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.     

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.     

Fieldwork Journal at F.E.G.S.

SUMMARY

The challenge of working with the mentally ill population on the first Level I fieldwork exposure is often experienced in a setting where the on-site supervisor is a therapist from another discipline. Many skilled mental health professionals can offer a rich learning experience and assist students in mastering generic clinical skills in relating to and understanding the psychiatric population. Occupational therapy students bring to this clinical relationship the opportunity to demonstrate the effectiveness of occupational therapy interventions through group work, and individual evaluation and treatment, which benefits both the clients and the larger program. This article recounts the journal of a Level I student's journey through a setting that provided a receptive environment for fostering growth in the process of becoming truly comfortable and effective in the skills and roles of an occupational therapist in a mental health environment.     

Inspirational Beginnings in an Occupational Therapy Mental Health Setting

SUMMARY

This article includes excerpts from a fieldwork log for a student's Level I experience. The student was assigned to the Brooklyn Veteran's Administration Medical Center Inpatient and Day Hospital Program with an occupational therapist supervisor. It recounts the student's concerns, in a beginning placement, as an individual who had no previous exposure to a mentally ill population. In the course of understanding the role of occupational therapy with the benefit of a strong clinician role model, the student not only learns procedural skills in occupational therapy assessment and group leadership, but also engages in a reflective process of professional growth and begins to develop a more conditional and holistic perspective of the patients with whom she is working towards fine-tuning critical aspects of the therapeutic use of self. Through the use of a learning contract developed in the format of a Goal Attainment Scale (GAS), she formulates a goal for the psychomotor domain of improving skills in interpersonal relationships with patients focusing on using verbal and nonverbal communication for interaction in a     

Structural models and occupational aspirations: Black-white variations among deep-south adolescents

Multivariate techniques for attribute data and the backward elimination procedure developed in regression analysis were utilized in an analysis of the occupational aspirations of deep-south adolescents. An examination of the models constructed revealed that: (1) social class indicators accounted for the largest effect estimates; (2) residence was associated with a smaller, yet statistically significant portion of the variation; and (3) the effect of race was negligible when controls were applied. Application of the most efficient model to black and white subsamples revealed race variations in both composite effect estimates and the rank order of effect estimates. Implications of these findings are discussed in terms of the developmental model of occupational choice and suggestions for further research are presented.     

Matthews Model of Clinical Reasoning: A Systematic Approach to Conceptualize Evaluation and Intervention

Clinical reasoning is a complex process required for effective therapeutic encounters. Its development is poorly understood. The clinical reasoning process is placed in a historical context based on the occupational therapy literature. An emerging model of clinical reasoning is proposed. This model of clinical reasoning provides a unique perspective in order to compartmentalize the person, environment, and occupation constructs around the person’s life story, connect it directly to the occupational therapy practice framework, and determine treatment priorities, emphasizing a client-centered perspective. A client-centered model of clinical reasoning supports efforts to provide effective intervention.     

Integrating Basic and Advanced Fieldwork With Academic Coursework

This paper presents a model for integrating academic and clinical learning in allied health. In this model (which is based on the TAR - teaching, application, reinforcement - approach) two levels of fieldwork are used: an introductory level which begins prior to and continues throughout a theory course, and an advanced level which follows successful completion of that course. Both levels are linked to the theory course through a series of workbooks, clinical exercises, and seminars. The introductory level fieldwork begins as a one-week full-time clinical placement, with structured activities focusing on the observation of five basic concepts. These concepts are then explored theoretically in the first part of the theory course, applied during the weekly continuation of the introductory fieldwork, and reinforced in a weekly seminar. Mastery of the five basic concepts provides a foundation for related advanced concepts presented in the latter part of the theory course, applied through specific assignments at the advanced level of fieldwork, and reinforced in a biweekly college seminar concurrent with the three-month fieldwork.     

Music as a Therapeutic Medium for Occupational Engagement: Implications for Occupational Therapy

Music is a meaningful occupation; a summary of current literature and the authors’ experiences regarding health and wellness benefits and potential for music as a therapeutic medium in occupational therapy practice is presented. An interview and a summary of the authors’ experiences illustrate the role for music and its benefits for occupational therapy. These benefits are described through three themes which emerged: (a) music as a means of increasing group cohesion toward common goals, (b) music as a means of increasing socialization, and (c) music as a meaningful occupation can empower individuals to enhance and embrace wellness and recovery.     

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.     

Occupational Therapy in a Community-Based Prevention Program

Occupational Therapists have shifted their practice base from a primarily medical model to one involving many different services within the community. Members of this discipline as well as those of the entire health-care field have discovered that preventionj based programs better anticipate and meet consumer needs. The community program described here serves 3, 4, and 5-year -old socio-culturally disadvantaged preschoolers. The program occurs weekly in a local library and includes the librarian's story hour and special activities designed and implemented by the occupational therapists. By observing each child's behavior, occupational therapists can compare normal growth and development with a particular population. The design and delivery of such programs is influenced by many factors including, but not limited to, financing, community values and institutions, and the occupational therapist's understanding of prevention. Increased understanding, as well as the potential application, of occupational therapy's contribution to the prevention of health related problems are further enhanced by the utilization of this program as a field training site for occupational therapy students.     

