective and affordable therapies are needed for treating people with severe and persistent mental illness in a community mental health setting. In this pilot study, we evaluated the effectiveness of a modified dialectical behavior therapy (DBT) protocol for improving symptoms and functioning in a cohort of persons with severe and persistent mental illness. We provided six months of weekly DBT skills training in a group setting. Depression symptoms decreased significantly after treatment. There was a wide range of number of sessions attended, with a minority of the participants completing the full course of treatment. Increased attendance was correlated with improvements in depression symptoms, overall symptoms, quality of life, and community functioning. The study findings suggest that the group skills training component of DBT can be successfully implemented in a community mental health center and that further research to determine its efficacy in comparison to other treatments is warranted.     

An Integrative Review of School-Based Mental Health Interventions for Elementary Students: Implications for Occupational Therapy

Occupational therapy for children and youth experiencing mental health conditions is often overlooked in current school-based services, as the traditional role within the system is often limited to physical health issues. The purpose of this integrative review is to investigate current psychosocial interventions within school settings to understand the effects of services provided and to determine potential roles for school-based occupational therapists. The findings of this review support occupational therapists in facilitating interventions that target mental health in school settings. Psychotherapy presented the strongest evidence for reducing psychosocial symptoms in school settings.     

Exploring Mindfulness With Occupational Therapists Practicing in Mental Health Contexts

Mindfulness, defined as “a purposeful, non-anxious, reflective presence,” (Epstein, 2003a Epstein, R. M., 2003a. Mindful practice in action (I): Technical competence, evidence-based medicine, and relationship-centered care, Families, Systems, &; Health 21 (1) (2003a), pp. 1–9.[Crossref] , [Google Scholar], p. 1) has been identified as a potentially key practice skill of effective health care practitioners working in mental-health settings. The purpose of this mixed-methods study was to explore the cultivation and use of mindfulness in the clinical practice and everyday lives of occupational therapists who practice in mental health. Results revealed that mindfulness is perceived as being an important clinical quality, which enhances therapist well-being and effectiveness, and contributes to improved client outcomes. Relevance to occupational therapy practice philosophies and directions for future research are discussed.     

Corporate Psychology: An Answer to Occupational Mental Health

Corporate planners acknowledge that productivity is directly related to employee mental health. This recognition is reflected by the recent upsurge of corporate in-house, human resource programs. Although their latent function may be economic rather than humanitarian, these programs nevertheless provide psychological assistance for problems considered to be normal episodes of human development. Counseling psychologists may be the best equipped to work with a corporate clientele because, unlike the clinician, the counselor is trained to work with healthy, instead of disturbed, personalities. Most of the developmental crises encountered by the corporate psychologist are associated with stress, midlife, or career development.     

A Natural Approach in Mental Health Practice: Occupational Adaptation Revealed

A single case study of the stories told by one occupational therapist about her clients in mental health settings is presented in this article. Qualitative analysis revealed key concepts of the role of the occupational therapist as defined by occupational adaptation theory, along with unique perspectives of occupational therapy in mental health settings. The outcome of this study is a demonstration of the unique insight occupational therapy brings to addressing client recovery in mental health settings, specifically from an occupational adaptation perspective. This insight should enlighten others as to the necessity of skilled occupational therapy in mental health settings.     

Transformative Experience of Master of Occupational Therapy Students in a Non-traditional Fieldwork Setting

The purpose of this qualitative pilot study is to further understand the transformative experiences of Master of Occupational Therapy students who engaged in a role emerging fieldwork. Five students were interviewed and their reflective journals were analyzed following a fieldwork experience at an at-risk youth shelter. Four themes emerged through the coding process: fear and anxiety of the unknown, clinical reasoning and self-reflection, personal and professional growth, and further understanding of occupational therapy. Results indicate the powerful impact of role emerging fieldwork on the development of the student and provide a framework for meeting the standards of psychosocial fieldwork experiences.     

Sensory Modulation for People with Anxiety in a Community Mental Health Setting

Anxiety is a common mental health issue involving cognitive and physiological hypersensitivity to threat. It negatively affects occupational participation. Sensory modulation intervention aims to use calming sensory input to manage the hypersensitivity and physiological arousal associated with anxiety. The empirical evidence for using sensory interventions for anxiety, however, is limited. This mixed methods single subject case design explored the effectiveness of a 6-week sensory modulation intervention for reducing anxiety and improving occupational participation. Results showed significant reduction in anxiety and improved participation, providing further evidence that sensory modulation is an effective approach for the self-management of anxiety.     

Learning Contracts and the Use of Goal Attainment Scaling (GAS) for Occupational Therapy Students on Mental Health Fieldwork

SUMMARY

To counteract stereotyped views of the mentally ill and to empower occupational therapy students on their mental health clerkship, students developed individualized learning contracts. The contract required formulating their educational goals as a series of graded steps structured through the use of a sequential numerical scale, Goal Attainment Scaling (GAS) (Kiresuk & Sherman, 1968). Goals were related to the students' social-emotional concerns and anxieties encountered in this practice area through an affective GAS also known as a comfort scale. Task skills were addressed via a psychomotor/cognitive GAS. Students took an active role in monitoring their progress on their GAS while exploring emotional reactions. Through the use of an interactive log format, students received ongoing feedback and support from the academic instructor while honing their performance and clinical reasoning skills. Students often articulated a positive transformation of their views of the mentally ill and their sense of efficacy and comfort in working with this population fostered by success with their personal goal achievement on their GAS.