The Role of the Occupational Therapist as a Community Consultant

Concern for health development has been in the forefront of occupational therapy practice and training for many years. However, consultation in this area to community agencies and grass roots programs is a relatively new endeavor for occupational therapists. This article describes community consultation in a demonstration project emphasizing the concept of preventive mental health. Steps in establishing the consultation role are discussed using the theoretical constructs of systems consultation. Discussion of the educational objectives for field training in community mental health, community experience during the field training, and the supervisory and communication networks essential to such a program are presented as a model in developing the role of the occupational therapist as a community consultant.     

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.     

Powerful Occupational Therapists: A Community of Professionals, 1950–1980

A powerful community of therapists changed occupational therapy in the United States between 1950 until 1980. These innovators, primarily women, strategically positioned themselves to market the emerging profession. These therapists, categorized as theorists and futurists, political movers and new and old guard sustainers, determined occupational therapy's direction. Participating in the 1950s rehabilitation, the 1960s equal rights, and the 1970s women's movements, the community of therapists separated from the male-dominated medical model to gain professional and scientific authority. An internal tension arouse between those therapists embracing an objective, and arguably male, science and those supporting a characteristically feminine caring philosophical base.     

Advocacy,Partnerships and Client Centered Practice in California

SUMMARY

This article highlights the many accomplishments of California based mental health occupational therapists in fostering liaisons in the community, collaborating with consumers and families and developing innovative programs. It also provides a rationale and theoretical construct for occupational therapists to provide quality interventions while both protecting and expanding their present practice through the use of client centered services.     

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.     

Essential Elements for Community Engagement in Evidence-Based Youth Violence Prevention

In the field of youth violence prevention, there has been increasing emphasis on “evidence based” programs and principles shown through scientific research as reaching their intended outcomes. Community mobilization and engagement play a critical role in many evidence‐based programs and strategies, as it takes a concerted effort among a wide range of people within a community to alter behavior and maintain behavioral change. How do concerned individuals and groups within a community engage others within and outside of that community to effectively plan, develop and implement appropriate EB programs as well as evaluate the outcomes and impacts of locally developed programs yet to be proven? The authors discuss five elements essential for community engagement in evidence‐based youth violence prevention based on their work in a university‐community partnership through the Asian/Pacific Islander Youth Violence Prevention Center (API Center), a National Academic Center for Excellence on Youth Violence Prevention Center supported by the Centers for Disease Control and Prevention. They include: (a) aligning EBPs with a community's shared vision and values; (b) establishing an inclusive environment for the planning, implementation and evaluation of EBPs; (c) nurturing collaboration for increased effectiveness and efficacy of EBPs; (d) building adequate leadership and community capacity to develop and sustain EBPs; and (e) building a learning community for evaluation and self‐reflection. The authors propose placing greater emphasis on “evaluative thinking” and organizational capacity for evaluation as we pursue evidence‐based practices for youth violence prevention. This is especially important for ethnic groups for which an evidence base is not well established.     

Assessing Proprioception in Children: A Review

Proprioception is the subconscious and conscious awareness of the spatial and mechanical status of the musculoskeletal framework. When working with children with motor delays and sensory integrative dysfunction, occupational therapists routinely assess the client's proprioceptive system. However, currently available assessments for occupational therapists are primarily observer-based and concerns have been raised about the reliability of observer-based assessments of sensation. The author's purpose was to review measures of proprioception currently available to occupational therapists and explore direct measures of proprioception from neuroscience and rehabilitation that can be adapted for pediatric clinical use. Observer-based and direct measurements of proprioception assessments complement each other in meeting clinical needs. A better understanding of both types of evaluation will improve proprioceptive evaluation.     

Establishing and Evaluating the Key Functions of an Interactive Systems Framework Using an Assets-Getting to Outcomes Intervention

Community practitioners can face difficulty in achieving outcomes demonstrated by prevention science. Building a community practitioner's prevention capacity—the knowledge and skills needed to conduct critical prevention practices—could improve the quality of prevention and its outcomes. The purpose of this article is to: (1) describe how an intervention called Assets‐Getting To Outcomes (AGTO) was used to establish the key functions of the ISF and present early lessons learned from that intervention's first 6 months and (2) examine whether there is an empirical relationship between practitioner capacity at the individual level and the performance of prevention at the program level—a relationship predicted by the ISF but untested. The article describes an operationalization of the ISF in the context of a five‐year randomized controlled efficacy trial that combines two complementary models designed to build capacity: Getting To Outcomes (GTO) and Developmental Assets. The trial compares programs and individual practitioners from six community‐based coalitions using AGTO with programs and practitioners from six similar coalitions that are not. In this article, we primarily focus on what the ISF calls innovation specific capacity and discuss how the combined AGTO innovation structures and uses feedback about its capacity‐building activities, which can serve as a model for implementing the ISF. Focus group discussions used to gather lessons learned from the first 6 months of the AGTO intervention suggest that while the ISF may have been conceptualized as three distinct systems, in practice they are less distinct. Findings from the baseline wave of data collection of individual capacity and program performance suggest that practitioner capacity predicts, in part, performance of prevention programs. Empirically linking practitioner capacity and performance of prevention provides empirical support for both the ISF and AGTO. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

Spirituality in Occupational Therapy: Do We Practice What We Teach?