On the perceived structure of occupations

Previous studies aimed at testing the structure of occupations have been based on analysis of aggregate data. In studies comparing the hierarchical and the hexagonal-circular models for the structure of interests, the former fit the data at least as well as the latter. The present study compared separately for each subject the hierarchical and the hexagonal models as the hypothesized structures for occupations. Twenty-six students judged the similarity between all possible pairs of 24 high-level occupations, 3 occupations for each of Roe's eight fields. The findings demonstrated that (a) the within-subject structures resemble the structure found in the aggregate data; (b) the structure of occupations based on similarity judgments resembles the structure based on preference data; (c) diagnostic properties suggest that for most subjects the perceived structure of occupations can be better described as clustering than as two-dimensional; (d) a tree representation of the perceived structure of occupations is more adequate than is the two-dimensional representation; and (e) the within-subject structure fit the hierarchical model better than it fit the hexagonal-circular model for all but one subject. A detailed analysis revealed those predictions of each model which were disconfirmed by most subjects' judgments. These results provide additional support for the relative advantage of the hierarchical over the circular model. These findings' implications for the structure of vocational interests and occupational choice were discussed.     

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.     

Beta-MPT: Multinomial processing tree models for addressing individual differences

Traditionally, multinomial processing tree (MPT) models are applied to groups of homogeneous participants, where all participants within a group are assumed to have identical MPT model parameter values. This assumption is unreasonable when MPT models are used for clinical assessment, and it often may be suspect for applications to ordinary psychological experiments. One method for dealing with parameter variability is to incorporate random effects assumptions into a model. This is achieved by assuming that participants’ parameters are drawn independently from some specified multivariate hyperdistribution. In this paper we explore the assumption that the hyperdistribution consists of independent beta distributions, one for each MPT model parameter. These beta-MPT models are ‘hierarchical models’, and their statistical inference is different from the usual approaches based on data aggregated over participants. The paper provides both classical (frequentist) and hierarchical Bayesian approaches to statistical inference for beta-MPT models. In simple cases the likelihood function can be obtained analytically; however, for more complex cases, Markov Chain Monte Carlo algorithms are constructed to assist both approaches to inference. Examples based on clinical assessment studies are provided to demonstrate the advantages of hierarchical MPT models over aggregate analysis in the presence of individual differences.     

The New Occupational Therapy Paradigm: Implications for Integration of the Psychosocial Core of Occupational Therapy in All Clinical Specialties

In this paper, it is argued that the new occupational therapy paradigm includes a core of psychosocial skills, consistent with the profession's historical roots in mental health. It is proposed that contrary to the declining presence of occupational therapy in mental health, psychosocial interventions should be explicitly integrated in all professional practice, such that occupational therapy will become the profession of choice in addressing psychosocial issues of all clients irrespective of clinical specialty. A case study is presented as an example to demonstrate how this explicit integration may be achieved in physical rehabilitation.     

Pro-criminal attitudes,intervention, and recidivism

We review the recent research literature on pro-criminal attitudes (PCAs) as a causal factor of recidivism with a focus on studies on the effectiveness of offender treatment programs targeting PCAs to prevent recidivism. The main conclusions that can be derived from the literature are: (1) the evidence supports the hypothesis that PCAs are related to reoffending; (2) most investigated offender treatment programs tend to reduce PCAs, although the general lack of adequate control group designs does not rule out alternative explanations for this reduction; and (3) there is no conclusive empirical evidence that intervention programs designed to reduce PCAs are effective in reducing recidivism. Empirical research in this area lacks the theoretical and methodological rigor to test causal models of the influence of treatment on reducing PCAs, and effects of PCAs on recidivism. Limitations of the empirical evidence are related to inadequate research designs and/or suboptimal data analysis strategies. Recommendations concerning optimized research designs and data analysis strategies that are likely to provide more conclusive evidence on the relation of PCAs, PCA treatment, and recidivism are given.     

Engagement within occupational trainees: Individual difference predictors and commitment outcome

The present study examines occupational entrants' experiences of their vocational training, its relation with relevant internal characteristics, and its proposed impact on commitment to the profession. Particular focus is paid to trainees' engagement, hypothesizing motivation and self-efficacy as predictors, and occupational commitment as a distal outcome. Data were from 247 recent entrants into professional degree programs (architecture, engineering). All hypothesized predictive relations were supported, such that motivation (as both a composite and as solely intrinsic) and self-efficacy are predictive of engagement, and engagement is predictive of occupational commitment among early-stage trainees. Further, engagement partially mediated the relation between self-efficacy and commitment, and fully mediated the relation between motivation and commitment. Squared multiple correlations for endogenous variables indicated substantial variance in engagement and commitment accounted for by their respective predictors. Moreover, two structural equation models were examined and compared, proposing more holistic nomological nets for how these constructs fit together. A respecified model accounting for a sole focus on intrinsic motivation and a direct path between motivation and commitment was an excellent fit, superseding a competing model conceptualizing motivation as a composite and only an indirect motivation–commitment path. Finally, need for achievement moderated the relation between motivation and engagement such that the relation is stronger for individuals high in need for achievement than it is for those low in the desire to grow in their profession. The study contributes to our understanding of how early occupational trainees' experiences of work and individual characteristics impact their commitment to their intended profession.