Current and Future Education and Practice

SUMMARY

This article describes a national study conducted by the American Occupational Therapy Association Mental Health Special Interest Section to assess the adequacy of mental health content and fieldwork experiences in occupational therapy educational programs preparing graduates for current and future mental health practice. The results of the study indicate that occupational therapists, especially those who practice in mental health settings, must become more “business-oriented.” This orientation includes educating occupational therapy students about reimbursement issues, legal and political systems, marketing strategies, and advocacy roles. Other recommendations are discussed as possible ways to prepare future practitioners more effectively for roles in community-based settings.     

Pre-Admission Factors Influencing Practice Area Preference in Occupational Therapy

ABSTRACT

The percentage of graduates choosing to practice in mental health has declined in recent years. This study examined pre-admission practice area preference of 219 applicants to an undergraduate occupational therapy program. Results indicated that applicants were most influenced by prior experience: 99.6% were exposed to physical disabilities occupational therapy and 82.5% were exposed to mental illness practice area. Forty-eight percent, however, expressed a preference for physical disabilities while only 11 % preferred to work in the field of mental health. University recruiters may need to actively seek out students with a strong preference for mental health. Longitudinal studies to track factors affecting change of practice area preference throughout the educational process are also necessary.     

The end of mental illness thinking?

Mental health theory and practice are in a state of significant flux. This theoretical article places the position taken by the British Psychological Society Division of Clinical Psychology (DCP) in the context of current practice and seeks to critically examine some of the key factors that are driving these transformations. The impetus for a complete overhaul of existing thinking comes from the manifestly poor performance of mental health services in which those with serious mental health problems have reduced life expectancy. It advocates using the advances in our understanding of the psychological, social and physical mechanisms that underpin psychological wellbeing and mental distress, and rejecting the disease model of mental distress as part of an outdated paradigm. Innovative research in genetics, neuroscience, psychological and social theory provide the platform for changing the way we conceptualise, formulate and respond to psychological distress at both community and individual levels.     

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.     

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.     

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.     

Understanding the Mental Health Travails of Custodial Grandparents

Grandcarers are at-risk of poor mental health outcomes. Current knowledge of the support needs of grandcarers is fragmented. To help fill this knowledge gap qualitative analysis was undertaken on 49 interviews conducted with custodial grandparents. The findings reveal that conflicted occupational roles coupled with the complexity of the stressors facing grandcarers both contribute to their social isolation and to their self-doubts about their ability to adequately attend to their grandchildren’s needs. Greater awareness among occupational therapists (OTs) of custodial grandparents’ mental health travails and an increased understanding of key occupational therapy (OT) practice initiatives are central to addressing grandcarers’ mental health travails.     

“It Would Be a Shame to Lose Them”: A Critical Historical,Scoping, and Expert Review on the Use of Projective Assessments in Occupational Therapy,Part I

Projective assessments have a long history in occupational therapy, yet their relevance may be questioned. This first article reviews the clinical utility of projective assessments by providing a critical history of their development, followed by a scoping review of the current evidence. The second article outlines the opinions of nine experts in this field. Through this comprehensive process, conceptual and methodological issues are articulated in order to suggest educational and clinical guidelines, and future research avenues. The place of projective assessments in occupational therapy is demonstrated as a salient specialty area of practice in the current evolving landscape of mental health.     

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.     

Effectiveness of Occupational Therapy Interventions for Students with Mental Illness Transitioning to Higher Education: A Systematic Review

This systematic review examined the available evidence for occupational therapy interventions for students with any mental illness transitioning to post-secondary education. Seven articles were included. The evidence of occupational therapy interventions for this population supported the use of supported education programs consisting of goal setting, skill development, and cognitive training, as well as student-directed planning. Quantity of high levels of research was limited. Articles included were not exclusively related to transition into post-secondary education, but also focused on vocation and supported education. Additional research is needed to determine the best practice in transition services for individuals with any mental illness.     

The Kawa Model: Therapists' Experiences in Mental Health Practice

This pilot study sought to gather information related to the experience of occupational therapists, using the Kawa Model of practice in a mental health setting. Two therapists utilized the model with one client, each over a six-week period. Through qualitative inquiry, the participants (therapists) revealed that, although initially apprehensive about using a new model, they found that the Kawa Model increased client/therapist interaction and energy levels and challenged them to push the boundaries of therapeutic practice. This research suggests that exploration of new models of practice may be beneficial in terms of facilitating successful partnerships and outcomes with clients in mental health settings.     