This mixed-method study examined the responses of 97 occupational therapists on the subject of spirituality in occupational therapy practice. The inclusion of spirituality into the Occupational Therapy Practice Framework (2008) implies that clinicians address spirituality as a component of client-centered practice. This research revealed a gap between education, theory, and practice as evidenced in the quantitative and qualitative data. Although occupational therapy is intended to be holistic, therapists require a more complete understanding of what spirituality is and what the role of the occupational therapist is when addressing spirituality in evaluation or treatment. The discussion of this research provides information for future occupational therapy educators and educational programs as they seek to incorporate the construct of spirituality into curricula.     

Post-Discharge Experiences of People with Psychosis Following Partial Hospital Program Completion

Partial hospital programs are day programs which act as a bridge between inpatient and outpatient care for people with severe and persistent mental illness. This study explored the gap that exists in understanding the post-discharge experiences of people who have experienced psychosis. Qualitative interviews were conducted with 8 participants with psychosis, at least 4 weeks after completing partial hospital program. Identified themes included improved sense of wellness, changes in structure/routine, accessing community resources, social support and engagement, engagement in leisure, and impact of medication. Occupational therapists can use these findings to enhance programming at partial hospital programs and other similar programs.     

Implementing a Comprehensive Program for the Prevention of Conduct Problems in Rural Communities: The Fast Track Experience

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.     

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.     

Relationships,Environment, and the Brain: How Emerging Research is Changing What We Know about the Impact of Families on Human Development

Recent research is providing family therapists with new information about the complex interaction between an individual's biological makeup and his/her social and physical environment. Family and social relationships, particularly during sensitive periods early in life, can affect a child's biological foundation. Additionally, stress during the early years can have a lasting effect on an individual's physical and mental health and contribute to the onset of severe mental illness. Community programs have been developed to intervene early with families who have an at‐risk child to prevent or minimize the onset of mental illness including providing partnerships with at‐risk mothers of infants to shape attachment relationships. Programs are also developing individual and family interventions to prevent the onset of psychosis. Practicing family therapists can incorporate emerging neuroscience and early intervention research and leverage the growing base of community programs to enhance the effectiveness and sustainability of mental health outcomes for clients. Additionally, family therapy education programs should broaden student training to incorporate the growing body of information about how family relationships affect individual mental health development.     

Touch,enjoyment and health: In infancy

The paper explores Peter Lomas's influence on the author as a therapist, and in particular his idea that therapy is inescapably an ethical endeavour, however much we try to avoid this. Less persuasive, however, is Lomas's belief in therapy as a moral influence. The author sees it more as an ethical space (after Roger Poole) where people can feel free to explore, without judgement, the difficulties that have brought them there - despair, loss, inauthenticity, unfulfilled lives. The paper also explores R.D. Laing's idea of ‘fear of the soul’ which afflicts therapists (including those who do not hold much with ideas of technique) - despite our title - as well as many of those who come to see us. This fear is, it is argued, understandable as it takes us into uncharted waters, a minefield. In other words, therapy can be dangerous. The paper draws both on the author's work with individuals, and in the Philadelphia Association's community house, with which he has been involved for many years.     

Housing First and Photovoice: Transforming Lives,Communities, and Systems

This article presents findings from a community‐based participatory evaluation of a Housing First program on the Island of O'ahu. In this study, clients in a Housing First program used Photovoice to evaluate the program and to advocate for progressive housing policies. Written together by members of the Housing First Photovoice group, this collaborative article describes the outcomes from both the Housing First program and the Photovoice project and demonstrates the ways in which participatory program evaluations can interact with client‐driven programs like Housing First to produce a cumulative, transformative impact. Findings suggest that community psychologists hoping to re‐engage with community mental health systems through enacting transformative change should consider taking a community‐based participatory approach to program evaluation because increased client voice in community mental health programs and their evaluations can have far‐reaching, transformative impacts for research, practice, and policy.     

青少年网络成瘾的预防与干预研究

网络成瘾障碍(Internet Addiction Disorder,IAD)已成为影响青少年身心健康和正常学业表现的重要因素。针对青少年网络成瘾的心理预防与干预研究已开展逾十年,分析与总结显示,已有研究采用个体、团体等不同干预模式,采用认知行为、动机激发等不同咨询与治疗理论,对青少年网络成瘾行为的干预进行了大量探索;其中以团体干预模式及认知行为疗法为主导,并呈现多模式多理论相融合的趋势。借鉴已有研究的成果与不足,我们采用家庭治疗、认知行为、动机激发等多种咨询与治疗理论,结合心理需求网络满足优势等网络成瘾理论,形成了个体-家庭-学校的多水平预防与干预方案,并得到了实证研究的检验。今后的研究应进一步考虑青少年网络成瘾的生理因素,将生物-心理-社会三方面相结合形成系统性的网络成瘾预防与干预模式。     

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.     

An Economic Evaluation of the Garrett Lee Smith Memorial Suicide Prevention Program

For more than a decade, the Garrett Lee Smith Youth Suicide Prevention Program has provided funding for community‐based suicide prevention programs to states, tribes, and colleges across the United States. Recent studies provided evidence of the program's effectiveness in reducing suicide mortality and suicide attempts among youth. This study compares the cost of implementing the program with the estimated savings resulting from avoided hospitalization and emergency department visits associated with the averted suicide attempts. The findings suggest that the cost of implementing multifaceted community‐based suicide prevention strategies may be more than outweighed by savings in the health sector.