Religion,Evolution, and Mental Health: Attachment Theory and ETAS Theory

This article reviews the historical origins of Attachment Theory and Evolutionary Threat Assessment Systems Theory (ETAS Theory), their evolutionary basis and their application in research on religion and mental health. Attachment Theory has been most commonly applied to religion and mental health in research on God as an attachment figure, which has shown that secure attachment to God is positively associated with psychological well-being. Its broader application to religion and mental health is comprehensively discussed by Kirkpatrick (2005). ETAS Theory explains why certain religious beliefs—including beliefs about God and life-after-death—should have an adverse association, an advantageous association, or no association at all with mental health. Moreover, it makes specific predictions to this effect, which have been confirmed, in part. The authors advocate the application of ETAS Theory in research on religion and mental health because it explains how religious and other beliefs related to the dangerousness of the world can directly affect psychiatric symptoms through their affects on specific brain structures.     

Satellite babies in transnational families: A study of parents' decision to separate from their infants

This study examines a practice which is characteristic of an era of intensifying globalization: As part of a transnational lifestyle, an increasing number of immigrants to North America send infants thousands of miles back to their country of origin to be raised by members of their extended families—a culturally sanctioned tradition. After several years of separation, the children return to the biological parents to attend school in the adopted country, a custom which, according to Western mental health models, could have significant sequelae for attachment relationships and other facets of development. This practice is particularly prevalent among immigrants from the People's Republic of China, but a modified version of it can be found in other groups as well. The work described here is the first phase of a longitudinal project that explores the advantages and potential repercussions, for both infants and parents, of a transnational lifestyle. The current study reviews the decision‐making process of a group of Chinese Canadian immigrant parents who are considering a separation from their infants. Preliminary findings show that the expected concerns about disrupting attachment relationships are embedded in more salient considerations of economic need and cultural perspective. These exploratory data exemplify an emergent field of culture‐focused research and practice in infant mental health, and support the call for innovative models to situate infant developmental pathways in global and transcultural contexts.     

A Client-Centered Model of Instructional Design for Psychoeducation Interventions in Occupational Therapy

Occupational therapists often use psychoeducational interventions in mental health settings. Recent systematic reviews have validated the efficacy of this approach, but the occupational therapy literature on the instructional design process is scarce. In this article the author reviews factors relevant to the instructional design of psychoeducation and then proposes a client-centered instructional design model that considers the client's capacity for engagement, the instructional context/environment, and the learning content demands in the selection of appropriate instructional approaches. The design process is illustrated in four vignettes using behavioral, acquisitional, cognitive, and constructivist approaches.     

Putting Values into Practice: Public Policy and the Future of Mental Health Consumer-run Organizations

The purpose of the paper is to reflect on value dilemmas in mental health consumer-run organizations and to discuss implications for research, policy, and practice. We review the roots of consumer-run organizations in the self-help movement and the psychiatric survivor liberation movement, focusing on the distinctive values espoused by consumer-run organizations. We also discuss evidence-based and value-based approaches to mental health policy formulation and mental health reform, noting the particular importance of value-based approaches and the role that consumer-run organizations can play in mental health reform. Based on our experiences conducting a participatory action research study of four mental health consumer-run organizations, we identify and examine several value dilemmas, discuss the lessons that we learned about these value dilemmas, and note their implications for future directions in research, policy, and practice.     

College Student High-Risk Drinking as a Maladaptive Serious Leisure Hobby

The role of occupational therapy in community child and adolescent mental health services (CAMHS) multidisciplinary teams is not well documented. This qualitative study investigated the perception of occupational therapy practice held by community CAMHS workers in the Perth, Australia, metropolitan region. Eight mental health community CAMHS professionals took part in semi-structured interviews. Three themes emerged which included team membership, the nature of the work, and the team and occupational therapy. This article focuses on the third theme. Findings suggest a limited understanding of the scope of occupational therapy practice. Implications for occupational therapy in CAMHS are discussed.     

The Internet and World Wide Web as a Resource for Mental Health Occupational Therapists

SUMMARY

The Information Superhighway, the buzzword referring to the Internet and World Wide Web system, is a new resource for occupational therapy. Therapists are discovering how the Internet and World Wide Web can allow them to access the information that they need for research, treatment planning, education, communication, and leisure pursuits. This article describes how the Internet and World Wide Web work, defines terms and tools common to these new technologies, and gives some specific locations that an occupational therapist may find useful. References are shared that relate to general mental health resources and occupational therapy in mental health resources.     

Emotion Regulation with Mindful Arts Activities Using a Personalized Self-Soothing Kit

Contrary to the occupational therapy tradition, there is little current research on harmonizing expressive doing with contemporary occupational therapy practice. This phenomenological multiple case study explored an integrated application of mindfulness, creative activity, and sensory modulation for adult mental health services users by making and using personalized self-soothing kits. The results showed significant improvements in arousal regulation, positive changes in emotion regulation and mixed results for mood regulation. Progress in participation in present roles and an increased focus on future productivity goals were also among the outcomes reported. The theoretical and clinical implications of the findings 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.